O uso da escala geográfica na saúde pública: as escalas da leishmaniose visceral / The use of the geographic scale in health: the scales of visceral leishmaniasis

Resumo A escala geográfica tem sido amplamente discutida na tentativa de formar um conceito que dê conta de explicar as diferentes realidades do espaço. Nos diversos seguimentos de planejamento em saúde, faz-se uma adoção das categorias e conceitos geográficos sem entender os problemas inerentes à escala geográfica, o que afeta diretamente nas políticas públicas implantadas e, consequentemente, na vida das pessoas. O objetivo deste artigo foi discutir o conceito de escala a partir dos seus diferentes níveis, e debater a dificuldade de articulá-los por meio da atuação dos órgãos de vigilância em saúde pública brasileira que lidam com a leishmaniose visceral. Realizamos uma revisão de literatura para demonstrar como o debate do conceito de escala geográfica com a saúde é ainda incipiente. Utilizamos conceitos geográficos, integrando as políticas municipais, estaduais e nacional sob a ótica da escala geográfica. Dessa forma, acreditamos que seja possível uma articulação dos órgãos dos sistemas de saúde com a sociedade na transposição de escalas, num acontecer solidário, produzindo um sistema de saúde mais eficaz. A discussão não será aqui esgotada, mas permitirá uma reflexão nas opções teórico-metodológicas em pesquisas e em saúde pública.

Abstract The geographical scale has been broadly discussed in an attempt to formulate a concept that succeeds in explaining different space-related realities. In the various sectors of health planning, geographic categories and concepts have been adopted without understanding the problems inherent to the geographical scale, which directly affects public policies implemented and, consequently, people's lives. The scope of this paper was to discuss the concept of scale based on the different scale levels and the difficulty of their implementation by means of the activities of the organs that operate in public health surveillance that deal with visceral leishmaniasis. A systematic review of the literature was conducted to show how the debate about geographical scale and health is still incipient. Geographical concepts were used, integrating municipal, state and national policies from the perspective of the geographic scale. Thus, the contention is that cooperation between health agencies and society is possible by the transposition of scales, creating an environment of solidarity and a more effective health system. The discussion does not end here, but it will make it viable to reflect on the theoretical and methodological options in research and in public health.

Seroprevalence of HBV, HCV and HIV co-infection in selected individuals from state of São Paulo, Brazil

Few studies are available on hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection in populations living in small and medium-sized Brazilian cities. We evaluated the seroprevalence of these viruses in selected individuals from a clinic of infectology, who were referred to the University Regional Hospital of the West Region of state of São Paulo, Brazil. Among a total of 7,021 individuals seen in the clinic following receipt of preliminary ELISA results or having the suggested clinical signs of viral hepatitis or HIV, 1,228 were systematically screened. Isolated or associated HBsAg, HCV and HIV antibodies were found in 44.9 percent of the subjects. Anti-HIV antibodies were found in 24.7 percent of the patients, 20.3 percent of whom had an HIV monoinfection and 4.4 percent of whom were co-infected with hepatitis viruses (HCV: 4 percent; HBV: 0.4 percent). Anti-HCV antibodies were found in 14 percent of the patients and 5.9 percent had anti-HBsAg antibodies. HCV infection affected males more than females (p < 0.05) and individuals > 50-years old had an increased prevalence of anti-HCV compared to HIV (p = 0.0001) or HBV (p = 0.0063). HCV-RNA was detected in 73.5 percent of the samples with a predominance of genotype 1 (72.5 percent). A significant percentage (44.9 percent) of the selected individuals was positive for antibodies against HBV, HCV and/or HIV; these patients would otherwise have remained undiagnosed.