El uso de los factores socioeconómicos en el mapeamento de zonas de riesgo de tuberculosis en una ciudad del noreste de Brasil

In Brazil the challenge of meeting the needs of those living in deprived areas has generated discussions on replacing the existing approach to epidemiological surveillance with an integrated public health surveillance system.
This new approach would supplant the traditional focus on high-risk individuals with a method for identifying high-risk populations and the areas where these persons live.
Given the magnitude of the problem that tuberculosis (TB) poses for Brazil, we chose that disease as an example of how such a new, integrated public health surveillance system could be constructed.
We integrated data from several sources with geographic information to create an indicator of tuberculosis risk for Olinda, a city in the Brazilian state of Pernambuco.
In order to stratify the urban space in Olinda and to check for an association between the resulting TB risk gradient and the mean incidence of the disease between 1991 and 1996, we applied two different methods: 1) a “social deprivation index” and 2) principal component analysis followed by cluster analysis.
Our results showed an association between social deprivation and the occurrence of TB. The results also highlighted priority groups and areas requiring intervention. We recommend follow-up that would include treating acid-fast bacilli smear-positive pulmonary TB cases, tracing of these persons’ contacts, and monitoring of multidrug-resistant cases, all in coordination with local health services.

http://www.paho.org/english/dbi/es/Souza.pdf

Análisis espacial de casos de tuberculosis en los inmigrantes y los residentes permanentes, Beijing, 2000-2006

The data on all the TB cases reported in Beijing from 2000 through 2006 were obtained from the Beijing Institute for Tuberculosis Control, which specializes in TB prevention and research and is responsible for supervision of TB control in 18 districts of metropolitan Beijing. The cases that met the diagnostic criteria of TB issued by Ministry of Public Health in 2003 were included in the analyses.

The data include information on age, origin, current address, and date of TB onset. To assess the contribution of the migrant population from different areas, the case origins were divided into 4 zones, according to economic status and geography, i.e., western zone (including Shanxi, Gansu, Qinghai, Ningxia, Inner Mongolia, Xinjiang, Tibet, Sichuan, Chongqing, Guizhou, Guangxi, Yunnan Provinces, or other administrative regions), middle zone (including Heilongjiang, Jilin, Shanxi, Henan, Anhui, Hubei, Hunan, Jiangxi Provinces), eastern zone (including Liaoning, Hebei, Shandong, Jiangsu, Zhejiang, Fujian, Guangdong, Hainan Provinces), and 2 municipalities (Tianjin and Shanghai).

The zonal classification corresponded to that of the Report on Nationwide Survey on Epidemiology of Tuberculosis in 2000 (18) and thus was easily used for comparison. The case data have been stratified by age, gender, origin, and onset date of TB; age was divided into 3 groups: 1) 0-14 years, 2) 15-64 years, and 3) [greater than or equal to] 65 years. All the TB cases were coded according to the address where they resided (geo-coded) and matched to a 1:100,000 digital map of Beijing by using ArcGIS version 9.1 software (ESRI Inc., Redlands, CA, USA).

The demographic data of permanent residents and migrant population for each district were obtained from the 2000-2006 censuses, provided by Beijing Municipal Public Security Bureau (8,9,19-23). The 18 districts of Beijing, covering a total surface area of [approximately equal to] 16,800 [km.sup.2], had 11,976,900 permanent residents and 5,475,000 migrants in 2006 (9). On the basis of these data, the population densities of each district in different years were calculated and displayed on the digital map of Beijing.

The permanent residents in our study were defined as those who reside in Beijing with registered hukou in Beijing, and the migrant population was defined as those who had been residing in Beijing >1 month but whose hukou were still held in their homelands. Persons originally from other countries were beyond the scope of our current study. A shape file of property boundary data of 18 districts in Beijing 2003 obtained from the Ministry of Water Resources of the People's Republic of China was used to generate visual presentations with 1:100,000 scale by using ArcGIS 9.1.

Statistical Analysis

The dynamic changes in population densities and the TB case notification rate of both migrant population and permanent residents from 2000 to 2006 were displayed by district on the digital map of the Beijing municipality. Global Moran's 1 statistics with z score test and Getis's [G.sup.*.sub.i] statistics, which specify 10 km as the threshold of distance, have been used to detect the spatial distribution and the hot spots of TB in the 2 populations . Global Moran's I is used to discern spatial autocorrelation of TB cases in the study area and disclose the spatial pattern of disease with z score at the district level. A statistically significant (z score [greater than or equal to] 1.96) estimate of I indicates that neighboring districts (within 10 km) have a similar prevalence rate of TB and that the cases are likely to cluster at the district level (24). Getis's [G.sup.*.sub.i] statistics only assess positive spatial autocorrelation and are used to detect hot spots in the study area. A calculated value of [G.sup.*.sub.i] [greater than or equal to] 1.96 indicates that district i and its neighboring districts (within 10 km) have a TB prevalence rate that is statistically significantly different (higher) than other districts. District i is the center of the area with the higher TB prevalence rate, and is defined as a TB hot spot .

http://findarticles.com/p/articles/mi_m0GVK/is_9_14/ai_n28570097/pg_2

El uso de la tecnología de los SIG para identificar las áreas de transmisión y de incidencia de la tuberculosis

Background: Currently in the U.S. it is recommended that tuberculosis screening and treatment programs be targeted at high-risk populations. While a strategy of targeted testing and treatment of persons most likely to develop tuberculosis is attractive, it is uncertain how best to accomplish this goal. In this study we seek to identify geographical areas where on-going tuberculosis transmission is occurring by linking Geographic Information Systems (GIS) technology with molecular surveillance.

Methods: This cross-sectional analysis was performed on data collected on persons newly diagnosed with culture positive tuberculosis at the Tarrant County Health Department (TCHD) between January 1, 1993 and December 31, 2000. Clinical isolates were molecularly characterized using IS6110-based RFLP analysis and spoligotyping methods to identify patients infected with the same strain. Residential addresses at the time of diagnosis of tuberculosis were geocoded and mapped according to strain characterization. Generalized estimating equations (GEE) analysis models were used to identify risk factors involved in clustering.

Results: Evaluation of the spatial distribution of cases within zip-code boundaries identified distinct areas of geographical distribution of same strain disease. We identified these geographical areas as having increased likelihood of on-going transmission. Based on this evidence we plan to perform geographically based screening and treatment programs.

Conclusion: Using GIS analysis combined with molecular epidemiological surveillance may be an effective method for identifying instances of local transmission. These methods can be used to enhance targeted screening and control efforts, with the goal of interruption of disease transmission and ultimately incidence reduction.

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=529461&blobtype=pdf

Los padrones de transmisión de la tuberculosis en una zona de alta incidencia : Un analisis espacial

SETTING: In the Cape Town suburbs of Ravensmead and Uitsig, tuberculosis has reached epidemic levels,with notifications of 1340/100 000 in 1996. These suburbs are characterised by overcrowding, high unemployment and poverty. It is traditionally believed that tuberculosis transmission takes place mainly in households after close contact with an infectious person. Studies have recently linked tuberculosis transmission to locations outside the household, and have associated these places with a particular high-risk lifestyle. Anthropological studies in some suburbs of Cape Town, in which a very high number of local drinking places (shebeens) were identified (17 per km2), have suggested that social drinking is part of such a lifestyle.
OBJECTIVE: To investigate various risk factors and places of transmission of tuberculosis using a geographical information system (GIS).
RESULTS AND CONCLUSION: The 1128 bacteriologically- proven cases of tuberculosis studied over the period 1993–1998 were investigated using spatial epidemiological techniques of exploratory disease mapping. Point pattern analysis and spatial statistics indicated clustering of cases in the areas of high incidence. Significant associations of tuberculosis notifications were found with unemployment, overcrowding and number of shebeens per enumerator sub-district. High tuberculosis notifications with unemployment and its associated poverty emerged as the strongest association.

Información:
http://www.ingentaconnect.com/content/iuatld/ijtld/2003/00000007/00000003/art00015?crawler=true

http://docstore.ingenta.com/cgi-bin/ds_deliver/1/u/d/ISIS/47267217.1/iuatld/ijtld/2003/00000007/00000003/art00015/68B5C8268A9F52B11227235619E265CE1B221D4DDC.pdf?link=http://www.ingentaconnect.com/error/delivery&format=pdf

Uso de SIG para representar espacialmente la prevalencia del VIH / SIDA y la tuberculosis y sus consecuencias demográficas en algunos países en el Áfr

Background
With the onset of the new millennium Sub-Saharan Africa is currently the epicenter of HIV/AIDS infection with 23.3m at the beginning of 2000 (Mail & Guardian, 2001) and with the worldwide estimates pegged at 51,32m (Mail & Guardian, 2003). Sub-saharan Africa thus has 70% of world infections in an area that has only 10% of the global population. The HIV/AIDS disease knows no boundaries, but spatial epidemiology through cartographical analysis may yield vital clues as to HIV distribution (clustered or random) across communities with different norms and socio-economic status. Moreover, researchers have placed a closer relationship between TB and HIV/AIDS and argue that the two diseases are known for activating and reactivating each other. With HIV increasing the chance of reactivating dormant TB infection from 10% to 50% during a person’s life per year (DOH, 1997) and recent studies have suggested that 40% of all TB cases are attributed to HIV infection. Cartographic and GIS techniques would also assist in developing measures for monitoring the geographical spread of the HIV/AIDS pandemic over three years and TB and HIV incidence levels over two years in selected countries across sub-Saharan Africa.

Methods
A base map for the HIV/AIDS mapping would be constructed for the purpose of HIV/AIDS spatial portrayal over the three years and TB and HIV incidence levels over two years. Using ArcView GIS, HIV/AIDS prevalence data and HIV and TB incidence levels from three countries are cartographically mapped retrospectively from 1997 to 2000 to show current trends in the spread of the HI virus and HIV versus TB geographic dispersion. Further, choropleth techniques would show the rates of incidence of the HI virus per administrative district level for the selected countries over three years and also look at some consequences to their respective district populations. The accumulative effect of an increase in HIV/AIDS per district over a set period: 1997 to 2000 and HIV versus TB over a two year period would also be spatially portrayed via choropleth mapping.

Results
Whiteside and Sunter (2000) reckons that AIDS claims 5 500m men, women and children everyday in Africa. Studies conducted in both rural and urban areas in nine different African countries showed more women affected than men (13:10); this is continuing to skew the demography of many African countries with men outnumbering women. An interesting turnaround in HIV/AIDS prevalence is only visible in Uganda. In many of the other African countries a mortality decline by 25% between 1997 and 2004 and life expectancy from about 66 to 49years by 2004 is quite possible. South Africa is most frightening with the KwaZulu-Natal Province, South Africa being consistently high at 32.5%. In 1998, the Mpumalanga province in South Africa had the second highest prevalence rate (30%) but dropped to 27.9% in 1999 putting the province in the third place behind the Free State. One of the lowest prevalence occurs in the Limpopo Province (LP), South Africa, where a sample survey in 2000, based on 1808 blood specimens, found 238 (13.2%) women attending ANC’s to be HIV positive. This was a 1.77% increase from 1999’s 11.43% and a 5% increase from the 1997’s 8.2% (DOH, 2000).

According to Pulse Track (1998) the MRC diagnosed 107 000 cases of Tuberculosis in 1997 with 18 964 reported TB cases in the Western Cape Province, South Africa alone, an increase of 26% from its 1997 levels of 15 034, with KZN Province ranked a close second at 9 672 (1998) reported TB cases, a mere 4% reduction from 1997 (10 075 TB cases). Ironically, the Limpopo Province, South Africa recorded the lowest TB cases in 1998 (2 112), a drop of 8% since 1997 (1 947) and this province also ranked among the one of the lowest HIV prevalence rates in South Africa with a drop of 2.77 % to 8.73% in 2000 from 11.5% (1998). According to WHO (2000) 9.4m people were infected with TB and HIV throughout the world and it doubles every year. However, WHO (2000) states that 70% (6.58m) of them live in Sub-Saharan Africa (UNAIDS, 2000). South Africa recorded a 32.8% HIV + TB cases (1998) from an estimated 180 507 TB cases against a TB incidence of 419/100 000 population. Of this the KZN province recorded the highest HIV + TB cases (49.8%) from an estimated 39 650 TB cases against a TB incidence of 433/100 000. The Western Cape was tagged the lowest at 16.8% of 22 942 estimated TB cases against a TB incidence value of 614 per 100 000. The impact on life expectancy, fertility, mortality and dependency ratio versus HIV and TB would also be highlighted using choropleth cartographic mapping techniques for the 1998 – 2000 period.

Kamanga et al’s (2000) study in Zambia showed that HIV has increased the burden of TB in Sub-Saharan Africa. They continue to argue that prevalence rates for TB in Zambia are over 400/100 000 population per year attributed largely due to an increase in HIV infection rate. Being HIV+ constitutes a risk factor for progressing from TB infection to TB disease (DOH, SA 2000). In their analysed HIV-1 seroprevalence study among TB clinic attendants in Africa, Shandera et al (2000) found the mean and median HIV-1 prevalence for TB clinic attendants was 20 and 16.8% respectively for all 28 nations, and 28,2% for attendants in Central, South, and East Africa. Interestingly, this research effort brings out similar comparisons between the selected Sub-Saharan countries and Shandera et al’s studies in Africa.

Conclusion
The spatial dynamics of this pandemic and the association of TB with HIV can be portrayed using Cartographic and GIS techniques via choropleth mapping of HIV/AIDS and TB prevalence data. Moreover, the emerging patterns of the spread of HIV/AIDS and HIV and TB, within the different districts, of the three selected countries over a three year period may provide some guidelines to the possible trend that HIV/AIDS would take over the next four year cycle and how the relationship between HIV and TB would pan out towards the approach of the new millenium and more importantly its demographic impact on key population indicators for example life expectancy. This study, however, argues the need to for appropriate clinical, educational and social programs to secure some control or curtailment on the spatial spread of TB and the HI virus in sub-Saharan Africa by 2004.

Información :

http://www.gisdevelopment.net/application/health/overview/ma03096abs.htm

La Tuberculosis en Brasil : Construcción de un sistema de vigilancia de base territorial

Objetivo
Analisar a ocorrência da tuberculose, identificando variáveis definidoras de situações coletivas de risco que determinam sua distribuição espacial, como subsídio à implantação de um sistema de vigilância de base territorial para controle da tuberculose.
Métodos
Estudo ecológico realizado no período 1996-2000, em Olinda, município da região metropolitana do Recife, PE. A mediana do número de casos de tuberculose, notificados por setor censitário, serviu como ponto de corte para caracterização das áreas de alta e baixa transmissão. Um modelo de regressão logística, utilizando essa variável resposta, permitiu estimar as “odds-ratio” de algumas variáveis socioeconômicas do Censo Demográfico de 2000 e de outras co-variáveis relacionadas com a transmissão da doença.
Resultados
A tuberculose em Olinda apresentou altas taxas de incidência no período (média de 111 casos por 100.000 habitantes). Verificou-se que são significativamente associadas à ocorrência da tuberculose, as variáveis: média de moradores por domicílio (OR=2,2; IC 95%: 1,3; 3,6); existência de famílias com mais de um caso no período (OR=5,1; IC 95%: 2,3; 11,3); e presença de casos de retratamento (OR=6,8; IC 95%: 2,7; 17,1). Setores censitários com a ocorrência desses dois últimos eventos concentraram 45% do total de casos do período, representando apenas 28% da população do município.
Conclusões
Duas das três variáveis explicativas associadas a maiores taxas de incidência da doença são informações que devem ser monitorizadas, em nível local, pelo sistema de vigilância da tuberculose. O simples mapeamento de casos de retratamento e de domicílios com ocorrência de repetidos casos, permitiria refinar o foco de atenção em micro-áreas prioritárias para intervenções intensivas, como forma de enfrentar o problema da tuberculose.

http://www.scielo.br/pdf/rsp/v39n1/11.pdf

MAPEAMENTO DOS LOCAIS DE OCORRÊNCIA DA TUBERCULOSE

O presente trabalho tem como finalidade utilizar técnicas de geoprocessamento para mapear os locais de ocorrência da Tuberculose no município de Uberlândia-MG, assim como realizar levantamento bibliográfico a respeito das principais informações sobre esta enfermidade e sobre as técnicas de geoprocessamento. O barateamento dos custos de hardwares e softwares tem impulsionado a utilização de Sistemas de Informação Geográfica nas áreas da saúde, como instrumento de análise e espacialização das doenças e de prevenção e vigilância em saúde. Neste sentido, foi possível mapear os locais de ocorrência da Tuberculose em Uberlândia, nos anos de 1995 a 2003, a partir de dados obtidos na dissertação de Mestrado “Comportamento epidemiológico da Tuberculose em Uberlândia (MG): situações coletivas de risco, de 1995 a 2003” de Sandra Soares Alvim, do Instituto de Geografia da Universidade Federal de Uberlândia.

A Tuberculose é a doença infecto-contagiosa que mais causa mortes no Brasil, que, segundo a Organização Mundial de Saúde (OMS), è o único país das Américas que se encontra entre as vinte e duas nações responsáveis por 70% dos casos desta enfermidade em todo o mundo.

A Tuberculose também é apontada por muitos como um “mal social”, por estar intimamente ligada às condições precárias das classes sociais menos favorecidas. Isto acontece devido ao fato da doença se estabelecer mais facilmente em indivíduos de baixa resistência orgânica, que pode ser causada por inúmeros fatores como má qualidade de vida, falta de higiene, tabagismo, alcoolismo e etc (FUNDAÇÃO OSVALDO CRUZ, 2005).

Más información :

http://www.propp.ufu.br/revistaeletronica/Edicao%202006_1/G/bia.pdf

El concepto de salud mental en la atención primaria

This paper reviews the origins of the current concept of mental health, starting from the mental hygiene movement, initiated in 1908 by consumers of psychiatric services and professionals interested in improving the conditions and the quality of treatment of people with mental disorders. The paper argues that, more than a scientific discipline, mental health is a political and ideological movement involving diverse segments of society, interested in the promotion of the human rights of people with mental disorders and the quality of their treatment.

Más Información:

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2408392&blobtype=pdf