Rita Barradas Barata

Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs

Despite pronounced reductions in the number of deaths due to infectious diseases over the past six decades, infectious diseases are still a public health problem in Brazil. In this report, we discuss the major successes and failures in the control of infectious diseases in Brazil, and identify research needs and policies to further improve control or interrupt transmission. Control of diseases such as cholera, Chagas disease, and those preventable by vaccination has been successful through efficient public policies and concerted efforts from different levels of government and civil society. For these diseases, policies dealt with key determinants (eg, the quality of water and basic sanitation, vector control), provided access to preventive resources (such as vaccines), and successfully integrated health policies with broader social policies. Diseases for which control has failed (such as dengue fever and visceral leishmaniasis) are vector-borne diseases with changing epidemiological profiles and major difficulties in treatment (in the case of dengue fever, no treatment is available). Diseases for which control has been partly successful have complex transmission patterns related to adverse environmental, social, economic, or unknown determinants; are sometimes transmitted by insect vectors that are difficult to control; and are mostly chronic diseases with long infectious periods that require lengthy periods of treatment.

Perfil dos pesquisadores com bolsa de produtividade em pesquisa do CNPq da área de saúde coletiva

O artigo analisa, com base nas informacoes do curriculo Lattes, o perfil dos pesquisadores com bolsa de produtividade em pesquisa do CNPq na area de Saude Coletiva. A analise levou em conta a formacao graduada e pos-graduada, area de atuacao, producao e divulgacao cientifica. As comparacoes sao feitas entre as classes de pesquisadores e com dados do diretorio de grupos de pesquisa. A maioria dos pesquisadores (70%) sao formados em Ciencias da Saude, principalmente em Medicina, ou em Ciencias Humanas (18%), principalmente Sociologia. Sessenta por cento fizeram mestrado e doutorado em Saude Coletiva, mas ha entre 20 e 30% de pesquisadores, dependendo da classe, sem formacao especifica na area. A maioria atua em Epidemiologia. A producao cientifica, expressa em produtos bibliograficos, varia de 10,56 produtos/ano de obtencao do doutorado para os pesquisadores 2C a 6,60 produtos/ano para os pesquisadores 1A. Para artigos completos publicados em periodicos os valores sao 3,56 e 2,87, respectivamente. A producao e divulgada principalmente em periodicos A internacional e, A e B nacional. Os periodicos que concentram a publicacao sao Cadernos de Saude Publica e Revista de Saude Publica.

Immunization coverage in the first year of life in four cities in the state of São Paulo, Brazil

A vacinacao constitui uma importante medida para a prevencao de doencas e a avaliacao de sua eficiencia e fundamental para garantir o sucesso dos programas de imunizacao. O presente estudo descreve os resultados de um inquerito domiciliar para estimar a cobertura vacinal da coorte nascida em 1996 nos municipios de Sao Paulo, Osasco, Francisco Morato e Guarulhos, Estado de Sao Paulo, Brasil. O Municipio de Sao Paulo foi dividido em cinco estratos, de acordo com as condicoes de vida. O estudo seguiu a metodologia preconizada pela Organizacao Pan-Americana da Saude para a realizacao de inqueritos de cobertura vacinal. A proporcao de criancas com esquema de vacinacao completo no momento da entrevista, considerando-se a informacao oral e de caderneta, esteve acima de 90% para todos os municipios, exceto Francisco Morato (municipio com piores condicoes de vida). Para os estratos no Municipio de Sao Paulo, encontramos as piores coberturas nos dois extremos. Quando se consideram apenas as doses aplicadas no 1° ano de vida, as coberturas nao atingiram valores seguros. O uso de servicos privados de vacinacao foi diretamente proporcional as condicoes de vida. A diferenca entre as coberturas calculadas a partir dos dados de producao e as calculadas a partir de doses administrativas determinadas pelo inquerito e inversamente proporcional as condicoes de vida nos municipios. Os resultados sugerem que inqueritos de cobertura vacinal como o descrito no presente artigo deveriam ser realizados tambem em outros municipios. Alem disso, e importante treinar os funcionarios das salas de vacinacao para que preencham adequadamente os dados de vacinacao, intensificar a divulgacao do calendario oficial de imunizacao aos profissionais de saude e facilitar o acesso da populacao aos servicos de saude.Immunization is an important disease prevention measure, and evaluating the effectiveness of immunization programs is crucial to ensuring their success. This study describes the results of a household survey in four cities in the state of São Paulo, Brazil: Francisco Morato, Guarulhos, Osasco, and São Paulo. The survey was done in order to estimate immunization coverage for the cohort of children born in 1996. The city of São Paulo was divided into five strata, according to socioeconomic and living conditions. The survey followed the methodology that the Pan American Health Organization recommends for immunization coverage surveys. The proportion of children who had received a complete set of the recommended vaccinations at the time of the interview, taking into account both oral reports and information recorded on the childrens immunization cards, was above 90% for all the cities except Francisco Morato, which had the worst living conditions. In the city of São Paulo, the worst coverage was found in the lowest and highest strata. When only the doses received during the first year of life were considered, the coverage was not adequate to produce herd immunity. The use of private vaccination services was higher in the areas with better living conditions. The difference between the coverage calculated based on data from health services and the coverage calculated based on the survey was inversely proportional to living conditions. Our results suggest that surveys similar to the one described here should be carried out in other cities. Employees who provide vaccination services should be trained to correctly record vaccination data. In addition, it is important to make health professionals aware of the official immunization calendar, and to facilitate the publics access to health services.

Inquéritos populacionais: aspectos metodológicos, operacionais e éticos

Eliseu Alves Waldman H. Maria Dutilh Novaes Maria de Fatima Militao de Albuquerque Maria do Rosario Dias de Oliveira Latorre Manoel Carlos Sampaio de Almeida Ribeiro Mauricio Vasconcellos Ricardo Arraes de Alencar Ximenes Rita Barradas Barata Tânia Giacomo do Lago Zilda Pereira da Silva 1 Universidade de Sao Paulo, Faculdade de Saude Publica 2 Faculdade de Medicina da Universidade de Sao Paulo 3 Universidade Federal de Pernambuco, Centro de Ciencias da Saude, Departamento de Medicina Clinica 4 Universidade de Sao Paulo, Faculdade de Saude Publica, Departamento de Epidemiologia 5 Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Departamento de Medicina Social 6 Instituto Brasileiro de Geografia e Estatistica IBGE 7 Universidade Federal de Pernambuco, Centro de Ciencias da Saude, Departamento de Medicina Tropical 8 Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Departamento de Medicina Social 9 Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Departamento de Medicina Social 10 Fundacao Sistema Estadual de Analise de Dados SEADE

Intra-urban differentials in death rates from homicide in the city of São Paulo, Brazil,1988-1994

The objective of this research was to analyze the relationship between socioeconomic statistics and homicide mortality rates in the city of São Paulo between 1988 and 1994. City districts were grouped into five geographic areas. A socioeconomic indicator (ISE) was constructed with census information combining average income of the family head, illiteracy rate for the population over 5 yr of age, average number of rooms and number of persons per household. The higher the score, the better the socioeconomic situation (possible values: 4 to 384). Deaths from homicide were grouped by residential areas, and the rates for these areas were calculated. The association between homicide rates and the socioeconomic situation was analyzed with Spearman correlation coefficients. Average ISE scores varied from 291 in the Central area (homicide rate = 27.96 deaths per 100000) to 119.9 in the East area (homicide rate = 40.38). The Spearman coefficient between ISEs and homicide rates was -0.98 (p < 0.05). Due to the heterogeneity inside the areas, the median ISE is a better indicator of the socioeconomic conditions yielding an rs = -1.0. Almost half the population resides in areas with the highest risk of homicide mortality (East and South). Taking the Central area as a reference, we found risks of 1.36 in the Western, 1.37 in the Northern, 1.44 in the Eastern and 2.67 in the Southern areas.

O desafio das doenças emergentes e a revalorização da epidemiologia descritiva

Este artigo trata das doencas emergentes e re-emergentes apresentando seu conceito, as principais ocorrencias nos ultimos 25 anos, e os determinantes dessas ocorrencias. Trata tambem da epidemiologia descritiva e sua utilizacao na investigacao desses problemas de saude apontando a importância de sua recuperacao pelos epidemiologistas. Finalmente, sao mencionados os desafios que as doencas emergentes colocam para a pratica em saude coletiva e tambem para o desenvolvimento metodologico da epidemiologia descritiva.

Correlation between homicide rates and economic indicators in São Paulo, Brazil, 1996

Around 30% of the deaths due to violent causes in Brazil result from homicides. Violence has traditionally been related to larger social problems, such as poverty. Recently, however, a positive correlation has been observed between higher incomes and an increase in the homicide rate, so that some researchers have begun to consider inequality, rather than poverty, as an explanation for the epidemic of violence. The objective of this study was to investigate the correlation between urbanization, poverty, and economic inequality and homicide rates in the state of São Paulo, Brazil, in 1996. Information regarding population size, average monthly income of household heads, income distribution, and Gini index was obtained for each municipality, based on the demographic census. Homicide rates were calculated based on official data. Data were analyzed in terms of correlation and relative risk with 95% confidence intervals. Homicide rates rose in direct proportion to city population and ranged from 6.96 (per 100,000 inhabitants) in municipalities with a population smaller than 10,000 inhabitants, to 55.54 in municipalities with more than 1 million inhabitants. Relative risk ranged from 1.35 to 7.98. A significant correlation with population size was found only for incomes above 3.11 times the minimum wage and a Gini index greater than 0.50. There was a strong, direct, and significant correlation between homicide rates and the income ratio between the ninetieth and the twentieth percentiles of the population. It is necessary to probe more deeply into the macrosocial determinants of homicide rates in order to identify indicators of inequality that can generate meaningful data for developing public health strategies.

Meningococcal disease in São Paulo, Brazil, in the 20th century: epidemiological characteristics

Este estudo analisa o comportamento epidemiologico da doenca meningococica na cidade de Sao Paulo, Brasil, ao longo do seculo XX. Utilizando dados de prontuarios, atestados de obito e do sistema de vigilância epidemiologica os autores descrevem a tendencia secular da doenca, sua variacao sazonal, a distribuicao espacial e por idade e sexo. A tendencia secular mostra incidencia constante nos periodos endemicos, interrompida pela presenca de epidemias. As quatro epidemias registradas durante o seculo XX ocorreram em momentos de graves perturbacoes sociais e foram produzidas pelos sorogrupos A, A e C, e B e C. A variacao sazonal com exacerbacao no outono/inverno mantem-se constante durante todo o seculo. A distribuicao espacial acompanha os deslocamentos da populacao pobre no espaco urbano. A distribuicao por idade e sexo mantem-se inalterada em todos os periodos endemicos, mostrando maior risco entre os menores de um ano e decrescimos acentuados a proporcao que aumenta a idade. Os periodos epidemicos, com excecao do ultimo, mostram alteracao significante na distribuicao etaria, com aumento do risco entre jovens e adultos jovens, e ocorrencia de casos em todas as faixas etarias.Este estudo analisa o comportamento epidemiologico da doenca meningococica na cidade de Sao Paulo, Brasil, ao longo do seculo XX. Utilizando dados de prontuarios, atestados de obito e do sistema de vigilância epidemiologica os autores descrevem a tendencia secular da doenca, sua variacao sazonal, a distribuicao espacial e por idade e sexo. A tendencia secular mostra incidencia constante nos periodos endemicos, interrompida pela presenca de epidemias. As quatro epidemias registradas durante o seculo XX ocorreram em momentos de graves perturbacoes sociais e foram produzidas pelos sorogrupos A, A e C, e B e C. A variacao sazonal com exacerbacao no outono/inverno mantem-se constante durante todo o seculo. A distribuicao espacial acompanha os deslocamentos da populacao pobre no espaco urbano. A distribuicao por idade e sexo mantem-se inalterada em todos os periodos endemicos, mostrando maior risco entre os menores de um ano e decrescimos acentuados a proporcao que aumenta a idade. Os periodos epidemicos, com excecao do ultimo, mostram alteracao significante na distribuicao etaria, com aumento do risco entre jovens e adultos jovens, e ocorrencia de casos em todas as faixas etarias.This study analyzes the epidemiological behavior of meningococcal disease in the city of São Paulo, Brazil, over the course of the 20th century. Applying data from patient records, death certificates, and epidemiological surveillance, the authors describe trends in the disease throughout the century, seasonal variations, and incidence distribution by area, age, and gender. The temporal trends show constant incidence during endemic periods, interrupted by epidemic events. Four epidemic events during the last century occurred in circumstances of serious social disturbances and were caused by serogroups A (the first two), A and C, and B and C, respectively. Seasonal variations involved aggravation during autumn and winter throughout the entire century. Geographic distribution followed the displacement of the poor population in the urban territory. Age and gender distribution remained unaltered during all the endemic periods, showing an increased risk associated with younger age. The epidemic periods (except for the last) showed major alterations in age and gender distribution, with an increased risk among young people and youth adults and occurrence in all age brackets.

Tendência temporal da mortalidade por homicídios na cidade de São Paulo, Brasil, 1979-1994

To study homicide trends by gender and age, 1979-1994, São Paulo, Brazil, cubic polynomials were used to determine the best model for adjusting to time trends in homicide mortality rates by age and gender in the city of São Paulo, Brazil, 1979-1994. The model best adjusted to each group was selected considering the regression coefficient (Beta) , R2 value, residual analysis, and models simplicity. The results show linear growth for total rates and rates by gender due to behavior of rates in the 20-29 and 30-39 year age groups. The reciprocal model adjusted best to rates for the 40-49 and 50-59 year age groups, while rates for adolescents followed the multiplicative model. There was no significant relationship between homicide rates and time for the remaining groups (under 10 and over 59 years). Rates for males were considerably higher in all age groups. The remarkably steady growth in homicide rates among adolescents and young adults is consistent with trends observed in other urban areas in developing and developed countries and denotes deteriorating living conditions and increased poverty.

Comportamento sexual e percepções sobre HIV/Aids no Brasil

Tão raros como essenciais, os inquéritos de âmbito nacional constituem ferramentas indispensáveis à formulação e monitoramento de políticas públicas. Em parceria entre o Centro Brasileiro de Análise e Planejamento (CEBRAP) e o Programa Nacional de DST e Aids, Ministério da Saúde, foi conduzido, em 2005, um amplo inquérito denominado “Comportamento Sexual e Percepções da População Brasileira sobre HIV/Aids”, a partir de uma amostra de 5.040 entrevistados, representativa da população urbana brasileira. Este inquérito, assim como o anterior, homônimo, realizado em 1998 fornecem informações relevantes para o balizamento das ações preventivas.