Outbreak of acute gastroenteritis caused by adenovirus type 41 in a kindergarten

In response to an alert due to epidemic gastroenteritis in children in a kindergarten, an outbreak investigation was carried out in a Portuguese municipality. The objectives were to establish an aetiological diagnosis, assess vaccine efficacy if possible, and to take corrective measures if necessary. The warden at the kindergarten was interviewed, and we visited the premises. The overall attack rate was 11·4% and most cases were mild. Stool samples from three symptomatic children were collected and screened for the presence of noroviruses, rotaviruses and adenoviruses. High vaccination coverage against rotaviruses was recorded in children aged <2 years. We initially thought that noroviruses and rotaviruses were more likely to have been the aetiological cause of the disease, but the outbreak was caused by infection with adenovirus 41. These viruses should not be overlooked in the laboratory protocol in the study of acute gastroenteritis outbreaks.     

Communicating alcohol narratives: creating a healthier relationship with alcohol

Alcohol, like mental health, is a neglected topic in public health discussions. However, it should be defined as a priority public health area because the evidence available to support this is very persuasive. Although only half the world's population drinks alcohol, it is the world's third leading cause of ill health and premature death, after low birth weight and unsafe sex, and the world's greatest cause of ill health and premature death among individuals between 25 and 59 years of age. This article aims to outline current global experiences with alcohol policies and suggests how to communicate better evidence-based policy responses to alcohol-related harm using narratives. The text summarizes 6 actions to provide incentives that would favor a healthier relationship with alcohol in contemporary society. Actions include price and availability changes, marketing regulations, changes in the format of drinking places and on the product itself, and actions designed to nudge people at the time of their purchasing decisions. Communicating alcohol narratives to policymakers more successfully will likely require a discourse emphasizing the reduction of heavy drinking occasions and the protection of others from someone else's problematic drinking.     

Clinical and Multimodal Imaging Findings and Risk Factors for Ocular Involvement in a Presumed Waterborne Toxoplasmosis Outbreak,Brazil

In 2015, an outbreak of presumed waterborne toxoplasmosis occurred in Gouveia, Brazil. We conducted a 3-year prospective study on a cohort of 52 patients from this outbreak, collected clinical and multimodal imaging findings, and determined risk factors for ocular involvement. At baseline examination, 12 (23%) patients had retinochoroiditis; 4 patients had bilateral and 2 had macular lesions. Multimodal imaging revealed 2 distinct retinochoroiditis patterns: necrotizing focal retinochoroiditis and punctate retinochoroiditis. Older age, worse visual acuity, self-reported recent reduction of visual acuity, and presence of floaters were associated with retinochoroiditis. Among patients, persons >40 years of age had 5 times the risk for ocular involvement. Five patients had recurrences during follow-up, a rate of 22% per person-year. Recurrences were associated with binocular involvement. Two patients had late ocular involvement that occurred >34 months after initial diagnosis. Patients with acquired toxoplasmosis should have long-term ophthalmic follow-up, regardless of initial ocular involvement.     

Non-medical use of opioid analgesics in contemporary Brazil: Findings from the 2015 Brazilian National Household Survey on Substance Use

ABSTRACT

Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2–0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3–3.4), 1.4 (95%C.I.:1.1–1.7) and 0.6 (95%C.I.:0.4–0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36–0.78)], those aged 12–24 [0.56 (95% C.I.:0.34–0.92)], persons with monthly family incomes between R$1,501–3,000 [0.59 (95% C.I.:0.38–0.92)] or greater than R$3,000 [0.64 (95% C.I.:0.42–0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46–0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms.     

Conditional Cash Transfers in the Amazon: From the Nutrition Transition to Complex Dietary Behavior Change

ABSTRACT

Nutrition transition theory describes a progressive substitution of local staples for industrialized processed foods in local diets, a process documented diversely across world regions, and increasingly observed in rural areas of the global south. Here we examine the role of conditional cash transfer programs, in particular the emblematic Brazilian Bolsa Família (BFP), in driving nutritional transition in rural areas of the Amazon. Based on ethnographic research with both participating and nonparticipating women in the Amanã Sustainable Development Reserve (SDR), our analysis integrates Food Frequency Questionnaires (FFQ), seasonal 24-hour food intake recalls, and stable isotope ratios in fingernails to examine dietary behavioral change. Contrary to dietary changes observed elsewhere in the Amazon, participation in the BFP is not associated with a significant substitution of local staples for industrialized processed foods in Amanã. While an increase in the consumption of some industrialized foods was observed, it has been selective and it has not changed the structure of diets. Factors such as social and cultural value of local staples, resident’s involvement with the SDR, their relationship with lake and upland forest and agricultural environments, and limited market access have buffered the expansion of industrialized processed foods as observed elsewhere.     

Quality-of-life outcomes of a weight management program for adolescents based on motivational interviewing

Objective

To compare motivational interviewing (MI) with conventional care regarding the health-related quality-of-life (HRQoL) of adolescents with overweight/obesity.

The Impact of Socioeconomic Factors,Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis

Background:No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers.Objectives:To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil.Methods:An ecological study using secondary data from Brazilian Health Informatics Department between 2013–2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R² and lowest Akaike Information Criterion.Results:A total of 22,920 individuals died from IHD between 2013–2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran’s I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R²: 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05).Conclusion:Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil.Highlights

• The increase in ischemic heart disease mortality rates is related to geographical disparities.
• The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health.
• Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state.
• Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling.