Resumo A Atenção Primária à Saúde (APS) é considerada imprescindível para a efetividade dos sistemas de saúde. O objetivo deste estudo foi avaliar a qualidade da assistência prestada na APS em um município de Pernambuco. Realizou-se um estudo exploratório através da escuta a 525 usuários utilizando questionários estruturados. A avaliação da qualidade considerou as dimensões: acessibilidade, assistência clínica, relação profissional-usuário, atividades comunitárias e estrutura. Os resultados apontam para um contexto de perpetuação das vulnerabilidades sociais e o desafio em alcançar um atendimento equitativo e universal. Os principais aspectos de insatisfação foram: dificuldade de acesso a consultas e exames especializados, tempo de espera para atendimento e possibilidade de apresentar reclamações. Por outro lado, os entrevistados apresentaram-se satisfeitos com o atendimento médico e de enfermagem, principalmente quanto ao respeito, privacidade, escuta e confidencialidade. Verificou-se que apesar dos profissionais de saúde se empenharem na prestação de um atendimento humanizado, foi evidente a fragmentação do cuidado na rede estudada, o que dificulta o seguimento adequado e oportuno ao paciente, refletindo negativamente na qualidade da assistência prestada.

Abstract Primary health care is an essential component of effective health systems. The aim of this study aim was to evaluate the quality of primary care in a city in the state of Pernambuco, Brazil. We conducted an exploratory study with 525 service users using structured questionnaires. The quality of primary care was assessed across five dimensions: accessibility, clinical care, professional-user relations, community activities and structure. The findings point to the perpetuation of social vulnerabilities and challenges in achieving equitable universal care. Dissatisfaction rates were highest in the following categories: access to specialist appointments and exams, appointment wait time, and opportunity to make complaints. However, respondents were satisfied with medical and nursing care, particularly in relation to respect, privacy, listening and confidentiality. The findings show that, although health professionals were committed to providing humanized care, fragmentation of care is evident, hampering the provision of adequate and timely follow-up and negatively affecting the quality of care.

Resumo A Atenção Primária à Saúde (APS) é considerada imprescindível para a efetividade dos sistemas de saúde. O objetivo deste estudo foi avaliar a qualidade da assistência prestada na APS em um município de Pernambuco. Realizou-se um estudo exploratório através da escuta a 525 usuários utilizando questionários estruturados. A avaliação da qualidade considerou as dimensões: acessibilidade, assistência clínica, relação profissional-usuário, atividades comunitárias e estrutura. Os resultados apontam para um contexto de perpetuação das vulnerabilidades sociais e o desafio em alcançar um atendimento equitativo e universal. Os principais aspectos de insatisfação foram: dificuldade de acesso a consultas e exames especializados, tempo de espera para atendimento e possibilidade de apresentar reclamações. Por outro lado, os entrevistados apresentaram-se satisfeitos com o atendimento médico e de enfermagem, principalmente quanto ao respeito, privacidade, escuta e confidencialidade. Verificou-se que apesar dos profissionais de saúde se empenharem na prestação de um atendimento humanizado, foi evidente a fragmentação do cuidado na rede estudada, o que dificulta o seguimento adequado e oportuno ao paciente, refletindo negativamente na qualidade da assistência prestada.

Abstract Primary health care is an essential component of effective health systems. The aim of this study aim was to evaluate the quality of primary care in a city in the state of Pernambuco, Brazil. We conducted an exploratory study with 525 service users using structured questionnaires. The quality of primary care was assessed across five dimensions: accessibility, clinical care, professional-user relations, community activities and structure. The findings point to the perpetuation of social vulnerabilities and challenges in achieving equitable universal care. Dissatisfaction rates were highest in the following categories: access to specialist appointments and exams, appointment wait time, and opportunity to make complaints. However, respondents were satisfied with medical and nursing care, particularly in relation to respect, privacy, listening and confidentiality. The findings show that, although health professionals were committed to providing humanized care, fragmentation of care is evident, hampering the provision of adequate and timely follow-up and negatively affecting the quality of care.

Abstract Duplication of the short arm of chromosome 12 is a rare chromosomal abnormality that may arise de novo or result from malsegregation of a balanced parental translocation. This study comprises the clinical description, cytogenetic and cytogenomic analyses and genotype-phenotype correlation in a patient with facial dysmorphism, developmental delay and intellectual impairment caused by non-mosaic partial duplication and a paracentric inversion 12p. The patient’s GTG-banded karyotype was 46,XX,invdup(12)(pter → p13.32::p11.1 → p13.31::p13.31 → qter). A genetic gain of approximately 28 Mb was detected in the chromosomal region arr[GRCh37]12p13.31-p11.1(6914072_34756209)x3. The chromosomal alteration seen in our patient is described as “pure” partial duplication 12p. In most cases, duplication 12p phenotype is characterized by dysmorphic features, multiple congenital anomalies and intellectual disability. A small number of cases in literature have described genes associated with neurodevelopmental disease, such as ING4, CHD4, MFAP5, GRIN2B, SOX5, SCN8A and PIANP. In our patient the duplication 12p was de novo. This study should contribute to the genotype-phenotype correlation in partial duplication 12p cases.

MUC1 is a heavily glycosylated mammalian transmembrane protein expressed by mucosal secretory tissues for both protection against microbial infection and lubrication. An important characteristic of MUC1 is its variable number of tandem repeats (VNTR) containing several sites for O-glycosylation. VNTR length has been associated with many human diseases and with certain economically important traits in domestic ruminants. The aim of the present study was to correlate the length of MUC1 gene VNTR with expected progeny differences (EPDs) obtained for growth, fertility and carcass traits. Five alleles were identified, with alleles containing short VNTRs being more frequent than those with long, thereby demonstrating that Brazilian Nelore cattle are characterized by high frequencies in short MUC1 VNTRs. Statistical analyses revealed there to be no significant association between VNTR length and EPDs for weight at 120 days (W120), scrotal circumference at 365 (SC365) and 450 (SC450) days, age at first calving (AFC), and rib eye area (REA).

Chromosomal rearrangements involving partial deletion of the short arm of chromosome 4 and partial duplication of the short arm of chromosome 8 have been described both in Pitt-Rogers-Danks syndrome (PRDS) and Wolf-Hirschhorn syndrome (WHS), the former being considered a milder phenotype of the latter. We describe a patient with partial deletion of chromosome 4 and partial duplication of chromosome 8 documented by array-comparative genomic hybridization (Array-CGH). In addition to the typical features of PRDS, the patient exhibited some clinical signs (genital hypoplasia, radioulnar synostosis and mesomelic limb shortness) infrequently, or never previously, reported in PRDS. These findings broaden the spectrum of anomalies generally associated with these syndromes.

We sampled 119 Nelore cattle (Bos indicus), 69 harboring B. indicus mtDNA plus 50 carrying Bos taurus mtDNA, to estimate the frequencies of putative mtDNA single nucleotide polymorphisms (SNPs) and investigate their association with Nelore weight and scrotal circumference estimated breeding values (EBVs). The PCR restriction fragment length polymorphism (PCR-RFLP) method was used to detect polymorphisms in the mitochondrial asparagine, cysteine, glycine, leucine and proline transporter RNA (tRNA) genes (tRNAasn, tRNAcys, tRNAgly, tRNAleu and tRNApro). The 50 cattle carrying B. taurus mtDNA were monomorphic for all the tRNA gene SNPs analyzed, suggesting that they are specific to mtDNA from B. indicus cattle. No tRNAcys or tRNAgly polymorphisms were detected in any of the cattle but we did detect polymorphic SNPs in the tRNAasn, tRNAleu and tRNApro genes in the cattle harboring B. indicus mtDNA, with the same allele observed in the B. taurus sequence being present in the following percentage of cattle harboring B. indicus mtDNA: 72.46% for tRNAasn, 95.23% for tRNAleu and 90.62% for tRNApro. Analyses of variance using the tRNAasn SNP as the independent variable and EBVs as the dependent variable showed that the G -> T SNP was significantly associated (p < 0.05) with maternal EBVs for weight at 120 and 210 days (p < 0.05) and animal's EBVs for weight at 210, 365 and 455 days. There was no association of the tRNAasn SNP with the scrotal circumference EBVs. These results confirm that mtDNA can affect weight and that mtDNA polymorphisms can be a source of genetic variation for quantitative traits.

The Y-encoded, testis-specific protein (TSPY) is a Y-specific gene. The copy numbers of TSPY range from 20 to 60 in men and up to 200 in bulls. In this study, we examined the possibility of using the TSPY gene to sex cattle. DNA from blood samples of 100 Nelore cattle (50 males and 50 females) from the Nelore Cattle Breeding Program (PMGRN) was screened for TSPY by PCR using TSPY-specific primers. The assay was highly specific since all male samples were TSPY-positive and all female samples were negative. Positive results were also obtained at low DNA concentrations (less than 1 rhog/muL). These results showed that TSPY was a good male-specific marker, the usefulness of which was enhanced by the high copy number of the gene. This is the first report to demonstrate the applicability of TSPY for sexing cattle.

Restriction fragment length polymorphism (RFLP) has been detected at the bovine kappa-casein locus. The polymorphism has been analyzed for its effects in cattle production, mostly for milk traits and even for maternal effect on pre-weaning weights. We used polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) to genotype 408 Nellore animals for the non-silent mutation (Thr/Ile136 and Asp/Ala148) that characterizes the A and B variants of the polymorphism and compared expected progeny difference (EPD) for a maternal effect on 120 and 210 days weights and direct EPD for 120, 210, 450 and 550 day weight between AA and AB animals. The EPD values were obtained from the University of São Paulo (Brazil) Nellore Cattle Breeding Program, which evaluated 266,272 animals in 2001. Analysis of Variance was used to compare weight expected progeny differences (EPDs) between animals genotyped as AA and AB. The A allele frequency was 0.911. Although the AA animals had higher weight EPDs than AB animals the differences were not statistically significant (p > 0.05).

In general, the effects of poverty on early cognitive performance have been studied using a definition of poverty based on terms of income, and within the context of paradigms of cognitive evaluation based on the hypothesis of a general intelligence factor. Conversely, in the present report the concept of Unsatisfied Basic Needs (UBN) was used as poverty criterion, and a cognitive paradigm of executive functions based on neurobiological concepts was applied. This paradigm outlines the existence of discrete and interactive components of cognitive functioning guided toward objectives, and associated to the activation of cerebral circuits that involves the prefrontal cortex. The performance of 247 preschoolers (3 to 5 year-olds) from schools in District 4 of the City of Buenos Aires (Boca-Barracas), and in the districts of Vicente López and San Isidro of Gran Buenos Aires, was compared. Sample groups included children from poor (UBN) and non-poor homes or with Satisfied Basic Needs (SBN). They were studied with a battery of executive tests [A-not-B, Spatial Reversal, and Color Reversal (Espy, Kaufmann, McDiarmid, & Glisky, 1999); Three and Four Colors (Balamore & Wozniak, 1984); Strooplike Day-Night (Gerstadt, Hong, & Diamond (1994); and Tower of London (Shallice, 1982)] to evaluate the components of cognitive flexibility (working memory, attentional shifting, self-monitoring, and conceptual transfer), goal-setting (initiating, planning, problem solving, and strategic behavior), and attentional control. A selection procedure was applied to all cases, taking into account: prematurity, weight at the time of birth, medical record of neurological and developmental disorders, actual weight, height and their relationship at the time of testing, intellectual quotient of execution (WPPSI), and official certification of child abuse in their homes. Poor homes were identified by applying a scale of socio-economic level (NES) based on conceptual and operational definitions used by the Instituto Nacional de Estadísticas y Censos (INDEC) of Argentina. Bivariate and multivariate tests were applied to analyze the effects of the independent variables (socio-economic group, age, sex and difficulty level) on the dependents and their interactions. Correlations and simple regressions were applied to analyze the associations between cognitive performance and socio-economic level. In A-not-B, Spatial Reversal and Color Reversal tests the UBN group made less previous correct trials before reaching the efficiency criteria (difficulty to find the hidden rule) and consecutive correct trials (difficulty to maintain outstanding information). They also made more reiterative errors (failure in the control of interferences). In the Three and Four Colors Test, the UBN group had lower scores in all the analyzed variables. Children within this group also needed more demonstrations and verbalizations from the experimenters. In the Tower of London Test, UBN children showed an increased delay to begin and to organize the task, and were less efficient in achieving the objectives. Planning time decreased when cognitive demands were increased. The SBN group showed an inverse profile. Both groups had similar performance in the Stroop-like Day-Night Test. When performance variations were analyzed in terms of age and difficulty level, the tendencies were similar to those reported in previous studies. Gender differences were registered in A-not-B and Tower of London tests, with girls showing a better perform-ance. Finally, there were positive associations between performance success and socio-economic total score, and negative associations between errors and socio-economic total score. Present results confirm that poverty has a negative impact on cognitive performance in terms of the executive function paradigm used. The advantages of a cognitive paradigm based on a neurobiological theoretical framework in the context of social and school intervention programs for children from a socially risky population, are also discussed.

El estudio de los efectos de la pobreza sobre el desempeño cognitivo durante las primeras fases del desarrollo, ha sido efectuado predominantemente en base a la definición de pobreza según el ingreso y el uso de paradigmas de inteligencia basados en la hipótesis de un factor general de funcionamiento cognitivo. En el presente trabajo se utilizó el concepto de Necesidades Básicas Insatisfechas (NBI) como criterio de pobreza y se aplicó un paradigma cognitivo de funcionamiento ejecutivo proveniente de la Neurociencia. El mismo plantea el análisis de componentes de comportamientos inteligentes orientados hacia objetivos y asociados a la activación de circuitos cerebrales que involucran centralmente a la región prefrontal. Se comparó el desempeño ejecutivo de 247 niños escolarizados de 3 a 5 años de edad, provenientes de hogares pobres (NBI) y no pobres o con Necesidades Básicas Satisfechas (NBS), y de jardines de infantes del Distrito Escolar 4 de la Ciudad de Buenos Aires (Boca-Barracas) y de distritos escolares de Vicente López y San Isidro del Gran Buenos Aires (Argentina). Se administró una batería de pruebas que evalúan componentes de flexibilidad cognitiva, logro de objetivos y control atencional. Los resultados obtenidos muestran perfiles de desempeño diferentes entre ambos grupos. El perfil de desempeño menos eficiente en términos de las variables estudiadas se observó en el grupo de niños proveniente de hogares pobres. Estos resultados constituyen un aporte significativo de un paradigma neurocientífico para la implementación de estrategias de intervención orientadas a estimular el funcionamiento cognitivo de tipo ejecutivo de niños de edad preescolar.

OBJETIVO: Avaliar o impacto da vacinação contra o Haemophilus influenzae b na incidência de meningites em crianças menores de cinco anos de idade. MÉTODOS: Utilizou-se o delineamento tipo "antes-depois" para comparar as taxas de incidência de meningites por Haemophilus influenzae b nos períodos pré-vacinação (julho/95-junho/99) e pós-vacinação (julho/99-junho/2001) no Estado de Goiás. A definição de caso de meningite bacteriana seguiu os critérios da Organização Mundial de Saúde. As taxas de meningite por Streptococcus pneumoniae e Neisseria. meningitidis foram utilizadas para efeito de comparação. Para análise estatística foram utilizados o teste de chi2 e o t de Student. Valores de p<0,05 foram considerados estatisticamente significantes. RESULTADOS: Foi detectada meningite bacteriana aguda em 979 crianças no período de estudo. A incidência de meningite por Haemophilus influenzae b diminuiu de 10,8x10(5) no período pré-vacinal para 2,3x10(5) no segundo ano pós-vacina, significando 78% de redução no risco, principalmente na faixa etária de 7-23 meses (p<0,05). Foram prevenidos 65 casos de meningite por Haemophilus influenzae b. Observou-se aumento na incidência de meningite por S. pneumoniae. Foi observada falha vacinal em um caso. CONCLUSÕES: Expressivo declínio da incidência de meningite por Haemophilus influenzae b foi detectado, precocemente, logo após o primeiro ano de introdução da vacina contra o Haemophilus influenzae b. Assim, se faz necessária a vigilância contínua com instrumental de alta acurácia para: (i) detectar re-emergência do Haemophilus influenzae b; (ii) avaliar possibilidade de falha vacinal; (iii) identificar mudanças no padrão dos sorotipos do H. influenzae.

OBJECTIVE: To assess the impact of the Haemophilus influenzae b (Hib) conjugate vaccine in reducing the incidence of meningitis among children under five years old. METHODS: A 'before-after' design was used to compare Hib meningitis incidence rates in the pre-vaccine (July 1995 - June 1999) and post-vaccine (July 1999 - June 2001) periods in the state of Goiás, central Brazil. Bacterial meningitis case definition was based on World Health Organization criteria. Incidence rates of S. pneumoniae and N. meningitidis were used for comparison purposes. Chi-squared and Student's t tests were used for statistical analysis. P-values below 0.05 were considered as statistically significant. RESULTS: 979 children with acute bacterial meningitis were detected throughout the entire period. The incidence rate of Hib meningitis decreased from 10.8 (x10(5)) in the pre-vaccine period to 2.3 (x10(5)) in the 2nd year post vaccination, leading to a risk reduction of 78%, targeted to the 7-23 months age group (p<0.05). A total of 65 cases of Hib meningitis were prevented. An increase in S. pneumoniae meningitis was observed. Vaccine failure was detected in one child. CONCLUSIONS: This study showed that mass immunization with Hib conjugate vaccine brought about an expressive decline in childhood Hib meningitis in Goiás soon after the first year. Notwithstanding, an enhancement of surveillance using high-accuracy tools is essential to: (i) detect a possible reemergence of Hib; (ii) identify vaccine failure, and (iii) monitor changes in the H. influenzae serotype profile over time.

OBJETIVO: Avaliar o impacto da vacinação contra o Haemophilus influenzae b na incidência de meningites em crianças menores de cinco anos de idade. MÉTODOS: Utilizou-se o delineamento tipo "antes-depois" para comparar as taxas de incidência de meningites por Haemophilus influenzae b nos períodos pré-vacinação (julho/95-junho/99) e pós-vacinação (julho/99-junho/2001) no Estado de Goiás. A definição de caso de meningite bacteriana seguiu os critérios da Organização Mundial de Saúde. As taxas de meningite por Streptococcus pneumoniae e Neisseria. meningitidis foram utilizadas para efeito de comparação. Para análise estatística foram utilizados o teste de chi2 e o t de Student. Valores de p<0,05 foram considerados estatisticamente significantes. RESULTADOS: Foi detectada meningite bacteriana aguda em 979 crianças no período de estudo. A incidência de meningite por Haemophilus influenzae b diminuiu de 10,8x10(5) no período pré-vacinal para 2,3x10(5) no segundo ano pós-vacina, significando 78% de redução no risco, principalmente na faixa etária de 7-23 meses (p<0,05). Foram prevenidos 65 casos de meningite por Haemophilus influenzae b. Observou-se aumento na incidência de meningite por S. pneumoniae. Foi observada falha vacinal em um caso. CONCLUSÕES: Expressivo declínio da incidência de meningite por Haemophilus influenzae b foi detectado, precocemente, logo após o primeiro ano de introdução da vacina contra o Haemophilus influenzae b. Assim, se faz necessária a vigilância contínua com instrumental de alta acurácia para: (i) detectar re-emergência do Haemophilus influenzae b; (ii) avaliar possibilidade de falha vacinal; (iii) identificar mudanças no padrão dos sorotipos do H. influenzae.

OBJECTIVE: To assess the impact of the Haemophilus influenzae b (Hib) conjugate vaccine in reducing the incidence of meningitis among children under five years old. METHODS: A 'before-after' design was used to compare Hib meningitis incidence rates in the pre-vaccine (July 1995 - June 1999) and post-vaccine (July 1999 - June 2001) periods in the state of Goiás, central Brazil. Bacterial meningitis case definition was based on World Health Organization criteria. Incidence rates of S. pneumoniae and N. meningitidis were used for comparison purposes. Chi-squared and Student's t tests were used for statistical analysis. P-values below 0.05 were considered as statistically significant. RESULTS: 979 children with acute bacterial meningitis were detected throughout the entire period. The incidence rate of Hib meningitis decreased from 10.8 (x10(5)) in the pre-vaccine period to 2.3 (x10(5)) in the 2nd year post vaccination, leading to a risk reduction of 78%, targeted to the 7-23 months age group (p<0.05). A total of 65 cases of Hib meningitis were prevented. An increase in S. pneumoniae meningitis was observed. Vaccine failure was detected in one child. CONCLUSIONS: This study showed that mass immunization with Hib conjugate vaccine brought about an expressive decline in childhood Hib meningitis in Goiás soon after the first year. Notwithstanding, an enhancement of surveillance using high-accuracy tools is essential to: (i) detect a possible reemergence of Hib; (ii) identify vaccine failure, and (iii) monitor changes in the H. influenzae serotype profile over time.

Este estudo avaliou três técnicas de análise espacial para detectar aglomerados intra-urbanos de casos de pneumonias na infância: método de Kernel, técnica de hierarquia de vizinhos próximos e estatística espacial scan. Setecentos e vinte e quatro casos de pneumonia confirmados radiologicamente foram identificados entre maio de 2000 a agosto de 2001, por vigilância prospectiva implementada em Goiânia, Goiás, Brasil. Todos os casos foram georreferenciados em mapa digital. A incidência anual de pneumonia foi de 566 casos/100 mil crianças. Utilizando-se análise descritiva tradicional obteve-se uma distribuição em mosaico das taxas de incidência de pneumonia, enquanto a utilização de métodos espaciais mostrou uma distribuição não aleatória dos casos. A estatística espacial scan identificou duas áreas de alto risco para ocorrência de pneumonia, incluindo um aglomerado primário (RR = 2,1; p < 0,01) e um aglomerado secundário (RR = 1,3; p = 0,01). Os dados utilizados neste estudo mostram como o sistema de informação geográfica e a análise espacial podem ser aplicados para a identificação de áreas alvo de pneumonia para intervenções em saúde pública.

This study examined the spatial distribution of childhood community-acquired pneumonia detected through prospective surveillance in Goiânia, Brazil. Three spatial analysis techniques were applied to detect intra-urban geographic aggregation of pneumonia cases: Kernel method, nearest neighbor hierarchical technique, and spatial scan statistic. A total of 724 pneumonia cases confirmed by chest radiography were identified from May 2000 to August 2001. All cases were geocoded on a digital map. The annual pneumonia risk rate was estimated at 566 cases/100,000 children. Analysis using traditional descriptive epidemiology showed a mosaic distribution of pneumonia rates, while GIS methodologies showed a non-random pattern with hot spots of pneumonia. Cluster analysis by spatial scan statistic identified two high-risk areas for pneumonia occurrence, including one most likely cluster (RR = 2.1; p < 0.01) and one secondary cluster (RR = 1.3; p = 0.01). The data used for the study are in line with recent WHO-led efforts to improve and standardize pediatric pneumonia surveillance in developing countries and show how GIS and spatial analysis can be applied to discriminate target areas of pneumonia for public heath intervention.

Este estudo avaliou três técnicas de análise espacial para detectar aglomerados intra-urbanos de casos de pneumonias na infância: método de Kernel, técnica de hierarquia de vizinhos próximos e estatística espacial scan. Setecentos e vinte e quatro casos de pneumonia confirmados radiologicamente foram identificados entre maio de 2000 a agosto de 2001, por vigilância prospectiva implementada em Goiânia, Goiás, Brasil. Todos os casos foram georreferenciados em mapa digital. A incidência anual de pneumonia foi de 566 casos/100 mil crianças. Utilizando-se análise descritiva tradicional obteve-se uma distribuição em mosaico das taxas de incidência de pneumonia, enquanto a utilização de métodos espaciais mostrou uma distribuição não aleatória dos casos. A estatística espacial scan identificou duas áreas de alto risco para ocorrência de pneumonia, incluindo um aglomerado primário (RR = 2,1; p < 0,01) e um aglomerado secundário (RR = 1,3; p = 0,01). Os dados utilizados neste estudo mostram como o sistema de informação geográfica e a análise espacial podem ser aplicados para a identificação de áreas alvo de pneumonia para intervenções em saúde pública.

This study examined the spatial distribution of childhood community-acquired pneumonia detected through prospective surveillance in Goiânia, Brazil. Three spatial analysis techniques were applied to detect intra-urban geographic aggregation of pneumonia cases: Kernel method, nearest neighbor hierarchical technique, and spatial scan statistic. A total of 724 pneumonia cases confirmed by chest radiography were identified from May 2000 to August 2001. All cases were geocoded on a digital map. The annual pneumonia risk rate was estimated at 566 cases/100,000 children. Analysis using traditional descriptive epidemiology showed a mosaic distribution of pneumonia rates, while GIS methodologies showed a non-random pattern with hot spots of pneumonia. Cluster analysis by spatial scan statistic identified two high-risk areas for pneumonia occurrence, including one most likely cluster (RR = 2.1; p < 0.01) and one secondary cluster (RR = 1.3; p = 0.01). The data used for the study are in line with recent WHO-led efforts to improve and standardize pediatric pneumonia surveillance in developing countries and show how GIS and spatial analysis can be applied to discriminate target areas of pneumonia for public heath intervention.

A endemia hansênica apresenta-se, na virada do milênio, no limiar da sua eliminação como problema global de saúde pública. O Brasil é o único país da América Latina onde a doença não foi eliminada, tendo sido a meta de eliminação postergada para 2005. Neste artigo discute-se o declínio da prevalência após a introdução da poliquimioterapia (PQT) para o tratamento da hanseníase, não acompanhada pela redução da incidência no mesmo período. Os progressos na área de imunologia, biologia molecular e seqüenciamento genômico do M. leprae são apresentados enquanto perspectivas de pesquisa e de aplicação potencial para diagnóstico, prognóstico e vigilância na hanseníase. Apesar do êxito das atuais estratégias de controle tem-se observado com preocupação a redução do interesse e do apoio financeiro em pesquisa na hanseníase e na desestruturação dos serviços de saúde frente ao atual cenário de eliminação. A exclusão da hanseníase da lista de doenças prioritárias é prematura, representando um perigo concreto de não se eliminar a doença, mas a pesquisa em hanseníase. Fica evidente a necessidade de investir na produção de conhecimentos de áreas básica e aplicada que viabilizem uma maior compreensão dos mecanismos de transmissão da infecção, da efetividade dos métodos de prevenção e controle, serão essenciais na "erradicação" da infecção pelo M. leprae.

At the beginning of the millennium the elimination of leprosy as a public health problem was considered an attainable goal worldwide. Brazil is the only Latin American country where leprosy is still endemic and the elimination goal has been postponed to 2005. In this review, we discuss the currently declining prevalence after the implementation of multi-drug therapy (MDT), without the reduction in incidence in the same period. The progress in the fields of immunology, molecular biology and the recent accomplishment of M. leprae genomic sequence indicate the new tools potentially applicable to leprosy diagnosis, prognosis and surveillance. Despite the success of the current public health strategy there is a global concern about the lack of interest and financial support for leprosy research, for the maintenance and improvement of field expertise in public health. The exclusion of leprosy among public health priorities was premature and represents a real threat of not eliminating leprosy, but leprosy research. It is necessary to generate knowledge on basic and applied research for understanding the mechanism of transmission of the infection, and to test new preventive and therapeutic tools in order to achieve the "eradication" of the M. leprae infection. Maintenance and field expertise are essential for leprosy surveillance during and after its elimination.

A endemia hansênica apresenta-se, na virada do milênio, no limiar da sua eliminação como problema global de saúde pública. O Brasil é o único país da América Latina onde a doença não foi eliminada, tendo sido a meta de eliminação postergada para 2005. Neste artigo discute-se o declínio da prevalência após a introdução da poliquimioterapia (PQT) para o tratamento da hanseníase, não acompanhada pela redução da incidência no mesmo período. Os progressos na área de imunologia, biologia molecular e seqüenciamento genômico do M. leprae são apresentados enquanto perspectivas de pesquisa e de aplicação potencial para diagnóstico, prognóstico e vigilância na hanseníase. Apesar do êxito das atuais estratégias de controle tem-se observado com preocupação a redução do interesse e do apoio financeiro em pesquisa na hanseníase e na desestruturação dos serviços de saúde frente ao atual cenário de eliminação. A exclusão da hanseníase da lista de doenças prioritárias é prematura, representando um perigo concreto de não se eliminar a doença, mas a pesquisa em hanseníase. Fica evidente a necessidade de investir na produção de conhecimentos de áreas básica e aplicada que viabilizem uma maior compreensão dos mecanismos de transmissão da infecção, da efetividade dos métodos de prevenção e controle, serão essenciais na "erradicação" da infecção pelo M. leprae.

At the beginning of the millennium the elimination of leprosy as a public health problem was considered an attainable goal worldwide. Brazil is the only Latin American country where leprosy is still endemic and the elimination goal has been postponed to 2005. In this review, we discuss the currently declining prevalence after the implementation of multi-drug therapy (MDT), without the reduction in incidence in the same period. The progress in the fields of immunology, molecular biology and the recent accomplishment of M. leprae genomic sequence indicate the new tools potentially applicable to leprosy diagnosis, prognosis and surveillance. Despite the success of the current public health strategy there is a global concern about the lack of interest and financial support for leprosy research, for the maintenance and improvement of field expertise in public health. The exclusion of leprosy among public health priorities was premature and represents a real threat of not eliminating leprosy, but leprosy research. It is necessary to generate knowledge on basic and applied research for understanding the mechanism of transmission of the infection, and to test new preventive and therapeutic tools in order to achieve the "eradication" of the M. leprae infection. Maintenance and field expertise are essential for leprosy surveillance during and after its elimination.