RESUMEN
OBJECTIVES: Concerns about the increasing impact of severe COVID-19 in younger individuals in Brazil came after a recent synchronised country-wide wave of cases in Brazil. This communication analyses how hospitalisations due to COVID-19 changed in the age groups 18-49 years and ≥70 years. STUDY DESIGN: Longitudinal study based on secondary data. METHODS: Data from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records (including COVID-19 notifications), were used in this study. Statistical control charts examined changes in the magnitude and variation of younger (18-49 years) and older (≥70 years) adults who were hospitalised between 15th March 2020 and 19th June 2021. RESULTS: During the few first weeks of the pandemic in Brazil, the number of COVID-19 hospitalisations increased in older adults but decreased in younger adults. Subsequently, hospitalisations reached statistical control zones in epidemiological weeks (EW) 19-48 of 2020 (EW 19-48/2020) and EW 03-05/2021 (18-49 y, mean = 26.1%; ≥70 y, mean = 32.8%). Between EW 49/2020 and EW 02/2021, the number of hospitalisations of younger adults dropped to levels below the lower control limit. In contrast, the number of hospitalisations of older adults surpassed the upper limit of the corresponding statistical control zones. However, from EW 06/2021, numbers of hospitalisations changed from statistical control zones, with hospitalisations of younger adults increasing and reaching 44.9% in EW 24/2021 and hospitalisations of older adults decreasing until EW 19/2021 (14.1%) and reaching 17.3% in EW 24/2021. CONCLUSIONS: An increasing number of COVID-19 hospitalisations were observed in younger adults from EW 06/2021. This could be a result of the successful vaccination programme in older adults, who were initially prioritised, and possibly an increased exposure to highly transmissible variants of COVID-19 in younger adults who had to go to work in the absence of social protection (i.e. government financial support). Potential consequences of COVID-19 hospitalisations in younger adults could include a reduced life expectancy of the population and an increased number of people unable to perform daily activities due to post-COVID-19 conditions.
Asunto(s)
COVID-19 , Adolescente , Adulto , Anciano , Brasil/epidemiología , Hospitalización , Humanos , Estudios Longitudinales , Persona de Mediana Edad , SARS-CoV-2 , Adulto JovenRESUMEN
BACKGROUND: The presence of virilizing signs associated with high serum androgen levels in postmenopausal women is rare. Virilizing ovarian tumors (VOTs) and ovarian stromal hyperthecosis (OH) are the most common etiologies in virilized postmenopausal women. The differential diagnosis between these two conditions is often difficult. OBJECTIVE: To evaluate the contribution of clinical features, hormonal profiles and radiological studies to the differential diagnosis of VOT and OH. DESIGN: A retrospective study. SETTING: A tertiary center. MAIN OUTCOME MEASURES: Clinical data, hormonal status (T, E2, LH and FSH), pelvic images (transvaginal sonography and MRI) and anatomopathology were reviewed. PATIENTS: Thirty-four postmenopausal women with a diagnosis of VOT (13 women) and OH (21 women) were evaluated retrospectively. RESULTS: Clinical signs of hyperandrogenism were more prevalent in the VOT group than the OH group. Although the VOT group showed higher T and E2 levels and lower gonadotropin levels than the OH group, a great overlap occurred among the hormone levels. A pelvic MRI provided an accurate differentiation of these two conditions. CONCLUSION: In this group of patients, the main features contributing to the differential diagnosis of VOT and OH were serum levels of testosterone and gonadotropins and the presence of an ovarian nodule identified on the MRI. Although the association of clinical, hormonal and radiological features contributes to the differential diagnosis of these two conditions, histopathological analysis remains the gold standard for the diagnosis of ovarian hyperandrogenism in postmenopausal women.
Asunto(s)
Estradiol/sangre , Hiperandrogenismo/etiología , Neoplasias Ováricas/diagnóstico por imagen , Ovario/diagnóstico por imagen , Lesiones Precancerosas/diagnóstico por imagen , Testosterona/sangre , Regulación hacia Arriba , Anciano , Estudios de Cohortes , Diagnóstico Diferencial , Regulación hacia Abajo , Femenino , Hormona Folículo Estimulante Humana/sangre , Estudios de Seguimiento , Humanos , Hiperandrogenismo/epidemiología , Hiperplasia/sangre , Hiperplasia/diagnóstico por imagen , Hiperplasia/patología , Hiperplasia/fisiopatología , Hormona Luteinizante/sangre , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tamaño de los Órganos , Neoplasias Ováricas/sangre , Neoplasias Ováricas/patología , Neoplasias Ováricas/fisiopatología , Ovario/patología , Posmenopausia , Lesiones Precancerosas/sangre , Lesiones Precancerosas/patología , Lesiones Precancerosas/fisiopatología , Prevalencia , Estudios Retrospectivos , Neoplasia Tecoma/sangre , Neoplasia Tecoma/diagnóstico por imagen , Neoplasia Tecoma/patología , Neoplasia Tecoma/fisiopatología , Carga Tumoral , UltrasonografíaRESUMEN
A adequada manipulação do pescado desde sua captura até seu processamento tecnológico, além da manutenção das condições higiênico-sanitárias, o que inclui a qualidade da água utilizada na cadeia, influencia na carga microbiana inicial apresentada. A fim de retardar o processo de deterioração, diminuir as perdas e os riscos iminentes à saúde coletiva, como a propagação de agentes etiológicos de doenças alimentares, são empregados diferentes métodos de conservação. Os feixes de elétrons são utilizados em vários países e levam à destruição dos microrganismos por alterações em suas estruturas, as quais ocorrem pela remoção de elétrons de seus átomos. Objetivou-se, no presente trabalho, contribuir para a avaliação da eficiência da irradiação por feixe de elétrons na qualidade microbiológica de filés de corvina (M. furnieri) refrigerados, desembarcados no município de Niterói - RJ, Brasil. Foram realizadas contagem de bactérias heterotróficas aeróbias mesófilas, de bactérias heterotróficas aeróbias psicrotróficas e enumeração de Enterococcus spp. e, posteriormente, comparadas as amostras do grupo controle com as dos grupos irradiados a doses de 0,7 e 1,0kGy. Os peixes inteiros foram adquiridos no cais de Itaipu, filetados no mercado, embalados a vácuo e mantidos a ±4°C. Embora não tenha sido encontrada diferença estatisticamente significativa entre os três grupos (P>0,05) em nenhuma das análises, concluiu-se que o processamento utilizado foi eficaz na redução do crescimento das três bactérias pesquisadas no dia zero de ambos os grupos irradiados.
The proper handling of fish from capture to technological processing, as well as maintenance of sanitary conditions and the quality of water, can influence the initial microbial load presented. In order to slow down the deterioration process, the reduction of losses and eminent risk to public health as the spread of etiological agents of foodborne illness are different methods used for storage. Electron beams are used in several countries and lead to the destruction of microorganisms by changes in their structures, which occur by removing electrons from their atoms. The objective in the present study contributes to the evaluation of electron beam irradiation efficiency in microbiological quality of chilled croaker fillets (M. furnieri), landed in Niterói - RJ, Brazil. Were performed Bacteria Count Heterotrophic aerobic mesophilic, psychrotrophic bacteria Heterotrophic Aerobic and enumeration of Enterococcus spp. and subsequently compared to the control group of samples with the groups irradiated at doses of 0.7 and 1.0kGy. Whole fish were purchased from the Itaipu pier, threaded on the market, vacuum packed and kept at ±4°C. Although there was no statistically significant difference among the three groups (P>0.05) in any of the analyzes, it was concluded that the application of this technology was effective in reducing the growth of the three bacteria surveyed on day zero of both irradiated groups.
Asunto(s)
Animales , Conservación de Alimentos/métodos , Irradiación de Alimentos , Noxas/efectos de la radiación , Peces/microbiología , Antígenos Bacterianos/efectos de la radiación , Carga Bacteriana/veterinaria , Técnicas MicrobiológicasRESUMEN
We present the MOlecular NETwork (MONET) ontology as a model to integrate data from different networks that govern cell function. To achieve this, different existing ontologies were analyzed and an integrated ontology was built in a way to make it possible to share and reuse knowledge, support interoperability between systems, and also allow the formulation of hypotheses through inferences. By studying the cell as an entity of a myriad of elements and networks of interactions, we aim to offer a means to understand the large-scale characteristics responsible for the behavior of the cell and to enable new biological insights.
Asunto(s)
Humanos , Animales , Algoritmos , Fenómenos Fisiológicos Celulares , Modelos Biológicos , Bases de Datos como Asunto , Análisis por Micromatrices/métodos , Simulación por ComputadorRESUMEN
Several endogenous phospholipase A(2) inhibitors (PLIs) have been purified from the blood plasma of a number of snake species and are classified into three classes (alpha, beta and gamma) according to their structure and specificity. In the present study we have cloned transcripts of a protein homologous to CNF, a gammaPLI present in Crotalus durissus terrificus plasma, that is encoded in the liver of Lachesis muta muta (the bushmaster snake), a species evolutionarily related to Crotalus. The cDNA sequences code for two isoforms of a 200-residue protein including a 19-residue signal peptide followed by 181 amino acid residues in the mature form and a putative N-linked carbohydrate site. The deduced primary structures and some properties of those new proteins were compared to those of CNF. Multiple alignment was performed with the aminoacid sequences of all the gammaPLIs described so far and this used in the construction of a phylogenetic tree.
Asunto(s)
ADN Complementario/genética , Fosfolipasas A/antagonistas & inhibidores , Venenos de Víboras/genética , Viperidae , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Clonación Molecular , Cartilla de ADN , Biblioteca de Genes , Datos de Secuencia Molecular , Filogenia , Isoformas de Proteínas , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Alineación de Secuencia , Homología de Secuencia de Aminoácido , Venenos de Víboras/químicaRESUMEN
OBJECTIVE: To analyze the spatial distribution of leprosy, identify areas of potential case underreporting or high transmission risk, and to assess the ecological association of leprosy distribution with multibacillary cases. METHODS: This study was carried out in 94 neighborhoods of Recife, Brazil. Data was obtained from the Ministry of Health's Disease Reporting System. An ecological approach with the empirical Bayesian method was applied for local rate flattening, using data from a neighborhood matrix. RESULTS: The mean annual occurrence was 17.3% of new cases in individuals under the age of 15 (28.3% corresponded to multibacillary forms), revealing an intense disease transmission. The spatial distribution of leprosy indicated three areas where there was a concentration of high detection rates and low-income neighborhoods. CONCLUSIONS: The Bayesian method allowed to reassess epidemiological indicators based on data from neighboring spatial units. This enabled to identify areas that should be prioritized in municipal control programs, either because of underreporting of cases or the higher number of occurrences related to multibacillary forms in individuals under 15.
Asunto(s)
Lepra/epidemiología , Características de la Residencia , Adolescente , Teorema de Bayes , Brasil/epidemiología , Niño , Preescolar , Notificación de Enfermedades , Humanos , Lactante , Recién Nacido , Lepra/prevención & control , Lepra/transmisiónRESUMEN
Violence is of major importance in the health profile of Brazilian metropolitan areas and should be treated as a public health problem. Spatial analysis methods can be highly useful for the surveillance and prevention of violence. This paper analyzes the spatial distribution of victims' place of residence in relation to the main causes of violent death in Porto Alegre (1996) in order to identify vulnerable areas. For motor vehicle accidents, homicides, and suicide, the victim's place of residence was pinpointed using the municipal Geographic Information System. The point patterns of health events and population density were analyzed using a Kernel smoother, visually compared. Some areas with higher concentration of events are similar to population distribution but differ from each other in the remaining high concentration areas, thus indicating specific micro-areas at risk. Areas of higher homicide risk are mainly located on the periphery of the more urbanized area, with worse socioeconomic conditions. Motor vehicle accidents are concentrated in areas that are simultaneously commercial and residential and are traversed by streets with heavy traffic. Suicide deaths are more evenly distributed over the territory. Identification of risk areas provides meaningful information for developing preventive and health promotion measures focusing on the events for which health policies may play a central role.
Asunto(s)
Causas de Muerte , Violencia/estadística & datos numéricos , Adulto , Anciano , Brasil/epidemiología , Causas de Muerte/tendencias , Niño , Preescolar , Análisis por Conglomerados , Femenino , Humanos , Lactante , Recién Nacido , Sistemas de Información , Masculino , Densidad de Población , Características de la ResidenciaRESUMEN
This study uses a spatial-temporal model to analyze the spatial spread of the AIDS epidemic (adult cases) in the municipality of Rio de Janeiro, Brazil, during three periods: 1988-1990, 1991-1993, and 1994-1996. City districts were used as the geographic units of analysis. A spatial analysis was also performed for pediatric AIDS cases due to vertical HIV transmission, according to period of birth, 1985-90 and 1991-96. For total adult AIDS cases, the initial period was characterized by a polygonal cluster located around the harbor area, which expanded from west to east. Among homosexual cases, in situ growth predominated, and a decrease in the intensity of the diffusion process was observed from the second to the final period. Among heterosexual cases, the epidemic displayed a relevant geographic spread, mainly from 1988-1990 to 1991-1993. Among female cases in the final time period, a cluster of high incidence rates was found towards the northwest, including very poor areas. Among pediatric cases in 1991-1996, a significant correlation was found between AIDS incidence rates and poverty levels in the respective municipal districts. The results suggest that a more complete understanding of AIDS spatial-temporal dynamics can make a major contribution to preventive measures.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Modelos Estadísticos , Agrupamiento Espacio-Temporal , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adulto , Brasil/epidemiología , Brotes de Enfermedades , Femenino , Humanos , Incidencia , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Masculino , EmbarazoRESUMEN
The environmental context in which a leptospirosis outbreak took place during the summer of 1996 in the Rio de Janeiro Western Region was examined by using spatial analysis of leptospirosis cases merged with socio-demographic data using Geographic Information System (GIS). Risk areas were mapped based on flood and solid waste accumulation information for the region. Incidence rates were calculated for each area by the division of number of cases per total population in the specific areas. Higher rates were observed for census tracts inside the flood risk area and in the vicinities of waste accumulation sites. These findings are in agreement with the expected risk of leptospirosis, evidencing the role of environmental and collective factors in the determination of the disease.
Asunto(s)
Desastres , Brotes de Enfermedades , Ambiente , Leptospirosis/epidemiología , Animales , Brasil/epidemiología , Humanos , Incidencia , Modelos Biológicos , Densidad de Población , Medición de Riesgo , Roedores , Salud UrbanaRESUMEN
This study assesses the health care provided to Kaingáng Indians in Rio Grande do Sul, Brazil. Deaths preventable by primary health care among the Indians and occurring from 1985 to 1995 were compared to the same rates for the State of Rio Grande do Sul as a whole. Secondary data on health care services were supplemented by field interviews with indigenous leaders and with employees from participating institutions. A Geographic Information System (GIS) was used to correlate distribution of deaths and access to health services. The Kaingáng settlements are connected by paved roads to counties with at least a public health clinic or even a small hospital in some cases. Secondary referrals are treated in Palmeiras das Missões and Frederico Westphallen and tertiary care is provided in Passo Fundo. What distinguishes the Indian settlements from the rest of the State are the high rates of deaths preventable by primary health care and those related to ill-defined conditions, malnutrition, tuberculosis, and cancer of the uterine cervix.
Asunto(s)
Atención a la Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Indicadores de Salud , Indígenas Sudamericanos , Calidad de la Atención de Salud/organización & administración , Brasil , Atención a la Salud/normas , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Servicios de Salud del Indígena/normas , Humanos , Ciencia de la Información , Calidad de la Atención de Salud/normasRESUMEN
OBJECTIVE: To analyze late clinical evolution after surgical treatment of children, with reparative and reconstructive techniques without annular support. METHODS: We evaluated 21 patients operated upon between 1975 and 1998. Age 4.67+/-3.44 years; 47.6% girls; mitral insufficiency 57.1% (12 cases), stenosis 28.6% (6 cases), and double lesion 14.3% (3 cases). The perfusion 43.10+/-9.50 min, and ischemia time were 29.40+/-10.50 min. The average clinical follow-up in mitral insufficiency was 41.52+/-53.61 months. In the stenosis group (4 patients) was 46.39+/-32.02 months, and in the double lesion group (3 patients), 39.41+/-37.5 months. The echocardiographic follow-up was in mitral insufficiency 37.17+/-39.51 months, stenosis 42.61+/-30.59 months, and in the double lesion 39.41+/-37.51 months. RESULTS: Operative mortality was 9.5% (2 cases). No late deaths occurred. In the group with mitral insufficiency, 10 (83.3%) patients were asymptomatic (p=0.04). The majority with mild reflux (p=0.002). In the follow-up of the stenosis group, all were in functional class I (NYHA); and the mean transvalve gradient varied between 8 and 12 mmHg, average of 10.7 mmHg. In the double lesion group, 1 patient was reoperated at 43 months. No endocarditis or thromboembolism were reported. CONCLUSION: Mitral stenosis repair has worse late results, related to the valve abnormalities and associated lesions. The correction of mitral insufficiency without annular support showed good long-term results.
Asunto(s)
Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Adolescente , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Válvula Mitral/anomalías , Insuficiencia de la Válvula Mitral/congénito , Estenosis de la Válvula Mitral/congénito , Factores de Tiempo , Resultado del TratamientoRESUMEN
Mitral valve repair may be performed without ring support with advantages related to results and complications. The objective of this study was to analyze the long-term clinical results following surgical repair and reconstruction without the use of rings in cases of congenital mitral lesions in children less than 12 years of age. Twenty-one patients who had undergone surgery during the period from 1975 to 1998 were evaluated. The mean age was 4.6 +/- 3.4 years. Females represented 47.6% of the total. Mitral regurgitation was present in 57.1% (12 patients), stenosis in 28.6% (6 patients), and the mixed lesion group represented 14.3% (3 patients). Perfusion time was 43.1 +/- 9.5 minutes and ischemic time 29.4 +/- 10.5 minutes. Follow-up time was 41.5 +/- 53.6 months for the regurgitation group, 46.3 +/- 32.0 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Echocardiographical follow-up time was 37.17 +/- 39.51 months for the regurgitation group, 42.61 +/- 30.59 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Operative mortality was 9.5% (two cases). There were no late deaths. In the regurgitation group, 10 patients (83.3%) were asymptomatic (p = 0.004). In the echocardiographical follow-up, most of the patients had minimal regurgitation. In the clinical follow-up of the stenosis group all patients were in functional class I (NYHA). The mean transvalvular gradient measured by echocardiography was from 8 to 12 mmHg with a mean gradient of 10.7 mmHg. In the mixed lesion group there was one reoperation at postoperative month 43. There were no cases of endocarditis or thromboembolism. Mitral valve repair in congenital lesions is associated with good late results. The majority of cases in the regurgitation group remain asymptomatic and do not require reoperation. Rings or annular support are not necessary in such cases. Satisfactory repair is more difficult to achieve in cases of mitral stenosis due to valvular abnormalities and the seriousness of the associated lesions.
Asunto(s)
Insuficiencia de la Válvula Mitral/congénito , Estenosis de la Válvula Mitral/congénito , Válvula Mitral/anomalías , Niño , Preescolar , Ecocardiografía , Femenino , Humanos , Lactante , Masculino , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/mortalidad , Estenosis de la Válvula Mitral/cirugía , Factores de TiempoRESUMEN
The infant mortality rate has been considered a summary of the quality of life and level of development of a given population. However, this indicator is very sensitive to such simple measures as oral rehydration therapy, vaccination, and continuation of breast-feeding. Given that such health activities have become more widespread, an infant mortality rate may no longer reflect a particular development model. With the aim of broadening the discussion regarding infant mortality, this study analyzed the 153 neighborhoods of the city of Rio de Janeiro, Brazil. Our objective was to identify areas with more risk, and the priority groups for interventions to decrease infant mortality. We analyzed neonatal and postneonatal mortality in each neighborhood. We also identified the children's home neighborhood and the location of their deaths and related these results to the socioeconomic classification of the corresponding neighborhoods. In relation to the average infant mortality rate for the city, we could not make statistically significant comparisons for some neighborhoods due to their small number of births. One-third of the infant deaths could have been prevented with early diagnosis and treatment. Only 15% of the deaths were considered unavoidable. Both neonatal mortality and postneonatal mortality were geographically dispersed, with no direct association with the socioeconomic profile of the neighborhoods. An analysis of the children's place of residence and the location of their deaths showed flows of patients from poor areas to more affluent city areas with better health services. This pattern highlights the effect of access to quality medical care on infant mortality.
Asunto(s)
Accesibilidad a los Servicios de Salud , Mortalidad Infantil/tendencias , Brasil , Humanos , Lactante , Recién Nacido , Características de la Residencia , Factores de Riesgo , Factores SocioeconómicosRESUMEN
Extracellular recording techniques were used to study the effects of the nitric oxide releasing agents diethylamine-NO (DEA-NO) and S-nitroso-N-acetyl-penicillamine (SNAP) on synaptic transmission in the intermediate and medial part of the hyperstriatum ventrale (IMHV), a part of the domestic chick forebrain that is essential for some forms of early learning. The field response evoked by local electrical stimulation was recorded in the IMHV in an in vitro slice preparation. DEA-NO (100-200 mgr) significantly depressed the field response in a concentration dependent and reversible manner. However, the depression produced by perfusion with 400 mgr DEA-NO, was not reversed following washout of the drug. With 400 mgr DEA-NO, NO reaches a maximum concentration of 10 mgr at 2 min of perfusion, and then declines slowly. SNAP (400 mgr) produced an effect similar to 400 mgr DEA-NO. Neither the immediate nor the longer-term depressive effect of NO is mediated by activation of guanylyl cyclase because in the presence of both low and high doses of ODQ, a potent and selective inhibitor of NO-stimulated guanylyl cyclase, NO produced the same depression of the field response. There is evidence however that the IMHV possesses c-GMP responsive elements since direct perfusion of 8-Br-cGMP (1 mM) produced a long-term but not an immediate depression. The long-term depression produced by 400 mgr DEA-NO was eliminated in the presence of either a selective adenosine A(1) receptor antagonist or an ADP-ribosyltransferase inhibitor. It was also possible to prevent the long-term effect in the presence of tetraethyl ammonium a K(+)-channel blocker. These results suggest that the NO may be acting presynaptically in a synergistic fashion with the adenosine A(1) receptor to depress transmitter release.
Asunto(s)
Condicionamiento Psicológico/fisiología , Memoria/fisiología , Óxido Nítrico/metabolismo , Prosencéfalo/crecimiento & desarrollo , Prosencéfalo/metabolismo , Animales , Pollos , GMP Cíclico/análogos & derivados , GMP Cíclico/farmacología , Potenciales Evocados/fisiología , Guanilato Ciclasa/metabolismo , Hidrazinas/farmacología , Plasticidad Neuronal/fisiología , Neuronas/efectos de los fármacos , Neuronas/enzimología , Donantes de Óxido Nítrico/farmacología , Óxidos de Nitrógeno , Penicilamina/análogos & derivados , Penicilamina/farmacología , Poli(ADP-Ribosa) Polimerasas/metabolismo , Canales de Potasio/fisiología , Receptores Adrenérgicos alfa 1/fisiología , Sinapsis/fisiología , Transmisión Sináptica/efectos de los fármacos , Transmisión Sináptica/fisiología , Tetraetilamonio/farmacología , Xantinas/farmacologíaRESUMEN
STUDY OBJECTIVES: To establish the geographical relation of health conditions to socioeconomic status in the city of Rio de Janeiro, Brazil. DESIGN: All reported deaths in the municipality of Rio de Janeiro, from 1987 to 1995, obtained from the Mortality Information System, were considered in the study. The 24 "administrative regions" that compose the city were used as the geographical units. A geographical information system (GIS) was used to link mortality data and population census data, and allowed the authors to establish the geographical pattern of the health indicators considered in this study: "infant mortality rate"; "standardised mortality rate"; "life expectancy" and "homicide rate". Information on location of low income communities (slums) was also provided by the GIS. A varimax rotation principal component analysis combined information on socioeconomic conditions and provided a two dimension basis to assess contextual variation. MAIN RESULTS: The 24 administrative regions were aggregated into three different clusters, identified as relevant to reflect the socioeconomic variation. Almost all health indicator thematic maps showed the same socioeconomic stratification pattern. The worst health situation was found in the cluster composed of the harbour area and northern vicinity, precisely in the sector where the highest concentration of slum residents are present. This sector of the city exhibited an extremely high homicide rate and a seven year lower life expectancy than the remainder of the city. The sector that concentrates affluence, composed of the geographical units located along the coast, showed the best health situation. Intermediate health conditions were found in the west area, which also has poor living standards but low concentration of slums. CONCLUSIONS: The findings suggest that social and organisation characteristics of low income communities may have a relevant role in understanding health variations. Local health and other social programmes specifically targeting these communities are recommended.
Asunto(s)
Indicadores de Salud , Mortalidad , Áreas de Pobreza , Clase Social , Adolescente , Adulto , Anciano , Brasil/epidemiología , Censos , Niño , Preescolar , Interpretación Estadística de Datos , Homicidio/estadística & datos numéricos , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Esperanza de Vida , Persona de Mediana Edad , Programas InformáticosRESUMEN
The paper summarizes recent findings on the epidemiology and pathogenesis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/Aids), highlighting the role of co-infections with major tropical diseases. Such co-infections have been studied in the Brazilian context since the beginning of the Aids epidemic and are expected to be more frequent and relevant as the Aids epidemic in Brazil proceeds towards smaller municipalities and the countryside, where tropical diseases are endemic. Unlike opportunistic diseases that affect basically the immunocompromised host, most tropical diseases, as well as tuberculosis, are pathogenic on their own, and can affect subjects with mild or no immunosuppression. In the era of highly active anti-retroviral therapies (HAART), opportunistic diseases seem to be on decrease in Brazil, where such medicines are fully available. Benefiting from HAART in terms of restoration of the immune function, putative milder clinical courses are expected in the future for most co-infections, including tropical diseases. On the other hand, from an ecological perspective, the progressive geographic diffusion of Aids makes tropical diseases and tuberculosis a renewed challenge for Brazilian researchers and practitioners dealing with HIV/Aids in the coming years.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Enfermedades Parasitarias/epidemiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/parasitología , Animales , Brasil/epidemiología , Enfermedad de Chagas/complicaciones , Enfermedad de Chagas/epidemiología , Enfermedades Endémicas , Humanos , Leishmaniasis/complicaciones , Leishmaniasis/epidemiología , Malaria/complicaciones , Malaria/epidemiología , Enfermedades Parasitarias/complicacionesRESUMEN
The environmental and social context in which a leptospirosis outbreak took place during the summer of 1996 in the Rio de Janeiro Western Region was examined by using spatial analysis of leptospirosis cases merged with population and environmental data in a Geographical Information System (GIS). Important differences were observed between places where residences of leptospirosis cases are concentrated and other places in the region. Water supply coverage, solid waste collection, sewerage system coverage and flood risk area were the main determining variables from an initial list of ten. The influence of these unfavorable social and environmental factors is verified hundreds of meters distant from the leptospirosis case residences, demonstrating a necessity to broaden the area of health surveillance practices. The geocoding indicated that some cases did not report contact with flood water, even though they were geographically adjacent to cases who did report this contact. Cases may only report exposures they believe are related to the disease. Geocoding is a useful tool for evaluating such bias in the exposure recall.
Asunto(s)
Brotes de Enfermedades , Leptospirosis/epidemiología , Análisis de Varianza , Animales , Brasil/epidemiología , Desastres , Ambiente , Geografía , Humanos , Sistemas de Información , Densidad de Población , Medición de Riesgo , Roedores , Saneamiento , Salud Urbana , Microbiología del Agua , Abastecimiento de AguaRESUMEN
AIMS: To describe AIDS and malaria geography in Brazil, highlighting the role of injecting drug users (IDUs) in malaria outbreaks occurring in malaria-free regions, and the potential clinical and public health implications of malaria/HIV co-infection. DESIGN: Review of the available literature and original analyses using geoprocessing and spatial analysis techniques. FINDINGS: Both HIV/AIDS and malaria distribution are currently undergoing profound changes in Brazil, with mutual expansion to intersecting geographical regions and social networks. Very recent reports describe the first clinical case of AIDS in a remote Amazonian ethnic group, as well as malaria cases in Rio de Janeiro state (hitherto a malaria-free area for 20 years); in addition, two outbreaks of both infections occurred at the beginning of the 1990s in the most industrialized Brazilian state (São Paulo), due to the sharing of needles and syringes by drug users. Spatial data point to: (a) the expansion of HIV/AIDS towards malarigenic areas located in the centre-west and north of Brazil, along the main cocaine trafficking routes, with IDU networks apparently playing a core role; and (b) the possibility of new outbreaks of secondary malaria in urban settings where HIV/AIDS is still expanding, through the sharing of needles and syringes. CONCLUSIONS: New outbreaks of cases of HIV and malaria are likely to occur among Brazilian IDUs, and might conceivably contribute to the development of treatment-resistant strains of malaria in this population. Health professionals should be alert to this possibility, which could also eventually occur in IDU networks in developed countries.