A expansão da hanseníase no nordeste brasileiro

The epidemiological aspects of hanseniasis in Recife from 1960 to 1985 were studied. Clinical-epidemiological records of 3,923 leprosy patients reported to the Secretaria de Saúde do Estado de Pernambuco were reviewed. The cruce as well as the age, sex and type-specific detection rates were calculated. The way the cases were detected and the time elapsed between the appearance of the first symptoms and the disease was analysed. The analysis of the time trend during the observation period showed an increase in the detection rate with time, rising from 5.5 per 100,000 inhabitants in 1960 to 36.1 per 100,000 inhabitants in 1985. The higher frequency of the tuberculoid type of leprosy and the high percentage of patients under 15 might reflect the expansion of the disease in Recife. The decline and the stabilization in the time elapsed between the appearance of the disease and its detection, from 1979 onwards, indicates a more prompt detection and, as a consequence of that, that the rate of detection is approaching the incidence rate. From 1970 to 1985 the most common means of detecting cases of Hanseniasis was through dermatological consultation followed by disease notification. Only 14.2% of the cases were discovered through the surveillance of contacts. The analysis of the epidemiological and operational indicators suggest that the increase in the detection rate over the period from 1960 to 1985 was due both to expansion of the disease and improvement in control measures. The prevalence rate of Hanseniasis in Recife in December 1984 was 2.04 per 100,000 inhabitants; according to the WHO criteria Recife may be considered an area of high endemicity.Caracterizou-se a situação epidemiológica da hanseníase na cidade de Recife, Estado de Pernambuco, Brasil, entre 1960 e 1985, pela análise de 3.923 fichas clínico-epidemiológicas de pacientes notificados à Secretaria de Saúde do Estado de Pernambuco, Brasil. Foram calculados os coeficientes de detecção de casos brutos e específicos por sexo, grupo etário e forma clínica, além de analisados o modo de detecção dos casos e o intervalo de tempo decorrido entre o aparecimento dos sintomas e o diagnóstico de hanseníase. O estudo da tendência temporal do coeficiente de detecção de casos revelou um crescimento progressivo de 5,5:100 000 habitantes em 1960 para 36,1:100 000 habitantes, em 1985. O predomínio da forma tuberculóide e o elevado percentual de menores de 15 anos acometidos pela doença podem estar refletindo a expansão da endemia na cidade do Recife, PE. A diminuição e estabilização do intervalo de tempo decorrido desde o aparecimento dos sintomas até o diagnóstico de hanseníase, a partir de 1979, foram consideradas indicadores da detecção mais precoce dos casos e, conseqüentemente, da aproximação do coeficiente de detecção de casos do coeficiente de incidência. Entre 1970 e 1985, o modo de detecção de casos mais freqüente foi a consulta dermatológica, seguida pela notificação; apenas 14,2% dos casos foram descobertos através da vigilância de comunicantes. A análise dos indicadores epidemiológicos e operacionais sugere que o aumento expressivo do coeficiente de detecção de casos deve ser resultado tanto da expansão da endemia quanto da implementação de algumas das ações de controle. Já o coeficiente de prevalência calculado para a cidade do Recife, em dezembro de 1985, foi de 2,04/mil habitantes, situando-se a cidade como área de alta endemicidade para a hanseníase, pelos critérios da Organização Mundial de Saúde

Análise espacial dos determinantes socioeconômicos dos homicídios no Estado de Pernambuco

OBJECTIVE: To investigate the association between homicide rates and socio-economic variables taking into account the spatial site of the indicators. METHODS: An ecological study was conducted. The dependent variable was the rate of homicides among the male population aged 15 to 49 years, residing in the districts of the State of Pernambuco from 1995 to 1998. The independent variables were an index of the living conditions, per capita family income, Theil inequality index, Gini index, average income of the head of the family, poverty index, rate of illiteracy, and demographic density. The following techniques were used in the analysis: a spatial autocorrelation test determined by the Moran index, multiple linear regression, a spatial regression model (CAR) and a generalized additive model for the detection of spatial trend (LOESS). RESULTS: The illiteracy and the poverty index explained 24.6% of the total variability of the homicide rates and there was an inverse relationship. Moran´s I statistics indicated spatial autocorrelation between municipalities. The multiple linear regression model best fitted for the purposes of this study was the Conditional Auto Regressive (CAR) model. The latter confirmed the association between the poverty index, illiteracy and homicide rates. CONCLUSIONS: The inverse association observed between socio-economic indicators and homicides may be expressing a process that propitiates improvement in living conditions and that is linked predominantly to conditions that generate violence, such as drug traffic.OBJETIVO: Investigar a associação entre variáveis socioeconômicas e taxas de homicídio, considerando a localização espacial dos indicadores. MÉTODOS: Utilizou-se o método de estudo ecológico. A variável dependente foi taxa de homicídio da população masculina de 15 a 49 anos, residente nos municípios do Estado de Pernambuco, em 1995 a 1998. As variáveis independentes referem-se a: índice de condições de vida, renda familiar per capita, desigualdade de Theil, índice de Gini, renda média do chefe de família, índice de pobreza, taxa de analfabetismo, densidade demográfica.Utilizou-se teste de correlação espacial determinado pelo Índice de Moran, regressão múltipla, Conditional Auto Regressive (CAR) e a função Loess, como modelo de detecção de tendência especial. RESULTADOS: Os indicadores taxa de analfabetismo e índice de pobreza explicaram 24,6% da variabilidade total das taxas de homicídio, cuja associação foi inversa. O índice de Moran revelou autocorrelação espacial entre os municípios. O modelo de regressão espacial que melhor se adequou ao estudo foi o CAR, que confirmou a associação entre índice de pobreza, analfabetismo e homicídio. CONCLUSÕES: A relação inversa observada entre os indicadores socioeconômicos e homicídios pode expressar determinado processo que propicia melhoria das condições de vida, e está atrelado predominantemente a condições geradoras de violência, como a do tráfico de drogas

Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases.

The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition

An evaluation of factors associated with taking and responding positive to the tuberculin skin test in individuals with HIV/AIDS

<p>Abstract</p> <p>Background</p> <p>The tuberculin skin test (TST) is still the standard test for detecting latent infection by <it>M tuberculosis </it>(LTBI). Given that the Brazilian Health Ministry recommends that the treatment of latent tuberculosis (LTBI) should be guided by the TST results, the present study sets out to describe the coverage of administering the TST in people living with HIV at two referral health centers in the city of Recife, where TST is offered to all patients. In addition, factors associated with the non-application of the test and with positive TST results were also analyzed.</p> <p>Methods</p> <p>A cross-sectional study was carried out with HIV patients, aged 18 years or over, attending outpatient clinics at the Correia Picanço Hospital/SES/PE and the Oswaldo Cruz/UPE University Hospital, who had been recommended to take the TST, in the period between November 2007 and February 2010. Univariate and multivariate logistic regression analyses were carried out to establish associations between the dependent variable - taking the TST (yes/no), at a first stage analysis, and the independent variables, followed by a second stage analysis considering a positive TST as the dependent variable. The odds ratio was calculated as the measure of association and the confidence interval (CI) at 95% as the measure of accuracy of the estimate.</p> <p>Results</p> <p>Of the 2,290 patients recruited, 1087 (47.5%) took the TST. Of the 1,087 patients who took the tuberculin skin test, the prevalence of TST ≥ 5 mm was 21.6% among patients with CD4 ≥ 200 and 9.49% among those with CD4 < 200 (p = 0.002). The patients most likely not to take the test were: men, people aged under 39 years, people with low educational levels and crack users. The risk for not taking the TST was statiscally different for health service. Patients who presented better immunity (CD4 ≥ 200) were more than two and a half times more likely to test positive that those with higher levels of immunodeficiency (CD4 < 200).</p> <p>Conclusions</p> <p>Considering that the TST is recommended by the Brazilian health authorities, coverage for taking the test was very low. The most serious implication of this is that LTBI treatment was not carried out for the unidentified TST-positive patients, who may consequently go on to develop TB and eventually die.</p

A produção do conhecimento científico e as políticas de saúde pública: reflexões a partir da ocorrência da filariose na cidade do Recife, Pernambuco, Brasil

O artigo discute a relação entre a produção científica sobre a ocorrência da filariose bancroftiana no Brasil e o processo de formulação e implementação da política de saúde voltada ao seu controle. Para tanto, realiza uma revisão da produção do conhecimento e das políticas específicas, no período compreendido desde a criação do Programa de Combate à Filariose, em meados do século passado, até a criação do SUS, no marco da descentralização do controle das endemias. Centrando suas observações empíricas na ambiência da cidade do Recife, espaço urbano no qual ainda prevalece a filariose, ressalta os processos institucionais e destaca o papel dos distintos atores neles envolvidos. Partindo da hipótese de que se até à primeira metade do século vinte faltavam o conhecimento científico e o desenvolvimento tecnológico para o controle do problema, a seguir, quando esses avanços são disponibilizados, outros requerimentos, agora do campo da política, irão se impor, atuando como determinantes da persistência da endemia na cidade