How many AIDS epidemics can occur in São Paulo city?

OBJECTIVE: An ecological study describring the spatial characteristics of AIDS in São Paulo city between 2001 and 2010 according to the place of residence of reported cases in adults. METHODS: The AIDS reported cases (28,146), grouped by sex, were geocodified (25,969) and linked with a census tract database (18,953). Case and population at risk data supplied spatial cluster identification and relative risk estimate by the scan method, using the discrete Poisson model. Incidence rate and proportional distribution allowed comparing people living in the high-risk clusters areas to other locations by age, race/ethnicity, schooling and transmission category. RESULTS: The AIDS incidence rate decreased in both sexes except among young men and older people. The identification of spatial high-risk clusters showed that the decrease of AIDS did not occur in the same way in the city. Clusters located in the central area presented the highest AIDS incidence rates (245.7/100,000 men), especially among black women (RR = 7.9), men who have sex with men (66.2%) and injection drug users (10.7%) participation. In peripheral clusters, identified only in the female population, the epidemic can be related to the poverty of these women (22.5% low education level). Residents in the north and central-south areas of the city are generally black, with little schooling, and predominantly heterosexually infected. CONCLUSIONS: The study of spatial clusters using a census tract helps to determine epidemiological patterns inside the city and in specific populations. Spatial stratification and key population epidemiological patterns were identified in four regions in São Paulo cit

Covid-19 hospital mortality using spatial hierarchical models: cohort design with 74,994 registers

OBJECTIVE: To investigate the relationship between covid-19 hospital mortality and risk factors, innovating by considering contextual and individual factors and spatial dependency and using data from the city of São Paulo, Brazil. METHODS: The study was performed with a spatial hierarchical retrospective cohort design using secondary data (individuals and contextual data) from hospitalized patients and their geographic unit residences. The study period corresponded to the first year of the pandemic, from February 25, 2020 to February 24, 2021. Mortality was modeled with the Bayesian context, Bernoulli probability distribution, and the integrated nested Laplace approximations. The demographic, distal, medial, and proximal covariates were considered. RESULTS: We found that per capita income, a contextual covariate, was a protective factor (odds ratio: 0.76 [95% credible interval: 0.74–0.78]). After adjusting for income, the other adjustments revealed no differences in spatial dependence. Without income inequality in São Paulo, the spatial risk of death would be close to one in the city. Other factors associated with high covid-19 hospital mortality were male sex, advanced age, comorbidities, ventilation, treatment in public healthcare settings, and experiencing the first covid-19 symptoms between January 24 and February 24, 2021. CONCLUSIONS: Other than sex and age differences, geographic income inequality was the main factor responsible for the spatial differences in the risk of covid-19 hospital mortality. Investing in public policies to reduce socioeconomic inequities, infection prevention, and other intersectoral measures should focus on lower per capita income, to control covid-19 hospital mortalit

Spatial pattern of mortality from breast and cervical cancer in the city of São Paulo

OBJETIVOS: Verificar o padrão espacial da mortalidade pelos cânceres de mama e do colo do útero, em áreas da atenção primária à saúde, levando em consideração as condições socioeconômicas. MÉTODOS: O estudo é ecológico, de janeiro de 2000 a dezembro de 2016. A área de estudo é o município de São Paulo, Brasil, e suas 456 áreas de abrangência das unidades básicas de saúde. As informações sobre óbitos de mulheres com 20 anos ou mais de idade foram geocodificadas segundo endereço de residência. Foram calculadas as taxas de mortalidade, padronizadas por idade, e suavizadas pelo método bayesiano empírico local, além de agrupadas em três ou dois anos para reduzir a flutuação aleatória dos dados. Além disso, foram calculados os índices de Moran global e local bivariados, para verificar a existência de aglomeração espacial das taxas de mortalidade padronizadas com um domínio de condição socioeconômica, elaborado a partir do Índice Paulista de Vulnerabilidade Social. RESULTADOS: A taxa de sucesso da geocodificação foi de 98,9%. A mortalidade por câncer de mama, sem estratificação por tempo, apresentou um padrão com maiores taxas localizadas nas regiões centrais e com melhores condições socioeconômicas. Apresentou queda ao final do período e mudança de padrão espacial, com aumento da mortalidade nas regiões periféricas. Já a mortalidade por câncer do colo do útero manteve-se com as maiores taxas nas regiões periféricas e com piores condições socioeconômicas, apesar de apresentar redução ao longo do tempo. CONCLUSÃO: O padrão espacial da mortalidade pelos cânceres do estudo, ao longo do tempo, sugere associação com as melhores condições socioeconômicas do município, seja como proteção (colo) ou risco (mama). Esse conhecimento pode direcionar recursos para a prevenção e a promoção da saúde nos territórios.OBJECTIVE: To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions. METHODS: Th is i s a n e cological s tudy, f rom J anuary 2 000 t o D ecember 2 016. Th e s tudy area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS – São Paulo Index of Social Vulnerability). RESULTS: The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time. CONCLUSION: The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories

Dysbiotic oral microbiota contributes to alveolar bone loss associated with obesity in mice

Periodontal diseases (PD) are inflammatory conditions that affect the teeth supporting tissues. Increased body fat tissues may contribute to activation of the systemic inflammatory response, leading to comorbidities. Some studies have shown that individuals with obesity present higher incidence of PD than eutrophics. Objective: To investigate the impact of obesity on periodontal tissues and oral microbiota in mice. Methodology: Two obesity mice models were performed, one using 12 weeks of the dietary protocol with a high-fat (HF) diet in C57BL/6 mice and the other using leptin receptor-deficient mice (db/db-/-), which became spontaneously obese. After euthanasia, a DNA-DNA hybridization technique was employed to evaluate the microbiota composition and topical application of chlorhexidine (CHX), an antiseptic, was used to investigate the impact of the oral microbiota on the alveolar bone regarding obesity. Results: Increased adipose tissue may induce alveolar bone loss, neutrophil recruitment, and changes in the oral biofilm, similar to that observed in an experimental model of PD. Topical application of CHX impaired bone changes. Conclusion: Obesity may induce changes in the oral microbiota and neutrophil recruitment, which are associated with alveolar bone loss

Soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares no município de São Paulo, 2020

OBJECTIVE: To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS: A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS: Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4–17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6–20.6) and state (16.2%; 95%CI 14.4–18.2) public school systems compared to the private school system (11.7; 95%CI 10.0–13.7), among black and brown students (18.4%; 95%CI 16.8–20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9–20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION: Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.OBJETIVO: Estimar a soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares de quatro a 14 anos de idade residentes no município de São Paulo, segundo variáveis clínicas, demográficas, epidemiológicas e sociais, durante o período de fechamento das escolas como medida de controle da covid-19. MÉTODOS: Realizou-se um inquérito sorológico em setembro de 2020 com amostra aleatória estratificada por tipo de rede de ensino (pública municipal, pública estadual e privada). Foi coletada amostra de sangue venoso utilizando-se o teste de imunoensaio de fluxo lateral da fabricante Wondfo para detecção de anticorpos totais contra o vírus SARS-CoV-2. Aplicaram-se questionários semiestruturados para o levantamento de dados clínicos, demográficos, sociais e epidemiológicos. RESULTADOS: A soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares foi de 16,6% (IC95% 15,4–17,8). O estudo encontrou soroprevalências mais elevadas na rede pública municipal (18,5%; IC95% 16,6–20,6) e estadual (16,2%; IC95% 14,4–18,2) em relação à rede privada (11,7; IC95% 10,0–13,7) e entre escolares da raça/cor preta e parda (18,4%; IC95% 16,8–20,2) e no estrato social mais vulnerável (18,5%; IC95% 16,9–20,2). A pesquisa identificou menores soroprevalências nos escolares que relataram seguir as medidas recomendadas de proteção contra a covid-19. CONCLUSÃO: A soroprevalência de anticorpos contra o vírus SARS-CoV-2 atinge principalmente os escolares socialmente mais vulneráveis. Este estudo pode contribuir para embasar políticas públicas que reforcem a importância da suspensão das aulas presenciais e da necessidade de estratégias de medidas de proteção e acompanhamento do status sorológico daqueles que ainda não foram contemplados no calendário vacinal

Factors associated with breast and cervical cancer mortality in the city of São Paulo: an ecological comparative analysis

Objetivos: Identificar a variabilidade espacial intraurbana da mortalidade por câncer de mama e câncer do colo do útero e possíveis fatores associados. Analisar padrões temporais de tendência e sazonalidade na realização dos exames de rastreamento para câncer do colo do útero e mama, segundo faixa etária, gestão administrativa, e nos estabelecimentos municipais, nível de Atenção à Saúde. Métodos: Entre 2009 e 2016 foram registrados 10.124 óbitos por câncer de mama e 2.116 óbitos por câncer do colo do útero em mulheres com 20 anos e mais residentes no município de São Paulo. Os registros foram geocodificados por endereço de residência e agregados segundo Áreas de Abrangência das UBS do município. Foram realizadas modelagens espaciais em um contexto Bayesiano, utilizando-se a abordagem INLA (Integrated Nested Laplace Approximations) para verificar a associação dos óbitos pelos dois cânceres com indicadores sociais, demográficos, econômicos, educacionais e assistenciais. Desenvolveu-se análise de séries temporais dos exames citopatológico cérvico-vaginal / microflora e mamografia bilateral para rastreamento realizados em mulheres com 20 anos e mais residentes no município de São Paulo entre 2010 e 2019. Foram ajustados modelos lineares generalizados, com resposta binomial negativa, da razão de procedimentos em função do mês de referência, ano, faixa etária. Para o cálculo do risco relativo (RR) e da variação percentual (%) em relação a Outubro (VPM) e anual (VPA) foram utilizadas técnicas de regressão segmentada e variáveis indicadoras para o período. Resultados: A taxa geral de geocodificação foi 99,4%. As mortalidades por câncer de mama e por câncer do colo do útero apresentaram padrões espaciais inversos no município de São Paulo. Algumas variáveis estiveram associadas à mortalidade por câncer de mama: tempo de deslocamento entre uma e duas horas para o trabalho (RR 0,97; IC95% 0,93:1,00); proporção de mulheres responsáveis pelo domicílio (RR 0,97; IC95% 0,94:0,99) e proporção de óbitos por câncer de mama ocorridos em estabelecimentos privados (RR 1,04; IC95% 1,00:1,07). À mortalidade por câncer do colo do útero, estiveram associados: tempo de deslocamento para o trabalho entre meia e uma hora (RR 0,92; IC95% 0,87:0,98); rendimento domiciliar per capita até 3,0 salários mínimos (RR 1,27; IC95% 1,18:1,37) e razão de menores de um ano em relação à população feminina de 15 a 49 anos (RR 1,09; IC95% 1,01:1,18). A razão de exames citopatológico cérvico-vaginal / microflora estimada na população sem plano de saúde é elevada, com queda a partir de 2013. Observou-se aumento no rastreamento por mamografia na faixa etária preconizada; porém, é alta a proporção deste procedimento em mulheres abaixo de 50 anos. O rastreamento para câncer do colo do útero e mama não apresentou sazonalidade em relação ao mês de Outubro. Conclusão: Este estudo permitiu testar a associação entre diferentes indicadores nas áreas de abrangência da Atenção Primária à Saúde e a variabilidade espacial intraurbana da mortalidade por câncer de mama e do colo do útero no município de São Paulo. Além de analisar a tendência temporal e a sazonalidade relacionada a Outubro do rastreamento para câncer do colo do útero e mama, bem como evidenciar as diferenças na solicitação destes exames segundo gestão administrativa e nível de Atenção à Saúde, no sentido de colaborar com a prevenção destes cânceres.Objectives: To identify intra-urban spatial variability in mortality from breast and cervical cancer and possible associated factors. To analyze temporal patterns of trend and seasonality in the performance of screening tests for cervical and breast cancer, according to age group, administrative management, and in municipal establishments, Health Care level. Methods: Between 2009 and 2016, 10,124 deaths were recorded from breast cancer and 2,116 deaths from cervical cancer in women aged 20 years and over living in the city of São Paulo. The records were geocoded by home address and aggregated according to the coverage areas of the municipal UBS. Spatial modeling was carried out in a Bayesian context, using the INLA (Integrated Nested Laplace Approximations) approach to verify the association of deaths from both cancers with social, demographic, economic, educational and health care indicators. Time series analysis of cervical-vaginal / microflora cytopathological exams and bilateral mammography for screening performed on women aged 20 years and over living in the city of São Paulo between 2010 and 2019 was developed. Generalized linear models were adjusted, with negative binomial response, the ratio of procedures according to the reference month, year and age group. To calculate the relative risk (RR) and the percentage change (%) in relation to October (MPC) and annual (APC) time, we used segmented regression techniques and indicator variables for the period. Results: The general rate of geocoding was 99.4%. Mortalities due to breast cancer and cervical cancer showed inverse spatial patterns in the city of São Paulo. Some variables were associated with breast cancer mortality: commuting time between one and two hours to work (RR 0.97; 95% CI 0.93:1.00); proportion of women responsible for the household (RR 0.97; 95% CI 0.94:0.99) and proportion of breast cancer deaths that occurred in private establishments (RR 1.04; 95% CI 1.00:1.07). Cervical cancer mortality was associated with: commuting time between half an hour and an hour to work (RR 0.92; 95% CI 0.87:0.98); per capita household income up to 3.0 minimum wages (RR 1.27; 95% CI 1.18:1.37) and ratio of children under one year old to the female population aged 15 to 49 years (RR 1.09; 95% CI % 1.01:1.18). The ratio of cervical-vaginal / microflora cytopathological examinations estimated in the population without a health plan is high, with a drop from 2013. There was an increase in screening by mammography in the recommended age group; however, the proportion of this procedure in women under 50 is still high. The screening for cervical and breast cancer did not show seasonality in relation to October. Conclusion: This study allowed to test the association between different indicators in the areas covered by Primary Health Care and the intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo. In addition to analyzing the temporal trend and seasonality related to October of cervical and breast cancer screening, as well as highlighting the differences in the request for these tests according to the administrative management and the Health Care level, in order to collaborate with the prevention of these cancers