Maria Concebida da Cunha Garcia

Spatial analysis of deaths from pulmonary tuberculosis in the city of São Luís, Brazil

OBJECTIVE: To characterize deaths from pulmonary tuberculosis, according to sociodemographic and operational variables, in the city of São Luís, Brazil, and to describe their spatial distribution. METHODS: This was an exploratory ecological study based on secondary data from death certificates, obtained from the Brazilian Mortality Database, related to deaths from pulmonary tuberculosis. We included all deaths attributed to pulmonary tuberculosis that occurred in the urban area of São Luís between 2008 and 2012. We performed univariate and bivariate analyses of the sociodemographic and operational variables of the deaths investigated, as well as evaluating the spatial distribution of the events by kernel density estimation. RESULTS: During the study period, there were 193 deaths from pulmonary tuberculosis in São Luís. The median age of the affected individuals was 52 years. Of the 193 individuals who died, 142 (73.60%) were male, 133 (68.91%) were Mulatto, 102 (53.13%) were single, and 64 (33.16%) had completed middle school. There was a significant positive association between not having received medical care prior to death and an autopsy having been performed (p = 0.001). A thematic map by density of points showed that the spatial distribution of those deaths was heterogeneous and that the density was as high as 8.12 deaths/km2. CONCLUSIONS: The sociodemographic and operational characteristics of the deaths from pulmonary tuberculosis evaluated in this study, as well as the identification of priority areas for control and surveillance of the disease, could promote public health policies aimed at reducing health inequities, allowing the optimization of resources, as well as informing decisions regarding the selection of strategies and specific interventions targeting the most vulnerable populations.

Dendritic Cells Transfected with scFv from Mab 7.B12 Mimicking Original Antigen gp43 Induces Protection against Experimental Paracoccidioidomycosis

Paracoccidioidomycosis (PCM), endemic in Latin America, is a progressive systemic mycosis caused by Paracoccidioides brasiliensis (P. brasiliensis), which primarily attacks lung tissue. Dendritic cells (DCs) are able to initiate a response in naïve T cells, and they also participate in Th-cell education. Furthermore, these cells have been used for therapy in several disease models. Here we transfected DCs with a plasmid (pMAC/PS-scFv) encoding a single chain variable fragment (scFv) of an anti-Id antibody that is capable of mimicking gp43, the main antigenic component of P. brasiliensis. First, Balb/c mice were immunized subcutaneously with pMAC/PS-scFv and, after seven days, scFv protein was presented to the regional lymph nodes cells. Moreover, we showed that the DCs transfected with scFv were capable of efficiently activating proliferation of total lymph node cells and inducing a decrease in lung infection. Therefore, our results suggested that the use of scFv-transfected DCs may be a promising therapy in the paracoccidioidomycosis (PCM) model.

Spatial clustering and local risk of leprosy in São Paulo, Brazil

Background Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. Methods Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. Results A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919). Conclusion These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.

Epidemiological characteristics of cases of death from tuberculosis and vulnerable territories

Objective: to characterize the differences in the clinical and epidemiological profile of cases of death that had tuberculosis as an immediate or associated cause, and to analyze the spatial distribution of the cases of death from tuberculosis within the territories of Ribeirão Preto, Brazil. Method: an ecological study, in which the population consisted of 114 cases of death from tuberculosis. Bivariate analysis was carried out, as well as point density analysis, defined with the Kernel estimate. Results: of the cases of death from tuberculosis, 50 were the immediate cause and 64 an associated cause. Age (p=.008) and sector responsible for the death certificate (p=.003) were the variables that presented statistically significant associations with the cause of death. The spatial distribution, in both events, did not occur randomly, forming clusters in areas of the municipality. Conclusion: the difference in the profiles of the cases of death from tuberculosis, as a basic cause and as an associated cause, was governed by the age and the sector responsible for the completion of the death certificate. The non-randomness of the spatial distribution of the cases suggests areas that are vulnerable to these events. Knowing these areas can contribute to the choice of disease control strategies.Objective: to characterize the differences in the clinical and epidemiological profile of cases of death that had tuberculosis as an immediate or associated cause, and to analyze the spatial distribution of the cases of death from tuberculosis within the territories of Ribeirao Preto, Brazil.Method: an ecological study, in which the population consisted of 114 cases of death from tuberculosis. Bivariate analysis was carried out, as well as point density analysis, defined with the Kernel estimate.Results: of the cases of death from tuberculosis, 50 were the immediate cause and 64 an associated cause. Age (p=.008) and sector responsible for the death certificate (p=.003) were the variables that presented statistically significant associations with the cause of death. The spatial distribution, in both events, did not occur randomly, forming clusters in areas of the municipality.Conclusion: the difference in the profiles of the cases of death from tuberculosis, as a basic cause and as an associated cause, was governed by the age and the sector responsible for the completion of the death certificate. The non-randomness of the spatial distribution of the cases suggests areas that are vulnerable to these events. Knowing these areas can contribute to the choice of disease control strategies.

Adaptação cultural para o Brasil da escala Tuberculosis-related stigma

The process of stigmatization associated with TB has been undervalued in national research as this social aspect is important in the control of the disease, especially in marginalized populations. This paper introduces the stages of the process of cultural adaptation in Brazil of the Tuberculosis-related stigma scale for TB patients. It is a methodological study in which the items of the scale were translated and back-translated with semantic validation with 15 individuals of the target population. After translation, the reconciled back-translated version was compared with the original version by the project coordinator in Southern Thailand, who approved the final version in Brazilian Portuguese. The results of the semantic validation conducted with TB patients enable the identification that, in general, the scale was well accepted and easily understood by the participants.The process of stigmatization associated with TB has been undervalued in national research as this social aspect is important in the control of the disease, especially in marginalized populations. This paper introduces the stages of the process of cultural adaptation in Brazil of the Tuberculosis-related stigma scale for TB patients. It is a methodological study in which the items of the scale were translated and back-translated with semantic validation with 15 individuals of the target population. After translation, the reconciled back-translated version was compared with the original version by the project coordinator in Southern Thailand, who approved the final version in Brazilian Portuguese. The results of the semantic validation conducted with TB patients enable the identification that, in general, the scale was well accepted and easily understood by the participants.

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

INTRODUCTION The objective was to identify space and space-time risk clusters for the occurrence of deaths in a priority city for the control of tuberculosis (TB) in the Brazilian Northeast. METHODS Ecological research was undertaken in the City of São Luis/Maranhão. Cases were considered that resulted in deaths in the population living in the urban region of the city with pulmonary TB as the basic cause, between 2008 and 2012. To detect space and space-time clusters of deaths due to pulmonary TB in the census sectors, the spatial analysis scan technique was used. RESULTS In total, 221 deaths by TB occurred, 193 of which were due to pulmonary TB. Approximately 95% of the cases (n=183) were geocoded. Two significant spatial clusters were identified, the first of which showed a mortality rate of 5.8 deaths per 100,000 inhabitants per year and a high relative risk of 3.87. The second spatial cluster showed a mortality rate of 0.4 deaths per 100,000 inhabitants per year and a low relative risk of 0.10. A significant cluster was observed in the space-time analysis between 11/01/2008 and 04/30/2011, with a mortality rate of 8.10 deaths per 100,000 inhabitants per year and a high relative risk (3.0). CONCLUSIONS The knowledge of priority sites for the occurrence of deaths can support public management to reduce inequities in the access to health services and permit an optimization of the resources and teams in the control of pulmonary TB, providing support for specific strategies focused on the most vulnerable populations.

The impact of social inequities on mortality due to pulmonary tuberculosis in São Luis, Maranhão, Brazil.

Introduction: Authors theorize about the relation between social inequities and death by tuberculosis. Nevertheless, the literature is restricted as to verifying the relation between these events in view of space. Therefore, the study objective was to identify areas with social inequity and its impact on the mortality rate by pulmonary tuberculosis.Methods: Ecological study, which considered deaths from pulmonary tuberculosis in the urban area of the city between 2008 and 2012, available in Mortality Information System. For the construction of the social inequity indicator, the principal component analysis was used, Multiple linear regression with the least squares method and spatial regression were used to verify the impact of inequity on mortality by TB. The spatial dependence was confirmed using Moran’s Global Index.Results: 193 deaths were identified. The social inequity was statistically associated with the mortality (R2=23.86%) in the multiple linear regression model with spatial dependence (Moran I=0.285; p<0.001), which evidenced the highest rates of mortality in the weighted areas with high and intermediate social inequity.Conclusion: Social inequity explains mortality by tuberculosis in the city investigated. To reduce the deaths by 95% until 2035, the actions the health authorities have established should not only promote better access to medical and diagnostic technologies, but also actions that promote the social development of the areas and their resident populations

Patrón espacial y tendencia temporal de la mortalidad debido a la tuberculosis

Objetivos: describir el perfil epidemiologico de la mortalidad por tuberculosis (TB), analizar el patron espacial de estas muertes e investigar la tendencia temporal de la mortalidad por tuberculosis en el noreste de Brasil. Metodos: estudio ecologico basado en datos secundarios de mortalidad. Las muertes por TB se incluyeron en el estudio. Se calcularon las estadisticas descriptivas y se estimaron y suavizaron las tasas de mortalidad bruta mediante el Metodo Bayesiano Empirico Local. La regresion de Prais-Winsten se utilizo para analizar la tendencia temporal en los coeficientes de mortalidad por TB. La tecnica de densidad de Kernel se utilizo para analizar la distribucion espacial de la mortalidad por TB. Resultados: la tuberculosis estuvo presente en 236 muertes. El peso de muertes por tuberculosis fue mayor en hombres, personas solteras y personas de origen etnico mixto y la edad media al momento de la muerte fue de 51 anos. Las muertes por tuberculosis se agruparon en los distritos de salud del este, oeste y norte y el coeficiente de mortalidad por tuberculosis se mantuvo estable durante todo el periodo de estudio. Conclusiones: los analisis del patron espacial y la tendencia temporal de la mortalidad revelaron que ciertas areas con tasas mas altas de mortalidad por TB y, por lo tanto, deberian ser priorizadas en las intervenciones de salud publica dirigidas a esta enfermedad.ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.

Padrão espacial e tendência temporal da mortalidade por tuberculose

Objetivos: describir el perfil epidemiologico de la mortalidad por tuberculosis (TB), analizar el patron espacial de estas muertes e investigar la tendencia temporal de la mortalidad por tuberculosis en el noreste de Brasil. Metodos: estudio ecologico basado en datos secundarios de mortalidad. Las muertes por TB se incluyeron en el estudio. Se calcularon las estadisticas descriptivas y se estimaron y suavizaron las tasas de mortalidad bruta mediante el Metodo Bayesiano Empirico Local. La regresion de Prais-Winsten se utilizo para analizar la tendencia temporal en los coeficientes de mortalidad por TB. La tecnica de densidad de Kernel se utilizo para analizar la distribucion espacial de la mortalidad por TB. Resultados: la tuberculosis estuvo presente en 236 muertes. El peso de muertes por tuberculosis fue mayor en hombres, personas solteras y personas de origen etnico mixto y la edad media al momento de la muerte fue de 51 anos. Las muertes por tuberculosis se agruparon en los distritos de salud del este, oeste y norte y el coeficiente de mortalidad por tuberculosis se mantuvo estable durante todo el periodo de estudio. Conclusiones: los analisis del patron espacial y la tendencia temporal de la mortalidad revelaron que ciertas areas con tasas mas altas de mortalidad por TB y, por lo tanto, deberian ser priorizadas en las intervenciones de salud publica dirigidas a esta enfermedad.ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.

Spatial pattern and temporal trend of mortality due to tuberculosis

Objetivos: describir el perfil epidemiologico de la mortalidad por tuberculosis (TB), analizar el patron espacial de estas muertes e investigar la tendencia temporal de la mortalidad por tuberculosis en el noreste de Brasil. Metodos: estudio ecologico basado en datos secundarios de mortalidad. Las muertes por TB se incluyeron en el estudio. Se calcularon las estadisticas descriptivas y se estimaron y suavizaron las tasas de mortalidad bruta mediante el Metodo Bayesiano Empirico Local. La regresion de Prais-Winsten se utilizo para analizar la tendencia temporal en los coeficientes de mortalidad por TB. La tecnica de densidad de Kernel se utilizo para analizar la distribucion espacial de la mortalidad por TB. Resultados: la tuberculosis estuvo presente en 236 muertes. El peso de muertes por tuberculosis fue mayor en hombres, personas solteras y personas de origen etnico mixto y la edad media al momento de la muerte fue de 51 anos. Las muertes por tuberculosis se agruparon en los distritos de salud del este, oeste y norte y el coeficiente de mortalidad por tuberculosis se mantuvo estable durante todo el periodo de estudio. Conclusiones: los analisis del patron espacial y la tendencia temporal de la mortalidad revelaron que ciertas areas con tasas mas altas de mortalidad por TB y, por lo tanto, deberian ser priorizadas en las intervenciones de salud publica dirigidas a esta enfermedad.ABSTRACT Objectives: To describe the epidemiological profile of mortality due to tuberculosis (TB), to analyze the spatial pattern of these deaths and to investigate the temporal trend in mortality due to tuberculosis in Northeast Brazil. Methods: An ecological study based on secondary mortality data. Deaths due to TB were included in the study. Descriptive statistics were calculated and gross mortality rates were estimated and smoothed by the Local Empirical Bayesian Method. Prais-Winsten’s regression was used to analyze the temporal trend in the TB mortality coefficients. The Kernel density technique was used to analyze the spatial distribution of TB mortality. Results: Tuberculosis was implicated in 236 deaths. The burden of tuberculosis deaths was higher amongst males, single people and people of mixed ethnicity, and the mean age at death was 51 years. TB deaths were clustered in the East, West and North health districts, and the tuberculosis mortality coefficient remained stable throughout the study period. Conclusions: Analyses of the spatial pattern and temporal trend in mortality revealed that certain areas have higher TB mortality rates, and should therefore be prioritized in public health interventions targeting the disease.