David Soeiro | UFMG - The Federal University of Minas Gerais (original) (raw)
Papers by David Soeiro
PLoS neglected tropical diseases, Sep 1, 2018
The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and muco... more The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016. We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change. The age-standardized incidence rate of leishmaniasis decreased 48.5% from 1990 (71.0, 95%UI 24.3-150.7) to 2016 (36.5, 95%UI 24.7-50.9), whereas the age-standardized DALY increased 83.6% over the studied period from 12.2 (95%UI 7.9-18.8) to 22.4 (95%UI 13.3-36.2). The age-standardized incidence rate and YLL for VL increased by 52.9% and 108% from 1990 to 2016, respectively. Considering CML, the age-standardized incidence rate a...
Acta Tropica, 2014
Spatial analysis of epidemiological data may be used to assist in the implementation of surveilla... more Spatial analysis of epidemiological data may be used to assist in the implementation of surveillance and control measures against visceral leishmaniasis (VL) in endemic areas. This ecological study aimed to identify priority areas for surveillance and control of VL in São Luís, the capital of the state of Maranhão in northeast Brazil, a highly endemic area for the disease. We evaluated the spatial structure of the incidence rates of human VL and of the mean number of human and canine cases occurring between 2005 and 2007 in 355 neighborhoods (aggregated into 203 geographical analytical units) within the municipality. The presence of spatial autocorrelation was explored using global and local Moran's I statistics. A local indicator of spatial autocorrelation was used to generate maps for the identification of VL clusters. The global Moran's I index revealed a weak, but statistically significant spatial autocorrelation for human VL incidence rates (I = 0.138). A total of 43 geographical analytical units, encompassing 121 neighborhoods, were identified as priority areas for implementing surveillance and control actions. For the purpose of defining an action plan for the delivery of these measures, those 16 geographical analytical units (encompassing 54 neighborhoods) identified as clusters with high incidence rates of human VL should receive the highest priority. An additional nine geographical analytical units (comprising 28 neighborhoods) showed non-significant clustering of high rates of human, and might be considered as the next priority for VL management. Finally, a further 18 geographical analytical units (covering 39 neighborhoods) had records of coexisting human and canine VL cases during the study period, and these should receive priority attention when resources become available. Spatial data analysis is a valuable tool for defining priority areas for VL surveillance in high transmission areas contributing to a more effective management of financial and technical resources, increasing the sustainability and efficiency of control efforts.
PLOS Negleted Tropical Diseases, 2018
Leishmaniasis are diseases caused by obligatory intracellular parasites of the genus Leishmania a... more Leishmaniasis are diseases caused by obligatory intracellular parasites of the genus Leishmania and are transmitted to humans through the bite of female sandflies during blood repast. Untreated visceral leishmaniasis can lead to death, while cutaneous and mucocutaneous forms generally do not pose risk of death but can cause disability and permanent injury, which raises stigma and social prejudice. The Global Burden of Disease Study (GBD) is a systematic and scientific effort to quantify the health loss caused by infectious and non-infectious diseases and injury and their risk factors categorized by age, sex, and geographic distribution at specific periods of time. The present article describes, for the first time, the burden of leishmaniasis in the 27 Brazilian federated units. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states. Understanding the burden of these diseases and their regional differences is of great relevance for the establishment of adequate and region-specific surveillance and control measures. In addition, it can help in the rational use of available resources and in decision making aimed at reducing the transmission of the parasite and the burden of this disabling and potentially lethal disease.
BACKGROUND: In the current context of high fatality rates associated with American visceral leish... more BACKGROUND: In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented.METHODS/PRINCIPAL FINDINGS: The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40-50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far.CONCLUSIONS/SIGNIFICANCE: Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.
Abstract Spatial analysis of epidemiological data may be used to assist in the implementation of... more Abstract
Spatial analysis of epidemiological data may be used to assist in the implementation of surveillance and control measures against visceral leishmaniasis (VL) in endemic areas. This ecological study aimed to identify priority areas for surveillance and control of VL in São Luís, the capital of the state of Maranhão in northeast Brazil, a highly endemic area for the disease. We evaluated the spatial structure of the incidence rates of human VL and of the mean number of human and canine cases occurring between 2005 and 2007 in 355 neighborhoods (aggregated into 203 geographical analytical units) within the municipality. The presence of spatial autocorrelation was explored using global and local Moran's I statistics. A local indicator of spatial autocorrelation was used to generate maps for the identification of VL clusters. The global Moran's I index revealed a weak, but statistically significant spatial autocorrelation for human VL incidence rates (I = 0.138). A total of 43 geographical analytical units, encompassing 121 neighborhoods, were identified as priority areas for implementing surveillance and control actions. For the purpose of defining an action plan for the delivery of these measures, those 16 geographical analytical units (encompassing 54 neighborhoods) identified as clusters with high incidence rates of human VL should receive the highest priority. An additional nine geographical analytical units (comprising 28 neighborhoods) showed non-significant clustering of high rates of human, and might be considered as the next priority for VL management. Finally, a further 18 geographical analytical units (covering 39 neighborhoods) had records of coexisting human and canine VL cases during the study period, and these should receive priority attention when resources become available. Spatial data analysis is a valuable tool for defining priority areas for VL surveillance in high transmission areas contributing to a more effective management of financial and technical resources, increasing the sustainability and efficiency of control efforts.
Destaques: "Revisitar o processo de avaliação dos pesquisadores e dos cursos deveria permitir ... more Destaques:
"Revisitar o processo de avaliação dos pesquisadores e dos cursos deveria permitir repensar do processo de identificação de fragilidades da produção intelectual em saúde coletiva, da avaliação dos cursos e dos pesquisadores deste campo. Nesse sentido, acredito que a proposta de Camargo Jr. 1 de se posicionar a favor de uma ruptura com o ranqueamento que considera somente indicadores quantitativos de produção é bastante válida, trazendo à tona o debate quantitativo versus o qualitativo na avaliação, com uma tendência que a academia tem em dicotomizar estas diferentes abordagens tal qual no método da pesquisa científica, superado no fato de que podem ser complementares nos mais diferentes contextos. Uma "falsa polêmica" posteriormente retratada pelo autor 4. Como colocado por Struchiner 5 (p. 1717): "... não podemos abrir mão de nenhuma fonte de informação. Se utilizadas separadamente, essas avaliações serão ilusórias".
Essa lógica produtivista também cerceia e enfraquece o debate do campo da saúde coletiva no momento da formação na pós-graduação, quando não é mais prioridade situar e problematizar as diferentes áreas e o campo de atuação do profissional de saúde coletiva no seu momento de formação. Nosso debate de sociedade e dimensão política das necessidades de saúde enfraquece junto com a fragmentação e compartimentalização das áreas, onde pesquisar o detalhe, o específico é prioritário e considerado suficiente. Como investigar as árvores sem perder de vista a floresta (que em alguns contextos, está em chamas)? Como preparar um indivíduo comprometido com as necessidades da sociedade brasileira e do SUS a fazer as perguntas que devem ser respondidas?
Da mesma forma, é escasso o incentivo para o "pensar pedagógico" na formação de mestres e doutores. A formação de docentes/educadores encontra-se fragilizada por esse contexto que não contribui para a politização e visão crítica sobre o ato de educar. Assim é necessário revisitarmos a Lei de Diretrizes e Bases da educação nacional 6 que trata, em seu Art. 66, do tema: "a preparação para o exercício do magistério superior far-se-á em nível de pós-graduação, prioritariamente em programas de mestrado e doutorado". Tal fato não tem ocorrido de forma consistente e ampliada, assim reproduzimos a lógica do "ensinando se aprende", porém sem teorizar criticamente este processo, gerando um ciclo vicioso em que a prática e a leitura de bases pedagógicas não são importantes."
The risk factors associated with canine visceral leishmaniosis (CVL) in Brazil are unclear and co... more The risk factors associated with canine visceral leishmaniosis (CVL) in Brazil are unclear and controversial. The objectives of this systematic review and meta-analysis were to identify the best evidence available in this field and to determine the gaps in existing knowledge. Literature searches were carried out using four databases, the reference lists within articles, and references provided by experts in the field. Theoretical discussions or separate and independent meta-analyses of p-values or of effect sizes were used to pool information about each variable. Thirty-six articles were selected for detailed review, including 31 cross-sectional, two ecological and three cohort studies. The variables showing significant association with CVL were short hair, purebred, peri-domestic restricted (as compared with domestic-restricted dogs), and presence of green areas adjacent to home. The occurrence of CVL was also associated with the presence of domestic fowl in the home environment, with free dogs (as compared with restrained dogs), with male gender and with dogs >1 or 2 years of age, although these associations were not statistically significant. Due to the small number of publications, consistent results could not be obtained concerning the role of other factors. Most studies did not describe the criteria of eligibility and the process of selection of participants in sufficient detail and employed only one diagnostic test as proof of infection. Few studies controlled for confounding variables. No statistical evidence of publication bias was detected, but a great deal of information contained in the primary articles was lost because the results were not adequately described. The results of this review contribute to a better understanding of CVL and should assist in optimizing the development and implementation of control policies. Continuous actions, prioritizing dogs at higher risk and areas with higher abundance of green vegetation, together with policies to promote responsible dog ownership are mandatory. Problems concerning study design and data analysis described in the present study need to be taken into consideration in future studies. These must follow clear procedures to select participants and utilize standardized, valid and reliable diagnostic methods. The development of multivariate models and the use of the STROBE statement for description of the results should also be encouraged. Further research should investigate the patterns identified and prioritize CVL-related factors that have not been fully recognized or elucidated. Finally, ecological and cohort studies of CVL and investigations in other countries of Latin America are urgently required.
"Background Still today, more than 30 years after the beginning of the process of visceral leish... more "Background
Still today, more than 30 years after the beginning of the process of visceral leishmaniasis' urbanization, there is little knowledge about the risk factors for itsoccurrence, despite their relevance to the control and understanding of disease dynamics. The present study is the first systematic review with meta-analysis about factors associated with Leishmania infantum infection in humans in the Americas.
Methods and Findings
After searching different databases, consultations to the reference lists of articles and to experts in the field, 51 studies were reviewed. Theoretical discussions or meta-analysis of p-values or of effect sizes were used to pool information about each variable. The Q test and the I statistic were used to assess heterogeneitiesamong the studies. Male sex was associated with visceral leishmaniasis in studies which used the leishmanin skin test for diagnosis and in those where the outcomewas the clinical disease; the opposite occurred when serological diagnosis was applied. Younger individuals were less frequently infected than adults, but were moreprone to illness. Although with different levels of evidence and of heterogeneity, the presence of dogs at home, higher dog seropositivity in nearby areas, lower socioeconomic status and highly vegetated areas were associated with L. infantum infection. This was not noticed for the presence of chickens in the house and withnutritional status. Susceptibilities to bias and limitations in the analysis and in the description of results were often identified in the studies analyzed.
Conclusions
Results showed the existence of consistent patterns for some of the factors analyzed and should be taken into account in developing more effective and well-targetedcontrol measures. Studies must be conducted in new areas of the continent, with improved methodological quality and prioritizing the investigation of the patternsidentified and their causes, as well as variables for which knowledge is poor."
Na Educação permanente em Saúde, a Educação a Distância (EAD) representa um caminho tanto para ac... more Na Educação permanente em Saúde, a Educação a Distância (EAD) representa um caminho tanto para aconstrução coletiva e dialógica do conhecimento quanto para a melhoria das práticas dos trabalhadores dosetor. A EAD na Saúde contribui também para a consolidação de um modelo mais equitativo e democrático depromoção e atenção à saúde no País. Por ser a formação e qualificação dos trabalhadores da saúde que atuamno SUS uma das missões da Fundação Oswaldo Cruz (Fiocruz), este artigo se propõe a realizar um exercíciode aproximação entre as áreas de EAD e Educação em Saúde a partir da experiência do curso Andando nasNuvens, promovido pela Fiocruz, por meio do Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT), pelo Núcleo de Experimentação de Novas Tecnologias (NEXT). O curso foi analisadoqualitativamente, mediante o Discurso do Sujeito Coletivo (DSC), em dois momentos, a saber: na avaliaçãopré-curso, com 45 discursos, e na avaliação final, com 26 discursos analisados. Nesses 71 discursos, percebeu-seque as sínteses dos DSCs na avaliação pré-curso giraram em torno de conhecimentos e interesses por pesquisas;na avaliação final do curso, as sínteses dos DSCs giraram em torno da presença ativa dos tutores e das dificuldades em lidar com as tecnologias.
Comoespaço deformulação e contribuiçãopara aformação dospós-graduandos emsaúde, este fórum seprop... more Comoespaço deformulação e contribuiçãopara aformação dospós-graduandos emsaúde, este fórum sepropõea desenvolver suasatividadesjunto aosmovimentossociaise àpós-graduação comoespaço privilegiado deformação dedocentes, gestores eprofissionaisdesaúdequeatuem diretamentenosserviços e na construção depolíticaspúblicas de saúdeno Brasil. Entendemos que,hd umapauta ampla de discussão acercadaformação inicial edapósgraduaçãodosprofissionaisdesaúde,comdebatedasdiretrizescurricularesnacionaisede estratégias eprogramasqueviabilizem a reorientação daformaçãoprofissionalconectadaasdemandas do SistemaÚnico de Saúde.
-O que mais preocupa não é o grito dos violentos, nem dos corruptos, nem dos desonestos, nem dos ... more -O que mais preocupa não é o grito dos violentos, nem dos corruptos, nem dos desonestos, nem dos sem-caráter, nem dos sem-ética. O que mais preocupa é o silêncio dos bons.‖ Martin Luther King 3 À minha família e amigos, pelo apoio em todos os momentos desta caminhada. 4 Agradecimentos À minha família, pelo apoio incondicional nesta etapa profissional. Em especial, para minha mãe, Suely Soeiro, meu pai João Barbosa e minhas tias Regina Melo e Lucimar Soeiro; Ao Prof. Guilherme Werneck pela orientação, amizade e confiança depositada em mim na realização deste trabalho; À Profa. Ana Lúcia Abreu Silva pelo incentivo e apoio constante neste desafio; Ao meu tio, José Américo Soeiro, sua esposa Silvia Nery e meus primos Marcela, Nathália e Leonardo pelo apoio e conforto familiar no início desta jornada; À amiga Kelly Marques e sua família (Remédios, Nazáro e Kelton), por terem me recebido como se fosse parte da família no Rio de Janeiro; À ENSP/FIOCRUZ que deu suporte acadêmico e financeiro para a realização deste trabalho; À FAPEMA pela concessão de bolsa de pesquisa no início do curso e à FIOCRUZ pela bolsa de pesquisa concedida durante o período do curso. Aos profissionais do Centro de Controle de Zoonoses de São Luís, em especial Maria do Carmo Magalhães, João Batista Pires (ex-coordenador) e Nordman Wall, pelo apoio sempre que necessário; Ao Prof. Maurício Rangel pela ajuda na confecção da base de dados do município de São Luís; Aos amigos de turma do mestrado em Epidemiologia em Saúde Pública, em especial ao Robson Bruniera, Lidiane Toledo, Juliana Kabad e Carla Barreto pelo apoio e momentos de descontração; 5
Leishmania infection in humans, dogs and sandflies was examined in the endemic visceral leishmani... more Leishmania infection in humans, dogs and sandflies was examined in the endemic visceral leishmaniasis (VL) municipality of Raposa, state of Maranhão, Brazil. In this study, we examined Leishmania chagasi infection in the blood serum of both humans and Canis familiaris and the natural Leishmania sp. infection rate in the sandfly vector, Lutzomyia longipalpis. Enzyme-linked immunosorbent assay, indirect immunofluorescence reaction and polymerase chain reaction were performed to detect Leishmania infections in humans, dogs and sandflies, respectively. Overall, 186 out of 986 studied human beings were infected with L. chagasi parasites, representing an infection prevalence of 18.9%. An even higher infection rate was detected in dogs, where 66 (47.8%) out of 138 were infected. Among all Lu. longipalpis captured (n = 1,881), only 26.7% were females. The Leishmania infection frequency for the vector Lu. longipalpis was 1.56%. Remarkably, all infected sandflies were found in the peridomiciliary area. Furthermore, a high incidence of asymptomatic forms of VL in the human and canine populations was observed. The results of this study suggest autochthonous transmission of L. chagasi in this endemic area for visceral leishmaniasis because infection by Leishmania sp. was identified in all important elements of the transmission chain.
Ciência Animal …, Jan 1, 2010
PLoS neglected tropical diseases, Sep 1, 2018
The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and muco... more The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016. We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change. The age-standardized incidence rate of leishmaniasis decreased 48.5% from 1990 (71.0, 95%UI 24.3-150.7) to 2016 (36.5, 95%UI 24.7-50.9), whereas the age-standardized DALY increased 83.6% over the studied period from 12.2 (95%UI 7.9-18.8) to 22.4 (95%UI 13.3-36.2). The age-standardized incidence rate and YLL for VL increased by 52.9% and 108% from 1990 to 2016, respectively. Considering CML, the age-standardized incidence rate a...
Acta Tropica, 2014
Spatial analysis of epidemiological data may be used to assist in the implementation of surveilla... more Spatial analysis of epidemiological data may be used to assist in the implementation of surveillance and control measures against visceral leishmaniasis (VL) in endemic areas. This ecological study aimed to identify priority areas for surveillance and control of VL in São Luís, the capital of the state of Maranhão in northeast Brazil, a highly endemic area for the disease. We evaluated the spatial structure of the incidence rates of human VL and of the mean number of human and canine cases occurring between 2005 and 2007 in 355 neighborhoods (aggregated into 203 geographical analytical units) within the municipality. The presence of spatial autocorrelation was explored using global and local Moran's I statistics. A local indicator of spatial autocorrelation was used to generate maps for the identification of VL clusters. The global Moran's I index revealed a weak, but statistically significant spatial autocorrelation for human VL incidence rates (I = 0.138). A total of 43 geographical analytical units, encompassing 121 neighborhoods, were identified as priority areas for implementing surveillance and control actions. For the purpose of defining an action plan for the delivery of these measures, those 16 geographical analytical units (encompassing 54 neighborhoods) identified as clusters with high incidence rates of human VL should receive the highest priority. An additional nine geographical analytical units (comprising 28 neighborhoods) showed non-significant clustering of high rates of human, and might be considered as the next priority for VL management. Finally, a further 18 geographical analytical units (covering 39 neighborhoods) had records of coexisting human and canine VL cases during the study period, and these should receive priority attention when resources become available. Spatial data analysis is a valuable tool for defining priority areas for VL surveillance in high transmission areas contributing to a more effective management of financial and technical resources, increasing the sustainability and efficiency of control efforts.
PLOS Negleted Tropical Diseases, 2018
Leishmaniasis are diseases caused by obligatory intracellular parasites of the genus Leishmania a... more Leishmaniasis are diseases caused by obligatory intracellular parasites of the genus Leishmania and are transmitted to humans through the bite of female sandflies during blood repast. Untreated visceral leishmaniasis can lead to death, while cutaneous and mucocutaneous forms generally do not pose risk of death but can cause disability and permanent injury, which raises stigma and social prejudice. The Global Burden of Disease Study (GBD) is a systematic and scientific effort to quantify the health loss caused by infectious and non-infectious diseases and injury and their risk factors categorized by age, sex, and geographic distribution at specific periods of time. The present article describes, for the first time, the burden of leishmaniasis in the 27 Brazilian federated units. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states. Understanding the burden of these diseases and their regional differences is of great relevance for the establishment of adequate and region-specific surveillance and control measures. In addition, it can help in the rational use of available resources and in decision making aimed at reducing the transmission of the parasite and the burden of this disabling and potentially lethal disease.
BACKGROUND: In the current context of high fatality rates associated with American visceral leish... more BACKGROUND: In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented.METHODS/PRINCIPAL FINDINGS: The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40-50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far.CONCLUSIONS/SIGNIFICANCE: Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.
Abstract Spatial analysis of epidemiological data may be used to assist in the implementation of... more Abstract
Spatial analysis of epidemiological data may be used to assist in the implementation of surveillance and control measures against visceral leishmaniasis (VL) in endemic areas. This ecological study aimed to identify priority areas for surveillance and control of VL in São Luís, the capital of the state of Maranhão in northeast Brazil, a highly endemic area for the disease. We evaluated the spatial structure of the incidence rates of human VL and of the mean number of human and canine cases occurring between 2005 and 2007 in 355 neighborhoods (aggregated into 203 geographical analytical units) within the municipality. The presence of spatial autocorrelation was explored using global and local Moran's I statistics. A local indicator of spatial autocorrelation was used to generate maps for the identification of VL clusters. The global Moran's I index revealed a weak, but statistically significant spatial autocorrelation for human VL incidence rates (I = 0.138). A total of 43 geographical analytical units, encompassing 121 neighborhoods, were identified as priority areas for implementing surveillance and control actions. For the purpose of defining an action plan for the delivery of these measures, those 16 geographical analytical units (encompassing 54 neighborhoods) identified as clusters with high incidence rates of human VL should receive the highest priority. An additional nine geographical analytical units (comprising 28 neighborhoods) showed non-significant clustering of high rates of human, and might be considered as the next priority for VL management. Finally, a further 18 geographical analytical units (covering 39 neighborhoods) had records of coexisting human and canine VL cases during the study period, and these should receive priority attention when resources become available. Spatial data analysis is a valuable tool for defining priority areas for VL surveillance in high transmission areas contributing to a more effective management of financial and technical resources, increasing the sustainability and efficiency of control efforts.
Destaques: "Revisitar o processo de avaliação dos pesquisadores e dos cursos deveria permitir ... more Destaques:
"Revisitar o processo de avaliação dos pesquisadores e dos cursos deveria permitir repensar do processo de identificação de fragilidades da produção intelectual em saúde coletiva, da avaliação dos cursos e dos pesquisadores deste campo. Nesse sentido, acredito que a proposta de Camargo Jr. 1 de se posicionar a favor de uma ruptura com o ranqueamento que considera somente indicadores quantitativos de produção é bastante válida, trazendo à tona o debate quantitativo versus o qualitativo na avaliação, com uma tendência que a academia tem em dicotomizar estas diferentes abordagens tal qual no método da pesquisa científica, superado no fato de que podem ser complementares nos mais diferentes contextos. Uma "falsa polêmica" posteriormente retratada pelo autor 4. Como colocado por Struchiner 5 (p. 1717): "... não podemos abrir mão de nenhuma fonte de informação. Se utilizadas separadamente, essas avaliações serão ilusórias".
Essa lógica produtivista também cerceia e enfraquece o debate do campo da saúde coletiva no momento da formação na pós-graduação, quando não é mais prioridade situar e problematizar as diferentes áreas e o campo de atuação do profissional de saúde coletiva no seu momento de formação. Nosso debate de sociedade e dimensão política das necessidades de saúde enfraquece junto com a fragmentação e compartimentalização das áreas, onde pesquisar o detalhe, o específico é prioritário e considerado suficiente. Como investigar as árvores sem perder de vista a floresta (que em alguns contextos, está em chamas)? Como preparar um indivíduo comprometido com as necessidades da sociedade brasileira e do SUS a fazer as perguntas que devem ser respondidas?
Da mesma forma, é escasso o incentivo para o "pensar pedagógico" na formação de mestres e doutores. A formação de docentes/educadores encontra-se fragilizada por esse contexto que não contribui para a politização e visão crítica sobre o ato de educar. Assim é necessário revisitarmos a Lei de Diretrizes e Bases da educação nacional 6 que trata, em seu Art. 66, do tema: "a preparação para o exercício do magistério superior far-se-á em nível de pós-graduação, prioritariamente em programas de mestrado e doutorado". Tal fato não tem ocorrido de forma consistente e ampliada, assim reproduzimos a lógica do "ensinando se aprende", porém sem teorizar criticamente este processo, gerando um ciclo vicioso em que a prática e a leitura de bases pedagógicas não são importantes."
The risk factors associated with canine visceral leishmaniosis (CVL) in Brazil are unclear and co... more The risk factors associated with canine visceral leishmaniosis (CVL) in Brazil are unclear and controversial. The objectives of this systematic review and meta-analysis were to identify the best evidence available in this field and to determine the gaps in existing knowledge. Literature searches were carried out using four databases, the reference lists within articles, and references provided by experts in the field. Theoretical discussions or separate and independent meta-analyses of p-values or of effect sizes were used to pool information about each variable. Thirty-six articles were selected for detailed review, including 31 cross-sectional, two ecological and three cohort studies. The variables showing significant association with CVL were short hair, purebred, peri-domestic restricted (as compared with domestic-restricted dogs), and presence of green areas adjacent to home. The occurrence of CVL was also associated with the presence of domestic fowl in the home environment, with free dogs (as compared with restrained dogs), with male gender and with dogs >1 or 2 years of age, although these associations were not statistically significant. Due to the small number of publications, consistent results could not be obtained concerning the role of other factors. Most studies did not describe the criteria of eligibility and the process of selection of participants in sufficient detail and employed only one diagnostic test as proof of infection. Few studies controlled for confounding variables. No statistical evidence of publication bias was detected, but a great deal of information contained in the primary articles was lost because the results were not adequately described. The results of this review contribute to a better understanding of CVL and should assist in optimizing the development and implementation of control policies. Continuous actions, prioritizing dogs at higher risk and areas with higher abundance of green vegetation, together with policies to promote responsible dog ownership are mandatory. Problems concerning study design and data analysis described in the present study need to be taken into consideration in future studies. These must follow clear procedures to select participants and utilize standardized, valid and reliable diagnostic methods. The development of multivariate models and the use of the STROBE statement for description of the results should also be encouraged. Further research should investigate the patterns identified and prioritize CVL-related factors that have not been fully recognized or elucidated. Finally, ecological and cohort studies of CVL and investigations in other countries of Latin America are urgently required.
"Background Still today, more than 30 years after the beginning of the process of visceral leish... more "Background
Still today, more than 30 years after the beginning of the process of visceral leishmaniasis' urbanization, there is little knowledge about the risk factors for itsoccurrence, despite their relevance to the control and understanding of disease dynamics. The present study is the first systematic review with meta-analysis about factors associated with Leishmania infantum infection in humans in the Americas.
Methods and Findings
After searching different databases, consultations to the reference lists of articles and to experts in the field, 51 studies were reviewed. Theoretical discussions or meta-analysis of p-values or of effect sizes were used to pool information about each variable. The Q test and the I statistic were used to assess heterogeneitiesamong the studies. Male sex was associated with visceral leishmaniasis in studies which used the leishmanin skin test for diagnosis and in those where the outcomewas the clinical disease; the opposite occurred when serological diagnosis was applied. Younger individuals were less frequently infected than adults, but were moreprone to illness. Although with different levels of evidence and of heterogeneity, the presence of dogs at home, higher dog seropositivity in nearby areas, lower socioeconomic status and highly vegetated areas were associated with L. infantum infection. This was not noticed for the presence of chickens in the house and withnutritional status. Susceptibilities to bias and limitations in the analysis and in the description of results were often identified in the studies analyzed.
Conclusions
Results showed the existence of consistent patterns for some of the factors analyzed and should be taken into account in developing more effective and well-targetedcontrol measures. Studies must be conducted in new areas of the continent, with improved methodological quality and prioritizing the investigation of the patternsidentified and their causes, as well as variables for which knowledge is poor."
Na Educação permanente em Saúde, a Educação a Distância (EAD) representa um caminho tanto para ac... more Na Educação permanente em Saúde, a Educação a Distância (EAD) representa um caminho tanto para aconstrução coletiva e dialógica do conhecimento quanto para a melhoria das práticas dos trabalhadores dosetor. A EAD na Saúde contribui também para a consolidação de um modelo mais equitativo e democrático depromoção e atenção à saúde no País. Por ser a formação e qualificação dos trabalhadores da saúde que atuamno SUS uma das missões da Fundação Oswaldo Cruz (Fiocruz), este artigo se propõe a realizar um exercíciode aproximação entre as áreas de EAD e Educação em Saúde a partir da experiência do curso Andando nasNuvens, promovido pela Fiocruz, por meio do Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (ICICT), pelo Núcleo de Experimentação de Novas Tecnologias (NEXT). O curso foi analisadoqualitativamente, mediante o Discurso do Sujeito Coletivo (DSC), em dois momentos, a saber: na avaliaçãopré-curso, com 45 discursos, e na avaliação final, com 26 discursos analisados. Nesses 71 discursos, percebeu-seque as sínteses dos DSCs na avaliação pré-curso giraram em torno de conhecimentos e interesses por pesquisas;na avaliação final do curso, as sínteses dos DSCs giraram em torno da presença ativa dos tutores e das dificuldades em lidar com as tecnologias.
Comoespaço deformulação e contribuiçãopara aformação dospós-graduandos emsaúde, este fórum seprop... more Comoespaço deformulação e contribuiçãopara aformação dospós-graduandos emsaúde, este fórum sepropõea desenvolver suasatividadesjunto aosmovimentossociaise àpós-graduação comoespaço privilegiado deformação dedocentes, gestores eprofissionaisdesaúdequeatuem diretamentenosserviços e na construção depolíticaspúblicas de saúdeno Brasil. Entendemos que,hd umapauta ampla de discussão acercadaformação inicial edapósgraduaçãodosprofissionaisdesaúde,comdebatedasdiretrizescurricularesnacionaisede estratégias eprogramasqueviabilizem a reorientação daformaçãoprofissionalconectadaasdemandas do SistemaÚnico de Saúde.
-O que mais preocupa não é o grito dos violentos, nem dos corruptos, nem dos desonestos, nem dos ... more -O que mais preocupa não é o grito dos violentos, nem dos corruptos, nem dos desonestos, nem dos sem-caráter, nem dos sem-ética. O que mais preocupa é o silêncio dos bons.‖ Martin Luther King 3 À minha família e amigos, pelo apoio em todos os momentos desta caminhada. 4 Agradecimentos À minha família, pelo apoio incondicional nesta etapa profissional. Em especial, para minha mãe, Suely Soeiro, meu pai João Barbosa e minhas tias Regina Melo e Lucimar Soeiro; Ao Prof. Guilherme Werneck pela orientação, amizade e confiança depositada em mim na realização deste trabalho; À Profa. Ana Lúcia Abreu Silva pelo incentivo e apoio constante neste desafio; Ao meu tio, José Américo Soeiro, sua esposa Silvia Nery e meus primos Marcela, Nathália e Leonardo pelo apoio e conforto familiar no início desta jornada; À amiga Kelly Marques e sua família (Remédios, Nazáro e Kelton), por terem me recebido como se fosse parte da família no Rio de Janeiro; À ENSP/FIOCRUZ que deu suporte acadêmico e financeiro para a realização deste trabalho; À FAPEMA pela concessão de bolsa de pesquisa no início do curso e à FIOCRUZ pela bolsa de pesquisa concedida durante o período do curso. Aos profissionais do Centro de Controle de Zoonoses de São Luís, em especial Maria do Carmo Magalhães, João Batista Pires (ex-coordenador) e Nordman Wall, pelo apoio sempre que necessário; Ao Prof. Maurício Rangel pela ajuda na confecção da base de dados do município de São Luís; Aos amigos de turma do mestrado em Epidemiologia em Saúde Pública, em especial ao Robson Bruniera, Lidiane Toledo, Juliana Kabad e Carla Barreto pelo apoio e momentos de descontração; 5
Leishmania infection in humans, dogs and sandflies was examined in the endemic visceral leishmani... more Leishmania infection in humans, dogs and sandflies was examined in the endemic visceral leishmaniasis (VL) municipality of Raposa, state of Maranhão, Brazil. In this study, we examined Leishmania chagasi infection in the blood serum of both humans and Canis familiaris and the natural Leishmania sp. infection rate in the sandfly vector, Lutzomyia longipalpis. Enzyme-linked immunosorbent assay, indirect immunofluorescence reaction and polymerase chain reaction were performed to detect Leishmania infections in humans, dogs and sandflies, respectively. Overall, 186 out of 986 studied human beings were infected with L. chagasi parasites, representing an infection prevalence of 18.9%. An even higher infection rate was detected in dogs, where 66 (47.8%) out of 138 were infected. Among all Lu. longipalpis captured (n = 1,881), only 26.7% were females. The Leishmania infection frequency for the vector Lu. longipalpis was 1.56%. Remarkably, all infected sandflies were found in the peridomiciliary area. Furthermore, a high incidence of asymptomatic forms of VL in the human and canine populations was observed. The results of this study suggest autochthonous transmission of L. chagasi in this endemic area for visceral leishmaniasis because infection by Leishmania sp. was identified in all important elements of the transmission chain.
Ciência Animal …, Jan 1, 2010