Suitability of containers from different sources as breeding sites of Aedes aegypti (L.) in a cemetery of Buenos Aires City, Argentina

Cemeteries are ideal urban areas to study the importance of different types of containers as breeding sites of Aedes aegypti (L.). In the present study, the suitability of plastic, glass, ceramic and metal containers was evaluated in four patches within a cemetery of Buenos Aires City, Argentina. Between October 1998 and May 2000, we found 215 breeding sites of Ae. aegypti out of 13,022 water-filled containers examined. In two patches containing microenvironments sheltered from the sun, the use of the different types of containers was proportional to the offer (correlation coefficient = 0.99, P < 0.05 in both cases). In the remaining patches, plastic and metal containers were the most and less frequent breeding sites, respectively (P < 0.001 in both cases). The number of immatures per breeding site (median = 4.5) did not show significant differences among the four types of containers examined (H3, 215 = 1.216, P = 0.749). Differences found in patches from a same cemetery suggest that different microenvironmental conditions affect the suitability of each type of container for Ae. aegypti breeding. Plastic containers appeared as key breeding sites that should be removed to reduce the Ae. aegypti population in the study area.

Clinical and epidemiological aspects of human parvovirus B19 infection in an urban area in Brazil (Niterói city area, State of Rio de Janeiro, Brazil)

This study was designed to analyse the clinical and epidemiological data from human parvovirus B19 cases in a six-year study of rash diseases conduct in an urban area in Brazil (Niterói city area, State of Rio de Janeiro). A total of 673 patients with acute rash diseases were seen at two primary health care units and at a general hospital. A clotted blood sample was collected from all subjects at the time of consultation. Forty-nine per cent (330 cases) of the patients were negative for dengue, rubella and measles IgM or for low avidity IgG to HHV-6. Of these 330, 105 (31.8%) were identified as IgM positive to parvovirus B19 by using an antibody capture EIA. During the study period, three distinct peaks of parvovirus infection were detected, suggesting that the disease appears to cycle in approximately 4-5 years. B19 infection was characterized by variable combinations of fever, flu-like symptoms, arthropathy, and gastrointestinal symptoms. Frequency of fever and arthropathy was substantially higher in adults, 75% [chi2 (1 D.F.) = 11.39, p = 0.0007] and 62.5% [chi2 (1 D.F.) = 29.89, p = 0.0000], respectively. "Slapped-cheek" appearance and reticular or lace-like rash were seen in only 30.1% of the children. No adult presented this typical rash. The lack of the typical rash pattern in a large proportion of parvovirus B19 and the similarity of clinical manifestations to other rash diseases, specially to rubella, highlight the difficulty of diagnosing B19 infection on clinical grounds alone.

Planning for an Ageing Population: Strategic Considerations

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An Integrated Work Force Planning Strategy For The Health Services 2009 - 2012

An Integrated Work Force Planning Strategy For The Health Services 2009 – 2012 Click here to download PDF 1.6mb

Prevalence of Clostridium spp. and Clostridium difficile in children with acute diarrhea in São Paulo city, Brazil

Species of Clostridium are widely distributed in the environment, inhabiting both human and animal gastrointestinal tracts. Clostridium difficile is an important pathogen associated with outbreaks of pseudomembranous colitis and other intestinal disorders, such as diarrhea. In this study, the prevalence of Clostridium spp. and C. difficile, from hospitalized children with acute diarrhea, was examined. These children were admitted to 3 different hospitals for over 12 months. Eighteen (20%) and 19 (21%) stool specimens from children with (90) and without (91) diarrhea respectively, were positive to clostridia. Only 10 C. difficile strains were detected in 5.5% of the stool samples of children with diarrhea. None healthy children (without diarrhea) harbored C. difficile. From these 10 C. difficile, 9 were considered as toxigenic and genotyped as tcdA+/tcdB+ or tcdA-/tcdB+, and 1 strain as nontoxigenic (tcdA-/tdcB-). They were detected by the citotoxicity on VERO cells and by the multiplex-polymerase chain reaction. Thirty clinical fecal extracts produced minor alterations on VERO cells. The presence of C. difficile as a probable agent of acute diarrhea is suggested in several countries, but in this study, the presence of these organisms was not significant. More studies will be necessary to evaluate the role of clostridia or C. difficile in diarrhoeal processes in children.

Planning Practice Guidance

The Department for Communities and Local Government has published National Planning Practice Guidance which recognises the importance of local infrastructure planning in the development of healthy communities. The guidance supports the National Planning Policy Framework and now includes a section on health and wellbeing. This guidance sets out the government’s planning policies for England and how these are expected to be applied by local authorities. A significant development in the guidance is the recognition of the important role the planning system can play in facilitating social interaction and creating healthy, inclusive communities. Local planning authorities should ensure that health and wellbeing, and health infrastructure are considered in local and neighbourhood plans and in planning decision making.

Seasonal pattern of abundance of Aedes aegypti (Diptera: Culicidae) in Buenos Aires city, Argentina

In Buenos Aires, the most crowded city of Argentina, there is a potential risk of dengue virus transmission by the mosquito Aedes aegypti during late summer. The temporal patterns of oviposition activity and abundance of breeding sites of this vector were studied in two cemeteries of the city. Between September 1998 and August 1999, we examined 142 ovitraps weekly and a total of 18,010 water-filled containers. Both study areas showed remarkable differences in the percentages of positive ovitraps (19% vs 8%) and breeding sites (18% vs 1%), but similar temporal abundance patterns. The percentage of breeding sites was higher in summer and autumn than in spring and winter, and the percentage of positive ovitraps was higher in summer than in the other three seasons. Immatures were recorded from the first week of October to the second week of July, and oviposition activity from the third week of October until the end of April. In both cemeteries and with both methodologies the highest infestation levels were registered in March (ovitraps: 41.8% and 20.6%, breeding sites: 39.2% and 3.4%). These highest abundances took place after several months with mean temperatures above 20ºC and accumulated rainfalls above 150 mm. A sharp decline in oviposition activity was observed when monthly mean temperature decreased to 16.5ºC, and no eggs were found below 14.8ºC. Seasonal fluctuation of Ae. aegypti abundances in mid-latitudes like Buenos Aires would allow reduction of the egg mosquito population through the elimination of containers during the coldest months, which are free of adults.

Feeding preference of the sand flies Lutzomyia umbratilis and L. spathotrichia (diptera: Psychodidae, Phlebotominae) in an urban forest patch in the city of Manaus, Amazonas, Brazil

Precipitin tests were performed on blood meals of 199 sand flies (161 Lutzomyia umbratilis, 34 L. spathotrichia, two Lutzomyia of group shannoni, one L. anduzei) in a non-flooded upland forest on the Campus of the Universidade Federal do Amazonas. This is the second largest forest fragment in an urban setting in Brazil. Results on L. umbratilis, which is considered to be the principal leishmaniasis vector in this region, indicated rodents as its predominant blood source in contrast to previous reports in which blood meal analysis indicated that this species fed principally on Xenarthra (particularly sloths)

Rôle des paramètres sociopolitiques et des connaissances dans la gestion des risques hydrologiques

Résumé Rôle des paramètres sociopolitiques et des connaissances dans la gestion des risques hydrologiques¦La recherche analyse (1) la mise en oeuvre de la gestion des risques hydrologiques et (2) les connaissances dont disposent les acteurs sur ces derniers, ainsi que (3) les interdépendances entre ces deux volets. Au total, trois études de cas ont été réalisées dont deux études régionales (ville de Berne, commune de Saillon) et une étude sur un acteur spécifique (les corporations de digues dans le canton de Berne). Les données empiriques ont été obtenues par des entretiens oraux semi-directifs et des enquêtes écrites.¦La gestion des risques hydrologiques est fortement influencée par des paramètres sociopolitiques, c'est-à-dire par les intérêts et les objectifs des acteurs, par les rapports de force entre ceux-ci ainsi que par les processus de négociation et de décision. Dans la pratique, les démarches de gestion se restreignent toutefois majoritairement aux aspects physiques, techniques et administratifs des risques hydrologiques. La dimension sociopolitique est ainsi négligée, ce qui est source de conflits qui ralentissent considérablement la planification de la protection contre les crues, voire la bloquent même complètement. La gestion des risques hydrologiques est en outre largement focalisée sur la réduction des aléas. Lés débats sur la vulnérabilité sont nettement plus rares bien qu'ils soient indispensables lorsqu'il s'agit de traiter les risques de façon holistique.¦Etant donné l'importance de la dimension sociopolitique et de la vulnérabilité, il est nécessaire que les démarches prévues dans la gestion des risques hydrologiques soient reconsidérées et adaptées. De plus, une meilleure intégration de tous les acteurs concernés est primordiale afin de trouver des solutions qui soient acceptables pour une majorité. Pour l'instant, le recours à des instruments de négociation est insuffisant.¦Les connaissances des risques hydrologiques et de leur gestion peuvent être classées en quatre répertoires (connaissances du système, de l'événement, de l'intervention et connaissances sociopolitiques) qui influent tous sur la réduction des risques. Parmi les facteurs les plus importants susceptibles de déclencher des transformations se trouvent l'occurrence de crues, la réalisation d'études (portant sur les aléas, la vulnérabilité, les mesures, etc.), l'échange de connaissances entre les acteurs, ainsi que la recherche de solutions lors de la gestion.¦Les caractéristiques des connaissances varient considérablement selon les acteurs. L'appartenance à un groupe donné ne permet toutefois pas à elle seule de déterminer l'état des connaissances : tous les acteurs peuvent avoir des connaissances pertinentes pour la gestion des risques. Les différences entre les acteurs rendent pourtant la communication compliquée. Ce problème pourrait être atténué par des médiateurs qui assureraient un travail de traduction. Dans la pratique, de telles instances manquent généralement.¦La gestion et les connaissances des risques hydrologiques sont fortement interdépendantes. L'état et les caractéristiques des connaissances déterminent directement la qualité de la protection contre les crues. Des lacunes ou des imprécisions peuvent donc entraîner une gestion non adaptée aux risques présents. Afin d'éviter une telle situation, il est important que les connaissances sur les risques hydrologiques et sur les possibilités d'y faire face soient régulièrement remises à jour. Ne devant pas se restreindre à l'expérience de crues passées, il est impératif qu'elles contiennent aussi des réflexions prospectives et des scénarios novateurs.¦La gestion n'est pas seulement demandeuse en connaissances, elle est également susceptible d'en générer de nouvelles et d'élargir les connaissances existantes. Il convient donc de considérer la création et le transfert de connaissances comme une tâche centrale de la gestion des risques.¦Zusammenfassung Die Rolle der soziopolitischen Parameter und des Wissens im Umgang mit hydrologischen Risiken¦Die Arbeit untersucht drei Themenbereiche: (1) den soziopolitischen Umgang mit hydrologischen Risiken, (2) das Wissen, über das die Akteure bezüglich der Hochwasserrisiken verfügen sowie (3) die Wechselwirkungen zwischen diesen beiden Themenfeldern. Insgesamt wurden drei Fallstudien durchgeführt, darunter zwei regionale Studien (Stadt Bern, Gemeinde Saillon) und eine Untersuchung eines spezifischen Akteurs (Schwellenkorporationen im Kanton Bern). Die empirischen Daten wurden anhand von halbstandardisierten Interviews und schriftlichen Umfragen erhoben.¦Das Management hydrologischer Risiken ist stark von soziopolitischen Parametern beeinflusst, d.h. von Interessen und Zielvorstellungen der Akteure, von Machtverhältnissen und von Verhandlungs- und Entscheidungsprozessen. Die in der Praxis vorgesehenen Schritte zur Reduktion der Hochwasserrisiken beschränken sich jedoch meist auf die physischen, administrativen und technischen Aspekte der Risiken. Die Vernachlässigung ihrer soziopolitischen Dimension führt zu Konflikten, welche die Planung von Hochwasserschutzprojekten deutlich verlangsamen oder gar blockieren. Des Weiteren konzentriert sich das Risikomanagement im Wesentlichen auf die Reduktion der Gefahren. Gesellschaftliche Debatten zur Vulnerabilität sind deutlich seltener, obschon sie für einen umfassenden Umgang mit Risiken unabdingbar sind.¦Angesichts der Bedeutung der soziopolitischen Dimension und der Vulnerabilität ist es notwendig, dass die Vorgehensweise im Risikomanagement überdacht und angepasst wird. Zudem ist eine bessere Integration aller betroffener Akteure unablässig, um mehrheitsfähige Lösungen zu finden. Zur Zeit ist der Rückgriff auf entsprechende Instrumente ungenügend.¦Das Wissen über hydrologische Risiken und deren Management kann in vier Repertoires eingeteilt werden (Systemwissen, Ereigniswissen, Interventionswissen, soziopolitisches Wissen), die alle bei der Reduktion von Risiken bedeutsam sind. Zu den wichtigsten Faktoren, die Wissenstransformationen auslösen, gehören Hochwasserereignisse, die Durchführung von Studien (zu Gefahren, zur Vulnerabilität, zu Massnahmen usw.), der Wissensaustausch zwischen Akteuren und die Suche nach Lösungen während des Risikomanagements.¦Die Merkmale der Wissensformen unterschieden sich stark zwischen den verschiedenen Akteuren. Die Zugehörigkeit eines Akteurs zu einer bestimmten Gruppe ist jedoch kein ausreichendes Kriterium, um dessen Wissensstand zu bestimmen: Alle Akteure können über Wissen verfügen, das für den Umgang mit Risiken relevant ist. Die Unterschiede zwischen den Akteuren gestalten die Kommunikation allerdings schwierig. Das Problem liesse sich entschärfen, indem Mediatoren eingesetzt würden, die als Übersetzer und Vermittler agierten. In der Praxis fehlen solche Instanzen weitgehend.¦Zwischen dem Umgang mit hydrologischen Risken und dem Wissen bestehen enge Wechselwirkungen. Der Zustand und die Eigenschaften der Wissensformen bestimmen direkt die Qualität des Hochwasserschutzes. Lückenhaftes und unpräzises Wissen kann demnach zu einem Risikomanagement führen, das den tatsächlichen Gegebenheiten nicht angepasst ist. Um eine solche Situation zu verhindern, muss das Wissen über Risiken und Hochwasserschutz regelmässig aktualisiert werden. Dabei darf es sich nicht auf die Erfahrung vergangener Hochwasser beschränken, sondern hat auch vorausschauende Überlegungen und neuartige Szenarien einzubeziehen.¦Das Risikomanagement benötigt nicht nur Wissen, es trägt auch dazu bei, neues Wissen zu t generieren und bestehendes zu erweitern. Die Erarbeitung und der Transfer von Wissen sind deshalb als zentrale Aufgaben des Risikomanagements zu betrachten.¦Abstract¦The role of socio-political parameters and of knowledge in the management of hydrological risks¦The purpose of the thesis is to analyse (1) the socio-political management of hydrological risks, (2) the knowledge about hydrological risks, and (3) the interaction between risk management and knowledge. Three case studies were carried out, two at a regional level (city of Berne, village of Saillon) and one about a specific stakeholder (the dyke corporations in the canton of Berne). Empirical data were collected by the means of semi-structured interviews and surveys.¦The management of hydrological risks is highly influenced by socio-political issues, i.e. by interests and goals of stakeholders, by the balance of power between stakeholders, as well as by negotiations and decision-making processes. In practice, however, risk management is mainly constrained by physical, technical, and administrative aspects. The neglect of the socio-political dimension may thus be the source of conflicts which significantly delay the planning and implementation of flood protection measures, or even stop them. Furthermore, risk management mostly concentrates on hazard reduction. Discussions on vulnerability issues are less frequent although they are fundamental for treating risks in a holistic manner.¦Because of the importance of the social-political dimension and of vulnerability issues, it is necessary that the common approach of managing hydrological risks is reconsidered and adapted. Moreover, the integration of all stakeholders that are concerned with hydrological risks is essential for finding solutions which are supported by a majority. For instance, the application of appropriate negotiation instruments is insufficient.¦Knowledge about hydrological risks and their management can be classified into four categories (system knowledge, event knowledge, intervention knowledge, socio-political knowledge) which are all influencing the reduction of risks. Among the most important factors that are likely to trigger knowledge transformations, one can point out flood events, studies about risk parameters (hazards, vulnerability, protection measures, etc.), knowledge exchange between stakeholders, and the search for solutions during risk management.¦The characteristics of knowledge vary considerably between stakeholders. The affiliation to a specific group is thus not a sufficient criterion to determine the quality of a stakeholder's knowledge: every stakeholder may have knowledge that is relevant for risk management. However, differences between stakeholders complicate the communication. This problem could be attenuated by mediators which ensure the translation between stakeholders. In practice, such instances are generally lacking.¦The management and knowledge of hydrological risks are highly interdependent. The state and the characteristics of the four categories of knowledge determine directly the quality of flood protection. Gaps and imprecison may thus lead to forms of management which are not adapted to the actual risks. This kind of situation can be avoided by updating regularly the knowledge about hydrological risks and about protection measures. However, knowledge must not be restricted to the experience of past floods. On the contrary, it is indispensable also to involve prospective reflections and new scenarios.¦Risk management does not only require knowledge, it may also generate new knowledge and enlarge existing knowledge. The creation and the transfer of knowledge has thus to be seen as a central task in risk management.

The prevalence of human immunodeficiency virus type 1 and hepatitis C virus among injection drug users who use high risk inner-city locales in Miami, Florida

In order to estimate the prevalence of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) co-infection in hard-to-reach intravenous drug users, 199 subjects from high-risk inner-city locales, the so called "shooting galleries", were consented, interviewed, and tested in Miami, FL, US. Positive HIV-1 status was based on repeatedly reactive ELISA and confirmatory Western Blot. Positive HCV status was based on reactive ELISA and confirmatory polymerase chain reaction techniques. Overall, 50 (25%) were not infected with either virus, 61 (31%) were HIV-1/HCV co-infected, 17 (8%) infected by HIV-1 only, and 71 (36%) infected by HCV only. The results of the multivariable analyses showed that more years using heroin was the only significant risk factor for HCV only infection (odds ratio = 1.15; 95% confidence interval = 1.07, 1.24) and for HIV-1/HCV co-infection (odds ratio = 1.17; 95% confidence interval = 1.09, 1.26). This paper demonstrates that HIV-1/HCV co-infection is highly prevalent among so called "shooting galleries".

Clustering and hot spot detection in socio-economic spatio-temporal data

Distribution of socio-economic features in urban space is an important source of information for land and transportation planning. The metropolization phenomenon has changed the distribution of types of professions in space and has given birth to different spatial patterns that the urban planner must know in order to plan a sustainable city. Such distributions can be discovered by statistical and learning algorithms through different methods. In this paper, an unsupervised classification method and a cluster detection method are discussed and applied to analyze the socio-economic structure of Switzerland. The unsupervised classification method, based on Ward's classification and self-organized maps, is used to classify the municipalities of the country and allows to reduce a highly-dimensional input information to interpret the socio-economic landscape. The cluster detection method, the spatial scan statistics, is used in a more specific manner in order to detect hot spots of certain types of service activities. The method is applied to the distribution services in the agglomeration of Lausanne. Results show the emergence of new centralities and can be analyzed in both transportation and social terms.

A Survey of Health Service Utilisation and Health Needs of a Population of Patient with HIV/ AIDS

This study described the demographic and medical characteristics of a population of patients with HIV/AIDS attending the department of Genito-Urinary Medicine (GUM) at a major Dublin hospital. The study population's utilisation of statutory and voluntary medical and social services at primary care level, satisfaction with services received and perceived need for services examined. The information obtained was used to make recommendations concerning the provision of care to patients with HIV/AIDS. The study was carried out between February and November 1994. Data was collected from a consecutive sample of eighty inpatients using n interviewer-administered questionnaire which contained both closed and open questions. The first forty patients interviewed were reviewed six months following the initial interview to document changes in physical condition and uptake of medical services over that time period. Data for the second part of the study was obtained by review of the patients' medical case notes and interview with the individual hospital medical social worker assigned to each patient. Over ninety percent of respondents were from the Greater Dublin Area. Almost three quarters were intravenous drug users (IVDUs), and the majority of these patients came from south inner city Dublin. The methodology was biased towards sampling patients with advanced disease and 73% had CDC Stage 4 disease. Twenty percent required some assistance with the activities of daily living when first interviewed. Most were reliant on informal carers. Social and physical dependency increased substantially over the six month period of the follow-up study of forty patients. Financial difficulties were identified as a particular area of need. Only ten percent of those interviewed were in current employment and over 80% were dependent on statutory payments. There is a need for greater co-ordination between the providers of services to patients HIV/AIDS and an improved system of data collection regarding patients' uptake of services and unmet needs is required to assist in future service planning.This resource was contributed by The National Documentation Centre on Drug Use.