Insecticide treated mosquito nets for malaria control in India-experience from a tribal area on operational feasibility and uptake

The study assessed the operational feasibility and acceptability of insecticide-treated mosquito nets (ITNs) in one Primary Health Centre (PHC) in a falciparum malaria endemic district in the state of Orissa, India, where 74% of the people are tribes and DDT indoor residual spraying had been withdrawn and ITNs introduced by the National Vector Borne Disease Control Programme. To a population of 63,920, 24,442 ITNs were distributed free of charge through 101 treatment centers during July-August 2002. Interview of 1,130, 1,012 and 126 respondents showed that the net use rates were 80%, 74% and 55% in the cold, rainy and summer seasons, respectively. Since using ITNs, 74.5-76.6% of the respondents observed reduction of mosquito bites and 7.2-32.1% reduction of malaria incidence; 37% expressed willingness to buy ITNs if the cost was lower and they were affordable. Up to ten months post-treatment, almost 100% mortality of vector mosquitoes was recorded on unwashed and washed nets (once or twice). Health workers re-treated the nets at the treatment centers eight months after distribution on a cost-recovery basis. The coverage reported by the PHC was only 4.2%, mainly because of unwillingness of the people to pay for re-treatment and to go to the treatment centers from their villages. When the re-treatment was continued at the villages involving personnel from several departments, the coverage improved to about 90%.Interview of 126 respondents showed that among those who got their nets re-treated, 81.4% paid cash for the re-treatment and the remainder were reluctant to pay. Majority of those who paid said that they did so due to the fear that if they did not do so they would lose benefits from other government welfare schemes. The 2nd re-treatment was therefore carried out free of charge nine months after the 1st re-treatment and thus achieved coverage of 70.4%. The study showed community acceptance to use ITNs as they perceived the benefit. Distribution and re-treatment of nets was thus possible through the PHC system, if done free of charge and when personnel from different departments, especially those at village level, were involved.

Influence of nitrogen fertilization and green manure on the economic feasibility of no-tilled wheat in the Cerrado

The search for higher profitability in wheat crop with cost reduction technologies that may promote sustainability is an important matter in Brazilian agriculture. This study evaluated the profitability of no-tilled wheat, reducing nitrogen topdressing doses with the cultivation of green manure before the wheat crop. The experiment was carried out in Selvíria (MS), Brazil, in 2009/10. The experiment was arranged in a randomized block design with 36 treatments in splitplots and four replicates. The plots were formed by six types of green manure: Cajanus cajan L. BRS Mandarin, Crotalaria juncea L., Pennisetum americanum L. BRS 1501, fallow area and mixed cropping of Pennisetum americanum L. + Cajanus cajan L. and Pennisetum americanum L. + crotalaria which provided straw for no-tilled wheat in the winter, following the rice crop in the summer. The subplots were formed by six levels of topdressing nitrogen (0, 25, 50, 75, 100 and 125 kg N ha-1) using urea as a nitrogen source. The wheat grown after green manure in the previous winter crop, with no nitrogen topdressing and a rate of 25 kg ha-1 N, had more frequently production costs above the gross income. Wheat production cost after the mixed cropping Pennisetum americanum L. + Cajanus cajan L. and Pennisetum americanum L. + Crotalaria juncea L. from the previous winter crop, combined with nitrogen rates of 50 and 75 kg N ha-1, provided better profitability compared with the other green manures evaluated.

Leprosy control: perspectives & epidemiological and operational aspects

OBJECTIVES: As a starting point, a vast variety of 200 technical papers and documents published during the ten years 1999-2008, from Brazilian and international organizations dedicated to the control of leprosy, was taken. A study was then undertaken to investigate its future evolutive possibilities by employing resources obtained from scenario analyses. DESIGN: The methodological reconstruction in use was of a qualitative nature, based on a bibliographic review and content analysis techniques. The latter were employed in a documental, categorical, contingent, frequency-based format, in compliance with appropriate and pertinent conditions. RESULTS: Nowadays, important elements on epidemiological and operational aspects have been regained, as well as respective perspectives. CONCLUSIONS: A projection is made towards the fact that the maintenance of the disease's present incidence levels constitute economic and sanitary challenges that confront issues ranging from the neoliberal model of global societal organization to specific competences of actions taken by health teams in the field.

CHEMOPROPHYLAXIS TO CONTROL LEPROSY AND THE PERSPECTIVE OF ITS IMPLEMENTATION IN BRAZIL: A PRIMER FOR NON-EPIDEMIOLOGISTS

The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention.

Feasibility study of the immunogenicity and safety of a novel DTPw/Hib (PRP-T) Brazilian combination compared to a licensed vaccine in healthy children at 2, 4, and 6 months of age

Vaccination of infants with conjugated Haemophilus influenzae type b (Hib) vaccines has been proven to reduce Hib meningitis by 95% and pneumoniae by 20%. The routine use of Hib vaccine is facilitated by the introduction of combination vaccines into the EPI (Expanded Plan of Immunization). The objective of this study was to compare the immunogenicity and reactogenicity of an extemporaneously mixed DTPw/Hib (diphtheria-tetanus-whole cell pertussis) combination, using the technology of two Brazilian manufacturers, against a licensed DTPw/Hib European combination in 108 infants vaccinated at 2, 4 and 6 months according to the local national schedule. The Brazilian combination was highly immunogenic with Hib seroprotection rates (anti-PRP > 0.15 mg /ml of 98% after 2 doses and 100% after 3). Also for tetanus and pertussis the new Brazilian combination was as immunogenic as the European counterpart, except the diphtheria seroprotection rates and titers were lower. There was also no clinically relevant difference in reactogenicity. If these feasibility results are confirmed, the Brazilian DTPw/Hib combination should help to boost the uptake of Hib vaccination in Brazil.

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS: A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS: Of the 85 cases analyzed, 51.7% were male participants, and 60% were brown. Concerning the age, 54.8% of women were between 35 and 49 years, and 57.6% of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3% of cases, and the multibacillary form was found in 72.9%. The skin smear was positive in 42.3%. The occurrence of reaction was found in 43.5% of cases, and 83.5% had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7% of the patients. Most of the individuals (96.4%) lived in houses made of brick with more than three rooms (72.6%) and two persons per room (65.1%). Concerning the level of education, 41.4% of women and 34.1% of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5%), and that in the end was the age group of 20 to 34 (29.9%) with Grade 0, 30.7% Grade 1, and 11.5% Grade 2. CONCLUSIONS: The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

Safety, feasibility, and results of exercise testing for stratifying patients with chest pain in the emergency room

OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64%) patients were eligible for exercise testing, but only 268 (40%) underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70%) were males. Twenty-eight (10%) patients had a previous history of coronary artery disease, 244 (91%) had a normal or unspecific electrocardiogram, and 150 (56%) underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13%) were positive, 191 (71%) were negative, and 43 (16%) were inconclusive. In the group of patients with a positive exercise test, 21 (62%) underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal) (p<0.0001), previous coronary artery disease (p<0.0001), and route 2 (patients at higher risk) correlated with a positive or inconclusive test (p<0.0001). CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.

The feasibility of forecasting influenza epidemics in Cuba

A large influenza epidemic took place in Havana during the winter of 1988. The epidemiologic surveillance unit of the Pedro Kouri Institute of Tropical Medicine detected the begining of the epidemic wave. The Rvachev-Baroyan mathematical model of the geographic spread of an epidemic was used to forecast this epidemic under routine conditions of the public health system. The expected number of individuals who would attend outpatient services, because of influenza-like illness, was calculated and communicated to the health authorities within enough time to permit the introduction of available control measures. The approximate date of the epidemic peak, the daily expected number of individuals attending medical services, and the approximate time of the end of the epidemic wave were estimated. The prediction error was 12%. The model was sufficienty accurate to warrant its use as a pratical forecasting tool in the Cuban public health system.

Parasitological diagnosis of schistosomiasis mansoni: fecal examination and rectal biopsy

Even with all progress in the search of sensitive and methods for the immunological diagnosis of schistosomiasis, the microscopic detection of eggs of the parasite in the stool still remains the most widely used tool for the actual diagnosis of active infection. Among the coproscopic methods, Kato's technic modified by Katz et al (Kato/Katz) has the advantages of higher sensitivity, the possibility of egg quantification, its low operational cost and its feasibility in areas with minimal infra-structure. The oorgram of the rectal mucosa is valuable in initial clinical trials of schistosomicides, when it is needed to observe egg morphology in tissue. It could be an alternative method for individual diagnosis, being more sensitive than a single stool exam in low intensity infection. However, the increased sensitivity of a higher number of fecal exams makes that invasiveprocedure unnecessary. In the assessment of cure of schistosomiasis, Kato/Katz method (three fecal samples in one, three and six months after treatment) and the rectal biopsy four months after treatment, are equally reliable.

Effect of investments on fundamentals and market reaction on pre-operational and operational Brazilian companies for the period 2006-2012

ABSTRACT This paper provides evidence on the market reaction to corporate investment decisions whose shareholder value is largely attributed to growth options. The exploratory research raised pre-operational companies and their operational pairs on the same economy segments. It had the purpose of investigating the existence of statistical differentiation from financial indicators that reflect the installed assets and growth assets, and then study the market reaction to changes in fixed assets as a signaling element about investment decisions. The formation process of operational assets and shareholder value almost exclusively dependent on asset growth stands out in the pre-operational companies. As a result, differentiation tests confirmed that the pre-operational companies had their value especially derived on growth options. The market reaction was particularly bigger in pre-operational companies with abnormal negative stock returns, while the operational companies had positive returns, which may indicate that the quality of the investment is judged based on the financial disclosure. Additionally, operational companies' investors await the disclosure to adjust their prices. We conclude that the results are consistent with the empirical evidence and the participants in financial markets to long-term capital formation investments should give that special attention.

INCLUDING RISK IN ECONOMIC FEASIBILITY ANALYSIS:A STOCHASTIC SIMULATION MODEL FOR BLUEBERRY INVESTMENT DECISIONS IN CHILE

ABSTRACT The traditional method of net present value (NPV) to analyze the economic profitability of an investment (based on a deterministic approach) does not adequately represent the implicit risk associated with different but correlated input variables. Using a stochastic simulation approach for evaluating the profitability of blueberry (Vaccinium corymbosum L.) production in Chile, the objective of this study is to illustrate the complexity of including risk in economic feasibility analysis when the project is subject to several but correlated risks. The results of the simulation analysis suggest that the non-inclusion of the intratemporal correlation between input variables underestimate the risk associated with investment decisions. The methodological contribution of this study illustrates the complexity of the interrelationships between uncertain variables and their impact on the convenience of carrying out this type of business in Chile. The steps for the analysis of economic viability were: First, adjusted probability distributions for stochastic input variables (SIV) were simulated and validated. Second, the random values of SIV were used to calculate random values of variables such as production, revenues, costs, depreciation, taxes and net cash flows. Third, the complete stochastic model was simulated with 10,000 iterations using random values for SIV. This result gave information to estimate the probability distributions of the stochastic output variables (SOV) such as the net present value, internal rate of return, value at risk, average cost of production, contribution margin and return on capital. Fourth, the complete stochastic model simulation results were used to analyze alternative scenarios and provide the results to decision makers in the form of probabilities, probability distributions, and for the SOV probabilistic forecasts. The main conclusion shown that this project is a profitable alternative investment in fruit trees in Chile.

Reforestation feasibility in area formerly used for cattle rasing in the state of Rondônia, Northwest Brazilian Amazon

Little knowledge on initial behavior of native tree species in recovering landscapes in the Amazon is a current concern for expanding reforestation in the region. Thus, the aim of this study was to evaluate the establishment of native tree species that could be used for reforestation in area previously covered by a pasture of brachiaria grass (Brachiaria brizantha) destined for intensive cattle rasing in the State of Rondônia. For this, there were performed previous diagnostic of landscape changes and the election of tree species based on the ecological group information. Some of the critical macronutrients for plant growth were supplied in the holes to alleviate nutrient deficiencies. In addition, growth and survival parameters were taken to evaluate the initial behavior of species. Six native tree species planted with different combinations (10mx10m, 5mx5m and 3mx3m) had survival rate and growth (total height, girth stem and crown projection area) measured in different intervals: 6-month, 12-month and 24-month after planting. All the species presented survival rate over 90% at 24 months and comparable growth indices to other native species under similar situation and in the region. Overall, Schizolobium amazonicum (bandarra), the non-identified legume tree 1 (acácia grande) and Colubrina glandulosa (sóbrasil) averaged over 90% the highest girth stem growth all over the area. S. amazonicum and the non-identified legume tree 1 (acácia grande) presented the best results for height and canopy area growth parameters, respectively. The combination among native tree species from initial successional ecological groups and fertilizer was favorable to promote reforestation in the conditions of the study area in Rondônia.

Operational characteristics of four metering systems for agricultural fertilizers and amendments

The use of fertilizers and solid amendments in agriculture generates special interest for their effect on crop productivity, as well as for their environmental impact. The efficient use of these products demands knowing their physical and mechanical properties, the storing conditions effect and the operational characteristics of the metering systems used in the fertilizing equipment. In this context, the present study was developed with the purpose of evaluating the operational characteristics of different fertilizing metering systems and to determine the adequate metering system-product operational parameters, using powder lime, powder gypsum, granular 10-30-10 (N-P-K), and granular urea. Operational differences were established among four types of commercial fertilizer metering systems, including wire auger, star-shaped feed wheel, feed screw and ridged traction wheel. The study found that the unloading rate depends directly on the fertilizer metering system's rotating speed and is affected by particle size, repose angle, bulk density and moisture content of the applied product. The wire auger and star-shaped feed wheel metering systems were adequate for the distribution of powder products and the feed screw for granulated fertilizers. Furthermore, theoretical and experimental characteristic equations were established, defining curves for calibration and handling of the products plus the rotating speed range in which a better distributing behavior was achieved.

Operational performance of the mechanized and semi-mechanized potato harvest

Potato is an important crop plant throughout the world. Harvesting is a fundamental step in its production system. Maybe, it is the most complex and expensive operation. Thus, the objective of this work was to compare the cost of the mechanized and semi-mechanized harvest, the operational capacity and the production losses during the potato harvest process. The work was accomplished in a commercial farming, cultivated under pivot system, in the municipal district of Perdizes - MG, Brazil. A completely randomized design with two treatments was used: mechanized and semi-mechanized harvest. The mechanized harvest used a self-propelled harvester. In the semi-automated harvest, a digger mounted on tractor was used and the potato was manually harvested. It was concluded that the cost of mechanized harvest was 49.03% lower than the cost of semi-mechanized harvest. On average, the harvester had a work for 23 workers in manual harvest. Mechanized harvest showed losses of 2.35% of potato yield, while the semi-mechanized harvest showed losses of 6.32%.