Survey of Trachoma within School Students in the State of Roraima, Brazil

Purpose: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis. There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from the contacts of children with trachoma. Design: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national average in 2003. The sample was stratified according to population size. Participants: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. Methods: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. Main Outcome Measures: Prevalence and grade of trachoma, age, gender, race, and municipality location. Results: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%–5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%–6.0%) compared with urban areas (3.9%; 95% CI, 2.9%–4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9 –2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.1–10.5). Conclusions: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence among the contacts of students with trachoma was higher than the school population, highlighting the importance of contact tracing.

Prevalência de tracoma entre escolares brasileiros

OBJETIVO: Estimar a prevalência e descrever a distribuição do tracoma entre escolares em municípios brasileiros. MÉTODOS: Estudo de corte transversal, usando amostragem por conglomerados, da população escolar dos municípios brasileiros com Índice de Desenvolvimento Humano-Municipal menor que a média nacional. O inquérito de prevalência de tracoma foi realizado pelo Ministério da Saúde entre 2002 e 2007. Foram selecionados 119.531 alunos de 2.270 escolas localizadas em 1.156 municípios. Os alunos foram submetidos ao exame ocular externo, com lupa (2,5X), para detecção de sinais clínicos de tracoma segundo critérios da OMS. Estimou-se a prevalência de tracoma segundo estado e em nível nacional, e seus respectivos intervalos de 95% de confi ança. Para a comparação de variáveis categóricas foram usados os testes do Qui-quadrado e do Qui-quadrado de tendência linear. RESULTADOS: Foram detectados 6.030 casos de tracoma, resultando em prevalência de 5,0% (IC95% 4,5;5,4). Não foi encontrada diferença signifi cante entre os sexos. A prevalência de tracoma foi de 8,2% entre menores de cinco anos de idade, diminuindo nas faixas etárias mais altas (p < 0,01). Houve diferença signifi cante entre as prevalências de tracoma na zona urbana e rural, 4,3% versus 6,2%, respectivamente (p < 0,01). Foram detectados casos em 901 municípios (77,7% da amostra), em todas as regiões do País. Em 36,8% dos municípios selecionados a prevalência foi superior a 5%. CONCLUSÕES: O estudo mostra que o tracoma é um importante problema de saúde pública no Brasil, contradizendo a crença de que a endemia estaria controlada no País. O inquérito realizado apresenta uma linha de base para avaliação das intervenções planejadas com vistas ao alcance da meta mundial de certifi cação da eliminação do tracoma como causa de cegueira no Brasil, até 2020.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.

Servicio Web para gestión de juego cooperativo sobre desarrollo humano

Este Proyecto Fin de Carrera (PFC) tiene como objetivos el análisis, diseño e implementación de un sistema web que permita a los usuarios familiarizarse con el Índice de Desarrollo Humano (IDH), publicado anualmente por Naciones Unidas, ofreciendo un servicio de gestión y descarga de una aplicación móvil relacionada con dicho índice. La aplicación móvil es un juego educativo basado en preguntas sobre el IDH de los países, desarrollada en paralelo con este proyecto. El servicio web implementado en este proyecto facilita tanto la descarga, administración y actualización de contenidos como la interacción entre los usuarios. El sistema está formado por un servidor web, una base de datos de usuarios y contenidos y un portal web desde el cual puede descargarse la aplicación móvil, realizar consultas sobre estadísticas de juego y conocer el IDH sin necesidad de jugar. El buscador avanzado que ha sido desarrollado para conocer el IDH permite al usuario adquirir destrezas y entrenarse por sí solo para mejorar sus resultados de juego. Los administradores del sistema tienen la capacidad de gestionar el contenido del portal, los usuarios que solicitan darse de alta y la funcionalidad ofrecida, es decir, actualización del juego, foros y noticias. La instalación del sistema implementado en un servidor web ha permitido su verificación exitosa así como la provisión del servicio de información y sensibilización sobre el IDH, actualizado mediante la información de Naciones Unidas, motivación original del proyecto. ABSTRACT This Final Year Project takes as targets the analysis, design and implementation of a web system that allows to the users to familiarize with the Human Development Index (HDI), published annually by United Nations, offering a service of management and download a mobile application associated with that index. The mobile application is an educational game based on questions on the IDH of the countries, developed in parallel with this project. The web service implemented by means of this Project facilitates download, administration and update of contents and the interaction between the users across the cooperative game. The system consists of a web server, a database of users and content and a web portal from which you can download the mobile application, perform queries on game statistics, or discover the HDI without need for play. The advanced search engine that has been developed for the HDI allows the user to purchase and train for skills to improve their game results. System administrators have the ability to manage the content of the portal, users requesting register and the functionality offered, i.e., update to the game, forums and news. The installation of the system that was implemented has allowed successful verification and the provision of an information and awareness on the HDI, updated with the information from the United Nations, original motivation of the project.

Aplicación móvil para el acceso a juego de naipes sobre el desarrollo humano

Este Proyecto Fin de Carrera (PFC) tiene como objetivo el análisis, diseño e implementación de un videojuego móvil multijugador, con un enfoque educativo, para la sensibilización sobre el Índice de Desarrollo Humano (IDH). El sistema resultante se ha desarrollado para la Plataforma Android, utilizando el Framework AndEngine, que utiliza aceleración hardware de la GPU para garantizar un buen rendimiento en terminales de gama baja, de modo que pueda utilizarse en un amplio número de terminales móviles disponibles en el mercado. La aplicación se presenta como un juego de cartas con los diferentes países y sus datos humanitarios, los jugadores deben conocer el peso de los índices de desarrollo (esperanza de vida, renta, educación) de los países en comparación con los países de los otros jugadores. El sistema de juego premia a los jugadores con mayores conocimientos sobre los datos humanos de los diferentes países del mundo, de ese modo los mejores jugadores serán los que tengan más conocimientos de estos datos. El juego permite jugar partidas en solitario utilizando jugadores manejados por la CPU, o multijugador mediante WIFI o 3G. La actualización de la información y de los datos de las partidas se realiza a través de la comunicación con un servidor web ya implementado de forma complementaria a la realización de este proyecto. El sistema ha sido integrado y validado satisfactoriamente con diferentes terminales móviles y usuarios de diferente perfil de edad y uso. El videojuego se puede descargar de la página web creada en un proyecto complementario a éste (pendiente de publicación web), y ya se encuentra también disponible en Google Play. https://play.google.com/store/apps/details?id=xnetcom.pro.cartas&hl=es_419 ABSTRACT. This Project End of Career (PFC) takes as an aim the analysis, design and implementation of a multiplayer mobile videogame, with an educational approach, for the awareness on the Human Development Index (HDI). The resultant system has been developed for the Platform Android, using the AndEngine Framework, which uses hardware acceleration of the GPU to ensure a good performance on low-end terminals, so that it can be used in a wide range of mobile handsets available in the market. The application is presented as a card game with the different countries and his humanitarian information, the players must know the weight of the indexes of development (life expectancy, revenue, education) of the countries in comparison with the countries of other players. The game system rewards players with more knowledge on human information of different countries, thus the best players will be those with more knowledge of these information. The game allows to play items in solitarily using players handled by the CPU, or multiplayer by means of WIFI or 3G. The update of the information and data of the online games is done through communication with a web server implemented as a complement to the realization of this project. The system has been built and successfully validated with different mobile terminals and users of different age and usage profile. The game can be downloaded from the website created in a complementary project to this (web publication pending), and is now also available on Google Play https://play.google.com/store/apps/details?id=xnetcom.pro.cartas&hl=es_419

Exceso de peso, aspectos económicos, políticos y sociales en el mundo: un análisis ecológico

Se analizaron las prevalencias de exceso de peso, según índice de masa corporal (IMC), en adultos y su asociación con algunas variables demográficas, socioeconómicas e índice de democracia. Se realizó un diseño ecológico que consideró un total de 105 países, con datos de IMC de 2000 a 2006. Las demás variables se obtuvieron en correspondencia con el año del dato de estado nutricional, o su referente más cercano. Se utilizaron los puntos de corte de la Organización Mundial de la Salud (OMS) para IMC. Se calcularon correlaciones de Spearman y modelos de regresión múltiple. El sobrepeso y la obesidad se correlacionaron en ambos sexos con la disponibilidad energética y con el Índice de Desarrollo Humano (IDH) y sus variables constitutivas. En cuanto a las variables relacionadas con democracia, la correlación fue inversa y más fuerte con el nivel ponderal de los hombres. En conclusión, indicadores de condiciones de vida más favorables en los países se asociaron de forma directa con mayores prevalencias de exceso de peso poblacional, con comportamientos diferentes en función del género.

Work-related health problems among resident immigrant workers in Italy and Spain

Background: in both Spain and Italy the number of immigrants has strongly increased in the last 20 years, currently representing more than the 10% of workforce in each country. The segregation of immigrants into unskilled or risky jobs brings negative consequences for their health. The objective of this study is to compare prevalence of work-related health problems between immigrants and native workers in Italy and Spain. Methods: data come from the Italian Labour Force Survey (n=65 779) and Spanish Working Conditions Survey (n=11 019), both conducted in 2007. We analyzed merged datasets to evaluate whether interviewees, both natives and migrants, judge their health being affected by their work conditions and, if so, which specific diseases. For migrants, we considered those coming from countries with a value of the Human Development Index lower than 0.85. Logistic regression models were used, including gender, age, and education as adjusting factors. Results: migrants reported skin diseases (Mantel-Haenszel pooled OR=1.49; 95%CI: 0.59-3.74) and musculoskeletal problems among those employed in agricultural sector (Mantel-Haenszel pooled OR=1.16; 95%CI: 0.69-1.96) more frequently than natives; country-specific analysis showed higher risks of musculoskeletal problems among migrants compared to the non-migrant population in Italy (OR=1.17; 95% CI: 0.48-1.59) and of respiratory problems in Spain (OR=2.02; 95%CI: 1.02-4.0). In both countries the risk of psychological stress was predominant among national workers. Conclusions: this collaborative study allows to strength the evidence concerning the health of migrant workers in Southern European countries.

El bienestar en España: una perspectiva de largo plazo, 1850-1991

Los historiadores económicos han estimado tradicionalmente el bienestar en términos de renta por persona. Durante la última década se han publicado, sin embargo, diversos trabajos que utilizan otros indicadores. Siguiendo esta línea de investigación, el artículo contrasta cuatro indicadores del bienestar en España (renta per capita, índice de Desarrollo Humano, Índice Físico de Calidad de Vida y estatura), dos de los cuales son inéditos (IDH e IFCV). Los resultados complican el objeto de estudio, pero sirven para proponer algunas hipótesis que deben ser ratificadas o desmentidas por futuras investigaciones.

Diferencias provinciales de bienestar en la España del siglo XX

By using three indicators of the standard of living (income per capita, the Human Development Index and the Physical Quality of Life Index), this article provides new information regarding the evolution of the differences in well-being between the Spanish provinces throughout the 20th century. The results reveal that the disparities were enormous at the beginning of the century, after which a highly significant process of convergence took place, which was comparatively lower in terms of income per person than it was with respect to the HDI or the PQLI. Another noteworthy finding is that, irrespective of the indicator used, the well-being of each province is significantly influenced by that of its neighbours throughout the whole of the period analysed.

Expert Opinions on Improving Femicide Data Collection across Europe: A Concept Mapping Study

Femicide, defined as the killings of females by males because they are females, is becoming recognized worldwide as an important ongoing manifestation of gender inequality. Despite its high prevalence or widespread prevalence, only a few countries have specific registries about this issue. This study aims to assemble expert opinion regarding the strategies which might feasibly be employed to promote, develop and implement an integrated and differentiated femicide data collection system in Europe at both the national and international levels. Concept mapping methodology was followed, involving 28 experts from 16 countries in generating strategies, sorting and rating them with respect to relevance and feasibility. The experts involved were all members of the EU-Cost-Action on femicide, which is a scientific network of experts on femicide and violence against women across Europe. As a result, a conceptual map emerged, consisting of 69 strategies organized in 10 clusters, which fit into two domains: “Political action” and “Technical steps”. There was consensus among participants regarding the high relevance of strategies to institutionalize national databases and raise public awareness through different stakeholders, while strategies to promote media involvement were identified as the most feasible. Differences in perceived priorities according to the level of human development index of the experts’ countries were also observed.

Education and Social Protection Systems in Southern and Eastern Mediterranean Countries. MEDPRO Technical Report No. 20/January 2013

This report assesses the current status of the education and social protection systems in 11 southern and eastern Mediterranean countries. It compares these countries using various education indicators and attempts to highlight the main differences in the social protection systems among the countries using qualitative analysis. The report finds that despite the differences among the countries, they share a common feature: when measured by the UN Development Programme’s Human Development Index (HDI), their inequality-adjusted values are significantly lower than their HDI values and ranks when not taking inequality into account. Nevertheless, significant improvements have been achieved in all the quantitative indicators for education, while the qualitative performance is still modest in the majority of the countries studied. As to the social protection aspect, the research reveals that various social protection programmes are being adopted in the 11 countries. As most of their financing is covered by government budgets, however, this places a high fiscal burden on them. Yet few of the countries (Turkey being the most notable) are trying to improve the sustainability of their social insurance schemes.

Inequality in the Southern Mediterranean: A survey of selected countries. MEDPRO Technical Report No. 23/December 2012

This paper addresses the issues of current levels of inequality: their trends, determinants and future scenarios, demonstrating that welfare levels are measured by per capita consumption. Location, educational attainment and employment status have been identified as the key factors affecting levels of welfare and its distribution. A benefit incidence analysis was performed to investigate benefits of different deciles of per capita expenditure from education and health services. The inequality patterns in countries under investigation present significant variations; countries such as Turkey, Morocco and Tunisia show relatively high inequality while others, such as Egypt or Syria, show moderate to low inequality. Inequality in human development was addressed using the inequality-adjusted human development index (IHDI), introduced by Global HDR 2010. The average loss in the HDI due to inequality in all Arab countries under investigation is about 20%. Two reference scenarios (optimistic and pessimistic) were used to project future paths up to 2020 and 2030. The impact of positive growth is increasing inequality and a shrinking middle class. Results show that the rich benefit most from this growth path. The opposite trend is observed for the pessimistic scenario.

O ambiente interagências nas operações de pacificação do Complexo da Maré

O objetivo do presente estudo foi realizar uma análise da interação do Exército Brasileiro perante os 42 (quarenta e dois) órgãos civis e militares no conjunto de favelas da Maré e de que forma estas influenciaram na doutrina das operações militares de pacificação. A Operação São Francisco - iniciada em 5 de abril de 2014 pela Força de Pacificação (F Pac), foi designada aos componentes do Ministério da Defesa para assegurar e promover a garantia da lei e da ordem (GLO) pública nas comunidades do Complexo da Maré, na cidade do Rio de Janeiro. A metodologia proposta baseou-se em uma pesquisa aplicada com técnica de abordagem mista, através da pesquisa bibliográfica, da análise dos documentos e relatórios da F Pac e da realização de entrevistas aos integrantes das forças militares e dos civis que prestaram serviços públicos na região supracitada. Para isso, foi utilizado o método indutivo por meio dos testes estatísticos, que visaram identificar relacionamentos causais entre as demandas de serviços públicos civis atendidos nas comunidades, bem como a influência destas nas operações de pacificação e nas políticas de defesa voltadas à atualização da doutrina e das operações militares. As contribuições teóricas esperadas foram a observação das mudanças no emprego operacional em um ambiente com alta criminalidade e baixo Índice de Desenvolvimento Humano (IDH) e fornecer informações para o emprego colaborativo das instituições civis sob a proteção militar (mas não sob o controle militar). Isto visou proporcionar à população o acesso aos serviços públicos básicos com segurança e minimizou o desgaste das ações de GLO através da conquista da opinião pública local. As contribuições práticas esperadas residiram no aumento do potencial militar, através da integração de políticas públicas efetivas das pastas civis. As implicações referiram-se a abordagem e a maior interação entre as pastas governamentais militares e civis através da mediação da Seção de Assuntos Civis. As pesquisas deste trabalho evidenciaram por serem restritas ao contexto da pacificação de um conjunto de favelas da capital do Estado do Rio de Janeiro no ano de 2014.

Social indicators and comparisons of living standards

Construction of an international index of standards of living, incorporating social indicators and economic output, typically involves scaling and weighting procedures that lack welfare-economic foundations. Revealed preference axioms can be used to make quality-of-life comparisons if we can estimate the representative household's production technology for the social indicators. This method is applied to comparisons of gross domestic product (GDP) and life expectancy for 58 countries. Neither GDP rankings, nor the rankings of the Human Development Index (HDI), are consistent with the partial ordering of revealed preference. A method of constructing a utility-consistent index incorporating both consumption and life expectancy is suggested. (C) 2003 Elsevier Science B.V. All rights reserved.

PENTECOSTAIS, MIGRAÇÃO E REDES RELIGIOSAS NA PERIFERIA DE SÃO PAULO: UM ESTUDO DO BAIRRO DE PERUS

Esta pesquisa analisa as razões do crescimento do número de pentecostais no bairro paulistano de Perus, zona noroeste de São Paulo a partir do fenômeno de migração urbana. Com IDH figurando na 81ª posição entre os 96 distritos da capital paulista, o bairro apresenta grande concentração de igrejas pentecostais. 20,9% de sua população declarou-se com esta filiação religiosa no Censo 2000. O índice é alto quando comparado com a média da população pentecostal do município de São Paulo, calculado em 11,9%. Perus faz parte da periferia urbana, porém, no próprio bairro, há vilas que sofrem com maior falta de infra-estrutura, formando pequenas periferias dentro da periferia. Com crescimento associado à primeira fábrica de Cimento do país, a Cia de Cimento Portland Perus, o bairro foi o endereço de chegada de milhares de migrantes desde as primeiras décadas do século XX, a princípio originários do interior do estado de São Paulo e de Minas Gerais. No entanto, mesmo com o fechamento da fábrica, o bairro continua a receber migrantes de outras regiões, como o Nordeste do país e mesmo moradores de outros bairros da cidade de São Paulo. Assim, esta pesquisa pretende detectar como as redes religiosas pentecostais, existentes em uma multiplicidade de denominações, se fazem presentes no processo de acolhida e adaptação do migrante em sua chegada ao bairro e em que medida a filiação religiosa ganha importância neste processo de movimento e circulação populacional no espaço urbano.