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Background: Vaccine hesitancy (VH) is a recognized threat to public health that undermines efforts to mitigate disease burden. This study aims to gather available evidence regarding COVID-19 VH in Mexico, estimate the prevalence of VH, and its determinants to inform policymaking in this country. Methods: Following PRISMA guidelines, a systematic review of the MEDLINE literature, articles that estimated the prevalence of COVID-19 VH in Mexico were included in the analysis to obtain a pooled estimate. We used a binomial-normal model for meta-analysis of proportions (i.e., generalized linear mixed model) to perform the metanalysis. We then performed a narrative review of COVID-19 VH in Mexican subpopulations. Results: Seven studies met inclusion criteria. We estimated a pooled prevalence of COVID-19 VH of 16 % (95 % CI: 11-23 %) in Mexico. We found an association between VH and demographic characteristics, intrinsic vaccine factors, and beliefs. Subgroup analyses from specific studies suggested that patients with clinical conditions such as breast cancer or rheumatologic diseases had a higher prevalence of VH. Conclusions: VH is a highly complex and dynamic phenomenon in Mexico. Characterizing and understanding COVID-19 vaccine hesitancy in the Mexican population helps target future policy interventions to mitigate the spread and impact of infectious diseases. The implications of VH differ among groups that may be at higher risk of severe disease, underscoring the importance of prompt research among these groups as well as targeted interventions to address VH.
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Several GWAS reported Myocyte Enhancer Factor 2 C (MEF2C) gene associations with white matter microstructure and psychiatric disorders, and MEF2C involvement in pathways related to neuronal development suggests a common biological factor underlying these phenotypes. We aim to refine the MEF2C effects in the brain relying on an integrated analysis of white matter and psychiatric phenotypes in an extensively characterized sample. This study included 870 Brazilian adults (47% from an attention-deficit/hyperactivity disorder outpatient clinic) assessed through standardized psychiatric interviews, 139 of which underwent a magnetic resonance imaging scan. We evaluated variants in the MEF2C region using two approaches: 1) a gene-wide analysis, which uses the sum of polymorphism effects, and 2) SNP analyses, restricted to the independent variants within the gene. The outcomes included psychiatric phenotypes and fractional anisotropy for brain images. Results: The gene-wide analyses pointed to a nominal association between MEF2C and the Temporal Portion of the Superior Longitudinal Fasciculus (SLFTEMP). The SNP analysis identified four independent variants significantly associated with SLFTEMP and one (rs4218438) with Substance Use Disorder. Our findings showing specific associations of MEF2C variants with temporal-frontal circuitry components may help to elucidate how the MEF2C gene underlies a broad range of psychiatric phenotypes since these regions are relevant to executive and cognitive functions.
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Transtorno do Deficit de Atenção com Hiperatividade , Substância Branca , Humanos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Fatores de Transcrição MEF2/genética , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Imageamento por Ressonância Magnética , Transtorno do Deficit de Atenção com Hiperatividade/genética , AnisotropiaRESUMO
Tuberculosis (TB) of the central nervous system (CNS) presents high mortality due to brain damage and inflammation events. The formation and deposition of immune complexes (ICs) in the brain microvasculature during Mycobacterium tuberculosis (Mtb) infection are crucial for its pathobiology. The relevance of ICs to Mtb antigens in the pathogenesis of CNS-TB has been poorly explored. Here, we aimed to establish a murine experimental model of ICs-mediated brain vasculitis induced by cell wall antigens of Mtb. We administered a cell wall extract of the prototype pathogenic Mtb strain H37Rv to male BALB/c mice by subcutaneous and intravenous routes. Serum concentration and deposition of ICs onto blood vessels were determined by polyethylene glycol precipitation, ELISA, and immunofluorescence. Histopathological changes in the brain, lung, spleen, liver, and kidney were evaluated by hematoxylin and eosin staining. Our results evidenced that vasculitis developed in the studied tissues. High serum levels of ICs and vascular deposition were evident in the brain, lung, and kidneys early after the last cell wall antigen administration. Cell wall Mtb antigens induce strong type III hypersensitivity reactions and the development of systemic vasculitis with brain vascular changes and meningitis, supporting a role for ICs in the pathogenesis of TB.
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Mycobacterium tuberculosis , Tuberculose , Vasculite , Masculino , Animais , Camundongos , Complexo Antígeno-Anticorpo , Modelos Animais de Doenças , Tuberculose/microbiologia , Antígenos de Bactérias , Parede CelularRESUMO
The course of ADHD from childhood up to young adulthood has been characterized in several studies. However, little is known about the course of symptoms into middle age and beyond. This study aims to evaluate predictors of ADHD trajectories in midlife based on three assessments. The follow-up sample comprised 323 adults with ADHD, evaluated at baseline and seven and thirteen years later, from the average ages of 34 up to 47 years old. ADHD status at reassessments was used to characterize trajectories. Demographics, ADHD features, comorbidities, and polygenic scores for ADHD and genetically correlated psychiatric disorders were evaluated to predict ADHD trajectories. Study retention rate was 67% at T2 (n = 216) and 62% at T3 (n = 199). Data from patients evaluated three times showed that 68.8% coursed stable, 25.5% unstable, and 5.7% remission trajectory of ADHD. Women, individuals with more severe syndromes, higher frequency of comorbidities at reassessments, and genetic liability to depression present a higher probability of a stable trajectory. Our findings shed light on midlife ADHD trajectories and their gender, genomic and clinical correlates.
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PURPOSE: To present a clinical case and surgical technique for management of optic disk pit (ODP) maculopathy. METHODS: Surgical technique video of lens sparring pars plana vitrectomy, autologous scleral flap insertion and gas tamponade. RESULTS: After 1 year follow-up visual acuity was restored to 20/25, retinal serous detachment and schisis were resolved and the autologous scleral flap remained in the (ODP). CONCLUSION: In this case, treatment with pars plana vitrectomy autologous scleral flap insertion and gas tamponade for optic pit maculopathy provided satisfactory anatomical and functional results.
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Anormalidades do Olho , Degeneração Macular , Disco Óptico , Descolamento Retiniano , Anormalidades do Olho/cirurgia , Humanos , Descolamento Retiniano/cirurgia , Tomografia de Coerência Óptica , VitrectomiaRESUMO
Over the last decade, Baltimore has become a non-traditional sanctuary city, receiving an unprecedented influx of Latino immigrants, mostly from Central America's Northern Triangle, who are often fleeing violence in their home countries. This study explored the nature and frequency of healthcare utilization for mental health problems among uninsured/uninsurable Latinos who received outpatient care between 2012 and 2015 through an academic hospital-affiliated program that covers primary and specialty services to uninsured patients without regard to documentation status. Encounters for mental health disorders were the most common category, accounting for 14.88% of all visits. Mood (78%) and anxiety disorders (16%) were the most prevalent mental health diagnoses. The most frequent reason to seek care was symptom, signs, and ill-defined conditions (37.47%), and within this subgroup, pain was the leading cause of seeking care (88%), which may indicate high rates of somatization of mental health distress. This study presents a unique opportunity to explore the burden and nature of mental health needs among a population for which healthcare information is rarely attainable and highlights the need for culturally competent screening mechanisms and interventions to address the stressors faced by emergent communities.
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Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Hispânico ou Latino/psicologia , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Transtornos Mentais/etnologia , Transtornos Mentais/terapia , Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Baltimore/epidemiologia , América Central/etnologia , Criança , Emigrantes e Imigrantes , Emigração e Imigração , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Política , Adulto JovemRESUMO
BACKGROUND: The prediction of future obesity patterns is crucial for effective strategic planning. However, disproportionally changing body mass index (BMI) distributions pose particular challenges. Flexible modelling of the shape of BMI distributions may improve prediction performance. METHODS: We used data from repeated national health surveys conducted in Mexico, Colombia and Peru at four or five time points between 1988 and 2014. Data from all surveys except the last survey were used to construct prediction models for three obesity indicators (median BMI, overweight/obesity prevalence and obesity prevalence) for the time of the last survey. We assessed their performance using predicted curves, absolute prediction errors and comparison of actual and predicted distributions. With one method, we modelled the shape of BMI distributions assuming BMI follows a Box-Cox Power Exponential (BCPE) distribution, whose parameters were modelled as a function of interval or nominal 5-year age groups, time and their interaction terms. In a second method, we modelled each of the obesity indicators directly as a function of the same covariates using quantile and logistic regression. RESULTS: The BCPE model with interval age groups yielded the best prediction performance in predicting obesity prevalence. Average absolute prediction errors across all age groups were 4.3 percentage points (95% percentile interval: 1.9, 7.5), 2.5 (1.2, 6.1) and 1.7 (1.0, 9.3), with data from Mexico, Colombia and Peru, respectively. This superiority was weak or none for overweight/obesity prevalence and median BMI. CONCLUSION: The BCPE model performed better for prediction of the extremes of BMI distribution, possibly by incorporating its shape more precisely.
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Modelos Estatísticos , Obesidade , Índice de Massa Corporal , Colômbia/epidemiologia , Inquéritos Epidemiológicos , Humanos , México/epidemiologia , Obesidade/epidemiologia , Peru/epidemiologia , Reprodutibilidade dos TestesRESUMO
BACKGROUND/OBJECTIVES: Previous studies about obesity and its associated factors in low- and middle-income countries have been based mostly on women of reproductive age. Furthermore, disproportionally changing BMI distributions have been a challenge for its appropriate modeling. In this context, we assessed the magnitude and rate of change in BMI distribution by socioeconomic and geographic factors in both sexes in Latin American countries, modeling the shape of BMI distributions. SUBJECTS/METHODS: We used data from national surveys conducted in Mexico, Colombia, and Peru at two time points between 2005 and 2013 (N = 57,414, 13,5403, and 30,811, respectively). We estimated shapes of BMI distributions for 2005 and 2010, and assessed their changes, using the generalized additive model for location, scale, and shape (GAMLSS), in which BMI was assumed to follow a Box-Cox Power Exponential (BCPE) distribution. RESULTS: In all the three countries, higher education was negatively associated with BMI in women but somewhat positive in men; and household wealth was positively associated in men but not in women. Lower household wealth was associated with higher rates of change in BMI distributions in women. CONCLUSION: Education and household wealth were associated with BMI distributions and their change over time. Observed sex differences in these associations have implications for designing relevant policies and programs to approach target populations effectively. The BCPE-GAMLSS method can provide a useful visual assessment of time-varying measures.
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Renda , Índice de Massa Corporal , Colômbia/epidemiologia , Feminino , Geografia , Humanos , Masculino , México/epidemiologia , Peru/epidemiologia , Fatores SocioeconômicosRESUMO
Resumen El síndrome de Budd-Chiari es una entidad definida como la obstrucción al flujo sanguíneo en el tracto de salida hepático. Esta obstrucción se puede localizar desde las pequeñas venas hepáticas hasta la entrada de la vena cava inferior a la aurícula derecha. En la mayoría de los casos, se ocasiona por una trombosis endoluminal conocida como Budd-Chiari primario y secundario, cuando ocurre por una compresión extrínseca asociada a las lesiones que ocupan espacio como malignidad. Por tanto, los estados trombofílicos hereditarios se conocen como los principales factores de riesgo. El embarazo y el puerperio, al ser estados hipercoagulables, se pueden asociar al síndrome de Budd-Chiari, sin embargo, la prevalencia reportada en la literatura es muy variable dependiendo de la población estudiada. En Colombia no hay estudios de incidencia o prevalencia de la enfermedad; existen varios reportes de caso, pero no relacionados con el embarazo. Reportamos el caso de una paciente, que 12 semanas posparto presentó un síndrome de Budd-Chiari; además presentamos el manejo ofrecido, la evolución clínica y una revisión de la literatura de los casos asociados con el embarazo.
Abstract Budd-Chiari syndrome is defined as obstruction of hepatic blood outflow. This obstruction can be located anywhere from the small hepatic veins at the entrance of the inferior vena cava to the right atrium. Most cases are primary Budd-Chiari syndrome which is caused by endoluminal thrombosis. Secondary Budd-Chiari syndrome occurs as the result of extrinsic compression associated with space-occupying lesions such as malignant tumors. Hereditary thrombophilic states are the main risk factors, but since pregnancy and the puerperium are hypercoagulable states, they can be associated with Budd-Chiari syndrome. Nevertheless, the prevalence of this type of case in the literature varies according to the population studied. There have been no studies on the incidence or prevalence of this disease in Colombia. The small number of case reports here have not been related to pregnancy. We report the case of a patient who developed Budd-Chiari syndrome 12 weeks postpartum. Our report includes management and clinical evolution as well as a review of the literature of cases associated with pregnancy.
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Humanos , Feminino , Adolescente , Período Pós-Parto , Síndrome de Budd-Chiari , Trombose , LiteraturaRESUMO
Colorectal cancer (CRC) is one type of tumor with the highest frequency and mortality worldwide. Although current treatments increase patient survival, it is important to detect CRC in early stages; however, most CRC, despite responding favorably to treatment, develop resistance and present recurrence, a situation that will inevitably lead to death. In recent years, it has been shown that the main reason for drug resistance is the presence of colon cancer stem cells (CSC). Pericytes are also capable of tumor homing and are important cellular components of the tumor microenvironment (TME), contributing to the formation of vessels and promoting metastasis; however, they have not been considered very important as a therapeutic target in cancer. In this review, we highlight the contribution of pericytes and cancer stem cells to some classical hallmarks of cancer, namely, tumor angiogenesis, growth, metastasis, and evasion of immune destruction, and discuss therapies targeting pericytes and cancer stem cells in CRC.
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OBJECTIVE: To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS: The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS: The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19-3.56), 1.73 (95%CI 1.19-2.51) and 1.10 (95%CI 1.03-1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS: As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.
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Transmissão de Doença Infecciosa/estatística & dados numéricos , Florestas , Malária/epidemiologia , Malária/transmissão , Brasil/epidemiologia , Cidades/epidemiologia , Humanos , Incidência , Modelos Logísticos , Fatores de Risco , Estações do Ano , Fatores Socioeconômicos , Análise Espaço-Temporal , Fatores de TempoRESUMO
Introducción: En el tratamiento del Cáncer Cervico Uterino la braquiterapia (BQT) con planificación tridimensional (3D) está altamente extendida, aunque por su costo otros centros utilizan BQT con planificación bidimensional (2D). Es importante establecer si el beneficio que se obtiene con BQT en 3 D, en la protección a los órganos de riesgo, es un factor determinante para el cambio hacia esta nueva tecnología. El objetivo del estudio es comparar las dosis en ambos tipos de BQT en los órganos adyacentes al útero como el colon y vejiga. Métodos: El presente estudio descriptivo, incluye pacientes con diagnóstico de cáncer de cuello uterino que recibieron BQT en el período comprendido de enero 2015 a diciembre 2018, en el servicio Radioterapia del Hospital Solón Espinosa Ayala, Quito-Ecuador. Las variables fueron la dosis recibida con planificaciones en 2D y 3D. Se obtuvo histogramas dosis volumen de los órganos de riesgo: recto y vejiga. Se comparan los promedios con T de Student. Resultados: Participaron 44 casos, de 50.6 ±13.8 años de edad. En estadío clínico IIB 24 casos (55 %). La dosis prescrita de BQT en el grupo fue de 683.6 ±27 cGY. El tipo de aplicador usado fue en la gran mayoría AyT de 5 mm en 34 casos (77 %). La mayoría de los tratamientos consistieron en terapias de 4 sesiones 32 casos (73 %), con 117 implantes para BQT. La dosis planificada en vejiga en 2D fue 5.5 Gy, versus 5.1 Gy en 3D, P= 0.01. La dosis planificada en recto en 2D fue 2.8 Gy; versus 3.0 Gy en 3D P= 0.06. Conclusión: La planificación en 3D reduce significativamente 0.4 Gy la dosis irradiada a vejiga. En el caso del recto la dosis la dosis no produce cambios estadísticos respecto a planificación en 2D.
Introduction: In the treatment of Uterine Cervical Cancer brachytherapy (BQT) with three-dimensional planning (3D) is highly widespread, although for its cost other centers use BQT with two-dimensional planning (2D). It is important to establish if the benefit obtained with BQT in 3 D, in the protection of risk organs, is a determining factor for the change towards this new technology. The aim of the study is to compare the doses in both types of BQT in the organs adjacent to the uterus such as the colon and bladder. Methods: The present descriptive study includes patients diagnosed with cervical cancer who received BQT in the period from January 2015 to December 2018, in the Radiotherapy service of the Hospital Solón Espinosa Ayala, Quito-Ecuador. The variables were the dose received with 2D and 3D plans. Histograms were obtained volume volume of the organs at risk: rectum and bladder. The averages are compared with Student's T. Results: There were 44 cases, of 50.6 ± 13.8 years of age. In clinical stage IIB 24 cases (55%). The prescribed dose of BQT in the group was 683.6 ± 27 cGY. The type of applicator used was in the great majority AyT of 5 mm in 34 cases (77%). The majority of treatments consisted of therapies of 4 sessions 32 cases (73%), with 117 implants for BQT. The planned dose in 2D bladder was 5.5 Gy, versus 5.1 Gy in 3D, P = 0.01. The planned dose in rectum in 2D was 2.8 Gy; versus 3.0 Gy in 3D P = 0.06). Conclusion: 3D planning significantly reduces 0.4 Gy the dose irradiated to the bladder. In the case of the rectum, the dose does not produce statistical changes with respect to 2D planning.
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Humanos , Braquiterapia , Neoplasias do Colo do Útero , Colo do Útero , Radioterapia , Planejamento da Radioterapia Assistida por Computador , ColoRESUMO
ABSTRACT OBJECTIVE To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19-3.56), 1.73 (95%CI 1.19-2.51) and 1.10 (95%CI 1.03-1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.
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Humanos , Florestas , Transmissão de Doença Infecciosa/estatística & dados numéricos , Malária/transmissão , Malária/epidemiologia , Estações do Ano , Fatores Socioeconômicos , Fatores de Tempo , Brasil/epidemiologia , Modelos Logísticos , Incidência , Fatores de Risco , Cidades/epidemiologia , Análise Espaço-TemporalRESUMO
OBJECTIVE: Unequal obesity distributions among adult populations have been reported in low- and middle-income countries, but mainly based on data of women of reproductive age. Moreover, incorporation of ever-changing skewed BMI distributions in analyses has been a challenge. Our study aimed to assess magnitude and rates of change in BMI distributions by age and sex. DESIGN: Shapes of BMI distributions were estimated for 2005 and 2010, and their changes were assessed, using the generalized additive model for location, scale and shape (GAMLSS) and assuming BMI follows a Box-Cox power exponential (BCPE) distribution. SETTING: Nationally representative, repeated cross-sectional health surveys conducted between 2005 and 2013 in Mexico, Colombia and Peru. SUBJECTS: Adult men and non-pregnant women aged 20-69 years. RESULTS: Whereas women had more right-shifted and wider BMI distributions than men in almost all age groups across the countries in 2010, men in their 30s-40s experienced more rapid increases in BMI between 2005 and 2010, notably in Peru. The highest increase in overweight and obesity prevalence was observed among Peruvian men of 35-39 years, with a 5-year increase of 21 percentage points. CONCLUSIONS: The BCPE-GAMLSS method is an alternative to analyse measurements with time-varying distributions visually, in addition to conventional indicators such as means and prevalences. Consideration of differences in BMI distributions and their changes by sex and age would provide vital information in tailoring relevant policies and programmes to reach target populations effectively. Increases in BMI portend increases of obesity-associated diseases, for which preventive and preparative actions are urgent.
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Índice de Massa Corporal , Obesidade/epidemiologia , Adulto , Distribuição por Idade , Idoso , Colômbia/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Peru/epidemiologia , Distribuição por Sexo , Fatores de Tempo , Adulto JovemRESUMO
Los miomas o fibromas, son tumores benignos que aparecen frecuentemente en el útero, y aunque a veces pueden ser asintomáticos, en muchas mujeres son la razón más común de las intervenciones ginecológicas. Algunos autores consideran que la causa es desconocida, otros le dan valor al estímulo estrogénico mantenido o aumentado, que activa los genitoblastos, mesodérmico y celular embrionario que responden a este estímulo. Se presenta el caso de un fibroma uterino complicado con una necrobiosis séptica diagnosticada en una paciente de 63 años de edad. El apoyo diagnóstico con ultrasonografía es de vital importancia en la sospecha diagnóstica de este tipo tumor y sus complicaciones.
Myomas or fibroids are benign tumors that frequently appear in the uterus, and although they can sometimes be asymptomatic, in many women they are the most common reason for gynecological interventions. Some authors consider that the cause is unknown. Others give value to the maintained or increased estrogenic stimulus, which activates the embryonic cell, mesodermal and genitoblasts that respond to this stimulus. We present the case of a complicated uterine fibroid with a septic necrobiosis diagnosed in a 63-year-old patient. Ultrasonography is of vital importance in the diagnosis when there is suspicion of this type of tumor and its complications.
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Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Uterinas/prevenção & controle , Leiomioma/complicações , Leiomioma/diagnóstico por imagem , Necrobiose Lipoídica/mortalidadeRESUMO
The aim of this research was to investigate the origin of imported cases of dengue in the city of Araraquara, Brazil and to describe the disease's main epidemiological characteristics. The study encompassed all confirmed cases of dengue recorded in the Information System for Notifiable Diseases (SINAN) [Sistema de Informação de Agravos de Notificação] from 1998 to 2013. Cases whose origin of infection was likely located outside Araraquara were considered imported. The epidemiological study entailed a descriptive analysis of the data, regarding the distribution of cases by sex, age, and classification of imported and autochthonous cases. A geographic information system was used to map flows and estimate distances. There were 6,913 confirmed cases, 419 of which were imported. In most cases, the origin of infection was located in the state of São Paulo as well as other Brazilian regions. The results indicate the relevance of imported cases and differences in the epidemiological profile with respect to age and sex. Conclusions indicate the need to increase epidemiological and environmental health surveillance at ports, airports, truck stops, and bus and train terminals.
El objetivo de este trabajo fue investigar el origen de los casos importados de dengue en la ciudad de Araraquara, Brasil y describir las principales características epidemiológicas. El estudio abarcó todos los casos confirmados de dengue registrados en el Sistema de Información de Enfermedades de Notificación (SINAN) [Sistema de Informação de Agravos de Notificação] de 1998-2013. Se consideraron como casos importados aquellos cuyo lugar de origen de infección se ubicara fuera de Araraquara. Se realizó un análisis descriptivo de la distribución de los casos por género, edad y clasificación de casos importados y autóctonos. Se utilizó un sistema de información geográfica para mapear los flujos y estimar las distancias de los puntos de contagio. Se incluyeron 6.913 casos confirmados, de los cuales 419 fueron importados. En la mayoría de estos casos, el origen de infección se ubicó en el estado de San Pablo, además de otras regiones brasileñas. Los resultados indican la relevancia de los casos importados y diferencias en el perfil epidemiológico por edad y sexo. Las conclusiones indican la necesidad de aumentar la vigilancia epidemiológica y de salud ambiental en los puertos, aeropuertos, paradas de camiones y terminales de buses y trenes.
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Dengue/epidemiologia , Dengue/transmissão , Epidemias , Viagem , Clima Tropical , Saúde da População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Sistemas de Informação Geográfica , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Vigilância em Saúde Pública , Análise Espacial , Adulto JovemRESUMO
INTRODUCTION: Malaria still is a public health problem in the Americas. In 2015, Brazil accounted for 37% of all cases in the Americas, and of these cases, 99.5% were located in the Brazilian Amazon. Despite the mobilization of resources from the Brazilian National Plan for Malaria Control, too many municipalities have high transmission levels. The objective of this study is to evaluate the local epidemiological profile of malaria and its trend between 2010 and 2015 in the Brazilian Amazon. This study also aims to recognize the epidemiological differences in the local temporo-spatial dynamics of malaria. METHODS: Malaria data were stratified by the annual parasite incidence (API) over the six-year period and by municipality. We used the method of seasonal decomposition by Loess smoothing to capture trend, seasonal and irregular components. A generalized linear model was applied to quantify trends, and the Kruskal-Wallis Rank Sum was applied to test for seasonality significance. RESULTS: The malaria API declined by 61% from 2010 to 2015, and there was a 40% reduction of municipalities with high transmission (determined as an API higher than 50). In 2015, 9.4% of municipalities had high transmission and included 62.8% of the total cases. The time-series analyses showed different incidence patterns by region after 2012; several states have minimized the effect of the seasonality in their incidence rates, thus achieving low rates of incidence. There were 13 municipalities with sustained high transmission that have become the principal focus of malaria control; these municipalities contained 40% of the cases between 2013 and 2015. DISCUSSION: Brazil has achieved advances, but more sustained efforts are necessary to contain malaria resurgence. The use of malaria stratification has been demonstrated as a relevant tool to plan malaria programs more efficiently, and spatiotemporal analysis corroborates the idea that implementing any intervention in malaria should be stratified by time to interpret tendencies and by space to understand the local dynamics of the disease.
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RESUMEN El objetivo de este trabajo fue investigar el origen de los casos importados de dengue en la ciudad de Araraquara, Brasil y describir las principales características epidemiológicas. El estudio abarcó todos los casos confirmados de dengue registrados en el Sistema de Información de Enfermedades de Notificación (SINAN) [Sistema de Informação de Agravos de Notificação] de 1998-2013. Se consideraron como casos importados aquellos cuyo lugar de origen de infección se ubicara fuera de Araraquara. Se realizó un análisis descriptivo de la distribución de los casos por género, edad y clasificación de casos importados y autóctonos. Se utilizó un sistema de información geográfica para mapear los flujos y estimar las distancias de los puntos de contagio. Se incluyeron 6.913 casos confirmados, de los cuales 419 fueron importados. En la mayoría de estos casos, el origen de infección se ubicó en el estado de San Pablo, además de otras regiones brasileñas. Los resultados indican la relevancia de los casos importados y diferencias en el perfil epidemiológico por edad y sexo. Las conclusiones indican la necesidad de aumentar la vigilancia epidemiológica y de salud ambiental en los puertos, aeropuertos, paradas de camiones y terminales de buses y trenes.
ABSTRACT The aim of this research was to investigate the origin of imported cases of dengue in the city of Araraquara, Brazil and to describe the disease's main epidemiological characteristics. The study encompassed all confirmed cases of dengue recorded in the Information System for Notifiable Diseases (SINAN) [Sistema de Informação de Agravos de Notificação] from 1998 to 2013. Cases whose origin of infection was likely located outside Araraquara were considered imported. The epidemiological study entailed a descriptive analysis of the data, regarding the distribution of cases by sex, age, and classification of imported and autochthonous cases. A geographic information system was used to map flows and estimate distances. There were 6,913 confirmed cases, 419 of which were imported. In most cases, the origin of infection was located in the state of São Paulo as well as other Brazilian regions. The results indicate the relevance of imported cases and differences in the epidemiological profile with respect to age and sex. Conclusions indicate the need to increase epidemiological and environmental health surveillance at ports, airports, truck stops, and bus and train terminals.