Evaluation of prenatal care in a micro-regional health system in the State of Ceará, Brazil

This article presents an analysis of prenatal care provided in a micro-regional health system in the State of Ceará, Brazil. The objectives were to analyze the population covered by the Family Health Program (FHP) teams; to evaluate data from the Basic Health Care Information System and the Live Birth Information System; and to establish a profile of medical and nursing services provided during prenatal care. Data were collected from the fourth health micro-region in the town of Baturité and the Ceará State Health Department in May-June 2001, through review of patient records, free observations, and searches in the information systems. Despite the excellent population coverage by FHP teams, resulting in improved access, increased numbers of prenatal visits, improved vaccine coverage, and early diagnosis of complications of pregnancies, the impact of these measures need to be assessed in terms of the real improvement in the women s quality of life. A protocol also needs to be followed by doctors and nurses throughout the course of prenatal care, besides guaranteeing medical consultations as an integral part of the program.     

Swarms of starlings in Basel: a natural phenomenon, a nuisance or a health risk?

A Natural Phenomenon, Molestation or a Health Risk? For the last two decades an avenue in the centre of Basel (Altrheinweg, Klybeckquartier) is known as site for overnight accommodation and assembly of starlings (Sturnus vulgaris) during autumn. The nightly visitors cause an immense contamination that directly affects a nursery and a primary school. The aim of the present study was the evaluation of the health risk for the population due to the starlings' droppings, particularly for the children from the nursery school. Between August and December of the years 1995 and 1996 the population of starlings was observed, the contamination of the area with faeces was quantified, the presence of microorganisms in the faeces was determined and the contamination of the soil from the Altrheinweg was compared with that from other avenues and parks. Furthermore, the children attending the nursery school were monitored for possible infections due to the birds' droppings. In mid-October, when the population of starlings reached their maximum of about 15,000 birds, 1053 defecations per night and square metre were counted on an average in 1995 and 1821 in 1996. The microbiological analysis of the starlings' faeces showed a high contamination with Campylobacter spp. (1995: 95.5%; 1996: 100%), L. monocytogenes (1995: 36.5%; 1996: 26.7%) and C. psittaci (1995: 40.5%), a lower contamination with Salmonella spp. (1995: 1.0%), S. aureus (1995: 2.0%), Y. enterocolitica (1995: 1.5%) and Y. pseudotuberculosis (1995: 1.0%). Mycotic and parasitic human pathogens were not found. The contamination of the soil from the Altrheinweg with Campylobacter spp. and L. monocytogenes was significantly greater than that of the other avenues and parks in Basel. However, the investigations conducted by the school medical service showed that no infections among the children attending the nursery school could be correlated to the presence of the starlings. Even if the heavy contamination of the area with droppings of starlings presents a potential health risk, a continuous or systematic transmission of infectious agents seems rather improbable due to the contamination-avoiding behaviour of the children, the characteristics of the microorganisms involved and the climatic conditions in autumn. This situation showed however not reduce our awareness of such a potential health risk.     

Perception of work conditions in a traditional farming community in Boa Esperança, Nova Friburgo, Rio de Janeiro State, Brazil

The impact of pesticide use on human and environmental health has received attention from the international scientific community for some time, especially in developing countries where such chemical agents are used extensively and indiscriminately. The present study adopts a methodological approach to risk perception analysis based on rapid surveys, including: participatory observation; semi-structured interviews with key informants; and evaluation of local work processes. Field data analysis revealed several issues related to the risk perception profile of the study population, including the development of defensive strategies toward work hazards, subjective responses to potentially hazardous situations, and the role of individual risk perception as a determinant of human exposure to pesticides.     

Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool,Florida, USA

In September 2013, local county health officials in Tallahassee, Florida, USA, were notified of a laboratory-confirmed pertussis case in a 1-year-old preschool attendee. During a 5-month period, 26 (22%) students 1–5 years of age, 2 staff from the same preschool, and 11 family members met the national case definition for pertussis. Four persons during this outbreak were hospitalized for clinical management of pertussis symptoms. Only 5 students, including 2 students with pertussis, had not received the complete series of vaccinations for pertussis. Attack rates in 1 classroom for all students who received the complete series of vaccinations for pertussis approached 50%. This outbreak raises concerns about vaccine effectiveness in this preschool age group and reinforces the idea that recent pertussis vaccination should not dissuade physicians from diagnosing, testing, or treating persons with compatible illness for pertussis.     

Prevalence of obesity in a locality of the State of S?o Paulo, Brazil, 1987]

The prevalence of obesity in Araraquara, a county of 150,000 inhabitants situated 250 km from S. Paulo, Brazil was studied. The study population, of 18-74 yrs. of age, resident in the urban area in 1987, was composed of 1,126 inhabitants, 502 males and 624 females, selected through a cluster equiprobabilistic sampling process. The prevalence of overweight (Quetelet 25-29.9 Kg/m2) was 26.9% for males and 27.7% for females. The prevalence of obesity (Quetelet equal or greater than 30.0 kg/m2) was 10.2% for males and 14.7% for females. These percentages are high when compared with those of affluent Anglo-saxon countries. The reasons for this phenomenon are discussed in the light of the fact that the economy of the city is affluent and is dependent on agroindustrial activities. When own cut-off criteria (P85 and P95 for Quetelet for 20-29 yrs of age, for each sex) are calculated, the "lean pattern" for Araraquara County is leaner than that for the a United States population. This raises doubts as to the possibility of applying cut-off criteria of particular regions to regions of different characteristics.     

Occurrence of Vibrio parahaemolyticus in mussels (Perna perna, Linnaeus, 1758) from a natural coastal bed in the municipality of Palhoça, Santa Catarina, Brazil

A study was carried out on the occurrence of Vibrio parahaemolyticus in forty samples of mussels (Perna perna, Linnaeus, 1758) from a natural bed at Pinheira Beach, Municipality of Palho?a, Santa Catarina (Brazil), during a three-month period. The most probable number technique was used for isolation methodology with prior enrichment of samples in alkaline peptone water and subsequent planting on thiosulfate citrate bile salts sucrose agar. Vibrio parahaemolyticus was found in 52.5% of samples of mussels with a most probable number range of <3 to 93 organisms/g. Serotyping was performed on 61 isolates and our findings indicate that 36.1% of these isolates were serologically non-typable; 54.1% of isolates displayed only flagellate antigenic structures and 8.2% had both antigenic structures. None of the isolates were Kanagawa positive.     

Evaluation of a GMP training of milkers in dairy goat farms in São Paulo, Brazil

A good manufacturing practices (GMP) training course was applied for goat milkers and evaluated using microbiological analysis in milk before and after training. Milkers from three dairy goat farms located in São Paulo, Brazil, were submitted to a one-hour course on GMP and recommended guidelines for milking. Samples of raw milk were collected before and one to two months after training, and analysed for aerobic mesophilic, psychrotrophic, coliform, Staphylococcus aureus and Salmonella spp counts. Only mesophilic counts decreased (p < 0.05) after training in two of three farms studied. Although important to assess the overall quality of milk, microbiological parameters should not be used alone for the evaluation of GMP effectiveness for goat milkers.     

Development of a food frequency questionnaire in a probabilistic sample of adults from Niterói, Rio de Janeiro, Brazil

With the purpose of generating a list of foods for a food-frequency questionnaire, data from 24h dietary recalls on a typical day from a probabilistic sample of 1,724 adults of Niterói, Rio de Janeiro, Brazil, were analyzed. The frequency of food intake, the total intake of energy and macronutrients and the relative contribution of each food item to total energy and macronutrient intake were calculated. The most frequently reported food items (> 50% of adults) were rice, coffee, beans, refined canesugar, and bread. Whole milk was consumed more frequently then skimmed milk or semi-skimmed milk. Beef was consumed by more adults than chicken, pork or fish. Approximately 90% of energy and macronutrients intake was explained by 65 food items. The list of food items generated in the present analysis is similar to those found in other samples of adults from urban areas in Brazil. It may be possible to generate a core list of common foods with addition of regional foods to be used nationally in urban areas of the country.     

Sperm characteristics in a sample of healthy adolescents in São Paulo, Brazil

The article presents preliminary data from a prospective investigation in a sample of healthy 14-17-year-old students from a technical school in Sao Paulo, Brazil. Ninety-six Tanner stage 5 and thirty-one Tanner stage 4 adolescents were evaluated: testicular volume was measured using a Prader orchidometer, and semen analysis was performed according to standard procedures. Median testicular volume was 20.0 ml among Tanner 5 students and 15.0 ml in Tanner 4 students in both the right and left testes. No significant differences were found in sperm volume or motility. Median concentration was 66.0 million/ml for Tanner 5 and 47.0 million/ml for Tanner 4 subjects. Morphological patterns showed abnormal forms in 81.9% of Tanner 5 and 93.6% of Tanner 4 adolescents. Oligospermia (sperm concentration < 5 million/ml) was observed in 7.3% of Tanner stage 5 and 12.9% of Tanner stage 4 individuals. Azoospermia was observed in 3 students (1.8%), with counts less than 1.0 in 8 students (4.8%). The authors discuss the observed results, analyzing the potential implications arising from biological development and potential environmental exposures.     

Health evaluation of gold miners living in a mercury-contaminated village in Serra Pelada, Pará, Brazil

Serra Pelada is a village in the Amazon region of Brazil where most of the inhabitants are former gold miners. Of 235 individuals evaluated, 219 were males (93.19%), 16 were females (6.80%), and the mean age was 52.07 years (standard deviation = 11.57). Most were heavy drinkers (62.44%) and smokers (70.30%), and 85.53% had previously suffered from malaria. Reported symptoms included fatigue (30.60%), irritability (35.62%), excitability (14.16%), insomnia (34.48%), memory loss (61.80%), visual field constriction (4.18%), paresthesia (64.93%), partial hearing loss (16.35%), and gingivitis (18.01%). After an examination of the residents, the authors observed several neurological symptoms: tremors (22.80%), involuntary ocular movement (2.20%), visual field constriction (4.18%), Romberg syndrome (2.33%), involuntary tongue movement (2.19%), dysdiadochokinesia (0.43%), failure of a finger-nose test (10.96%), failure of a knee-heel test (4.84%), inability to complete a tandem march (6.25%), muscular weakness (2.27%), and damage to sensory organs (24.66%). The authors concluded that these neurological changes possibly resulted from mercury toxicity; however, they could not determine a significant correlation with the mercury levels detected in participants' urine.     

Seroepidemiological survey of human cysticercosis in a municipality of Piauí State, Northeast Brazil

As part of parasitological studies in the area surrounding the Serra da Capivara National Park, Piauí State, Northeast Brazil, from 1999 to 2001, the current study aimed to evaluate the epidemiological profile of human cysticercosis in the Municipality of Jo?o Costa. Clinical and epidemiological data were obtained, and blood samples were drawn for immunoenzymatic serological tests (ELISA and Western blot), using Taenia crassiceps as the antigen. The first stage, in 1999, investigated 169 individuals with a confirmed history or suspicion of infection/disease involving the teniasis/cysticercosis complex, along with the family members. Some 13.6% of the individuals were seroreactive for cysticercosis by the ELISA method. The second stage, in 2001, evaluated 92 serum samples of individuals who had been detected as reactive for cysticercosis in the first stage, along with their family members; 24% of the samples were reactive to cysticercosis by ELISA and 29% by Western blot. During this same stage a coprological survey was performed with 701 individuals, including volunteers. Prevalence of intestinal parasites was 51%, with a higher prevalence of protozoans (95%) than helminths (5%). The results indicate the endemicity of cysticercosis in the area, in addition to the high frequency of intestinal protozoan infections.     

Description of a large measles epidemic in Democratic Republic of Congo, 2010–2013

Background

Although measles mortality has declined dramatically in Sub-Saharan Africa, measles remains a major public health problem in countries like the Democratic Republic of Congo (DRC). Here, we describe the large measles epidemic that occurred in the Democratic Republic of Congo between 2010 and 2013 using data from the national surveillance system as well as vaccine coverage surveys to provide a snapshot of the epidemiology of measles in DRC.

Methods

Standardized national surveillance data were used to describe measles cases from 2010 to 2013. Attack rates and case fatality ratios were calculated and the temporal and spatial evolution of the epidemic described. Data on laboratory confirmation and vaccination coverage surveys as a part of routine program monitoring are also presented.

Findings

Between week 1 of 2010 and week 45 of 2013, a total of 294,455 cases and 5,045 deaths were reported. The cumulative attack rate (AR) was 0.4%. The Case Fatality Ratio (CFR) was 1.7% among cases reported in health structures through national surveillance. A total of 186,178 cases (63%) were under 5 years old, representing an estimated AR of 1.4% in this age group. Following the first mass vaccination campaigns, weekly reported cases decreased by 21.5%. Results of post-vaccination campaign coverage surveys indicated sub-optimal (under 95%) vaccination coverage among children surveyed.

Conclusions

The data reported here highlight the need to seek additional means to reinforce routine immunization as well as ensure the timely implementation of Supplementary Immunization Activities to prevent large and repeated measles epidemics in DRC. Although reactive campaigns were conducted in response to the epidemic, strategies to ensure that children are vaccinated in the routine system remains the foundation of measles control.

     

Prevalence of hypovitaminosis a in children of peripheral districts of Campinas São Paulo, Brazil

The prevalence of hypovitaminosis A among children of the peripheral districts of the city of Campinas, S o Paulo, Brazil, was estimated by determining serum retinol levels by High Performance Liquid Chromatography (HPLC) in a sample of 131 children aged between three and ten years, between April 1991 and February 1992. A prevalence of 17.6% and retinol concentrations in the range of 0.35 to 0.70 micromol/L were found (CI=11.1-24.1; 95%), indicating the existence of public health risk Ophthalmological examinations, however, failed to detect any cases of xerophthalmy. Additional characterization of the sample was obtained from 341 children. The per capita income of the average household was surprisingly high for low-income areas. According to FAO-WHO standards, food consumption was adequate only for protein (133.96%). Adequacy levels were low for energy (87.76%) and particularly for vitamin A (66.13%) and iron (42.14%). Height for-age and weight-for-height anthropometric indices revealed that many children were located below -1 standard deviation.     

Explicit guidelines for qualitative research: a step in the right direction, a defence of the 'soft' option, or a form of sociological imperialism?

Within the context of health service research, qualitative research has sometimes been seen as a 'soft' approach, lacking scientific rigour. In order to promote the legitimacy of using qualitative methodology in this field, numerous social scientists have produced checklists, guidelines or manuals for researchers to follow when conducting and writing up qualitative work. However, those working in the health service should be aware that social scientists are not all in agreement about the way in which qualitative work should be conducted, and they should not be discouraged from conducting qualitative research simply because they do not possess certain technical skills or extensive training in sociology, anthropology or psychology. The proliferation of guidelines and checklists may be off-putting to people who want to undertake this sort of research, and they may also make it even more difficult for researchers to publish work in medical journals. Consequently, the very people who may be in a position to change medical practice may never read the results of important qualitative research.     

Increasing healthcare workers’ uptake of seasonal influenza vaccination in a tertiary-care pediatric hospital in Greece with a low-cost,tailor-made,multifaceted strategy

BackgroundHealthcare workers’ (HCW) seasonal influenza vaccination (SIV) is critical to prevent nosocomial influenza. However, HCW vaccination rates remain unacceptably low in many European institutions. A two-year three-step initiative was implemented at a tertiary-care pediatric hospital with 750 beds in Athens, Greece with the aim of increasing SIV among HCW.MethodsΑ cross-sectional anonymous survey of HCWs was conducted during the 2015–16 influenza season with the aim to evaluate attitudes, knowledge, and specific barriers and facilitators for SIV. Stratified analysis was used to identify factors associated with no prior history of influenza vaccination. Multifaceted interventions were implemented in the 2016–2017 season. These included 1) education around influenza disease and SIV, and 2) communication of availability and opportunity (time and place) of SIV. Interventions were designed to target HCWs with the lowest SIV rates in the previous three years.ResultsWe achieved a 67% response rate, with 363 respondents (106 doctors, 145 nurses, 101 other hospital staff; 11 did not provide their profession). Most (64%) had not been vaccinated in the previous three years; only 14% received the vaccine annually. Non-vaccination rates were significantly higher among nurses (76%) and cleaning and food-service workers (73%) compared to doctors (40%) (P < 0.001). Protection of self, family, patients and colleagues were the most common motivations. Concerns about the safety and effectiveness of the vaccine, the belief that one does not belong to a high-risk group were the most common barriers. The interventions led to an increase in SIV uptake by the HCWs in the hospital, from 19% to 31%.ConclusionsIn a country with very low reported rates of vaccination among HCWs, a simple, low-cost, tailor-made intervention strategy can lead to an increase in SIV uptake. Stratifying data according to vaccination history may reveal a diversity of targets for improvement that might otherwise be missed.