Application of spatio-temporal scan statistics for the detection of areas with increased risk for American visceral leishmaniasis in the state of Bahia, Brazil.

Mirroring the global increase of registered cases of American visceral leishmaniasis (AVL), this infection has become a growing public health problem in Brazil during the last several years. As the traditional approach to control employed by the governmental health agencies has failed to reduce the incidence and epidemic outbreaks of this illness, we propose a re-evaluation of the national strategy of intervention and monitoring. Our thinking is based on a series of spatio-temporal scan statistics of the west-central region of the state of Bahia covering the 11-year period from 1994 to 2004. By analyzing the situation, spatially and temporally, we show that the disease is a not only a growing focal threat but that it is also appearing in the form of endemic clusters in the cities. The areas where the disease has been found have been classified according to the degree of risk of infection for humans and canines. The overall objective of this study was to identify areas of increased risk of AVL, including its seasonality, and to suggest ways and means to improve the detection of the disease. The findings presented here should not only be of interest for the efforts to control AVL in the study area but also be useful for developing control strategies in other endemic regions of Brazil.

Irregularly shaped small shadows on chest radiographs, dust exposure, and lung function in coalworkers' pneumoconiosis.

The predominant shapes of small opacities on the chest radiographs of 895 British coalminers have been studied. The aims were to determine whether irregular (as distinct from rounded) small opacities can be identified reproducibly, whether their occurrence is related to dust exposure, and whether they are associated with excess prevalence of respiratory symptoms or impairments of lung function. Six of the doctors responsible for regular radiological surveys of all British coalminers each classified all 895 radiographs twice and independently, using the International Labour Organisation's 1980 classification system. The majority view was that 39 films showed predominantly irregular small opacities, 131 showed predominantly small rounded opacities, and 587 showed no small opacities. Readers' opinions varied about the presence and shapes of shadows on the other 138 films. In general, consistency between readers (and within readers on repeated viewings) was satisfactory. The occurrence and profusion of irregular shadows were related significantly both to the men's ages and additionally to their cumulative exposure to respirable coalmine dust as determined from 15 years' dust monitoring close to where the miners had worked. For any given level of exposure, the average level of profusion of the small irregular opacities was less than the corresponding profusion of small rounded opacities. The prevalence rates of chronic cough and phlegm, and of breathlessness, were higher in those with small irregular opacities than in those with no small opacities (category 0/0), but the differences were not statistically significant after adjustment for other factors including smoking habits. The presence of irregular (but not rounded) small shadows was associated with an impairment in respiratory function averaging about 190 ml deficits in both FEV1 and FVC. These deficits were not explicable in terms of the men's ages, body sizes, and smoking habits and they were in addition to the lung function losses attributable to the miners' dust exposure as such. It is concluded that the presence and profusion of small irregular opacities should be taken into consideration when assessing the severity of coalworkers' simple pneumoconiosis.

Factors predisposing to the development of progressive massive fibrosis in coal miners.

Altogether 238 759 miners employed by the National Coal Board were examined in the third of the Board's radiological surveys from 1969 to 1973 inclusive. Excluding those diagnosed as having progressive massive fibrosis (PMF) on that occasion, 210 847 were in collieries still operating at the time of the fourth survey four to five years later 132 728 attended for radiography at the same colliery on the second occasion, and were used to study the attack rate of PMF. In all groups in the age range 35-54 and having category 2 simple pneumoconiosis (SPN) or less, 80% or more had a second radiograph. It was found that the probability of developing PMF increased sharply with rising category of SPN; however, half the cases occurred in men having SPN categories 0 or 1, who were in the majority. Current coalface work had no significant effect on the attack rate. Age increased the attack rate of PMF within each major SPN category (0, 1, 2, and 3), especially the higher categories. All or part of this effect may have been due to the fact that SPN in younger men with categories 1 and 2 tends to lie in the lower range within these categories. Similarly, a lower distribution of SPN within each category associated with a low overall local prevalence may account wholly or in part for the great difference between the attack rates of PMF supervening on each category of SPN in Scotland and South Wales. The rank (quality) of coal mined had no effect on the attack rate.

The relationship between coal rank and the prevalence of pneumoconiosis.

As part of the Periodic X-ray Scheme of the National Coal Board (NCB), a comparison is made between the previous and new films of all miners who were face-workers on the former occasion, five years earlier. This assessment is made by distributing the films randomly to all the NCB readers. This paper compares the rank of coal mined in each colliery with each colliery's percentage prevalence of pneumoconiosis of at least ILO category 1 in the films of previous face-workers obtained during the third survey round (1969-73). Of the NCB's 291 collieries in Britain, information enabling a rank classification to be made was available for 250, employing 62 362 face-workers. In these 250 mines a progressive and five-fold increase in prevalence was observed from collieries mining low-rank (bituminous) coal to those mining coal of high ranks (anthracite and high-grade steam and coking coal). A possible reason for this is that, in the past, high-rank collieries may have had the highest mass-concentrations of respirable dust.