RESUMO
RATIONALE: The highest burden of liver cancer occurs in developing countries, where the use of herbal medicine (HM) is still widespread. Despite this trend, few studies have been conducted to report HM practices of patients with a hepatic tumor in the developing world. Hence, this study aimed to document the use of HM among patients with liver cancer in Peru. STUDY DESIGN AND METHODS: A comparative behavioral epidemiological survey was conducted among liver cancer patients attending the National Cancer Institute of Peru. Information was obtained by direct interviews based on a semistructured questionnaire. The use of HM in Peruvian liver cancer patients was reported, first, regarding general consumption prior to the onset of disease, and second, after the appearance of symptoms that patients would relate to their tumor. In parallel, general consumption of HM in noncancerous people was assessed as a comparative figure. A correspondence analysis was performed to reveal potential associations between the symptoms of cancer and the specific use of HM. RESULTS: Eighty-eight patients and 117 noncancerous individuals participated in the survey. Overall, 68.3% of the people interviewed claimed to use HM on a regular basis for general health preservation. Furthermore, 56.8% of the patients turned to plants first to treat the disorders for which they later came to the cancer care center. When compared with the number of plant species used routinely (n = 78), a selection of plants was made by patients in response to the symptoms of cancer (n = 46). At least 2 plant species, Aloe vera and Morinda citrifolia, were significantly associated with the treatment of liver cancer-related symptoms in the patient group. CONCLUSIONS: The present study is the first survey on the HM practices of patients with liver cancer in Latin America and, more broadly, in the developing world. Our findings confirm that HM remains one of the principal primary health care resources in Peru, even for a severe disease like liver cancer. These traditional, complementary and alternative medicine practices should be taken into consideration in Peruvian health programs aiming to educate the population in cancer prevention and treatment, as well as integrative cancer management.
Assuntos
Terapias Complementares/métodos , Neoplasias Hepáticas/tratamento farmacológico , Fitoterapia , Adulto , Feminino , Pesquisas sobre Atenção à Saúde , Medicina Herbária/métodos , Humanos , Medicina Integrativa/métodos , Oncologia Integrativa/métodos , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Peru , Prática Profissional , Adulto JovemRESUMO
BACKGROUND: In December 2010, a Plasmodium vivax malaria outbreak occurred among French forces involved in a mission to control illegal gold mining in French Guiana. The findings of epidemiological and entomological investigations conducted after this outbreak are presented here. METHODS: Data related to malaria cases reported to the French armed forces epidemiological surveillance system were collected during the epidemic period from December 2010 to April 2011. A retrospective cohort study was conducted to identify presumed contamination sites. Anopheles mosquitoes were sampled at the identified sites using Mosquito Magnet and CDC light traps. Specimens were identified morphologically and confirmed using molecular methods (sequencing of ITS2 gene and/or barcoding). Anopheles infections with Plasmodium falciparum and P. vivax were tested by both enzyme-linked immunosorbent assay and real-time PCR. RESULTS: Seventy-two P. vivax malaria cases were reported (three were mixed P. falciparum/P. vivax infections), leading to a global attack rate of 26.5% (72/272). Lack of compliance with vector control measures and doxycycline chemoprophylaxis was reported by patients. Two illegal gold mining sites located in remote areas in the primary forest were identified as places of contamination. In all, 595 Anopheles females were caught and 528 specimens were formally identified: 305 Anopheles darlingi, 145 Anopheles nuneztovari s.l., 63 Anopheles marajoara and 15 Anopheles triannulatus s.l. Three An. darlingi were infected by P. falciparum (infection rate: 1.1%) and four An. marajoara by P. vivax (infection rate: 6.4%). DISCUSSION: The main drivers of the outbreak were the lack of adherence by military personnel to malaria prevention measures and the high level of malaria transmission at illegal gold mining sites. Anopheles marajoara was clearly implicated in malaria transmission for the first time in French Guiana. The high infection rates observed confirm that illegal gold mining sites must be considered as high level malaria transmission areas in the territory. CONCLUSIONS: Illegal gold mining activities are challenging the control of malaria in French Guiana. Collaboration with neighbouring countries is necessary to take into account mobile populations such as gold miners. Malaria control strategies in the French armed forces must be adapted to P. vivax malaria and sylvatic Anopheles species.
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Anopheles/parasitologia , Malária/epidemiologia , Malária/transmissão , Mineração , Animais , Feminino , Guiana Francesa/epidemiologia , Ouro , Humanos , Insetos Vetores/parasitologia , Masculino , Estudos RetrospectivosRESUMO
Surveillance of travel-acquired dengue could improve dengue risk estimation in countries without ability. Surveillance in the French army in 2010 to 2011 highlighted 330 dengue cases, mainly in French West Indies and Guiana: DENV-1 circulated in Guadeloupe, Martinique, French Guiana, New Caledonia, Djibouti; DENV-3 in Mayotte and Djibouti; and DENV-4 in French Guiana.
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Dengue/etnologia , Surtos de Doenças/estatística & dados numéricos , Militares , Viagem , Adulto , Feminino , França/epidemiologia , Guiana Francesa/etnologia , Guadalupe/etnologia , Humanos , Incidência , Masculino , Martinica/etnologia , Pessoa de Meia-Idade , Nova Caledônia/etnologia , Estudos Retrospectivos , Índias Ocidentais/etnologia , Adulto JovemRESUMO
We obtained health surveillance epidemiologic data on malaria among French military personnel deployed to French Guiana during 1998-2008. Incidence of Plasmodium vivax malaria increased and that of P. falciparum remained stable. This new epidemiologic situation has led to modification of malaria treatment for deployed military personnel.
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Quimioprevenção/métodos , Malária Falciparum/parasitologia , Malária Vivax/parasitologia , Plasmodium falciparum/fisiologia , Plasmodium vivax/fisiologia , Animais , Antimaláricos/administração & dosagem , Antimaláricos/uso terapêutico , Surtos de Doenças/prevenção & controle , Reservatórios de Doenças/parasitologia , Guiana Francesa/epidemiologia , Humanos , Incidência , Insetos Vetores/parasitologia , Estudos Longitudinais , Malária Falciparum/tratamento farmacológico , Malária Falciparum/epidemiologia , Malária Falciparum/prevenção & controle , Malária Falciparum/transmissão , Malária Vivax/tratamento farmacológico , Malária Vivax/epidemiologia , Malária Vivax/prevenção & controle , Malária Vivax/transmissão , Militares , Plasmodium falciparum/efeitos dos fármacos , Plasmodium vivax/efeitos dos fármacosRESUMO
To perform epidemiological surveillance during deployments, the French military health service has developed a real-time surveillance approach. The objective was to identify the benefits and problems of this approach. A prototype of real-time surveillance has been set up in French Guiana since 2004. Its permanent evaluation has allowed identifying strengths and weaknesses. The experience has permitted expansion of the concept to French forces in Djibouti and also development of a global approach for the whole French armed forces. Real-time surveillance has shown its usefulness for early warning during different real and simulated situations. Functional and architectural choices have permitted interoperability with allied nations. However, the information produced was only the first step of the diagnostic epidemiological situation followed by other investigations. This first step of development has highlighted the required complementarity with traditional epidemiological surveillance.
Assuntos
Surtos de Doenças/prevenção & controle , Militares , Vigilância da População/métodos , Interpretação Estatística de Dados , França/epidemiologia , Guiana Francesa , HumanosRESUMO
In South America, dengue is the arbovirus-transmitted disease with the highest incidence. Unlike other arboviruses, wild mammals have no confirmed role in the cycle of dengue in the neotropics, although serological studies have suggested a possible secondary amplification cycle involving mammals other than nonhuman primates. In French Guiana, where all four serotypes (DENV-1, DENV-2, DENV-3, DENV-4) are present, the disease is endemic with outbreak events. To determine whether wild mammals can be infected by DENV, rodents, marsupials, and bats were captured over several periods, from 2001 to 2007, at two sites. The first location is a secondary forest surrounded by an urban area where dengue is endemic. The second location is a forest edge site where the disease has not yet emerged. A total of 10,000 trap-nights were performed and 616 mammals were captured. RNAs representing the four DENV serotypes were detected at both sites by reverse-transcriptase polymerase chain reaction in the livers and/or sera of 92 mammals belonging to 14 out of 32 species distributed among all the orders investigated: Rodentia (33 positive/146 tested), Marsupialia (40/318), and Chiroptera (19/152). Sequence analyses of a portion of the capsid and premembrane junction revealed that mammal strains of DENV-1, DENV-2, DENV-3, and DENV-4 had only 92.6%, 89%, 95%, and 95.8% identity, respectively, with strains circulating in the human population during the same periods. Regarding DENV-2, strains related (99% identity) to those responsible for an epidemic event in humans in French Guiana concurrent to the capture sessions were also evidenced, suggesting that wild mammals in edge habitats can be infected by circulating human strains. Our results demonstrate, for the first time, that neotropical wild mammals can be infected with dengue virus. The question of whether mammals maintain DENV in enzootic cycles and can play a role in its reemergence in human populations remains to be answered.
Assuntos
Quirópteros , Vírus da Dengue/isolamento & purificação , Dengue/veterinária , Marsupiais , Doenças dos Roedores/virologia , Animais , Animais Selvagens , Quirópteros/sangue , Quirópteros/virologia , Vírus da Dengue/classificação , Vírus da Dengue/genética , Guiana Francesa , Humanos , Fígado/virologia , Cadeias de Markov , Marsupiais/sangue , Marsupiais/virologia , Dados de Sequência Molecular , Filogenia , RNA Viral/análise , RNA Viral/sangue , RNA Viral/química , Reação em Cadeia da Polimerase Via Transcriptase Reversa/veterinária , Roedores , Sorotipagem , ÁrvoresRESUMO
During a dengue-3 outbreak in Paraguay at the beginning of 2007, capillary blood samples absorbed onto filter papers were collected from 44 suspected cases. These samples were subjected to three molecular and serologic tests, and 31 of the 44 samples gave a positive result by at least one of the techniques used. Molecular analyses detected the dengue-3 serotype in 22 patients and additionally the dengue-2 serotype in two patients. Therefore two different serotypes were co-circulating during this outbreak. Overall, this study validates the use of dried-blood samples for field screening investigations. Indeed, all types of laboratory studies of dengue were possible with samples consisting of a few drops of dried blood from finger pricks.
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Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Surtos de Doenças , Antígenos Virais/sangue , Dengue/sangue , Vírus da Dengue/classificação , Vírus da Dengue/genética , Vírus da Dengue/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Papel , Paraguai/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: A dengue fever outbreak occured in French Guiana in 2006. The objectives were to study the value of a syndromic surveillance system set up within the armed forces, compared to the traditional clinical surveillance system during this outbreak, to highlight issues involved in comparing military and civilian surveillance systems and to discuss the interest of syndromic surveillance for public health response. METHODS: Military syndromic surveillance allows the surveillance of suspected dengue fever cases among the 3,000 armed forces personnel. Within the same population, clinical surveillance uses several definition criteria for dengue fever cases, depending on the epidemiological situation. Civilian laboratory surveillance allows the surveillance of biologically confirmed cases, within the 200,000 inhabitants. RESULTS: It was shown that syndromic surveillance detected the dengue fever outbreak several weeks before clinical surveillance, allowing quick and effective enhancement of vector control within the armed forces. Syndromic surveillance was also found to have detected the outbreak before civilian laboratory surveillance. CONCLUSION: Military syndromic surveillance allowed an early warning for this outbreak to be issued, enabling a quicker public health response by the armed forces. Civilian surveillance system has since introduced syndromic surveillance as part of its surveillance strategy. This should enable quicker public health responses in the future.
Assuntos
Dengue/epidemiologia , Surtos de Doenças , Militares , Vigilância da População/métodos , Dengue/diagnóstico , Dengue/prevenção & controle , Surtos de Doenças/prevenção & controle , Diagnóstico Precoce , Guiana Francesa/epidemiologia , Humanos , Medicina MilitarRESUMO
In order to estimate the level of under-reporting and to improve estimates of the incidence of tuberculosis (TB) in the vicinity of Cayenne, French Guiana, we performed capture-recapture analysis from 1996 through 2003. We cross-linked data from the Institut Pasteur, the Département d'Information Médicale of Cayenne Hospital, and the Service de Lutte Anti-Tuberculeuse. The estimate of 381 TB cases obtained after matching those three sources was revised to 425 (95% confidence interval: 407, 453) using the capture-recapture model based on sample coverage. The corresponding average annual incidence was 63.1 TB cases per 100,000 population. The evaluated sensitivity of the compulsory notification system was 35.3%, indicating wide under-notification of TB in the vicinity of Cayenne. The estimated coverage reported by the three sources was fairly accurate (i.e. 85.9%), but not sufficient to evaluate the risk of transmission of TB in the Ile-de-Cayenne (Cayenne and its suburbs).
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Vigilância da População/métodos , Tuberculose Pulmonar/epidemiologia , Notificação de Doenças , Guiana Francesa/epidemiologia , Humanos , IncidênciaRESUMO
To study a 2001 dengue fever outbreak in Iracoubo, French Guiana, we recorded the location of all patients' homes and the date when symptoms were first observed. A geographic information system (GIS) was used to integrate the patient-related information. The Knox test, a classic space-time analysis technique, was used to detect spatiotemporal clustering. Analysis of the relative-risk (RR) variations when space and time distances vary, highlighted the maximum space and time extent of a dengue transmission focus. The results show that heterogeneity in the RR variations in space and time corresponds to known entomologic and epidemiologic factors, such as the mosquito feeding cycle and host-seeking behavior. This finding demonstrates the relevance and potential of the use of GIS and spatial statistics for elaborating a dengue fever surveillance strategy.