Orientador: Sandra Elisa Contri Pitton / Banca: Lucy Marion Calderini Philadelpho Machado / Banca: José Bueno Conti / Resumo: O crescimento urbano-industrial no Brasil, gerou contradições no espaço intra-urbano posto que as cidades apresentam em suas áreas periféricas habitações precárias, ambientes mal-concebidos e com saneamento inadequado e/ou ineficiente, atestando contra o conforto e saúde das pessoas, fato que propicia uma baixa qualidade ambiental e de vida. As doenças, principalmente as infecto-contagiosas, atualmente, se configuram em um excelente parâmetro para a investigação da qualidade ambiental e de vida urbana. As doenças transmissíveis, apesar de serem amplamente conhecidas, controladas e prevenidas, ainda causam altos índices de morbidade e de mortalidade e retratam a pobreza social, tecnológica e econômica, bem como o descaso político. A dengue, uma doença transmissível, reapareceu no espaço urbano devido a vários fatores sócio-ambientais, destaca-se: a falta de saneamento, o baixo nível educacional, fatores comportamentais, econômicos, culturais e falta de políticas públicas. No que diz respeito aos fatores ambientais destaca-se o clima, pois as temperaturas elevadas e as precipitações abundantes favorecem o desenvolvimento de vetores que, conseqüentemente, elevam o risco de doenças infecciosas. Desse modo, a presente investigação de mestrado buscou analisar as relações existentes entre o (re)aparecimento da Dengue e alterações socioambientais que ocorreram no espaço urbano de Piracicaba-SP, visando contribuir com as políticas públicas locais. Embasada na perspectiva da Geografia Socioambiental, a pesquisa utilizou-se de métodos e técnicas variadas, adotando uma postura pragmática. Assim, através da cartografia temática e da confecção de gráficos e tabelas, analisou-se a ocorrência espacial intra urbana da Dengue, que mostrou que a moléstia possui relações com o ritmo climático e com as variáveis sociais estudadas, principalmente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The urban industrial growth in Brazil, caused contradictions into urban areas, its because the cities showing in this poor areas precarious residences, uncertain environmental with inadequate and insufficient sanitation, acting against well-being and health of their residents, offering to their a low quality of environmental and low quality of life. The contagious illness, at moment, were a good parameters to investigate the quality of environmental and the quality of urban life. The transmissible illness, although been known, and could be prevented, it stills causing high taxes of morbidity and mortality and retreating the social and technological poor and political negligence. The Dengue Fever, a transmissible illness, come back (again) into the urban space in association with some factors like the no education of the people, no adequate sanitation and no political investments. The climate is a environmental factor that have association with the Dengue fever mainly the high temperatures and abundance rain whom that helped the vector cycle. In this way, the present paper analyzed the relationships between the occurrence of Dengue Fever and the environmental and social modifications in the urban space of Piracicaba-SP, and this work looking for helping the public sector. Using the Socioambiental perspective of Geography, this investigate adopt various techniques and methods. This paper analyzed the occurrence of Dengue Fever into the urban area using maps, graphics and tables, who shows that the illness has association with the climatic rhythm and with the density of houses and people. A final map was elaborated and it shows the urban areas were more affect about the Dengue Fever. This map shows the areas of risk to Dengue Fever. / Mestre

Submitted by Rafael Catão (rafadicastro@gmail.com) on 2016-07-06T18:58:37Z No. of bitstreams: 1 tese_v1_final.pdf: 18601124 bytes, checksum: 4b334ab5c27130fef2e66b1e2b7ed93a (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-07-07T17:20:25Z (GMT) No. of bitstreams: 1 catao_rc_dr_prud.pdf: 18601124 bytes, checksum: 4b334ab5c27130fef2e66b1e2b7ed93a (MD5) / Made available in DSpace on 2016-07-07T17:20:25Z (GMT). No. of bitstreams: 1 catao_rc_dr_prud.pdf: 18601124 bytes, checksum: 4b334ab5c27130fef2e66b1e2b7ed93a (MD5) Previous issue date: 2016-05-02 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Trinta anos após sua reemergência o dengue se encontra presente em aproximadamente todo o país. Devido às características sociais e ambientais, quase toda a extensão território nacional é propicio ao desenvolvimento da doença. Porém, existem alguns clusters de municípios que nunca notificaram casos autóctones ou que possuem taxas e casos muito abaixo da média. Esses municípios estão aglomerados em áreas com características (sociais e ambientais) semelhantes, evidenciando algum fato geográfico que impede ou limita a expansão/consolidação da doença naquela área. Propomos denominar essas áreas de barreiras geográficas de difusão, que dificultam ou impedem a transmissão do dengue nesses referidos clusters. As barreiras seriam componentes do Complexo Patogênico do Dengue, juntamente com as áreas nucleares e franjas, conformariam essa área de transmissão estável. Os complexos patogênicos foram definidos por Max Sorre (1933) e são constituídos pela extensão estável dos entes da cadeia epidemiológica de uma doença. Definimos como recorte empírico o estado de São Paulo. Como hipótese da pesquisa, aventamos que na análise da ampliação e consolidação do complexo patogênico do dengue no estado de São Paulo as barreiras geográficas de difusão do são formadas em relação aos determinantes socioespaciais em múltiplas escalas espaciais e temporais, modulando o processo de difusão da doença. O objetivo geral consiste em compreender o processo de ampliação e consolidação do complexo patogênico do dengue no estado de São Paulo e sua relação com a difusão espacial e as barreiras geográficas. Para tanto foi mapeada a difusão de vetores, da doença e mapeado o complexo no estado de São Paulo. / Thirty years after re-emerging dengue fever is already present in most parts of Brazil. Due to its environmental and social characteristics, almost the entire extension of national territory is propitious to the development of the disease. However, there are some municipalities’ clusters that have never notified autochthonous cases or that have rates and cases far below average. These municipalities’ clusters are in areas with similar environment and social characteristics, highlighting some geographic factor that prevents or limits the expansion/consolidation of the disease in that area. We propose nominate such areas as diffusion barriers, that difficult or blocks dengue transmission in these clusters. The barriers are components of the Dengue’s Pathogenic Complex, along with fringes and core areas, which conforms the stable transmission area. Defined by Max Sorre (1933), the Pathogenic Complex constitutes the stable spatial extension of a diseases transmission chain. We defined Sao Paulo state as the study area of the thesis. As hypothesis, we defined that in the analysis of the expansion and consolidation of the dengue fevers pathogenic complex in the Sao Paulo State the diffusion barriers are formed in relationship to the socio-spatial determinants in multiple temporal and spatial scales, modulating the diseases diffusion process. The aim of the thesis consists in comprehend the expansion and consolidation of dengue fevers pathogenic complex in Sao Paulo state and its relationship with spatial diffusion and geographical barriers. To achieve this aim we mapped and modelled the vector and the disease diffusion and propose a synthesis cartography of the pathogenic complex. / FAPESP 2014/17676-0 / FAPESP 2012/05913-1

Since Dengue fever (DF) and its related forms, Dengue Hemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS) have become important health concerns worldwide, it is also imperative to develop methods which will help in the analysis of the incidences. Dengue fever cases are growing in number as it also invades widely, affecting larger number of countries and crossing climatic boundaries. Considering that the disease as of now has neither an effective vaccine nor a cure, monitoring in order to prevent or control is the resorted alternative. GIS and its related technologies offer a wealth of interesting capabilities towards achieving this goal. The intention of this study was to develop methods to describe dengue fever outbreaks taking Rio de Janeiro, Brazil as a case study. Careful study of Census data with appropriate attributes was made to find out their potential influence on dengue fever incidence in the various regions or census districts. Dengue incidence data from year 2000 to year 2008 reported by the municipal secretariat of Rio was used to extract the necessary census districts. Base map files in MapInfo format were converted to shape files.  Using ArcGIS it was possible to merge the dengue fever incidence data with the available base map file of the City of Rio according to corresponding census districts. Choropleth maps were then created using different attributes from which patterns and trends could be used to describe the characteristic of the outbreak with respect to the socio-economic conditions. Incidence data were also plotted in Excel to see temporal variations. Cluster analysis were performed with the Moran I technique on critical periods and years of dengue outbreak. Using the square root of dengue incidence from January to April 2002 and 2008, inverse distance was selected as the conceptualised spatial relationship, Euclidean distance as the distance method. More detailed analyses were then done on the selected critical years of dengue outbreak, (years 2002 and 2008), to investigate the influence of socio-economic variables on dengue incidence per census district.   Dengue incidence rate appeared to be higher during the rainy and warmer months between December and May. Outbreaks of dengue occurred in years 2002 and 2008 over the study period of year 2000 to 2008. Some factors included in the census data were influential in the dengue prevalence according to districts. Satisfactory results can be achieved by using this strategy as a quick method for assessing potential dengue attack, spread and possible enabling conditions. The method has the advantage where there is limited access to field work, less financial means for acquisition of data and other vital resources. A number of difficulties were encountered during the study however and leaves areas where further work can be done for improvements. More variables would be required in order to make a complete and comprehensive description of influential conditions and factors.  There is still a gap in the analytical tools required for multi-dimensional investigations as the ones encountered in this study.  It is vital to integrate ‘GPS’ and ‘Remote Sensing’ in order to obtain a variety of up-to-date data with higher resolution.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / Os Ãleos essenciais produzidos por diversas espÃcies vegetais sÃo misturas, por vezes, bastante complexas com variadas funÃÃes ecolÃgicas como inibiÃÃo de germinaÃÃo, proteÃÃo contra predadores, atraÃÃo de polinizadores, proteÃÃo contra perda de Ãgua e aumento da temperatura. Os Ãleos essenciais sÃo obtidos atravÃs de mÃtodos fÃsicos de extraÃÃo e apresentam diversas aplicaÃÃes, como flavorizantes, conservantes, fixadores, agentes antibacterianos e antifÃngicos. VÃrios produtos industriais tambÃm utilizam Ãleos essenciais em suas formulaÃÃes, como pesticidas, repelentes e atraentes se apresentando como uma alternativa natural no controle ou na eliminaÃÃo de pragas. A restriÃÃo de alguns pesticidas sintÃticos promoveu ainda mais a pesquisa em busca de novos produtos que pudessem desempenhar a funÃÃo daqueles que nÃo estÃo mais disponÃveis no mercado. VÃrios biopesticidas estÃo relatados na literatura e dentre eles o dilapiol, que à um fenilpropanoide de atividade inseticida comprovada, encontrado em alto teor no Ãleo essencial de Piper aduncum L. (Piperaceae). Neste trabalho, foi analisada a variabilidade quantitativa do dilapiol nos Ãleos essenciais (OE) obtidos das folhas frescas de P. aduncum e quando submetidas a 24, 48, 72 e 96h de secagem a 40 ÂC. Os OE foram submetidos a reaÃÃes de hidrogenaÃÃo e hidroxilaÃÃo em busca de biopesticidas mais ativos e todos os produtos foram analisados por CG-EM, RMN1H e RMN13C. O teor de dilapiol foi analisado por CGâFID e por CLAE, obtendo-se em mÃdia 89,68% e 89,91% respectivamente, e permitiu concluir que a temperatura de secagem nÃo influencia no conteÃdo deste composto presente no OE de P. aduncum. O segundo componente majoritÃrio do Ãleo foi identificado como β-cariofileno (4,47%). O ensaio larvicida frente a Aedes aegypti realizado forneceu IC50 de 47,12 mg/L, confirmando o potencial deste produto como biopesticida. / Essential oils produced by various plant species are mixtures sometimes quite complex with varied ecological functions, such as inhibition of germination, protection against predators, attraction of pollinators, protection against water loss and temperature rise. Essential oils are obtained by physical extraction methods and present several applications, such as flavorings, preservatives, fixatives, antibacterial and antifungal agents. Various industrial products also use essential oils in their formulations, such as pesticide repellents and attractive presenting as a natural alternative to control or eliminate pests. The restriction of some synthetic pesticides further promoted the search for new products that could play the role of those who are no longer available in the market. Several biopesticides are reported and among them dilapiolle, which is a phenylpropanoid with proven insecticidal activity found in high content in essential oil of Piper aduncum L. (Piperaceae). In this work, we analyzed the quantitative variability in dilapiolle essential oils (EO) obtained from fresh leaves of P. aduncum and when subjected to 24, 48, 72 and 96 h of drying at 40 ÂC. The EO underwent hydrogenation and hydroxylation reactions in search of more active biopesticides and all products were analyzed by GC-MS, NMR 1H and NMR 13C. The content of dilapiolle was analyzed by GC-FID and HPLC, yielding on average 89.68 % and 89.91 % respectively and showed that the drying temperature does not influence the content of this compound in P. aduncum EO. The second major component of the oil was identified as β-caryophyllene (4.47 %). The test larvicide against Aedes aegypti performed provided IC50 of 47.12 mg/L, confirming the potential of this product as a biopesticide.

O dengue e o dengue hemorrágico são considerados como as arboviroses mais importantes do ponto de vista da saúde pública além de serem também as mais disseminadas. O greening ou huanglongbing (HLB), por sua vez, é uma doença de difícil controle e rápida disseminação que afeta seriamente a produção de citros no mundo todo. É considerada a pior doença de citros da atualidade pois não tem cura e leva ao declínio e morte das árvores em alguns anos. O DMDS é um composto sulfúrico volátil derivado de plantas e que tem despertado um crescente interesse devido a sua comprovada atividade repelente e inseticida além de ação nematicida e disinfectante do solo. Visando oferecer uma alternativa para o controle de ambas as doenças, este trabalho teve como objetivo desenvolver um método de microencapsulação por spray drying e spray congealing para o dimetil dissulfeto (DMDS), visando a redução da sua volatilidade através de uma liberação controlada para o ambiente. Dessa forma, tornar-se-ia viável sua utilização como repelente, larvicida e inseticida no combate ao vetor do dengue além da sua utilização como repelente no controle do greening nas lavouras de citrus. Tentou-se a microencapsulação através de spray congealing utilizando enxofre como microencapsulante mas não se obteve sucesso devido as características térmicas do enxofre. Foram obtidas micropartículas de DMDS microencapsulado em goma arábica através da técnica de spray drying. As micropartículas e o processo de secagem foram caracterizados com relação ao rendimento de secagem, rendimento de microencapsulação, morfologia, teor de água residual, atividade de água, densidades aparente e compactada e propriedades de fluxo. Confirmou-se a possibilidade de microencapsulação de DMDS por spray drying e eficiência da goma arábica na retenção do mesmo. As partículas obtidas apresentaram boas propriedades de atividade de água, teor de água residual e densidade mas propriedades de fluxo que requerem melhoria. Foi feito também um estudo simplificado da viabilidade técnico-econômica da implantação de uma unidade de produção de DMDS microencapsulado. Esse estudo foi baseado no processo de microencapsulação estudado. Foram analisados diversos parâmetros econômicos e através destas análises verificou-se que a produção de DMDS microencapsulado pelo método utilizado seria economicamente viável. / Dengue fever and dengue hemorrhagic fever are not only considered the most important arboviruses from public health standpoint but also the most disseminated ones. Greening or huanglongbing (HLB) is a citrus disease of difficult control and fast dissemination that affects citrus production all over the world. It is considered the worst citrus disease nowadays since it does not have a cure and it causes the decline and death of the trees in a few years. Dimethyl disulfide is a volatile sulphur compound derived from plants and that has aroused growing interest due to its proved repellence and insecticidal activity, soil disinfection and nematocidal properties. Therefore, this work aimed at developing a DMDS microencapsulation method via spray drying and spray congealing in order to decrease DMDS\' volatility through a controlled release to the environment and offer a control alternative to both diseases. This would make DMDS use as a repellent, larvicide and insecticide of dengue fever\'s vector and also its use in greening control as a repellent viable. We tried to microencapsulate the DMDS through spray congealing using sulfur as a microenpsulating agent but it was unsuccessful due to the thermal characteristics of sulfur. DMDS was microencapsulated in Arabic gum through spray drying. Drying yield, microencapsulation yield, morphology of the particles, residual water percentage, water activity, bulk and tapped density and flow properties were used to characterize the microparticles and the drying process. Feasibility of DMDS microencapsulation and Arabic gum efficiency in DMDS retention were confirmed. The microparticles presented good bulk and tapped density, residual water percentage and water activity properties though its flow properties requiring further improvement. A simplified technical-economical evaluation of a DMDS microencapsulation factory was also done. This evaluation was based on the studied microencapsulation process. Many economical parameters were analysed and those analyses showed that DMDS microparticles production using the studied method would be economically viable.

This is a study of the creation and negotiation of different forms of knowledge about dengue fever. I explore how anthropology, in collaboration with ideas and practices drawn from science and art, may transform public understandings of dengue. Dengue is a vector-borne disease transmitted to humans by the bite of a mosquito which is infected with the dengue virus. Mosquito-borne diseases have normally been treated through vector control and the elimination of breeding sites. Until 1960, the use of the pesticide DDT allowed the virtual eradication of Aedes aegypti (Ae. aegypti) in many places of the world. DDT was banned in most of the world by 1970 and by 1980 the focus on vector-control was replaced by a discourse of sanitation, in which health authorities tried to ‘educate’ populations and ‘teach’ proper hygienic habits to avoid mosquito-human contact. At present, these practices are changing again. The World Health Organisation (WHO) suggests that dengue incidence could be reduced at least 50% by 2020 through applying health campaigns and social interventions that involve having people participating in the control of dengue outbreaks. In this thesis I explore how WHO guidelines are applied in the control of dengue in Medellín, and how we can think about the concepts of ‘knowledge’, ‘education’ and public health campaigns through ethnographic methods. My project has been about looking at how different understandings – or different forms of knowledge – are part of interactions of different ‘publics’, non-expert citizens, virologists, entomologists and artists. My argument is that health campaigns should be re-designed – privileging relations and stimulating debate – by focusing on experience and moving towards managing the disease and living with the mosquito. Contrary to the different models enacted in health campaigns – which neglect the value of everyday experiences – I advocate for interdisciplinary collaboration as a relational art strategy that can generate an intersubjective exchange of experiences.

L’importance et l’expansion des arboviroses comme la dengue ou le virus Zika nécessite des modèles pour mieux comprendre et prédire leurs dynamiques. La propagation vectorielle de ces maladies est influencée par de multiples facteurs humains et environnementaux qui rendent complexe la construction de modèles épidémiologiques parcimonieux. Parallèlement, de nombreux outils théoriques et computationnels existent désormais pour confronter ces modèles aux données observées. L’objectif de ce travail de thèse est donc d’apporter l’éclairage des données sur les modèles de propagation des arboviroses. Dans un premier temps, il s’agit d’identifier les éléments les plus importants à incorporer pour modéliser les dynamiques de la dengue en milieu rural, dans la région de Kampong Cham (Cambodge). Différents modèles sont comparés, complexifiant à la fois le détail de l’histoire de la maladie et la prise en compte des formes de stochasticité. Dans le cadre déterministe, on a pu souligner l’importance des interactions entre sérotypes, et le faible intérêt pour la représentation explicite des moustiques vecteurs et des individus asymptomatiques. Par ailleurs, la prise en compte des incertitudes indique qu’une large part de la dynamique est capturée seulement par la stochasticité et non par les éléments du squelette déterministe du modèle. Aussi étudie-t-on dans un second temps d’autres aspects de la transmission de la dengue, comme la saisonnalité et la structure spatiale, grâce à des données d’épidémies à Rio de Janeiro (Brésil). Dans un dernier temps, ces méthodes et modèles sont appliqués à l’étude d’un arbovirus émergent, le virus Zika. A partir de données d’épidémies survenues dans le Pacifique, les paramètres-clé de la propagation du virus sont estimés dans le cadre stochastique, et leur variabilité est envisagée à la fois en termes de contexte géographique et de modèle épidémiologique, par la comparaison de quatre îles et de deux modèles à transmission vectorielle. Par ailleurs, la question des interactions potentielles du virus Zika avec celui de la dengue est explorée. / Arboviruses such as the dengue and Zika viruses are expanding worldwide and mo- deling their dynamics can help to better understand and predict their propagation, as well as experiment control scenarios. These mosquito-borne diseases are influenced by a multiplicity of human and environmental factors that are complex to include in parsimonious epidemiological models. In parallel, statistical and computational tools are nowadays available to confront theore- tical models to the observed data. The objective of this PhD work is therefore to study arbovirus propagation models in the light of data. Firstly, in order to identify the most important elements to incorporate in models for dengue dynamics in a rural setting, several dengue models are com- pared using data from the Kampong Cham region in Cambodia. Models incorporate increasing complexity both in the details of disease life history and in the account for several forms of sto- chasticity. In the deterministic framework, including serotype interactions proved decisive, whereas explicit modeling of mosquito vectors and asymptomatic infections had limited added value, when seasonality and underreporting are already accounted for. Moreover, including several forms of un- certainties highlighted that a large part of the disease dynamics is only captured by stochasticity and not by the elements of the deterministic skeleton. Therefore, secondly, we explore other aspects of transmission, such as seasonality and spatial structure, in the case of dengue epidemics in Rio de Janeiro (Brazil). Finally, the models and estimation methods are applied to study an emerging arbovirus, the Zika virus. Using data from epidemics in the Pacific, we estimate the key parameters of disease propagation in the stochastic framework and explore their variability in terms of geogra- phic setting and model formulation by comparing four islands and two models with vector-borne transmission. In addition, potential interactions with the dengue virus are explored.

A dengue à transmitida por mosquitos hematÃfagos do gÃnero Aedes das espÃcies aegypti e albopictus. O vÃrus dengue (DENV) pertence à famÃlia Flaviviridae do gÃnero FlavivÃrus e possui quatro sorotipos que foram designados como: DENV-1, DENV-2, DENV-3 e DENV-4. A doenÃa pode manifestar-se como uma enfermidade infecciosa aguda, caracterizada por um amplo espectro clÃnico que varia desde formas de infecÃÃo assintomÃtica ou febre indiferenciada atà as formas graves, com hemorragia e/ou choque. Este estudo apresentou como objetivo descrever os aspectos epidemiolÃgicos, clÃnicos e laboratoriais de pacientes com suspeita de dengue atendidos no Hospital SÃo Josà de DoenÃas Infecciosas (HSJ) e no Hospital Nossa Senhora da ConceiÃÃo (HDNSC) no perÃodo de fevereiro a dezembro de 2010. Dessa forma, foram recrutados 93 pacientes, sendo que, 86 preencheram os critÃrios de inclusÃo. Os pacientes foram recrutados por busca ativa nas emergÃncias e nas enfermarias dos referidos hospitais e submetidos a um protocolo de acompanhamento por meio de uma ficha de avaliaÃÃo clÃnica inicial (1 ao 5Âdia de doenÃa) e de uma ficha de avaliaÃÃo subsequente (6 ao 7 dia de doenÃa). Foram realizadas pelo menos duas mensuraÃÃes de hematÃcrito, plaquetas, alÃm de exames bioquÃmicos e exames especÃficos para dengue. Os sinais e os sintomas mais prevalentes nos pacientes com suspeita de dengue foram: febre, cefaleia e mialgia. Vinte e cinco pacientes (29%) apresentavam manifestaÃÃes hemorrÃgicas espontÃneas, sendo que, as hemorragias cutÃneas (petÃquias e equimoses) foram as mais encontradas (15%). Quando avaliada a populaÃÃo feminina em idade reprodutiva, 6% apresentaram metrorragia. A prova do laÃo foi realizada em 80 pacientes, sendo positiva em 20 pacientes (25%). Dos 86 pacientes, 48 (55,8%) foram positivos para dengue por pelo menos uma das tÃcnicas: imunocromatografia NS1 (16%), RT-PCR (19%), ELISA IgM (44%), imunocromatografia IgM (42%) e ELISA NS1 (27%). O vÃrus dengue foi detectado em 16 pacientes, sendo, DENV-1 em 1 paciente (6,2%), DENV-2 em 14 pacientes (87,5%) e DENV-3 em 1 paciente (6,2%). Vinte e seis pacientes (54,1%) preencheram os critÃrios do MinistÃrio da SaÃde (MS) de Dengue ClÃssica (DC), 10 (20,8%) de Febre HemorrÃgica de Dengue (FHD) e 12 (25%) de Dengue com ComplicaÃÃo (DCC). A relaÃÃo entre sexo feminino e masculino foi de aproximadamente 1,1/1, com predomÃnio maior de adultos jovens. Quanto ao critÃrio de gravidade do MS, 60% dos casos suspeitos de dengue foram classificados como grau II e nenhum caso como grau IV. Dos critÃrios de extravasamento plasmÃtico preconizado pelo MS, a hipoalbuminemia esteve presente em 5 pacientes (10,4%). A queda do hematÃcrito acima de 20% apÃs hidrataÃÃo foi observada em apenas 4 pacientes (8,3%). No perÃodo do estudo, foram diagnosticados dois pacientes com dengue e leptospirose, sendo que um paciente complicou com pÃrpura trombocitopÃnica idiopÃtica, esses pacientes tiveram evoluÃÃo benigna. Portanto salientamos a necessidade de um diagnÃstico precoce, antes do desenvolvimento das manifestaÃÃes graves, de polÃticas de erradicaÃÃo do Aedes e da estruturaÃÃo de um serviÃo de referÃncia. / Dengue is transmitted by blood-sucking mosquitoes of the species of the genus Aedes aegypti and albopictus. Dengue virus (DENV) belongs to the genus Flavivirus of the Flaviviridae family and has four serotypes that were designated as: DENV-1, DENV-2, DENV-3 and DENV-4. The disease can manifest as an acute infectious disease characterized by a wide clinical spectrum ranging from asymptomatic forms of infection or undifferentiated fever to severe forms, with bleeding and / or shock. This study had as objective to describe the epidemiological, clinical and laboratory features of patients with suspected dengue fever treated at the St Joseph Hospital of Infectious Diseases (HSJ) and the Hospital Nossa Senhora da ConceiÃÃo (HDNSC) in the period from February to December 2010. Thus, we recruited 93 patients, 86 met the inclusion criteria. Patients were recruited by an active search in emergencies and in the ward of these hospitals and underwent a follow-up protocol through an initial clinical evaluation form (from day 1 to day 5 of illness) and an evaluation form following (from the 6 to 7 day of illness). Were performed at least two measurements of hematocrit, platelets, and biochemical tests and specific tests for dengue. The signs and symptoms more prevalent in patients with suspected dengue were fever, headache and myalgia. Twenty-five patients (29%) had spontaneous bleeding manifestations and the cutaneous bleeding (petechiae and ecchymosis) were the most frequent (15%). When evaluating the female population of reproductive age, 6% had metrorrhagia. The tourniquet test was performed in 80 patients and was positive in 20 patients. Of 86 patients, 48 (55,8%) were positive for dengue at least one of the techniques: immunochromatography NS1 (16%), RT-PCR (19%), IgM ELISA (44%), IgM immunochromatography (42%) and NS1 ELISA (27%). The dengue virus was detected in 16 patient and, DENV-1 in 1 patient (6.2%), DENV-2 in 14 patients (87.5%) and DENV-3 in 1 patient (6.2%). Twenty- six patients (54,1%) met the criteria of the Ministry of Health (MOH) Classic Dengue (DC), 10 (20,8%) of Dengue Hemorrhagic Fever (DHF) and 12 (25%) of Dengue with complication (DCC). The relationship bet ween females and males were approximately 1.1/1, with higher prevalence in young adults The criterion for severity of MOH, 60% of suspected dengue cases were classified as grade II and none as grade IV. Plasma extravasation of criteria recommended by MOH, hypoalbuminemia was present in 5 patients (10,4%). The drop in hematocrit higher than 20% after hydration was observed in only 4 patients (8,3%). During the study period, two patients were diagnosed with dengue and leptospirosis, and one patient complicated with idiopathic thrombocytopenic purpura, these patients had a benign outcome. Therefore we stress the need for early diagnosis, before the development of severe manifestations, of policies to eradicate Aedes and structure a reference service.

Made available in DSpace on 2014-12-17T15:55:06Z (GMT). No. of bitstreams: 1 MariaCSS.pdf: 226872 bytes, checksum: 5198c11c0d1b74ef4c431b468f17ac87 (MD5) Previous issue date: 2006-08-29 / This study sprang from the hypothesis that spatial variations in the morbidity rate for dengue fever within the municipality of Natal are related to intra-city socioeconomic and environmental variations. The objective of the project was to classify the different suburbs of Natal according to their living conditions and establish if there was any correlation between this classification and the incidence rate for dengue fever, with the aim of enabling public health planners to better control this disease. Data on population density, access to safe drinking water, rubbish collection, sewage disposal facilities, income level, education and the incidence of dengue fever during the years 2001 and 2003 was drawn from the Brazilian Demographic Census 2000 and from the Reportable Disease Notification System -SINAN. The study is presented here in the form of two papers, corresponding to the types of analysis performed: a classification of the urban districts into quartiles according to the living conditions which exist there, in the first article; and the incidence of dengue fever in each of these quartiles, in the second. By applying factorial analysis to the chosen socioeconomic and environmental indicators for the year 2000, a compound index of living condition (ICV) was obtained. On the basis of this index, it was possible to classify the urban districts into quartiles. On undertaking this grouping (paper 1), a heterogeneous distribution of living conditions was found across the city. As to the incidence rate for dengue fever (paper 2), it was discovered that the quartile identified as having the best living conditions presented incidence rates of 15.62 and 15.24 per 1000 inhabitants respectively in the years 2001 and 2003; whereas the quartile representing worst living conditions showed incidence rates of 25.10 and 10.32 for the comparable periods. The results suggest that dengue fever occurs in all social classes, and that its incidence is not related in any evident way to the chosen formula for living conditions / Este estudo partiu da hip?tese de que as varia??es espaciais na magnitude da morbidade por dengue em Natal s?o influenciadas pelas desigualdades intra-urbanas de fatores socioecon?micos e ambientais. Visando identificar as diferen?as intr?nsecas de cada um deles, no sentido de fornecer subs?dios para as decis?es dos gestores p?blicos no que se refere ao controle da dengue, esta disserta??o teve como objetivo caracterizar os bairros da cidade do Natal de acordo com as condi??es de vida. Foram utilizados dados populacionais sobre densidade demogr?fica, abastecimento de ?gua, coleta de lixo, esgotamento sanit?rio, renda, escolaridade e incid?ncia da dengue no per?odo de 2001 e 2003. Esses dados foram provenientes do Censo Demogr?fico 2000 e do Sistema de Informa??es de Agravos Notific?veis -SINAN. O estudo foi apresentado sob a forma de dois artigos, de acordo com o recorte espacial utilizado: quatro estratos de condi??o de vida, no primeiro; e incid?ncia da dengue em cada estrato de condi??o de vida, no segundo. A partir dos indicadores referentes ?s condi??es socioecon?micas e ambientais obteve-se, por meio de an?lise fatorial, um indicador sint?tico da condi??o de vida (ICV). Com base no ICV, os bairros foram agrupados, para a constitui??o de quatro estratos de condi??o de vida. Na categoriza??o dos bairros segundo condi??es de vida (artigo 1) identificou-se uma distribui??o heterog?nea entre os bairros. Nos estratos (artigo 2), o de melhor condi??o de vida apresentou coeficiente de incid?ncia igual a 15,62 e 15,24 nos per?odos de 2001 e 2003, para cada 1000 habitantes, respectivamente; o estrato de pior condi??o de vida mostrou os coeficientes de incid?ncia de 25,10 e 10,32 para os per?odos de 2001 e 2003, respectivamente. Os resultados sugerem que este agravo ocorre em todas as classes sociais, a sua incid?ncia n?o est? relacionada de alguma forma evidente com o ICV

Submitted by Julio Cesar de Azevedo Vieira (julio_vieira@globo.com) on 2018-06-16T14:57:18Z No. of bitstreams: 1 dissertacao_JulioCesarVieira.pdf: 1988173 bytes, checksum: 55cb349d2840d5de748cbd814f155bb9 (MD5) / Rejected by Marcia Bacha (marcia.bacha@fgv.br), reason: O aluno irá submeter com o novo PDF on 2018-06-19T14:38:11Z (GMT) / Submitted by Julio Cesar de Azevedo Vieira (julio_vieira@globo.com) on 2018-06-26T21:10:08Z No. of bitstreams: 1 dissertacao_JulioCesarVieira.pdf: 1801751 bytes, checksum: 382cab03be50d392c166a61e21222c05 (MD5) / Approved for entry into archive by Janete de Oliveira Feitosa (janete.feitosa@fgv.br) on 2018-07-05T13:19:09Z (GMT) No. of bitstreams: 1 dissertacao_JulioCesarVieira.pdf: 1801751 bytes, checksum: 382cab03be50d392c166a61e21222c05 (MD5) / Made available in DSpace on 2018-07-16T19:25:05Z (GMT). No. of bitstreams: 1 dissertacao_JulioCesarVieira.pdf: 1801751 bytes, checksum: 382cab03be50d392c166a61e21222c05 (MD5) Previous issue date: 2018-04-17 / Dengue é uma doença infecciosa que afeta países subtropicais. Autoridades de saúde locais utilizam informações sobre o número de notificações para monitorar e prever epidemias. Este trabalho foca na modelagem do número de casos de dengue semanal em quatro cidades do estado do Rio de Janeiro: Rio de Janeiro, São Gonçalo, Campos dos Goytacazes, e Petrópolis. Modelos de séries temporais são frequentemente utilizados para prever o número de casos de dengue nos próximos ciclos (semanas ou meses), particularmente, modelos SARIMA (Modelo Sazonal Autorregressivo Integrado de Médias Móveis) apresentam uma boa performance em situações distintas. Modelagens alternativas ainda incluem informação sobre o clima da região para melhorar a performance preditiva. Apesar disso, modelos que usam apenas dados históricos e de clima podem não possuir informações suficientes para capturar mudanças entre os regimes de não-epidemia e epidemia. Duas razões para isso são o atraso na notificação dos casos e que possivelmente não houveram epidemias nos anos anteriores. Baseando-se no sistema de monitoramento InfoDengue, esperasse que incluindo dados sobre ”numero de reprodução efetiva dos mosquitos”(RT) e ”número de tweets se referindo a dengue”(tweets) possam melhorar a qualidade das previsões no curto (1 semana) e longo (8 semanas) prazo. Foi possível mostrar que modelos de séries temporais incluindo RT e informações climáticas frequentemente performam melhor do que o modelo SARIMA em termos do erro preditivo quadrático médio (RMSE). Incluir a variável sobre o twitter não mostrou uma melhora no RMSE. / Dengue fever is an infectious disease affecting subtropical countries. Local health departments use the number of notified cases to monitor and predict epidemics. This work focus on modeling weekly incidence of dengue fever in four cities of the state of Rio de Janeiro: Rio de Janeiro, São Gonçalo, Campos dos Goytacazes, and Petrópolis. Time series models are often used to predict the number of cases in the next cycles (weeks, months), in particular, SARIMA (Seazonal Auto-Regressive Integrated Moving Average) models are shown to perform well in distinct settings. Alternative models also include climate covariates to improve the quality of the forecasts. However, models that only use historical and climate data may no have sufficient information to capture changes from non-epidemic to an epidemic regime. Two reasons are that there is a delay in the notification of cases and there might not have had epidemics in the previous years. Based on the INFODENGUE monitoring system we argue data including the "effective reproduction number of mosquitoes" (RT) and "number tweets referring to dengue" (tweets) may improve the quality of forecasts in the short (1 week) to long (8 weeks) range. We show that time series models including RT and climate information often outperform SARIMA models in terms of mean squared predictive error (RMSE). Inclusion of twitter did not improve the RMSE.