Surtos de diarreia na região Nordeste do Brasil em 2013, segundo a mídia e sistemas de informação de saúde – Vigilância de situações climáticas de risco e emergências em saúde

Space-Time Clustering and Socioeconomic Factors Associated with Mortality from Diarrhea in Alagoas, Northeastern Brazil: A 20-Year Population-Based Study

Acute diarrhea is the second leading cause of death among children in developing countries and is strongly related with the socioeconomic conditions of the population. In Brazil, data show a drop in the diarrhea mortality rate. Nevertheless, the northeastern region still has the most deaths. Considering this, we analyze high-risk areas for diarrhea- and gastroenteritis-related deaths, and their association with social determinants of health (SDH) in the state with one of the worst human development indicators in Brazil (Alagoas) between 2000 and 2019. We applied temporal, spatial, and space−time risk modelling. We used a log-linear regression model to assess temporal trends and the local empirical Bayesian estimator, the global and local Moran indices for spatial analysis. Spearman’s correlation was used to correlate mortality rates with SDH. A total of 3472 diarrhea-related deaths were reported during this period in Alagoas. We observed a decreasing time trend of deaths in the state (9.41/100,000 in 2000 to 2.21 in 2019; APC = −6.7; p-value < 0.001), especially in children under one year of age. However, there was stability among adults and the elderly. We identified two high-risk spatiotemporal clusters of mortality in inland municipalities. Lastly, mortality rates correlated significantly with 90% of SDH. Taken together, these findings indicate that diarrhea diseases remain a serious public health concern in Alagoas, mainly in the poorest and inland municipalities. Thereby, it is urgently necessary to invest in measures to control and prevent cases, and improve the living conditions of the poorest populations and those with the highest social vulnerability index.

[Climate change, changes in productivity and health: complex interactions in the national literature]

This article reviews the scientific output published in national journals on the interactions that are established between the concepts of climate change, productive changes (including changes in land use) and human health in the last ten years (from 2008 to 2017), highlighting the theoretical-methodological trends of this output. To achieve this, a review of the literature was made from publications made available in the Scientific Electronic Library Online (SciELO) and the CAPES Journals Portal. The results obtained demonstrate the advances made in the last ten years by the interdisciplinary teams that dealt with the subject over the period analyzed. At the same time, this article identifies the research gaps that can be exploited in future research. In addition, a positive sophistication and refinement of analytical tools and instruments have been identified that are able to gather consistent information about a broad and complex reality characterized by the diversity of biomes, climatic scenarios and productive systems.

Climate and climate-sensitive diseases in semi-arid regions: a systematic review

OBJECTIVES

We aim to describe the relationships between climate variables and climate-sensitive diseases (CSDs) in semi-arid regions, highlighting the different main groups of CSDs and their climate patterns.

METHODS

This systematic review considered Medline, Science Direct, Scopus and Web of Science. The data collection period was August and September 2019 and included studies published between 2008 and 2019. This study followed a protocol based on the PRISMA statement. Data analysis was done in a qualitative way.

RESULTS

The most of works were from Africa, Asia and Iran (71%), where temperature was the main climatic variable. Although the studies provide climatic conditions that are more favorable for the incidence of vector-borne and respiratory diseases, the influence of seasonal patterns on the onset, development and end of CSDs is still poorly understood, especially for gastrointestinal disorders. Moreover, little is known about the impact of droughts on CSDs.

CONCLUSIONS

This review summarized the state of art of the relationship between climate and CSDs in semi-arid regions. Moreover, a research agenda was provided, which is fundamental for health policy development, priority setting and public health management.

The cyanobacterial saxitoxin exacerbates neural cell death and brain malformations induced by Zika virus

The northeast (NE) region of Brazil commonly goes through drought periods, which favor cyanobacterial blooms, capable of producing neurotoxins with implications for human and animal health. The most severe dry spell in the history of Brazil occurred between 2012 and 2016. Coincidently, the highest incidence of microcephaly associated with the Zika virus (ZIKV) outbreak took place in the NE region of Brazil during the same years. In this work, we tested the hypothesis that saxitoxin (STX), a neurotoxin produced in South America by the freshwater cyanobacteria Raphidiopsis raciborskii, could have contributed to the most severe Congenital Zika Syndrome (CZS) profile described worldwide. Quality surveillance showed higher cyanobacteria amounts and STX occurrence in human drinking water supplies of NE compared to other regions of Brazil. Experimentally, we described that STX doubled the quantity of ZIKV-induced neural cell death in progenitor areas of human brain organoids, while the chronic ingestion of water contaminated with STX before and during gestation caused brain abnormalities in offspring of ZIKV-infected immunocompetent C57BL/6J mice. Our data indicate that saxitoxin-producing cyanobacteria is overspread in water reservoirs of the NE and might have acted as a co-insult to ZIKV infection in Brazil. These results raise a public health concern regarding the consequences of arbovirus outbreaks happening in areas with droughts and/or frequent freshwater cyanobacterial blooms.

Plinia cauliflora (Mart.) Kausel: A comprehensive ethnopharmacological review of a genuinely Brazilian species

ETHNOPHARMACOLOGICAL RELEVANCE

Plinia cauliflora (Mart.) Kausel is widespread in alluvial plains and open forests in Brazil, Argentina, and Paraguay. The fruits of P. cauliflora are used as food, and almost all parts of this species have long been used as a traditional Brazilian medicine for the treatment of skin irritations, flu, diarrhea, labyrinthitis, genito-urinary problems, and asthma.

THE AIM OF THE REVIEW

This review provides comprehensive and up-to-date information on P. cauliflora with regard to its ethnopharmacological uses, constituents, biological activities, and toxicology, all of which are useful for future research and the development of new drugs.

MATERIALS AND METHODS

The information and data on P. cauliflora were collected from ethnobotanical textbooks and scientific databases, such as PubMed, Scopus, EBSCO, Science Direct, Google, and Google Scholar.

RESULTS

The main chemical constituents in P. cauliflora preparations were depsides, flavonoids, and hydrolysable tannins. The main medicinal use of the species in Brazil is for the treatment of diarrhea. Although antimicrobial potential of this species has been demonstrated, data on gastrointestinal motility are still incipient and need further investigation. Studies that indicate the efficacy of its traditional use for sore throat, pelvic hemorrhage, uterine wounds, vaginal discharge, and flu are nonexistent. The scientific literature does not describe any toxic effects of its popular use. However, the available data do not allow us to conclude that the ethnomedicinal use of this species is safe, with a lack of well-designed preclinical tests and randomized clinical trials.

CONCLUSION

This review summarizes research on the traditional use, phytochemistry, biological activities, and toxicology of P. cauliflora. Although P. cauliflora possesses significant biological activities, much of its ethnomedicinal use has not been scientifically evaluated. Well-designed pharmacological and toxicological assays and randomized clinical trials are still needed to validate its ethnopharmacological use as an herbal medicine.

Climate variability and hospitalizations due to infectious diarrheal diseases in a municipality of the Western Brazilian Amazon Region

Morbimortality due to infectious diarrheal diseases still is a serious health issue in Brazil and is highly related to factors such as weather, environment, and people's life conditions. This study aimed to analyze the relationship between hospitalization rates due to infectious diarrheal diseases among the population of the municipality of Rio Branco (AC), Brazil and precipitation, river level, humidity and temperature between 2000 and 2013. Data were retrieved from the Hospital Information System of the SUS (Unified Health System), the National Institute of Meteorology and the National Water Agency. Multiple Poisson and negative binomial regression models were adjusted. Results showed that there is a positive association between hospitalization due to infectious diarrheal diseases and the level of the Acre river (RR: 1.07; CI 95%: 1.04 to 1.1); these hospitalization rates fell 14% between 2000 and 2013 (RR: 0.86; CI 95%: 0.85 to 0.87). The most vulnerable group was the age group of less than 1 year of age. This study showed the vulnerability of an Amazonian city to climate variability and its respective epidemiological influence on the incidence of hospitalizations due to infectious diarrheal diseases.

Health monitoring during water scarcity in Mayotte, France, 2017

Background

During the 2016–2017 austral summer, unprecedented water scarcity was observed in the south of Mayotte, French island in the Indian Ocean. Therefore, authorities introduced restrictive measures to save the water of this part of the island. The rationing system affected over 65,000 people, for four months. In order to detect a possible deterioration of the health situation, a strengthened epidemiological surveillance system was set up.

Methods

Surveillance focused on intestinal and skin diseases, which are often associated with a lack of hygiene or poor-quality drinking and bathing water. Three pathologies were monitored: acute diarrhoea, acute gastroenteritis and skin diseases and also, proportion of antidiarrhoeal and rehydration solutions sales in pharmacies. Cases of leptospirosis were also under surveillance. The analyses consisted of comparing the collected data according to the areas that were either affected or not affected by the water restrictions. Comparisons with historical data were also made.

Results

Although none of the surveillance systems were able to demonstrate any impact on skin diseases, they revealed a very sharp increase in the proportion of consultations for acute diarrhoea and gastro-enteritis in the southern area. This was corroborated by a high increase in the sales of antidiarrhoeals and oral rehydration solutions via the sentinel pharmacists in the south of the island compared with those of the north. Comparison with historical data highlighted the occurrence of an unusual situation.

Conclusion

These water restrictions caused a real deterioration in the health status of the inhabitants who were deprived of water.

[Temporal trend and spatial distribution of congenital syphilis in the state of Rio Grande do Sul between 2001 and 2012]

The scope of the study was to evaluate the temporal trend and spatial distribution of congenital syphilis (CS) in the state of Rio Grande do Sul. All cases reported by the SINASC/DATASUS between 2001 and 2012 were included. The number of live births was obtained from DATASUS. Incidence rates of CS were grouped according to micro-regions of IBGE and analyzed for the entire period and for triennia. The spatial correlation was analyzed by the global Moran index (I) and the local index. 3,613 cases were reported. Between 2007 and 2012 89 neonates (3.6%) died. Rates varied from to 1.03 in 2001 to 5.1 cases per 1000 live births in 2012, with an annual increase of 0.84 cases per 1000 live births (p < 0.01) and 93.88% of explained variance. The micro-regions were spatially independent (I = 0.06; p = 0.25), with Porto Alegre having the highest incidence (4.19 cases / 1000 live births) and Jaguarão the lowest (0.23 cases / 1000 live births). Micro-regions with significant local spatial dependence were observed. The increase in cases of CS highlights poor prenatal quality care. Identification of the micro-regions with the highest incidence is essential to focus public policy on this health problem.

Conquistas, limites e obstáculos à redução de riscos ambientais à saúde nos 30 anos do Sistema Único de Saúde

Resumo A Constituição de 1988 representou importantes conquistas de direitos em torno de um projeto de país com um modelo de desenvolvimento socioeconômico orientado para a redução de risco de doenças e agravos e um meio ambiente ecologicamente equilibrado. Estas conquistas se manifestaram nas políticas, na institucionalização e na criação de espaços institucionais de participação da sociedade. O objetivo deste artigo é situar as conquistas e também os limites e obstáculos na agenda de saúde e ambiente expressos nestes 30 anos do Sistema Único de Saúde. As conquistas são situadas a partir da ampliação dos espaços institucionais de participação da sociedade e institucionalização no Sistema Único de Saúde dos temas relacionados aos riscos ambientais. Os limites são situados a partir da relação entre desenvolvimento e padrões de riscos ambientais presentes nos níveis global, regional, local e comunitário. Por fim são apontados os obstáculos que, a partir do golpe parlamentar de 2016, não só acentuaram os limites já existentes, como vem produzindo retrocessos em diversas áreas relacionadas à saúde ambiental.

Increased Hospitalizations for Neuropathies as Indicators of Zika Virus Infection, according to Health Information System Data, Brazil

Neurologic manifestations of Zika infection must be adequately recognized and treated; our study methods can be used for monitoring and warning systems.

Evidence is increasing that Zika virus can cause extensive damage to the central nervous system, affecting both fetuses and adults. We sought to identify traces of possible clinical manifestations of nervous system diseases among the registers of hospital admissions recorded in the Brazilian Unified Health System. Time series of several diagnoses from the International Classification of Diseases, 10th Revision, were analyzed by using control diagrams, during January 2008–February 2016. Beginning in mid-2014, we observed an unprecedented and significant rise in the hospitalization rate for congenital malformations of the nervous system, Guillain-Barré syndrome, encephalitis, myelitis, and encephalomyelitis. These conditions are compatible with viral infection and inflammation-associated manifestations and may have been due to the entrance of Zika virus into Brazil. These findings show the necessity of adequately diagnosing and treating suspected cases of Zika virus infection and also that health surveillance systems can be improved by using routine data.