Valdelaine Etelvina Miranda de Araújo

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.

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.

Factors associated with death from dengue in the state of Minas Gerais, Brazil: historical cohort study

To analyse the clinical and epidemiological profiles of dengue haemorrhagic fever (DHF), dengue shock syndrome (DSS) and complicated dengue cases and deaths from 2008 to 2010 that occurred in the state of Minas Gerais, south‐eastern Brazil, and to identify factors associated with death from dengue.

Microcefalia no Brasil: prevalência e caracterização dos casos a partir do Sistema de Informações sobre Nascidos Vivos (Sinasc), 2000-2015

OBJECTIVE to describe the prevalence coefficients and characterize cases of microcephaly at birth in Brazil from 2000-2015. METHODS this is a descriptive study with data from the Information System on Live Births (Sinasc). The coefficients were calculated by region and characteristics of mothers and live births (LB). RESULTS the annual average number of microcephaly cases was 164 for the period 2000-2014, whilst in 2015, 1,608 cases were registered (54.6 cases per 100 thousand LB). Higher coefficients were observed among preterm babies (81.7; 95%CI 72.3;92.2), born from black-skinned (70.9; 95%CI 58.5;85.9) or to brown-skinned (71.5; 95%CI67.4;75.8) women, to women aged ≤19 (70.3; 95%CI 63.5;77.8) or ≥40 (62.1; 95%CI 46.6;82.6), with ≤3 years of study (73.4; 95%CI 58.2;92.4) and residents in the Northeast region (138.7; 95%CI 130.9;147.0). CONCLUSION the high number of microcephaly cases in 2015 reinforces the importance of Sinasc and the need to improve the surveillance of congenital anomalies.OBJETIVO: describir coeficientes de prevalencia y caracterizar casos de microcefalia al nacer en Brasil, en el periodo 2000-2015. METODOS: estudio descriptivo con datos del Sistema de Informaciones sobre Nacidos Vivos (Sinasc). Los coeficientes fueron calculados segun regiones, caracteristicas maternas y del nacido vivo (NV). RESULTADOS: el promedio anual de casos de microcefalia fue 164 en el periodo 2000-2014, mientras en 2015 fue 1.608 (54,6 casos por 100.000 NV). Coeficientes mas elevados fueron observados entre prematuros (81,7; IC95% 72,3-92,2), nacidos de madres negras (70,9; IC95% 58,5-85,9) o pardas (71,5; IC95% 67,4-75,8), con edades ≤19 (70,3; IC95% 63,5-77,8) o ≥40 anos (62,1; IC95% 46,6-82,6), ≤3 anos de estudio (73,4; IC95% 58,2-92,4), y residentes del Noreste (138,7; IC95% 130,9-147,0). CONCLUSION: el elevado numero de casos de microcefalia, en 2015, refuerza la importancia del Sinasc y necesidad de mejorias del sistema de vigilancia de anomalias congenitas.

Avaliação das atividades de controle da leishmaniose visceral em Belo Horizonte, Minas Gerais, 2006-2011

OBJETIVO: avaliar as atividades de controle da leishmaniose visceral (LV) em Belo Horizonte-MG, Brasil. METODOS: estudo descritivo para avaliacao do Programa de Vigilância e Controle da Leishmaniose Visceral pautado em seus objetivos; utilizaram-se dados dos Sistemas de Informacao de Controle de Zoonoses e de Agravos de Notificacao. RESULTADOS: entre 2007 e 2011, verificou-se adequacao da estrategia de controle do reservatorio com aumento da cobertura de areas priorizadas (23,4%) e da populacao canina examinada (43,3%), eutanasia dos caes sororreagentes superior a 85,0% e reducao de 47,8% na soroprevalencia canina; no periodo 2008-2011, observou-se reducao na incidencia de casos humanos de 7,2 para 3,9/100 mil habitantes; nao houve ampliacao da cobertura de areas priorizadas para o controle do vetor. CONCLUSAO: os indicadores de resultados demonstraram o alcance dos objetivos do programa, com diferente adequacao entre as estrategias de controle; a complexidade da intervencao, porem, indica a necessidade de revisao das acoes propostas.

Aumento da carga de dengue no Brasil e unidades federadas, 2000 e 2015: análise do Global Burden of Disease Study 2015

RESUMO: Objetivo: Descrever as principais metricas sobre dengue geradas pelo Global Burden of Disease (GBD) Study 2015, para o Brasil e suas 27 unidades federadas, nos anos de 2000 e 2015. Metodos: As metricas descritas foram: taxas de incidencia e de mortalidade por dengue, padronizadas por idade, years of life lost (YLL), years lived with disability (YLD) e disability adjusted life years (DALY) (frequencia absoluta e taxas padronizadas por idade). As metricas estimadas foram apresentadas com intervalos de incerteza (II 95%) para 2000 e 2015, acompanhadas da variacao relativa percentual. Resultados: Verificou-se aumento de 232,7% no numero de casos e de 639,0% no numero de mortes entre os anos de 2000 e 2015 no pais. A taxa de incidencia variou 184,3% e a taxa de mortalidade mostrou-se baixa, mas com aumento de 500,0% no periodo avaliado. As taxas de YLL, YLD e DALY aumentaram 420,0, 187,2 e 266,1%, respectivamente. Em 2015, DALY foi semelhante entre mulheres e homens (21,9/100.000). O DALY aumentou mais que o dobro em todas as unidades da federacao. Conclusao: O aumento acentuado de dengue ao longo dos anos associa-se a introducao e/ou circulacao de um ou mais sorotipos do virus e crescente proporcao de pacientes acometidos pela forma grave da doenca. Apesar da baixa taxa de mortalidade, a dengue contribui para consideravel perda de anos saudaveis de vida no Brasil por acometer elevado numero de pessoas, de todas as faixas etarias, ocasionando algum grau de incapacidade durante a infeccao sintomatica, e em razao dos obitos, principalmente, em criancas.Objective: To describe the main metrics on dengue generated by Global Burden of Disease (GBD) Study 2015, for Brazil and its 27 federated units, in the years 2000 and 2015. Methods: The metrics described were: incidence and mortality rates by dengue, standardized by age, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) (in absolute frequency and age-standardized rates). The estimated metrics were presented with uncertainty intervals (UI 95%) for the years 2000 and 2015, accompanied by the relative percentages of changes. Results: The number of cases increased 232.7% and the number of deaths increased 639.0% between 2000 and 2015 in the country. The incidence rate varied 184.3% and the mortality rate was low, but with an increase of 500.0% in the period evaluated. The YLL, YLD, and DALY rates increased 420.0, 187.2, and 266.1%, respectively. In 2015, DALY was similar among women and men (21.9/100,000). The DALY increased more than double in all the Brazilian federated units. Conclusion: The marked increase in dengue over the years is associated with the introduction and/or circulation of one or more serotypes of the transmitter virus and an increasing proportion of patients affected by the severe form of the disease. Despite the low mortality rate of the disease in comparison between the years of study, the disease contributes to the loss of healthy years of life in Brazil as it affects a large number of people, from all age groups, causing some degree of disability during the infection and deaths, especially, in children.

PW 0695 Factors associated to mortality due to suicide among adults in brazil

Suicide is a complex phenomenon, influenced by several factors and, therefore, generalizations of risk factors are counterproductive. Thus, contextual analyses can point out situations of greater risk and contribute to the formulation of policies to prevent attempts and deaths due to this cause. In order to describe and analyze both the individual and context factors associated with suicide deaths among adults (twenty years old or over), in Brazil from 2010 to 2015, the model of social health determinants proposed by Dahlgren and Whitehead was adopted. Crude suicide mortality rates were calculated using data from the Mortality Information System, according to individual and context variables, and a hierarchical and multilevel approach was performed, with the crude mortality rate by suicide as the outcome variable. A total of 60 440 deaths due to suicide were recorded, with a mortality rate of 7.5 per 1 00 000 inhabitants. Hanging (4.6) was the main means used to commit suicide. Higher risks were observed among the elderly aged 70 or over (8.9), individuals with 0 to 3 years of schooling (7.7), and indigenous people (12.4). Individual factors significantly associated with suicide were: male sex (relative risk 1.34; 95% confidence interval 1.16–1.54); indigenous ethnicity/skin color (2.03; 1.90–2.16); 0 to 3 years of schooling (1.05; 1.03–1.07); agricultural/forestry/fishing workers (1.14; 1.12–1.16). Context factors were: average of less than three residents per household (1.21; 1.19–1.22); absence of Psychosocial Care Center (Caps) (1.14; 1,13–1,16); municipalities with lower urbanization rate (1.38; 1.32–1.44), lower Gini index (1.10; 1.07–1.14), small-sized population (1.86; 1.82–1.89), located in the South of the country (1.60; 1.56–1.64). Context-level characteristics may influence suicidal behaviors above and beyond individual-level effects, although it is difficult to determine how the characteristics of the context level exert such influence.