Tegumentary leishmaniasis in the State of Amazonas: what have we learned and what do we need?

This study evaluated the occurrence of American tegumentary leishmaniasis (ATL) in the State of Amazonas, Brazil, in the last 30 years with emphasis on the last 10 years (2001 to 2010). The disease was predominantly observed in males (76.2%), in the 21- to 30-year-old age group (26.6%) and in extractive workers (43.7%); 3.3% of the cases were the mucosal form. The endemic channel shows the disease seasonality, with a predominance of cases at the beginning and end of each year. The number of cases by municipality in the period of 2001-2010 shows the maintenance of the endemic in the localities where the highest numbers of cases have always been registered, namely, Manaus, Rio Preto da Eva, Itacoatiara and Presidente Figueiredo. The comparison of data from 2001 to 2005 and from 2006 to 2010 showed the emergence of this disease in municipalities that had been previously unaffected. In the last years, there has been a significant increase in the activities of control, diagnosis and treatment of leishmaniasis in the State of Amazonas. In conclusion, the historical series of ATL analyzed in this study suggests that the transmission foci remain and are even expanding, though without continuous transmission in the intra- or peridomicile settings. Moreover, the disease will persist in the Amazon while the factors associated with infection acquisition relative to forest exploitation continue to have economic appeal. There is a real expectation of wide variations in disease incidence that can be influenced by climate and economic aspects.

Malaria epidemiology in the State of Piauí, Northeastern Brazil: a retrospective study with secondary data

Abstract: INTRODUCTION Malaria is not considered endemic in State of Piauí. METHODS Malaria epidemiology was examined using surveillance data. RESULTS: During 2002-2013, of the 484 cases of malaria, 217 were classified as probably acquired in Piauí, most frequently in the Campo Largo, Buriti dos Lopes, and Luzilândia municipalities, and 267 were considered probably imported, from the States of Pará, Maranhão, Amazonas, Roraima, and Rondônia. Probably-imported cases occurred throughout the year, while 80.2% of the probably-acquired cases occurred in April-August, peaking at the end of the rainy season. CONCLUSIONS Malaria surveillance should be intensified. Further ecoepidemiological and entomological studies are needed.

Seasonality, age structure and reproduction of Leptodactylus (Lithodytes) lineatus (Anura, Leptodactylidae) in Rondônia state, southwestern Amazon, Brazil

Leptodactylus(Lithodytes) lineatus (Schneider, 1799) is an Amazonian leaf litter frog considered rare or uncommon in several studies on anuran communities. Despite being a widely distributed frog in Amazonian forests, knowledge of the biology and ecology of this species is relatively scarce. This species has been reported to live in association with leaf-cutter ant nests (Atta spp.) during the breeding period. In this paper we present data on the seasonality of this species and some reproductive information gathered at a locality of Rondônia state, northwestern Brazil. Field work was carried out between April 2001 and March 2002, with the use of pitfall traps with drift fences as a survey method. Leptodactylus (L.) lineatus had a higher capture frequency in this locality compared to that of other studies carried out in other Amazonian localities, possibly because this species has secretive habits, such as calling and breeding from nests of leaf-cutting ants, and are difficult to find during visual encounter surveys. The breeding period occurs between October and March. Calling males and egg-bearing females were found between September and February and juvenile recruitment occurred mainly from the end of the rainy season to the beginning of the dry season (February to June). Males and females show sexual dimorphism in SVL, females being significantly larger than males. The number of ovarian eggs per female varies from 110 to 328 and analyses indicate that there is a significant correlation with SVL.

Primary care at Swiss universities--current state and perspective.

BACKGROUND: There is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012. RESULTS: Although primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 - 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills. CONCLUSION: So far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture.

Total antioxidant capacity of plasma in asymptomatic carrier state of Neisseria meningitidis

Reduction of the antioxidant capacity of plasma has been linked with the impairment of an effective immune response and so we hypothesized that the carriage rate of Neisseria meningitidis in asymptomatic subjects might correlate with the levels of antioxidants in plasma. To this end we took pharyngeal swabs from 339 children in Marquesado Basic Health Zone, Granada, Spain and in addition determined the total antioxidant capacity (TAC) in plasma samples from these subjects. The overall prevalence of N. meningitidis carriage was 5.9% (mean age 7.1 years) with rates of 10.3% in children aged 3 < or =years, 3.9% between 4 and 7 years and 2.4% in older subjects. Plasma TAC for the < or =3-year-olds was 0.13 for carriers and 1.10 for non-carrier controls (P=0.04), 0.13 for carriers aged 4-7 years (controls 0.63) and 0.28 for carriers aged >7 years (controls 0.52). We analysed the association between TAC in plasma (<0.37 - 2 S.D.) and the carrier state of N. meningitidis. In the carrier state, the odds ratio for this association (TAC in plasma <0.25) was 8.44 (95% CI 1.5-48.9). These findings may suggest a reduced immune response in the host favourable to nasopharyngeal persistence of meningococci.

Genetic and morphological characterisation of a new species of the genus Hysterothylacium (Nematoda) from Paralichthys isosceles Jordan, 1890 (Pisces: Teleostei) of the Neotropical Region, state of Rio de Janeiro, Brazil

Taking into account the difficulties of taxonomic identification of larval anisakid nematodes based on morphological characters, genetic analyses were performed, together with those usually applied, in order to identify anisakid larvae found in the flounder Paralichthys isosceles from the littoral of the state of Rio de Janeiro, Brazil. The analysis of 1,820 larvae revealed a new species, similar to Hysterothylacium MD, Hysterothylacium 2, Hysterothylacium KB and Hysterothylacium sp regarding the absence of the larval tooth, an excretory pore situated below the nerve ring level, and slender lateral alae. Moreover, the new species differs from Hysterothylacium fortalezae and Hysterothylacium reliquens with regard to the number and size of spines present on the tail end and from Hysterothylacium patagonicus by the absence of interlabia. The maximum parsimony and neighbour joining tree topologies based on the 18S ribosomal DNA gene, complete internal transcribed spacer region and cytochrome oxidase 2 (COII) gene demonstrated that the Brazilian larvae belong to Raphidascarididae and represent a unique genetic entity, confirmed as a new Hysterothylacium species. Furthermore, the new species presents COII genetic signatures and shares polymorphisms with Raphidascarididae members. This is the first description of a new anisakid species from Brazil through the integration of morphological and molecular taxonomy data.

Lutzomyia diamantinensis sp. nov., a new phlebotomine species (Diptera: Psychodidae) from a quartzite cave in Diamantina, state of Minas Gerais, Brazil

A new species of Brazilian phlebotomine sandfly found in Brazil, municipality of Diamantina, state of Minas Gerais, is described based on males and females collected in a quartzite cave. The body of spermathecae is continuous to the individual duct, lanky and tapering at the end, with conical shaped, not striated and presenting the head with dense setae. The male presents gonostyle with four spines and a small subterminal seta and gonocoxite with one group of persistent setae. The paramere is simple with a group of small setae on the dorsal apex. The morphological features of this new species permit its inclusion in the migonei group.

State-Society Relationships, Social Trust and the Development of Labour Market Policies in Italy and Sweden

The first decade of the twenty-first century may be remembered for the rebirth of consensus on labour market policy. After three decades of bitter political and ideological controversy between a neo-liberal and a traditional social democratic approach, a new model, often labelled flexicurity, has emerged. This model is promoted by numerous political organisations since it promises to put an end to the old trade-off between equality and efficiency. Several countries are embracing the flexicurity model as a blueprint for labour market reform, but others, mostly belonging to the 'Mediterranean Rim', are clearly lagging behind. Why is it so difficult for these countries to implement the flexicurity model? This paper argues that the application of a flexicurity strategy in these countries is complicated by the lack of social trust between social partners and the state as well as political economy traditions that highlight the role of labour market regulation as a source of social protection.

State of Iowa HIV and AIDS Surveillance Report, December 2003

There were 33 new diagnoses of HIV infection reported in Iowa in the 4th quarter. Keeping in mind that more diagnoses will yet be reported for 2003, we have so far received reports of 79 Iowans who were newly diagnosed with HIV infection in 2003. Reports on persons diagnosed in the last quarter of the year will continue to trickle in through the end of March, but we’ll definitely be substantially below the 104 diagnoses we saw in 2002.

Comfort of the patient's family in an Intensive Care Unit related to welcoming

This study aimed to identify the level of comfort of families of patients in a critical health condition related to the welcoming practices performed by the hospital staff. Interviews were conducted with 250 relatives in hospitals of the state Bahia, using a Likert scale. Data were analyzed as percentages and quartiles. For nine of the 12 statements of the scale, most relatives scored their comfort level between very and totally comfortable, median of 4,revealing kindness, tranquility and friendly communication with family members. More than half of the sample scored its level as not at all to more or less comfortable, median of 3, for statements about demonstration of interest towards the relative by the staff and flexible visiting of the patient. The necessity of greater interest of the team in the condition and needs of the family was observed. Promoting comfort from the dimension of welcoming demands interdisciplinary actions grounded in humanistic philosophy, in which the nurse has an important role to play.

Temporal distribution of Aedes aegypti Linnaeus (Diptera, Culicidae), in a Hospital in Cuiabá, State of Mato Grosso, Brazil

This study aimed at registering and monitoring the presence of Aedes aegypti in the University Hospital Júlio Muller, Cuiabá-MT, as well as investigating the influence of temperature and rainfall on its temporal distribution and egg densities in ovitraps. The study was performed from April/2007 to March/2008, utilizing ovitraps with 10% of hay infusion and a wood paddle as an oviposition substrate. For surveillance, one ovitrap was placed in each of the 12 points distributed throughout the hospital. Ovitraps were collected monthly at the end of a 5-day installation period. After egg counting, wood paddles were immersed in water to allow larval eclosion for species identification through optical microscopy. Egg Density Index (EDI), Positive Ovitraps Index (POI), and Mean Number of Eggs (MNE) were used for data analysis. The presence of A. aegypti in the hospital was registered throughout the study period, except in July. The MNE was proportionally higher in the internal area (n= 8.47 eggs/paddle) when compared to the external area (n= 5.46 eggs/paddle), and was higher in September/October 2007 and January/February 2008. A significant increase in EDI, POI and MNE was registered in periods where the average temperature was higher, and the increase in POI was also concomitant with an increase in rainfall. The continuous presence of A. aegypti in the hospital throughout the study period, points out the need of including this mosquito in the arthropod control list in this environment. This is particularly important, considering that A. aegypti is an important vector of several arboviroses.

Seasonality in insect abundance in the "Cerrado" of Goiás State, Brazil

Seasonality in insect abundance in the "Cerrado" of Goiás State, Brazil. Many studies have provided evidence that tropical insects undergo seasonal changes in abundance and that this is partly due to alternation between the dry and rainy seasons. In the Brazilian "Cerrado" (savannah), this season alternation is particularly evident. The purpose of this work was to study the seasonal abundance of insects in a "Cerrado" area in the municipality of Pirenópolis, Goiás State, Brazil. The insects were captured fortnightly using a light trap between September 2005 and August 2006. The insects collected were separated at the order level and counted. Faunistic analysis was performed to select the predominant insect orders, a multiple linear regression to examine the relation between climatic variables (temperature and precipitation) with the abundance of insects and a circular distribution analysis to evaluate the existence of seasonality in the abundance of insect orders. A total of 34,741 insect specimens were captured, belonging to 19 orders. The orders with the greatest number of specimens were Hymenoptera (8,022), Coleoptera (6,680), Diptera (6,394), Lepidoptera (6,223), Isoptera (2,272), Hemiptera (2,240) and Trichoptera (1,967), which represent 97.3% of all the specimens collected. All the orders, except for Diptera, Isoptera and Trichoptera, showed a relationship with the climate variables (temperature), and all the orders, except for Diptera, presented a grouped distribution, with greater abundance in the transition from the end of the dry season (September) to the start of the rainy one (October/November). A discussion about seasonality on the abundance of the insects is presented.

State and industry in the 1940s: The Spanish automobile industry

The decade of the 1940s was one of the darkest periods in the country's history, with years of famine, repression, general misery, and impoverishment of all aspects of national life ranging from culture to the economy. During those years plans were made to establish a Spanish motor industry once the Civil War had come to an end in 1939. It seemed a propitious moment for private enterprise and various foreign motor companies presented proposals for manufacturing their entire vehicle range, from cars to trucks. However, the government plans were for a State monopoly, a policy which meant that any private projects which did not contemplate the regime taking management decisions were rejected out of hand. From 1941 onwards, any new initiative was required to meet the plans set by INI. The main argument running through this paper is that one can only understand the development of the modern Spanish motor industry if one grasps the haggling between motor companies and government regarding market entry and the impact of the regime's autarchic policies in the 1940s.

Surrogate decision making for patients with end-stage dementia.

OBJECTIVE: We aim to explore how health surrogates of patients with dementia proceed in decision making, which considerations are decisive, and whether family surrogates and professional guardians decide differently. METHODS: We conducted an experimental vignette study using think aloud protocol analysis. Thirty-two family surrogates and professional guardians were asked to decide on two hypothetical case vignettes, concerning a feeding tube placement and a cardiac pacemaker implantation in patients with end-stage dementia. They had to verbalize their thoughts while deciding. Verbalizations were audio-recorded, transcribed, and analyzed according to content analysis. By experimentally changing variables in the vignettes, the impact of these variables on the outcome of decision making was calculated. RESULTS: Although only 25% and 31% of the relatives gave their consent to the feeding tube and pacemaker placement, respectively, 56% and 81% of the professional guardians consented to these life-sustaining measures. Relatives decided intuitively, referred to their own preferences, and focused on the patient's age, state of wellbeing, and suffering. Professional guardians showed a deliberative approach, relied on medical and legal authorities, and emphasized patient autonomy. Situational variables such as the patient's current behavior and the views of health care professionals and family members had higher impacts on decisions than the patient's prior statements or life attitudes. CONCLUSIONS: Both the process and outcome of surrogate decision making depend heavily on whether the surrogate is a relative or not. These findings have implications for the physician-surrogate relationship and legal frameworks regarding surrogacy. Copyright © 2011 John Wiley & Sons, Ltd.