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Background: Increased pediatric COVID-19 occurrence due to the SARS-CoV-2 Omicron variant has raised concerns about the effectiveness of existing vaccines. The protection provided by the SOBERANA-02-Plus vaccination scheme against this variant has not yet been studied. We aimed to evaluate the scheme's effectiveness against symptomatic Omicron infection and severe disease in children. Methods: In September 2021, Cuba implemented a mass pediatric immunization with the heterologous SOBERANA-02-Plus scheme: 2 doses of conjugated SOBERANA-02 followed by a heterologous SOBERANA-Plus dose. By December, before the Omicron outbreak, 95.4% of 2-18 years-old had been fully immunized. During the entire Omicron wave, we conducted a nationwide longitudinal post-vaccination case-population study to evaluate the real-world effectiveness of the SOBERANA-02-Plus scheme against symptomatic infection and severe disease in children without previous SARS-CoV-2 infection. The identification of COVID-19 cases relied on surveillance through first line services, which refer clinical suspects to pediatric hospitals where they are diagnosed based on a positive RT-PCR test. We defined the Incidence Rate ratio (IRR) as IRvaccinated age group/IRunvaccinated 1-year-old and calculated vaccine effectiveness as VE = (1-IRR)∗100%. 24 months of age being the 'eligible for vaccination' cut-off, we used a regression discontinuity approach to estimate effectiveness by contrasting incidence in all unvaccinated 1-year-old versus vaccinated 2-years-old. Estimates in the vaccinated 3-11 years-old are reported from a descriptive perspective. Findings: We included 1,098,817 fully vaccinated 2-11 years-old and 98,342 not vaccinated 1-year-old children. During the 24-week Omicron wave, there were 7003/26,241,176 person-weeks symptomatic COVID-19 infections in the vaccinated group (38.2 per 105 person-weeks in 2-years-old and 25.5 per 105 person-weeks in 3-11 years-old) against 3577/2,312,273 (154.7 per 105 person-weeks) in the unvaccinated group. The observed overall vaccine effectiveness against symptomatic infection was 75.3% (95% CI, 73.5-77.0%) in 2-years-old children, and 83.5% (95% CI, 82.8-84.2%) in 3-11 years-old. It was somewhat lower during Omicron BA.1 then during Omicron BA.2 variant circulation, which took place 1-3 and 4-6 months after the end of the vaccination campaign. The effectiveness against severe symptomatic disease was 100.0% (95% CI not estimated) and 94.6% (95% CI, 82.0-98.6%) in the respective age groups. No child death from COVID-19 was observed. Interpretation: Immunization of 2-11 years-old with the SOBERANA-02-Plus scheme provided strong protection against symptomatic and severe disease caused by the Omicron variant, which was sustained during the six months post-vaccination follow-up. Our results contrast with the observations in previous real-world vaccine effectiveness studies in children, which might be explained by the type of immunity a conjugated protein-based vaccine induces and the vaccination strategy used. Funding: National Fund for Science and Technology (FONCI-CITMA-Cuba).
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Familia y escuela son instituciones primarias de la sociedad que convergen en la construcción de las bases del carácter y las pautas de comportamiento; por ello, se espera que en estas inicien los acompañamientos al desarrollo afectivo-sexual, mediante el reconocimiento del derecho a la libertad y la autonomía de los niños, niñas y adolescentes. Este artículo tuvo como objetivo analizar la transformación de las perspectivas sobre el acompañamiento afectivo-sexual de la familia y la escuela. Se llevó a cabo una revisión documental de textos académicos que tratan a la familia y la escuela como escenarios de formación afectivo-sexual. Se encontró que las perspectivas del acompañamiento afectivo-sexual son muy diversas, en ocasiones se abordan con fines informativos y, otras, como un elemento importante para la formación de seres sociales. Se concluyó que familia y escuela son aptas para ofrecer acompañamiento afectivo-sexual, por lo cual es importante que su labor sea colaborativa y en pro de la libertad y autonomía de los niños, niñas y adolescentes.
Family and school are the primary institutions of society, which converge in the construction of the foundations of character and behavior patterns; For this reason, it is there that support for affective-sexual development is expected to begin, by recognizing the right to freedom and autonomy of children and adolescents. This article aimed to analyze how the perspectives on the affective-sexual accompaniment of the family and the school have been transformed. A documentary review of academic texts that treat the family and the school as scenarios of affective-sexual formation was carried out. It was found that the perspectives of affective-sexual accompaniment are very diverse, sometimes it is addressed for informational purposes and, others, as an important element for the formation of social beings. It was concluded that family and school are suitable to offer affective-sexual accompaniment, for which it is important that their work is collaborative and in favor of the freedom and autonomy of children and adolescents.
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Humanos , Criança , Adolescente , Desenvolvimento Sexual , Desenvolvimento Infantil , Desenvolvimento do AdolescenteRESUMO
BACKGROUND: Theobroma cacao is a major source of flavonoids such as catechins and their monomers proanthocyanidins (PAs), widely studied for their potential benefits in cardiovascular diseases. Light has been shown to promote plant secondary metabolite production in vitro. In this study, cacao cells cultured in 7.5 L stirred tank photobioreactors (STPs) were exposed to a change of white to blue LED lights for 28 days (d). RESULTS: Transcriptomic analyses were performed in three time points comparing changing expression patterns, after cell exposure to white light (d0-VS-d14), after a shift from white to blue light (d14-VS-d15), and after an extended period of blue light for the following 15 days (d15-VS-d28). Under white light, there was enrichment in metabolic pathways associated with cell growth (carbon, glycolysis, and amino acid biosynthesis) accompanied by a significant increase in the PAs content. In the shift to blue light, further increase in PAs content was observed concomitantly with the significant expression of TWO-COMPONENT RESPONSE REGULATOR genes involved in the early stress responses via circadian clock and hormone pathways. Under blue light exposure, we observed a depletion of PAs content associated with ROS-mediated stress pathways. CONCLUSIONS: Light effects on large-scale cell cultures in photobioreactors are complex and pleiotropic; however, we have been able to identify key regulatory players upstream cacao flavonoid biosynthesis in STPs, including TWO-COMPONENT SYSTEM and ROS-signaling genes. The crosstalk between flavonoid biosynthesis and regulatory networks led to understand the dynamics of flavonoid production and degradation in response to light-driven ROS signals. This can be used to optimize the time, and the yield of in vitro targeted metabolites in large-scale culture systems.
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Cacau , Cacau/genética , Flavonoides , Regulação da Expressão Gênica de Plantas , Fotobiorreatores , TranscriptomaRESUMO
RESUMEN Introducción: Durante enfermedades infecciosas emergentes en curso como la COVID-19, la vigilancia espacio-temporal es fundamental para identificar áreas prioritarias para intervenciones específicas, diferenciar intensidad diagnóstica y asignación de recursos. Objetivo: Modelar la evolución del riesgo relativo de presentación de casos de COVID-19 e identificar conglomerados en municipios donde la enfermedad se mantuvo en el periodo posterior al descenso de la curva epidémica en Cuba. Métodos: El periodo mencionado comprendió entre el 26/05/2020 hasta el 4/09/2020. Se realizaron corridas cíclicas del modelo prospectivo espacio-temporal de Poisson, con incrementos progresivos de 14 días, mediante la aplicación SaTScan™ 9.6. Resultados: Se identificaron 15 conglomerados significativos (p ≤ 0,0001) cuya extensión involucró desde uno hasta trece municipios, con distribución en seis provincias (Pinar del Río, Artemisa, La Habana, Mayabeque, Matanzas, Villa Clara y Ciego de Ávila). En los conglomerados todos los municipios mostraron riesgo relativo alto, entre ellos, La Palma en la provincia de Pinar del Río y Ciego de Ávila en la provincia del mismo nombre, con los valores más altos, 119,95 y 121,04, respectivamente. Conclusión: El modelo empleado pudo identificar los conglomerados en territorios con significativa probabilidad de ocurrencia de COVID-19, así como periodos de evolución del riesgo relativo. Además, reconoce los municipios que merecen prioridad para intensificar en ellos intervenciones de contención y control sanitario y evitar la reemergencia de la enfermedad con mayor dispersión espacial.
ABSTRACT Introduction: During the occurrence of ongoing emerging infectious diseases such as COVID-19, spatiotemporal surveillance is crucial to identify priority areas for specific interventions, differentiate diagnostic intensity and assign resources. Objective: To model the evolution of the relative risk of presentation of COVID-19 cases and to identify clusters in municipalities where the disease remains at the stage following the descent of the epidemic curve in Cuba. Methods: The period mentioned was from 26/05/2020 to 4/09/2020. Cyclic runs of Poisson's prospective spatiotemporal model were performed, with progressive 14-day increases, using the software SaTScan™ 9.6. Results: A total 15 significant clusters were identified (p ≤ 0.0001) extending over one to thirteen municipalities and distributed in six provinces (Pinar del Río, Artemisa, Havana, Mayabeque, Matanzas, Villa Clara and Ciego de Ávila). In the clusters, all municipalities showed a high relative risk among them, La Palma in Pinar del Rio province and Ciego de Avila in the province of the same name, with the highest values, 119.95 and 121.04, respectively. Conclusion: The model was able to identify territories with a significant likelihood of COVID-19 occurrence, as well as periods in the evolution of relative risk. It also showed that surveillance and early warning strategies may facilitate prioritization of health control and containment interventions aimed at preventing the reemergence of the disease with greater spatial coverage.
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Catechins, including catechin (C) and epicatechin (E), are the main type of flavonoids in cacao seeds. They play important roles in plant defense and have been associated with human health benefits. Although flavonoid biosynthesis has been extensively studied using in vitro and in vivo models, the regulatory mechanisms controlling their accumulation under light/dark conditions remain poorly understood. To identify differences in flavonoid biosynthesis (particularly catechins) under different light treatments, we used cacao cell suspensions exposed to white-blue light and darkness during 14 days. RNA-Seq was applied to evaluate differential gene expression. Our results indicate that light can effectively regulate flavonoid profiles, inducing a faster accumulation of phenolic compounds and shifting E/C ratios, in particular as a response to switching from white to blue light. The results demonstrated that HY5, MYB12, ANR and LAR were differentially regulated under light/dark conditions and could be targeted by overexpression aiming to improve catechin synthesis in cell cultures. In conclusion, our RNA-Seq analysis of cacao cells cultured under different light conditions provides a platform to dissect key aspects into the genetic regulatory network of flavonoids. These light-responsive candidate genes can be used further to modulate the flavonoid production in in vitro systems with value-added characteristics.
Assuntos
Cacau/genética , Catequina/biossíntese , Flavonoides/biossíntese , Regulação da Expressão Gênica de Plantas , Proteínas de Plantas/genética , Sementes/genética , Fatores de Transcrição/genética , Cacau/citologia , Cacau/metabolismo , Cacau/efeitos da radiação , Catequina/genética , Flavonoides/genética , Redes Reguladoras de Genes , Luz , Fotoperíodo , Células Vegetais/metabolismo , Células Vegetais/efeitos da radiação , Proteínas de Plantas/classificação , Proteínas de Plantas/metabolismo , Sementes/citologia , Sementes/metabolismo , Sementes/efeitos da radiação , Análise de Sequência de RNA , Fatores de Transcrição/classificação , Fatores de Transcrição/metabolismo , TranscriptomaRESUMO
Cocoa butter (CB) is produced in the seeds of Theobroma cacao representing 50% of its dry weight. The lipid composition plays an important role in the physicochemical, rheological, and sensory properties of the CB, making this fat a valuable resource for the production of chocolates, cosmetics, and pharmaceuticals. In this paper, are described experimental strategies used for a rational improvement of biomass production and fatty acids in cacao cell suspension cultures. First, the lipid profile in four cacao varieties is characterized, and then, one variety is selected to induce cell suspensions using a direct method without previous establishment of a callus phase. To improve growth and total fat production in cell suspension cultures, modified DKW media and newly designed media culture, based on the mineral concentrations of cacao seeds (cacao biomass production, "CBP"), are analyzed and compared. In addition, the effect of acetate in the lipid profile of cell suspensions is evaluated. Ultrastructural histological analysis of lipid vesicles in cacao seeds and cell suspensions is also performed. The results will show that it is feasible to establish cacao suspensions without the calli step and increase the biomass production by selecting a suitable cacao variety and tissue and also applying a new culture media formulation. In addition, it is possible to synthesize fatty acids in cell cultures and modify the lipid profile adding a precursor of the novo biosynthesis of fatty acids such as the acetate. Transmission electronic microscopy examinations and differential interference contrast microscopy analysis will demonstrate that lipid vesicles are the main reserve substance in both cacao seeds and cell suspensions.
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Biomassa , Cacau , Lipídeos de Membrana/metabolismo , Células Vegetais/metabolismo , Cacau/citologia , Cacau/metabolismo , Técnicas de Cultura de CélulasRESUMO
Evaluar la motilidad y morfología espermática en los estudiantes de la Universidad de Oriente. Se realizó el espermatograma a 100 estudiantes de la Universidad de Oriente, Núcleo de Sucre, Cumaná, Venezuela, y se aplicó a los datos un análisis de regresión lineal simple con un nivel de confianza del 95 por ciento. El 12 por ciento de los estudiantes fueron astenospérmicos, 11 por ciento oligospérmicos y 9 por ciento oligoastenospérmicos. Los astenospérmicos, tuvieron una correlación negativa moderada entre motilidad y anormalidades de la pieza principal (r=-0,58), estadísticamente significativa. En los oligoastenospérmicos hubo una correlación lineal negativa moderada (r=-0,57) entre motilidad y anormalidades de cabeza, estadísticamente no significativa. Se sugiere que la causa probable de alteración de la motilidad progresiva, es por defectos de la cola y exceso de citoplasma residual en espermatozoides de estudiantes astenospérmicos, y anormalidades de cabeza en espermatozoides de oligoastenospérmicos.
To evaluate motility and sperm morphology in students of the Universidad de Oriente. We performed semen analysis to 100 students from the Universidad de Oriente, Nuclei Sucre, Cumana, Venezuela, according to WHO criteria, 1999, and applied to the data a simple linear regression analysis with a confidence level of 95 percent. Diagnosis was 12 percent asthenozoospermic, 11 percent oligozoospermic and 9 percent oligoasthenozoospermic. The asthenozoospermic, had a moderate negative linear correlation between motility and principal piece abnormalities (r =- 0.58) statistically significant. In oligoasthenozoospermic there was a moderate negative correlation (r =-0.57) between motility and abnormalities of the head, not statistically significant. We suggest that the probable cause of altered motility is principal tail defects and excess residual cytoplasm in sperm asthenozoospermic students, and abnormalities in sperm head oligoasthenozoospermic.
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Humanos , Masculino , Astenozoospermia , Astenozoospermia/mortalidade , Motilidade dos Espermatozoides , OligospermiaRESUMO
Partiendo de una caracterización general de los procesos impulsados desde mediados de la década del 90 del pasado siglo, encaminados a la recuperación del sector de la salud, y centrados en mejorar la calidad de los servicios, la eficiencia, la efectividad, y mantener la equidad, se describe la evolución de indicadores fundamentales de servicios, de recursos humanos y de infraestructuras en salud. Tomando como substrato los anteriores resultados, se exponen los objetivos y contenidos esenciales de las actuales transformaciones del Sistema Nacional de Salud basado en procesos de reorganización, concentración y regionalización de los servicios, para discutir implicaciones de las reestructuraciones en la distribución territorial, con énfasis en las tensiones entre racionalidad y equidad de acceso real o percibido.
The general characterization of the processes that have been prompted since the mid 90's, aimed at the health sector recovery and at the improvement of the quality of service, the efficiency and the effectiveness of the system, and at keeping equity, was taken as basis for the description of the evolution of fundamental indicators of service, human resource and health infrastructure in this article. The essential objectives and contents of the present changes in the national health care system aided by reorganization, concentration and regionalization of services were explained in order to discuss the implications of restructuring in the territorial distribution, emphasizing controversies between rationality and real or perceived access equity.
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Efetividade , Eficiência , Gestão da Qualidade Total , Serviços de SaúdeRESUMO
En las ultimas dos décadas se ha avanzado en la documentación de la distribución de los problemas sociales y de salud de la población en la región, en el marco de la intensificación de las desigualdades e iniquidades, de los procesos de descentralización, y la progresiva introducción de métodos y técnicas para el procesamiento y análisis de datos. Las siguientes reflexiones tienen como objetivo discutir los limitados avances en la inclusión de información de contextos de vida en los análisis territoriales de la salud de la población, y sus posibles efectos en la comparación entre unidades del mismo nivel. Se caracterizaron las condiciones ventajosas en que ha evolucionado la información en salud, y la permanencia de problemas tales como la carencia o falta de integración de información, y el riesgo de que la producción de datos y las técnicas de análisis, evolucionen más rápido que las reformulaciones teóricas o metodológicas necesarias y posibles. Se plantearon algunos presupuestos asociados a la heterogeneidad de las divisiones territoriales y de la distribución de la población en el caso concreto de Cuba, se propuso la revisión, precisión o creación de nuevos indicadores, en especial aquellos que den cuenta de los cambios más recientes ocurridos en el país, de forma que las clasificaciones de territorios por condiciones de vida, o por tipos de poblamiento se actualicen, así como la construcción de unidades territoriales alternativas o complementarias de contextos más homogéneos, que permitan mejorar los análisis de la producción social de problemas de salud.
For the last two decades, advances have been made in the documentation of social and health problems of the population in the region within the framework of increased inequalities and inequities, more decentralizing processes and progressive introduction of data processing and analysis methods and techniques. The following reflections were aimed at discussing the few advances made in the inclusion of life environment information in the population health analyses per territory, and its possible effects on the comparison among units placed at the same level. The favorable conditions in which health information had developed and the persistence of some problems such as lack of integrated data, and likely evolution of data production and analysis techniques at a pace faster than that of necessary theoretical and/or methodological reformulations were described. Some assumptions related to heterogeneity of territorial divisions and of population distribution in Cuba were stated. The review or clarification of existing indicators, or the creation of new ones particularly those accounting for the most recent domestic changes were suggested, with a view to updating the classification of territories by their living conditions or by type of population. Also, the proposal of building alternative or supplementary territorial units characterized by more homogeneous contexts was made in order to improve the analysis of social production of health problems.
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Los servicios farmacéuticos comunitarios han sido poco estudiados en Cuba. El objetivo de este trabajo es caracterizar estos servicios en la provincia Ciudad de la Habana. Fueron calculados el número de habitantes por farmacia, farmacias por habitantes, farmacia por 10 000 habitantes, habitantes por licenciado en farmacia, licenciado por 10 000 habitantes, licenciado por farmacia y farmacia por consultorios. Los resultados obtenidos permitieron identificar que los territorios de La Habana Vieja, Habana del Este, Centro Habana y Boyeros, tenían una situación desfavorable en el indicador número de habitantes por farmacia, mientras que en el municipio Cotorro, era mucho más favorable. Se apreció, además, la falta de relación entre la diferenciación territorial de la prevalencia de algunas enfermedades crónicas y la distribución de los servicios. Los resultados, mostraron, en general, una elevada heterogeneidad intermunicipal de los servicios farmacéuticos comunitarios, que se amplía en las áreas de salud. Se presentan algunas propuestas para el incremento de la eficiencia y efectividad de estos servicios.
The community-based pharmaceutical services have not been thoroughly studied in Cuba. The objective of this paper is to characterize these services in the City of Havana province using the estimation of the number of inhabitants per drugstore, of drugstores per inhabitant, of drugstores per 10 000 pop., of inhabitants per Bachelor of Pharmacy, of Bachelors per 10 000 pop., of Bacherlors per drugstore and of drugstores per doctor's offices. The results made it possible to identify Old Havana, Eastern Havana, Centro Habana and Boyeros municipalities as the territories that faced the most unfavorable situation in terms of number of inhabitants per drugstore whereas the situation of Cotorro municipality was much more favorable. Territorial differentiation in the prevalence of some chronic diseases and the distribution of services were unrelated. Generally, the results showed great inter-municipal heterogeneity of community-based pharmaceutical services, being more extensive in the health areas. Some proposals for increasing efficiency and effectiveness of these services were put forward.
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No Brasil, a hanseníase é um problema de Saúde Pública e seu plano de eliminação está entre as ações de relevância nacional. A redução da prevalência da doença a partir de 1991 não coincide com a diminuição da detecção de casos novos. Existe um reconhecimento internacional sobre o comportamento focal da hanseníase, ou seja, sua distribuição restrita a espaços onde coincide com um conjunto de premissas para sua produção. No Brasil, a espacialidade da doença tem sido estudada de forma pontual em alguns Estados e Municípios, sem sistematização. O Sistema de Informação de Agravos de Notificação (Sinan), recentemente implementado pelo Ministério da Saúde, permite explorações detalhadas da doença. Este trabalho foi dedicado ao estudo da hanseníase no Brasil a partir de um esboço de sua distribuição macroregional e estadual centrado na atenção a sua distribuição municipal, no período de 1998 a 2002. Conformou-se um sistema de informação geográfica que possibilita a análise da diferenciação espacial das taxas de detecção geral em menores de 15 anos de idade e por formas clínicas, indicadores considerados fundamentais na análise da evolução da endemia, assim como a identificação dos espaços críticos de produção da doença. Os resultados sugerem a expansão da hanseníase em focos localizados nas Regiões Norte, Centro-Oeste e Nordeste, associados às frentes de colonização agrícola da Amazônia Legal e ao crescimento de determinadas cidades e Regiões Metropolitanas...
Hansen disease is a public health problem in Brazil and its plan of elimination is a relevant national action. The prevalence reduction since 1991 is not accompanied by decreased detection of new cases. According to an internationalacknowledgement about focal behavior of Hansen disease, its restricted distribution of space, which coincides with whole social premises for its production in Brazil. The spatiality of leprosy has been studied punctually, in some states and municipal districts, without systemization. The Notifying Diseases Information System (Sinan), recently implemented by the Ministry of Health, allows detailed explorations of the disease. This essay studies the geography of the Hansen disease in Brazil, starting from a summary of states and macro-regional distribution, focused in municipal distribution, in the period of 1998 to 2002. A geographical system of information was conformed to make possible the analysis of the spatial difference of the coefficients of general detection and in people under 15 years old, and by clinical form, fundamental indicators in the examination of the endemic evolution, as well as the identification of the critical spaces of production of the disease. The results suggest the expansion of the local focus of hansen disease in the North, Middle-West and North-East Regions, associated with the agricultural colonization in Legal Amazon and the development of some cities and metropolitan areas
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Humanos , Masculino , Feminino , Hanseníase/epidemiologiaRESUMO
Con el objetivo de establecer las bases para la implementación futura de un Programa de Atención Farmacéutica, se realizó un diagnóstico de algunas características de los servicios farmacéuticos comunitarios de las provincias occidentales cubanas y el municipio especial Isla de la Juventud , a partir de la información obtenida en la Supervisión Nacional realizada a 791 farmacias comunitarias del territorio, durante los meses de febrero a diciembre del año 2004. Se identificaron y calcularon indicadores relacionados con la población, cantidad de farmacias, su clasificación y presencia del profesional farmacéutico; se encontró que en esta región de Cuba, existe una distribución heterogénea de las farmacias comunitarias, no relacionada con la población, así como una baja proporción de licenciados por farmacia, independientemente de que están presentes, en todas las provincias, los 4 tipos de farmacia establecidos en el país. Se profundizó en el análisis de la capital, Ciudad de La Habana; se concluyó que sus características son similares a las encontradas para toda la región occidental
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Serviços Comunitários de Farmácia , Assistência Farmacêutica , Indicadores de Qualidade em Assistência à Saúde , CubaRESUMO
Se identificaron y calcularon indicadores relacionados con la población, cantidad de farmacias, clasificación, existencia de Formulario Nacional de Medicamentos y Manual de Procedimientos de 1 044 farmacias comunitarias, ubicadas en las provincias centrales y 4 provincias de la región Oriental de Cuba, con el objetivo de conocer si existen las condiciones adecuadas que permitan el ejercicio de la atención farmacéutica en este territorio. Para ello se calculó el índice de farmacias por 10 000 habitantes, y habitantes por farmacia. Se procesó la información obtenida a partir de un modelo de recogida de datos, utilizado en la Supervisión Nacional , realizada a las farmacias incluidas en el estudio entre febrero y diciembre de 2004. Mediante la aplicación de la prueba de comparación de porcentajes y MAPINFO (Programa para el Diseño de Mapas), se detectó que existe gran déficit de unidades de farmacias en relación con el número de habitantes por provincia
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Humanos , Assistência Farmacêutica , Farmácias , Atenção Primária à Saúde , CubaRESUMO
La presente investigación se propone abordar la distribución territorial de la lepra en Brasil con el objetivo de identificar las regularidades de su diferenciación espacial y aportar conocimientos que permitan progresar en la comprensión de los procesos de su producción social. Fueron calculadas las tasas anuales de detección de casos, brutos y específicos, para las regiones y estados del país. La evolución espacio-temporal fue realizada mediante la construcción de series históricas. Se expone como substrato de los análisis una síntese sobre la distribución histórico-geográfica de la endemia en Brasil. La serie histórica del período 1960 - 2002, permite comparar las tasas de detección de las regiones, en la primera década, con las tasas más bajas, a excepción de la región Norte, que se destaca com la mayor detección. Todas las regiones elevan la detección a partir de la década del 70, siendo la Sul la de detección más baja. Las regiones Norte y Centro Oeste, mantienen las más altas detecciones de casos y los mayores incrementos, lo cual evidencia la desigual evolución regional de la endemia en el país. La permanencia histórica de elevada incidencia de la lepra en la región Norte, en el estado de Maranhão y Pernambuco en la región Nordeste, del estado de Paraná en la región Sul, así como relativamente bajas incidencias en el resto de esta última región, sugieren la existencia de contextos geográficos de diferente vulnerabilidad a la producción social de la lepra, y de nuevos componentes en la organización espacial en algunos territorios.