Epidemiological factors related to the transmission risk of Trypanosoma cruzi in a Quilombola community, State of Mato Grosso do Sul, Brazil

INTRODUCTION: This work was an epidemiological investigation of the risk of Trypanosoma cruzi transmission in the rural Quilombola community of Furnas do Dionízio, State of Mato Grosso do Sul, Brazil. METHODS: Of the 71 animals examined, seven were captured (two opossums, Didelphis albiventris; four rats, Rattus rattus; and one nine-banded armadillo, Dasypus novemcinctus) and 64 were domestic (one canine, Canis familiaris; five pigs, Sus scrofa; two bovines, Bos taurus; five caprines, Capra sp.; and 51 ovines, Ovis aries). Parasitological tests were performed to detect parasites in the blood and to identify the morphology of flagellates. These methods included fresh examinations, buffy coat tests and blood cultures. Molecular analysis of DNA for identification of trypanosomatids was performed by polymerase chain reaction (PCR) with primers S35 and S36. RESULTS: The parasitological tests showed flagellates in an opossum and two cattle. The molecular tests showed DNA from T. cruzi in an opossum and a pig. Triatoma sordida was the only triatomine species found in the community, and it colonized households (four specimens) and the surrounding areas (124 specimens). Twenty-three specimens tested positive for flagellates, which were subsequently identified as T. cruzi by PCR. CONCLUSIONS: Data analysis demonstrated that T. cruzi has a peridomestic life cycle that involves both domestic and wild mammals.

Portuguese business groups at the beginning of the 21st century: Trends, characteristics and configurations

This study considers the literature on the persistence of business groups in developed economies and analyzes the Portuguese case. The reconstruction of the largest business groups assembles information relevant to define characteristics that enable them to thrive. Increasing internationalization, more specialization in core activities and family control define these types of big businesses. New sectors also emerge as a characteristic of these business groups when compared to the ones existing 40 years ago.

Trauma and envenoming caused by stingrays and other fish in a fishing community in Pontal do Paranapanema, state of São Paulo, Brazil: epidemiology, clinical aspects, and therapeutic and preventive measures

INTRODUCTION: Accidents caused by fish are common in inland fishing communities in Brazil, being work-related injuries in the majority of cases. These populations have no information on the mechanisms of trauma or envenoming. METHODS: Through a questionnaire administered to fishermen, we obtained clinical and epidemiological data on accidents in Rosana, Pontal do Paranapanema, State of São Paulo, Brazil. These data were analyzed and converted into an easily understood prevention and treatment program for the colony. RESULTS: Thirty-nine fishermen replied to the survey. All of the patients had been hurt by fish. Of those mentioned, the yellow catfish (Pimelodus maculatus) was the main fish species associated with injuries, but others also caused trauma to the fishermen. Six fishermen had been envenomed by stingrays. Pain and ulcers were the main symptoms and were described as intolerable. Approximately half of those injured were treated using traditional folk remedies. CONCLUSIONS: The fishermen suffered multiple accidents with catfish, which are venomous and cause intense pain, as well as trauma due to other fish, such as surubins, traíras, freshwater croakers, and piranhas. Approximately 16% of those interviewed presented with envenomation from stingrays. Our data and previous experience in the area led to the creation of a pamphlet with clear language that can effectively help fishermen in the region, an area in need of health services and disease prevention. This initiative also applies to the whole La Plata River basin, which has similar fauna.

Antibody levels in children after 10 years of vaccination against hepatitis B: a brazilian community-based study

INTRODUCTION: It is known that the hepatitis B (HB) vaccine is effective, but it is alarming that sudden drops of antibody levels may coincide with the onset of adolescence. METHODS: Antibody levels against HB vaccine surface antigen (anti-HBs) and HB vaccine core antigen (anti-HBc) were measured on the blood samples of children with a mean age of 11.4 years. RESULTS: About 54.8% had protective levels of anti-HBs. Of those who were anti-HBc-positive (4.4%), an average of 218.4 anti-HBs mIU/mL was found. CONCLUSIONS: Immunological protection was found in the majority of children. However, more studies are needed to elucidate the heritability of nonresponders and establish strategies against such events.

A harmonização fiscal europeia

With this dissertation we aim to analyze the most relevant aspects of the excise duties harmonized regime, considering Community origins, but having also in attention all legal specifications of its implementation in Portugal. The legal regime of excise duties is presented as an ambitious theme, considering the challenge of different branches of law that influence this subject, such as Tax, Economic and Community laws, the inescapable influence of customs procedures, or regarding environmental objectives. In the European context, the harmonization of excise duties was seen as a condition for the implementation of the internal market, contributing to undo secular tax barriers between Member States and, since so, ensure fair competition and free movement of services and goods. Along with VAT, the excise duties harmonization process could represent a potential European tax system, essential for a full and integrated single market. In this context, it is essential to pay special attention to specific characteristics of excise duties regime, such as ‘duty suspension arrangement’ applicable during the production phase, storage and movement in certain conditions. The growing importance of excise duties, as for revenue or extra-fiscal purposes, recommends new academic studies on this subject, seeking new opportunities and challenges.

Assessing the community needs of mental health residential care service users in Republic of Moldova

RESUMO: Background: Problemas de saúde mental são um grande problema clínico e social na República da Moldávia, representando uma quota significante de deficiência, sendo classificada no top cinco das dez linhas na hierarquia das condições. A taxa de incidência tem sido crescente na República da Moldávia, atingindo cerca de 15.000 por ano (14,655 em 2011), ou seja, 411,4 por 100 mil habitantes, e uma taxa de prevalência de 97.525 pessoas em 2011, ou seja, 2,737.9 por 100 mil habitantes. Sistema de atendimento psiquiátrico fornece serviços de saúde mental escassos a nível da comunidade, visando principalmente terapia hospitalar, centralizada, através de uma rede de três hospitais psiquiátricos, com 1.860 camas e 4 sanatórios psico- neurológicos com 1890 camas, assim alimentando-se a estigmatização do paciente. Objetivos: O objetivo deste estudo foi a avaliação das necessidades individuais dos beneficiários e do seu nível de autonomia dentro de cuidados residenciais, para o planeamento de reformas de saúde mental e desinstitucionalização na República da Moldávia. Este estudo foi encomendado pelo Ministério do Trabalho, Proteção Social e da Família e pelo Ministério da Saúde, com o apoio da Organização Mundial da Saúde, para determinar o cumprimento eficaz do artigo 19 da Convenção da ONU. O estudo tem os seguintes objetivos: Avaliar o nível de autonomia dos residentes nos hospitais psiquiátricos e sanatórios psico-neurológico, usando uma amostra representativa de 10 por ce nto do número total de pacientes/residentes e comparação cruzada; Para avaliar quatro sanatórios psico-neurológicos para adultos e três hospitais psiquiátricos; Para desenvolver recomendações para o planeamento da desinstitucionalização das pessoas com problemas de saúde mental e colocação na comunidade com base nos resultados do estudo. Metodologia e resultados: O estudo fez uso de duas ferramentas globais: questionário para a avaliação individual dos residentes do estabelecimento de saúde mental, e questionário de avaliação institucional. Todos os entrevistados foram divididos em quatro categorias conforme com o grau de dependência e preparação de viver de forma independente na comunidade. Apenas 1,2% dos entrevistados de PNHB eram totalmente dependentes de terceiros ou serviços especializados, tornando-se a categoria 4, que necessitam de cuidados e apoio contínuo. No PH esta categoria de pessoas é ausente. Conclusões: A condição dos entrevistados foi pior em PNBH que em PH. No entanto, ainda, aqueles que estão prontos para ser desinstitucionalizados correspondem com a maior parte dos entrevistados. Todos os hospitais tinham o consentimento do utente para admissão e tratamento, enquanto não houve consentimento qualquer em PNBH. É bastante óbvio que tanto os hospitais como também a sistema de assistência residencial não atingem a sua finalidade, o que significa que a maioria dos utentes pode ser desinstitucionalizados, sem qualquer terapia de suporte.------------------ABSTRACT: Background: Mental health problems are a major clinical and social issue in the Republic of Moldova,accounting for a significant share of disability and ranking in top five of the ten lines in the hierarchy of conditions. The incidence rate has been growing in the Republic of Moldova to reach approximately 15 thousand a year (14,655 in 2011), i.e. 411.4 per 100 thousand population, and a prevalence rate of 97,525 thousand people in 2011, i.e. 2,737.9 per 100 thousand population. Psychiatric care system provides for scanty mental health services at community level, aiming mainly at centralized hospital-based therapy through a network of three psychiatric hospitals tallying up 1,860 beds and 4 psycho-neurological boarding houses with 1,890 beds, thus fuelling up patient stigmatization. Objectives: The purpose of this study was to assess the individual needs of beneficiaries and their level of autonomy within residential care for the planning of mental health system reforms and deinstitutionalization in the Republic of Moldova. This study was commissioned by the Ministry of Labour, Social Protection and Family and by the Ministry of Health, with the World Health Organization support, to provide for effective enforcement of article 19 of the UN CRPD. The study pursued the following goals: To evaluate the level of autonomy of the psychiatric hospital and psycho-neurological boarding house residents by using a representative sample of 10 per cent of the total number of patients / residents and cross-comparison; To evaluate four psycho-neurological boarding houses for adults and three psychiatric hospitals; To develop recommendations for planning the deinstitutionalization of people with mental health problems and community placement based on the study findings.Methodology and results: The study made use of two global tools: questionnaire for individual assessment of mental health facility residents, and institutional assessment questionnaire. All interviewees were divided into four categories by one’s degree of dependence and readiness to live independently in the community. Only 1.2% of respondents from PNHB were fully dependent on a third party or specialized services, making up category 4, requiring continuous care and support. In PH this category of people is absent.Conclusions: The condition of respondents was worse in PNBH than in PH. However, yet, those ready to be deinstitutionalized accounted for most of respondents there. All hospitals had the resident’s consent to admission and treatment, whereas there was no consent in PNBH whatsoever. It is quite obvious that both the hospitals and residential care system do not achieve their intended purpose, meaning that the majority of residents may be deinstitutionalized without any support therapy.

Community-acquired methicillin-resistant Staphylococcus aureus carrying SCCmec type IV in southern Brazil

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen commonly associated with nosocomial infections. However, it has also been associated with community-acquired skin and soft tissue infections (CA-MRSA). There are few data on the identification and prevalence of CA-MRSA infections in Brazil. METHODS: This is a cross-sectional study of 104 patients with community-acquired skin infections attending two health care centers in Porto Alegre, southern Brazil. MRSA isolates were characterized by molecular methods, including detection of the mecA gene by PCR, gene SCCmec typing, Panton-Valentine leukocidin (PVL) detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). RESULTS: From the 104 samples, 58 Staphylococcus aureus isolates were obtained, of which five (8.6%) had a CA-MRSA-resistant profile. All five isolates had the mecA gene and amplified to SCCmec type IV. Analysis of chromosomal DNA by PFGE revealed the presence of two clusters related to international clones (OSPC and USA 300), with a Dice similarity coefficient >80%. The study was complemented by MLST, which detected three different strains: ST30, ST8, and ST45, the latter not presenting any relation with the clones compared in PFGE. CONCLUSIONS: The presence of CA-MRSA reveals an important change in the epidemiology of this pathogen and adds new elements to the knowledge of the molecular biology of infections by MRSA with SCCmec type IV in southern Brazil.

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly

IntroductionThe objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients.MethodsThis was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors.ResultsWe included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis.ConclusionsAlthough relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Conception and first results of a cross-sectional national study on the demography, disease characteristics and socioeconomics status of the Portuguese patients with multiple sclerosis : the PORT-MS study

RESUMO: Introdução e objetivos: Não existia um estudo multicêntrico que descrevesse as características dos doentes com EM, da doença em si, ou do seu tratamento, em Portugal.Métodos: Doentes McDonald 2010 positivos foram sequencialmente recrutados em 7 centros entre Maio e Novembro 2014. Aplicou-se um Caderno de Recolha de Dados incidindo na demografia, doença, educação e emprego (estudo PORT-MS). Resultados: 561 doentes incluídos. Primeiros sintomas aos 30,2±10,5 anos (RRMS 29,2±10, PPMS 39,4±11,7, p<0,001); diagnóstico 3,2±5,3 anos depois (RRMS 3,0±5,1, PPMS 4,9±2,5, p=0,002); tempo de doença após diagnóstico 9,4±7,2 anos (semelhante RRMS no diagnóstico e PPMS); idade atual 42,9±12,4 anos (grupo RRMS no diagnóstico 42,0±12,1, PPMS 52,5±11,3, p<0,001); EDSS atual 2,5 (RRMS 2.0, PPMS 6.0); proporção feminino:masculino é 2,5:1 (RRMS semelhante, PPMS 1,1:1, p<0,05); no diagnóstico RRMS 90,6%, SPMS 0,9%, PPMS 8,6%; 9,5% dos RRMS encontravam-se em SP na inclusão (nomeadamente os com mais idade no diagnóstico e/ou atualidade ou tempo de doença mais prolongado). PPMS mais frequente em doentes diagnosticados mais tardiamente (p<0,001), onde aumenta também ligeiramente a proporção de mulheres na PPMS. Nas últimas décadas: novos casos mostram estabilidade na proporção de géneros e tipos de doença; idade nos primeiros sintomas e no diagnóstico aumentou ligeiramente, tempo entre eles diminuiu ligeiramente. Proporção sob DMT (Maio 2014): global 84,5%; atualmente RRMS 90,4%; SPMS 70,8%; PPMS 36,8%; progressivas agregadas 48%. Tipo de DMT, amostra global: interferões 56,5%, GA 18,4%, Natalizumab 11,6%, Fingolimod 9,7%. Global: economicamente ativos 61,5%, desemprego 13,5%, 74,1% dos não activos estão reformados por doença. Gravidezes após diagnóstico em 15% mulheres. Casos com história familiar positiva 7,8%. Discussão e conclusões: Incluída cerca de 10% da população portuguesa. Resultados congruentes com dados internacionais. Elevada proporção sob DMT, mesmo EDSS alto e formas progressivas. Terapêuticas de segunda linha sub representadas. Doentes jovens e com doença ligeira com vida económica ativa; restantes essencialmente reformados por doença.---------------- ABSTRACT : Background/aims: In Portugal, there wasn’t a multicentric study on the general characteristics (demography, disease milestones, DMT, socioeconomic status) of Multiple Sclerosis patients. Methods: Patients fulfilling McDonald 2010 criteria were sequentially recruited from May to November 2014 in 7 centers and data was systematically collected. Results: 561 patients included. First symptoms occurred at 30,2±10,5 years-old (RRMS 29,2±10, PPMS 39,4±11,7, p<0,001); diagnosis 3,2±5,3 years later (RRMS 3,0±5,1, PPMS 4,9±2,5, p=0,002); 9,4±7,2 years elapsed since diagnosis (similar for those is RRMS at diagnosis and PPMS); current age 42,9±12,4 years-old (group RRMS at diagnosis 42,0±12,1, PPMS 52,5±11,3, p<0,001); current EDSS 2,5 (RRMS 2.0, PPMS 6.0); females to males 2,5:1 (RRMS similar, PPMS 1,1:1, p<0,05); at diagnosis RRMS 90,6%, SPMS 0,9%, PPMS 8,6%; 9,5% of RRMS reached SP at inclusion (those older at diagnosis, in actuality, or with longer follow-up). PPMS more frequente in patients diagnosed at older ages (p<0,001), also slight increase in females. Along the last decades: new cases have showed stable proportions of gender and disease types; age at first symptoms and diagnosis slightly increased, time between them slightly decreased. Proportion on DMT (May 2014): 84,5% of all; 90,4% of currently in RRMS; 70,8% of SPMS; 36,8% of PPMS; 48% of progressive forms together. Type of DMT, all patients: interferons 56,5%, Glatiramer Acetate 18,4%, Natalizumab 11,6%, Fingolimod 9,7%. Economically active 61,5% of all, unemployment 13,5%, 74,1% of non-active are retired due to disease. Females pregnant after diagnosis 15%. Positive family cases in 7,8%. Discussion/Conclusions: 10% of the national MS population collected. Data generally consistente with international reports. Proportion under DMT relatively high in all disease types, but second line therapies underrepresented. Young patients with mild disease have an active economic life. Those not active are essentially retired due to disease.

Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers

Introduction Chronic hepatitis B virus (HBV) infection and liver steatosis (LS) are the most common causes of chronic liver disease, and their coexistence is frequently observed in clinical practice. Although metabolic syndrome is the main cause of LS, it has not been associated with HBV infection. The aims of this study were to describe the lipid profile and prevalence of LS among HBV carriers and to identify the characteristics associated with LS in this group. Methods This retrospective cross-sectional study included hepatitis B surface antigen (HBsAg)-positive patients evaluated during 2011 and 2012. Results Of the 83 patients included, the mean age was 46.4±12.5 years, 53% were men, and 9.1% were hepatitis B e antigen (HBeAg) -positive. These patients exhibited the following lipid profile: total cholesterol = 175.4±38.8mg/dL, low-density lipoprotein (LDL) = 113.0±32.7mg/dL, and triglycerides = 91.1±45.2mg/dL. Their fasting glucose was 95.3±14.5g/dL, and fasting insulin was 6.1±5.9µIU/mL. Liver steatosis was observed on abdominal ultrasound in 11.3% of individuals. Factors associated with the presence of LS included higher levels of total cholesterol, prothrombin activity, fasting insulin, and body mass index (BMI) as well as lower levels of aspartate aminotransferase (AST). Conclusions These findings suggest that LS in patients with chronic HBV appears to be a consequence of metabolic alterations and insulin action rather than of viral factors.

Social capital : Social capital and psychological sense of community in the neighborhood - Predicting and preventing

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário

Characteristics of pregnant and lactating women with leprosy

INTRODUCTION: The clinical characteristics of women who conceive during leprosy and the association between leprosy and pregnancy are not well known. METHODS: This cross-sectional study included 49 pregnant or lactating women diagnosed with leprosy in 2011. RESULTS: The patients had a clinical dimorphous form of leprosy (44.9%), no physical incapacity at diagnosis (87.5%), and no complications in either the patient or infant (33.4%). In 36.3% of cases, leprosy symptoms were presented in the last trimester of pregnancy, and in 31.9% of patients were in the first trimester of lactation. CONCLUSIONS: The association between leprosy and pregnancy should be routinely investigated, particularly in endemic areas.

Supplementary private health insurance: The characteristics of subscribers

Despite the fact that public medical care has being heavily subsidized through a statutory national health system there has been a growing number of people who opt to enroll in extra private coverage. Using a two part model to infer the insurance decision and subsequent amount of insurance chosen we found out that people’s decision over private health coverage is not related with their health. The pattern of consumption of medical care that is not available in the public sector and a good socio economic background were found significant modeling the demand for private health insurance.

Impact of livestock on a mosquito community (Diptera: Culicidae) in a Brazilian tropical dry forest

AbstractINTRODUCTION: This study evaluated the effects of cattle removal on the Culicidae mosquito community structure in a tropical dry forest in Brazil.METHODS: Culicidae were collected during dry and wet seasons in cattle presence and absence between August 2008 and October 2010 and assessed using multivariate statistical models.RESULTS: Cattle removal did not significantly alter Culicidae species richness and abundance. However, alterations were noted in Culicidae community composition.CONCLUSIONS: This is the first study to evaluate the impact of cattle removal on Culicidae community structure in Brazil and demonstrates the importance of assessing ecological parameters such as community species composition.