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.
A gravidez na adolescência é um problema de saúde pública comum em todo o mundo. O objetivo deste estudo ecológico é estudar o padrão espacial da associação entre os percentuais de gravidez na adolescência e características socioeconômicas dos municípios do Estado de São Paulo, Brasil. Para isso, foi utilizado um modelo bayesiano com uma distribuição espacial que segue uma estrutura condicional autorregressiva (CAR), baseado em algoritmos Monte Carlo em cadeias de Markov (MCMC). Foram usados dados do Sistema de Informações sobre Nascidos Vivos (SINASC) e do Instituto Brasileiro de Geografia e Estatística (IBGE). Verificou-se que a ocorrência de gravidezes precoces apresentou-se maior nos municípios de menor produto interno bruto (PIB) per capita, com maior incidência de pobreza, de menor tamanho populacional, menor índice de desenvolvimento humano (IDH) e maior percentual de indivíduos com índice paulista de vulnerabilidade social (IPVS) igual a 5 ou 6, ou seja, mais vulneráveis. O estudo demonstra uma estreita associação entre gravidez na adolescência e indicadores econômicos e sociais.
Estudo descritivo exploratório que teve como objetivos identificar as características sociodemográficas das pessoas com lesão da medula espinhal (LME) e de seus cuidadores familiares e avaliar o conhecimento dos cuidadores sobre prevenção de úlcera por pressão (UPP). Participaram do estudo 47 pessoas com LME e 47 cuidadores que responderam a um teste de conhecimento sobre prevenção de UPP. Esse teste é composto por questões fechadas com opções de resposta: V = verdadeiro, F = falso e NS = não sei. Para análise estatística dos dados, foi utilizado o PROC TTEST do Software SAS® 9. Dos indivíduos com LME, 80,8% eram do sexo masculino, idade média de 41,6 anos e 57,5% tiveram lesão medular traumática. Quanto aos cuidadores, 89,3% eram do sexo feminino, com média de idade de 44 anos, 76,6% casados. A porcentagem média de acertos no teste de conhecimento foi de 67,8% (DP = 14,8), o mínimo foi 14,3% e o máximo foi 88,5%, o que demonstrou conhecimento insuficiente relacionado com a prevenção de UPP. A porcentagem de acertos no teste foi menor conforme o aumento da idade. A identificação dos déficits de conhecimento dos cuidadores sobre a temática permite ao enfermeiro realizar um planejamento de estratégias educativas para prevenção de UPP.
Background Cannabis consumption is a modifiable risk factor associated with psychosis, but not all cannabis users develop psychosis. Animal studies suggest that an antecedent active immune system interacts with subsequent cannabis exposure and moderates the cannabis–psychosis association, supporting the two-hit hypothesis. The clinical investigations are few, and it is unclear if the immune system is a biological candidate moderating the cannabis–psychosis association or whether cannabis increases inflammation, which in turn, augments psychosis likelihood. Methods We explored the mediating and moderating role of blood inflammation using PROCESS macro. We used data from a cross-sectional study, including 153 first-episode psychosis patients and 256 community-based controls. Participants answered the Cannabis Experience Questionnaire (cannabis frequency, age of onset, and duration), and plasma cytokines were measured [interleukin (IL)-1β, IL-6, IL-4, IL-10, tumour necrosis factor-α (TNF-α), interferon-γ (IFN-γ), transforming growth factor-β (TGF-β); multiplex]. We computed an inflammatory composite score (ICS) to represent the systemic inflammatory state. Confounders included sex, age, ethnicity, educational level, body mass index, tobacco smoking, lifetime use of other drugs, and antipsychotic treatment. Results Mediation: Cannabis consumption was not associated with increased inflammation, thus not supporting a mediating effect of inflammation. Moderation: Daily use and age of onset <17 interacted significantly with the ICS to increase the odds of psychosis beyond their individual effects and were only associated with psychosis among those scoring medium–high in the ICS. Conclusions Immune dysregulation might be part of the pathophysiology of psychosis, not explained by cannabis use or other confounders. We provide the first and initial evidence that immune dysregulation modifies the cannabis–psychosis association, in line with a two-hit hypothesis.
PURPOSE:To describe associations between pregnancy rates in adolescence and socioeconomic and social responsibility indicators in the municipalities of the State of Minas Gerais, Southeast of Brazil, in the year of 2010. METHODS: Ecological study using data from the Brazilian Live Birth Information System (SINASC). The percentage of live births to adolescent mothers (LBAM) for each municipality was calculated based on the quotient between number of born alive infants of mothers aged 10-19 years old and total number of live births in the year of 2010. Fully Bayesian models were used to obtain the percentages of LBAM adjusted for spatial effects and to assess possible associations with socioeconomic and social responsibility indicators. RESULTS: The crude percentage of LBAM for the total number of live births in the municipalities of Minas Gerais in 2010 ranged from 0 to 46.4%, with median percentage being 19.6% and the first and third quartiles being 15.6 and 23.1%, respectively. This study has demonstrated a close relationship between adolescent pregnancy and socioeconomic indicators. LBAM percentages were found to be higher in municipalities with low population density, low human development index and other low development indicators. CONCLUSION: The strong relationship between LBAM percentages and socioeconomic indicators suggests that adolescent pregnancy is more a social than a biological problem. Therefore, programs and actions should go beyond sexual education and information on preventive health methods. ResumoOBJETIVO: Descrever as associações entre os percentuais de gravidez na adolescência e indicadores socioeconômicos e de responsabilidade social dos municípios do estado de Minas Gerais, sudeste do Brasil, no ano de 2010. MÉTODOS: Estudo ecológico, utilizando dados do Sistema de Informações sobre Nascidos Vivos (SINASC). O percentual de nascidos vivos de mães adolescentes (LBAM) para cada município foi calculado segundo o quociente entre o número de nascidos vivos de mães com idade entre 10 e 19 anos e o número total de nascidos vivos registrados no ano de 2010. Modelos totalmente bayesianos foram utilizados para a obtenção de percentuais de LBAM ajustados por efeitos espaciais e para avaliar as possíveis associações com os indicadores socioeconômicos e de responsabilidade social. RESULTADOS: Os percentuais brutos de LBAM em relação ao total de nascidos vivos nos municípios de Minas Gerais no ano de 2010 variaram de 0 a 46,4%, com uma mediana de 19,6%. O primeiro e o terceiro quartis são, respectivemente, 15,6 e 23,1%. O estudo evidenciou uma estreita relação entre a gravidez na adolescência e indicadores econômicos e sociais. Os percentuais de LBAM se mostraram maiores nos municípios com menor tamanho populacional, menores valores do Índice de Desenvolvimento Humano e menores valores de outros indicadores de desenvolvimento. CONCLUSÃO: A forte relação entre os percentuais de LBAM e os indicadores sociais e econômicos sugerem que a gravidez adolescente é muito mais um problema social que biol...
In this study we used Bayesian space-temporal regression models to estimate the incidence of TB in Ribeirão Preto, SP (years 2006 to 2009) by the coverage area of health units, associating it with the covariates of interest (IPVS, Income and Education predominant those areas). The method is based on MCMC simulations for estimate the posterior distributions of TB incidence in Ribeirão Preto. As a result, we have maps that show a spatial pattern more clearly, with estimates smoother and less random fluctuations. We observed that the areas with the highest incidence rates also have medium and high social vulnerability index. Concerning income, the prevailing salary range of household heads in these regions is between 0 and 3 minimum wages and the prevailing level of education of household heads in these regions is the elementary school. The results of the models in Bayesian analysis show that with increasing social vulnerability significantly increased the incidence of TB in Ribeirao Preto. In areas where vulnerability is high incidence of TB is nearly 15 times the incidence of areas without vulnerability. There was a significant increase in the incidence of tuberculosis in Ribeirão Preto during the years studied, the highest incidence recorded in 2009. The use of maps improved visualization of areas that deserve special attention for TB control, in addition, the association of disease with income, education and social vulnerability that bring benefits to the managers responsible for planning the municipality to plan interventions with special attention these areas, uniting efforts to reduce poverty and social inequality, alternatives to improve income distribution and improve access to basic sanitation among other priorities.
In elderly individuals, low educational level may represent a risk factor for the development of dementia and a proxy of cognitive reserve. Objective: This study examined the cognitive and neuroanatomic correlates of high versus low educational levels in cognitively healthy community-dwelling older adults in Brazil. Methods: Fifty-three older adults (mean age: 68±5.3 years) were divided into a “low education” group [LE; 1-4 years of education (N=33)] and “high education” group [HE; >11 years of education (N=20)]. Both groups completed a comprehensive neuropsychological battery and underwent in vivo structural MRI close to the time of testing. Results: Higher educational level increased the chance of having better scores on neuropsychological tests, including verbal and visual delayed recall of information, verbal learning, category fluency, global cognition, and vocabulary. Better scores on these tests were observed in the HE group relative to the LE group. Despite this, there were no group differences between MRI measures. Conclusion: Older adults with higher educational levels showed better scores on neuropsychological measures of cognition, highlighting the need for education-adjusted norms in developing countries. Given the absence of differences in structural anatomy between the groups, these findings appear to be best explained by theories of cognitive reserve.
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