Region-growing segmentation algorithms are useful for remote sensing image segmentation. These algorithms need the user to supply control parameters, which control the quality of the resulting segmentation. This letter proposes an objective function for selecting suitable parameters for region-growing algorithms to ensure best quality results. It considers that a segmentation has two desirable properties: each of the resulting segments should be internally homogeneous and should be distinguishable from its neighbourhood. The measure combines a spatial autocorrelation indicator that detects separability between regions and a variance indicator that expresses the overall homogeneity of the regions.

Objective: To analyze the association between the time of disease and the onset of diabetes mellitus complications and to describe the characteristics of the diabetics' population of a mid-sized city located in the Midwest of the state of Minas Gerais. Methods: Cross-sectional study conducted with 1320 patients with diabetes mellitus. The data were obtained from the registration system of Hypertensive and diabetic patients and the following variables were evaluated: sociodemographic characteristics, duration of disease and diabetes complications. Results: Among patients who have the diagnosis of the disease for more than 10 years, the percentage of those that present complications 156 (32.2%) is higher than among those with the diagnosis of the disease for less than 10 years 45 (12.1%). Conclusion:The results showed that the onset of diabetes-related complications might be associated with the duration of disease. ResumoObjetivo: Analisar a associação entre o tempo da doença e o aparecimento de complicações do diabetes mellitus e descrever as características da população de diabéticos de um município de médio porte do Centro Oeste mineiro. Métodos: Estudo transversal realizado com 1320 usuários com diabetes mellitus. Os dados foram obtidos do sistema de cadastramento de Hipertensos e Diabéticos e foram avaliadas as variáveis: características sociodemográficas, duração da doença e complicações do diabetes. Resultados: Entre os usuários que possuem o diagnóstico da doença há mais de 10 anos, o percentual daqueles que apresentam complicações 156 (32,2%) é maior do que entre os que possuem o diagnóstico da doença há menos de 10 anos 45 (12,1%). Conclusão: Os resultados apontaram que a presença de complicações relacionadas ao diabetes pôde ser associada ao tempo de duração da doença.

BackgroundThe prevalence of type 2 diabetes mellitus is increasing substantially worldwide, leading to serious economic effects, complications and deaths. This study evaluated the effectiveness of an empowerment program providing support for psychosocial, behavioral, and clinical aspects of diabetes to help Brazilian users of public health services obtain metabolic control of this condition.MethodsIn this cluster randomized trial, participants aged 30–80 diagnosed with type 2 diabetes were recruited from ten Brazilian public health units in 2014 and 2015. Five units were randomly assigned to receive the empowerment program based on a behavior change protocol, and five continued to receive only conventional treatment. The primary outcome was the biochemical and anthropometric parameters, and the secondary outcomes were self-care, attitude, knowledge and empowerment related to diabetes. The effect of the experiment was defined as the percentage variation between the values at the initial and final periods. To evaluate this effect and to compare it in the two groups, tests were used for paired and independent samples, respectively.ResultsThere were 238 participants: 127 and 111 in the intervention and control group, respectively. For glycated hemoglobin, the mean effect in the control and intervention groups was 3.93 and −5.13, respectively (p < 0.001). Levels of glycated hemoglobin and other metabolic indicators, as well as the most part of the secondary outcomes showed a significant difference in the experimental group compared to the control group.ConclusionsThe empowerment program improved metabolic control of type 2 diabetes in Brazilian users.Trial registration NCT02132338 - April 22, 2014.

In this paper, we present spatial analysis of the association between all incidents cases of human Visceral Leishmaniasis and seropositive dogs, from 1994 to 1997

BackgroundIn Brazil, lethality from visceral leishmaniasis (VL) is high and few studies have addressed prognostic factors. This historical cohort study was designed to investigate the prognostic factors for death from VL in Belo Horizonte (Brazil).MethodologyThe analysis was based on data of the Reportable Disease Information System-SINAN (Brazilian Ministry of Health) relating to the clinical manifestations of the disease. During the study period (2002–2009), the SINAN changed platform from a Windows to a Net-version that differed with respect to some of the parameters collected. Multivariate logistic regression models were performed to identify variables associated with death from VL, and these were included in prognostic score.Principal FindingsModel 1 (period 2002–2009; 111 deaths from VL and 777 cured patients) included the variables present in both SINAN versions, whereas Model 2 (period 2007–2009; 49 deaths from VL and 327 cured patients) included variables common to both SINAN versions plus the additional variables included in the Net version. In Model 1, the variables significantly associated with a greater risk of death from VL were weakness (OR 2.9; 95%CI 1.3–6.4), Leishmania-HIV co-infection (OR 2.4; 95%CI 1.2–4.8) and age ≥60 years (OR 2.5; 95%CI 1.5–4.3). In Model 2, the variables were bleeding (OR 3.5; 95%CI 1.2–10.3), other associated infections (OR 3.2; 95%CI 1.3–7.8), jaundice (OR 10.1; 95%CI 3.7–27.2) and age ≥60 years (OR 3.1; 95%CI 1.4–7.1). The prognosis score was developed using the variables associated with death from VL of the latest version of the SINAN (Model 2). The predictive performance of which was evaluated by sensitivity (71.4%), specificity (73.7%), positive and negative predictive values (28.9% and 94.5%) and area under the receiver operating characteristic curve (75.6%).ConclusionsKnowledge regarding the factors associated with death from VL may improve clinical management of patients and contribute to lower mortality.

BackgroundVisceral leishmaniasis (VL) is a vector-borne disease whose factors involved in transmission are poorly understood, especially in more urban and densely populated counties. In Brazil, the VL urbanization is a challenge for the control program. The goals were to identify the greater risk areas for human VL and the risk factors involved in transmission.MethodologyThis is an ecological study on the relative risk of human VL. Spatial units of analysis were the coverage areas of the Basic Health Units (146 small-areas) of Belo Horizonte, Minas Gerais State, Brazil. Human VL cases, from 2007 to 2009 (n = 412), were obtained in the Brazilian Reportable Disease Information System. Bayesian approach was used to model the relative risk of VL including potential risk factors involved in transmission (canine infection, socioeconomic and environmental features) and to identify the small-areas of greater risk to human VL.Principal FindingsThe relative risk of VL was shown to be correlated with income, education, and the number of infected dogs per inhabitants. The estimates of relative risk of VL were higher than 1.0 in 54% of the areas (79/146). The spatial modeling highlighted 14 areas with the highest relative risk of VL and 12 of them are concentrated in the northern region of the city.ConclusionsThe spatial analysis used in this study is useful for the identification of small-areas according to risk of human VL and presents operational applicability in control and surveillance program in an urban environment with an unequal spatial distribution of the disease. Thus the frequent monitoring of relative risk of human VL in small-areas is important to direct and prioritize the actions of the control program in urban environment, especially in big cities.

We present results from an analysis of human visceral Leishmaniasis cases based on public health records of Belo Horizonte, Brazil, from 1994 to 1997. The main emphasis in this study is on the development of a spatial statistical model to map and project the rates of visceral Leishmaniasis in Belo Horizonte. The model allows for space-time interaction and it is based on a hierarchical Bayesian approach. We assume that the underlying rates evolve in time according to a polynomial trend specific to each small area in the region. The parameters of these polynomials receive a spatial distribution in the form of an autonormal distribution. While the raw rates are extremely noisy and inadequate to support decisions, the resulting smoothed rates estimates are considerably less affected by small area issues and provide very clear directions to implement public health actions.

Despite advancements in renal replacement therapies and increased survival, patients still face several physical, psychological and social limitations as consequences of chronic kidney disease and treatment complexity. 1,2 The daily struggle with end-stage renal disease symptoms and related comorbidities, along with the need to cope with psychosocial stressors, directly impacts patients' quality of life and mental health. 3,4 Depression and anxiety are considered to be the most common end-stage renal disease-related psychological disorders, with higher prevalence and incidence rates in this population than those in the general population. 5-10 According to the World Health Organization, the estimated global prevalence rates of depression and anxiety in 2015 were 4.4% and 3.6%, respectively, with an increase in reported cases of 18% between 2005 and 2015. 11 The anxiety and depression rates that have been estimated among end-stage renal disease patients are not accurate: they range from 0 to 100%, depending on the diagnostic criteria, assessment tool and population characteristics. 12 A systematic review of 55 studies revealed prevalence rates of 38% and 27% for anxiety and depression, respectively, among end-stage renal disease patients. 13 The high frequency and impact of affective symptoms in nephrology practice have led the research community to devote increasing attention to depression and anxiety over the last few years. 7 In end-stage renal disease, these mental disorders are associated with various conditions that lead to poorer health outcomes, with direct impacts on patients' quality of life and survival. 14-23 Anxiety and depression are also associated with unhealthy forms of behavior, such as alcohol and tobacco use, poor eating habits, sedentary lifestyle and non-compliance with treatment. 24 These factors translate into increased risks of clinical events and the need for emergency services, thus resulting in higher healthcare costs. 25-26