EDUARDO MASSAD
Projetos de Pesquisa
Unidades Organizacionais
Departamento de MedicinaLegal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina - Docente
LIM/01 - Laboratório de Informática Médica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/01 - Laboratório de Informática Médica, Hospital das Clínicas, Faculdade de Medicina - Líder
51 resultados
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- The risk of dengue for non-immune foreign visitors to the 2016 summer olympic games in Rio de Janeiro, Brazil(2016) XIMENES, Raphael; AMAKU, Marcos; LOPEZ, Luis Fernandez; COUTINHO, Francisco Antonio Bezerra; BURATTINI, Marcelo Nascimento; GREENHALGH, David; WILDER-SMITH, Annelies; STRUCHINER, Claudio Jose; MASSAD, EduardoBackground: Rio de Janeiro in Brazil will host the Summer Olympic Games in 2016. About 400,000 non-immune foreign tourists are expected to attend the games. As Brazil is the country with the highest number of dengue cases worldwide, concern about the risk of dengue for travelers is justified. Methods: A mathematical model to calculate the risk of developing dengue for foreign tourists attending the Olympic Games in Rio de Janeiro in 2016 is proposed. A system of differential equation models the spread of dengue amongst the resident population and a stochastic approximation is used to assess the risk to tourists. Historical reported dengue time series in Rio de Janeiro for the years 2000-2015 is used to find out the time dependent force of infection, which is then used to estimate the potential risks to a large tourist cohort. The worst outbreak of dengue occurred in 2012 and this and the other years in the history of Dengue in Rio are used to discuss potential risks to tourists amongst visitors to the forthcoming Rio Olympics. Results: The individual risk to be infected by dengue is very much dependent on the ratio asymptomatic/symptomatic considered but independently of this the worst month of August in the period studied in terms of dengue transmission, occurred in 2007. Conclusions: If dengue returns in 2016 with the pattern observed in the worst month of August in history (2007), the expected number of symptomatic and asymptomatic dengue cases among tourists will be 23 and 206 cases, respectively. This worst case scenario would have an incidence of 5.75 (symptomatic) and 51.5 (asymptomatic) per 100,000 individuals.
- Attention performance among Brazilian truck drivers and its association with amphetamine use: pilot study(2013) OLIVEIRA, Lucio Garcia de; SANTOS, Bernardo dos; GONCALVES, Priscila Dib; CARVALHO, Heraclito de Barbosa; MASSAD, Eduardo; LEYTON, VilmaThe aim of this article was to describe the attention functioning of twenty-two truck drivers and its relationship with amphetamine use. Those drivers who reported using amphetamines in the twelve months previous to the interview had the best performance in a test evaluating sustained attention functioning. Although amphetamine use may initially seem advantageous to the drivers, it may actually impair safe driving. The findings suggest the importance of monitoring the laws regarding amphetamine use in this country.
- The Optimal Age of Vaccination Against Dengue with an Age-Dependent Biting Rate with Application to Brazil(2020) MAIER, Sandra B.; MASSAD, Eduardo; AMAKU, Marcos; BURATTINI, Marcelo N.; GREENHALGH, DavidIn this paper we introduce a single serotype transmission model, including an age-dependent mosquito biting rate, to find the optimal vaccination age against dengue in Brazil with Dengvaxia. The optimal vaccination age and minimal lifetime expected risk of hospitalisation are found by adapting a method due to Hethcote (Math Biosci 89:29-52). Any number and combination of the four dengue serotypes DENv1-4 is considered. Successful vaccination against a serotype corresponds to a silent infection. The effects of antibody-dependent enhancement (ADE) and permanent cross-immunity after two heterologous infections are studied. ADE is assumed to imply risk-free primary infections, while permanent cross-immunity implies risk-free tertiary and quaternary infections. Data from trials of Dengvaxia indicate vaccine efficacy to be age and serostatus dependent and vaccination of seronegative individuals to induce an increased risk of hospitalisation. Some of the scenarios are therefore reconsidered taking these findings into account. The optimal vaccination age is compared to that achievable under the current age restriction of the vaccine. If vaccination is not considered to induce risk, optimal vaccination ages are very low. The assumption of ADE generally leads to a higher optimal vaccination age in this case. For a single serotype vaccination is not recommended in the case of ADE. Permanent cross-immunity results in a slightly lower optimal vaccination age. If vaccination induces a risk, the optimal vaccination ages are much higher, particularly for permanent cross-immunity. ADE has no effect on the optimal vaccination age when permanent cross-immunity is considered; otherwise, it leads to a slight increase in optimal vaccination age.
- Brain activity and medical diagnosis: an EEG study(2013) RIBAS, Laila Massad; ROCHA, Fabio Theoto; ORTEGA, Neli Regina Siqueira; ROCHA, Armando Freitas da; MASSAD, EduardoBackground: Despite new brain imaging techniques that have improved the study of the underlying processes of human decision-making, to the best of our knowledge, there have been very few studies that have attempted to investigate brain activity during medical diagnostic processing. We investigated brain electroencephalography (EEG) activity associated with diagnostic decision-making in the realm of veterinary medicine using X-rays as a fundamental auxiliary test. EEG signals were analysed using Principal Components (PCA) and Logistic Regression Analysis Results: The principal component analysis revealed three patterns that accounted for 85% of the total variance in the EEG activity recorded while veterinary doctors read a clinical history, examined an X-ray image pertinent to a medical case, and selected among alternative diagnostic hypotheses. Two of these patterns are proposed to be associated with visual processing and the executive control of the task. The other two patterns are proposed to be related to the reasoning process that occurs during diagnostic decision-making. Conclusions: PCA analysis was successful in disclosing the different patterns of brain activity associated with hypothesis triggering and handling (pattern P-1); identification uncertainty and prevalence assessment (pattern P-3), and hypothesis plausibility calculation (pattern P-2); Logistic regression analysis was successful in disclosing the brain activity associated with clinical reasoning success, and together with regression analysis showed that clinical practice reorganizes the neural circuits supporting clinical reasoning.
- Equilibrium Analysis of a Yellow Fever Dynamical Model with Vaccination(2015) RAIMUNDO, Silvia Martorano; AMAKU, Marcos; MASSAD, EduardoWe propose an equilibrium analysis of a dynamical model of yellow fever transmission in the presence of a vaccine. The model considers both human and vector populations. We found thresholds parameters that affect the development of the disease and the infectious status of the human population in the presence of a vaccine whose protection may wane over time. In particular, we derived a threshold vaccination rate, above which the disease would be eradicated from the human population. We show that if the mortality rate of the mosquitoes is greater than a given threshold, then the disease is naturally (without intervention) eradicated from the population. In contrast, if the mortality rate of the mosquitoes is less than that threshold, then the disease is eradicated from the populations only when the growing rate of humans is less than another threshold; otherwise, the disease is eradicated only if the reproduction number of the infection after vaccination is less than 1. When this reproduction number is greater than 1, the disease will be eradicated from the human population if the vaccination rate is greater than a given threshold; otherwise, the disease will establish itself among humans, reaching a stable endemic equilibrium. The analysis presented in this paper can be useful, both to the better understanding of the disease dynamics and also for the planning of vaccination strategies.
- Modelling the impact of the long-term use of insecticide-treated bed nets on Anopheles mosquito biting time(2017) FERREIRA, Claudia P.; LYRA, Silas P.; AZEVEDO, Franciane; GREENHALGH, David; MASSAD, EduardoBackground: Evidence of changing in biting and resting behaviour of the main malaria vectors has been mounting up in recent years as a result of selective pressure by the widespread and long-term use of insecticide-treated bed nets (ITNs), and indoor residual spraying. The impact of resistance behaviour on malaria intervention efficacy has important implications for the epidemiology and malaria control programmes. In this context, a theoretical framework is presented to understand the mechanisms determining the evolution of feeding behaviour under the pressure of use of ITNs. Methods: An agent-based stochastic model simulates the impact of insecticide-treated bed nets on mosquito fitness by reducing the biting rates, as well as increasing mortality rates. The model also incorporates a heritability function that provides the necessary genetic plasticity upon which natural selection would act to maximize the fitness under the pressure of the control strategy. Results: The asymptotic equilibrium distribution of mosquito population versus biting time is shown for several daily uses of ITNs, and the expected disruptive selection on this mosquito trait is observed in the simulations. The relative fitness of strains that bite at much earlier time with respect to the wild strains, when a threshold of about 50% of ITNs coverage highlights the hypothesis of a behaviour selection. A sensitivity analysis has shown that the top three parameters that play a dominant role on the mosquito fitness are the proportion of individuals using bed nets and its effectiveness, the impact of bed nets on mosquito oviposition, and the mosquito genetic plasticity related to changing in biting time. Conclusion: By taking the evolutionary aspect into account, the model was able to show that the long-term use of ITNs, although representing an undisputed success in reducing malaria incidence and mortality in many affected areas, is not free of undesirable side effects. From the evolutionary point of view of the parasite virulence, it should be expected that plasmodium parasites would be under pressure to reduce their virulence. This speculative hypothesis can eventually be demonstrated in the medium to long-term use of ITNs.
- Climate Change and Aedes Vectors: 21st Century Projections for Dengue Transmission in Europe(2016) LIU-HELMERSSON, Jing; QUAM, Mikkel; WILDER-SMITH, Annelies; STENLUND, Hans; EBI, Kristie; MASSAD, Eduardo; ROCKLOV, JoacimWarming temperatures may increase the geographic spread of vector-bome diseases into temperate areas. Although a tropical mosquito-borne viral disease, a dengue outbreak occurred in Madeira, Portugal, in 2012; the first in Europe since 1920s. This outbreak emphasizes the potential for dengue re-emergence in Europe given changing climates. We present estimates of dengue epidemic potential using vectorial capacity (VC) based on historic and projected temperature (1901-2099). VC indicates the vectors ability to spread disease among humans. We calculated temperature-dependent VC for Europe, highlighting 10 European cities and three non-European reference cities. Compared with the tropics, Europe shows pronounced seasonality and geographical heterogeneity. Although low, VC during summer is currently sufficient for dengue outbreaks in Southern Europe to commence-if sufficient vector populations (either Ae. aegypti and Ae albopictus) were active and virus were introduced. Under various climate change scenarios, the seasonal peak and time window for dengue epidemic potential increases during the 21st century. Our study maps dengue epidemic potential in Europe and identifies seasonal time windows when major cities are most conducive for dengue transmission from 1901 to 2099. Our findings illustrate, that besides vector control, mitigating greenhouse gas emissions crucially reduces the future epidemic potential of dengue in Europe. (C) 2016 The Authors.
- A Note on the Risk of Infections Invading Unaffected Regions(2018) AMAKU, Marcos; COUTINHO, Francisco Antonio Bezerra; ARMSTRONG, Margaret; MASSAD, EduardoWe present two probabilistic models to estimate the risk of introducing infectious diseases into previously unaffected countries/regions by infective travellers. We analyse two distinct situations, one dealing with a directly transmitted infection (measles in Italy in 2017) and one dealing with a vector-borne infection (Zika virus in Rio de Janeiro, which may happen in the future). To calculate the risk in the first scenario, we used a simple, nonhomogeneous birth process. The second model proposed in this paper provides a way to calculate the probability that local mosquitoes become infected by the arrival of a single infective traveller during his/her infectiousness period. The result of the risk ofmeasles invasion of Italy was of 93% and the result of the risk of Zika virus invasion of Rio de Janeiro was of 22%.
- Estimated Zika virus importations to Europe by travellers from Brazil(2016) MASSAD, Eduardo; TAN, Ser-Han; KHAN, Kamran; WILDER-SMITH, AnneliesBackground: Given the interconnectivity of Brazil with the rest of the world, Zika virus (ZIKV) infections have the potential to spread rapidly around the world via viremic travellers. The extent of spread depends on the travel volume and the endemicity in the exporting country. In the absence of reliable surveillance data, we did mathematical modelling to estimate the number of importations of ZIKV from Brazil into Europe. Design: We applied a previously developed mathematical model on importations of dengue to estimate the number of ZIKV importations into Europe, based on the travel volume, the probability of being infected at the time of travel, the population size of Brazil, and the estimated incidence of ZIKV infections. Results: Our model estimated between 508 and 1,778 imported infections into Europe in 2016, of which we would expect between 116 and 355 symptomatic Zika infections; with the highest number of importations being into France, Portugal and Italy. Conclusions: Our model identified high-risk countries in Europe. Such data can assist policymakers and public health professionals in estimating the extent of importations in order to prepare for the scale up of laboratory diagnostic assays and estimate the occurrence of Guillain-Barre Syndrome, potential sexual transmission, and infants with congenital ZIKV syndrome.
- A public health risk assessment for yellow fever vaccination: a model exemplified by an outbreak in the state of Sao Paulo, Brazil(2015) RIBEIRO, Ana Freitas; TENGAN, Cilea; SATO, Helena Keico; SPINOLA, Roberta; MASCHERETTI, Melissa; FRANCA, Ana Cecilia Costa; PORT-CARVALHO, Marcio; PEREIRA, Mariza; SOUZA, Renato Pereira de; AMAKU, Marcos; BURATTINI, Marcelo Nascimento; COUTINHO, Francisco Antonio Bezerra; LOPEZ, Luis Fernandez; MASSAD, EduardoWe propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of Sao Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of Sao Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.