Introducao e expansao da Leishmaniose visceral americana em humanos no estado de Sao Paulo, 1999-2011

OBJETIVO : Analisar a expansão da ocorrência de leishmaniose visceral americana em humanos e identificar localidades prioritárias para o desenvolvimento de ações de vigilância e controle. MÉTODOS : A área de estudo constituiu-se dos 316 municípios do estado de São Paulo pertencentes às cinco regiões de saúde com ocorrência da leishmaniose visceral americana em humanos, utilizando os casos autóctones e óbitos, com ano de notificação e município de ocorrência. Calcularam-se taxas de incidência e de mortalidade e letalidade por município, por região e para a área de estudo. Utilizaram-se o estimador bayesiano empírico para obtenção de taxas de incidência e de mortalidade bayesianas locais para cada município e a krigagem para visualização da distribuição espacial das temperaturas e das precipitações pluviométricas. RESULTADOS : Foram detectados 73 municípios com transmissão da doença. As primeiras ocorrências deram-se em áreas com maiores temperaturas e menores pluviosidades, mas sua disseminação também ocorreu em áreas menos quentes e mais úmidas. A expansão da leishmaniose visceral americana em humanos apresentou um eixo principal de disseminação no sentido noroeste para sudeste, acompanhando a rodovia Marechal Rondon e o gasoduto Bolívia-Brasil, e um eixo secundário, na direção norte-sul, acompanhando a malha rodoviária. As taxas de incidência, segundo regiões de saúde, apresentaram um pico seguido de queda, com exceção da região de São José do Rio Preto. Observou-se maior concentração de municípios com altas taxas de incidência e mortalidade nas regiões de saúde de Araçatuba, Presidente Prudente e Marília. CONCLUSÕES : Possíveis fatores determinantes da expansão da doença incluíram a rodovia Marechal Rondon e a construção do gasoduto Bolívia-Brasil. Fatores climáticos pareceram não ter papel determinante nessa expansão. O uso de técnicas de análise espacial permitiu identificar municípios com possível subnotificação de casos e óbitos e indicar municípios prioritários para o desenvolvimento de ações de vigilância e controle.

Determinantes sociais da saude e o Programa Saude da Familia no municipio de Sao Paulo

OBJETIVO Analisar a situação do trabalho com determinantes sociais da saúde no âmbito do Programa Saúde da Família. MÉTODOS Estudo de caso com métodos mistos de pesquisa, ancorados em estratégia sequencial explanatória, com 171 gerentes das unidades do Programa Saúde da Família em São Paulo, SP, em 2005/2006. Questionários autopreenchíveis foram aplicados. Entrevistas semiestruturadas e grupos focais foram realizados com amostra intencional de profissionais envolvidos no trabalho com determinantes sociais da saúde. Os dados quantitativos foram analisados por análise descritiva, análise de correspondência múltipla, análise de agrupamento e testes de correlação entre variáveis. Os dados qualitativos foram apurados por análise de conteúdo e a criação de categorias temáticas. RESULTADOS Apesar da concentração de atividades direcionadas ao cuidado com a doença, o Programa Saúde da Família realizou atividades relacionadas à determinação social da saúde, contemplando todas as formas de abordagem da promoção da saúde (biológico, comportamental, psicológico, social e estrutural) e os principais determinantes sociais da saúde descritos na literatura. Houve diferença significativa quanto à abrangência dos determinantes trabalhados nas unidades em relação às diferentes regiões do município. Constatou-se fragilidade das iniciativas e a sua desconexão com a estrutura programática do Programa Saúde da Família. CONCLUSÕES A quantidade e variedade de atividades com determinantes sociais da saúde realizadas no Programa Saúde da Família mostram potencial para trabalhar a determinação social da saúde. Mas a fluidez de objetivo e o caráter extraordinário das atividades descritas questionam sua sustentabilidade como parte integral da atual estrutura organizacional do programa.

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil. METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness. RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients. CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

Vulnerabilities in snakebites in Sao Paulo, Brazil

ABSTRACT OBJECTIVE To describe elements of vulnerability of victims of snakebite. METHODS This qualitative, descriptive, cross-sectional study had, as theoretical framework, the concept of vulnerability in individual, social, and programmatic dimensions. We interviewed 21 patients admitted into a hospital specialized in the care of accidents caused by venomous animals. The interviews were analyzed according to a discourse analysis technique. RESULTS Patients were mainly young men, living in remote countryside areas, where health services frequently have limited resources. We found social and individual conditions of vulnerability, such as precarious schooling, low professional qualification, housing without access to piped water, no sewage treated, and no regular garbage collection, and lack of knowledge on this health problem. Regarding the programmatic dimension, we found limited accessibility to the health services that could affect the prognosis and the frequency of sequelae and deaths. CONCLUSIONS Considering such vulnerabilities evoke the need to improve the program for control the Accidents by Venomous Animals and the training of health workers, we highlight the potential use of the concept of vulnerability, which may amplify the understanding and the recommendations for the practice and education related to snakebites.

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo.METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care.RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician.CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

Finding Aedes aegypti in a natural breeding site in an urban zone, Sao Paulo, Southeastern Brazil

ABSTRACT This is the description of how nine Aedes aegypti larvae were found in a natural breeding site in the Pinheiros neighborhood, city of Sao Paulo, SP, Southeastern Brazil. The record was conducted in December 2014, during an entomological surveillance program of dengue virus vectors, with an active search of potential breeding sites, either artificial or natural. Finding Ae. aegypti larvae in a tree hole shows this species’ ability to use both artificial and natural environments as breeding sites and habitats, which points towards the importance of maintaining continuous surveillance on this mosquito in all kinds of water-holding containers.

Occurrence of campylobacter jejuni in diarrhoeic and non-diarrhoeic children in Sao Paulo, Brazil

Campylobacter jejuni was looked for in the feaces of 262 children, beeing 189 with acute diarrhoea, 31 with chronic diarrhoea and 42 controls. The organism was isolated from 14 (7.4%), 2 (6.5%) and 6 (14.3%) of the children, and each group, respectively.

SEROPREVALENCE OF CHAGASIC INFECTION IN YOUNG INDIVIDUALS IN A BLOOD CENTER IN THE STATE OF SAO PAULO, BRAZIL

SUMMARY This study aimed at estimating the number of cases of non-negative serological reactions to Chagas disease in blood donors at the Blood Center of Botucatu, São Paulo, Brazil, from 2003 to 2010 and at relating them to their cities of origin. Five hundred and seventy-four non-negative results for Chagas disease were evaluated. Of these, 371 (64.8%) were reagent, and 203 (35.4%) were inconclusive. The prevalence of Chagas disease in blood donors was 0.05%. There were, on average, 72 cases/year, and a prevalence of males was observed (64.8%). Forty-three (7.49%) individuals were 18 to 30 years old; 92 (16.02%) were 31 to 40; 147 (25.61%) 41 to 50, and 292 (50.87%) were older than 50 years. It was observed that 29.3% of females with reagent serology were at their fertile age (18 and 45 years). The majority of donors were originally from cities in the southwestern and central regions of São Paulo, but individuals from other states contributed with 20%. The provenance of most donors was the city of Botucatu/SP, followed by the city of Taquarituba/SP. Therefore, the profile of donors at this blood center favors the occurrence of a larger number of non-negative serological reactions. Although there has been a significant reduction in the number of new cases/year for this disease, it is still a public-health problem, and results suggest the need for new epidemiological assessments in the studied region.

Spontaneous reporting of adverse events following pandemic influenza A (H1N1) immunization in a reference center in the State of Sao Paulo, Brazil

Introduction This paper describes adverse events (AEs) temporally associated to the pandemic influenza A (H1N1) vaccine observed in a reference center in São Paulo, Brazil, during a 2010 mass vaccination campaign. Methods A retrospective study involving persons who sought medical care for AEs following influenza vaccination. Data were retrieved from medical records, vaccine AE notification forms, and a computerized system for immunobiological registration. Results Sixty-six vaccinees sought medical care for AEs after immunization. The most frequent AEs were fever, headache, myalgia, and pain at the injection site. No serious AEs were reported. Conclusions Few vaccinees spontaneously reported AEs to influenza A (H1N1) vaccine at this center.

The Budget 2009 Tax Proposals and Activity in the UK Continental Shelf (UKCS)

NORTH SEA STUDY OCCASIONAL PAPER No. 113

Taxation and Total Government Take from the UK Continental Shelf (UKCS) Following Phase 3 of the European Emissions Trading Scheme (EU ETS)

NORTH SEA STUDY OCCASIONAL PAPER No. 117