RESUMO
This study investigates social and clinical factors associated with migration among individuals affected by leprosy. A cross-sectional study was conducted among those newly diagnosed with leprosy (2006-2008), in 79 endemic municipalities in the state of Tocantins, Brazil (N = 1,074). In total, 76.2% were born in a municipality different from their current residence. In the five years before diagnosis 16.7% migrated, and 3.6% migrated after leprosy diagnosis. Findings reflect aspects associated with historical rural-urban population movement in Brazil. Indicators of poverty were prominent among before-diagnosis migrants but not after-diagnosis migrants. Migration after diagnosis was associated with prior migration. The association of multibacillary leprosy with migration indicates healthcare access may be an obstacle to early diagnosis among before-diagnosis migrants, which may also be related to the high mobility of this group.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Doenças Endêmicas , Hanseníase/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , População Rural , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
This study investigates social and clinical factors associated with migration among individuals affected by leprosy. A cross-sectional study was conducted among those newly diagnosed with leprosy (2006-2008), in 79 endemic municipalities in the state of Tocantins, Brazil (N = 1,074). In total, 76.2% were born in a municipality different from their current residence. In the five years before diagnosis 16.7% migrated, and 3.6% migrated after leprosy diagnosis. Findings reflect aspects associated with historical rural-urban population movement in Brazil. Indicators of poverty were prominent among before-diagnosis migrants but not after-diagnosis migrants. Migration after diagnosis was associated with prior migration. The association of multibacillary leprosy with migration indicates healthcare access may be an obstacle to early diagnosis among before-diagnosis migrants, which may also be related to the high mobility of this group.
Este estudo investiga fatores sociais e clínicos associados à migração entre pessoas afetadas pela hanseníase. Estudo transversal entre recém- diagnosticados com hanseníase (2006-2008), em 79 municípios endêmicos do Estado de Tocantins, Brasil (N = 1.074). No total, 76,2% nasceram em município diferente de sua residência atual. Nos cinco anos antes do diagnóstico, 16,7% migraram, e 3,6% migraram após o diagnóstico da hanseníase. Resultados refletem aspectos associados com o movimento histórico da população rural-urbana no Brasil. Indicadores de pobreza foram proeminentes antes do diagnóstico de migrantes. A migração após o diagnóstico foi associada com migração anterior. A associação da forma multibacilar com migração indica que o acesso à saúde pode ser um obstáculo para o diagnóstico precoce de migrantes, o que pode também estar relacionado com a elevada mobilidade desse grupo.
Este estudio investiga los factores sociales y clínicos asociados con la migración entre las personas afectadas por lepra. Un estudio transversal se llevó a cabo entre las personas recién diagnosticadas con lepra (2006-2008), en 79 municipios endémicos en el estado de Tocantins, Brasil (N = 1,074). En total, el 76,2% nacieron en otro municipio diferente a su residencia actual. En los cinco años antes del diagnóstico el 16,7% emigró, y el 3,6% migró después del diagnóstico de lepra. Los resultados reflejan aspectos relacionados con el movimiento histórico de la población rural-urbana en Brasil. Los indicadores de pobreza fueron sobresalientes entre el grupo de migrantes antes del diagnóstico. La migración tras el diagnóstico se asoció a una migración anterior. La asociación de lepra multibacilar con migración indica que el acceso a la atención médica puede ser un obstáculo para el diagnóstico temprano en el grupo de migrantes antes de la migración.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem , Doenças Endêmicas , Emigração e Imigração/estatística & dados numéricos , Hanseníase/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Acessibilidade aos Serviços de Saúde , População Rural , Fatores Socioeconômicos , População UrbanaRESUMO
In the present study, 155 dogs euthanized by the Zoonotic Disease Unit of Uberlândia in Minas Gerais State (Southeast Brazil) were autopsied. Ectoparasites were collected, and the intestinal content of dogs was systematically examined for the presence of helminthic parasites. In total, we isolated 5,155 metazoan parasites of eight species (three intestinal helminth species, five ectoparasite species). The cestode Dipylidium caninum was present in 57 dogs (36.8 %), the nematodes Ancylostoma caninum in 30 (19.4 %) and Toxocara canis in 24 (15.5 %), respectively. Among the ectoparasites, 139 (89.7 %) dogs were infested with Rhipicephalus sanguineus, 115 (74.2 %) with Ctenocephalides felis, 5 (3.2 %) with Tunga penetrans and one specimen (0.7 %) with Amblyomma cajennense, while myiasis was found in one dog (0.7 %). In logistic regression analysis, young age (adjusted odds ratio 5.74; 95 % confidence interval 1.18-27.85) and male sex (3.60; 1.24-10.40) were significantly associated with toxocariasis, and crossbreed dogs (8.20; 1.52-44.31), with dipylidiasis. Male (2.23; 1.12-4.43) and crossbreed dogs (5.17; 1.17-22.83) had also a significant higher number of concomitant parasitoses. Spatial distribution of dogs by neighbourhood identified high-risk areas. Our systematic study shows that dogs in Uberlândia carry a high number of parasites which may cause zoonotic diseases in humans; therefore, further specific evidence-based intervention measures are needed.
Assuntos
Ectoparasitoses/veterinária , Enteropatias/veterinária , Fatores Etários , Animais , Brasil/epidemiologia , Cestoides/isolamento & purificação , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Cães , Ectoparasitoses/epidemiologia , Feminino , Helmintíase/epidemiologia , Enteropatias/epidemiologia , Enteropatias Parasitárias , Ixodidae/crescimento & desenvolvimento , Masculino , Nematoides/isolamento & purificação , Prevalência , Fatores Sexuais , Sifonápteros/crescimento & desenvolvimentoRESUMO
OBJECTIVE: To determine the extent of population movement after diagnosis with leprosy and to describe the underlying motives and determinants for relocation. DESIGN: A cross-sectional study was conducted among those newly diagnosed with leprosy in 79 endemic municipalities in the state of Tocantins, central Brazil. Individuals were identified through the National Information System for Notifiable Diseases (SINAN) database and interviewed with structured questionnaires. RESULTS: In total, 224 (20.9%) out of 1070 individuals relocated after their diagnosis with leprosy. Respondents moved to another neighbourhood in the same municipality (n = 178, 79.5%), followed by another municipality in Tocantins state (n = 26, 11.6%) and in another state (n = 11, 4.9%). The primary motives and/or determinants for relocation were: home ownership (n = 55, 28.4%), familial reasons (n = 43, 19.2%), to seek better living conditions (n = 27, 13.9%), employment (n = 26, 11.6%), and better neighbourhood (n = 22, 9.8%). Other motives were related to better access to leprosy diagnosis/treatment (n = 11, 4.9%), owner-terminated rental (n = 5, 2.2%), personal finances/could not afford housing (n = 4, 1.8%). Perceived stigma due to leprosy was mentioned by one participant (0.5%). CONCLUSION: In Tocantins state, population movement is lower among individuals recently diagnosed with leprosy, as compared to the overall population. The primary motives for relocation after leprosy diagnosis were related to lifestyle changes. Stigma and treatment-related reasons did not appear to be common motives for population movement. These results may reflect policy changes instituted from the Brazilian Program of Leprosy Control to decentralise leprosy services and intensify health education campaigns within a broader concept of Information, Education and Communication.
Assuntos
Hanseníase/diagnóstico , Motivação , Dinâmica Populacional , Preconceito , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Estudos Transversais , Pessoas com Deficiência , Emprego , Feminino , Financiamento Pessoal/economia , Política de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Hanseníase/tratamento farmacológico , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estigma Social , Adulto JovemRESUMO
Objetivo: descrever o conhecimento dos profissionais de saúde sobre a tungíase em área endêmica. Métodos: estudo transversal, mediante aplicação de questionário estruturado a profissionais de Saúde Pública de seis bairros no município de Uberlândia, estado de Minas Gerais, Brasil, em 2010. Resultados: participaram do estudo 78 profissionais de saúde, dos quais 38 observaram alta prevalência de tungíase em humanos; para 61 deles, a ocorrência da tungíase tem variação sazonal, de julho a setembro; casos graves foram corretamente associados a infecções secundárias (20/78) ou superinfestação (11/78); a maioria das questões teve considerável proporção de respostas Não sabe (Mín-Máx: 8/78-52/78), especialmente aquelas relacionadas à epidemiologia da doença. Conclusão: a tungíase é negligenciada na atenção primária e o conhecimento dos profissionais de saúde sobre a doença, mesmo lotados em área endêmica, é insuficiente.
Objective: to describe tungiasis-related knowledge of health professionals in an endemic area. Methods: a cross-sectional study, using structured questionnaire applied to 78 public health professionals of six districts in the municipality of Uberlândia, state of Minas Gerais, Brazil, in 2010. Results: the study included 78 health professionals, from which 38 reported their observation of high prevalence of tungiasis in humans; for 61 of them, tungiasis occurrence has seasonal variation, from July to September; severe cases were correctly associated with secondary infections (20/78) or superinfestation (11/78); most of the questions had considerable proportion of answers 'Do not know' (Min-Max: 8/78-52/78), especially those related to the epidemiology of the disease. Conclusion: tungiasis is neglected by primary health care and the knowledge of health professionals about the disease, even in endemic areas were they work, is insufficient.
Assuntos
Humanos , Animais , Masculino , Feminino , Criança , Adulto , Estudos Transversais , Educação Profissional em Saúde Pública , Pessoal de Saúde , TrombiculidaeRESUMO
BACKGROUND: Low adherence to multidrug therapy against leprosy (MDT) is still an important obstacle of disease control, and may lead to remaining sources of infection, incomplete cure, irreversible complications, and multidrug resistance. METHODOLOGY/PRINCIPAL FINDING: We performed a population-based study in 78 municipalities in Tocantins State, central Brazil, and applied structured questionnaires on leprosy-affected individuals. We used two outcomes for assessment of risk factors: defaulting (not presenting to health care center for supervised treatment for >12 months); and interruption of MDT. In total, 28/936 (3.0%) patients defaulted, and 147/806 (18.2%) interrupted MDT. Defaulting was significantly associated with: low number of rooms per household (OR = 3.43; 0.98-9.69; p = 0.03); moving to another residence after diagnosis (OR = 2.90; 0.95-5.28; p = 0.04); and low family income (OR = 2.42; 1.02-5.63: p = 0.04). Interruption of treatment was associated with: low number of rooms per household (OR = 1.95; 0.98-3.70; p = 0.04); difficulty in swallowing MDT drugs (OR = 1.66; 1.03-2.63; p = 0.02); temporal non-availability of MDT at the health center (OR = 1.67; 1.11-2.46; p = 0.01); and moving to another residence (OR = 1.58; 95% confidence interval: 1.03-2.40; p = 0.03). Logistic regression identified temporal non-availability of MDT as an independent risk factor for treatment interruption (adjusted OR = 1.56; 1.05-2.33; p = 0.03), and residence size as a protective factor (adjusted OR = 0.89 per additional number of rooms; 0.80-0.99; p = 0.03). Residence size was also independently associated with defaulting (adjusted OR = 0.67; 0.52-0.88; p = 0.003). CONCLUSIONS: Defaulting and interruption of MDT are associated with some poverty-related variables such as family income, household size, and migration. Intermittent problems of drug supply need to be resolved, mainly on the municipality level. MDT producers should consider oral drug formulations that may be more easily accepted by patients. Thus, an integrated approach is needed for further improving control, focusing on vulnerable population groups and the local health system.
Assuntos
Antibacterianos/administração & dosagem , Quimioterapia Combinada/métodos , Hanseníase/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/provisão & distribuição , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Suspensão de Tratamento , Adulto JovemRESUMO
BACKGROUND: Tungiasis, an ectoparasitosis caused by the female sand flea Tunga penetrans, is an important health problem in many impoverished communities in the tropics. Sand flea disease is associated with a broad spectrum of clinical pathology and severe sequels are frequent. Treatment options are limited. METHODOLOGY/PRINCIPAL FINDINGS: We assessed the effectiveness of the intermittent application of the plant-based repellent Zanzarin to reduce infestation intensity and tungiasis-associated morbidity in a resource-poor community in Brazil, characterized by a very high attack rate. The study population was randomized into three cohorts. Initially, during a period of four weeks, the repellent was applied twice daily to the feet of all cohort members. This reduced the number of embedded sandfleas to 0 in 98% of the participants. Thereafter members of cohort A applied the repellent every second week twice daily for one week, members of cohort B every fourth week for one week, and members of cohort C served as controls. Infestation intensity and tungiasis-associated morbidity were monitored during five months. The intermittent application of Zanzarin for one week every second week significantly reduced infestation intensity from a median 4 lesions (IQR 1-9) during the whole transmission season. In contrast, in cohort B (application of the repellent every fourth week) the infestation intensity remained twice as high (median 8 lesions, IQR 9-16; pâ=â0.0035), and in the control cohort C 3.5 times as high (median 14 lesions; IQR 7-26; pâ=â0.004 during the transmission season). Tungiasis-related acute pathology remained very low in cohort A (median severity score 2; IQR 1-4) as compared to cohort B (median severity score 5; IQR 3-7; p<0.001), and control cohort C (median severity score 6.5; IQR 4-8; p<0.001). CONCLUSIONS/SIGNIFICANCE: Our study shows that in a setting with intense transmission, tungiasis-associated morbidity can be minimized through the intermittent application of a plant-based repellent.
Assuntos
Controle de Doenças Transmissíveis , Repelentes de Insetos/administração & dosagem , Preparações de Plantas/administração & dosagem , Tunga/efeitos dos fármacos , Tungíase/prevenção & controle , Adolescente , Adulto , Aloe/química , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Cocos/química , Estudos de Coortes , Ectoparasitoses/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Óleos de Plantas/administração & dosagem , Pobreza , Tungíase/tratamento farmacológico , Tungíase/economia , Tungíase/parasitologia , Adulto JovemRESUMO
We determined the seroprevalence of Toxoplasma gondii and associated risk factors among 963 pregnant women attending an obstetric hospital in Fortaleza, Brazil. Seroprevalences of IgG and IgM against T. gondii were 68.6% (95% confidence interval [CI] = 65.6-71.6%) and 0.5% (95% CI = 0.06-1.0%), respectively. Seroprevalence of IgG was high in women less than 25 years of age (91.7%) and in low-income women (odds Ratio [OR] = 1.40, 95% CI = 1.02-1.90). Multivariate regression analysis showed that consumption of homemade water ice (adjusted OR = 1.49, 95% CI = 1.09-2.04), vegetables washed with untreated water (adjusted OR = 1.43, 95% CI = 1.05-1.94), consumption of chicken (adjusted OR = 1.49, 95% CI = 1.12-2.0), and dog ownership (adjusted OR= 1.46, 95% CI = 1.07-1.98) were factors associated with IgG seropositivity. Young women in northeastern Brazil living under poor socioeconomic conditions are at highest risk for acquiring infection with T. gondii. Oocyst contamination of water and soil must be addressed in future prevention strategies.
Assuntos
Complicações Parasitárias na Gravidez/epidemiologia , Toxoplasmose/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Análise Multivariada , Gravidez , Prevalência , Fatores de Risco , Toxoplasma/imunologia , Toxoplasmose/complicaçõesRESUMO
In Nigeria, schistosomiasis, caused predominantly by the species Schistosoma haematobium, is highly endemic in resource-poor communities. We performed a school-based survey in two rural communities in Osun State (Southwestern Nigeria) and assessed macrohaematuria, microhaematuria and proteinuria as indirect indicators for the presence of disease. Urine samples were inspected macroscopically for haematuria and screened for microhaematuria and proteinuria using urine reagent strips. The microscopic examination of schistosome eggs was used as the gold standard for diagnosis. In total, 447 schoolchildren were included in this study and had a 51% prevalence of urinary schistosomiasis. The sensitivity of microhaematuria (68%) and proteinuria (53%) for infection with S. haematobium was relatively low. In patients with a heavy infection (>or= 500 eggs/10 mL), the sensitivity of microhaematuria was high (95%). When the presence of macrohaematuria and the concomitant presence of microhaematuria and proteinuria were combined, it revealed a sensitivity of 63%, a specificity of 93% and a positive predictive value of 91%. Macrohaematuria also showed high specificity (96%) and a positive predictive value of 92%, while sensitivity was < 50%. These data show that combining urine reagent strip tests (presence of proteinuria and microhaematuria) and information on macrohaematuria increased the accuracy of the rapid diagnosis of urinary schistosomiasis in an endemic rural West African setting. This simple approach can be used to increase the quality of monitoring of schistosomiasis in schoolchildren.
Assuntos
Fitas Reagentes , Esquistossomose Urinária/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Nigéria/epidemiologia , Prevalência , Reprodutibilidade dos Testes , Esquistossomose Urinária/epidemiologia , Esquistossomose Urinária/urina , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
In Nigeria, schistosomiasis, caused predominantly by the species Schistosoma haematobium, is highly endemic in resource-poor communities. We performed a school-based survey in two rural communities in Osun State (Southwestern Nigeria) and assessed macrohaematuria, microhaematuria and proteinuria as indirect indicators for the presence of disease. Urine samples were inspected macroscopically for haematuria and screened for microhaematuria and proteinuria using urine reagent strips. The microscopic examination of schistosome eggs was used as the gold standard for diagnosis. In total, 447 schoolchildren were included in this study and had a 51 percent prevalence of urinary schistosomiasis. The sensitivity of microhaematuria (68 percent) and proteinuria (53 percent) for infection with S. haematobium was relatively low. In patients with a heavy infection (>500 eggs/10 mL), the sensitivity of microhaematuria was high (95 percent). When the presence of macrohaematuria and the concomitant presence of microhaematuria and proteinuria were combined, it revealed a sensitivity of 63 percent, a specificity of 93 percent and a positive predictive value of 91 percent. Macrohaematuria also showed high specificity (96 percent) and a positive predictive value of 92 percent, while sensitivity was < 50 percent. These data show that combining urine reagent strip tests (presence of proteinuria and microhaematuria) and information on macrohaematuria increased the accuracy of the rapid diagnosis of urinary schistosomiasis in an endemic rural West African setting. This simple approach can be used to increase the quality of monitoring of schistosomiasis in schoolchildren.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fitas Reagentes , Esquistossomose Urinária/diagnóstico , Nigéria/epidemiologia , Prevalência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Esquistossomose Urinária/epidemiologia , Esquistossomose Urinária/urinaRESUMO
BACKGROUND: We sought to study the epidemiology of scabies and to identify risk factors of severe disease in an impoverished rural community in northeast Brazil. METHODS: The study was designed as a repeated cross-sectional study based on two door-to-door surveys. One survey was carried out in the rainy season, the other in the dry season. The inhabitants of the community were examined for the presence of scabies and demographic, socioeconomic, and behavioral risk factors were assessed. Risk factors were analyzed using bivariate and multivariate regression analysis. RESULTS: The overall prevalence was 9.8% with no significant variation between seasons and the incidence was estimated to be 196/1000 person-years. The highest prevalence (18.2%) was observed in children younger than 4 years. Risk factors in the bivariate analysis were young age, presence of many children in the household, illiteracy, low family income, poor housing, sharing clothes and towels, and irregular use of shower. Age younger than 15 years, illiteracy, sharing of clothes, and living in the community for more than 6 months remained significant independent risk factors in multivariate regression analysis. LIMITATIONS: We used a clinical case definition; specificity and sensitivity were not verified. Men were underrepresented in the study population. CONCLUSIONS: In this impoverished community scabies is an important health problem characterized by continuous transmission throughout the year. The parasitic skin disease is embedded in a complex web of causation characterized by poor living conditions and a low level of education.
Assuntos
Áreas de Pobreza , População Rural/estatística & dados numéricos , Escabiose/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estações do Ano , Índice de Gravidade de Doença , Adulto JovemRESUMO
Introdução: Existe pouco conhecimento sistemático sobre a epidemiologia da tungíase em aéreas endêmicas. São necessários métodos de avaliação rápida para delimitar áreas em risco e possibilitar a implementação e avaliação do impacto de intervenções. Objetivo: Desenvolver e avaliar um método epidemiológico rápido para estimar a prevalência geral e a gravidade da tungíase em comunidades endêmicas com diferentes característica demográficas, sócio-culturais e ambientais. Material e Métodos: Análise de dez estudos transversais realizados em cinco comunidades, três do Brasil (dados secundários) e duas da Nigéria (dados primário), no período de 2001-2008. A tungíase foi diagnosticada clinicamente a partir da presença de lesões de Tunga penetrans na epiderme dos indivíduos. Para elaborar o método rápido, seis localizações topográficas dos pés foram selecionadas como potenciais indicadores de infestação em nível comunitário. Foram deitas regressões lineares, calculados coeficientes de determinação (R²) e os valores p. Critérios operacionais como rapidez e facilidade do exame também foram utilizados para a escolha do método mais adequado. Resultados: Ao todo, nos dez estudos transversais foram incluídos 7.121 indivíduos. As prevalências da tungíase variaram entre 21% e 54%. Nas duas comunidades nigerianas a prevalência geral da tungíase nas 302 pessoas examinadas foi de 47% (intervalo de confiança 95%; 41% - 53%)...
Assuntos
Humanos , Epidemiologia , Tunga , TungíaseRESUMO
BACKGROUND: Infestation with the human head louse (Pediculus humanus capitis) occurs worldwide. Existing treatment options are limited, and reports of resistance to commonly used pediculicides have been increasing. In this trial we assessed the efficacy of a product containing a high (92%) concentration of the silicone oil dimeticone (identical in composition to NYDA(R)), as compared to a 1% permethrin lotion. METHODS: Randomized, controlled, observer blinded clinical trial. Participants were recruited from a poor urban neighbourhood in Brazil where pediculosis capitis was highly prevalent. To minimize reinfestation during the trial, participants (145 children aged 5-15 years with head lice infestations) were transferred to a holiday resort outside the endemic area for a period of 9 days. Two applications of dimeticone or 1% permethrin were done, seven days apart. Outcome measures were defined as cure (absence of vital head lice) after first application and before and after second applications, degree of itching, cosmetic acceptability, and clinical pathology. RESULTS: Overall cure rates were: day 2 - dimeticone 94.5% (95% CI: 86.6% - 98.5%) and permethrin 66.7% (95% CI: 54.6% - 77.3%; p < 0.0001); day 7 - dimeticone 64.4% (95% CI: 53.3% - 75.3%) and permethrin 59.7% (95% CI: 47.5% - 71.1%; p = 0.5); day 9 - dimeticone 97.2% (95% CI: 90.3% - 99.7%) and permethrin 67.6% (95% CI: 55.4%-78.2%); p < 0.0001). Itching was reduced similarly in both groups. Cosmetic acceptability was significantly better in the dimeticone group as compared to the permethrin group (p = 0.01). Two mild product-related incidents occurred in the dimeticone group. CONCLUSION: The dimeticone product is a safe and highly efficacious pediculicide. Due to its physical mode of action (interruption of the lice's oxygen supply of the central nervous system), development of resistance is unlikely. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15117709.
Assuntos
Dimetilpolisiloxanos/uso terapêutico , Inseticidas/uso terapêutico , Infestações por Piolhos/tratamento farmacológico , Pediculus/efeitos dos fármacos , Dermatoses do Couro Cabeludo/tratamento farmacológico , Adolescente , Animais , Brasil , Criança , Pré-Escolar , Dimetilpolisiloxanos/efeitos adversos , Feminino , Humanos , Inseticidas/efeitos adversos , Masculino , Permetrina/uso terapêutico , Resultado do TratamentoRESUMO
The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
Assuntos
Ectoparasitoses/epidemiologia , Dermatoses do Pé/parasitologia , Sifonápteros , Doença Aguda , Adolescente , Adulto , Idoso , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Doença Crônica , Ectoparasitoses/complicações , Feminino , Dermatoses do Pé/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Áreas de Pobreza , Índice de Gravidade de Doença , População UrbanaRESUMO
A tungíase, ectoparasitose causada pela pulga Tunga penetrans, é endêmica em comunidades brasileiras de baixo poder aquisitivo. Neste estudo foram identificados habitantes de uma favela urbana em Fortaleza com carga parasitária elevada. Número de lesões, localização, estadiamento e patologias associadas foram registrados. Os 142 indivíduos identificados apresentaram condições de moradia extremamente precárias. Contou-se no total 3.445 lesões localizadas nos pés (mediana = 17 lesões; máximo = 98 lesões). Quase sem exceção, os indivíduos apresentaram deformações ungueais e edema e mais de 70 por cento dor e fissuras. Perda de unha foi observada em 46 por cento dos casos e deformação de dígitos em 25 por cento; 42 por cento apresentaram abscessos e 59 por cento queixaram-se de dificuldade de andar. Nossos dados mostram que a tungíase em comunidade urbana de baixa renda típica no nordeste brasileiro está associada a patologia grave. A doença precisa ser reconhecida como problema de saúde pública na região estudada e em outras áreas endêmicas semelhantes.
The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70 percent presented with pain and fissures. There was nail loss in 46 percent; deformation of the digits in 25 percent; abscesses in 42 percent; and complaints of walking difficulty in 59 percent. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
Assuntos
Humanos , Animais , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Ectoparasitoses/epidemiologia , Dermatoses do Pé/parasitologia , Sifonápteros , Doença Aguda , Brasil/epidemiologia , Doença Crônica , Ectoparasitoses/complicações , Dermatoses do Pé/epidemiologia , Áreas de Pobreza , Índice de Gravidade de Doença , População UrbanaRESUMO
BACKGROUND: Wilderness travellers to remote National Parks of Brazil may be particularly at risk of tropical diseases and injury. The aim of this study was to describe injury and illness, potentially hazardous situations, accidents and other incidents experienced by travellers to a remote National Park in Brazil. METHOD: The study was done in the National Park, "Serra da Capivara", in Piauí State northeast Brazil. Key informants were interviewed using semi-structured interviews, and a self-administered questionnaire was used for visitors. Questions included information on health problems and risk behaviour in the park, as well as pre-travel health advice. RESULTS: In total, 14 tour guides, 7 hotel managers and 17 health professionals were interviewed, as key informants. Eighty visitors returned the completed questionnaires (60 Brazilian, 20 foreigners). The key informants reported different risk behaviour of groups and individuals travellers, and incidents most commonly mentioned were minor injuries, insect bites/bee stings and allergic reactions. Seventy percent of the Brazilian and 55% of the foreign visitors had obtained pre-travel health advice, but only 5% of Brazilians and 15% of foreign visitors has obtained this advice from a physician. The most common source of information was other people who already had visited the park and travel books. Of the Brazilians, 13.3% reported some health incident during their stay, most commonly bee bites and headache. Two foreign travellers reported three incidents (insect bites/bee stings, diarrhoea and sunburn). Most commonly reported hazardous situations perceived by the tourists were possible accidents caused by falling from a stairway or falling stones, poisonous animals and insect bites/bee stings. CONCLUSIONS: Surveys conducted at remote tourist destinations are a feasible approach to report vulnerable situations, practices and incidents of visitors to a National Park. We have shown that most travellers are not adequately prepared and many experienced vulnerable situations during their visit to the National Park. It is important that visitors to National Parks in Brazil are encouraged to obtain travel health advice. The most common and potentially serious incident (bee stings) is rarely addressed in pre-travel health advice. Travel health advisers should ensure that they have access to locally relevant information for travellers, so that appropriate preventive measures can be instituted.
Assuntos
Acidentes , Diarreia/epidemiologia , Mordeduras e Picadas de Insetos , Queimadura Solar/epidemiologia , Viagem , Ferimentos e Lesões/epidemiologia , Adulto , Animais , Comportamento Animal , Brasil , Diarreia/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Queimadura Solar/prevenção & controle , Inquéritos e Questionários , Ferimentos e Lesões/prevenção & controleRESUMO
Represas desempenham um papel importante no desenvolvimento social e econômico de muitos países, e quase metade dos rios do mundo possui, pelo menos, uma grande represa. Somente no Brasil, existem mais de 500 represas hidrelétricas. O objetivo deste artigo é apresentar uma discussão a respeito do impacto que a construção de grandes represas hidrelétricas pode causar às comunidades originais das áreas alagadas pelo reservatório e seu entorno, notadamente sobre a saúde e a qualidade de vida destas populações. São apresentados casos de surtos epidêmicos causados por novas patologias e por doenças endêmicas que tiveram sua incidência avolumada, além de casos de identificação de novos patógenos e de intoxicação biológica que se refletiram na economia da comunidade. Esses casos foram relatados tanto para represas de outros países quanto nacionais. Discute-se, assim, a importância do planejamento prévio à construção do empreendimento, visando amenizar o impacto sobre a saúde humana.
Assuntos
Centrais Hidrelétricas , Saúde Ambiental , Meio Ambiente , Saúde PúblicaRESUMO
A Educação Ambiental (EA) insere-se como estratégia na atenção primária em saúde ambiental tendo como foco a promoção da saúde e o resgate da cidadania. Este estudo teve como objetivo capacitar professores da rede pública municipal de um município do interior do Piauí na elaboração de projetos para o desenvolvimento estrutural e funcional das escolas. O trabalho foi desenvolvido nos anos de 2000 e 2001 no Município de São João do Piauí. Um total de 123 professores das Zonas rural e urbana, distribuídos em 26 escolas, foram capacitados para elaboração, planejamento e execução de projetos de EA que adequados às necessidades de seis alunos. Todas as escolas elaboraram projetos com um ou mais objetivos, sendo que dessas, 19 os executaram. A articulação com a comunidade gerou uma reflexão sobre maiores possibilidades de ações sustentáveis e viáveis de enfrentamento de temas como doença de Chagas, leishmaniose e dengue. Os recursos financeiros e humanos foram captados a partir de ações planejadas e desenvolvidas pelas próprias escolas, junto à comunidade. A abordagem da EA mostrou-se uma estratégia eficiente, capaz de promover a reflexão e o posterior desenvolvimento de políticas e planejamento de ação integradas e intersetoriais com participação ativa da comunidade.
Assuntos
Educação em Saúde Ambiental , Saúde Ambiental , Promoção da Saúde , Capacitação em ServiçoRESUMO
Visando contribuir para o exame das relações entre o público e o particular na oferta de serviços, este trabalho considera as reações contrárias à participação de hospitais universitários na rede de serviços das empresas de planos e seguros de saúde. Os pressupostos que orientam essa pesquisa baseiam nas conexões entre a intensificação do uso de regras auto-reguladas, por uma parte do sistema público, cursando em paralelo à adoção de regras formadas para a alocação de recursos à atenção básica. Este trabalho se apóia em consultas a fontes de informação oficiais e na realização de um levantamento não exaustivo do noticiário sobre o tema. O estudo de análise de dois hospitais universitários que realiza convênios com empresas de planos e seguros de saúde serve como base empírica para a avaliação de três dimensões nos contratos formais ou informais dessas instituições com as empresas de planos e seguros de saúde: a jurídico-legal, a de assistência e a financeira. É importante advertir sobre o caráter exploratório dessa investigação e, sobretudo, para o viés de seleção dos casos (os dois hospitais selecionados realizam convênios para internação e estão direta ou indiretamente vinculados à Universidade Federal do Rio de Janeiro e à Universidade Federal do Rio Grande do Sul) que lhe emprestam uma inequívoca interinidade. (AU)