1
|
Isaacson JE, Ye JJ, Silva LL, Hernandes Rocha TA, de Andrade L, Scheidt JFHC, Wen FH, Sachett J, Monteiro WM, Staton CA, Vissoci JRN, Gerardo CJ. Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis. PLoS Negl Trop Dis 2023; 17:e0011305. [PMID: 37343007 PMCID: PMC10284398 DOI: 10.1371/journal.pntd.0011305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. METHODS We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. RESULTS We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. CONCLUSION Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.
Collapse
Affiliation(s)
| | - Jinny Jing Ye
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lincoln Luís Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
| | - Thiago Augusto Hernandes Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Fan Hui Wen
- Antivenom Production Section, Butantan Institute, São Paulo, São Paulo, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Charles John Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| |
Collapse
|
2
|
Dantas JDC, Marinho CDSR, Pinheiro YT, da Silva RAR. Temporal Trend of Gestational Syphilis between 2008 and 2018 in Brazil: Association with Socioeconomic and Health Care Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16456. [PMID: 36554342 PMCID: PMC9778377 DOI: 10.3390/ijerph192416456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
The increased number of cases in recent years has turned syphilis into a global public health problem. In 2020, 115,371 cases of acquired syphilis were reported (detection rate of 54.5 cases/100,000 inhabitants) in Brazil. In that same period, the country notified 61,441 cases of gestational syphilis (detection rate of 21.6 per 1000 live births). The number of syphilis cases points to the need to reinforce surveillance, prevention, and infection control actions, which is a worrying scenario for government organizations. This study aims to describe the temporal trend of gestational syphilis from 2008 to 2018 in Brazilian regions and to associate its detection rate with socioeconomic and health care indicators. We conducted an ecological study of temporal trends using secondary data from the Department of Informatics of the Unified Health System. The temporal trend was analyzed using the Joinpoint Regression program. The annual percent change (APC) and 95% confidence intervals (95%CI) were estimated and tested; statistical significance was assessed using the Monte Carlo permutation test. Correlations were assessed using Pearson's correlation coefficient, and statistical significance was calculated using Pearson's product-moment correlation. The gestational syphilis detection rate increased between 2008 and 2018. The South region showed the greatest trend, whereas the Midwest region presented the lowest trend. The following variables were significantly correlated with the gestational syphilis detection rate: Municipal Human Development Index, illiteracy rate, percentage of primary health care coverage, and proportion of doctors, nurses, and basic health units per inhabitant. Health policies are needed to mitigate social vulnerabilities and strengthen primary health care.
Collapse
Affiliation(s)
- Janmilli da Costa Dantas
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
| | | | - Yago Tavares Pinheiro
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
| | - Richardson Augusto Rosendo da Silva
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
- Center of Health Sciences, Department of Nursing, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil
| |
Collapse
|
3
|
Lago Sousa SM, Pedroso AO, Seabra IL, Oliveira Naiff Ferreira GR, Pereira Cruz Ramos AM, Polaro SHI, Pinheiro Botelho E. Spatial analysis of the AIDS mortality rate among young people in a province of the Brazilian Amazon: An ecological study. GEOSPATIAL HEALTH 2022; 17. [PMID: 36468598 DOI: 10.4081/gh.2022.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/09/2022] [Indexed: 06/17/2023]
Abstract
Worldwide, policies to combat human immunodeficiency virus (HIV) have led to a small decrease in the acquired immunodeficiency syndrome (AIDS) mortality rate among young people. For greater policy efficacy, it is necessary to determine the influence of social determinants of health (SDHs) in each territory. The objective of this study was to spatially analyse the AIDS mortality rate among young people in a province of the Brazilian Amazon and the spatial variability of the rate promoted by SDHs. All reports of AIDS deaths between 2007 and 2018 among young people living in the state of Pará were included in the study. The mortality rate was analysed using spatial distribution and autocorrelation, spatial scanning, and geographically weighted regression (GWR). During the study period, there were 1,372 deaths from AIDS among young people with a territorial expansion. The spatial autocorrelation showed two high-high clusters in the period from 2007 to 2010, one formed by municipalities in south-eastern Pará and one in the metropolitan region of Belém, with only the latter remaining between 2011 and 2018. This region showed a higher spatial risk for AIDS mortality and was the only cluster with spatiotemporal risk in the 2013-2018 period. Spatial variability was promoted by the i) the youth homicide rate, ii) the elementary school dropout rate and iii) the number of families registered in the Unified Registry for Social Programs (CadÚnico). This study provides support for the implementation of effective focal policies to combat HIV and reduce the mortality rate among young people in Pará.
Collapse
|
4
|
de Oliveira LR, dos Santos ES, Souto FJD. Syphilis in pregnant women and congenital syphilis: spatial pattern and relationship with social determinants of health in Mato Grosso. Rev Soc Bras Med Trop 2020; 53:e20200316. [PMID: 33111911 PMCID: PMC7580285 DOI: 10.1590/0037-8682-0316-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The increasing incidence of syphilis among pregnant women (PS) and congenital syphilis (CS) has negatively affected maternal-child health in Brazil. The spatial approach to diseases with social indicators improves knowledge of health situations. Herein, we aimed to evaluate the spatiotemporal distribution of incidences, identify the priority areas for infection control actions, and analyze the relationship of PS and CS clusters with social determinants of health in Mato Grosso. METHODS This is an ecological study with data from different health information systems. After data procedure linkage, we analyzed the Bayesian incidences of triennial infections during specific periods. We performed SATSCAN screenings to identify spatiotemporal clusters. Further, we verified the differences between the clusters and indicators using Pearson's chi-square test. RESULTS The variations in PS incidence were 0.9-20.5/1,000 live births (LB), 0.6-46.3/1,000 LB, and 2.1-23.2/1,000 LB in the first, second, and last triennium, respectively; for CS, the variations were 0-7.1/1,000 LB, 0-7.5/1,000 LB, and 0.3-10.8/1,000 LB in the first, second, and last triennium, respectively. Three clusters each were identified for PS (RR=2.02; RR=0.30; RR=21.45, p<0.0001) and CS (RR=3.55; RR=0.10; RR=0.26, p<0.0001). The high-risk clusters overlapped in time-space; CS incidence was associated with municipalities with a higher proportion of LB mothers of race/non-white color and with poor sanitary conditions, lower proportion of pregnant teenagers, and under 8 years of schooling. CONCLUSIONS The increase in the spatiotemporal evolution of PS and CS incidences and the extension of areas with persistent infections indicate the need for monitoring, especially of priority areas in the state.
Collapse
Affiliation(s)
| | | | - Francisco José Dutra Souto
- Universidade Federal de Mato Grosso, Faculdade de Medicina, Cuiabá, MT, Brasil
- Faculdade de Ciências Biomédicas de Cacoal, Curso de Medicina, Cacoal, RO, Brasil
| |
Collapse
|
5
|
Nascimento CAD, Teixeira KK, Tavares ADM, Souza AMGD, De Souza TA, Aiquoc KM, Barbosa IR. Qualidade dos dados, oportunidade e representatividade do sistema de vigilância epidemiológica da dengue em Natal, Rio Grande do Norte, 2012-2017. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i3.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.
Collapse
|
6
|
Tallman PS, Riley-Powell AR, Schwarz L, Salmón-Mulanovich G, Southgate T, Pace C, Valdés-Velásquez A, Hartinger SM, Paz-Soldán VA, Lee GO. Ecosyndemics: The potential synergistic health impacts of highways and dams in the Amazon. Soc Sci Med 2020; 295:113037. [PMID: 32475727 DOI: 10.1016/j.socscimed.2020.113037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 11/16/2022]
Abstract
Ecosyndemics refer to disease interactions that result from environmental changes commonly caused by humans. In this paper, we push scholarship on ecosyndemics into new territory by using the ecosyndemic framework to compare two case studies-the Southern Interoceanic highway in Peru and the Belo Monte hydroelectric dam in Brazil-to assess the likelihood of socio-environmental factors interacting and leading to ill health in a syndemic fashion. Assessing these two case studies using an ecosyndemic perspective, we find that the construction of dams and highways in tropical forests create the conditions for increases in vector-borne illnesses, surges in sex work and sexually-transmitted infections, and increased psychological stress resulting from violence, delinquency, and the erosion of social cohesion. We suggest that these processes could interact synergistically to increase an individual's immune burden and a population's overall morbidity. However, we find differences in the impacts of the Interoceanic highway and the Belo Monte dam on food, water, and cultural systems, and observed that community and corporate-level actions may bolster health in the face of rapid socio-ecological change. Looking at the case studies together, a complex picture of vulnerability and resilience, risk and opportunity, complicates straight-forward predictions of ecosyndemic interactions resulting from these development projects but highlights the role that the ecosyndemic concept can play in informing health impact assessments and future research. We conclude by proposing a conceptual model of the potential interactions between psychological stress, vector-borne illnesses, and sexaully-transmitted infections and suggest that future investigations of synergistic interactions among these factors draw from the biological, social, and ecological sciences.
Collapse
Affiliation(s)
- Paula Skye Tallman
- The Field Museum of Natural History, Keller Science Action Department, Chicago, IL, USA.
| | - Amy R Riley-Powell
- Tulane University, School of Public Health and Tropical Medicine. New Orleans, LA, USA; Institute of Development Studies, University of Sussex, Brighton, United Kingdom
| | - Lara Schwarz
- University of California San Diego, Family Medicine and Public Health Department, CA, USA; San Diego State University, School of Public Health, CA, USA
| | - Gabriela Salmón-Mulanovich
- Universidad Peruana Cayetano Heredia, School of Public Health and Administration, Lima, Peru; Pontificia Universidad Católica del Perú, Department of Biomedical Engineering, Lima, Peru
| | | | | | | | - Stella M Hartinger
- Universidad Peruana Cayetano Heredia, School of Public Health and Administration, Lima, Peru
| | - Valerie A Paz-Soldán
- Tulane University, School of Public Health and Tropical Medicine. New Orleans, LA, USA; Universidad Peruana Cayetano Heredia, School of Public Health and Administration, Lima, Peru
| | - Gwenyth O Lee
- University of Michigan, School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
7
|
ELLWANGER JOELHENRIQUE, KULMANN-LEAL BRUNA, KAMINSKI VALÉRIAL, VALVERDE-VILLEGAS JACQUELINEMARÍA, VEIGA ANABEATRIZGDA, SPILKI FERNANDOR, FEARNSIDE PHILIPM, CAESAR LÍLIAN, GIATTI LEANDROLUIZ, WALLAU GABRIELL, ALMEIDA SABRINAE, BORBA MAUROR, HORA VANUSAPDA, CHIES JOSÉARTURB. Beyond diversity loss and climate change: Impacts of Amazon deforestation on infectious diseases and public health. ACTA ACUST UNITED AC 2020; 92:e20191375. [DOI: 10.1590/0001-3765202020191375] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/17/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | | | | | | | | | - LÍLIAN CAESAR
- Universidade Federal do Rio Grande do Sul/UFRGS, Brazil
| | | | | | | | | | | | | |
Collapse
|
8
|
Wanzinack C, Signorelli MC, Reis C. Homicides and socio-environmental determinants of health in Brazil: a systematic literature review. CAD SAUDE PUBLICA 2018; 34:e00012818. [PMID: 30517311 DOI: 10.1590/0102-311x00012818] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022] Open
Abstract
Brazil currently has the highest absolute number of homicides in the world, which results from a complex range of factors. This study aimed at understanding the associations between socio-environmental determinants of health (SDH) and homicides in Brazil through a systematic literature review. The review followed PRISMA guidelines, selecting quantitative and qualitative studies published in Portuguese, English, and Spanish carried out between 2002 and 2017, available in the PubMed, MEDLINE, LILACS, SciELO and BVS-BIREME databases. Two trilingual reviewers tracked studies independently by basing on the eligibility criteria. We critically assessed the selected studies with the Critical Appraisal Skills Programme (CASP) or the Checklist for Analytical Cross-Sectional Studies, depending on the study design. We considered 60 studies and grouped their SDH into categories to develop a narrative synthesis about each SDH. These categories were: territory; race/ethnicity; gender; age; social inequalities and economic factors; development; education; work and employment; drugs and trafficking; other SDH. We found some SDH were more associated with homicides, such as being young, black, male, of low education level, and also people who lived in places of high social inequality, such as urban suburbs and agricultural frontiers. Unemployment and drug trafficking, as well as intersections between various SDH were also prominent. Education seems to be a protective factor for homicide. Despite the limited capacity of interpretation due to the high range of methodological approaches, this review shows the importance of considering SDH and their intersections when developing homicide prevention policies.
Collapse
Affiliation(s)
| | | | - Clóvis Reis
- Universidade Regional de Blumenau, Blumenau, Brasil
| |
Collapse
|
9
|
Zhang T, Yin F, Zhou T, Zhang XY, Li XS. Multivariate time series analysis on the dynamic relationship between Class B notifiable diseases and gross domestic product (GDP) in China. Sci Rep 2016; 6:29. [PMID: 28011977 PMCID: PMC5515987 DOI: 10.1038/s41598-016-0020-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/01/2016] [Indexed: 01/30/2023] Open
Abstract
The surveillance of infectious diseases is of great importance for disease control and prevention, and more attention should be paid to the Class B notifiable diseases in China. Meanwhile, according to the International Monetary Fund (IMF), the annual growth of Chinese gross domestic product (GDP) would decelerate below 7% after many years of soaring. Under such circumstances, this study aimed to answer what will happen to the incidence rates of infectious diseases in China if Chinese GDP growth remained below 7% in the next five years. Firstly, time plots and cross-correlation matrices were presented to illustrate the characteristics of data. Then, the multivariate time series (MTS) models were proposed to explore the dynamic relationship between incidence rates and GDP. Three kinds of MTS models, i.e., vector auto-regressive (VAR) model for original series, VAR model for differenced series and error-correction model (ECM), were considered in this study. The rank of error-correction term was taken as an indicator for model selection. Finally, our results suggested that four kinds of infectious diseases (epidemic hemorrhagic fever, pertussis, scarlet fever and syphilis) might need attention in China because their incidence rates have increased since the year 2010.
Collapse
Affiliation(s)
- Tao Zhang
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Fei Yin
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Ting Zhou
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Xing-Yu Zhang
- West China School of Public Health, Sichuan University, Chengdu, China.
| | - Xiao-Song Li
- West China School of Public Health, Sichuan University, Chengdu, China.
| |
Collapse
|
10
|
The expansion of the economic frontier and the diffusion of violence in the Amazon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5862-85. [PMID: 26024359 PMCID: PMC4483676 DOI: 10.3390/ijerph120605862] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/17/2015] [Indexed: 11/24/2022]
Abstract
Over the last few decades, the occupation of the Amazon and the expansion of large-scale economic activities have exerted a significant negative impact on the Amazonian environment and on the health of the Amazon’s inhabitants. These processes have altered the context of the manifestation of health problems in time and space and changed the characteristics of the spatial diffusion of health problems in the region. This study analyzed the relationships between the various economic processes of territorial occupation in the Amazon and the spatial diffusion of homicidal violence through the configuration of networks of production, as well as the movements of population and merchandise. Statistical data on violence, deforestation, the production of agricultural items, and socio-economic variables, georeferenced and available for the 771 municipalities of the Legal Amazon were used in this study. The results suggest that the diffusion of violence closely follows the economic expansion front, which is related to deforestation and livestock production but has little relation to grain production, demonstrating steps and typologies of recent occupation in the Amazon that promote violence. These spatial patterns reveal environmental and socio-economic macro-determinants that materialize in geographic space through the construction of highways and the formation of city networks.
Collapse
|
11
|
Abati PAM, Segurado AC. HIV testing and clinical status upon admission to a specialized health care unit in Pará, Brazil. Rev Saude Publica 2015; 49:16. [PMID: 25741647 PMCID: PMC4386565 DOI: 10.1590/s0034-8910.2015049004625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 09/17/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the clinical and laboratory characteristics of HIV-infected individuals upon admission to a reference health care center. METHODS This cross-sectional study was conducted between 1999 and 2010 on 527 individuals with confirmed serological diagnosis of HIV infection who were enrolled in an outpatient health care service in Santarém, PA, Northern Brazil. Data were collected from medical records and included the reason for HIV testing, clinical status, and count of peripheral CD4+ T lymphocytes upon enrollment. The data were divided into three groups, according to the patient’s year of admission – P1 (1999-2002), P2 (2003-2006), and P3 (2007-2010) – for comparative analysis of the variables of interest. RESULTS In the study group, 62.0% of the patients were assigned to the P3 group. The reason for undergoing HIV testing differed between genders. In the male population, most tests were conducted because of the presence of symptoms suggesting infection. Among women, tests were the result of knowledge of the partner’s seropositive status in groups P1 and P2. Higher proportion of women undergoing testing because of symptoms of HIV/AIDS infection abolished the difference between genders in the most recent period. A higher percentage of patients enrolling at a more advanced stage of the disease was observed in P3. CONCLUSIONS Despite the increased awareness of the number of HIV/AIDS cases, these patients have identified their serological status late and were admitted to health care units with active disease. The HIV/AIDS epidemic in Pará presents specificities in its progression that indicate the complex characteristics of the epidemic in the Northern region of Brazil and across the country.
Collapse
|
12
|
Donalisio MR, Cordeiro R, Lourenco RW, Brown JC. The AIDS epidemic in the Amazon region: a spatial case-control study in Rondonia, Brazil. Rev Saude Publica 2014; 47:873-82. [PMID: 24626491 DOI: 10.1590/s0034-8910.2013047004539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 07/05/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze spatial changes in the risk of AIDS and the relationship between AIDS incidence and socioeconomic variables in the state of Rondonia, Amazon region. METHODS A spatial, population case-control study in Rondonia, Brazil, based on 1,780 cases reported to the Epidemiological Surveillance System and controls based on demographic data from 1987 to 2006. The cases were grouped into five consecutive four-year periods. A generalized additive model was adjusted to the data; the dependent variable was the status of the individuals (case or control), and the independent variables were a bi-dimensional spline of the geographic coordinates and some municipality-level socioeconomic variables. The observed values of the Moran's I test were compared to a reference distribution of values generated under conditions of spatial randomness. RESULTS AIDS risk shows a marked spatial and temporal pattern. The disease incidence is related to socioeconomic variables at the municipal level in Rondônia, such as urbanization and human capital. The highest incidence rates of AIDS are in municipalities along the BR-364 highway and calculations of the Moran's I test show positive spatial correlation associated with proximity of the municipality to the highway in the third and fourth periods (p = 0.05). CONCLUSIONS Incidence of the disease is higher in municipalities of greater economic wealth and urbanization, and in those municipalities bisected by Rondônia's main roads. The rapid development associated with the opening up of once remote regions may be accompanied by an increase in these risks to health.
Collapse
|
13
|
Teixeira TRDA, Gracie R, Malta MS, Bastos FI. Social geography of AIDS in Brazil: identifying patterns of regional inequalities. CAD SAUDE PUBLICA 2014; 30:259-71. [DOI: 10.1590/0102-311x00051313] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 08/14/2013] [Indexed: 11/22/2022] Open
Abstract
The trend towards decline and stabilization of the AIDS epidemic in Brazil should be analyzed carefully, since aggregate data can mask regional or local inequalities in such a large and diverse country. The current study reevaluates the epidemic’s spatial dissemination and the AIDS-related mortality pattern in Brazil. The study considered all AIDS cases diagnosed in individuals over 18 years of age and living in Brazil, as well as AIDS deaths recorded in 1998-2008. Three-year moving average rates were estimated, and a spatial analysis was conducted using a local empirical Bayesian method. The epidemic was only found to be expanding in the North and Northeast regions, while declining in the rest of the country, especially in the Southeast. According to the findings, the apparent stabilization of AIDS mortality tends to mask regional disparities. Social determinants of health and regional disparities should be taken into account in program development and policymaking.
Collapse
|
14
|
Barcellos C, Lowe R. Expansion of the dengue transmission area in Brazil: the role of climate and cities. Trop Med Int Health 2013; 19:159-68. [DOI: 10.1111/tmi.12227] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Christovam Barcellos
- Instituto de Comunicação e Informação Científica e Tecnológica; Fundação Oswaldo Cruz; Rio de Janeiro Brazil
| | - Rachel Lowe
- Institut Català de Ciències del Clima; Barcelona Spain
| |
Collapse
|