Francisco Chiaravalloti Neto

Análise espacial da transmissão de dengue em cidade de porte médio do interior paulista

OBJETIVO: Analisar espacialmente a transmissao de dengue entre setembro de 1990 e agosto de 2002 em cidade de porte medio do interior paulista. METODOS: Utilizaram-se casos autoctones confirmados laboratorialmente e dados populacionais de Sao Jose do Rio Preto, obtidos da Fundacao Instituto Brasileiro de Geografia e Estatistica e da Prefeitura Municipal. Os casos foram geocodificados a partir do eixo de logradouros e agrupados segundo os 432 setores censitarios do municipio, resultando em mapas tematicos. RESULTADOS: Notou-se tendencia ascendente das incidencias anuais com pico em 2000/2001. Entre 1990 e 1994 a duracao da transmissao atingiu, no maximo, cinco meses em cada periodo, com aumento nos anos seguintes. No ultimo periodo, ocorreu nos 12 meses, sem interrupcao. A analise do periodo de maior incidencia mostrou que a transmissao nao ocorreu uniformemente. Enquanto 29% dos setores registraram incidencias inferiores a mil casos por 100 mil habitantes, 5% deles ultrapassaram os cinco mil casos. CONCLUSOES: Observou-se o processo da endemizacao, com transmissao durante todo o ano, sem a necessidade de introdutores. A caracteristica endemica da transmissao e a ocorrencia diferenciada segundo areas devem ser levadas em conta na estruturacao de estrategias para o controle de dengue.

Mortalidade por doenças cardiovasculares e níveis socioeconômicos na população de São José do Rio Preto, estado de São Paulo, Brasil

OBJECTIVEnTo analyze cardiovascular mortality indicators in São José do Rio Preto--a city in the State of São Paulo, Brazil--and to evaluate the municipalitys mortality rates by socioeconomic levels.nnnMETHODSnData used came from the Mortality Information System and from the Information and Computing Department of the federal governments Unified Health System (SUS). Standardized mortality rates and proportional cardiovascular mortality rates were calculated. A thematic map of the demographic census sectors of the citys urban area--grouped according to socioeconomic levels--was drawn up and is presented with the respective rates.nnnRESULTSnThe municipal, state, and national mortality rates decreased in the course of the 1980-2002 period. The municipal mortality rate in 2003 stood at 195.9 deaths per 100,000 inhabitants, with proportional cardiovascular mortality at 31.3%. The three main causes of death were cerebrovascular disease, myocardial infarction, and hypertensive disease. The mortality rate for the population corresponding to the group featuring the lowest socioeconomic levels was 40% higher than that of the group comprising the highest socioeconomic levels.nnnCONCLUSIONnThe cardiovascular mortality rate decreased in the three geographical areas analyzed. This group of diseases was responsible for approximately one-third of all deaths in São José do Rio Preto in 2003. The area with the lowest socioeconomic level presented the highest mortality rate.

Variáveis socioeconômicas e a transmissão de dengue

OBJETIVO: Avaliar a relacao entre o risco de ocorrencia de dengue e os niveis socioeconomicos. METODOS: Os casos autoctones de dengue confirmados entre setembro de 1990 a agosto de 2002 foram geocodificados e agrupados segundo setores censitarios urbanos de Sao Jose do Rio Preto, estado de Sao Paulo. Um fator socioeconomico foi gerado por meio da tecnica de analise de componentes principais, agrupando os setores censitarios em quatro niveis socioeconomicos. Os coeficientes de incidencia foram calculados, por ano e quadrienio, para cada um dos agrupamentos de setores censitarios, considerando-se o periodo entre setembro de um ano a agosto do ano seguinte. Sao apresentados mapas tematicos dos setores agrupados nos quatro niveis socioeconomicos com os respectivos coeficientes de incidencia da doenca. RESULTADOS: A analise de componentes principais produziu um fator socioeconomico responsavel por 87% da variacao total. Esse fator esteve associado com as incidencias de dengue apenas no ano de 1994-1995. CONCLUSOES: A ausencia de associacao encontrada entre risco de ocorrencia de dengue e niveis socioeconomicos na quase totalidade dos anos estudados mostra que esta e uma questao que precisa ser mais bem estudada e, talvez, dependa da realidade de cada municipio. E importante que sejam verificadas as relacoes espaciais entre a transmissao de dengue e outras variaveis, como o grau de imunidade da populacao; a efetividade das medidas de controle; o grau de infestacao pelo vetor; os habitos e atitudes da populacao, entre outros.

Avaliação dos resultados de atividades de incentivo à participação da comunidade no controle da dengue em um bairro periférico do Município de São José do Rio Preto, São Paulo, e da relação entre conhecimentos e práticas desta população

Este estudo foi realizado com o objetivo de avaliar os resultados de um trabalho educativo desenvolvido em um bairro periferico de Sao Jose do Rio Preto e a relacao existente entre conhecimentos e praticas desta populacao. Previa e posteriormente as atividades educativas, foram realizadas amostragens para medir o grau de conhecimento da populacao sobre dengue, seus vetores, criadouros e medidas de controle, e as quantidades de criadouros potenciais existentes. Pode-se afirmar que houve ganhos de conhecimentos da populacao local em termos da doenca, seus vetores e criadouros, mas nao em termos das medidas adotadas para controle de recipientes. Com relacao aos criadouros, praticamente nao houve alteracoes em suas quantidades entre as duas fases da pesquisa. Portanto, apesar da identificacao de ganhos de conhecimento, nao houve mudancas das praticas da populacao local. Os achados desta pesquisa sao preocupantes, uma vez que o principal resultado a ser alcancado pelo trabalho educativo, a mudanca de praticas em relacao aos criadouros dos vetores da dengue, nao esta sendo viabilizado.

Study of the relationship between Aedes (Stegomyia) aegypti egg and adult densities, dengue fever and climate in Mirassol, state of Sao Paulo, Brazil

The purpose of this study was to examine the relationship between Aedes aegypti egg and adult density indices, dengue fever and climate in Mirassol, state of São Paulo, Brazil, between November 2004-November 2005. Weekly collections of adults and eggs were made using, respectively, manual aspirators and oviposition traps that produced four entomological indices (positivity and average of females and eggs). Weekly incidence coefficients were calculated based on dengue cases. Each week, the data obtained from entomological indices were related to each other, dengue, and climate variables. The first index to show an association with dengue transmission was the female average, followed by female positivity and egg average. Egg positivity did not show a relationship with risk for dengue, but was sensitive to identifying the presence of the vector, principally in dry seasons. The relationship between climatic factors, the vector and the disease found in this study can be widely employed in planning and undertaking dengue surveillance and control activities, but it is a tool that has not been considered by the authorities responsible for controlling the disease. In fact, this relationship permits the use of information about climate for early detection of epidemics and for establishing more effective prevention strategies than currently exist.

População de Aedes aegypti (l.) em área endêmica de dengue, Sudeste do Brasil

OBJETIVO: Estudar a populacao de Aedes aegypti em area de transmissao de dengue sob o ponto de vista de frequencia, distribuicao espacial, paridade, desenvolvimento ovariano e conteudo do intestino medio. METODOS: O estudo foi realizado na cidade de Sao Jose do Rio Preto, SP. Foram selecionados dois setores, um com nivel socioeconomico baixo e outro com nivel medio. As observacoes foram realizadas entre 1996 e 1997. Foram feitas capturas no intra e peridomicilios com capturadores eletricos manuais. Sao dados detalhes das disseccoes para estudo do estado fisiologico das femeas e da classificacao utilizada. RESULTADOS: Capturaram-se 188 machos e 189 femeas. Obteve-se um indice de 0,46 femeas por casa. Dos machos e das femeas capturados, estavam no intradomicilio, respectivamente, 82,4% e 87,3%. Encontrou-se maior proporcao de femeas no setor de nivel socioeconomico mais baixo e com maior concentracao populacional. Foram analisadas 148 femeas, sendo 27,0% nuliparas e 10,1% oniparas. As demais foram classificadas nas fases III a V de Christophers e Mer (C & M) com 28,0% destas contendo sangue de coloracao vermelha no intestino medio. Das femeas, 87,9% ja haviam praticado a hematofagia. CONCLUSOES: A especie revelou grande tendencia a endofilia. A proporcao de nuliparas foi superior a de oniparas, apesar da maioria das femeas ser classificada nas fases III a V de C & M. Chama atencao o elevado percentual das femeas que praticaram a hematofagia e a ocorrencia de nao concordância gonotrofica.

Spatio-temporal tracking and phylodynamics of an urban dengue 3 outbreak in São Paulo, Brazil.

The dengue virus has a single-stranded positive-sense RNA genome of ∼10.700 nucleotides with a single open reading frame that encodes three structural (C, prM, and E) and seven nonstructural (NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5) proteins. It possesses four antigenically distinct serotypes (DENV 1–4). Many phylogenetic studies address particularities of the different serotypes using convenience samples that are not conducive to a spatio-temporal analysis in a single urban setting. We describe the pattern of spread of distinct lineages of DENV-3 circulating in São José do Rio Preto, Brazil, during 2006. Blood samples from patients presenting dengue-like symptoms were collected for DENV testing. We performed M-N-PCR using primers based on NS5 for virus detection and identification. The fragments were purified from PCR mixtures and sequenced. The positive dengue cases were geo-coded. To type the sequenced samples, 52 reference sequences were aligned. The dataset generated was used for iterative phylogenetic reconstruction with the maximum likelihood criterion. The best demographic model, the rate of growth, rate of evolutionary change, and Time to Most Recent Common Ancestor (TMRCA) were estimated. The basic reproductive rate during the epidemics was estimated. We obtained sequences from 82 patients among 174 blood samples. We were able to geo-code 46 sequences. The alignment generated a 399-nucleotide-long dataset with 134 taxa. The phylogenetic analysis indicated that all samples were of DENV-3 and related to strains circulating on the isle of Martinique in 2000–2001. Sixty DENV-3 from São José do Rio Preto formed a monophyletic group (lineage 1), closely related to the remaining 22 isolates (lineage 2). We assumed that these lineages appeared before 2006 in different occasions. By transforming the inferred exponential growth rates into the basic reproductive rate, we obtained values for lineage 1 of R0u200a=u200a1.53 and values for lineage 2 of R0u200a=u200a1.13. Under the exponential model, TMRCA of lineage 1 dated 1 year and lineage 2 dated 3.4 years before the last sampling. The possibility of inferring the spatio-temporal dynamics from genetic data has been generally little explored, and it may shed light on DENV circulation. The use of both geographic and temporally structured phylogenetic data provided a detailed view on the spread of at least two dengue viral strains in a populated urban area.

Avaliação sobre a adesão às práticas preventivas do dengue: o caso de Catanduva, São Paulo, Brasil

This paper presents the results of a qualitative survey on dengue fever prevention in an outlying neighborhood of Catanduva, Sao Paulo, Brazil. The research aimed to identify factors that interfere with on-going preventive practices by local residents. The authors began with a qualitative approach emphasizing preventive work within local womens daily context, mediated by the relationship they establish with vector control agents. The study indicates that to gain greater collaboration in dengue control requires: personalized consideration by both the programs and vector control agents, yet without excluding technical aspects; review of information content and communications methods: and training vector control agents to establish an on-going communications channel between the program and the population. Such factors can influence the populations interest in the prevention programs and minimize community discredit towards vector control activities.

Controle do dengue em uma área urbana do Brasil: avaliação do impacto do Programa Saúde da Família com relação ao programa tradicional de controle

A study was performed in different areas of São José do Rio Preto which include the Family Health Program (FHP) and the Dengue Control Program, and the results of integration between the two programs were evaluated. In addition to other responsibilities, community health agents instructed residents on dengue control measures, encouraging the population to adopt the practices in areas with the FHP. Vector control agents were responsible for breeding site control and instructed local residents on the Dengue Control Program. From 2001 to 2003, surveys were conducted to measure residents dengue control knowledge and practices. The proportions of residents in the FHP area that reported health services as a source of information increased significantly as compared to the other area. There were significant changes concerning the increase in information about the disease and reduction in vector breeding sites. The results show that integration between the programs is possible and could help optimize resources, avoiding duplicity of procedures and fostering greater community involvement in dengue control.

Prevalência do uso de drogas entre escolares do ensino médio do Município de São José do Rio Preto, São Paulo, Brasil

This study investigates the prevalence of drug consumption among secondary school students in Sao Jose do Rio Preto, Sao Paulo State, Southeast Brazil, and its distribution in relation to gender and grade in school. A cross-sectional survey was carried out in Sao Jose do Rio Preto. A self-applied questionnaire was answered by a proportional sample of 1,041 teenagers enrolled in 9th, 10th, and 11th grades in public schools. Lifetime consumption of psychoactive substances was: alcohol 77%, tobacco 28.7%, solvents 18.1%, marijuana 12.1%, amphetamines 3.7%, cocaine 3.3%, hallucinogens 3.1%, and crack 1.4%. Weekly use of marijuana was the highest (2.8%), followed by solvents (1.3%). Males consumed more alcohol, marijuana, cocaine, and crack than females. Nighttime use of tobacco, marijuana, cocaine, and hallucinogens was observed. In the present study, prevalence of psychoactive substance use was observed in Sao Jose do Rio Preto at rates similar to those found in other Brazilian studies.