Departamento de Epidemiología

Visceral leishmaniasis (VL), once considered a rural disease in Brazil, has progressively urbanised, particularly in the state of São Paulo (SSP), where the first urban cases emerged after the detection of the vector Lutzomyia longipalpis in 1997. This study explores the environmental, climatic, socioeconomic, and infrastructural factors associated with the expansion and establishment of VL in urban areas of SSP. For the statistical analysis, two types of models were developed. First, for all municipalities (with or without VL), the logistic regression model was used. Second, for the municipalities in which VL occurred between 1999 and 2012, a multilevel logistic regression model was used, accounting for repeated measurements (VL occurrence or non-occurrence in each municipality) over time. For both models, the associations between exposure variables and the outcome are expressed as odds ratios (OR) and their respective 95% CIs. We found that the presence of railways, highways, and sugarcane cultivation areas, as well as high annual temperatures and evapotranspiration rates, were associated with VL occurrence. Conversely, lower VL rates were associated with higher rainfall, higher altitude, and more rainy days. We conclude that unplanned urbanisation, poverty, population mobility, and climate change have facilitated the spread of the disease in São Paulo. The results highlight the need for integrated surveillance and control strategies that consider the socioenvironmental determinants to prevent further expansion of VL to other vulnerable urban areas of São Paulo State and bordering states.

Introduction: Patients satisfaction regarding medical care organizations like tertiary care hospital is important in the provision of services to patients. Patient satisfaction is a measure of how happy a patient is with their healthcare. Although “patient satisfaction” and “patient experience” are sometimes used interchangeably, they're actually two separate concepts. This effort has a positive impact on health and education sector in Bangladesh. Every year the demand of health care is increasing and health sector facing difficulties to maintaining the principle of high-quality health care delivery system. Objective: To analyze the level of satisfaction of patients attending the eye department of National institute of ophthalmology & Hospital, utilize the hospital service and determine the factors related to their satisfaction. Methodology: The present study was descriptive, cross sectional carried out in the outdoor, indoor and emergency of National institute of Ophthalmology Hospital, Dhaka from January 2021 to July 2021. Quantitative data has been collected. A sample population 384 patient using random sampling technique through face-to-face interview by using pretested semi structured questionnaire. The An ethical approval was obtained from the North South university public health department. Result: The patients were asked to evaluate the overall performance of the hospital. The majority (60.5%) said average and 39.5% said good. Conclusion: the patient satisfaction is very important to increase the flow of patient and reduce the burden of eye related service. Quality of care, doctor and staff attitude and behavior need to improve to enhance the satisfaction level of patient. Hospital general hygiene facility also need to improve. J.Natl.Inst.Ophthalmol.2024;7(2): 39-46

Plant diseases are a persistent constraint on crop productivity and food security, with fungal and oomycete pathogens causing significant yield and quality losses even under intensive management. This review analyzes how climate change is reconfiguring plant disease epidemiology by altering the host–pathogen–environment relationship through warming, shifts in precipitation, rising atmospheric CO₂, and an increasing frequency of extreme events. The objective is to synthesize evidence on (i) climate-driven redistribution and instability of plant diseases, (ii) climate-mediated host vulnerability and potential breakdown of resistance, (iii) pathogen adaptation and the emergence or re-emergence of diseases, and (iv) agroecosystems as dynamic disease networks. A narrative and integrative literature review was conducted using peer-reviewed studies and foundational references in plant pathology, emphasizing mechanistic and cross-scale interpretations. The synthesis indicates that climate change promotes spatial range shifts, episodic outbreaks, and greater uncertainty in disease risk, while also challenging conventional forecasting and management schedules. Moreover, climatic variability can reduce the reliability of chemical control and intensify selection for resistance, reinforcing the need for adaptive, integrated approaches. The review concludes that plant pathology must advance toward climate-informed, systems-based frameworks that integrate epidemiology, host resistance, environmental monitoring, and evolutionary processes to strengthen resilience and safeguard food systems under accelerating environmental change.

The resurgence of Visceral Leishmaniasis (VL) is a natural cyclical phenomenon with an inter-epidemic period of 10-15 years. It might be due to the persistence of a silent parasite pool amongst post kala-azar dermal leishmaniasis (PKDL) and asymptomatic leishmanial infection (ALI). The present study targeted to find out the obstacles for unearthing and proper management of the hidden parasite pool for prevention of the resurgence of VL in erstwhile endemic districts of West Bengal, India. Two strategies were employed to identify the latent parasite reservoirs: follow-up of individuals having a previous history of VL and/or PKDL and limited mass sero-surveillance within a 500-m radius of recently treated VL and PKDL. Diagnosed PKDL and VL cases were treated and ALI were followed up. A total of 95 new PKDL and 70 relapse PKDL were diagnosed during the entire study period; those remained undiagnosed in spite of ongoing case searching methods recommended by the national VL elimination programme. 'Relapse PKDL'-a new challenge for VL elimination has been identified. The incidence of PKDL declined steadily during successive study years. Limited mass survey revealed 17 VL, 2 PKDL and 124 ALI. Most of the ALI sero-reverted during the follow up period and 2 of them converted to disease VL. The present work revealed three major obstacles. First, identification of the occult parasite pool may be resolved by applying the searching methods used in this study. Second, case confirmation of 'relapse PKDL' may be achieved by examining slit skin samples at the local level by existing staff with proper training. Alternative short duration treatment strategy for the treatment of new and relapse PKDL is needed. Third, considering the long inter-epidemic period and observed declining trend of incident PKDL, such surveillance should be continued for 10-15 years for the prolonged post-elimination phase and finally to achieve eradication.

To investigate the association between educational attainment and sex in the prevalence of toothache and tooth extraction, considering the interaction between these variables. This cross-sectional study utilised data from 40,369 participants in the 2019 Brazilian National Health Survey (PNS). Adjusted prevalence ratios (PR) for toothache and tooth extraction were estimated by sex and educational attainment using Poisson regression. These values were also used to estimate the population attributable fraction. Individuals with low education attainment, both women (PR 1.59; 95% CI: 1.38–1.85) and men (PR 1.60; 95% CI: 1.35–1.89), exhibited a higher prevalence of toothache compared to women with high education. However, highly educated men showed a 21% reduction in toothache prevalence (PR: 0.79; 95% CI: 0.66–0.94). Regarding tooth extraction, prevalence was higher among women (PR: 2.40; 95% CI: 2.09–2.76) and men (PR: 3.07; 95% CI: 2.67–3.52) with low education compared to highly educated women. The interaction between sex and educational attainment was significant for tooth extraction on both multiplicative (RPR: 1.24; 95% CI: 1.01–1.52) and additive (REPI: 0.62; 95% CI: 0.27–0.96) scales, and for toothache on the multiplicative scale only (RPR: 1.28; 95% CI: 1.01–1.61). The prevalence of toothache and tooth extraction attributable to men with low educational attainment was 7.8% (95% CI: 5.5%–10.0%) and 21.4% (95% CI: 19.9%–22.8%), respectively. A positive interaction between sex and educational attainment was identified for both toothache and tooth extraction, indicating a disadvantage for men with low education.

In July 2023, we investigated a cluster of jaundice cases in Madurai district, Tamil Nadu, to identify outbreaks, etiology, and source and to propose control measures. A door-to-door survey identified 119 cases, with an attack rate of 8.3 per 1000. An environmental investigation and matched case-control study confirmed that the outbreak was linked to contaminated urban local body (ULB) water. Consuming ULB piped water caused 33% of cases (odds ratio [OR] 9.9, 95% confidence interval [CI]: 2.5-38.6), whereas drinking unboiled water caused 81% (OR 15.1, 95% CI: 5.4-42.3). The outbreak highlighted the need for improved water and sewage management in the district.

Leptospirosis outbreaks have risen in India over the past three decades, especially in coastal regions. On September 9, 2022, a cluster of fever with myalgia and diarrhoea was reported in Village X, Koraput district, Odisha. A rapid response team confirmed the outbreak, and an investigation was initiated on September 11. Our objective was to describe the event in terms of time, place, and person, and to identify potential sources. On confirmation of the outbreak, we diagnosed leptospirosis in seven cases by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA). We initiated the investigation on September 11 to describe the outbreak and identify its source. We defined a probable case as an individual who reported at least one listed symptom on or after August 9, 2022, and conducted an active surveillance by door-to-door survey. We conducted a descriptive analysis of the reported cases by plotting an epidemiological curve and calculating the attack rate by place and person. We identified 26 cases from September 3 to 17, 2022. The epi-curve indicated a continuous source outbreak. Higher attack rates were observed in low-lying areas, especially Majhi and Harijan Sahi. Adults aged 45-60 years and males were more affected. Most cases reported close contact with livestock and walking barefoot. All seven samples tested were positive for leptospirosis by IgM ELISA. Heavy rainfall and subsequent flooding likely increased rodent infestation, which may have led to the outbreak. Chemoprophylaxis for contacts reduced cases, and chlorination of drinking water was recommended to prevent further outbreaks.

ABSTRACTOBJECTIVE To develop an innovative graphical tool to represent Guttman errors and facilitate scalability analysis of measurement instruments in epidemiology.METHODS Implemented in R (RStudio), the guttemap function was developed to fill this gap. It provides an intuitive visual representation of Guttman errors, with color gradients that facilitate the assessment of measurement instruments, revealing internal patterns of inconsistency. The rationale underlying the proposed Guttman error map is presented, along with an annotated summary of the routine for its implementation.RESULTS Seven synthetic examples show the potential of graphical representation in identifying problem areas and how this helps to inform adjustments and develop more robust instruments.CONCLUSIONS With guttemap, Guttman error analysis becomes more accessible and interpretable, contributing to the improvement of measurement instruments and the advancement of epidemiological research.

Objective: To evaluate the association between running distance and intensity during high-intensity (HI) and low-intensity (LI) training sessions and sweat loss in elite female soccer players. Methods: Fifteen elite soccer players from a national team performed two 90-minute training sessions, one at high intensity (HI) and one at low intensity (LI), in a temperate environment. Sweat rate, sodium loss through sweat, and running patterns were measured. Results: In HI, total distance covered (p<0.001), number of sprints (p<0.001), and total physical load (p<0.001) were higher than in LI. HI also generated a higher sweat rate (p=0.02) and sodium loss through sweat (p=0.03), with no differences in sodium concentration. The sweat rate during HI and LI was associated only with the total distance covered (p=0.02; r=0.47). Conclusion: In elite female soccer players, high-intensity training induces greater sweat and sodium loss due to a higher sweat rate. Total distance covered appears to be the most influential factor. As a practical application, it is recommended to adjust the rehydration rate to the sweat rate in sessions with greater displacement.