BackgroundMore than 200,000 new cases of leprosy were reported by 105 countries in 2011. The disease is a public health problem in Brazil, particularly within high-burden pockets in the Amazon region where leprosy is hyperendemic among children.MethodologyWe applied geographic information systems and spatial analysis to determine the spatio-temporal pattern of leprosy cases in a hyperendemic municipality of the Brazilian Amazon region (Castanhal). Moreover, we performed active surveillance to collect clinical, epidemiological and serological data of the household contacts of people affected by leprosy and school children in the general population. The occurrence of subclinical infection and overt disease among the evaluated individuals was correlated with the spatio-temporal pattern of leprosy.Principal FindingsThe pattern of leprosy cases showed significant spatio-temporal heterogeneity (p<0.01). Considering 499 mapped cases, we found spatial clusters of high and low detection rates and spatial autocorrelation of individual cases at fine spatio-temporal scales. The relative risk of contracting leprosy in one specific cluster with a high detection rate is almost four times the risk in the areas of low detection rate (RR = 3.86; 95% CI = 2.26–6.59; p<0.0001). Eight new cases were detected among 302 evaluated household contacts: two living in areas of clusters of high detection rate and six in hyperendemic census tracts. Of 188 examined students, 134 (71.3%) lived in hyperendemic areas, 120 (63.8%) were dwelling less than 100 meters of at least one reported leprosy case, 125 (66.5%) showed immunological evidence (positive anti-PGL-I IgM titer) of subclinical infection, and 9 (4.8%) were diagnosed with leprosy (8 within 200 meters of a case living in the same area).Conclusions/SignificanceSpatial analysis provided a better understanding of the high rate of early childhood leprosy transmission in this region. These findings can be applied to guide leprosy control programs to target intervention to high risk areas.

BackgroundLeprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children.MethodsWe selected two elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups.ResultsLeprosy was detected in 11 (8.2 %) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p < .05) compared to our previous findings in randomly selected schools (63/1592; 3.9 %). The 2-year follow-up results showed that 22.3 and 9.4 % of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p < .01), indicating that a follow-up of 10 seropositives has a >90 % probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in “positive houses” compared to “negative houses” (p < .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85 % probability to detect at least one new case in 2 years.ConclusionsTargeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.

Leprosy in children is

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IntroductionLow back pain (LBP) is one of the largest and most frequent public health problems worldwide. Photobiomodulation therapy (PBMT) is a frequently used non-pharmacological therapy for the treatment of musculoskeletal disorders. However, there is little high-quality scientific evidence that demonstrates the effectiveness of PBMT in the treatment of patients with chronic LBP in the short, medium and long term. Therefore, the objective of this clinical trial is to evaluate the effects of PBMT in patients with chronic non-specific LBP in the short, medium and long term.Methods and analysesThis is a prospectively registered, two-arm randomised placebo-controlled trial with blinded patients, assessors and treatment providers. One hundred and forty-eight patients with chronic non-specific LBP will be recruited. Treatment sessions will be provided three times a week for 4 weeks (totaling 12 sessions) with patients receiving either placebo or active PBMT. For ethical reasons, all patients, regardless of treatment allocation, will also receive an information booklet based on ‘The Back Book’. Clinical outcomes will be measured at baseline, at the end of treatment, as well as 3, 6 and 12 months after randomisation. The primary outcomes will be pain intensity and disability measured after 12 sessions of treatment. The secondary outcomes will be pain intensity and disability measured at 3, 6 and 12 months after randomisation, in addition to specific disability and global perceived effect in all time points.Ethics and disseminationThe study was approved by the Research Ethics Committee of Universidade Cidade de São Paulo. The results will be disseminated through scientific publications and presentations at national and international scientific meetings.Trial registration number NCT03089424.

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A incidência e as taxas de mortalidade por Câncer Colorretal (CCR) têm apresentado uma tendência mundial de crescimento. Objetivo: Analisar a evolução temporal e comparar as tendências de taxa de mortalidade por CCR no estado de Sergipe e no Nordeste brasileiro, no período de 2008 a 2018. Métodos: Estudo documental, de óbitos por CCR, no estado de Sergipe e na região Nordeste. Os dados foram coletados no Sistema de Informação em Mortalidade, do Departamento de Informática do Sistema Único de Saúde. A análise temporal foi realizada com aplicação do modelo de regressão por pontos de inflexão Joinpoint Regression Analysis. Resultados: Os óbitos por CCR em Sergipe e no Nordeste, foi predominante na região do cólon, seguido pelo reto e junção retossigmoide, prevaleceu nos idosos, com semelhança entre os sexos, porém ligeiramente maior nas mulheres. As taxas de mortalidade permaneceram crescentes entre 2008 e 2018, tanto em Sergipe como no Nordeste do Brasil. Em Sergipe, destacaram-se os seguintes pontos de inflexão (joinpoints), um aumento da mortalidade de 8,6% ao ano em mulheres e de 5,3% ao ano em homens, enquanto o Nordeste apresentou uma taxa de crescimento de 6,6% ao ano, para ambos os sexos. Conclusão: Necessita-se do fortalecimento e ampliação de medidas de promoção em saúde com ações preventivas, de diagnóstico precoce e de tratamento do CCR focadas no rastreamento da população, principalmente a mais idosa. A realização e manutenção dessas ações, a longo prazo, são comprovadamente capazes de impactar, positivamente na redução dos óbitos por essa afecção.

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