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ABSTRACT: The incidence of human T-cell lymphotropic virus type 1 (HLTV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is not well defined in the literature. Several studies have reported different incidence rates, and recent publications suggest a higher incidence and prevalence of HAM/TSP. The interdisciplinary HTLV Research Group (GIPH) is a prospective open cohort study of individuals infected with HTLV-1/2. This study describes the demographic data and HAM/TSP incidence rate observed in 181 HTLV-1-seropositive individuals and compares the results with previous reports in the literature. HAM/TSP was diagnosed on the basis of the World Health Organization diagnostic criteria and Castro-Costa et al., 2006. Seven HAM/TSP incident cases were observed during the follow-up. The HAM/TSP incidence density was 5.3 cases per 1,000 HTLV-1-seropositive cases per year (95% confidence interval: 2.6-10.9), with a mean follow-up of 7 ± 4 years (range: 1 month to 15 years). HAM/TSP was more frequent in women in their 40s and 50s with probable infection via the sexual route. The HAM/TSP incidence density among HTLV-1-seropositive cases observed in the present study is higher than that in previous studies. HAM/TSP may be underdiagnosed in countries like Brazil where HTLV infection is prevalent. Orientation and prevent transmission of HTLV programs are needed. Currently, preventing HTLV-1 transmission is the most effective way to reduce the impact of HAM/TSP on society.
AIDS research and human retroviruses 04/2013; · 2.18 Impact Factor
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ABSTRACT: Resumo Introdução: a urbanização desordenada caracteriza-se pela existência de agregados espaciais com diferentes condições socioeconômicas e ambientais e que apresentam condições propícias à proliferação de insetos, vetores de várias doenças, especial-mente da dengue. O presente estudo descreveu e comparou a incidência da dengue em determinadas áreas (denominadas estratos) com diferentes níveis de infestação e de resultados em relação às intervenções em curso em Belo Horizonte. Objetivo: determinar e quantificar a associação entre a ocorrência da dengue e indicadores de infestação vetorial e de intervenção no município de Belo Horizonte. Métodos: adotou--se estudo observacional com delineamento ecológico. Foi realizada análise univariada entre as taxas estimadas de incidência de dengue e as categorias dos indicadores en-tomológicos e de intervenção utilizando-se o modelo binomial negativo. Utilizaram-se subdivisões geográficas do município (estratos) como unidade geográfica de análise. Resultados: verificou-se heterogeneidade nas taxas de incidência de dengue entre os estratos (mínimo de 276,4 e máximo de 9398,1/100.000), com média de 3285,5. Estratos com índice de infestação predial (IIP) ≥3% apresentaram RR=2,9 (IC95%: 1,3–6,4), quan-do contrastados a estrados com IIP <2%. Em estratos com média de ovos ≥ 20, RR=3,3 (IC95%: 1,5–7,3), quando contrastados com aqueles com <10. Locais não acessados por recusa ou ausência de morador num percentual entre 10,0 e 24,9 apresentaram RR=7,9 (IC95%: 4,4–14,4) em relação àqueles cujo percentual de não acesso foi inferior a 10,0%. Já a cobertura de imóveis vistoriados em relação à meta não teve associação com a taxa de incidência da doença. Conclusões: índices de infestação e imóveis não aces-sados para o tratamento focal associaram-se ao elevado risco de ocorrência de dengue nos distritos sanitários e estratos de Belo Horizonte, ocorrendo ainda heterogeneidade entre estratos quanto à incidência da dengue. Palavras-chave: Dengue/epidemiologia; Dengue/prevenção & controle; Zonas Urba-nas; Entomologia. absTRacT Introduction: Unplanned, uncontrolled urbanization is characterized by areas with different socioeconomic and environmental conditions that are conductive to the proliferation of insects, vectors of several diseases, especially dengue. This study describes and compares dengue incidence in selected areas (called strata) with different levels of both infestation and results of active prevention measures carried out in Belo Horizonte. Objective: To determine and quantify the association of dengue incidence with indicators of vectorial infestation and preventive measures in the Municipality of Belo Horizonte. Methods: This is an observa-tional study with ecological approach. Univariate analysis was carried out to assess the estimated rates of dengue incidence and the categories of entomological and active
Revista da Associação Médica de Minas Gerais 04/2013; 22:265-273.
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Eliseu Soares Oliveira Rocha,
Jaquelline Germano de Oliveira,
João Rodrigues Dos Santos,
Gisele Olinto Libânio Rodrigues,
Leandra Barcelos Figueiredo,
José Eduardo Marques Pessanha, Fernando Augusto Proietti,
Flávio Guimarães da Fonseca,
Claudio Antonio Bonjardim,
Paulo Cesar Peregrino Ferreira,
Erna Geessien Kroon
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ABSTRACT: Dengue virus (DENV) is the most prevalent arbovirus in the world, found mainly in tropical regions. As clinical manifestations present frequently as nonspecific febrile illness, laboratory diagnosis is essential to confirm DENV infections and for epidemiological studies. Recombinant envelope (E) antigens of four serotypes of DENV were used to develop an immunoglobulin G enzyme-linked immunosorbent assay (IgG-ELISA). To evaluate the IgG-ELISA, a panel of serum samples that had been tested previously by a plaque reduction neutralization test (PRNT) was investigated for the presence of anti-E antibodies against the four DENV serotypes. IgG-ELISA was found to have a sensitivity (91%) and specificity (98%) at a receiver-operating characteristic (ROC) optimized cutoff and demonstrated high performance as well as good indexes. A concordance of 97% was achieved between both assays, and only 21/704 (3%) samples were not concordant. The results of the present study demonstrate a moderate correlation between neutralizing antibody titers and IgG-ELISA values. These findings indicate that the recombinant protein-based IgG-ELISA is a suitable method for routine serodiagnosis, monitoring and seroepidemiological studies of DENV infections.
Journal of virological methods 09/2012; · 2.13 Impact Factor
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ABSTRACT: Although specific measurement instruments are necessary to better understand the relationship between features of neighborhoods and health, very few studies have developed instruments to measure neighborhood features in developing countries. The objective of the study was to develop valid and reliable measures of neighborhood context useful in a Latin American urban context, assess their psychometric and ecometric properties, and examine individual and neighborhood-level predictors of these measures. We analyzed data from a multistage household survey (2008-2009) conducted in Belo Horizonte City by the Observatory for Urban Health. One adult in each household was selected to answer a questionnaire that included scales to measure neighborhood domains. Census tracts were used to proxy neighborhoods. Internal consistency was evaluated by Cronbach's alpha, and multilevel models were used to estimate ecometric properties and to estimate associations of neighborhood measures with socioeconomic indicators. The final sample comprised 4048 survey respondents representing 149 census tracts. We assessed ten neighborhood environment dimensions: public services, aesthetic quality, walking environment, safety, violence, social cohesion, neighborhood participation, neighborhood physical disorder, neighborhood social disorder, and neighborhood problems. Cronbach's alpha coefficients ranged from 0.53 to 0.83; intraneighborhood correlations ranged from 0.02 to 0.53, and neighborhood reliability varied from 0.76 to 0.99. Most scales were associated with individual and neighborhood socioeconomic predictors. Questionnaires can be used to reliably measure neighborhood contexts in developing countries.
Journal of Urban Health 06/2012; · 2.13 Impact Factor
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ABSTRACT: This study considers the dengue occurrence in the city of Belo Horizonte over the last fifteen years. Approximately 186,000 cases registered from 1996 to 2011 were analyzed. The home address of individuals whose dengue case was notified was used as a proxy for exposure location. For determining possible outbreaks of disease and the specific patterns of dengue cases, spatial statistics used included Kernel's estimation. The occurrence of waves of dengue outbreaks was correlated with climatic and vector presence data. Outbreaks had different durations and intensities: case clustering, thinned out both spatially and temporally. These findings may be useful for public health professionals responsible for fighting the disease providing some tools for improving evaluation of interventions such as vector control and patient care, minimizing the collective and individual burden of the disease.
Journal of Tropical Medicine 01/2012; 2012:760951.
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ABSTRACT: Researchers in the health field often deal with the problem of incomplete databases. Complete Case Analysis (CCA), which restricts the analysis to subjects with complete data, reduces the sample size and may result in biased estimates. Based on statistical grounds, Multiple Imputation (MI) uses all collected data and is recommended as an alternative to CCA. Data from the study Saúde em Beagá, attended by 4,048 adults from two of nine health districts in the city of Belo Horizonte, Minas Gerais State, Brazil, in 2008-2009, were used to evaluate CCA and different MI approaches in the context of logistic models with incomplete covariate data. Peculiarities in some variables in this study allowed analyzing a situation in which the missing covariate data are recovered and thus the results before and after recovery are compared. Based on the analysis, even the more simplistic MI approach performed better than CCA, since it was closer to the post-recovery results.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 12/2011; 27(12):2299-313. · 0.83 Impact Factor
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ABSTRACT: To assess the validity of the estimates obtained through telephone survey and to measure the impact of the post-stratification weighting factor to adjust estimates.
The same questionnaire was completed by two independent samples of the population living in the municipality of Belo Horizonte city (Barreiro and West regions). One sample (n=440) completed the questionnaire of VIGITEL 2008 (telephone survey), and the other (n=4,048) of Saúde em Beagá (face to face household interview). The results of the two samples for 18 health-related variables were compared by means of test statistics. At first, residents who had a landline telephone line were compared to those who reported not having a telephone line; then, VIGITEL estimates, with and without post-stratification weight, were compared with Saúde em Beagá estimates.
Subjects who owned a landline telephone line had indicators for better economic conditions (housing, schooling, and skin color); higher prevalence of chronic diseases; lower exposure to risk factors for chronic diseases; and improved access to health services, compared to the those who reported not having a telephone line. Most VIGITEL estimates (without post-stratification weight) were similar to the sample of Saúde em Beagá that reported owning a residential landline, showing no major impact of the methodology to obtain this data (lower information bias). Even without post-stratification weight, VIGITEL estimates were similar to those of Saúde em Beagá. With post-stratification weight, the estimates of "number of residents", "skin color" and "physical activity" did not differ from those obtained by the face to face survey.
The results of both surveys were very similar. Because of the lower cost, the telephone interview is a good option in public health for the behavioral risk-factor surveillance system.
Revista Brasileira de Epidemiologia 09/2011; 14 Suppl 1:16-30.
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ABSTRACT: To detect dengue virus, eggs of Aedes sp were collected in the city of Belo Horizonte, Brazil, in 2007.
Egg samples were subsequently hatched and the larvae were tested for the presence of dengue virus RNA by RT-PCR.
Among the Aedes aegypti larvae samples, 163 (37.4%) out of 435 were positive, including 32 (10.9%) of 293 individual larvae samples concomitantly positive for two serotypes.
Virological surveillance detecting coinfected vectors in the field could represent an important strategy for understanding the numerous factors involved in the transmission and clinical presentation of dengue.
Revista da Sociedade Brasileira de Medicina Tropical 02/2011; 44(1):103-5. · 0.68 Impact Factor
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ABSTRACT: Confidential unit exclusion remains a controversial strategy to reduce the residual risk of transfusion-transmitted infections.
This study aimed to analyze confidential unit exclusion from its development in a large institution in light of confidential donation confirmation.
Data of individuals who donated from October 1, 2008 to December 31, 2009 were analyzed in a case-control study. The serological results and sociodemographic characteristics of donors who did not confirm their donations were compared to those who did. Variables with p-values < 0.20 in univariate analysis were included in a logistic multivariate analysis.
In the univariate analysis there was a statically significant association between positive serological results and response to confidential donation confirmation of "No". Donation type, (firsttime or return donor - OR 1.69, CI 1.37-2.09), gender (OR 1.66, CI 1.35-2.04), education level (OR 2.82, CI 2.30-3.47) and ethnic background (OR 0.67, CI 0.55-0.82) were included in the final logistic regression model. In all logistic regression models analyzed, the serological suitability and confidential donation confirmation were not found to be statistically associated. The adoption of new measures of clinical classification such as audiovisual touch-screen computer-assisted self-administered interviews might be more effective than confidential unit exclusion in the identification of donor risk behavior. The requirement that transfusion services continue to use confidential unit exclusion needs to be debated in countries where more specific and sensitive clinical and serological screening methods are available.
Our findings suggest that there are not enough benefits to justify continued use of confidential donation confirmation in the analyzed institution.
Revista brasileira de hematologia e hemoterapia. 01/2011; 33(4):263-7.
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ABSTRACT: In order to investigate the association between satisfaction with the neighborhood environment and self-rated health among older elderly, data from 814 participants of the eleventh wave of the Bambuí Cohort Study of Aging were analyzed using robust Poisson regression analyses. Those elderly with higher satisfaction with their neighborhoods (PR = 0.75; 95%CI: 0.63-0.87) were less likely to report worse self-rated health. The number of chronic diseases (two, PR = 1.69; 95%CI: 1.05-2.70, three or more, PR = 1.99, 95%CI: 1.27-3.13), difficulty in performing daily activities (PR = 1.51; 95%CI: 1.28-1.78), presence of depressive symptoms (PR = 1.68; 95%CI: 1.44-1.95) and frequency of leisure-time exercise in previous 90 days (less than once a week, PR =1.24; 95%CI: 1.03-1.50) were all positively and significantly associated with poor self-rated health. This study provided empirical evidence that satisfaction with the neighborhood environment was associated with the health of the older elderly. The findings further suggest the potential importance of including this indicator in analyses of place and health among the elderly.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 01/2011; 27 Suppl 3:S390-8. · 0.83 Impact Factor
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ABSTRACT: This study examined the adequacy of a health vulnerability index (HVI) for identifying intra-urban differences in vulnerability in the elderly population. Study participants (n = 1,055) were selected by probabilistic sampling of residents in the city of Belo Horizonte, Minas Gerais State, Brazil, aged 60 years or older (mean = 70.1 years). The HVI was constructed with indicators of socioeconomic conditions and premature mortality at the census tract level. Based on its location and HVI value, each participant's household was classified as low, medium, or high-risk. Results of multivariate ordinal logistic regression models showed graded and statistically significant associations between the household's risk level and the social and physical environment, health conditions and behaviors, and health service needs (adjusted prevalence ratios ranging from 1.17; 95% CI: 1.02-1.34 to 1.65; 95% CI: 1.45-1.88). The HVI appears to be a useful instrument for identifying health and social service needs among the elderly.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 12/2010; 26(12):2307-15. · 0.83 Impact Factor
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ABSTRACT: A major goal of health systems is to reduce inequities in access to services, that is, to ensure that health care is provided based on health needs rather than social or economic factors. This study aims to identify the determinants of health services utilization among adults in a large Brazilian city and intraurban disparities in health care use. We combine household survey data with census-derived classification of social vulnerability of each household's census tract. The dependent variable was utilization of physician services in the prior 12 months, and the independent variables included predisposing factors, health needs, enabling factors, and context. Prevalence ratios and 95% confidence intervals were estimated by the Hurdle regression model, which combined Poisson regression analysis of factors associated with any doctor visits (dichotomous variable) and zero-truncated negative binomial regression for the analysis of factors associated with the number of visits among those who had at least one. Results indicate that the use of health services was greater among women and increased with age, and was determined primarily by health needs and whether the individual had a regular doctor, even among those living in areas of the city with the worst socio-environmental indicators. The experience of Belo Horizonte may have implications for other world cities, particularly in the development and use of a comprehensive index to identify populations at risk and in order to guide expansion of primary health care services as a means of enhancing equity in health.
Journal of Urban Health 12/2010; 87(6):994-1006. · 2.13 Impact Factor
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ABSTRACT: Human T-cell leukemia virus type 1 (HTLV-1), the first human retrovirus to be discovered, is present in diverse regions of the world, where its infection is usually neglected in health care settings and by public health authorities. Since it is usually asymptomatic in the beginning of the infection and disease typically manifests later in life, silent transmission occurs, which is associated with sexual relations, breastfeeding, and blood transfusions. There are no prospects of vaccines, and screening of blood banks and in prenatal care settings is not universal. Therefore, its transmission is active in many areas such as parts of Africa, South and Central America, the Caribbean region, Asia, and Melanesia. It causes serious diseases in humans, including adult T-cell leukemia/lymphoma (ATL) and an incapacitating neurological disease (HTLV-associated myelopathy/tropical spastic paraparesis [HAM/TSP]) besides other afflictions such as uveitis, rheumatic syndromes, and predisposition to helminthic and bacterial infections, among others. These diseases are not curable as yet, and current treatments as well as new perspectives are discussed in the present review.
Clinical microbiology reviews 07/2010; 23(3):577-89. · 14.69 Impact Factor
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ABSTRACT: To evaluate the geographic distribution of human T-lymphotropic virus types 1 and 2 (HTLV-1/2) in the State of Minas Gerais, Brazil, in puerperal women whose newborns were tested for HTLV-1/2 during neonatal screening, and to overlap seropositivity with social and economic status determinants.
During September-November 2007, the dry-blood samples taken from newborns on filter paper for routine screening were also tested for maternal IgG anti-HTLV-1/2 antibodies. For reactive samples, the mothers of the newborns had blood drawn to test for these viruses.
The study analyzed 55,293 specimens taken from newborns. Of these, 52 (9.4 per 10,000) were reactive and 42 mothers (7.6 per 10,000) were confirmed with HTLV-1/2 infection. HTLV-1/2 geographic distribution was heterogeneous, with a tendency to be higher in the North and North-East parts of Minas Gerais. The highest rates of seropositivity were observed in Vale do Mucuri (55.9 per 10,000) and in Jequitinhonha (16.0 per 10,000), overlapping with the State's worst social and economic indicators.
To our knowledge this was the first time that neonatal screening for HTLV-1/2 was performed in Brazil. This model could be used in other areas with high HTLV-1/2 prevalence rates. The detection of carrier mothers can enable intervention measures, such as providing infant formula to newborns, to be implemented expeditiously to reduce vertical transmission.
Revista Panamericana de Salud Pública 05/2010; 27(5):330-7. · 0.85 Impact Factor
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Keli Bahia Felicíssimo Zocratto,
Maria Luz Osimani,
Liliana Martinez Peralta,
Laura Latorre,
Estela Muzzio,
Marcela Segura,
Hector Chiparelli, Fernando Augusto Proietti,
Jorge Rey,
Enrique Vazquez,
Paloma Cuchi,
Sergio Sosa Estani,
Diana Rossi,
Mercedes Weissenbacher,
Waleska Teixeira Caiaffa
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ABSTRACT: The aim is to estimate HBV prevalence and the associated risks among noninjecting cocaine users (NICUs). In 2002-2003, a total of 824 NICUs from Buenos Aires (Argentina) and Montevideo (Uruguay) were interviewed using a structured questionnaire. Serologic tests were carried out for Human Immunodeficiency Virus (HIV), hepatitis B (HBV), syphilis, and others. The population was divided into two serologic groups: HBV-infected and seronegative group. Univariate and binary logistic model were developed. The results seem to indicate that, among NICUs, HBV is transmitted through sexual contact. Prevention measures, including vaccine, are needed in order to control and minimize risks. The study's limitations are noted.
Substance Use & Misuse 05/2010; 45(12):2026-44. · 1.10 Impact Factor
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ABSTRACT: To determine the seroprevalence of dengue fever serotypes in three sanitary districts in the city of Belo Horizonte and investigate the association of seroprevalence with contextual and individual variables.
The survey was conducted in the sanitary districts of Venda Nova, Leste and Centro-Oeste between June 2006 and March 2007. All residents aged 1 year or older were eligible for the study. Participants answered a questionnaire and had a 5 mL blood sample collected to determine the presence of anti-dengue types 1, 2, and 3 virus antibodies by seroneutralization. The questionnaire covered demographic aspects, socioeconomic status, physical characteristics of the home, residential mobility between cities, previous history of signs and symptoms associated with dengue fever, and knowledge concerning dengue fever prevention measures, among others.
Seroprevalence was 11.9% (95%CI: 9.7-14.6) among the 709 individuals included in the study, and it was not associated with sex, age, family income, and having moved to another town in the past 10 years. Seropositivity was associated with type of construction (apartment or house/shanty, with apartment being a protection factor) and with an elevated health vulnerability index where the dwelling was located.
In this study, seroprevalence was lower than in previous studies carried out in mid-size and large Brazilian cities. This suggests that Belo Horizonte has employed efficient control measures. However, heterogeneity within the city was observed in terms of dengue fever transmission, which was largely associated with contextual indicators of vulnerability. The number of susceptibles is still high, and the control of dengue fever remains a difficult public health issue.
Revista Panamericana de Salud Pública 04/2010; 27(4):252-8. · 0.85 Impact Factor
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ABSTRACT: The main goal of this study was to describe the spatial and temporal distribution of candidates for blood donation in Belo Horizonte, Minas Gerais State, Brazil, who appeared at the Hemominas Foundation in 1994 and 2004. The study also compared the candidates for age, gender, and clinical approval for blood donation in space and space-time. Data were obtained from a cross-sectional study for 1994 and were randomly selected from all donor candidates for 2004. The samples were georeferenced using the residential address. The spatial analysis techniques employed were: Kernel maps, thematic maps of Bayesian empirical rates and crude rates, and Moran Global. According to the findings, spatial distribution of candidates was non-random. The Kernel maps helped detect points with higher or lower concentration of candidates. Thematic maps described the concentration of candidates in relation to the population for the various categories. The results could help detect areas for actions targeting donor recruitment and areas with specific blood donation public campaign needs.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 02/2010; 26(2):229-39. · 0.83 Impact Factor
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ABSTRACT: This study aimed to describe and evaluate dengue patterns after the implementation of the National Dengue Control Plan (PNCD). Incidence rates were analyzed and correlated with previous rates and climatic, demographic, and socioeconomic variables for the Brazilian municipalities that were targeted for priority dengue control. We conducted descriptive studies of epidemiological indicators after the implementation of the national plan and a statistical analysis considering the incidence rates from the previous period and climatic, demographic, and socioeconomic variables, using multiple linear regression. We found a significant association between dengue incidence during the period following implementation of the PNCD (2003-2006) as compared to pre-implementation (2001-2002), after adjusting for geographic and climatic indicators. Our findings suggest that the plan's objectives were not fully achieved. In conclusion, the persistent occurrence of dengue epidemics requires changes and reevaluation of current strategies, along with improvements in the dengue surveillance system.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 08/2009; 25(7):1637-41. · 0.83 Impact Factor
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ABSTRACT: This study aimed to describe the temporal-spatial patterns of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, from 1996 to 2002 and to analyze residential address as a proxy for exposure. Reported dengue cases were analyzed according to week of onset of symptoms and residential census tract. Local Moran's index was used to assess spatial autocorrelation of incidence coefficients, and recurrent census areas over different epidemic waves were also verified. Ripley's K-function was used to compare spatial distribution patterns between the two population groups, assuming that they were distributed differently around the city. A total of 99,559 dengue cases were analyzed, resulting in seven epidemic waves with different durations and intensities, with cases clustering in a small fraction of areas, thinning out both spatially and temporally. Distinct case distribution patterns were observed according to the two exposed groups, suggesting the need to improve the reporting of possible place of infection. The observed endemic pattern of the disease also requires specific strategies and poses a major challenge for health surveillance services.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 11/2008; 24(10):2385-95. · 0.83 Impact Factor
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International Journal of Epidemiology 08/2008; 37(4):784-5. · 6.41 Impact Factor
