The trypanosomatid evolution workshop London School of Hygiene and Tropical Medicine

The trypanosome evolution workshop, a joint meeting of the University of Exeter and the London School of Hygiene and Tropical Medicine, focused on topics relating to trypanosomatid and vector evolution. The meeting, sponsored by The Wellcome Trust, The Special Programme for Research and Training in Tropical Disease of World Health Organization and the British Section of the Society of Protozoologists, brought together an international group of experts who presented papers on a wide range of topics including parasite and vector phylogenies, molecular methodology and relevant biogeographical data.

The London School of Hygiene and Tropical Medicine: a new century of malaria research

The global malaria situation has scarcely improved in the last 100 years, despite major advances in our knowledge of the basic biology, epidemiology and clinical basis of the disease. Effective malaria control, leading to a significant decrease in the morbidity and mortality attributable to malaria, will require a multidisciplinary approach. New tools - drugs, vaccine and insecticides - are needed but there is also much to be gained by better use of existing tools: using drugs in combination in order to slow the development of drug resistance; targeting resources to areas of greatest need; using geographic information systems to map the populations at risk and more sophisticated marketing techniques to distribute bed nets and insecticides. Sustainable malaria control may require the deployment of a highly effective vaccine, but there is much that can be done in the meantime to reduce the burden of disease.

Hepatitis A Outbreak in a Public School in Rio de Janeiro, Brazil

From June 1 to July 1 1999, an outbreak involving 25 cases of hepatitis A occurred in a public school in Rio de Janeiro, Brazil. Since these cases were notified to the State Health Department, the National Reference Center for Hepatitis Viruses (CNRHV) was required to investigate the extent of hepatitis A virus (HAV) dissemination. Blood samples from all students were tested for IgM and total anti-HAV antibodies using a commercial enzyme-linked immunoassay (ELISA). At the same time, a questionnaire was completed in order to identify possible risk factors for HAV infection. The environmental investigation showed that there was no fecal contamination of the water supply. The epidemiological investigation demonstrated that almost 50% of this population was susceptible to HAV infection and probably person-to-person transmission was the principal mode of virus dissemination. In this situation, a massive vaccination campaign could control the HAV infection.

Assessment of schistosomiasis, through school surveys, in the Forest Zone of Pernambuco, Brazil

This work had the objective of assessing the present epidemiological situation regarding schistosomiasis through performing Kato-Katz coproscopic tests on representative samples of schoolchildren from each of the 43 municipality of endemic area of the state of Pernambuco, Brazil. The methodology is recommended by the World Health Organization to conduct sampled surveys among children at elementary school levels, ideal target group for baseline surveys: (i) schools are accessible; (ii) the greatest prevalence of schistosomiasis is found within this group; (iii) the data gathered from this age group can be used for intervention within the community as a whole. The following infection indicators were utilized: positivity (percentage of individuals examined with eggs of Schistosoma mansoni in the feces) and severity (geometric mean number of eggs per gram of feces, epg). These indicators allowed the area in general and the municipalities in particular to be categorized into prevalence and severity classes for S. mansoni. The prevalence classes were: low (<10%), medium (> 10 and < 50%), and high (> 50%); the severity classes were: low (1-99 epg), moderate (100-399 epg), and severe (> 400 epg). For the geohelminthic diseases, the following indicators were used: positivity for each geohelminth (percentage of individuals examined with eggs of geohelminths), and cumulative positivity (percentage of individuals examined with eggs of at least one geohelminth). The municipalities were categorized by means of their cumulative positivity into the following geohelminth prevalence classes (WHO 2002): low (< 50%), medium (> 50 and < 70%), and high (> 70%). The study covered 271 schools in 179 different localities, thus giving a total of 11,234 examinations performed. The overall positivity for S. mansoni was 14.4% and the egg count for this parasite in the feces gave a geometric mean of 67.9 epg which suggests a low general state of infection. These results allow this mesoregion to be categorized as presenting medium prevalence and low severity of schistosomiasis. The overall positivity rates for the geohelminths, Ascaris lumbricoides, Ancylostomidae, and Trichuris trichiura were, respectively, 30.4, 10.1, and 27.8%; the cumulative positivity was 45.4%. These results allow this mesoregion to be categorized as presenting low prevalence of geohelminthic diseases. The data show some municipalities in Pernambuco with prevalence greater than 20%, while others presented parasite loads greater than 100 epg. These indicators attest to the significant morbidity due to schistosomiasis regarding to the severity of infections established in young populations.

Long-term outcomes of school-based treatment for control of urinary schistosomiasis: a review of experience in Coast Province, Kenya

Urinary schistosomiasis remains a significant burden for Africa and the Middle East. The success of population-based control programs will depend on their impact, over many years, on Schistosoma haematobium reinfection and associated disease. In a multi-year (1984-1992) control program in Kenya, we examined risk for S. haematobium reinfection and late disease during and after annual school-based treatment. In this setting, long-term risk of new infection was independently associated with location, age, hematuria, and incomplete treatment, but not with sex or frequency of water contact. Thus, very local environmental features and age-related factors played an important role in S. haematobium transmission, such that population-based control programs should optimally tailor their efforts to local conditions on a village-by-village basis. In 2001-2002, the late benefits of earlier participation in school-based antischistosomal therapy were estimated in a cohort of formerly-treated adult residents compared to never-treated adults from the same villages. Among age-matched subjects, current infection prevalence was lower among those who had received remote therapy. In addition, prevalence of bladder abnormality was lower in the treated group, who were free of severe bladder disease. Treatment of affected adults resulted in rapid resolution of infection and any detectable bladder abnormalities. We conclude that continued treatment into adulthood, as well as efforts at long-term prevention of infection (transmission control) are necessary to achieve optimal morbidity control in affected communities.

The prevalence of schistosomiasis in school-aged children as an appropriate indicator of its prevalence in the community

School-aged children (6-15 years) from the endemic area of Pernambuco were evaluated both as a target group for and an indicator of schistosomiasis control in the community. Parasitological data were drawn from baseline stool surveys of whole populations that were obtained to diagnose Schistosoma mansoni infection. Nineteen representative localities were selected for assessing the prevalence of schistosomiasis among individuals in the following age groups: 0-5, 6-15, 16-25, 26-40 and 41-80 years. For each locality, the prevalence in each age group was compared to that of the overall population using contingency table analysis. To select a reference group, the operational difficulties of conducting residential surveys were considered. School-aged children may be considered to be the group of choice as the reference group for the overall population for the following reasons: (i) the prevalence of schistosomiasis in this age group had the highest correlation with the prevalence in the overall population (r = 0.967), (ii) this age group is particularly vulnerable to infection and plays an important role in parasite transmission and (iii) school-aged children are the main target of the World Health Organization in terms of helminth control. The Schistosomiasis Control Program should consider school-aged children both as a reference group for assessing the need for intervention at the community level and as a target group for integrated health care actions of the Unified Health System that are focused on high-risk groups.

High rates of undiagnosed leprosy and subclinical infection amongst school children in the Amazon Region

Leprosy in children is correlated with community-level factors, including the recent presence of disease and active foci of transmission in the community. We performed clinical and serological examinations of 1,592 randomly selected school children (SC) in a cross-sectional study of eight hyperendemic municipalities in the Brazilian Amazon Region. Sixty-three (4%) SC, with a mean age of 13.3 years (standard deviation = 2.6), were diagnosed with leprosy and 777 (48.8%) were seropositive for anti-phenolic glycolipid-I (PGL-I). Additionally, we evaluated 256 house-hold contacts (HHCs) of the students diagnosed with leprosy; 24 (9.4%) HHC were also diagnosed with leprosy and 107 (41.8%) were seropositive. The seroprevalence of anti-PGL-I was significantly higher amongst girls, students from urban areas and students from public schools (p < 0.0001). Forty-five (71.4%) new cases detected amongst SC were classified as paucibacillary and 59 (93.6%) patients did not demonstrate any degree of physical disability at diagnosis. The results of this study suggest that there is a high rate of undiagnosed leprosy and subclinical infection amongst children in the Amazon Region. The advantages of school surveys in hyperendemic areas include identifying leprosy patients at an early stage when they show no physical disabilities, preventing the spread of the infection in the community and breaking the chain of transmission.

Attitudes, knowledge, and opinions regarding mental health among undergraduate nursing students

A cross-sectional study involving 235 subjects was conducted in 2011 to compare the opinions of nursing students regarding mental illness and related care practices at two institutions in the state of Paraná, Brazil. Following approval by the ethics committee, data collection was initiated using an instrument containing questions regarding the importance of personal characteristics, knowledge of mental health, and the Opinions about Mental Illness (OMI) scale. Statistical analyses, including the Mann-Whitney test, Chi-squared test, and Spearman correlation at , were performed using SPSSv.15. The students exhibited significantly different characteristics only for Benevolence. Regarding the importance of knowledge about mental health, in comparison with students from the State University of Londrina (Universidade Estadual de Londrina – UEL), students at the State University of Maringa (Universidade Estadual de Maringá – UEM) considered psychological aspects more comprehensively than technical knowledge. We conclude that there are differences between students at these institutions in terms of knowledge and the factor Benevolence. Further studies are necessary to identify the underlying causes of such differences.

Expansion of undergraduate courses in nursing: dilemmas and contradictions facing the labor market

We sought to analyze, from the perspective of professors and students, the reasons and consequences of the expansion of undergraduate courses in nursing, discussing the dilemmas and the contradictions confronting the labor market. It was a qualitative study with data obtained from focus groups, conducted in 18 undergraduate nursing courses in the state of Minas Gerais, during the period of February to October of 2011. The narratives were submitted to critical discourse analysis. The results indicated that the education of the nurse was permeated by insecurity as to the future integration into the labor market. The insecurity translates into dilemmas that referred to employability and the precariousness of the working conditions. In this context, employment in the family health strategy emerges as a mirage. One glimpses the need for a political agenda with the purpose of discussion about education, the labor market and the determinants of these processes.

School age children with HIV/AIDS: possible discrimination and attitudes against

Survey-based study what purpose was to analyse respondents’ opinions about contacts with HIV/AIDS-affected people. It was performed using a paper-pencil method during visits of respondents at primary care centres and on-line through a link to the questionnaire distributed among patients of primary care physicians. The study involved 302 respondents, 80% of whom were women; the average age was 34.48 years. The majority of respondents did not know anyone with HIV/AIDS (89.6%). About 83.3% claimed that they would not decrease contacts with HIV/AIDS-affected people. According to 64.1% of respondents, children with HIV/AIDS should go to kindergarten/public or non-public school. We selected a group of respondents, who previously were not but now are inclined to limit such contacts. These respondents can be a potential target group for HIV/AIDS educational programmes. Most respondents think that there is insufficient information about the HIV/AIDS in the mass media.

Comprehensiveness in child healthcare teaching in Undergraduate Nursing: perspective of teachers

This qualitative study analyzed, from the teacher’s perspective, if the principle of comprehensiveness is included in child healthcare teaching in nursing education. The participants were 16 teachers involved in teaching child healthcare in eight undergraduate nursing programs. Data collection was performed through interviews that were submitted to thematic content analysis. The theory in teaching incorporates comprehensive care, as it is based on children’s epidemiological profile, child healthcare policies and programs, and included interventions for the promotion/prevention/rehabilitation in primary health care, hospitals, daycare centers and preschools. The comprehensive conception of health-disease process allows for understanding the child within his/her family and community. However, a contradiction exists between what is proposed and what is practiced, because the teaching is fragmented, without any integration among disciplines, with theory dissociated from practice, and isolated practical teaching that compromises the incorporation of the principle of comprehensiveness in child healthcare teaching.

Teaching-service integration: implications and roles in experiences of Undergraduate Courses in Nursing

The study aimed at understanding the implications of the teaching-service integration to nursing education from the perspective of teachers, students and professionals in Primary Healthcare as well as identifying the roles of teachers and professionals who follow practical experiences in education. This is a case study of qualitative approach carried out in five undergraduate courses in Nursing in the state of Santa Catarina. A total of 22 teachers and 14 professionals were interviewed and five focus groups were conducted with students. Results are presented in two categories: Implications of the teaching-service integration to education in Nursing: contributing factors and intervening factors and Relationships established in the experiences: a unison speech and a dissonant practice. The contributions of the teaching-service integration are undeniable. Despite this belief, there are intervening factors that need to be on the agenda for discussion. The role of facilitator in education emerged strongly despite conflicting perceptions remain.

Nursing: promoting the health of overweight children and adolescents in the school context

The study aimed to analyze the nursing interventions related to the competencies of health promotion of overweight children and adolescents in the school context, in light of the Galway Consensus through an integrative review. Articles published between 1988 and June, 2013 were found in the databases CINAHL, SCOPUS, MEDLINE/PubMed, Cochrane, LILACS and SciELO. A total of 139 publications were obtained from indexed descriptors. Ten articles were selected after reading. The most evident competencies for health promotion were: catalyzing change, needs assessment and impact assessment. The highlights were activities of health education and partnerships with other health professionals and the families of students. It was found that the skills of health promotion developed by nurses can contribute to the adoption of healthy habits by overweight children and adolescents.

Gerontology course in the nursing undergraduate curricula

Objective To explores nursing faculty members’ attitudes towards older people, their thoughts about gerontological nursing education. Method Five focus groups and a survey were used with nursing faculty members 132 at the three nursing schools to explore their attitudes towards the care of older people and the perceived status of gerontological nursing education. The survey was given to 132 faculty members, including 76 clinical instructors, 40 associate professors and 16 professors. The nursing faculty in general had a positive attitude toward older people (M=3.36, SD 0.25), and teachers’ attitudes were higher than those of their nursing students (M=3.18, SD0.29). Results This study results suggests that Saudi nursing curricula should include more extensive gerontology content and clinical experience with older people. Conclusion This is the first time in Saudi Arabia that research has listened to their voices and examined their commitments toward gerontology education.