Intra-urban differences underlying leprosy spatial distribution in central Brazil:geospatial techniques as potential tools for surveillance

This ecological study identified an aggregation of urban neighbourhoods spatial patterns in the cumulative new case detection rate (NCDR) of leprosy in the municipality of Rondonópolis, central Brazil, as well as intra-urban socioeconomic differences underlying this distribution. Scan statistics of all leprosy cases reported in the area from 2011 to 2017 were used to investigate spatial and spatiotemporal clusters of the disease at the neighbourhood level. The associations between the log of the smoothed NCDR and demographic, socioeconomic, and structural characteristics were explored by comparing multivariate models based on ordinary least squares (OLS) regression, spatial lag, spatial error, and geographically weighted regression (GWR). Leprosy cases were observed in 84.1% of the neighbourhoods of Rondonópolis, where 848 new cases of leprosy were reported corresponding to a cumulative NCDR of 57.9 cases/100,000 inhabitants. Spatial and spatiotemporal high-risk clusters were identified in western and northern neighbourhoods, whereas central and southern areas comprised low-risk areas. The GWR model was selected as the most appropriate modelling strategy (adjusted R²: 0.305; AIC: 242.85). By mapping the GWR coefficients, we identified that low literacy rate and low mean monthly nominal income per household were associated with a high NCDR of leprosy, especially in the neighbourhoods located within high-risk areas. In conclusion, leprosy presented a heterogeneous and peripheral spatial distribution at the neighbourhood level, which seems to have been shaped by intra-urban differences related to deprivation and poor living conditions. This information should be considered by decision-makers while implementing surveillance measures aimed at leprosy control.</p

Research On Zinc Blood Levels And Nutritional Status In Adolescents With Autoimmune Hepatitis.

Zinc deficiency in children and adolescents impairs their growing, development and immune system. To verify the existence of plasma and leukocyte zinc deficiency in adolescents with autoimmune hepatitis. The study comprised 23 patients with autoimmune hepatitis, aged 10-18 years, assisted at the Ambulatory Service of Pediatric Hepatology of the University of Campinas Teaching Hospital, Campinas, SP, Brazil, and adolescents with ages compatible with the patients' ages comprised the control group. Sample of blood in both groups was collected for the analyses of plasma zinc and leukocyte zinc by atomic absorption spectrophotometry, beyond the nutritional status was evaluated in each adolescent. The following statistical tests were used: Mann-Whitney, Spearman's correlation and interclass concordance analysis. The significance level adopted was 5%. The average zinc level in plasma in patients was 71.91 ± 11.79 µg/dL and, in the control group, it was 80.74 ± 10.92 µg/dL, showing a significant difference (P = 0.04). The leukocyte zinc level in patients was 222.33 ± 166.13 pmol/10⁶ cells and, in the control group, it was 226.64 ± 217.81 pmol/10⁶ cells; there was no statistical significance between them (P = 0.45). The evaluation of the nutritional status showed that eutrophy is prevalent in patients, and they presented a higher body fat value than the control group, with a significant difference. More research is needed with adolescents with autoimmune hepatitis regarding levels of essential micronutrients, such as zinc, because a good nutritional status can improve the prognostic of liver disease.4862-

Economic–Sanitation–Environmental (Dis)Connections in Brazil: A Trans-Scale Perspective From Minas Gerais State and BH Microregion

Brazil’s economic, environmental, and infrastructural landscape is characterised by local and regional inequalities, particularly evident in Minas Gerais state and the municipalities surrounding its capital, Belo Horizonte (BH) microregion. This research examines three primary domains: (a) economic metrics such as GDP per capita, wages, and formal employment; (b) the availability of clean water and sewage systems; and (c) the frequency of emergency decrees. It aims to ascertain whether these factors can delineate economic, health, and socio-environmental divides within the BH microregion and between its urban and rural areas. Economically, a pronounced gap exists between GDP growth and wage stability, underscoring disparities between the BH microregion and the broader state. While the BH microregion boasts higher salaries and GDP, it also grapples with a heightened cost of living. Disparities in water and sewage infrastructure are stark between urban and non-urban locales, with the latter often lacking access. Emergency decrees are correlated with municipal GDP, with lower-GDP areas experiencing more crises, albeit to a lesser extent in the BH microregion. Cluster analysis reveals a nexus between frequent emergencies, lower GDP, and improved access to water and sewage services. Addressing these challenges requires comprehensive public policies to foster local well-being and alleviate economic, infrastructural, and environmental disparities within both the state and the BH microregion

A compact minimal shadow boundary in Euclidean space is totally geodesic

We prove that a compact minimal shadow boundary of a hypersurface in Euclidean space is totally geodesic. We show that shadow boundaries detect principal directions and umbilical points of a hypersurface. As application we deduce that every shadow boundary of a compact strictly convex surface contains at least two principal direction

Gestão Participativa e a interface com trabalhadores do Sistema Único de Saúde: uma revisão integrativa

Trata-se de uma revisão integrativa de literatura com objetivo de integrar o conhecimento produzido acerca da Gestão Participativa e a interface dos trabalhadores do SUS. Para seleção dos artigos foram consultadas três bases de dados – Scielo, LiLACS e MEDLINE  - sendo incluídos doze artigos. Os resultados mostram estudos qualitativos, todos publicados entre 2008 a 2012. Identificou-se nos artigos que a Gestão Participativa é vivenciada por trabalhadores de saúde, muito embora haja dificuldades para a mesma. Os resultados evidenciaram um maior número de estudos nas regiões sul e sudeste brasileiro. Conclui-se que a Gestão Participativa é importante para o desenvolvimento do SUS e que é possível superar desafios e fazer com que o trabalhador de saúde participe mais do processo de decisões