Ilka Afonso Reis

Homicide clusters and drug traffic in Belo Horizonte, Minas Gerais State, Brazil from 1995 to 1999

The article presents a spatial analysis of homicides in Belo Horizonte according to the Minas Gerais Military Police records from 1995 to 1999. The authors identify clusters of high mortality risk and relate them to areas with drug traffic and associated violence. SaTScan software is used to locate the clusters.

Early Clinical Manifestations Associated with Death from Visceral Leishmaniasis

Background In Brazil, lethality from visceral leishmaniasis (VL) is high and few studies have addressed prognostic factors. This historical cohort study was designed to investigate the prognostic factors for death from VL in Belo Horizonte (Brazil). Methodology The analysis was based on data of the Reportable Disease Information System-SINAN (Brazilian Ministry of Health) relating to the clinical manifestations of the disease. During the study period (2002–2009), the SINAN changed platform from a Windows to a Net-version that differed with respect to some of the parameters collected. Multivariate logistic regression models were performed to identify variables associated with death from VL, and these were included in prognostic score. Principal Findings Model 1 (period 2002–2009; 111 deaths from VL and 777 cured patients) included the variables present in both SINAN versions, whereas Model 2 (period 2007–2009; 49 deaths from VL and 327 cured patients) included variables common to both SINAN versions plus the additional variables included in the Net version. In Model 1, the variables significantly associated with a greater risk of death from VL were weakness (OR 2.9; 95%CI 1.3–6.4), Leishmania-HIV co-infection (OR 2.4; 95%CI 1.2–4.8) and age ≥60 years (OR 2.5; 95%CI 1.5–4.3). In Model 2, the variables were bleeding (OR 3.5; 95%CI 1.2–10.3), other associated infections (OR 3.2; 95%CI 1.3–7.8), jaundice (OR 10.1; 95%CI 3.7–27.2) and age ≥60 years (OR 3.1; 95%CI 1.4–7.1). The prognosis score was developed using the variables associated with death from VL of the latest version of the SINAN (Model 2). The predictive performance of which was evaluated by sensitivity (71.4%), specificity (73.7%), positive and negative predictive values (28.9% and 94.5%) and area under the receiver operating characteristic curve (75.6%). Conclusions Knowledge regarding the factors associated with death from VL may improve clinical management of patients and contribute to lower mortality.

Relative Risk of Visceral Leishmaniasis in Brazil: A Spatial Analysis in Urban Area

Background Visceral leishmaniasis (VL) is a vector-borne disease whose factors involved in transmission are poorly understood, especially in more urban and densely populated counties. In Brazil, the VL urbanization is a challenge for the control program. The goals were to identify the greater risk areas for human VL and the risk factors involved in transmission. Methodology This is an ecological study on the relative risk of human VL. Spatial units of analysis were the coverage areas of the Basic Health Units (146 small-areas) of Belo Horizonte, Minas Gerais State, Brazil. Human VL cases, from 2007 to 2009 (n = 412), were obtained in the Brazilian Reportable Disease Information System. Bayesian approach was used to model the relative risk of VL including potential risk factors involved in transmission (canine infection, socioeconomic and environmental features) and to identify the small-areas of greater risk to human VL. Principal Findings The relative risk of VL was shown to be correlated with income, education, and the number of infected dogs per inhabitants. The estimates of relative risk of VL were higher than 1.0 in 54% of the areas (79/146). The spatial modeling highlighted 14 areas with the highest relative risk of VL and 12 of them are concentrated in the northern region of the city. Conclusions The spatial analysis used in this study is useful for the identification of small-areas according to risk of human VL and presents operational applicability in control and surveillance program in an urban environment with an unequal spatial distribution of the disease. Thus the frequent monitoring of relative risk of human VL in small-areas is important to direct and prioritize the actions of the control program in urban environment, especially in big cities.

A Stimulus-Centric Algebraic Approach to Sensors and Observations

The understanding of complex environmental phenomena, such as deforestation and epidemics, requires observations at multiple scales. This scale dependency is not handled well by todays rather technical sensor definitions. Geosensor networks are normally defined as distributed ad-hoc wireless networks of computing platforms serving to monitor phenomena in geographic space. Such definitions also do not admit animals as sensors. Consequently, they exclude human sensors, which are the key to volunteered geographic information, and they fail to support connections between phenomena observed at multiple scales. We propose definitions of sensors as information sources at multiple aggregation levels, relating physical stimuli to observations. An algebraic formalization shows their behavior as well as their aggregations and generalizations. It is intended as a basis for defining consistent application programming interfaces to sense the environment at multiple scales of observations and with different types of sensors.

Prognostic factors and scoring system for death from visceral leishmaniasis: an historical cohort study in Brazil.

Background In Brazil, case-fatality rates attributable to visceral leishmaniasis (VL) are high and knowledge of the risk factors associated with death may help reduce mortality. The aim of this study was to construct and validate a scoring system for prognosis of death from VL by using all cases reported in Brazil from 2007 to 2011. Methodology In this historical cohort study, 18,501 VL cases were analyzed; of these, 17,345 cases were cured and 1,156 cases caused death. The database was divided into two series: primary (two-thirds of cases), to develop the model score, and secondary (one-third of cases), to validate the scoring system. Multivariate logistic regression models were performed to identify factors associated with death from VL, and these were included in the scoring system. Principal Findings The factors associated with death from VL were: bleeding (score 3); splenomegaly (score 1); edema (score 1); weakness (score 1); jaundice (score 1); Leishmania–HIV co-infection (score 1); bacterial infection (score 1); and age (≤0.5 years [score 5]; >0.5 and ≤1 [score 2]; >19 and ≤50 [score 2]; >50 and <65 [score 3]; ≥65 [score 5]). It was observed that patients with a score of 4 had a probability of death of approximately 4.5% and had a worse prognosis. The sensitivity, specificity, and accuracy of this score were 89.4, 51.2, and 53.5, respectively. Conclusions/Significance The scoring system based on risk factors for death showed good performance in identifying patients with signs of severity at the time of clinical suspicion of VL and can contribute to improving the surveillance system for reducing case fatalities. The classification of patients according to their prognosis for death may assist decision-making regarding the transfer of the patients to hospitals more capable of handling their condition, admission to the intensive care unit, and adequate support and specific treatment.

Evaluating the effectiveness of an empowerment program for self-care in type 2 diabetes: a cluster randomized trial

BackgroundThe prevalence of type 2 diabetes mellitus is increasing substantially worldwide, leading to serious economic effects, complications and deaths. This study evaluated the effectiveness of an empowerment program providing support for psychosocial, behavioral, and clinical aspects of diabetes to help Brazilian users of public health services obtain metabolic control of this condition.MethodsIn this cluster randomized trial, participants aged 30–80 diagnosed with type 2 diabetes were recruited from ten Brazilian public health units in 2014 and 2015. Five units were randomly assigned to receive the empowerment program based on a behavior change protocol, and five continued to receive only conventional treatment. The primary outcome was the biochemical and anthropometric parameters, and the secondary outcomes were self-care, attitude, knowledge and empowerment related to diabetes. The effect of the experiment was defined as the percentage variation between the values at the initial and final periods. To evaluate this effect and to compare it in the two groups, tests were used for paired and independent samples, respectively.ResultsThere were 238 participants: 127 and 111 in the intervention and control group, respectively. For glycated hemoglobin, the mean effect in the control and intervention groups was 3.93 and −5.13, respectively (p < 0.001). Levels of glycated hemoglobin and other metabolic indicators, as well as the most part of the secondary outcomes showed a significant difference in the experimental group compared to the control group.ConclusionsThe empowerment program improved metabolic control of type 2 diabetes in Brazilian users.Trial registrationNCT02132338 - April 22, 2014.

Relationship between the users' contact time in educational programs on diabetes mellitus and self-care skills and knowledge

OBJETIVO Verificar a relacao entre o tempo de contato de usuarios em programas educativos e as variaveis conhecimento e autocuidado em diabetes mellitus. METODO Estudo longitudinal de abordagem quantitativa, com a participacao, na fase inicial, de 263 usuarios vinculados as Unidades Basicas de Saude de Belo Horizonte, Brasil, durante os anos de 2012 e 2013. Foram coletados dados com relacao ao tempo de contato total de participacao dos usuarios no programa educativo, quanto aos conhecimentos e ao autocuidado em diabetes mellitus adquiridos. Os dados foram analisados por meio do teste t-Student para a comparacao de medias, considerando um nivel de significância de 0,05. RESULTADOS A amostra final resultou em 151 usuarios. A analise revelou que a melhora nos escores de autocuidado foi estatisticamente maior durante a intervencao educativa de 8 horas ou mais (valor-p < 0,05). No respeito aos escores de conhecimentos, houve melhora estatisticamente significativa ao final do programa educativo. Nao foi possivel identificar um valor para o tempo de contato a partir do qual houvesse um aumento dos escores medios para a habilidade do conhecimento. CONCLUSAO Para melhorar a efetividade da promocao das habilidades relacionadas ao conhecimento e ao autocuidado em diabetes mellitus, e necessario considerar o tempo de contato como fator relevante do programa educativo.

Leishmania, Babesia and Ehrlichia in urban pet dogs: co-infection or cross-reaction in serological methods?

INTRODUCTION The present study was designed to assess the occurrence of co-infection or cross-reaction in the serological techniques used for detecting the anti-Leishmania spp., -Babesia canis vogeli and -Ehrlichia canis antibodies in urban dogs from an area endemic to these parasites. METHODS The serum samples from dogs were tested for the Babesia canis vogeli strain Belo Horizonte antigen and Ehrlichia canis strain São Paulo by immunofluorescence antibody test (IFAT) and by anti-Leishmania immunoglobulin G (IgG) antibody detection to assess Leishmania infection. We used the following four commercial kits for canine visceral leishmaniasis: ELISA, IFAT, Dual Path Platform (DPP) (Bio Manguinhos(r)/FIOCRUZ/MS) and a rK39 RDT (Kalazar Detect Canine Rapid Test; Inbios). RESULTS Of 96 serum samples submitted to serological assays, 4 (4.2%) were positive for Leishmania as determined by ELISA; 12 (12.5%), by IFAT; 14 (14.6%) by rK39 RDT; and 20 (20.8%), by DPP. Antibodies against Ehrlichia and Babesia were detected in 23/96 (23.9%) and 30/96 (31.2%) samples, respectively. No significant association was identified between the results of tests for detecting Babesia or Ehrlichia and those for detecting Leishmania (p-value>0.05). CONCLUSIONS In the present study, we demonstrated co-infection with Ehrlichia or Babesia and Leishmania in dogs from Minas Gerais (Brazil); we also found that the serological tests that were used did not cross-react.

Ectoparasites and anti-Leishmania antibodies: Association in an observational case–control study of dogs from a Brazilian endemic area

It has been proposed that the transmission of canine visceral leishmaniasis might involve the participation of mechanical vectors, including ticks of the family Ixodidae, in particular the brown dog tick Rhipicephalus sanguineus, and the cat flea Ctenocephalides felis felis. Here, the association between the infestation by R. sanguineus and C. felis felis and the occurrence of anti-Leishmania antibodies was evaluated in an observational case-control study of dogs living in a Brazilian endemic area for canine visceral leishmaniasis. Blood samples were taken once every three months for one year from 96 initially seronegative domestic dogs, and submitted to indirect immunofluorescence antibody assay. All dogs were evaluated for the presence of ticks and fleas, and the results were expressed qualitatively as infested or non-infested, irrespective of the intensity of infestation. At the end of follow-up, twenty dogs had turned seropositive, while 68 remained seronegative and 8 were excluded because of incomplete data. All the dogs were asymptomatic. The odds of infection was significantly greater (OR=3.54, CI95%=1.10-12.53) for dogs infested by C. felis felis compared to their non-infested counterparts. In contrast, the odds of infection showed no significance difference between non-infested and R. sanguineus-infested groups of dogs (OR=0.31, CI95%=0.03-1.52). This study provides further evidence for the potential role of C. felis felis in mechanically transmitting Leishmania among the canine population.

MONITORAMENTO TELEFÔNICO COMO ESTRATEGIA EDUCATIVA PARA O AUTOCUIDADO DAS PESSOAS COM DIABETES NA ATENÇÃO PRIMÁRIA

Objetivo: Describir la experiencia del monitoreo telefonico como estrategia educativa en ensenanza del auto-cuidado de personas con diabetes en la atencion primaria. Material y metodo: Estudio descriptivo, realizado con 115 pacientes de diabetes residentes en domicilios con linea telefonica fja y en seguimiento educativo en la atencion primaria, ano 2010. Entrevistas telefonicas fueron realizadas segun rutina semiestructurada. Resultados: De los 115 entrevistados, 44,8% practican actividad fisica y 58,3% siguen la dieta. En ambos grupos, la mayoria de practicantes de actividad fisica son adeptos a las caminatas. El porcentaje de pacientes que sigue la dieta es casi el mismo entre hombres y mujeres (60,0 y 57,9%). Conclusion: el monitoreo permitio reforzar la comunicacion y las informaciones para educar a los pacientes con diabetes, fortalecio el vinculo entre pacientes y profesionales y posibilito que estos intervinieran ante las dificultades de los pacientes en el manejo de la enfermedad, de forma rapida y efectiva.