An assessment of the economic impact Of climate change on the health sector in Saint Lucia

Climate change has the potential to impact on global, regional, and national disease burdens both directly and indirectly. Projecting and valuing these health impacts is important not only in terms of assessing the overall impact of climate change on various parts of the world, but also of ensuring that national and regional decision-making institutions have access to the data necessary to guide investment decisions and future policy design. This report contributes to the research focusing on projecting and valuing the impacts of climate change in the Caribbean by projecting the climate change-induced excess disease burden for two climate change scenarios in Saint Lucia for the period 2010 - 2050, and by estimating the non-market, statistical life-based costs associated with this excess disease burden. The diseases initially considered in this report are a variety of vector and water-borne impacts and other miscellaneous conditions; specifically, malaria, dengue fever, gastroenteritis/diarrhoeal disease, schistosomiasis, leptospirosis, ciguatera poisoning, meningococcal meningitis, and cardio-respiratory diseases. Disease projections were based on derived baseline incidence and mortality rates, available dose-response relationships found in the published literature, climate change scenario population projections for the A2 and B2 IPCC SRES scenario families, and annual temperature and precipitation anomalies as projected by the downscaled ECHAM4 global climate model. Monetary valuation was based on a transfer value of statistical life approach with a modification for morbidity. Using discount rates of 1, 2, and 4%, results show mean annual costs (morbidity and mortality) ranges of $80.2 million (in the B2 scenario, discounted at 4% annually) -$182.4 million (in the A2 scenario, discounted at 1% annually) for St. Lucia.1 These costs are compared to adaptation cost scenarios involving direct and indirect interventions in health care. This comparison reveals a high benefit-cost ratio suggesting that moderate costs will deliver significant benefit in terms of avoided health costs from 2010-2050. In this context indirect interventions target sectors other than healthcare (e.g. water supply). It is also important to highlight that interventions can target both the supply of health infrastructure (including health status and disease monitoring), and households. It is suggested that a focus on coordinated data collection and improved monitoring represents a potentially important no regrets adaptation strategy for St Lucia. Also, the need for this to be part of a coordinated regional response that avoids duplication in spending is highlighted.

The cost of hunger: Social and economic impact of child undernutrition in the Plurinational State of Bolivia, Ecuador, Paraguay and Peru

The Economic Commission for Latin America and the Caribbean (ECLAC) jointly with the World Program of Food (WFP) and recognized experts of the region developed a methodology that, using secondary information, estimate the opportunity cost derived from undernutrition. This methodology has been successfully applied in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the Dominican Republic, where the cost of undernutrition was estimated at 6.7 billion dollars in 2004. The present study covers four countries in South America: Bolivia, Ecuador, Paraguay and Peru. The results indicate that the cost of the malnutrition in these countries reached 4.3 billion dollars in 2005, which is equivalent to 3.3 per cent of the GDP of these countries. The results strongly point out that child undernutrition is not only a problem of health or an unacceptable situation ethically, but it is a national problem, given the enormous social costs and the loss of opportunities that it imposes on the national economy.

Assessment of surface water in two Amazonian rivers impacted by industrial wastewater, Barcarena City, Pará State (Brazil)

No ano de 2007, águas superficiais foram coletadas a partir de 21 pontos de amostragem na cidade de Barcarena, Região Norte, Brasil: um ponto de amostragem localizado em um pequeno córrego que recebe descarga de resíduos a partir da indústria de beneficiamento do caulim e deságua no Rio Curuperê, três pontos de amostragens localizados próximos de fontes que emergem na margem esquerda e deságuam no Rio Curuperê, nove pontos de amostragem no Rio Curuperê, que deságua no Rio Dendê, e oito no Rio Dendê, afluente da margem esquerda do Rio Pará. Para todas as amostras de água foram quantificadas 14 variáveis físico-químicas e níveis de 12 metais. Os resultados nos pontos próximos das fontes do Rio Curuperê apresentaram perfil físico-químico e níveis de metais típicos para águas superficiais e esses valores foram utilizados como referência para comparar e identificar possíveis alterações nas características químicas para os demais pontos de amostragem. Quando os resultados das fontes do rio Curuperê foram comparados com os resultados do ponto próximo a descarga de resíduos industriais foram observadas fortes alterações nos valores de 6 variáveis físico-químicas (pH, condutividade elétrica (EC), total de sólidos suspensos (TDS), nitrogênio amoniacal (N-NH4), sulfato (SO4) e salinidade) e aumento em magnitude dos níveis de quatro metais (Al, Fe, Mn e Zn), caracterizando que esses resíduos eram descarregados no ambiente sem tratamentos adequados. Os resultados nos demais pontos de amostragem demonstraram que estas condições anômalas também foram encontradas ao longo dos Rios Curuperê e Dendê, principalmente durante a maré baixa. A partir desta caracterização química das águas foram identificadas condições prejudiciais aos ecossistemas aquáticos e potencial risco à saúde da população local que usa os rios para consumo, recreação e transporte.

Descriptive study of HTLV infection in a population of pregnant women from the state of Pará, Northern Brazil

INTRODUÇÃO: No Brasil, estudos mostram que a soroprevalência do HTLV entre gestantes varia de 0 a 1,8%. Contudo, esta soroprevalência era desconhecida no Estado do Pará, Brasil. O presente estudo descreve, pela primeira vez, a soroprevalência do HTLV entre gestantes do Estado do Pará, Norte do Brasil. MÉTODOS: 13,382 gestantes foram submetidas à triagem para HTLV durante o pré-natal, e aquelas com sorologia alterada para anti-HTLV foram submetidas ao teste de Western Blot (WB), para confirmar e discriminar portadoras do HTLV-1 e do HTLV-2. RESULTADOS: A soroprevalência do HTLV na população de gestantes foi de 0,3%, sendo o HTLV-1 identificado em 95,3% das pacientes. O perfil demográfico das portadoras do HTLV foi de: mulheres com idade entre 20-40 anos (78,4%); residentes na região metropolitana de Belém (67,6%) e com nível educacional igual ao ensino médio (56,8%). Outras variáveis relacionadas à infecção foram: início das relações sexuais compreendido entre 12-18 anos (64,9%), e ter sido aleitada mais de 6 meses (51,4%). A maior parte das mulheres estudadas teve ao menos duas gestações anteriores (35,1%); e nenhum aborto (70,3%). Co-infecções (sífilis e HIV) foram descritas em 10,8% (4/37) das gestantes. A soroprevalência da infecção pelo HTLV em gestantes atendidas em Unidades Básicas de Saúde do Estado do Pará, Norte do Brasil foi de 0,3% semelhante à descrita em outros estudos brasileiros. As variáveis relacionadas com a infecção são indicadores importantes na identificação de gestantes com maior tendência a soropositividade pelo HTLV, sendo uma estratégia de controle e prevenção, evitando a transmissão vertical.

Serological Evidence of HTLV-I and HTLV-II Coinfections in HIV-1 Positive Patients in Belém, State of Pará, Brazil

ABSTRACT: The occurrence of HTLV-I/II and HIV-1 coinfections have been shown to be frequent, probably in consequence of their similar modes of transmission. This paper presents the prevalence of coinfection of HTLV among HIV-1 infected and AIDS patients in Belém, State of Pará, Brazil. A group of 149 patients attending the AIDS Reference Unit of the State Department of Health was tested for the presence of antibodies to HTLV-I/II using an enzyme immunoassay and the positive reactions were confirmed with a Western blot that discriminates between HTLV-I and HTLV-II infections. Four patients (2.7%) were positive to HTLV-I, seven (4.7%) to HTLV-II and one (0.7%) showed an indeterminate pattern of reaction. The present results show for the first time in Belém not only the occurrence of HTLV-II/HIV-1 coinfections but also a higher prevalence of HTLV-II in relation to HTLV-I. Furthermore, it also enlarges the geographical limits of the endemic area for HTLV-II in the Amazon region of Brazil.

Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará, Northern Brazil

Nós determinamos os fatores de risco à infecção pelo HCV em doadores de sangue no Estado do Pará, Brasil. Foram analisados 256 doadores de sangue atendidos na Fundação HEMOPA de 2004 a 2006, sendo divididos em dois grupos: infectados e não-infectados. O diagnóstico foi realizado por PCR em tempo real. Todos os participantes responderam a questionário sobre possíveis fatores de risco, sendo a modelagem estatística feita por regressão logística simples e múltipla. Os fatores de risco à infecção foram: uso de agulhas e seringas de vidros esterilizadas em casa (OR = 4,55), realização de tratamento dentário invasivo (OR = 3,08), compartilhamento de lâminas em domicílio (OR = 1,99), compartilhamento de lâminas descartáveis em barbearias, salões de beleza (OR = 2,34), e compartilhamento de material de manicure e pedicure (OR = 3,45). As autoridades de saúde devem conscientizar a população sobre o compartilhamento de materiais perfuro-cortantes em domicílio, salões de beleza e consultórios dentários como fatores de risco à infecção.

Between the processes of strengthening and weakening of the Family Health Strategy

This was a qualitative study with the purpose of designing a meta-model for the work process of the Family Health Strategy (FHS) team. It was based on the experience of six sample groups, composed of their members (physicians, professional nurses, dentists, dental assistants, licensed technical nurses and community health agents) in a city in São Paulo state, Brazil, totaling 54 subjects. Six theoretical models emerged from non-directive interviews. These were analyzed according to Grounded Theory and submitted to the meta-synthesis strategy, which produced the meta-model between the processes of strengthening and weakening of the FHS model: professional-team-community reciprocity as an intervening component. When analyzed in light of the Theory of Complexity (TC), it showed to be a work with a vertical and authoritarian tendency, which is largely hegemonic in the tradition of public health care policies.

Spatial distribution of dengue incidence and socio-environmental conditions in Campinas, São Paulo State, Brazil, 2007

This study aimed to analyze the spatial distribution of dengue risk and its association with socio-environmental conditions. This was an ecological study of the counts of autochthonous dengue cases in the municipality of Campinas, São Paulo State, Brazil, in the year 2007, aggregated according to 47 coverage areas of municipal health centers. Spatial models for mapping diseases were constructed with Bayesian hierarchical models, based on Integrated Nested Laplace Approximation (INLA). The analyses were stratified according to two age groups, 0 to 14 years and above 14 years. The results indicate that the spatial distribution of dengue risk is not associated with socio-environmental conditions in the 0 to 14 year age group. In the age group older than 14 years, the relative risk of dengue increases significantly as the level of socio-environmental deprivation increases. Mapping of socio-environmental deprivation and dengue cases proved to be a useful tool for data analysis in dengue surveillance systems.

Cyanobacteria detection in Guarapiranga Reservoir (São Paulo State, Brazil) using Landsat TM and ETM+ images

Algae bloom is one of the major consequences of the eutrophication of aquatic systems, including algae capable of producing toxic substances. Among these are several species of cyanobacteria, also known as blue-green algae, that have the capacity to adapt themselves to changes in the water column. Thus, the horizontal distribution of cyanobacteria harmful algae blooms (CHABs) is essential, not only to the environment, but also for public health. The use of remote sensing techniques for mapping CHABs has been explored by means of bio-optical modeling of phycocyanin (PC), a unique inland waters cyanobacteria pigment. However, due to the small number of sensors with a spectral band of the PC absorption feature, it is difficult to develop semi-analytical models. This study evaluated the use of an empirical model to identify CHABs using TM and ETM+ sensors aboard Landsat 5 and 7 satellites. Five images were acquired for applying the model. Besides the images, data was also collected in the Guarapiranga Reservoir, in São Paulo Metropolitan Region, regarding the cyanobacteria cell count (cells/mL), which was used as an indicator of CHABs biomass. When model values were analyzed excluding calibration factors for temperate lakes, they showed a medium correlation (R²=0.81, p=0.036), while when the factors were included the model showed a high correlation (R²=0.96, p=0.003) to the cyanobacteria cell count. The empirical model analyzed proved useful as an important tool for policy makers, since it provided information regarding the horizontal distribution of CHABs which could not be acquired from traditional monitoring techniques.

Spatial Distribution of the Risk of Dengue and the Entomological Indicators in Sumare, State of Sao Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sero-epidemiological survey for brucellosis, leptospirosis, and toxoplasmosis in free-ranging Alouatta caraya and Callithrix penicillata from Sao Paulo State, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Hospitalizations for Conditions Sensitive to Primary Care: A Geo-Epidemiological Profile Analysis of in a Hospital in the Sao Paulo State, From July 2010 to June 2011

The primary health care has been recognized as one of the key components of an effective health system. In its most developed form, the primary health care is the first contact with the health system and the site responsible for the organization of health care over time: individuals, their families and the general population; seeks to provide balance between the two goals of a national health system, which are improving the health of the population and provide equitable distribution of resources. Hospitalizations for primary care sensitive conditions (HPCSC) may be associated with deficiencies of service coverage primary health care or its effectiveness. Hospitalization rates can and should represent a warning sign, triggering mechanisms for analysis and search for explanations for these problems. The use of hospitalization data for HPCSC can serve as indicators of inequality in the health system, contributing to the evaluation of the deployment and implementation of health policies.

Serological survey and risk factors for brucellosis in water buffaloes in the state of Para, Brazil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Clinical aspects of envenomation caused by Tityus obscurus (Gervais, 1843) in two distinct regions of Para state, Brazilian Amazon basin: a prospective case series

Background: Scorpion envenomations are a major public health problem in Brazil, whose most dangerous cases are attributable to the genus Tityus. This study was designed to compare the clinical and demographic features of envenomations by Tityus obscurus in two areas of the state of Para located in the Amazon basin. Were compared demographic findings, local and systemic signs and symptoms of human envenomations caused by T. obscurus that occurred in western and eastern areas of the state.Results: Forty-eight patients with confirmed envenomation by T. obscurus were evaluated from January 2008 to July 2011. Most of them came from the eastern region, where male and female patients were present in similar numbers, while males predominated in the west. Median age groups were also similar in both areas. Most scorpion stings took place during the day and occurred significantly more frequently on the upper limbs. The time between the sting and admission to the health center was less than three hours in both areas. Most eastern patients had local manifestations while in the west, systemic manifestations predominated. Local symptoms were similar in both areas, but systemic signs and symptoms were more common in the west. Symptoms frequently observed at the sting site were local and radiating pain, paresthesia, edema, erythema, sweating, piloerection and burning. The systemic manifestations were significantly higher in patients from the west. Futhermore, neurological symptoms such as general paresthesia, ataxia, dysarthria, myoclonus, dysmetria, and electric shock-like sensations throughout the body were reported only by patients from the west.Conclusion: The present study shows that two regions of Para state differ in the clinical manifestations and severity of confirmed envenomation by T. obscurus which suggests a toxicity variation resulting from the diversity of T. obscurus venom in different areas of the Brazilian Amazon basin, and that T. serrulatus antivenom can be successfully used against T. obscurus.

Impact of insecticide resistance on the field control of Aedes aegypti in the State of São Paulo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)