Os eventos climáticos extremos têm fortes repercussões na saúde das pessoas, especialmente quando produz doenças ou mesmo quando provoca vítimas por acidentes. A população do Rio de Janeiro é vulnerável diante das variabilidades climáticas, principalmente pelo seu aspecto socioeconômico, pois o município tem topografia e clima que favorecem esta vulnerabilidade. Este artigo discute a evolução da leptospirose no Município do Rio de Janeiro, pelas trinta e duas Regiões administrativas, no período de 1996 a 2009, testando a hipótese de que as variações climáticas acarretam um aumento no número de casos da doença.Os dados meteorológicos utilizados foram fornecidos pelo Instituto Nacional de Meteorologia e pela Empresa Brasileira de Infra-Estrutura Aero-Portuária Os dados referentes à morbimortalidade da leptospirose foram coletados da Secretaria Municipal de Saúde e Defesa Civil/RJ. Neste trabalho, concluiu-se que há correlação entre a incidência da leptospirose e a pluviometria. No entanto, ao final, é enfatizado que a oscilação do número de casos não é determinada apenas pelo índice pluviométrico, outros fatores influenciam nessa dinâmica, tais como: saneamento, assim como fatores ambientais e sociais.

Avaliação econômica dos casos de Dengue atribuídos ao desastre de 2011 em Nova Friburgo (RJ), Brasil

This paper presents a study based on ecological parameters represented by diversity and richness indices applied in a community of mosquitoes (Diptera: Culicidae), at the National Forest of Caxiuanã, Melgaço municipality, state of Pará, in the Brazilian Amazon. A total of 25,433 specimens of culicids were collected in the study, from five field collection periods, over 10 months, between 2005 and 2006. Specimens were collected in four heights of the forest (ground level, 8 m, 16 m, and 30 m-canopy). Diversity indices of Shannon and Berger-Parker were obtained, and indicators of dominance of species were calculated. The species Culex portesi was dominant in this site, representing about 84% of specimens. Measures of richness and similarity (Jaccard) were obtained for the five strata of time and four height levels. According to the richness estimator abundance-based covered estimator (ACE) the greatest value occurred in April (2006), considering the levels of height to 16 m and on the ground. The estimates obtained have shown quantitative parameters of mosquito populations in the region of the Forest of Caxiuanã.

The present paper presents compulsory notifi cation data for infectious diseases and epidemiologic ones recorded at the Center for Strategic Information and Health Surveillance (CIEVS) for the period of March 2006 to April 2007. Data is presented in accordance with geographic distribution, time and risk classifi cation of the etiologic agents found, according to Ministry of Health regulations. The importance of this epidemiologic surveillance system is presented, debating the main topics required for quality improvement and information analysis. It is concluded, from the analysis of epidemiologic events and their relation to risk management, that the compulsory notifi cation system in Brazil is incomplete, irregular, delayed and, in a large percentage of cases, notifi cation cannot be completed and the agent may not be identifi ed. Quality of data varies from one region to another and from county to county within the same region. There is a high proportion of cases in which the etiologic agent is unknown and, in such cases, a high lethality is expected, establishing a high risk exposure condition for those health professionals involved in health surveillance. From these data, the study points out the need to improve the surveillance system and strengthens the idea of building maximum containment laboratories.

The present paper presents compulsory notifi cation data for infectious diseases and epidemiologic ones recorded at the Center for Strategic Information and Health Surveillance (CIEVS) for the period of March 2006 to April 2007. Data is presented in accordance with geographic distribution, time and risk classifi cation of the etiologic agents found, according to Ministry of Health regulations. The importance of this epidemiologic surveillance system is presented, debating the main topics required for quality improvement and information analysis. It is concluded, from the analysis of epidemiologic events and their relation to risk management, that the compulsory notifi cation system in Brazil is incomplete, irregular, delayed and, in a large percentage of cases, notifi cation cannot be completed and the agent may not be identifi ed. Quality of data varies from one region to another and from county to county within the same region. There is a high proportion of cases in which the etiologic agent is unknown and, in such cases, a high lethality is expected, establishing a high risk exposure condition for those health professionals involved in health surveillance. From these data, the study points out the need to improve the surveillance system and strengthens the idea of building maximum containment laboratories.

Background The greater burden of coronary heart disease (CHD) comes from low-middle income countries (LMIC). Socioeconomic status, environmental factors, poor access to healthcare, physical inactivity and excess consumption of carbohydrates, have explained part of this burden. However, the association between income level and CHD in LMIC with marked social inequalities is not fully understood, and whether there is influence of neighborhood walkability (walking-promoting potential of the residential built environment for daily activities) in this association requires further investigation. Purpose To investigate to what level income is associated with ischemic CHD in a LMIC with great social inequalities and to explore the potential role of neighborhood walkability in this association. Methods We evaluated patients referred for myocardial perfusion imaging with SPECT (SPECT-MPI) from February 2010 to August 2017 at a reference imaging center in our city, Brazil. Each patient was georeferenced and the exposure variable was the average income in Brazilian currency (Real) per month, from the patient's residential census block. Ischemic CHD was defined by an abnormal myocardial perfusion (summed stress score >3) during a SPECT-MPI study. Walkability was measured by a score combining street connectivity, residential density, commercial density and mixed land use. We used mixed effects models to evaluate the association between income level and ischemic CHD, adjusted for potential confounders, and performed a mediation analysis to measure the percentage of this association mediated by walkability. Results From 26,810 participants, those living in the lowest tertile income neighborhoods were younger (61±12 vs 63±13 vs 65±12 yrs old); with higher body mass index (28.4±5 vs 27.7±5 vs 27.4±4 kg/m2); more likely to be women (52 vs 49 vs 47%), current smokers (10 vs 9 vs 8%), sedentary (79 vs 76 vs 73%), having diabetes (27 vs 24 vs 23%), hypertension (65 vs 62 vs 60%) and with known CHD (21 vs 20 vs 19%) when compared to the second and the highest tertiles respectively, all with p<0.001. After adjusting for these potential confounders, income level was inversely associated with ischemic CAD (Figure). Neighborhoods with higher income levels were associated with better walkability scores (R = 0.34eta; p<0.001), but walkability did not mediate the association between income level and ischemic CHD (percent mediated = −0.3%). Figure 1. Association of income and CHD Conclusions In this large registry from a LMIC population, living in a lower-income neighborhood was associated with higher prevalence of ischemic CHD. Even though neighborhood walkability was directly associated with neighborhood income, it did not explain the association between income level and ischemic CHD.