Síndrome de Burnout em residentes multiprofissionais de uma universidade pública

Os Programas de Residência Multiprofissional buscam romper com os paradigmas em relação à formação de profissionais para o Sistema Único de Saúde (SUS) e contribuir para qualificar os serviços de saúde a partir de ações inovadoras. Entretanto, características específicas desses programas podem agregar estressores aos residentes e, levarem à Sídrome de Burnout. Dessa forma, verificou-se a ocorrência da Síndrome de Burnout nos Residentes Multiprofissionais da Universidade Federal de Santa Maria. Este estudo trata-se de um estudo descritivo, transversal e quantitativo. Aplicaram-se um formulário de dados sociodemográficos e o Versão Human Service Survey do Marlash Burnout Inventory em 37 residentes, entre abril e junho de 2011. Observou-se que 37,84% apresentaram Alta Exaustão Emocional; 43,24%, Alta Despersonalização; e 48,65%, Baixa Realização Profissional. Na associação dos domínios, verificou-se que 27% apresentaram indicativo para Síndrome de Burnout. Os residentes pesquisados estão expostos aos estressores da profissão e da formação, o que pode favorecer a ocorrência da síndrome nesses profissionais.

Prevalence of human papillomavirus infection in rural villages of the Bolivian Amazon

Cervical cancer constitutes a major health problem in developing countries like Bolivia. The roles of certain genotypes of human papillomaviruses (HPVs) in the pathogenesis of cervical cancer is well established. The prevalence of HPV infection among sexually active women varies greatly. Information regarding HPV infection in Bolivia is very much scarce, specially in regions like the Amazonian lowland. We studied 135 healthy women living in four rural localities of the Bolivian Amazon. Presence of HPV in DNA extracted from cervical swabs was analyzed using a reverse line hybridization assay. The estimated overall HPV infection prevalence among the studied rural localities was 5.9% (ranging from 0-16.6%). These values were unexpectedly low considering Bolivia has a high incidence of cervical cancer. The fact that Amazonian people seem to be less exposed to HPV, makes it likely that some other risk factors including host lifestyle behaviors and genetic background may be involved in the development of cervical cancer in this population.

Frequency of human toxocariasis in a rural population from Cajamarca, Peru determined by DOT-ELISA test

The aim of this study was to estimate the frequency of human toxocariasis in Cauday district, Cajamarca, Peru, using a dot-ELISA test. From June to October 2005, a total of 256 adult subjects were studied. Blood samples were collected for serology by a dot-ELISA test and for hematological examination. Parasitological examination was also carried out in stool samples to check cross-reactions in the dot-ELISA. The frequency observed was 44.92%, with a significant higher proportion of positivity in male subjects. From subjects with positive serology, 45.6% had respiratory symptoms, 40.44% abdominal pain, 32.35% hepatic symptoms, 14.7% cutaneous signs, 13.23% ocular manifestations, 43.38% eosinophilia, and all of these were statistically associated to serology. Among the population evaluated, 90.23% (231/256) were parasitized. From subjects with positive serology, 92.17% had at least one intestinal parasite and the most frequent were: Blastocystis hominis (68.38%), Giardia lamblia (28.68%), Hymenolepis nana (20.0%), Ascaris lumbricoides (15.65%), Entamoeba histolytica/E. dispar (13.24%), Cyclospora cayetanensis (4.41%), Cryptosporidium sp. (1.47%), Enterobius vermicularis (0.87%), Strongyloides stercoralis (0.87%), Taenia sp. (0.87%), and Trichuris trichiura (0.87%). The rate of false positives in the dot-ELISA test was improved by serum absorption each with A. suum antigens, with a decrease of cross-reactions. In conclusion, human toxocariasis is highly frequent in this population and some risk factors like dog/cat ownership, presence of pets within house, and previous history of geophagia were observed in the present study.

MOLECULAR INVESTIGATION OF HEMOTROPIC MYCOPLASMAS IN HUMAN BEINGS, DOGS AND HORSES IN A RURAL SETTLEMENT IN SOUTHERN BRAZIL

SUMMARY The aims of this study were to determine the prevalence of hemoplasmas in a rural Brazilian settlement's population of human beings, their dogs and horses, highly exposed to tick bites; to identify the tick species parasitizing dogs and horses, and analyze factors associated with their infection. Blood samples from 132 dogs, 16 horses and 100 humans were screened using a pan-hemoplasma SYBR green real-time PCR assay followed by a species-specific TaqMan real-time PCR. A total of 59/132 (44.7%) dog samples were positive for hemoplasmas (21 Mycoplasma haemocanisalone, 12 ' Candidatus Mycoplasma haematoparvum' alone and 21 both). Only 1/100 (1.0%) human sample was positive by qPCR SYBR green, with no successful amplification of 16S rRNA or 23 rRNA genes despite multiple attempts. All horse samples were negative. Dogs >1 year of age were more likely to be positive for hemoplasmas ( p= 0.0014). In conclusion, although canine hemoplasma infection was highly prevalent, cross-species hemoplasma transmission was not observed, and therefore may not frequently occur despite overexposure of agents and vectors.

Outbreak of human toxoplasmosis in a rural area. A three year serologic follow-up study

Thirty-six persons living on a farm located in the state of Minas Gerais (Brazil) were studied. Nine of them had the glandular form of toxoplasmosis, between May and August, 1976. These nine cases of toxoplasmosis were confirmed serologically by immunefluorescence-IF-, presenting IgG antibody titres between 1:4096 and 1:32000 and IgM antibody titres between 1:16 and 1:8000. Twelve out of thirty-six persons studied were considered to be "dubious cases". They were defined either by presenting a clinical picture compatible with acquired toxoplasmosis, yet having low serologic titres, or inversely they did not have a clear clinical picture but had serologic evidence of recent Toxoplasma infection. Fifteen out of thirty-six persons studied showed neither serologic nor clinical evidence of recent Toxoplasma infection. The epidemiologic information suggests two possible modes of transmission: a) poorly cooked pork at a barbecue party; b) farm vegetables and soil contaminated with Toxoplasma gondii oocysts (rat-cat cycle). Serologic follow-up nine months later in the human farm population demonstrated still high IgG titres, yet they tended to decline and IgM titres became negative. Three years later most of the IgG titres continued to decline and were almost compatible with the titres obtained in Brazilian population surveys.

Related factors to human toxocariasis in a rural community of Argentina

The objective of this study was to evaluate the relationship between toxocariasis frequency and demographic, environmental, sanitary variables, eosinophylia, and other intestinal parasites in a rural population of Argentina. Serological examination of 100 individuals was carried out by using ELISA technique for the detection of anti-toxocara antibodies. Eosinophiles in peripheral blood, presence of intestinal parasites, and demographic, environmental, and socio-cultural data were evaluated. Eighty-one feces samples of dogs belonging to the studied people were analyzed to detect eggs of Toxocara canis. Thirty of them were from 30 dogs and 51 were pools from dog feces. Samples of dirt from around the homes (n: 47) and from public park (n: 4) were taken. To determine the associations, the c² and Fisher tests were used. The seroprevalence was 23%. Eosinophilia in peripheral blood was detected in 86.95% seropositive individuals and in 37.66% seronegative individuals (p < 0.001, OR = 11.03). Of the 23 people with positive serology, 69.56% had at least one intestinal parasite. All individuals with positive serology had dogs in their homes. Among the dog owners there was a significant association between the presence of anti-toxocara antibodies and home flooding. Eggs of T. canis were detected in the feces of 5/81 dogs and three of these dogs belonged to individuals with positive serology. Eggs of Toxocara spp. were found in 41.17% of the dirt samples, eight of which came from the area surrounding the homes of individuals with positive serology (p = 0.032; OR = 4.36). Taking into account all the variables influencing the frequency of toxocariasis in this population, the implementation of Public Health programs specifically focused on anti-parasitic treatment of dogs is recommended.

Validity and reliability of a health care service evaluation instrument for tuberculosis

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis.METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis.RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators “training” and “access to recording instruments” was inferior to that of other indicators.CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.

Dynamics of transmission of Trypanosoma cruzi in a rural area of Argentina: III. Persistence of T. cruzi parasitemia among canine reservoirs in a two-year follow-up

A new cross-sectional survey of household- associated mongrel dogs as well as follow-up of previously parasitemic individuals was carried out in 1984 toy means of xenodiagnosis and serologic techniques to get a deeper insight into the relationship of T. cruzi parasitemia and age among canine hosts in a rural area of Argentina. Persistence of detectable parasitemia was age-independent, or at most, loosely related to age, confirming the pattern observed in 1982. Similarly no significant age-decreasing effect was recorded among seropositive dogs in: a) the probability of detecting parasites in a 2-year follow-up; b) their intensity of infectiousness (=infective force) for T. infestans 3rd-4th instar nymphs, as measured by the percentage of infected bugs observed in each dog xenodiagnosis. Moreover, not only was the infective force of seropositive dogs for bugs approximately constant through lifetime, but it was significantly higher than the one recorded for children in the present survey, and for human people by other researchers. Therefore, and since T. infestans field populations show high feeding frequencies on dogs, the latter are expected to make the greatest contribution to the pool of infected vectors in the rural household of Argentina. This characteristic should be sufficient to involve canine reservoirs definitely as a risk factor for human people residing in the same house. The increased severity of parasitemia observed among dogs in this survey may be related to the acute undernutrition characteristic of canine populations of poor rural areas in our country, which is expected to affect the ability of the host to manage the infection.

Water-contact patterns and schistosoma mansoni infection in a rural community in northeast Brazil

We evaluated the influence of water-related human activities, contaminative behaviour, house location, education and socio-economic status on endemic Schistosoma mansoni infection. The study was conducted in a hilry non-irrigated area of rural northeast Brazil amongst a defined population of subsistence farmers, of whom 93% were infected by age 20. The area was mapped, water bodies were surveyed, and a detailed questionnaire was performed on each household. Infection was assessed by duplicate stool examinations using the sensitive Bell technique to quantify egg excretion. For each household, and index of intensity of infection was computed by grouping individual log-transformed egg counts as an age-sex adjusted Z score. Few households had a sanitary installation or a domestic water supply. However, neither water-contact nor contaminative behavior were indiscriminate. The people made considerable effort to defaecate far from a water source, to obtain household drinking water from the cleanest source, and to bathe only at certain sites where privacy is assured. Land ownership and literacy correlated poorly with the household index of intensity of infection. The key influence on infection status was the relative location of the house and snail-free or snail colonized water sources. In this area, a safe domestic water supply is the critical input needed to achieve definitive control of endemic Schistosomiasis.

Recent occurence of human infection by Rocio arbovirus in Ribeira Valley, Brazil

The presence of IgM antibodies to Rocio in sera of two children from rural area of Ribeira Valley, Brazil, was detected by MAC-ELISA. This new arbovirus of the Flaviviridae family was responsible for an extensive encephalitis epidemic that occurred in the region in 1975-1977. Since 1980 no human disease caused by this virus has been diagnosed. An improvement on surveillance of Rocio infections and on the researches for virus identification in suspected vectors and reservoirs is necessary.

Schistosomiasis mansoni in the municipality of Pedro de Toledo (São Paulo, Brazil) where the Biomphalaria tenagophila is the snail host: I - Prevalence in human population (

Due to the scarce information about the epidemiological features of schistosomiasis in which the vector is Biomphalaria tenagophila, an investigation was carried in Pedro de Toledo in 1980 where such peculiarity is observed. Stool examinations (Kato-Katz method) were performed in 4,741 individuals (22.8% positive to Schistosoma mansoni eggs) of this 583 had previously received chemoterapy and 4,158 remainders, untreated. The schistosomiasis prevalence in those two groups where respectively 31.7% and 21.6%. Epidemiological investigation showed that 83.6% were autochthonous cases from the studied area: the autochthonous prevalence rate, and the intensity of infection in the untreated autochthonous cases were higher in males than in females; the intensity in the latter untreated group was low, 58.5 eggs/g feces (geometric mean). Moreover, according to the age groups the intensity of infections correlated well (r s = 0.745) with the prevalence rates. Schistosomiasis was verified to occur mostly during the leisure time and by the use of water streams for housework in rural zone. Only 0.4% out of 1,137 snails was positive for S. mansoni cercariae, apparently unchanged from the 1978 study when the human prevalence was 12.0%. The studied area presented differences and similarities in relation to the other Brazilian areas were the main intermediate host is B. glabrata.

Seroepidemiology of human toxoplasmosis in Chile

A series of already published and unpublished seroepidemiological surveys for toxoplasmosis, carried out in Chile in 1982-1994, is reviewed, expanded and analyzed. The surveys included 76,317 apparently healthy individuals of different ages (0.57% of the country's total population), from 309 urban and rural-periurban localities. Urban groups were integrated by blood donors, delivering mothers and middle grade schoolchildren, while rural-periurban individuals corresponded to unselected family groups. Blood samples were collected in filter paper. The presence of antibodies to Toxoplasma gondii was determined by the indirect hemagglutination test (IHAT), titers > 16 were considered positive. The test resulted positive in 28,124 (36.9%) of the surveyed people. Two hundred and six (0.3%) individuals presented IHAT titers > 1000, probably corresponding to acute or reactivated infections. A progressive increase of positive IHAT from northern to southern regions of the country was noted, phenomenom probably related to geographical conditions and to a higher production and consumption of different types of meat in the latter regions. It is postulated that ingestion of T. gondii cysts by humans is epidemiologically as important as ingestion of oocysts. The results presented stress the epidemiological importance of toxoplasmosis in humans, and warn about eventual implications in immunocompromised patients and in transplacental transmission, organ transplants and transfusions.

Human infection with Trypanosoma cruzi in Nasca, Peru: A seroepidemiological survey (1)

We estimated the proportion of seropositivity for infection with Trypanosoma cruzi (Chagas’ disease) in a sample of the rural population of the Province of Nasca, Department of Ica, southwestern Peru. Although Triatoma infestans, the only vector species identified in the Department of Ica, is often found in domestic environments, data of the extent of human infection with T. cruzi are scant. This study comprised 446 houses, known to be infested with triatomines, distributed in 19 rural localities. While visiting those houses we collected filter paper bloodspots from 864 occupants (of both sexes, aged one year or over). By means of the indirect fluorescent antibody test (IFAT), we detected anti-T. cruzi IgG antibodies in samples from 178 individuals (20.6%). Seropositivity was significantly more frequent in females (23.8%) than in males (17.5%). Among the 410 individuals in the 1- to 10-year-old age group (47.5% of the population sample), 85 (20.7%) were found seropositive, which is indicative of an early acquisition of the infection. Within this group no significant differences in seropositivity were associated with sex

UNA virus: first report of human infection in Argentina

Una virus (UNAV), Togaviridae family, is widely distributed in South America, where infections have been detected in mosquitoes and vertebrate hosts (humans, birds and horses). We analyzed human sera from Córdoba inhabitants aged 44 to 89 years and using a neutralization test, we found a prevalence of UNAV antibodies of 3.8% (3/79). The low titers detected suggest past infections probably acquired in rural areas of the Province of Córdoba (central Argentina). None sera were found positive for MAYV neutralizing antibodies. This is the first report of human infections by UNAV in Argentina.

Burkholderia pseudomallei: a case report of a human infection in Ceará, Brazil

Burkholderia pseudomallei has rarely been isolated from environmental and clinical specimens in South America, particularly, in Brazil. This report describes a case of melioidosis with fulminant sepsis in a 10 year old boy, from rural area, in Tejuçuoca, State of Ceará, Brazil. Blood samples were positive and, through the analysis of results from biochemical tests and of drugs susceptibility profile, identified this gram-negative bacillus as B. pseudomallei. The contamination source remains obscure in this case, as soil and water tanks samples submitted to microbiological analyses did not indicate the presence of B. pseudomallei.