Christovam Barcellos

Violence is of major importance in the health profile of Brazilian metropolitan areas and should be treated as a public health problem. Spatial analysis methods can be highly useful for the surveillance and prevention of violence. This paper analyzes the spatial distribution of victims' place of residence in relation to the main causes of violent death in Porto Alegre (1996) in order to identify vulnerable areas. For motor vehicle accidents, homicides, and suicide, the victim's place of residence was pinpointed using the municipal Geographic Information System. The point patterns of health events and population density were analyzed using a Kernel smoother, visually compared. Some areas with higher concentration of events are similar to population distribution but differ from each other in the remaining high concentration areas, thus indicating specific micro-areas at risk. Areas of higher homicide risk are mainly located on the periphery of the more urbanized area, with worse socioeconomic conditions. Motor vehicle accidents are concentrated in areas that are simultaneously commercial and residential and are traversed by streets with heavy traffic. Suicide deaths are more evenly distributed over the territory. Identification of risk areas provides meaningful information for developing preventive and health promotion measures focusing on the events for which health policies may play a central role.

The HIV/AIDS epidemic has been simplistically interpreted as a phenomenon restricted to risk groups that are socially and spatially circumscribed. However, epidemic trends in recent years have demonstrated the need to employ open diffusion models that emphasize social interaction as a means of spread of HIV. This study is a spatial analysis of the AIDS epidemic in Brazil, which sought to incorporate variables reflecting economic and demographic events into a system for processing geographically referenced health information. Findings indicate that metropolises and regional urban centers, mainly those in the Southeast, play an important role in the spread of the epidemic, not only because of their population density but also because they are centers of trade and social interaction. In smaller cities located in the state of São Paulo, a large number of AIDS cases among injecting drug users are concentrated, revealing the routes and centers of cocaine use.

The infant mortality rate has been considered a summary of the quality of life and level of development of a given population. However, this indicator is very sensitive to such simple measures as oral rehydration therapy, vaccination, and continuation of breast-feeding. Given that such health activities have become more widespread, an infant mortality rate may no longer reflect a particular development model. With the aim of broadening the discussion regarding infant mortality, this study analyzed the 153 neighborhoods of the city of Rio de Janeiro, Brazil. Our objective was to identify areas with more risk, and the priority groups for interventions to decrease infant mortality. We analyzed neonatal and postneonatal mortality in each neighborhood. We also identified the children's home neighborhood and the location of their deaths and related these results to the socioeconomic classification of the corresponding neighborhoods. In relation to the average infant mortality rate for the city, we could not make statistically significant comparisons for some neighborhoods due to their small number of births. One-third of the infant deaths could have been prevented with early diagnosis and treatment. Only 15% of the deaths were considered unavoidable. Both neonatal mortality and postneonatal mortality were geographically dispersed, with no direct association with the socioeconomic profile of the neighborhoods. An analysis of the children's place of residence and the location of their deaths showed flows of patients from poor areas to more affluent city areas with better health services. This pattern highlights the effect of access to quality medical care on infant mortality.

This study uses a spatial-temporal model to analyze the spatial spread of the AIDS epidemic (adult cases) in the municipality of Rio de Janeiro, Brazil, during three periods: 1988-1990, 1991-1993, and 1994-1996. City districts were used as the geographic units of analysis. A spatial analysis was also performed for pediatric AIDS cases due to vertical HIV transmission, according to period of birth, 1985-90 and 1991-96. For total adult AIDS cases, the initial period was characterized by a polygonal cluster located around the harbor area, which expanded from west to east. Among homosexual cases, in situ growth predominated, and a decrease in the intensity of the diffusion process was observed from the second to the final period. Among heterosexual cases, the epidemic displayed a relevant geographic spread, mainly from 1988-1990 to 1991-1993. Among female cases in the final time period, a cluster of high incidence rates was found towards the northwest, including very poor areas. Among pediatric cases in 1991-1996, a significant correlation was found between AIDS incidence rates and poverty levels in the respective municipal districts. The results suggest that a more complete understanding of AIDS spatial-temporal dynamics can make a major contribution to preventive measures.

Fish farming in the Amazon has been stimulated as a solution to increase economic development. However, poorly managed fish ponds have been sometimes associated with the presence of Anopheles spp. and consequently, with malaria transmission. In this study, we analyzed the spatial and temporal dynamics of malaria in the state of Acre (and more closely within a single county) to investigate the potential links between aquaculture and malaria transmission in this region. At the state level, we classified the 22 counties into three malaria endemicity patterns, based on the correlation between notification time series. Furthermore, the study period (2003-2013) was divided into two phases (epidemic and post-epidemic). Higher fish pond construction coincided both spatially and temporally with increased rate of malaria notification. Within one malaria endemic county, we investigated the relationship between the geolocation of malaria cases (2011-2012) and their distance to fish ponds. Entomological surveys carried out in these ponds provided measurements of anopheline abundance that were significantly associated with the abundance of malaria cases within 100 m of the ponds (P < 0.005; r = 0.39). These results taken together suggest that fish farming contributes to the maintenance of high transmission levels of malaria in this region.

This article discusses the linking of data from SINAN (the Reportable Diseases Database) and population census in Brazil to identify the socio-environmental context of hepatitis A, analyzing the contribution by environmental and socio-demographic variables to reported and confirmed cases of hepatitis A. Also, based on individual case data provided by SINAN, we discuss the pattern of hepatitis A endemicity in the city of Rio de Janeiro. At the aggregate level, the unit of analysis was the census tract and census data, associated with the location of 1,553 cases in the city from 1999 to 2001. The observed pattern was high to medium endemicity, indicating a less favorable situation than observed by sero-epidemiological studies. The mean rank of number of households with unfavorable conditions was higher in the census tracts with excess risk of hepatitis A (two or more cases), a statistically significant result according to the Mann-Whitney Test. Socio-demographic variables had more imp...

Maps and mapping procedures are useful tools for systematic interpretation and evaluation and for reporting of results to management. Applied to the Family Health Strategy (FHS), these maps permit the demarcation of the territory and the establishment of links between the territory, its population and health services. In this paper the use of maps by the FHS in 17 municipalities in northern and northeastern Brazil is studied and the process of demarcation and digitization of areas with the participation of teams is described. The survey conducted using questionnaires and discussion workshops showed that difficulties still prevail in reconciling the map (drawing) produced at the local level with maps produced by other government sectors. In general, the maps used at local level employ their own references, which prevent the interplay of information with other cartographic documents and their full use as a tool for evaluation and management. The combination of participatory mapping to...

The aim of this article was to analyze the decentralization of the HIV/AIDS epidemic (a shift towards rural areas or away from the coast) and to investigate access to HIV/AIDS services from 1988 to 2002 in the Zona da Mata, Minas Gerais State, Brazil. An ecological study was performed using temporal and spatial approaches. A hospital admissions flow between municipalities developed, and the reference group was AIDS patients over 15 years of age admitted in 1996 and 2004, residing in municipalities in the Zona da Mata. There were 2,469 reported AIDS cases in individuals over 15 during the period. Mean incidence and mortality rates were calculated and recalculated by a local empirical Bayesian method in order to more clearly represent the municipalities with the highest concentration of cases and deaths. Decentralization of the epidemic was observed. Juiz de Fora was the municipality with the most cases and may have acted as a hub for spread of HIV in the region. Hospital care for AID...

To review the literature published from 1995-2004 on the relationship between sanitation and health and to identify the main variables analyzed and the diseases or injuries used as markers of effect or environmental health. A search of Medline, SciELO, and LILACS on "sanitation" and "health" and "indicator" and "water" produced 103 articles, 17 of which were considered relevant for the analysis. We identified the study design and the sanitation and health variables analyzed in each of the 17 studies. The most common study design was ecological and was employed in seven of the 17 studies. In most (10 studies), the health variable was diarrhea and sanitation variable was water quality. Fifteen studies reported a positive association between the health and sanitation variables. There are still many gaps in our understanding of sanitation and its role, especially in large urban centers that are dependent on water and sewerage systems and often lac...

ABSTRACT The Global Burden of Disease is the official metrics of World Health Organization in use to support public health evidence-based decision-making. It has been systematically used to assess environmental risk factors such as unsafe Water, Sanitation and Hygiene (WASH), as part of the measurement of Environmental Burden (EB). This article reports on the first study in Brazil that estimates the EB attributable to unsafe WASH associated with diarrhea for children under five years old for the country and macro-regions for 1998. The EB of diarrhea for this subgroup was estimated using the population attributable fraction (PAF) method for four scenarios of exposition to unsafe WASH. Results of PAF were multiplied by the EB obtained from the 1998 Brazilian GDB Study. The regions with higher EB for children below five years old were north and northeast, both predominantly rural. The EB attributable to unsafe WASH was 15% in 1998. The estimation of the EB of diarrhea contributes to the re-assessment of Brazil's attainment of the Millennium Development Goals (MDG) in both health and environmental dimensions. Results obtained indicated that the country's precarious conditions of WASH in rural areas are below the goals of MDG, as well as in impoverished urban areas.

Resumo A incorporação da vigilância ambiental no campo das políticas públicas de saúde é uma demanda relativamente recente no Brasil. Um dos principais desafios da vigilância ambiental em saúde é a definição do seu objeto e a especificidade de suas ações. O conceito ampliado de exposição, tratado não como um atributo da pessoa, mas do conjunto de relações complexas entre

This chapter utilizes information about the patterns of spread of HIV/AIDS and the public health responses to the epidemic in the cities involved in the World Health Organization Multi-City Study on Drug Injecting and Risk of HIV Infection. The emphasis here concerns ...

The occurrence of disasters is often related to unforeseeable able natural processes. However, the analysis of major databases may highlight seasonal and long-term trends, as well as some spatial patterns where risks are concentrated. In this paper the process of acquiring and organizing climate-related disaster data collected by civil protection institutions and made available by the Brazilian Climate and Health Observatory is described. Preliminary analyses show the concentration of disasters caused by heavy rainfall events along the Brazilian coastline especially during the summer. Droughts have longer duration and extent, affecting large areas of the south and northeast regions of the country. These data can be used to analyze and monitor the impact of extreme climatic events on health, as well as identify the vulnerability and climate deteminants.

The aim of this article was to analyze the decentralization of the HIV/AIDS epidemic (a shift towards rural areas or away from the coast) and to investigate access to HIV/AIDS services from 1988 to 2002 in the Zona da Mata, Minas Gerais State, Brazil. An ecological study was performed using temporal and spatial approaches. A hospital admissions flow between municipalities developed, and the reference group was AIDS patients over 15 years of age admitted in 1996 and 2004, residing in municipalities in the Zona da Mata. There were 2,469 reported AIDS cases in individuals over 15 during the period. Mean incidence and mortality rates were calculated and recalculated by a local empirical Bayesian method in order to more clearly represent the municipalities with the highest concentration of cases and deaths. Decentralization of the epidemic was observed. Juiz de Fora was the municipality with the most cases and may have acted as a hub for spread of HIV in the region. Hospital care for AID...

Maps and mapping procedures are useful tools for systematic interpretation and evaluation and for reporting of results to management. Applied to the Family Health Strategy (FHS), these maps permit the demarcation of the territory and the establishment of links between the territory, its population and health services. In this paper the use of maps by the FHS in 17 municipalities in northern and northeastern Brazil is studied and the process of demarcation and digitization of areas with the participation of teams is described. The survey conducted using questionnaires and discussion workshops showed that difficulties still prevail in reconciling the map (drawing) produced at the local level with maps produced by other government sectors. In general, the maps used at local level employ their own references, which prevent the interplay of information with other cartographic documents and their full use as a tool for evaluation and management. The combination of participatory mapping to...

To identify relationships between tourism and health as well as the methods employed in studies about this topic. The PubMed and SciELO databases were searched in March of 2008 using the following strategy: traveler or traveller or tourism or tourist AND risk or hazard or vulnerability AND health or surveillance. The following were excluded: articles on animal health, conceptual and review articles, articles about non-tourist travel, and articles written in languages other than Portuguese, English, Italian, and Spanish. Of 153 articles identified, 112 were excluded, and 41 articles were examined. The number of articles on tourism and health increased from one in the 1970s to 34 in the 2000s. Most studies were carried out in Europe, followed by the Americas, and most covered insect-borne diseases, respiratory diseases transmitted from person to person, and gastrointestinal diseases. Mail, telephone, or face-to-face questionnaires were generally used for data collection. In terms of l...

The authors describe three recent experiences of epidemiological surveys of zoonotic diseases in Brazil. The role of spatial data acquisition and analysis has been reinforced, considering the intrinsic complexity of environmental and social factors affecting transmission. Health surveillance in Brazil is undergoing a decentralisation process, in accordance with which different responsibilities are attributed to each health institution, from federal level to county health secretaries, including local non-governmental organisations. The availability of data, as well as the skilled use of spatial analysis tools, contributed in this process, allowing rapid and low cost assessments of environmental risks.