ABSTRACT OBJECTIVE To investigate the relationship between covid-19 hospital mortality and risk factors, innovating by considering contextual and individual factors and spatial dependency and using data from the city of São Paulo, Brazil. METHODS The study was performed with a spatial hierarchical retrospective cohort design using secondary data (individuals and contextual data) from hospitalized patients and their geographic unit residences. The study period corresponded to the first year of the pandemic, from February 25, 2020 to February 24, 2021. Mortality was modeled with the Bayesian context, Bernoulli probability distribution, and the integrated nested Laplace approximations. The demographic, distal, medial, and proximal covariates were considered. RESULTS We found that per capita income, a contextual covariate, was a protective factor (odds ratio: 0.76 [95% credible interval: 0.74–0.78]). After adjusting for income, the other adjustments revealed no differences in spatial dependence. Without income inequality in São Paulo, the spatial risk of death would be close to one in the city. Other factors associated with high covid-19 hospital mortality were male sex, advanced age, comorbidities, ventilation, treatment in public healthcare settings, and experiencing the first covid-19 symptoms between January 24 and February 24, 2021. CONCLUSIONS Other than sex and age differences, geographic income inequality was the main factor responsible for the spatial differences in the risk of covid-19 hospital mortality. Investing in public policies to reduce socioeconomic inequities, infection prevention, and other intersectoral measures should focus on lower per capita income, to control covid-19 hospital mortality.

ABSTRACT OBJECTIVE To investigate the relationship between covid-19 hospital mortality and risk factors, innovating by considering contextual and individual factors and spatial dependency and using data from the city of São Paulo, Brazil. METHODS The study was performed with a spatial hierarchical retrospective cohort design using secondary data (individuals and contextual data) from hospitalized patients and their geographic unit residences. The study period corresponded to the first year of the pandemic, from February 25, 2020 to February 24, 2021. Mortality was modeled with the Bayesian context, Bernoulli probability distribution, and the integrated nested Laplace approximations. The demographic, distal, medial, and proximal covariates were considered. RESULTS We found that per capita income, a contextual covariate, was a protective factor (odds ratio: 0.76 [95% credible interval: 0.74–0.78]). After adjusting for income, the other adjustments revealed no differences in spatial dependence. Without income inequality in São Paulo, the spatial risk of death would be close to one in the city. Other factors associated with high covid-19 hospital mortality were male sex, advanced age, comorbidities, ventilation, treatment in public healthcare settings, and experiencing the first covid-19 symptoms between January 24 and February 24, 2021. CONCLUSIONS Other than sex and age differences, geographic income inequality was the main factor responsible for the spatial differences in the risk of covid-19 hospital mortality. Investing in public policies to reduce socioeconomic inequities, infection prevention, and other intersectoral measures should focus on lower per capita income, to control covid-19 hospital mortality. covid19 covid 19 covid-1 Paulo Brazil individuals residences pandemic 25 202 2021 context distribution approximations demographic distal medial considered covariate odds ratio 076 0 76 0.7 95% 95 [95 interval 0.74–0.78. 074078 0.74–0.78 . 74 78 0.74–0.78]) dependence comorbidities ventilation settings 2 inequities prevention covid1 1 covid- 20 07 7 0. 9 [9 07407 0.74–0.7 0.74–0.78] [ 0740 0.74–0. 074 0.74–0 0.74– 0.74

Resumo A leptospirose é uma zoonose que apresenta potencial epidêmico, principalmente após fortes chuvas que acarretam inundações, alagamentos e enxurradas. Algumas características da região costeira de Santa Catarina, localizada no Sul do Brasil, influenciam nesses processos. Portanto, a partir do estudo da leptospirose nos seis municípios do estado com as maiores incidências e picos epidêmicos de 2000 a 2015, buscou-se conhecer a tendência dessa doença e as variáveis climáticas e ambientais associadas à sua ocorrência, ajustando dois modelos com resposta binomial negativa. As maiores incidências foram encontradas em 2008 e 2011, com picos no mesmo mês ou no posterior aos eventos de desastres. A incidência apresentou forte comportamento sazonal, sendo maior nos meses do verão. Observou-se tendência de queda na incidência dos municípios estudados, estimada em 3,21% ao ano. Os fatores climáticos e ambientais mais fortemente associados foram o número de dias de chuva, a temperatura máxima e a presença de enxurrada e de inundação, com diferentes impactos entre os municípios. Houve interações significativas, indicando que o efeito de inundações na incidência não é o mesmo em todos os municípios e que as diferenças nas incidências entre os municípios dependem da ocorrência ou não de inundações.

Abstract Leptospirosis is a zoonosis with epidemic potential, especially after heavy rainfall causing river, urban and flash floods. Certain features of Santa Catarina’s coastal region influence these processes. Using negative binomial regression, we investigated trends in the incidence of leptospirosis in the six municipalities with the highest epidemic peaks between 2000 and 2015 and the climatic and environmental variables associated with the occurrence of the disease. Incidence was highest in 2008 and 2011, and peaks occurred in the same month or month after disasters. Incidence showed a strong seasonal trend, being higher in summer months. There was a decrease trend in incidence across the six municipalities (3.21% per year). The climatic and environmental factors that showed the strongest associations were number of rainy days, maximum temperature, presence of flash floods, and river flooding. The impact of these variables varied across the municipalities. Significant interactions were found, indicating that the effect of river flooding on incidence is not the same across all municipalities and differences in incidence between municipalities depend on the occurrence of river flooding.

ABSTRACT Since the reintroduction of dengue viruses in 1987, Sao Paulo State (SP), Brazil, has experienced recurrent epidemics in a growing number of municipalities, each time with more cases and deaths. In the present study, we investigated the spatio-temporal dynamics of dengue-related deaths and associated factors in SP. This was an ecological study with spatial and temporal components, based on notified dengue-related deaths in the municipalities of SP between 2007 and 2017. A latent Gaussian Bayesian model with Poisson probability distribution was used to estimate the standardized mortality ratios (SMR) for dengue and relative risks (RR) for the socioeconomic, demographic, healthcare-related, and epidemiological factors considered. Epidemiological factors included the annual information on the number of circulating serotypes. A total of 1,019 dengue-related deaths (0.22 per 100,000 inhabitant-years) between 2007 and 2017 were confirmed in SP by laboratory testing. Mortality increased with age, peaking at 70 years or older (1.41 deaths per 100,000 inhabitant-years). Mortality was highest in 2015, and the highest SMR values were found in the North, Northwest, West, and coastal regions of SP. An increase of one circulating serotype, one standard deviation in the number of years with cases, and one standard deviation in the degree of urbanization were associated with increases of 75, 35, and 45% in the risk of death from dengue, respectively. The risk of death from dengue increased with age, and the distribution of deaths was heterogeneous in space and time. The positive relationship found between the number of dengue serotypes circulating and years with cases at the municipality/micro-region level indicates that this information can be used to identify risk areas, intensify surveillance and control measures, and organize healthcare to better respond to this disease.

Resumo A leptospirose é uma zoonose que apresenta potencial epidêmico, principalmente após fortes chuvas que acarretam inundações, alagamentos e enxurradas. Algumas características da região costeira de Santa Catarina, localizada no Sul do Brasil, influenciam nesses processos. Portanto, a partir do estudo da leptospirose nos seis municípios do estado com as maiores incidências e picos epidêmicos de 2000 a 2015, buscou-se conhecer a tendência dessa doença e as variáveis climáticas e ambientais associadas à sua ocorrência, ajustando dois modelos com resposta binomial negativa. As maiores incidências foram encontradas em 2008 e 2011, com picos no mesmo mês ou no posterior aos eventos de desastres. A incidência apresentou forte comportamento sazonal, sendo maior nos meses do verão. Observou-se tendência de queda na incidência dos municípios estudados, estimada em 3,21% ao ano. Os fatores climáticos e ambientais mais fortemente associados foram o número de dias de chuva, a temperatura máxima e a presença de enxurrada e de inundação, com diferentes impactos entre os municípios. Houve interações significativas, indicando que o efeito de inundações na incidência não é o mesmo em todos os municípios e que as diferenças nas incidências entre os municípios dependem da ocorrência ou não de inundações.

Abstract Leptospirosis is a zoonosis with epidemic potential, especially after heavy rainfall causing river, urban and flash floods. Certain features of Santa Catarina’s coastal region influence these processes. Using negative binomial regression, we investigated trends in the incidence of leptospirosis in the six municipalities with the highest epidemic peaks between 2000 and 2015 and the climatic and environmental variables associated with the occurrence of the disease. Incidence was highest in 2008 and 2011, and peaks occurred in the same month or month after disasters. Incidence showed a strong seasonal trend, being higher in summer months. There was a decrease trend in incidence across the six municipalities (3.21% per year). The climatic and environmental factors that showed the strongest associations were number of rainy days, maximum temperature, presence of flash floods, and river flooding. The impact of these variables varied across the municipalities. Significant interactions were found, indicating that the effect of river flooding on incidence is not the same across all municipalities and differences in incidence between municipalities depend on the occurrence of river flooding.

ABSTRACT Objective: to analyze the spatial distribution of elder abuse in Ribeirão Preto-SP, according to victims’ place of residence and event. Method: an ecological study that analyzed 1,153 elder abuse police reports (2009 to 2013). Local gross and empirical Bayesian rates and Local Moran’s I were calculated. Results: there was a heterogeneous distribution of concentration of sectors with a high incidence rate surrounded by neighbors with also high rates, considering place of residence. In contrast, analysis by place of occurrence showed a greater concentration in the central areas of the municipality. More than 80% of cases of violence occurred at their own homes and with spatial dependence on distribution by occurrence up to a 5,000 m distance from their places of residence. Conclusion: data reinforce that violence is a complex phenomenon, affecting several social strata, including in central urban areas and in elderly people families’ own context.

RESUMEN Objetivo: analizar la distribución espacial de la violencia contra los adultos mayores en Ribeirão Preto - SP, según el lugar de residencia de la víctima y lugar del evento. Método: estudio ecológico, que analizó 1.153 denuncias de violencia contra el adulto mayor (2009 a 2013). Se calcularon las tasas bayesianas crudas y empíricas locales y el índice de Moran local. Resultados: hubo una distribución heterogénea de la concentración de sectores con alta tasa de incidencia rodeados de vecinos con tasas también altas, considerando el lugar de residencia. En contraste, el análisis por lugar de ocurrencia mostró una mayor concentración en las áreas centrales del municipio. Más del 80% de los casos de violencia ocurrieron en el propio domicilio y con dependencia espacial de la distribución por ocurrencia hasta una distancia de 5.000 m del lugar de residencia. Conclusión: los datos refuerzan el hecho de que la violencia es un fenómeno complejo, que afecta a varios estratos sociales, incluso en las zonas urbanas centrales y en el propio contexto familiar de los adultos mayores.

RESUMO Objetivo: analisar a distribuição espacial da violência contra idosos em Ribeirão Preto - SP, segundo local de residência da vítima e de ocorrência do evento. Método: estudo ecológico, que analisou 1.153 Boletins de Ocorrência de violência contra idosos (2009 a 2013). Foram calculadas taxas bruta e bayesiana empírica local e Índice Moran local. Resultados: evidenciou-se uma distribuição heterogênea da concentração de setores com alta taxa de incidência circundados por vizinhos com taxas também elevadas, considerando o local de residência. Em contrapartida, a análise por local de ocorrência demonstrou maior concentração nas áreas centrais do município. Mais de 80% dos casos de violência ocorreram nos próprios domicílios e com dependência espacial da distribuição por ocorrência até uma distância de 5.000 m do local de residência. Conclusão: os dados reforçam o fato da violência ser fenômeno complexo, que acomete diversas camadas sociais, inclusive em áreas centrais urbanas e no próprio contexto familiar do idoso.

RESUMO Objetivo: analisar a distribuição espacial da violência contra idosos em Ribeirão Preto - SP, segundo local de residência da vítima e de ocorrência do evento. Método: estudo ecológico, que analisou 1.153 Boletins de Ocorrência de violência contra idosos (2009 a 2013). Foram calculadas taxas bruta e bayesiana empírica local e Índice Moran local. Resultados: evidenciou-se uma distribuição heterogênea da concentração de setores com alta taxa de incidência circundados por vizinhos com taxas também elevadas, considerando o local de residência. Em contrapartida, a análise por local de ocorrência demonstrou maior concentração nas áreas centrais do município. Mais de 80% dos casos de violência ocorreram nos próprios domicílios e com dependência espacial da distribuição por ocorrência até uma distância de 5.000 m do local de residência. Conclusão: os dados reforçam o fato da violência ser fenômeno complexo, que acomete diversas camadas sociais, inclusive em áreas centrais urbanas e no próprio contexto familiar do idoso.

ABSTRACT Objective: to analyze the spatial distribution of elder abuse in Ribeirão Preto-SP, according to victims’ place of residence and event. Method: an ecological study that analyzed 1,153 elder abuse police reports (2009 to 2013). Local gross and empirical Bayesian rates and Local Moran’s I were calculated. Results: there was a heterogeneous distribution of concentration of sectors with a high incidence rate surrounded by neighbors with also high rates, considering place of residence. In contrast, analysis by place of occurrence showed a greater concentration in the central areas of the municipality. More than 80% of cases of violence occurred at their own homes and with spatial dependence on distribution by occurrence up to a 5,000 m distance from their places of residence. Conclusion: data reinforce that violence is a complex phenomenon, affecting several social strata, including in central urban areas and in elderly people families’ own context.

RESUMEN Objetivo: analizar la distribución espacial de la violencia contra los adultos mayores en Ribeirão Preto - SP, según el lugar de residencia de la víctima y lugar del evento. Método: estudio ecológico, que analizó 1.153 denuncias de violencia contra el adulto mayor (2009 a 2013). Se calcularon las tasas bayesianas crudas y empíricas locales y el índice de Moran local. Resultados: hubo una distribución heterogénea de la concentración de sectores con alta tasa de incidencia rodeados de vecinos con tasas también altas, considerando el lugar de residencia. En contraste, el análisis por lugar de ocurrencia mostró una mayor concentración en las áreas centrales del municipio. Más del 80% de los casos de violencia ocurrieron en el propio domicilio y con dependencia espacial de la distribución por ocurrencia hasta una distancia de 5.000 m del lugar de residencia. Conclusión: los datos refuerzan el hecho de que la violencia es un fenómeno complejo, que afecta a varios estratos sociales, incluso en las zonas urbanas centrales y en el propio contexto familiar de los adultos mayores.

Abstract INTRODUCTION: Ourinhos is a municipality located between the Pardo and Paranapanema rivers, and it has been characterized by the endemic transmission of schistosomiasis since 1952. We used geospatial analysis to identify areas prone to human schistosomiasis infections in Ourinhos. We studied the association between the sewage network, co-occurrence of Biomphalaria snails (identified as intermediate hosts [IHs] of Schistosoma mansoni), and autochthonous cases. METHODS: Gi spatial statistics, Ripley’s K12-function, and kernel density estimation were used to evaluate the association between schistosomiasis data reported during 2007-2016 and the occurrence of IHs during 2015-2017. These data were superimposed on the municipality sewage network data. RESULTS: We used 20 points with reported IH; they were colonized predominantly by Biomphalaria glabrata, followed by B. tenagophila and B. straminea. Based on Gi statistics, a significant cluster of autochthonous cases was superimposed on the Christoni and Água da Veada water bodies, with distances of approximately 300 m and 2200 m from the points where B. glabrata and B. straminea were present, respectively. CONCLUSIONS: The residence geographical location of autochthonous cases allied with the spatial analysis of IHs and the coverage of the sewage network provide important information for the detection of human-infection areas. Our results demonstrated that the tools used for direct surveillance, control, and elimination of schistosomiasis are appropriate.

ABSTRACT Dengue fever is re-emerging worldwide, however the reasons of this new emergence are not fully understood. Our goal was to report the incidence of dengue in one of the most populous States of Brazil, and to assess the high-risk areas using a spatial and spatio-temporal annual models including geoclimatic, demographic and socioeconomic characteristics. An ecological study with both, a spatial and a temporal component was carried out in Sao Paulo State, Southeastern Brazil, between January 1st, 2007 and December 31st, 2019. Crude and Bayesian empirical rates of dengue cases following by Standardized Incidence Ratios (SIR) were calculated considering the municipalities as the analytical units and using the Integrated Nested Laplace Approximation in a Bayesian context. A total of 2,027,142 cases of dengue were reported during the studied period. The spatial model allocated the municipalities in four groups according to the SIR values: (I) SIR<0.8; (II) SIR 0.8<1.2; (III) SIR 1.2<2.0 and SIR>2.0 identified the municipalities with higher risk for dengue outbreaks. “Hot spots” are shown in the thematic maps. Significant correlations between SIR and two climate variables, two demographic variables and one socioeconomical variable were found. No significant correlations were found in the spatio-temporal model. The incidence of dengue exhibited an inconstant and unpredictable variation every year. The highest rates of dengue are concentrated in geographical clusters with lower surface pressure, rainfall and altitude, but also in municipalities with higher degree of urbanization and better socioeconomic conditions. Nevertheless, annual consolidated variations in climatic features do not influence in the epidemic yearly pattern of dengue in southeastern Brazil.

O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.

Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.

El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.

O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.

Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.

El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.

ABSTRACT Introduction: Use of antibiotic and bacterial resistance is the result of a complex interaction not completely understood. Objectives: To evaluate the impact of entire antimicrobial use (community plus hospitals) on the incidence of bloodstream infections in intensive care units adjusted by socioeconomic factors, quality of healthcare, and access to the healthcare system. Design: Ecologic study using a hierarchical spatial model. Setting: Data obtained from 309 hospitals located in the state of São Paulo, Brazil from 2008 to 2011. Participants: Intensive care units located at participant hospitals. Outcome: Hospital acquired bloodstream infection caused by MDRO in ICU patients was our primary outcome and data were retrieved from São Paulo Health State Department. Socioeconomic and healthcare indexes data were obtained from IBGE (Brazilian Foundation in charge of national decennial census) and SEADE (São Paulo Planning and Development Department). Information on antimicrobial sales were obtained from IMS Brazil. We divided antibiotics into four different groups (1-4). Results: We observed a direct association between the use of group 1 of antibiotics and the incidences of bloodstream infections caused by MRSA (1.12; 1.04-1.20), and CR-Acinetobacter sp. (1.19; 1.10-1.29). Groups 2 and 4 were directly associated to VRE (1.72; 1.13-2.39 and 2.22; 1.62-2.98, respectively). Group 2 was inversely associated to MRSA (0.87; 0.78-0.96) and CR-Acinetobacter sp. (0.79; 0.62-0.97). Group 3 was inversely associated to Pseudomonas aeruginosa (0.69; 0.45-0.98), MRSA (0.85; 0.72-0.97) and VRE (0.48; 0.21-0.84). No association was observed for third generation cephalosporin-resistant Klebsiella pneumoniae and Escherichia coli. Conclusions: The association between entire antibiotic use and resistance in ICU was poor and not consistent for all combinations of antimicrobial groups and pathogens even after adjusted by socioeconomic indexes. Selective pressure exerted at the community level seemed not to affect the incidences of MDRO infection observed in intensive care setting.

A leishmaniose visceral é uma doença emergente e negligenciada em processo de expansão para áreas urbanas. A incidência da doença humana está relacionada com a infecção canina. Araçatuba e Birigui são municípios do Estado de São Paulo, Brasil, com soroprevalência da infecção canina de 8 a 10%, que empregam estratégias de controle voltadas ao reservatório canino baseado em inquérito sorológico e eutanásia dos cães soropositivos. Usando dados desses programas de controle para parametrizar modelos matemáticos, este estudo avaliou a eficácia dessas atividades. Estimamos que o controle atualmente empregado é capaz de reduzir em cerca de 20% a incidência de casos de leishmaniose visceral canina (LVC). Considerando-se um controle contínuo e um esforço das atividades de inquérito sorológico igual ao triplo da média do observado em Araçatuba e Birigui, a atividade de eutanásia de cães com diagnóstico positivo seria efetiva para o controle da infecção canina. Embora teoricamente possível, na prática, o controle da LVC com as estratégias preconizadas atualmente é insuficiente, pois exigiria superpor dificuldades enfrentadas por estas atividades como falta de recursos materiais, humanos e financeiros, além das questões éticas e jurídicas associadas.

Visceral leishmaniasis is an emerging and neglected disease that is currently expanding to urban areas. The incidence of human disease is related to canine infection. Araçatuba and Birigui are municipalities (counties) in the state of São Paulo, Brazil, with 8-10% seroprevalence of canine infection and that employ control strategies targeting the canine reservoir, based on serological survey and culling of seropositive dogs. Using data from these control programs to parameterize mathematical models, this study assessed the efficacy of these activities. We estimated that current control is capable of reducing the incidence of canine visceral leishmaniasis (CVL) by approximately 20%. Assuming continuous control and three times the current serological survey activities in Araçatuba and Birigui, culling dogs with a positive CVL diagnosis would be effective for the control of canine infection. Although theoretically possible, in practice the control of CVL with the currently recommended strategies is insufficient, since it would require overcoming the difficulties in these activities, such as lack of material, human, and financial resources, besides associated ethical and legal issues.

La leishmaniasis visceral es una enfermedad emergente y pasada por alto en proceso de expansión hacia áreas urbanas. La incidencia de la enfermedad humana está relacionada con la infección canina. Araçatuba y Birigui son municipios del estado de São Paulo, Brasil, con una seroprevalencia de infección canina de un 8 a un 10% que emplean estrategias de control dirigidas al reservorio canino, basado en una encuesta serológica y eutanasia de los perros seropositivos. Usando datos de esos programas de control para proporcionar parámetros en modelos matemáticos, este estudio evaluó la eficacia de esas actividades. Estimamos que el control actualmente empleado es capaz de reducir cerca de un 20% la incidencia de casos de leishmaniasis visceral canina (LVC). Si se considera un control continuo y un esfuerzo de las actividades de encuesta serológica igual al triple de la media de lo observado en Araçatuba y Birigui, la actividad de eutanasia de perros con diagnóstico positivo sería efectiva para el control de la infección canina. A pesar de que teóricamente es posible, en la práctica el control de la LVC con las estrategias preconizadas actualmente es insuficiente, puesto que exigiría superar dificultades a las que se enfrentan estas actividades como la falta de recursos materiales, humanos y financieros, además de las cuestiones éticas y jurídicas asociadas.

A leishmaniose visceral é uma doença emergente e negligenciada em processo de expansão para áreas urbanas. A incidência da doença humana está relacionada com a infecção canina. Araçatuba e Birigui são municípios do Estado de São Paulo, Brasil, com soroprevalência da infecção canina de 8 a 10%, que empregam estratégias de controle voltadas ao reservatório canino baseado em inquérito sorológico e eutanásia dos cães soropositivos. Usando dados desses programas de controle para parametrizar modelos matemáticos, este estudo avaliou a eficácia dessas atividades. Estimamos que o controle atualmente empregado é capaz de reduzir em cerca de 20% a incidência de casos de leishmaniose visceral canina (LVC). Considerando-se um controle contínuo e um esforço das atividades de inquérito sorológico igual ao triplo da média do observado em Araçatuba e Birigui, a atividade de eutanásia de cães com diagnóstico positivo seria efetiva para o controle da infecção canina. Embora teoricamente possível, na prática, o controle da LVC com as estratégias preconizadas atualmente é insuficiente, pois exigiria superpor dificuldades enfrentadas por estas atividades como falta de recursos materiais, humanos e financeiros, além das questões éticas e jurídicas associadas.

Visceral leishmaniasis is an emerging and neglected disease that is currently expanding to urban areas. The incidence of human disease is related to canine infection. Araçatuba and Birigui are municipalities (counties) in the state of São Paulo, Brazil, with 8-10% seroprevalence of canine infection and that employ control strategies targeting the canine reservoir, based on serological survey and culling of seropositive dogs. Using data from these control programs to parameterize mathematical models, this study assessed the efficacy of these activities. We estimated that current control is capable of reducing the incidence of canine visceral leishmaniasis (CVL) by approximately 20%. Assuming continuous control and three times the current serological survey activities in Araçatuba and Birigui, culling dogs with a positive CVL diagnosis would be effective for the control of canine infection. Although theoretically possible, in practice the control of CVL with the currently recommended strategies is insufficient, since it would require overcoming the difficulties in these activities, such as lack of material, human, and financial resources, besides associated ethical and legal issues.

La leishmaniasis visceral es una enfermedad emergente y pasada por alto en proceso de expansión hacia áreas urbanas. La incidencia de la enfermedad humana está relacionada con la infección canina. Araçatuba y Birigui son municipios del estado de São Paulo, Brasil, con una seroprevalencia de infección canina de un 8 a un 10% que emplean estrategias de control dirigidas al reservorio canino, basado en una encuesta serológica y eutanasia de los perros seropositivos. Usando datos de esos programas de control para proporcionar parámetros en modelos matemáticos, este estudio evaluó la eficacia de esas actividades. Estimamos que el control actualmente empleado es capaz de reducir cerca de un 20% la incidencia de casos de leishmaniasis visceral canina (LVC). Si se considera un control continuo y un esfuerzo de las actividades de encuesta serológica igual al triple de la media de lo observado en Araçatuba y Birigui, la actividad de eutanasia de perros con diagnóstico positivo sería efectiva para el control de la infección canina. A pesar de que teóricamente es posible, en la práctica el control de la LVC con las estrategias preconizadas actualmente es insuficiente, puesto que exigiría superar dificultades a las que se enfrentan estas actividades como la falta de recursos materiales, humanos y financieros, además de las cuestiones éticas y jurídicas asociadas.

RESUMO OBJETIVOS: Identificar aglomerados espaciais e espaço-temporais de altas taxas de incidência de aids em homens residentes no município de São Paulo desde o primeiro caso da doença em 1980. MÉTODOS: As notificações de HIV/aids foram obtidas do Sistema de Informação de Agravos de Notificação (57.440 homens) entre janeiro de 1980 e junho de 2012. Os casos foram geocodificados por endereço de residência; em seguida, análises de varredura puramente espacial, espaço-temporal e de variação espacial nas tendências temporais foram realizadas para três conjuntos de dados: total de casos de aids em homens com 13 anos de idade ou mais, homens com 50 anos ou mais e óbitos por aids. RESULTADOS: Foi possível geocodificar uma expressiva proporção de casos de aids (93,7%). Na análise de varredura puramente espacial, considerando-se todo o período avaliado, a epidemia de aids nos homens apresentou importante concentração espacial no Centro e em áreas contíguas das regiões Norte, Sudeste e Oeste do município, independentemente da faixa etária e da evolução para o óbito (riscos relativos entre 1,22 e 5,90). Levando-se em conta simultaneamente o espaço e o tempo, diversos aglomerados foram encontrados, espalhados por todas as regiões do município (riscos relativos entre 1,44 e 8,61). Na análise da variação espacial nas tendências temporais, os aglomerados nas regiões mais periféricas apresentaram maior incremento percentual anual das taxas da doença (de até 7,58%), denotando a tendência de “periferização” da epidemia nos homens na cidade de São Paulo. CONCLUSÕES: Este estudo permitiu a detecção de aglomerados geográficos de alto risco para a aids nos homens, apontando para áreas prioritárias no município, tanto para ações programáticas como para nortear outros estudos.

ABSTRACT OBJECTIVES: To identify spatial and space-time clusters with high incidence rates of AIDS in men living in the city of São Paulo since the first case of the disease in 1980. METHODS: HIV/AIDS notifications were obtained from the Notifiable Diseases Information System (57,440 men) between January 1980 and June 2012. The cases were geocoded by residence address; then analyses of purely spatial, space-time and spatial variation in temporal trends were performed for three sets of data: total cases of AIDS in men aged 13 years or older, men aged 50 years or older, and deaths from AIDS. RESULTS: It was possible to geocode a significant proportion of AIDS cases (93.7%). In the purely spatial scanning analysis, considering the entire period evaluated, the AIDS epidemic in men presented an important spatial concentration in the Center and in contiguous areas of the North, Southeast and West regions of the municipality, regardless of age group and evolution to death (relative risks between 1.22 and 5.90). Considering space and time simultaneously, several clusters were found, spread throughout all regions of the municipality (relative risks between 1.44 and 8.61). In the analysis of spatial variation in temporal trends, the clusters in the most peripheral regions presented a higher annual percentage increase in disease rates (up to 7.58%), denoting the tendency of “peripherization” of the epidemic in men in the city of São Paulo. CONCLUSIONS: This study allowed the detection of geographic clusters of high risk for AIDS in men, pointing to priority areas in the municipality, both for programmatic actions and to guide other studies.