Rosely Magalhães de Oliveira

Paracoccidioidomycosis mortality in Brazil (1980-1995)

This study analyzes 3,181 deaths from paracoccidioidomycosis in Brazil, based on 16 years of sequential data (from 1980 to 1995). During this period paracoccidioidomycosis showed considerable magnitude and low visibility, representing the eighth most common cause of death from predominantly chronic or recurrent types of infectious and parasitic diseases. It also had the highest mortality rate among the systemic mycoses. The mean annual mortality rate was 1.45 per million inhabitants, indicating a downward long-term trend (reduction of 31.28%), while spatial distribution among the different regions and States of Brazil was non-homogenous. The South (with the highest regional rate) and the Southeast showed a downward trend, while the Central West had the second highest rate in the country. At least one-fifth of Brazilian municipalities (or 22.71% of the countrys total area) reported deaths from paracoccidioidomycosis. Overall nationwide mortality per area was 3.73/10,000km2. The disease was endemic in non-metropolitan areas. The majority of deaths occurred in males (84.75%), and there was a sex ratio of 562 men/100 women. The 30-59-year and over-60-year age groups were the most affected. The study showed that the mortality rate justifies classifying this disease as a major health problem in Brazil.

Análise espacial da ocorrência de dengue e condições de vida na cidade de Nova Iguaçu, Estado do Rio de Janeiro, Brasil

The reemergence, spread, and persistence of dengue are currently challenging the Brazilian health system. Factors related to living conditions have been addressed to understand different health outcomes. This study examines the occurrence of dengue and its relationship to living conditions in the city of Nova Iguacu, Rio de Janeiro State, from 1996 to 2004. Data on dengue occurrence were obtained from the Brazilian National Disease Notification System (SINAN). A composite indicator of socioeconomic and urban infrastructure variables was created to characterize the prevailing living conditions, using 2000 census data. Operations between layers were used to identify spatial associations between the composite indicator and dengue incidence by neighborhood. The results do not show a linear relationship between poor living conditions and disease occurrence, but the spatial patterns indicated greater susceptibility of areas with inequalities in living conditions and behind highway access routes. The results also suggest that such inequalities can influence the dengue time trend. Thus, models that consider the interaction between socioeconomic variables (and not only the quantification of social indicators) can be useful for dengue surveillance.

Esporotricose urbana: epidemia negligenciada no Rio de Janeiro, Brasil

In the scientific literature, sporotrichosis has traditionally been associated with agricultural work, since the causative agent is found naturally in the soil. However, cases have been reported recently in an urban area, related to zoonotic transmission. The current study aimed to contribute to knowledge on sporotrichosis in an urban area through an exploratory analysis of its socio-spatial distribution in Rio de Janeiro, Brazil, from 1997 to 2007, identifying the areas with the heaviest transmission. The database from the Health Surveillance Service at the Evandro Chagas Institute for Clinical Research, Oswaldo Cruz Foundation, was used to estimate incidence rates and spatial distribution. During the study period, 1,848 cases of sporotrichosis were reported, predominantly in adult women not currently in the labor market. The leading source of infection was wounds caused by domestic cats, which contributed to the spread of sporotrichosis in this urban area. Georeferencing of 1,681 cases showed a transmission belt along the border between the city of Rio de Janeiro and the adjacent municipalities in the Greater Metropolitan Area.

Paracoccidioidomycosis mortality in the State of Paraná, Brazil, 1980/1998

The paracoccidioidomycosis mortality rate in the State of Paraná, Brazil (1980/1998) was analyzed using the death registry data from the Brazilian Mortality Information System and the estimated population from the Brazilian Institute of Geography and Statistics. To qualify the deaths, we deployed ICD-9 for 1980/1995 and ICD-10 for the more recent years. During this period there were 551 deaths from paracoccidioidomycosis in the State of Paraná. Most of the deaths were in male in the 30-59-year age group. The average annual mortality rate was 3.48 per million inhabitants, showing a tendency to stabilize during the study period. Paracoccidioidomycosis was the fifth cause of mortality among the predominantly chronic infectious diseases and had the highest mortality rate among the systemic mycoses. Paracoccidioidomycosis was observed in 184 counties in the State of Paraná. Most deaths were recorded in the North-Central meso-region, and the highest mortality rate occurred in the West meso-region.

Heterogeneidade espacial da dengue em estudos locais, Niterói, RJ

OBJETIVO: Analisar a ocorrencia espacial e temporal da dengue e sua associacao com a heterogeneidade de caracteristicas do ambiente urbano. METODOS: Foram georreferenciados 1.212 casos de dengue registrados no Sistema de Informacao de Agravos de Notificacao entre 1998 e 2006, no municipio de Niteroi, RJ, segundo setores censitarios. Os setores foram classificados em areas homogeneas para a ocorrencia da doenca: favela, estaleiro e urbano. Os casos foram agrupados em cinco periodos: dois interepidemicos 1998-2000 e 2003-2005; tres epidemicos 2001, 2002 e 2006 e analisados por meio de operacoes entre camadas em ambiente sistema de informacao geografica. Para identificacao de conglomerados com maior intensidade de casos, utilizou-se o metodo de kernel. O metodo de varredura espacial de Kulldorff foi usado para confirmacao estatistica desses clusters. RESULTADOS: Do total de casos, 57% eram do sexo feminino. As faixas etarias com maior concentracao de casos foram de 20-29 anos (20,5%) e de 30-39 anos (17,7%). O setor favela morro apresentou somente 11% dos domicilios atendidos por servico de coleta de lixo, o maior percentual de nao alfabetizados (8,7%) e de chefes de familia com rendimentos menores de 1 salario minimo (29,5%). Os casos permaneceram nos setores denominados favelas. No primeiro ano epidemico e nos periodos interepidemicos o maior numero de casos estava situado nos setores favelas morro e favela plana; no segundo e terceiro ano de epidemia, situavam-se no setor favela plana. CONCLUSOES: A parcela economicamente ativa foi a mais atingida na area de estudo. Os setores censitarios mostram heterogeneidade espacial em relacao as condicoes de vida e dentro de alguns setores, ha diferenciais na distribuicao espacial e temporal do risco de ocorrencia da dengue.OBJECTIVE To analyze the spatial and temporal occurrence of dengue fever and its association with the heterogeneity of urban environment characteristics. METHODS A total of 1,212 dengue cases, recorded in the Information System for Notifiable Diseases (Sinan) between 1998 and 2006, in the city of Niterói, Southeastern Brazil, were georeferenced according to census tracts. These tracts were classified into homogeneous areas for the occurrence of the disease: slum, shipyard and urban area. Cases were grouped into five periods--two inter-epidemic periods (1998-2000 and 2003-2005) and three epidemic periods (2001, 2002 and 2006)--and analyzed using operations between layers in a geographic information system (GIS) environment. The kernel method was used to identify clusters of cases. Kulldorffs spatial scan statistic was used to confirm these clusters statistically. RESULTS Of all cases, 57% were females. Age groups with the highest number of cases were 20-29-years (20.5%) and 30-39-years (17.7%). The hill slum sector showed only 11% of households covered by garbage collection service, the highest percentage of illiterate individuals (8.7%) and head of families with income lower than one monthly minimum wage (29.5%). Cases remained in the slum sectors. In the first epidemic year and in the inter-epidemic periods, the highest number of cases was found in the hill and flatland slum sectors; in the second and third epidemic years, in the flatland slum sector. CONCLUSIONS The economically active portion of the population was that most affected in the study area. Census tracts show spatial heterogeneity in relation to life conditions. In addition, in some tracts, there are differences in spatial and temporal distribution of the risk of occurrence of dengue fever.

Specific dengue transmission conditions at the local level: a study in Itaipu, Niterói, Rio de Janeiro State, Brazil

This study analyzes the specific conditions involved in dengue transmission in various areas in Itaipu, a coastal neighborhood in the city of Niterói, Rio de Janeiro State, Brazil, with a focus on socio-environmental determinants and conditioning factors. Four areas were selected with similar dengue incidence rates but different urban planning and socioeconomic patterns. The socio-spatial characteristics of each area were obtained through interviews with key informants and systematic observation. Two distinct factors were identified that may potentially condition the risk of dengue transmission. The first related to the limited water supply and scarce financial resources in a lower-income population. The second was associated with a group having better socioeconomic status, which allowed them to store water in larger tanks. The implementation of a housing infrastructure generated by real estate speculation was a determining factor for the creation of socio-spatial segregation, resulting in different forms of receptiveness and vulnerability to dengue. In this sense, the incomplete and unequal installation of housing infrastructure is a determining factor for the differentiated generation of vector breeding sites and thus for dengue transmission.

Comportamento epidemiológico da malária no Estado de Mato Grosso, 1980-2003

The temporal and spatial evolution of malaria in Mato Grosso was determined in periods from 1980-1985, 1986-1991, 1992-1997 and 1998-2003 and distributed by homogeneous microregion. The annual parasitic index of the state rose until 1992 and then diminished to 1.9 cases/1,000 inhabitants in 2003, the ratio of mortality and the lethality rate were greater in the 1980s. Of the 22 microregions, 13 presented an API inferior to 10 cases/1,000 inhabitants in all periods. Cases were concentrated in the microregions of Colíder, Alta Floresta, Aripuanã and Alto Guaporé. In 2003, only the microregion of Aripuanã continued to present an API superior to 50 cases/1,000 inhabitants. The microregions of Colíder, in 1983, 1985 to 1988 and 1990 and Alta Floresta, in 1991 presented deaths over 50/100,000 inhabitants, mainly in males aged 20-49 years. The distribution of the disease in microregions showed that malaria is predominantly found in concentrated sites.

Hospital morbidity due to paracoccidioidomycosis in Brazil (1998–2006)

To analyse hospital morbidity records due to paracoccidioidomycosis in Brazil, including its nationwide distribution in time and space, as well as key epidemiological and sociodemographic characteristics.

Uso de indicadores de nível local para análise espacial da morbidade por diarreia e sua relação com as condições de vida

Nos paises em desenvolvimento, cada crianca, apresentou em media tres episodios de diarreia por ano, no seculo XX. No Brasil, a diminuicao do numero de obitos por diarreia esteve mais associada a aplicacao de tecnicas de controle do que por transformacoes nas condicoes de vida. Este artigo tem por objetivo analisar a distribuicao espacial da morbidade por diarreia em criancas e sua associacao com condicoes de vida. Estudo ecologico, tendo como unidade de analise os bairros do municipio de Itaborai. A populacao do estudo foram as criancas < 5 anos hospitalizadas por diarreia, nos anos 2006 a 2009, disponiveis no SIH. Foram estabelecidos os indicadores Razao de Internacoes por Diarreia (RID) e Indicador Composto de condicoes de vida (ICV). As diarreias ainda representam elevada parcela das hospitalizacoes em criancas (15,5% entre 2006 e 2009). A RID foi elevada no periodo (69,7 hospitalizacoes/ 1.000 NV). A analise espacial identificou que os bairros com maiores valores de RID foram, em sua maioria, aqueles com maiores aglomeracoes populacionais e melhores condicoes de vida.The use of thalidomide was never discontinued in Brazil where it is prescribed for leprosy type 2 reaction. Babies with birth defects compatible with the thalidomide embryopathy phenotype were born after 1965, an indication that control on drug dispensing and use failed in the country. The article reports data on thalidomide dispensing and clinical uses in the Federal District in 2011/12, when new rules were put into effect, and data on drug dispensing and use obtained ten years earlier. It was found that the number of patients making use of thalidomide declined from 819 in 2001 to 369 in 2011/12. Leprosy accounted for over 70% of prescriptions in both time periods analyzed in this study. In the same time interval, however, use for lupus erythematosus decreased from 13.7 to 4.9%, while that for multiple myeloma increased from 2.9 to 20.3% of all prescriptions. Thalidomide prescription for the remaining approved indications was far less frequent, and so was the use for off label indications that accounted for <1% of prescriptions in 2001 and 2011/12. Registration of prescribing doctors, patients and dispensing units at the state department of health, apparently rendered this control more effective and reliable.

Indicadores socioambientais para vigilância da dengue em nível local

Este artigo caracteriza uma localidade quanto as condicoes de saneamento e processos de degradacao ambiental que possam estar relacionados a transmissao da dengue, alem de discutir a construcao de novos indicadores socioambientais visando a vigilância epidemiologica. A area de estudo foi a Ilha da Conceicao, no municipio de Niteroi, RJ. Informantes-chave foram entrevistados para obter informacoes que pudessem ser utilizadas nas construcoes de novos indicadores. Ao se compararem os dados do IBGE com os fornecidos pelos informantes, foram encontradas algumas diferencas. Os dados dos informantes sao mais condizentes com a realidade local, propiciando, de acordo com a area, a observacao de diferentes modus operandi de coleta de lixo e limpeza publica. Os casos concentraram-se nos setores favela plana e favela morro. Concluiu-se que os indicadores referentes a frequencia de abastecimento de agua e coleta de lixo se mostram importantes para serem analisados em estudos de nivel local associados com a incidencia da dengue.