Identification of factors and groups at risk of infection with Schistosoma mansoni: a strategy for the implementation of control measures?

A fourteen year schistosomiasis control program in Peri-Peri (Capim Branco, MG) reduced prevalence from 43.5 to 4.4%; incidence from 19.0 to 2.9%, the geometric mean of the number of eggs from 281 to 87 and the level of the hepatoesplenic form cases from 5.9 to 0.0%. In 1991, three years after the interruption of the program, the prevalence had risen to 19.6%. The district consists of Barbosa (a rural area) and Peri-Peri itself (an urban area). In 1991, the prevalence in the two areas was 28.4% and 16.0% respectively. A multivariate analysis of risk factors for schistosomiasis indicated the domestic agricultural activity with population attributive risk (PAR) of 29.82%, the distance (< 10 m) from home to water source (PAR = 25.93%) and weekly fishing (PAR = 17.21%) as being responsible for infections in the rural area. The recommended control measures for this area are non-manual irrigation and removal of homes to more than ten meters from irrigation ditches. In the urban area, it was observed that swimming at weekly intervals (PAR = 20.71%), daily domestic agricultural activity (PAR = 4.07%) and the absence of drinking water in the home (PAR=4.29%) were responsible for infections. Thus, in the urban area the recommended control measures are the substitution of manual irrigation with an irrigation method that avoids contact with water, the creation of leisure options of the population and the provision of a domestic water supply. The authors call attention to the need for the efficacy of multivariate analysis of risk factors to be evaluated for schistosomiasis prior to its large scale use as a indicator of the control measures to be implemented.

Impact of compliance with different guidelines on physical activity during pregnancy and perceived barriers to leisure physical activity

The aims of the this prospective study were to analyze physical activity (PA) engagement during the first and second trimesters, considering the different guidelines published on PA, to document the individual characteristics associated with the accomplishment of these guidelines and to examine pregnant women’s perceived barriers to leisure PA, using a socioecological framework. A sample of 133 pregnant women in two stages – at 10–12 weeks’ gestation (T1) and 20– 22 weeks’ gestation (T2) – were evaluated. PA was assessed by accelerometry during the T1 and T2 evaluation stages. Socio-demographic characteristics, lifestyle factors and barriers to leisure PA were assessed via questionnaire. A large proportion of women (ranging from 32% to 96%) did not reach the levels of PA recommended by the guidelines. There were no significant differences between T1 and T2 with regard to compliance with PA recommendations. A decrease in PA levels from T1 to T2 was noted for all recommendations. No associations were found between participants’ characteristics and adherence to the recommendations in T1 and T2. No significant differences were found in barriers to leisure PA between T1 and T2. The most commonly reported barriers to leisure PA were intrapersonal, not health related. Our results indicate that there were no differences between trimesters regarding compliance of PA recommendations, and perceived barriers were similar in both trimesters.

Toxoplasma-IgM and IgG-avidity in single samples from areas with a high infection rate can determine the risk of mother-to-child transmission

Anti-Toxoplasma IgG-avidity was determined in 168 serum samples from IgG- and IgM-positive pregnant women at various times during pregnancy, in order to evaluate the predictive value for risk of mother-to-child transmission in a single sample, taking the limitations of conventional serology into account. The neonatal IgM was considered the serologic marker of transmission. Fluorometric tests for IgG, IgM (immunocapture) and IgG-avidity were performed. Fifty-one of the 128 pregnant women tested gave birth in the hospital and neonatal IgM was obtained. The results showed 32 (62.75%) pregnant women having high avidity, IgM indexes between 0.6 and 2.4, and no infected newborn. Nineteen (37.25%) had low or inconclusive avidity, IgM indexes between 0.6 and 11.9, and five infected newborns and one stillbirth. In two infected newborns and the stillbirth maternal IgM indexes were low and in one infected newborn the only maternal parameter that suggested fetal risk was IgG-avidity. In the present study, IgG-avidity performed in single samples from positive IgM pregnant women helped to determine the risk of transmission at any time during pregnancy, especially when the indexes of the two tests were analysed with respect to gestational age. This model may be less expensive in developing countries where there is a high prevalence of infection than the follow-up of susceptible mothers until childbirth with monthly serology, and it creates a new perspective for the diagnosis of congenital toxoplasmosis.

Analysis of mental health service financial models with a particular emphasis of Ireland

ABSTRACT: Financing is a critical factor in ensuring the optimal development and delivery of a mental health system. The primary method of financing worldwide is tax-based. However many low income countries depend on out-of-pocket payments. There is a report on Irish Health Care funding but none that deals exclusively with mental health care. This paper analyses the various financial models that exist globally with respect to financing the mental health sector, examines the impact of various models on service users, especially in terms of relative ‘financial burden’ and provides a more detailed examination of the current mental health funding situation in Ireland After extensive internet and hardcopy research on the above topics, the findings were analysed and a number of recommendations were reached. Mental health service should be free at the point of delivery to achieve universal coverage. Government tax-based funding or mandatory social insurance with government top-ups, as required, appears the optimal option, although there is no one funding system applicable everywhere. Out-of-pocket funding can create a crippling financial burden for service users. It is important to employ improved revenue collection systems, eliminate waste, provide equitable resource distribution, ring fence mental health funding and cap the number of visits, where necessary. Political, economic, social and cultural factors play a role in funding decisions and this can be clearly seen in the context of the current economic recession in Ireland. Only 33% of the Irish population has access to free public health care and the number health insurance policy holders has dramatically declined, resulting in increased out-of-pocket payments. This approach risks negatively impacting on the social determinants of health, increasing health inequalities and negatively affecting economic productivity. It is therefore important the Irish government examines other options to provide funding for mental health services.

Burden experienced by families of patients with schizophrenia and its related factors

RESUMO: Objetivo: Este estudo teve como objetivo avaliar a carga dos cuidadores de doentes com Esquizofrenia e avaliar a correlação com determinadas características demográficas dos doentes e dos cuidadores, assim como com o nível de emoção expressa na família. Métodos: Este estudo descritivo-analítico foi realizado em 172 doentes com Esquizofrenia e seus cuidadores primários, que foram selecionados em ambulatório, a partir da consulta externa do Hospital Psiquiátrico em Teerão, no Irão, mediante uma amostra de conveniência. Os cuidadores foram entrevistados utilizando as escalas Zarit Burden Interview e Family Questionnaire, de forma a avaliar a sobrecarga sentida pelos cuidadores e o nível de emoção expressa na família, respectivamente. Os dados foram analisados por meio de testes de Mann-Whitney, Kruskal-Wallis, e Spearman. Resultados: O nível de sobrecarga vivenciada pela maioria dos cuidadores primários foi moderada a grave. A pontuação obtida nas sub-escalas de comentários emocionais, envolvimento excessivo e comentários críticos foram maiores do que o ponto de corte em 51,7% e 64,5% dos cuidadores, respectivamente. Os resultados mostraram que as pontuações obtidas nas duas subescalas do questionário família tinham uma correlação significativa e direta com a carga experimentada pelos cuidadores. O nível de carga experimentada pelos cuidadores foi significativamente diferente entre os grupos de idade e estado civil dos cuidadores, e género, status ocupacional e estado civil dos doentes. O número de membros da família, as condições 5 de alojamento, o tempo gasto pelo cuidador com o paciente diariamente, o nível de renda familiar e a duração da doença afetaram significativamente o nível de carga experimentada pelo cuidador. Conclusão: Com base nos resultados, alguns fatores demográficos dos cuidadores, pacientes e seus familiares afetam significativamente a carga experimentada pelos cuidadores primários. A maioria das famílias dos pacientes têm alto nível de emoção expressa e existe uma significativa associação direta entre as emoções expressas e a carga experimentada.------------ABSTRACT: Aim: This study aimed to assess the burden experienced by the caregiver of patients with Schizophrenia, and evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family. Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers selected from the outpatient clinic of a mental hospital in Tehran, Iran using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Mann-Whitney, Kruskal-Wallis, and Spearman’s tests. Results: The level of burden experienced by the majority of primary caregivers was moderate to severe. The scores obtained in the subscales of emotional over-involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers respectively. The results showed that the scores obtained in the two subscales of family questionnaire had a significant, direct correlation with the burden experienced by the caregivers. The level of burden experienced by the caregivers was significantly different between the subgroups of age and marital status of the caregivers, and gender, occupational status and marital status of the patients. Number of family members, home ownership status, time spent by the caregiver with the patient daily, level of family income and duration of disorder significantly affected the level of burden experienced by the caregiver. Conclusion: Based on the results, some demographic factors of the primary caregivers, patients and their family significantly affect the burden experienced by the primary caregivers. Most of the families of patients have high expressed emotions and a significant, direct association exists between the expressed emotions and the burden experienced.

The Impact of income support programs on transitions to employment

The income support programs are created with the purpose of fighting both, the poverty trap and the inactivity trap. The balance between both is fragile and hard to find. Thus, the goal of this work is to contribute to solve this issue by finding how income support programs, particularly the Portuguese RSI, affect transitions to employment. This is made through duration analysis, namely using Cox and Competing Risks models. A particular feature is introduced in this work as it incorporates the possibility of Defective Risks. The estimated hazard elasticity with respect to the amount of RSI received for individuals who move to employment is -0,41. More than a half of RSI receivers stays for more than a year and the probability of never leaving to employment is 44%. The results appear to indicate that RSI has affected negatively transitions to employment.

Determinants of mortality in oncology patients colonized or infected with Staphylococcus aureus

Oxacillin-resistant Staphylococcus aureus (ORSA) infection is an important cause of hospital morbidity and mortality. The objective of this study was to identify the main factors associated with death in patients colonized or infected with Staphylococcus aureus in a cancer center. A matched-pair case-control study enrolled all patients infected or colonized with ORSA (cases) admitted to the Hospital do Câncer in Rio de Janeiro from 01/01/1992 to 12/31/1994. A control was defined as a patient hospitalized during the same period as the case-patients and colonized or infected with oxacillin-susceptible Staphylococcus aureus (OSSA). The study enrolled 95 cases and 95 controls. Patient distribution was similar for the two groups (p > or = 0.05) with respect to gender, underlying diseases, hospital transfer, prior infection, age, temperature, heart and respiratory rates, neutrophil count, and duration of hospitalization. Univariate analysis of putative risk factors associated with mortality showed the following significant variables: admission to the intensive care unit (ICU), presence of bacteremia, use of central venous catheter (CVC), ORSA colonization or infection, pneumonia, use of urinary catheter, primary lung infection, prior use of antibiotics, mucositis, and absence of cutaneous abscesses. Multivariate analysis showed a strong association between mortality and the following independent variables: admission to ICU (OR [odds ratio]=7.2), presence of Staphylococcus bacteremia (OR=6.8), presence of CVC (OR=5.3), and isolation of ORSA (OR=2.7). The study suggests a higher virulence of ORSA in comparison to OSSA in cancer patients.

Simulation of OWES with five-Level converter linked to the grid: Harmonic assessment

This paper deals with a computing simulation for an offshore wind energy system taking into account the influence of the marine waves action throughout the floating platform. The wind energy system has a variable-speed turbine equipped with a permanent magnet synchronous generator and a full-power five level converter, injecting energy into the electric grid through a high voltage alternate current link. A reduction on the unbalance of the voltage in the DC-link capacitors of the five-level converter is proposed by a strategic selection of the output voltage vectors. The model for the drive train of the wind energy system is a two mass model, including the dynamics of the floating platform. A case study is presented and the assessment of the quality of the energy injected into the electric grid is discussed.

Erratum to: Measurement of the inclusive jet cross-section in proton-proton collisions at s√=7 TeV using 4.5 fb−1 of data with the ATLAS detector

It was found that the non-perturbative corrections calculated using Pythia with the Perugia 2011 tune did not include the effect of the underlying event. The affected correction factors were recomputed using the Pythia 6.427 generator. These corrections are applied as baseline to the NLO pQCD calculations and thus the central values of the theoretical predictions have changed by a few percent with the new corrections. This has a minor impact on the agreement between the data and the theoretical predictions. Figures 2 and 6 to 13, and all the tables have been updated with the new values. A few sentences in the discussion in sections 5.2 and 9 were altered or removed.

Factors associated with willingness to donate embryos for research among couples undergoing IVF

Between 2011 and 2012, 213 heterosexual couples undergoing fertility treatments in a Portuguese public fertility centre were systematically recruited to assess factors associated with willingness to donate embryos for research. Data were collected by questionnaire. Most couples (87.3%; 95% CI 82.1 to 91.5) were willing to donate embryos for research, citing benefits for science, health and infertile patients. Almost all couples (94.3%; 95% CI 89.8 to 96.7) reached consensus about the decision. Willingness to donate was more frequent in women younger than 36 years (adjusted OR 3.06; 95% CI 1.23 to 7.61) and who considered embryo research to be very important (adjusted OR: 6.32; 95% CI 1.85 to 21.64), and in Catholic men (adjusted OR 4.16; 95% CI 1.53 to 11.30). Those unwilling to donate reported conceptualizing embryos as children or living beings and a lack of information or fears about embryo research. Men with higher levels of trait anxiety (adjusted OR 0.90; 95% CI 0.84 to 0.96) were less frequently willing to donate. Future research on embryo disposition decision-making should include the assessment of gender differences and psychosocial factors. Ethically robust policies and accurate information about the results of human embryo research are required.

The Portuguese version of the Psychological Adjustment to Separation Test-Part A (PAST-A): a study with recently and non-recently divorced adults

Past research has demonstrated that divorced adults show more health problems and psychological distress than married adults. Considering the high prevalence rates of divorce among Western countries, new and robust measures should be developed to measure psychological distress after this specific transition in adulthood. The aim of this study was to adapt and validate a Portuguese version of the Psychological Adjustment to Separation Test-Part A (PAST-A; Sweeper and Halford in J Family Psychol 20(4):632–640, 2006). PAST-A is a self-report measure that assesses two key dimensions of separation adjustment problems: lonely-negativity and former partner attachment. Psychometric properties of the Portuguese version of PAST-A were assessed in terms of factor structure, internal consistency, and convergent and divergent validity, in an online convenience sample with divorced adults (N = 460). The PAST-A two-factor structure was confirmed by exploratory and confirmatory factor analyses, with each factor demonstrating very satisfactory internal consistency and good convergence. In terms of discriminant validity, the Portuguese PAST-A reveals a distinct factor from psychological growth after divorce. The results provided support for the use of the Portuguese PAST-A with divorced adults and also suggested that the explicative factors of the psychological adjustment to divorce may be cross-cultural stable. The non-existence of validated divorce-related well-being measures and its implications for divorce research are also discussed.

Distribution of risk factors in parents and siblings of patients with early coronary artery disease

OBJECTIVE: Early coronary artery disease (CAD) is associated with risk factors (RF). Offspring of parents with a RF have a greater prevalence of them. However, the distribution of RF in parents and siblings of patients with early CAD is unknown. METHODS: The study comprised the parents and siblings of 42 patients with early CAD (< 45 years), 29 males. Their mean age was 39.5±3.7 years. The following major RF were analyzed: smoking (> 5 cigarretes/day), hypercholesterolemia (total cholesterol > 200 mg/dL), hypertension (diastolic blood pressure > 90 mmHg), and diabetes (glycemia > 126 mg/dL). RESULTS: Of a total of 102 RF, 4, 3, 2, and 1 were observed in, respectively, 5, 15, 15, and 7 patients with early CAD, the most prevalent being smoking (86%) and hypercholesterolemia (83%). Diabetes was observed in 15 (36%) and hypertension in 16 (38%) patients. Smoking was more prevalent in the fathers (76%) and hypercholesterolemia in the mothers (30%). In 183 siblings, 131 RF were observed (1 patient with the disease had a mean of 4.7 siblings). The prevalences of smoking, hypertension, hypercholesterolemia, and diabetes in the siblings were, respectively, 32%, 18%, 14%, and 9%. The incidence of RF was as follows: 72 (39%) siblings had 1 RF, 25 (14%) siblings had 2 RF, and 3 (2%) siblings had 3 RF. In parents and their offspring, smoking was moderately correlated (r=0.43; P=0.02) with CAD. CONCLUSION: Smoking habit of parents is passed on to offspring, and, in association with hypercholesterolemia, it was the major cause of early CAD in offspring. High prevalence of smoking in offspring shows the potential responsibility of parents in the incidence of the disease in offspring.

Desarrollo de sistemas nano/micro-particulados con aplicación en la fotodegradación selectiva de contaminantes orgánicos en solución. Development of nano / micro-particles systems with application to selective photodegradation of organic pollutants in solution.

IDENTIFICACIÓN DEL PROBLEMA DE ESTUDIO. Las sustancias orgánicas solubles en agua no biodegradables tales como ciertos herbicidas, colorantes industriales y metabolitos de fármacos de uso masivo son una de las principales fuentes de contaminación en aguas subterráneas de zonas agrícolas y en efluentes industriales y domésticos. Las reacciones fotocatalizadas por irradiación UV-visible y sensitizadores orgánicos e inorgánicos son uno de los métodos más económicos y convenientes para la descomposición de contaminantes en subproductos inocuos y/o biodegradables. En muchas aplicaciones es deseable un alto grado de especificidad, efectividad y velocidad de degradación de un dado agente contaminante que se encuentra presente en una mezcla compleja de sustancias orgánicas en solución. En particular son altamente deseables sistemas nano/micro -particulados que formen suspensiones acuosas estables debido a que estas permiten una fácil aplicación y una eficaz acción descontaminante en grandes volúmenes de fluidos. HIPÓTESIS Y PLANTEO DE LOS OBJETIVOS. El objetivo general de este proyecto es desarrollar sistemas nano/micro particulados formados por polímeros de impresión molecular (PIMs) y foto-sensibilizadores (FS). Un PIMs es un polímero especialmente sintetizado para que sea capaz de reconocer específicamente un analito (molécula plantilla) determinado. La actividad de unión específica de los PIMs en conjunto con la capacidad fotocatalizadora de los sensibilizadores pueden ser usadas para lograr la fotodescomposición específica de moléculas “plantilla” (en este caso un dado contaminante) en soluciones conteniendo mezclas complejas de sustancias orgánicas. MATERIALES Y MÉTODOS A UTILIZAR. Se utilizaran técnicas de polimerización en mini-emulsión para sintetizar los sistemas nano/micro PIM-FS para buscar la degradación de ciertos compuestos de interés. Para caracterizar eficiencias, mecanismos y especificidad de foto-degradación en dichos sistemas se utilizan diversas técnicas espectroscópicas (estacionarias y resueltas en el tiempo) y de cromatografía (HPLC y GC). Así mismo, para medir directamente distribuciones de afinidades de unión y eficiencia de foto-degradación se utilizaran técnicas de fluorescencia de molécula/partícula individual. Estas determinaciones permitirán obtener resultados importantes al momento de analizar los factores que afectan la eficiencia de foto-degradación (nano/micro escala), tales como cantidad y ubicación de foto- sensibilizadores en las matrices poliméricas y eficiencia de unión de la plantilla y los productos de degradación al PIM. RESULTADOS ESPERADOS. Los estudios propuestos apuntan a un mejor entendimiento de procesos foto-iniciados en entornos nano/micro-particulados para aplicar dichos conocimientos al diseño de sistemas optimizados para la foto-destrucción selectiva de contaminantes acuosos de relevancia social; tales como herbicidas, residuos industriales, metabolitos de fármacos de uso masivo, etc. IMPORTANCIA DEL PROYECTO. Los sistemas nano/micro-particulados PIM-FS que se propone desarrollar en este proyecto se presentan como candidatos ideales para tratamientos específicos de efluentes industriales y domésticos en los cuales se desea lograr la degradación selectiva de compuestos orgánicos. Los conocimientos adquiridos serán indispensables para construir una plataforma versátil de sistemas foto-catalíticos específicos para la degradación de diversos contaminantes orgánicos de interés social. En lo referente a la formación de recursos humanos, el proyecto propuesto contribuirá en forma directa a la formación de 3 estudiantes de postgrado y 2 estudiantes de grado. En las capacidades institucionales se contribuirá al acondicionamiento del Laboratorio para Microscopía Óptica Avanzada (LMOA) en el Dpto. de Química de la UNRC y al montaje de un sistema de microscopio de fluorescencia que permitirá la aplicación de técnicas avanzadas de espectroscopia de fluorescencia de molecula individual. Water-soluble organic molecules such as certain non-biodegradable herbicides, industrial dyes and metabolites of widespread use drugs are a major source of pollution in groundwater from agricultural areas and in industrial and domestic effluents. Photo-catalytic reactions by UV-visible irradiation and organic sensitizers are one of the most economical and convenient methods for the decomposition of pollutants into harmless byproducts. In many applications it is highly desirable a high degree of specificity, effectiveness and speed of degradation of specific pollutants present in a complex mixture. In particular nano/micro-particles systems that form stable aqueous suspensions are highly desirable because they allow for easy application and effective decontamination of large volumes of fluids. Herein we propose the development of nano/micro particles composed by molecularly imprinted polymers (MIP) and photo-sensitizers (PS). The specific binding of MIP and the photo-catalytic ability of the sensitizers are used to achieve the photo-decomposition of specific "template" molecules in complex mixtures. Mini-emulsion polymerization techniques will be used to synthesize nano/micro MIP-FS systems. Spectroscopy (steady-state and time resolved) and chromatography (GC and HPLC) will be used to characterize efficiency, mechanisms and specificity of photo-degradation in these systems. In addition single molecule/particle fluorescence spectroscopy techniques will be used to directly measure distributions of binding affinities and photo-degradation efficiency in individual particles. The proposed studies point to a more detailed understanding of the factors affecting the photo-degradation efficiency in nano/micro-particles and to apply that knowledge in the design of optimized systems for photo-selective destruction of socially relevant aqueous pollutants.

Functional Capacity of Patients with Pacemaker Due to Isolated Congenital Atrioventricular Block

Background:Isolated congenital atrioventricular block (CAVB) is a rare condition with multiple clinical outcomes. Ventricular remodeling can occur in approximately 10% of the patients after pacemaker (PM) implantation.Objectives:To assess the functional capacity of children and young adults with isolated CAVB and chronic pacing of the right ventricle (RV) and evaluate its correlation with predictors of ventricular remodeling.Methods:This cross-sectional study used a cohort of patients with isolated CAVB and RV pacing for over a year. The subjects underwent clinical and echocardiographic evaluation. Functional capacity was assessed using the six-minute walk test. Chi-square test, Fisher's exact test, and Pearson correlation coefficient were used, considering a significance level of 5%.Results:A total of 61 individuals were evaluated between March 2010 and December 2013, of which 67.2% were women, aged between 7 and 41 years, who were using PMs for 13.5 ± 6.3 years. The percentage of ventricular pacing was 97.9 ± 4.1%, and the duration of the paced QRS complex was 153.7 ± 19.1 ms. Majority of the subjects (95.1%) were asymptomatic and did not use any medication. The mean distance walked was 546.9 ± 76.2 meters and was strongly correlated with the predicted distance (r = 0.907, p = 0.001) but not with risk factors for ventricular remodeling. (Arq Bras Cardiol. 2014; [online].ahead print, PP.0-0)Conclusions:The functional capacity of isolated CAVB patients with chronic RV pacing was satisfactory but did not correlate with risk factors for ventricular remodeling.

The demand elasticity on tolled motorways

This paper analyses the elasticities of demand in tolled motorways in Spain with respect to the main variables influencing it. The demand equation is estimated using a panel data set where the cross-section observations correspond to the different Spanish tolled motorways sections, and the temporal dimension ranges from the beginning of the eighties until the end of the nineties. The results show a high elasticity with respect to the economic activity level. The average elasticity with respect to petrol price falls around -0.3, while toll elasticities clearly vary across motorway sections. These motorway sections are classified into four groups according to the estimated toll elasticity with values that range from -0.21 for the most inelastic to -0.83 for the most elastic. The main factors that explain such differences are the quality of the alternative road and the length of the section. The long-term effect is about 50 per cent higher than the short term one; however, the period of adjustment is relatively short.