Neurological complications associated with emerging viruses in Brazil.

OBJECTIVE: To test the hypotheses that emerging viruses are associated with neurological hospitalizations and that statistical models can be used to predict neurological sequelae from viral infections. METHODS: An ecological study was carried out to observe time trends in the number of hospitalizations with inflammatory polyneuropathy and Guillain-Barré syndrome (GBS) in the state of Rio de Janeiro from 1997 to 2017. Increases in GBS from month to month were assessed using a Farrington test. In addition, a cross-sectional study was conducted analyzing 50 adults hospitalized for inflammatory polyneuropathies from 2015 to 2017. The extent to which Zika virus symptoms explained GBS hospitalizations was evaluated using a calibration test. RESULTS: There were significant increases (Farrington test, P<0.001) in the incidence of GBS following the introduction of influenza A/H1N1 in 2009, dengue virus type 4 in 2013, and Zika virus in 2015. Of 50 patients hospitalized, 14 (28.0%) were diagnosed with arboviruses, 9 (18.0%) with other viruses, and the remainder with other causes of such neuropathies. Statistical models based on cases of emerging viruses accurately predicted neurological sequelae, such as GBS. CONCLUSION: The introduction of novel viruses increases the incidence of inflammatory neuropathies.

Geographical information system (GIS) modeling territory receptivity to strengthen entomological surveillance: Anopheles (Nyssorhynchus) case study in Rio de Janeiro State, Brazil.

BACKGROUND: Extra-Amazonian malaria mortality is 60 times higher than the Amazon malaria mortality. Imported cases correspond to approximately 90% of extra-Amazonian cases. Imported malaria could be a major problem if it occurs in areas with receptivity, because it can favor the occurrence of outbreaks or reintroductions of malaria in those areas. This study aimed to model territorial receptivity for malaria to serve as an entomological surveillance tool in the State of Rio de Janeiro, Brazil. Geomorphology, rainfall, temperature, and vegetation layers were used in the AHP process for the receptivity stratification of Rio de Janeiro State territory. RESULTS: The model predicted five receptivity classes: very low, low, medium, high and very high. The 'very high' class is the most important in the receptivity model, corresponding to areas with optimal environmental and climatological conditions to provide suitable larval habitats for Anopheles (Nyssorhynchus) vectors. This receptivity class covered 497.14 km2 or 1.18% of the state's area. The 'high' class covered the largest area, 17,557.98 km2, or 41.62% of the area of Rio de Janeiro State. CONCLUSIONS: We used freely available databases for modeling the distribution of receptive areas for malaria transmission in the State of Rio de Janeiro. This was a new and low-cost approach to support entomological surveillance efforts. Health workers in 'very high' and 'high' receptivity areas should be prepared to diagnose all febrile individuals and determine the cause of the fever, including malaria. Each malaria case must be treated and epidemiological studies must be conducted to prevent the reintroduction of the disease.

Paracoccidioidomycosis mortality in Brazil (1980-1995)

This study analyzes 3,181 deaths from paracoccidioidomycosis in Brazil, based on 16 years of sequential data (from 1980 to 1995). During this period paracoccidioidomycosis showed considerable magnitude and low visibility, representing the eighth most common cause of death from predominantly chronic or recurrent types of infectious and parasitic diseases. It also had the highest mortality rate among the systemic mycoses. The mean annual mortality rate was 1.45 per million inhabitants, indicating a downward long-term trend (reduction of 31.28 percent), while spatial distribution among the different regions and States of Brazil was non-homogenous. The South (with the highest regional rate) and the Southeast showed a downward trend, while the Central West had the second highest rate in the country. At least one-fifth of Brazilian municipalities (or 22.71 percent of the country's total area) reported deaths from paracoccidioidomycosis. Overall nationwide mortality per area was 3.73/10,000km². The disease was endemic in non-metropolitan areas. The majority of deaths occurred in males (84.75 percent), and there was a sex ratio of 562 men/100 women. The 30-59-year and over-60-year age groups were the most affected. The study showed that the mortality rate justifies classifying this disease as a major health problem in Brazil

Paracoccidioidomycosis mortality in Brazil (1980-1995).

This study analyzes 3,181 deaths from paracoccidioidomycosis in Brazil, based on 16 years of sequential data (from 1980 to 1995). During this period paracoccidioidomycosis showed considerable magnitude and low visibility, representing the eighth most common cause of death from predominantly chronic or recurrent types of infectious and parasitic diseases. It also had the highest mortality rate among the systemic mycoses. The mean annual mortality rate was 1.45 per million inhabitants, indicating a downward long-term trend (reduction of 31.28%), while spatial distribution among the different regions and States of Brazil was non-homogenous. The South (with the highest regional rate) and the Southeast showed a downward trend, while the Central West had the second highest rate in the country. At least one-fifth of Brazilian municipalities (or 22.71% of the country's total area) reported deaths from paracoccidioidomycosis. Overall nationwide mortality per area was 3.73/10,000km2. The disease was endemic in non-metropolitan areas. The majority of deaths occurred in males (84.75%), and there was a sex ratio of 562 men/100 women. The 30-59-year and over-60-year age groups were the most affected. The study showed that the mortality rate justifies classifying this disease as a major health problem in Brazil.

Estudo da adesäo ao tratamento da hanseníase no município de Duque de Caxias - Rio de Janeiro: abandonos ou abandonados / Study of adhesion to treatment of the leprosy in municipal district of Duque de Caxias - Rio de Janeiro: abandoning or abandoned?

Este estudo teve por objetivo analisar os fatores determinantes do abandono do tratamento da hanseníase no município de Duque de Caxias, regiäo metropolitana do Rio de Janeiro, área hiperendêmica com um dos maiores índices de abandono do tratamento no Estado nos últimos anos. Dos 855 casos notificados entre 1995 e 1997, construíram-se coortes administrativas com 483 pacientes, 160 casos multibacilares e 323 paucibacilares. Destes, 73 casos estavam classificados pelo nível local como em abandono de tratamento. Verificou-se que os casos multibacilares têm o dobro de chance de abandonar o trantamento em relaçäo aos casos paucibacilares (RPC= 2,07(1,21 - 3,55)). Este aspecto tem especial relevância quando consideramos que tais casos apresentam até cinco vezes mais incapacidades físicas que os casos paucibacilares. Na análise espacial observou-se que tanto a detecçäo quanto o abandono distribuem-se por toda área do município. Os resultados mostram que as taxas de abandono estäo superestimadas, quando avaliadas segundo o atual esquema terapêutico proposto para casos multibacilares. Além disso, ao se considerar o índice de adesäo, tais casos näo têm significado epidemiológico na manutençäo da transmissäo da hanseníase visto que apenas 3,5(por cento) dos pacientes receberam doses insuficientes. Para um maior sucesso no controle desta endemia recomenda-se que as estratégias adotadas sejam voltadas para a detecçäo precoce de casos, o que terá influência na reduçäo do abandono do tratamento

Fatores associados ao domicílio e à família na determinaçäo da hanseníase, Rio de Janeiro, Brasil / Factors associated with household and family in leprosy transmission in Rio de Janeiro, Brazil

Analisa algumas características dos domicílios e dos chefes de família como possíveis fatores de determinaçäo da hanseníase. Compara unidades domiciliares onde existiam casos de hanseníase com dois grupos de domicílios de näo hansenianos. Como grupos de domicílios sem casos de hanseníase, estuda os domicílios vizinhos dos doentes e os domicílios fora dos focos ou áreas sem casos de hanseníase. Todos os domicílios localizam-se no município de Säo Gonçalo, área endêmica urbana na periferia da regiäo metropolitana do Rio de Janeiro. Em um mapa aerofotogramétrico, contendo a descriçäo dos 584 setores censitários, marcaram-se todos os 2412 casos diagnosticados residentes. Compara os domicílios com casos de hanseníase, Grupo I, com os seus respectivos vizinhos (Grupo II) e com os domicílios fora do foco (Grupo III). Os domicílios do Grupo I foram pareados com os seus respectivos vizinhos (Grupo II) e processados pelo método condicional. Para a comparaçäo entre os grupos I e III, usou-se o método incondicional. O Grupo I comparado com o II apresentou associaçäo entre idade e nível de escolaridade do chefe da família. A comparaçäo das características dos chefes de família e dos domicílios com casos de hanseníase em relaçäo aos localizados fora do foco mostrou, como fatores diferenciais, idade, tipo de casa e disponibilidade de pontos de água intradomiciliar. Discute que os contrastes da área fora do foco säo indicativos de um assentamento populacional mais recente e näo de fatores associados à hanseníase. Somente na análise pareada dos doentes com seus vizinhos, estando entäo os fatores ambientais da área de foco controlados, confirma a associaçäo da idade e do grau de escolaridade. Com os determinantes do nível particular próprio do grupo social, interagem, no nível individual, a idade e o grau de escolaridade como fatores que contribuem na morbidade da hanseníase nessa área do Estado do Rio de Janeiro.

A ética do desenvolvimento e a proteçao às condiçoes de saúde / The ethics of development and protection to health conditions

Discute-se a influência do modelo de desenvolvimento brasileiro sobre o meio ambiente e a saúde da populaçao, apontando suas características centrais e suas consequências, as denominadas eco-desigualdades. Relaciona-se dados que procuram ilustrar as relaçoes entre desenvolvimento, meio ambiente e saúde. Considera-se que a crise econômica da última década, bem como a aproximaçao do Estado brasileiro ao modelo neo-liberal, dificultam acentuadamente os investimentos nos setores sociais e públicos, antevendo-se enormes prejuízos para a populaçao, com a acentuaçao das desigualdades sociais no país. Enfatiza-se, por fim, a necessidade de uma nova ética nas relaçoes entre indivíduos, indivíduos e Estado e entre Naçoes