Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

Distribution and risk factors for Plasmodium and helminth co-infections: a cross-sectional survey among children in Bagamoyo district, coastal region of Tanzania.

BACKGROUND: Plasmodium and soil transmitted helminth infections (STH) are a major public health problem, particularly among children. There are conflicting findings on potential association between these two parasites. This study investigated the Plasmodium and helminth co-infections among children aged 2 months to 9 years living in Bagamoyo district, coastal region of Tanzania. METHODS: A community-based cross-sectional survey was conducted among 1033 children. Stool, urine and blood samples were examined using a broad set of quality controlled diagnostic methods for common STH (Ascaris lumbricoides, hookworm, Strongyloides stercoralis, Enterobius vermicularis, Trichuris trichura), schistosoma species and Wuchereria bancrofti. Blood slides and malaria rapid diagnostic tests (mRDTs) were utilized for Plasmodium diagnosis. RESULTS: Out of 992 children analyzed, the prevalence of Plasmodium infection was 13% (130/992), helminth 28.5% (283/992); 5% (50/992) had co-infection with Plasmodium and helminth. The prevalence rate of Plasmodium, specific STH and co-infections increased significantly with age (p < 0.001), with older children mostly affected except for S. stercoralis monoinfection and co-infections. Spatial variations of co-infection prevalence were observed between and within villages. There was a trend for STH infections to be associated with Plasmodium infection [OR adjusted for age group 1.4, 95% CI (1.0-2.1)], which was more marked for S. stercoralis (OR = 2.2, 95% CI (1.1-4.3). Age and not schooling were risk factors for Plasmodium and STH co-infection. CONCLUSION: The findings suggest that STH and Plasmodium infections tend to occur in the same children, with increasing prevalence of co-infection with age. This calls for an integrated approach such as using mass chemotherapy with dual effect (e.g., ivermectin) coupled with improved housing, sanitation and hygiene for the control of both parasitic infections.

INFLUENCE OF INFORMATION ABOUT THE BENEFITS OF CONSUMING FRUIT ON CONSUMER PREFERENCES IN TEMUCO, REGION OF THE ARAUCANÍA

ABSTRACT With the aim of identifying strategies to increase fruit consumption in Temuco, consumer segments were classified according to the importance and preference of theattributes type of fruit, package/ brand, benefit associated with fruit consumption and price. A survey was applied to 400 people in Temuco,Chile, distributed using a simple allocation: 200 working adults and 200university students. The questionnaire included the SWFL (Satisfaction with Food-related Life) scale, respondents’ fruit consumption habits and their characteristics. Using conjoint and cluster analyses, three segments were distinguished: Group 1 (22.0%) gave greatest importance to the package/brand and preferred themessage “prevents diseases” and “without information”; Group 2 (47.5%) gave greatest importance to the package/brand and preferred the message “prevents diseases”; Group 3 (30.5%) assigned greatest importance to the price and preferred the message “contains antioxidants”. The segments differed in their level of satisfaction with food-related life, self-declared lifestyle, age and presence of university students. The results provide input to promote fruit consumption in working adults and university students.

Occurrence and risk factors assessment associated with Mycoplasma gallisepticum (MG) infection in chickens in the semiarid region of Pernambuco, Brazil

Abstract: The aim of the present study was to assess the occurrence of Mycoplasma gallisepticum (MG) infection and risk factors of this disease in three hundred serum samples from on 23 familiar agricultural properties in the semiarid region of the state of Pernambuco, Brazil. ELISA was used to study antibodies anti-Mycoplasma gallisepticum. The univariate analysis (chi-squared test or Fischer's exact test) followed by multivariate analysis (logistic regression) were used to assess the risk factors with two variables: management and sanity of the poultry. It was detected a frequence of 53.33% (157/300) of the birds were positive for MG, with 100% foci. The risk factors confirmed by multivariate analysis, in the present study, were the presence of other poultry species on the property, including Numida meleagris (OR=2.22; p=0.005), parrots (OR=1.72; p=0.027), and of passerines (OR=1.88; p=0.007). These results showed that Mycoplasma gallisepticum infection is endemic among backyard poultry in the semiarid region of the state of Pernambuco. These birds could be a source of infection for other wild or domestic poultry. . This is the first report of the occurrence of avian mycoplasmosis in backyard poultry in the state of Pernambuco in northeastern Brazil. The risk factors identified should serve as a parameter for the health authorities to seek solutions related to controlling the disease.

Testing pigs of non-technified rearing farms for serum antibodies against Taenia solium in a region of the state of São Paulo, Brazil

Abstract: Taenia solium is a zoonotic tapeworm of great importance in developing countries, due to the occurrence of human taeniasis and cysticercosis. Pigs have an important role in the biological cycle of the parasite as intermediate hosts. The scientific literature has been describing risk factors associated with the occurrence of this disease that must be avoided in countries with poor sanitation, in order to reduce the exposure of swine to the parasite eggs. This research focused on testing pigs of non-technified rearing farms for serum antibodies against Taenia solium in the region of Jaboticabal municipality, in the state of São Paulo, Brazil. The found prevalence was 6.82% (CI 95% 4.18 - 9.45) at animal level and 28.87% (CI 95% 16.74 - 40.40) at herd level. These figures are probably associated with low technification adoption during animal rearing in the studied area, which increased the exposure of the animals to risk factors associated with the occurrence of Taenia solium complex. The results found based on serological evidences of swine cysticercosis in the studied region serves as a warning to public sanitary authorities to improve public health and control T. solium.

Comparative sequence analysis of the P-, M- and L-coding region of the measles virus CAM-70 live attenuated vaccine strain

Measles virus is a highly contagious agent which causes a major health problem in developing countries. The viral genomic RNA is single-stranded, nonsegmented and of negative polarity. Many live attenuated vaccines for measles virus have been developed using either the prototype Edmonston strain or other locally isolated measles strains. Despite the diverse geographic origins of the vaccine viruses and the different attenuation methods used, there was remarkable sequence similarity of H, F and N genes among all vaccine strains. CAM-70 is a Japanese measles attenuated vaccine strain widely used in Brazilian children and produced by Bio-Manguinhos since 1982. Previous studies have characterized this vaccine biologically and genomically. Nevertheless, only the F, H and N genes have been sequenced. In the present study we have sequenced the remaining P, M and L genes (approximately 1.6, 1.4 and 6.5 kb, respectively) to complete the genomic characterization of CAM-70 and to assess the extent of genetic relationship between CAM-70 and other current vaccines. These genes were amplified using long-range or standard RT-PCR techniques, and the cDNA was cloned and automatically sequenced using the dideoxy chain-termination method. The sequence analysis comparing previously sequenced genotype A strains with the CAM-70 Bio-Manguinhos strain showed a low divergence among them. However, the CAM-70 strains (CAM-70 Bio-Manguinhos and a recently sequenced CAM-70 submaster seed strain) were assigned to a specific group by phylogenetic analysis using the neighbor-joining method. Information about our product at the genomic level is important for monitoring vaccination campaigns and for future studies of measles virus attenuation.

Chemical composition and bioactive compounds of grape pomace (Vitis vinifera L.), Benitaka variety, grown in the semiarid region of Northeast Brazil

Grape pomace (Vitis vinifera L.), Benitaka variety, grown in the semiarid region of Northeast Brazil was evaluated in relation to chemical composition, and content of minerals and functional properties. Its microbiological quality and toxic potential, using Artemia salina sp, were also investigated. The results showed that the flour obtained from these residues had below neutral pH (3.82), moisture (3.33g/100g), acidity of (0.64g of citric acid/100g), and ash (4.65 g/100g). The amount of total dietary fiber (46.17g/100g) stood out quantitatively compared to the content of carbohydrate (29.2g/100 g), protein (8.49g/100g), and lipids (8.16g/100g). The total energy was 224Kcal/100g. With regard to the compounds with functional properties, higher values of insoluble fiber 79% (36.4 g/100 g); vitamin C (26.25 mg of acid ascorbic/100g), and anthocyanins (131mg/100g) were found. The minerals iron, potassium, zinc, manganese, and calcium were present in higher concentrations. There were no significant copper values. The results showed that the grape residues are an important source of nutrients and compounds with functional properties suggesting that they can be incorporated as an ingredient in the diet and/or used as a dietary supplement aiming at health benefits. The residues did not show microbiological contamination and were considered nontoxic.

Morbidity characteristics related to cardiovascular outcomes in French Canadian Families of the Saguenay-Lac-Saint-Jean region of Quebec

PROBLÉMATIQUE: L’Organisation Mondiale de la Santé (OMS) considère les maladies cardiovasculaires (MCVs) comme l'hypertension, la maladie coronarienne (par exemple, infarctus du myocarde), l'insuffisance cardiaque ainsi que les accidents cérébrovasculaires, parmi les principales causes de mortalité dans le monde. Les MCVs sont des maladies multifactorielles caractérisées par des interactions complexes entre le génome et l'environnement et dont la prévalence augmente rapidement dans toutes les populations du globe, ce qui vient compliquer d'autant l'étude de leurs bases héréditaires. Nos études précédentes sur la population fondatrice des familles Canadiennes-françaises de la région du Saguenay-Lac-Saint-Jean (SLSJ) au Québec ont permis d’obtenir une carte des loci significativement liés à des déterminants qualitatifs et quantitatifs de l’hypertension et ses déterminants métaboliques [1, 2]. HYPOTHÈSE ET OBJECTIF: Puisque nos données préliminaires nous suggèrent que la mort prématurée consécutive aux MCVs possède des composantes génétique et environnementale, notre hypothèse de départ est que les maladies avec occurrences fatales et non fatales (OF et ONF, respectivement) ont des caractéristiques distinctes, surtout lorsqu’en lien avec le système CV. Pour réaliser ce projet, nos objectifs sont d’analyser les causes de morbidité/mortalité d’hypertendus avec ou sans obésité chez des familles de la région du SLSJ. Nous accomplirons ceci en interrogeant les registres des hôpitaux et de l'état civil de même que les données généalogiques de 1950 jusqu'à maintenant. Nous voulons décrire et étudier les OF pour les comparer aux NFO. RÉSULTATS: Nous avons identifié un total de 3,654 diagnostiques appartenant aux OF et ONF chez les 343 sujets étudiés. Pour les OF, nous avons trouvé que: (1) un grand total de 1,103 diagnostiques du système circulatoire ont affecté 299 sujets avec 555 occurrences et 247 premières occurrences; (2) 333 des sujets participants ont reçu 1,536 diagnostiques non-CV avec 195 occurrences et 107 premières occurrences; (3) 62 diagnostiques de toutes autres causes chez 62 des sujets participants avec 81 occurrences et 11 premières occurrences. Pour les ONF: (1) 156 diagnostiques du système circulatoire ont affecté 105 sujets; (2) 60 diagnostiques de causes non-CV chez 53 des sujets; (3) et 718 diagnostiques de toutes autres causes chez 252 des sujets. Pour les OF, 109 des 333 sujets affectés par les maladies non-CV et 58 des 62 par toutes autres maladies étaient atteints simultanément par des MCV. Nous avons décrit les caractéristiques des maladies avec occurrences fatales et non fatales. Les MCVs prédominaient dans les résultats des premières occurrences et occurrences totales tandis que les maladies non-CV étaient les plus élevées pour les diagnostiques. De plus, les OF CV ont affecté 67.1% de notre échantillon de population, incluant les sujets co-affectés par les maladies non-CV ou de toutes autres causes. En fait, nos sujets ont un risque trois fois plus élevé de développer des MCVs (p<0.0001; χ2=1,575.348), tandis qu’il diminue de moitié pour les maladies non-CV comparativement au reste de la population du SLSJ (p=0.0006; χ2=11.834). Enfin, le risque de développer des tumeurs malignes est diminué de moitié dans notre échantillon comparativement à l’incidence régionale. CONCLUSION: Cette étude a apporté une nouvelle perspective sur les OF et ONF chez nos sujets de la région SLSJ du Québec après 11 ans. Quand on observe ces résultats en conjonction avec les MCVs, ce risque double.

Mosquito larvae borne viruses from the central travancore region of kerala: isolation and characterization

The present study was initiated when several massive outbreaks of Chikungunya, Dengue and Japanese Encephalitis were frequently reported across the State of Kerala. Multiple symptoms persisted among the affected individuals and the public health officials were in search of aetiological agents responsible for the out breaks and, other than clinical samples no resources were available. In this context, a study was undertaken to focus on mosquito larvae to investigate the viruses borne by them which remain silently prevalent in the environment. The study was not a group specific investigation limited to either arbovirus or enterovirus, but had a broad spectrum approach. The study encompassed the viral pathogens that could be isolated, their impact when passaged through cell lines, growth kinetics, titer of the working stocks in specific cell line, the structure by means of transmission electron microscopy(TEM), the one step growth and molecular characterization using molecular tools.

Effect of Community of Residence on Neurobehavioral Development in Infants and Young Children in a Flower-Growing Region of Ecuador

In this study we compared neurobehavioral development in Ecuadoran children living in two communities with high potential for exposure to organophosphate (OP) and carbamate pesticides to that of children living in a community with low potential for exposure. Residence in communities with high potential for exposure to OP and carbamate pesticides was associated with poorer neurobehavioral development of the child even after controlling for major determinants of delayed development. Malnourished populations may be particularly vulnerable to neurobehavioral effects of pesticide exposure.

Sociodemographic and nutritional correlates of neurobehavioral development: a study of young children in a rural region of Ecuador

To identify and describe the sociodemographic and nutritional characteristics associated with neurobehavioral development among young children living in three communities in the northeastern Andean region of Cayambe-Tabacundo, Ecuador. Women in the study communities who had a child 3 to 61 months of age completed a questionnaire about maternal and child health and sociodemographic characteristics. The Ages and Stages Questionnaire (ASQ) was directly administered to 283 children by two trained interviewers. Growth measurements and a hemoglobin finger-prick blood test were obtained in 2003–2004. Prevalence of developmental delay was calculated, and associations between child development and maternal, child, and household characteristics were explored. High frequencies of developmental delay were observed. Children 3 to 23 months old displayed delay in gross motor skills (30.1%), and children 48 to 61 months old displayed delay in problem-solving skills (73.4%) and fine motor skills (28.1%). A high frequency of both anemia (60.4%) and stunting (53.4%) was observed for all age groups. Maternal educational level was positively associated with communication and problem-solving skills, and monthly household income was positively associated with communication, gross motor, and problem-solving skills. The results suggest a high prevalence of developmental delay and poor child health in this population. Child health status and the child’s environment may contribute to developmental delay in this region of Ecuador, but sociodemographic factors affecting opportunities for stimulation may also play a role. Research is needed to identify what is causing high percentages of neurobehavioral developmental delay in this region of Ecuador.

Dietary Quality and Associated Factors among Factory Workers in the Metropolitan Region of Sao Paulo, Brazil

The workplace is a manageable community-based setting for ensuring proper nutrition. This study aimed to evaluate dietary quality and associated factors among adult workers at a cosmetics factory in the metropolitan area of Sao Paulo, Brazil. This factory was actively participating in the Brazilian Workers` Meal Program, which was created to ensure workers` nutritional health. In this cross-sectional study, data on 202 adult workers were assessed using questionnaires (sociodemographic, anthropometric, and lifestyle characteristics) administered during August and September 2006. Dietary intake, measured by 24-hour dietary recall, was used to calculate the modified Healthy Eating Index (HEI). A repeated administration of the 24-hour dietary recall was applied in a random subsample to calculate the modified HEI adjusted for the within-person variation in intake. Mean adjusted modified HEI scores were analyzed using multiple linear regression adjusted for energy. The mean adjusted modified HEI score was 72.3 +/- 8.0. The lowest adjusted modified HEI components scores were ""milk and dairy products"" (4.4 +/- 3.2) and ""sodium"" (3.7 +/- 3.1). Two percent of workers had ""poor diet"" (adjusted modified HEI score <51 points) and the majority (87%) had ""diet that needs modification"" (adjusted modified HEI score between 51 and 80), despite their participation in the meal program. Adjusted modified HEI scores were considerably higher for men (74.7 +/- 7.0) than for women (66.9 +/- 8.2) and for normal body mass index (calculated as kg/m(2)) (73.3 +/- 7.8) than for overweight/obese (70.9 +/- 8.1). Based on these results, the vast majority of workers were found to have diets that needed improvement. Individuals with higher-quality diets were more likely to have lower body mass index and to be male. J Am Diet Assoc. 2010;110:786-790.

Species diversity of Leishmania (Viannia) parasites circulating in an endemic area for cutaneous leishmaniasis located in the Atlantic rainforest region of northeastern Brazil

OBJECTIVES To identify the aetiological agents of cutaneous leishmaniasis and to investigate the genetic polymorphism of Leishmania (Viannia) parasites circulating in an area with endemic cutaneous leishmaniasis (CL) in the Atlantic rainforest region of northeastern Brazil. METHODS Leishmania spp. isolates came from three sources: (i) patients diagnosed clinically and parasitologically with CL based on primary lesions, secondary lesions, clinical recidiva, mucocutaneous leishmaniasis and scars; (ii) sentinel hamsters, sylvatic or synanthropic small rodents; and (iii) the sand fly species Lutzomyia whitmani. Isolates were characterised using monoclonal antibodies, multilocus enzyme electrophoresis (MLEE) and polymerase chain reaction-restriction fragment length polymorphism of the internal transcribed spacer region rDNA locus. RESULTS Seventy-seven isolates were obtained and characterised. All isolates were identified as Leishmania (Viannia) braziliensis serodeme 1 based on reactivity to monoclonal antibodies. MLEE identified 10 zymodemes circulating in the study region. Most isolates were classified as zymodemes closely related to L. (V.) braziliensis, but five isolates were classified as Leishmania (Viannia) shawi. All but three of the identified zymodemes have so far been observed only in the study region. Enzootic transmission and multiclonal infection were observed. CONCLUSIONS Our results confirm that transmission cycle complexity and the co-existence of two or more species in the same area can affect the level of genetic polymorphism in a natural Leishmania population. Although it is not possible to make inferences as to the modes of genetic exchange, one can speculate that some of the zymodemes specific to the region are hybrids of L. (V.) braziliensis and L. (V.) shawi.

Association between particulate matter from biomass burning and respiratory diseases in the southern region of the Brazilian Amazon

Objective. To investigate the short-term effects of exposure to particulate matter from biomass burning in the Amazon on the daily demand for outpatient care due to respiratory diseases in children and the elderly. Methods. Epidemiologic study with ecologic time series design. Daily consultation records were obtained from the 14 primary health care clinics in the municipality of Alta Floresta, state of Mato Grosso, in the southern region of the Brazilian Amazon, between January 2004 and December 2005. Information on the daily levels of fine particulate matter was made available by the Brazilian National Institute for Spatial Research. To control for confounding factors ( situations in which a non-causal association between exposure and disease is observed due to a third variable), variables related to time trends, seasonality, temperature, relative humidity, rainfall, and calendar effects ( such as occurrence of holidays and weekends) were included in the model. Poisson regression with generalized additive models was used. Results. A 10 mu g/m(3) increase in the level of exposure to particulate matter was associated with increases of 2.9% and 2.6% in outpatient consultations due to respiratory diseases in children on the 6th and 7th days following exposure. Significant associations were not observed for elderly individuals. Conclusions. The results suggest that the levels of particulate matter from biomass burning in the Amazon are associated with adverse effects on the respiratory health of children.

Microscopic features of tick-bite lesions in anteaters and armadillos - Emas National Park and the Pantanal region of Brazil

The naturally occurring wildlife host associations between ticks and tick-borne pathogens found in the neotropics are poorly described. Understanding tick-bite lesions is important as these are the site of host reaction to and pathogen delivery by ticks. As part of a comprehensive study concerning established and emerging tick-host relationships. The present work describes some aspects of tick-bite lesions in anteaters and armadillos captured at the Emas National Park and the Pantanal region of Brazil. Biopsies were of skin were taken and examine. Tick feeding sites of all animals displayed an eosinophilic homogeneous mass, the cement cone, and, occasionally, a feeding cavity underneath the tick attachment site. At these locations the epidermis was usually thickened due to keratinocyte hyperplasia. The main dermal changes included tissue infiltration with a varying number of inflammatory cells, edema, hemorrhage. and vascular dilatation. Cellular infiltration of the dermis was predominantly composed of mononuclear cells, neutrophils. and eosinophils. Mast cells were also seen in both non-parasitized and parasitized skin but were found in higher numbers at perivascular sites and in parasitized skin. Basophils were not seen at tick attachment sites of anteaters or armadillos.