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| Author(s): |
Beatriz Smidt Celere
Total Authors: 1
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| Document type: | Master's Dissertation |
| Press: | Ribeirão Preto. |
| Institution: | Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC) |
| Defense date: | 2016-08-29 |
| Examining board members: |
Ricardo Alexandre Arcêncio;
Maria Helena Larcher Caliri;
Luiz Eduardo Moschini
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| Advisor: | Susana Segura Muñoz |
| Abstract | |
Defined foci of pemphigus prevalence worldwide, including Brazil, raise the possibility that environmental factors trigger the onset of this disease. The northeastern region of the state of São Paulo is located within three Watersheds and is an appropriate site to investigate pemphigus because this disease is prevalent in both clinical forms--endemic pemphigus foliaceus (PFE) and pemphigus vulgaris (PV)--therein. In this study, we have used Geographic Information Systems (GIS) to describe the spatial distribution and temporal behavior of PV and PFE in this region of the state of São Paulo over the last five decades; we have also characterized land use in the city with the highest number of cases. Patients were identified based on patients\' medical records between 1965 and 2014. Thematic maps were developed with the ArcGIS 10.2 software. To represent the spatial distribution of pemphigus, maps were organized in decades from 1965 to 2014. For the city with the highest occurrence of PFE and PV cases, land use regarding hydrography, native vegetation, agriculture, exposed soil, and urbanization was analyzed within a 2-km buffer surrounding from the patients\' residencies considering the address where the pemphigus clinical signs and symptoms started. For additional analysis, thematic maps illustrating the distribution of pemphigus cases according to hypsometric classes, soil declivity, and population density by sector (North, South, East, West, and Central) were designed. Four hundred and twenty-six cases were analyzed. PFE cases predominated: they corresponded to 285 or 67% of the cases. Regarding spatial distribution and temporal evolution, PV was not reported from 1965 to 1974; notwithstanding, PV rose in the following four decades and overcame the number of PFE cases in the last decade. Regarding cumulative cases, both PV and PFE increased throughout the studied period, which revealed spatial expansion. The Pardo River Basin had the highest number of cases with a total of 153 (41% PV and 59% PFE). In the studied period, the number of cities with recorded cases of PV and PFE increased from 0 to 49 and from 13 to 60, respectively, with Ribeirão Preto and Batatais being the main geographical foci of PV and PFE, respectively. Ribeirão Preto was the city with the highest occurrence of pemphigus--35 PV cases and 37 PFE cases. Agricultural area (42%) and exposed soil (33.2%) were the land uses that predominated in the city. In addition, all patients with PV and PFE lived close to rivers and agricultural areas. In Ribeirão Preto, pemphigus cases were concentrated in the northern and western sectors; PFE cases were distributed at lower altitudes as compared to PV; and both PV and PFE predominated in areas with lower percentage of declivity. In the context of public health, GIS has become a powerful tool that helps researchers to understand the occurrence and trend of some events, leading to improved interventional strategies and disease control. The spatial distribution and temporal evolution analyses showed PV and PFE increased in the northeastern region of the state of São Paulo over the last five decades. This monitoring also helped to identify the main geographical foci of pemphigus. The predominance of agriculture and exposed soil in Ribeirão Preto and the proximity of the cases to rivers and agriculture reinforced the hypothesis that environmental factors play a role in pemphigus etiopathogenesis (AU) | |
| FAPESP's process: | 14/10038-8 - Spatial analysis of pemphigus vulgaris and pemphigus foliaceus distribution within the scope of three watersheds located in the Northeast region of São Paulo State and its relation with environmental factors |
| Grantee: | Beatriz Smidt Celere |
| Support Opportunities: | Scholarships in Brazil - Master |