Space-time description of dengue epidemic in Cruzeiro, SP, in 2006 and 2011

Objective: to identify patterns in the spatial and temporal distribution of cases of dengue fever occurring in the city of Cruzeiro, state of Sao Paulo (SP).Methods: an ecological and exploratory study was undertaken using spatial analysis tools and data from dengue cases obtained on the SinanNet. The analysis was carried out by area, using the IBGE census sector as a unit. The months of March to June 2006 and 2011 were assessed, revealing progress of the disease. TerraView 3.3.1 was used to calculate the Global Moran's I, month to month, and the Kernel estimator.Results: in the year 2006, 691 cases of dengue fever (rate of 864.2 cases/100,000 inhabitants) were georeferenced; and the Moran's I and p-values were significant in the months of April and May (TM = 0.28; p = 0.01; I-M = 0.20; p = 0.01) with higher densities in the central, north, northeast and south regions. In the year 2011, 654 cases of dengue fever (rate of 886.8 cases/100,000 inhabitants) were georeferenced; and the Moran's I and p-values were significant in the months of April and May (I, = 0.28; p = 0.01; I-M = 0.16; p = 0.05) with densities in the same regions as 2006. The Global Moran's I is a global measure of spatial autocorrelation, which indicates the degree of spatial association in the set of information from the product in relation to the average. The I varies between -1 and +1 and can be attributed to a level of significance (p-value). The positive value points to a positive or direct spatial autocorrelation.Conclusion: we were able to identify patterns in the spatial and temporal distribution of dengue cases occurring in the city of Cruzeiro, SP, and locate the census sectors where the outbreak began and how it evolved.

Decline in dental caries among 12-year-old children in Brazil, 1980-2005

Objectives This study was conducted to determine changes in values on the decayed, missing and filled teeth (DMFT) index in 12-year-old children in Brazil between 1980 and 2005, and to correlate DMFT values with human development index (HDI) values, time, population size of municipality and fluoridation of the water supply. Methods The present study represents a retrospective ecological study using secondary data from epidemiological surveys published in indexed journals, as well as data obtained from epidemiological official surveys carried out in Brazil in 1986, 1996 and 2003, and in the State of Sao Paulo in 1998 and 2002. Units of study were represented by Brazilian municipalities holding average DMFT index values for 12-year-old children. Multiple regression analysis was used to examine the correlations among DMFT and HDI values, and time, population size and fluoridation of the water supply. Results The final database included 550 records of DMFT values in 428 different towns. Regression analysis showed statistically significant correlations between DMFT index values and time (P < 0.001), fluoridation of the water supply (P < 0.001) and size of municipality (P < 0.001). Estimated mean DMFT index values were 8.36 in 1980, 6.08 in 1985, 4.45 in 1990, 3.29 in 1995, 2.46 in 2000 and 1.86 in 2005. Conclusions Data showed a significant decrease in dental caries across the entire country, with an average reduction of 25% occurring every 5 years. General trends indicated that a reduction in DMFT index values occurred over time, that a further reduction in DMFT index values occurred when a municipality fluoridated its water supply, and mean DMFT index values were lower in larger than in smaller municipalities.

Spatial regimes: dynamics of intentional homicides in the city of Sao Paulo between 2000 and 2008

Objective. To identify the existence of spatial and temporal patterns in the occurrence of intentional homicides in the municipality of Sao Paulo (MSP), Brazil, and to discuss the analytical value of taking such patterns into account when designing studies that address the dynamics and factors associated with the incidence of homicides. Methods. A longitudinal ecological study was conducted, having as units of analysis 13 205 census tracts and the 96 census districts that congregate these sectors in Sao Paulo. All intentional homicides reported in the city between 2000 and 2008 were analyzed. The gross homicide rates per 100 000 population was calculated as well as the global and local Bayesian estimates for each census tract during the study period. To verify the possibility of identifying different patterns of the spatial distribution of homicides, we used BoxMap and Moran's I index. Results. The homicide trends in the city of Sao Paulo in the last decade were not homogeneous and systematic. Instead, seven patterns of spatial distribution were identified; that is, seven spatial regimes for the occurrence of intentional homicides, considering the homicide rates within each census tract as well as the rates in adjacent tracts. These spatial distribution regimes were not contained within the limits of the census tracts and districts. Conclusions. The results show the importance of analyzing the spatial distribution of social phenomena without restriction of political and administrative boundaries.

Spatio-temporal patterns of tuberculosis incidence in Ribeirao Preto, State of Sao Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis

Introduction: The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirao Preto, State of Sao Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. Methods: We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. Results: The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirao Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. Conclusions: The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

Oral health and access to dental care services in relation to the Health Necessities Index. Sao Paulo, Brazil, 2008

The Health Department of Sao Paulo, Brazil, has developed a Health Necessities Index (HNI) to identify priority areas for providing health assistance. In 2008, a survey of the status of oral health was conducted. The objective of this ecological study was to analyze the status of oral health in relation to the HNI. The variables, stratified by the age of 5, 12 and 15 years old were: percentage of individuals with difficulty of access to dental care services; DMFT and DMFS; prevalence of the need for tooth extraction and treatment of dental caries. Data were analyzed for the 25 Health Technical Supervision Units (HTS). The Statistical Covariance Test was used as well as the Pearson correlation coefficient and linear regression model. A positive correlation was observed between high scores of the HNI and difficulty of access to services. In the HTS with high scores of HNI a higher incidence of dental caries was observed, a greater need for tooth extractions and low caries-free incidence. In order to improve health conditions of the population it is mandatory to prioritize actions in areas of social deprivation.

Spatio-temporal patterns of tuberculosis incidence in Ribeirão Preto, State of São Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis

INTRODUCTION: The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirão Preto, State of São Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. METHODS: We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. RESULTS: The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirão Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. CONCLUSIONS: The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

Evolução dos homicídios e indicadores de segurança pública no Município de São Paulo entre 1996 a 2008: um estudo ecológico de séries temporais

OBJETIVO: analisar a associação entre homicídios e indicadores de segurança pública no MSP entre 1996 e 2008, após controle para taxa de desemprego e proporção de jovens na população. METODOLOGIA: estudo ecológico de série temporal, tendo como unidade de análise o Município de São Paulo (MSP), entre 1996 e 2008. Variável dependente: óbitos por homicídio; variáveis independentes principais: taxa de aprisionamento-encarceramento (TAE), o acesso a armas de fogo (AAF), e a atividade policial (ATP). A análise dos dados foi realizada com o software Stata.IC 10.0. Modelos de regressão binomial negativa simples e multivariados foram construídos. RESULTADOS: A análise univariada demonstrou associação entre óbitos por homicídio e TAE e entre óbitos e ATP. O AAF não se mostrou associado à redução no número de óbitos por homicídios (p > 0,05). Após ajuste houve perda da significância na associação com ambos indicadores de Segurança Pública. CONCLUSÕES: No MSP o papel das ações de segurança pública perdem importância como fatores explicativos para a redução nos níveis de homicídios após controle para taxa de desemprego e redução na proporção de jovens. Os resultados reforçam a importância dos fatores socioeconômicos e demográficos para a mudança no cenário da segurança em São Paulo.

Identification of Urban Leprosy Clusters

Overpopulation of urban areas results from constant migrations that cause disordered urban growth, constituting clusters defined as sets of people or activities concentrated in relatively small physical spaces that often involve precarious conditions. Aim. Using residential grouping, the aim was to identify possible clusters of individuals in São José do Rio Preto, Sao Paulo, Brazil, who have or have had leprosy. Methods. A population-based, descriptive, ecological study using the MapInfo and CrimeStat techniques, geoprocessing, and space-time analysis evaluated the location of 425 people treated for leprosy between 1998 and 2010. Clusters were defined as concentrations of at least 8 people with leprosy; a distance of up to 300 meters between residences was adopted. Additionally, the year of starting treatment and the clinical forms of the disease were analyzed. Results. Ninety-eight (23.1%) of 425 geocoded cases were located within one of ten clusters identified in this study, and 129 cases (30.3%) were in the region of a second-order cluster, an area considered of high risk for the disease. Conclusion.This study identified ten clusters of leprosy cases in the city and identified an area of high risk for the appearance of new cases of the disease.

No temporal association between influenza outbreaks and invasive pneumococcal infections

OBJECTIVE: To assess whether the influenza peak in populations precedes the annual peak for invasive pneumococcal infections (IPI) in winter. DESIGN: Ecological study. Active surveillance data on influenza A and IPI in children up to 16 years of age collected from 1997 to 2003 were analysed. SETTING: Paediatric hospitals in Germany. Patients: Children under 16 years of age. RESULTS: In all years under study, the influenza A season did not appear to affect the IPI season (p = 0.49). Specifically, the influenza peak never preceded the IPI peak. CONCLUSION: On a population level there was no indication that the annual influenza epidemic triggered the winter increase in the IPI rate or the peak of the IPI distribution in children.

Sediment core fossils in ancient Lake Ohrid: testing for faunal change since the Last Interglacial

Ancient Lake Ohrid is probably of early Pleistocene or Pliocene origin and amongst the few lakes in the world harbouring an outstanding degree of endemic biodiversity. Although there is a long history of evolutionary research in Lake Ohrid, particularly on molluscs, a mollusc fossil record has been missing up to date. For the first time, gastropod and bivalve fossils are reported from the basal, calcareous part of a 2.6 m long sediment succession (core Co1200) from the north-eastern part of Lake Ohrid. Electron spin resonance (ESR) dating of mollusc shells from the same stratigraphic level yielded an age of 130 ± 28 ka. Lithofacies III sediments, i.e. a stratigraphic subdivision comprising the basal succession of core Co1200 between 181.5–263 cm, appeared solid, greyish-white, and consisted almost entirely of silt-sized endogenic calcite (CaCO3>70%) and intact and broken mollusc shells. Here we compare the faunal composition of the thanatocoenosis with recent mollusc associations in Lake Ohrid. A total of 13 mollusc species (9 gastropod and 4 bivalve species) could be identified within Lithofacies III sediments. The value of sediment core fossils for reconstructing palaeoenvironmental settings was evaluated and the agreement between sediment and palaeontological proxies was tested. The study also aims at investigating major faunal changes since the Last Interglacial and searching for signs of extinction events. The combined findings of the ecological study and the sediment characteristics suggest deposition in a shallow water environment during the Last Interglacial. The fossil fauna exclusively included species also found in the present fauna, i.e. no extinction events are evident for this site since the Last Interglacial. The thanatocoenosis showed the highest similarity with recent Intermediate Layer (5–25 m water depth) mollusc assemblages. The demonstrated existence of a mollusc fossil record in Lake Ohrid sediment cores also has great significance for future deep drilling projects. It can be hoped that a more far reaching mollusc fossil record will then be obtained, enabling insight into the early evolutionary history of Lake Ohrid.

Institutions for sustainable governance of forests: Equity, robustness and cross-level interactions in Mawlyngbna, Meghalaya, India

This study adopts Ostrom’s Social-Ecological Systems (SES) framework in empirical fieldwork to explain how local forestry institutions affect forest ecosystems and social equity in the community of Mawlyngbna in North-East India. Data was collected through 26 semi-structured interviews, participatory timeline development, policy documents, direct observation, periodicals, transect walks, and a concurrent forest-ecological study in the village. Results show that Mawlyngbna's forests provide important sources of livelihood benefits for the villagers. However, ecological disturbance and diversity varies among the different forest ownership types and forest-based livelihood benefits are inequitably distributed. Based on a bounded rationality approach, our analysis proposes a set of causal mechanisms that trace these observed social-ecological outcomes to the attributes of the resource system, resource units, actors and governance system. We analyse opportunities and constraints of interactions between the village, regional, and state levels. We discuss how Ostrom’s design principles for community-based resource governance inform the explanation of robustness but have a blind spot in explaining social equity. We report experiences made using the SES framework in empirical fieldwork. We conclude that mapping cross-level interactions in the SES framework needs conceptual refinement and that explaining social equity of forest governance needs theoretical advances.

A comparison of worker risk of injury while working on fully automated side loaders and other residential collection trucks at a large solid waste collection company

The study aim was to determine whether using automated side loader (ASL) trucks in higher proportions compared to other types of trucks for residential waste collection results in lower injury rates (from all causes). The primary hypothesis was that the risk of injury to workers was lower for those who work with ASL trucks than for workers who work with other types of trucks used in residential waste collection. To test this hypothesis, data were collected from one of the nation’s largest companies in the solid waste management industry. Different local operating units (i.e. facilities) in the company used different types of trucks to varying degrees, which created a special opportunity to examine refuse collection injuries and illnesses and the risk reduction potential of ASL trucks.^ The study design was ecological and analyzed end-of-year data provided by the company for calendar year 2007. During 2007, there were a total of 345 facilities which provided residential services. Each facility represented one observation.^ The dependent variable – injury and illness rate, was defined as a facility’s total case incidence rate (TCIR) recorded in accordance with federal OSHA requirements for the year 2007. The TCIR is the rate of total recordable injury and illness cases per 100 full-time workers. The independent variable, percent of ASL trucks, was calculated by dividing the number of ASL trucks by the total number of residential trucks at each facility.^ Multiple linear regression models were estimated for the impact of the percent of ASL trucks on TCIR per facility. Adjusted analyses included three covariates: median number of hours worked per week for residential workers; median number of months of work experience for residential workers; and median age of residential workers. All analyses were performed with the statistical software, Stata IC (version 11.0).^ The analyses included three approaches to classifying exposure, percent of ASL trucks. The first approach included two levels of exposure: (1) 0% and (2) >0 - <100%. The second approach included three levels of exposure: (1) 0%, (2) ≥ 1 - < 100%, and (3) 100%. The third approach included six levels of exposure to improve detection of a dose-response relationship: (1) 0%, (2) 1 to <25%, (3) 25 to <50%, (4) 50 to <75%, (5) 75 to <100%, and (6) 100%. None of the relationships between injury and illness rate and percent ASL trucks exposure levels was statistically significant (i.e., p<0.05), even after adjustment for all three covariates.^ In summary, the present study shows that there is some risk reduction impact of ASL trucks but not statistically significant. The covariates demonstrated a varied yet more modest impact on the injury and illness rate but again, none of the relationships between injury and illness rate and the covariates were statistically significant (i.e., p<0.05). However, as an ecological study, the present study also has the limitations inherent in such designs and warrants replication in an individual level cohort design. Any stronger conclusions are not suggested.^

Correlation of tuberculosis and human immunodeficiency virus in Harris County, Texas from 2009 through 2010 using Geographic Information Systems

A population based ecological study was conducted to identify areas with a high number of TB and HIV new diagnoses in Harris County, Texas from 2009 through 2010 by applying Geographic Information Systems to determine whether distinguished spatial patterns exist at the census tract level through the use of exploratory mapping. As of 2010, Texas has the fourth highest occurrence of new diagnoses of HIV/AIDS and TB.[31] The Texas Department of State Health Services (DSHS) has identified HIV infected persons as a high risk population for TB in Harris County.[29] In order to explore this relationship further, GIS was utilized to identify spatial trends. ^ The specific aims were to map TB and HIV new diagnoses rates and spatially identify hotspots and high value clusters at the census tract level. The potential association between HIV and TB was analyzed using spatial autocorrelation and linear regression analysis. The spatial statistics used were ArcGIS 9.3 Hotspot Analysis and Cluster and Outlier Analysis. Spatial autocorrelation was determined through Global Moran's I and linear regression analysis. ^ Hotspots and clusters of TB and HIV are located within the same spatial areas of Harris County. The areas with high value clusters and hotspots for each infection are located within the central downtown area of the city of Houston. There is an additional hotspot area of TB located directly north of I-10 and a hotspot area of HIV northeast of Interstate 610. ^ The Moran's I Index of 0.17 (Z score = 3.6 standard deviations, p-value = 0.01) suggests that TB is statistically clustered with a less than 1% chance that this pattern is due to random chance. However, there were a high number of features with no neighbors which may invalidate the statistical properties of the test. Linear regression analysis indicated that HIV new diagnoses rates (β=−0.006, SE=0.147, p=0.970) and census tracts (β=0.000, SE=0.000, p=0.866) were not significant predictors of TB new diagnoses rates. ^ Mapping products indicate that census tracts with overlapping hotspots and high value clusters of TB and HIV should be a targeted focus for prevention efforts, most particularly within central Harris County. While the statistical association was not confirmed, evidence suggests that there is a relationship between HIV and TB within this two year period.^

Composición florística y etnobotánica de las diferentes formaciones vegetales de la provincia de Loja, Ecuador

Pese a que Loja (Ecuador) presenta una gran riqueza ecológica y cultural, ni su patrimonio etnobotánico, ni cómo afecta el uso de las plantas al estado de conservación de los ecosistemas es bien conocido. Por ello se ha realizado un estudio etnobotánico y ecológico para conocer el papel que han jugado las plantas en la cultura tradicional de la provincia y comprender qué factores influyen en su uso. Durante 2006 y 2008 se entrevistó a 770 informantes (196 de ellos vendedores en mercados locales) y se realizaron 373 transectos en 118 remanentes boscosos, 51% indicados por la gente como lugares de recolección. Se ha registrado el saber etnobotánico de 717 especies pertenecientes a 143 familias, la mayoría nativas del Ecuador, 31 de ellas endémicas. Ello supone un 15% de la flora total de Loja. Sin embargo especies introducidas como Matricaria recutita o Eucalyptus globulus están entre las más citadas. La mayor riqueza se obtuvo para las plantas medicinales (509 especies), que se usan sobre todo para tratar las llamadas “inflamaciones internas” (210 especies, Matricaria recutita y Melissa officinalis principalmente) y trastornos del sistema digestivo (188, Matricaria recutita y Mentha pulegium). En los mercados se venden 169 especies, la mayoría para elaborar la bebida típica llamada horchata (65) y para curar “inflamaciones internas” (36). Además se emplean 414 con otros fines (161 para leña, 142 para alimentación humana, 133 para construcción de viviendas y muebles, 98 para artesanías, 89 ornamentales, 27 tintóreas y 72 para otros usos). En los remanentes se inventariaron 19.156 individuos correspondientes a 1440 especies de 153 familias, de las cuales 437 son empleadas por la población. La riqueza media de especies y de plantas útiles fue significativamente mayor en los remanentes recolectados lo cual parece demostrar que la explotación no afecta negativamente a la diversidad de especies al generar variabilidad de hábitats. También se vio que la proporción de especies útiles disminuye en los remanentes más diversos. También se observó que la probabilidad de uso de una especie aumenta con la frecuencia y la abundancia y disminuye con la distancia a los remanentes en los que aparece. Este patrón general no se cumple para las especies medicinales y ornamentales. Estos datos demuestran una gran riqueza de conocimientos tradicionales y una gran vitalidad del uso de muchas especies y corroboran la hipótesis de que los recursos vegetales más accesibles y abundantes son, salvo excepciones, los más empleados por la gente. ABSTRACT Although the Loja province (Ecuador) has a great ecological and cultural richness, neither the ethnobotanical heritage nor the incidence of plant use on ecosystems conservation it is well known. We have made an ethnobotanical and ecological study to determine the role played by plants in the traditional culture of the province and to understand what factors influence their use. Between 2006 and 2008 we interviewed 770 informants (196 of them vendors in local markets) and inventoried 373 transects in 118 forest remnants (51% of them indicated by people as collection sites). We recorded the ethnobotanical knowledge for 717 species belonging to 143 families, mostly native of Ecuador, 31 of which are endemic. This represents about a 15% of the total flora of Loja. However introduced species such as Matricaria recutita and Eucalyptus globulus are among the most cited. Medicinal plants (509 species) were the most abundant, and are used primarily to treat so‐called "internal inflammation" (210 species, with Matricaria recutita and Melissa officinalis as the most valued) and disorders of the digestive system (188, Matricaria recutita and Mentha pulegium). We recorded 169 species sold in markets, most of them (65) employed to elaborate a typical drink called horchata and to heal "internal inflammation" (36). In addition 414 are used for other purposes: 161 for firewood, 142 for human consumption, 133 for construction and furniture, 98 for handicrafts, 89 as ornamental, 27 for dye and 72 for other uses. In the forest remnants, 19,156 individuals corresponding to 1440 species of 153 families, 437 of which are used by the population were inventoried. The average species richness (both total and of useful plants) was significantly higher in exploited remnants, which suggest that exploitation does not adversely affect species diversity and instead increases habitat diversity. We also found that the proportion of useful species decreases in decreased in the most diverse remnants. It was also observed that the probability of use of a species increases with its frequency and abundance and decreases as the distance form localities to remnants where it appears increases. This general pattern however does not hold for medicinal and ornamental species. These results show the extraordinary wealth of traditional knowledge and the great vitality in the use of many species and support the hypothesis that most accessible and abundant plant resources are the most used by people.