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OBJECTIVE: To assess the presence, pattern and magnitude of socioeconomic inequalities on dengue, chikungunya and Zika in Latin America, accounting for their spatiotemporal distribution. METHODS: Using longitudinal surveillance data (reported arboviruses) from Fortaleza, Brazil and Medellin, Colombia (2007-2017), we fit Bayesian hierarchical models with structured random effects to estimate: (i) spatiotemporally adjusted incidence rates; (ii) Relative Concentration Index and Absolute Concentration Index of inequality; (iii) temporal trends in RCIs; and (iv) socioeconomic-specific estimates of disease distribution. The spatial analysis was conducted at the neighbourhood level (urban settings). The socioeconomic measures were the median monthly household income (MMHI) for Brazil and the Socio-Economic Strata index (SES) in Colombia. RESULTS: There were 281 426 notified arboviral cases in Fortaleza and 40 887 in Medellin. We observed greater concentration of dengue among residents of low socioeconomic neighbourhoods in both cities: Relative Concentration Index = -0.12 (95% CI = -0.13, -0.10) in Fortaleza and Relative Concentration Index = -0.04 (95% CI = -0.05, -0.03) in Medellin. The magnitude of inequalities varied over time across sites and was larger during outbreaks. We identified a non-monotonic association between disease rates and socioeconomic measures, especially for chikungunya, that changed over time. The Relative Concentration Index and Absolute Concentration Index showed few if any inequalities for Zika. The socioeconomic-specific model showed increased disease rates at MMHI below US$400 in Brazil and at SES-index below level four, in Colombia. CONCLUSIONS: We provide robust quantitative estimates of socioeconomic inequalities in arboviruses for two Latin American cities. Our findings could inform policymaking by identifying spatial hotspots for arboviruses and targeting strategies to decrease disparities at the local level.
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Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Análise Espacial , Infecção por Zika virus/epidemiologia , Adolescente , Adulto , Teorema de Bayes , Brasil/epidemiologia , Febre de Chikungunya/mortalidade , Cidades/epidemiologia , Colômbia/epidemiologia , Dengue/mortalidade , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Características de Residência , Fatores Socioeconômicos , Adulto Jovem , Infecção por Zika virus/mortalidadeRESUMO
BACKGROUND: The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year. Although most dengue infections are asymptomatic, patients can present with a wide spectrum of clinical symptoms ranging from mild febrile illness through to severe manifestations of bleeding, organ impairment, and hypovolaemic shock due to a systemic vascular leak syndrome. Clinical diagnosis of dengue and identification of which patients are likely to develop severe disease remain challenging. This study aims to improve diagnosis and clinical management through approaches designed a) to differentiate between dengue and other common febrile illness within 72 h of fever onset, and b) among patients with dengue to identify markers that are predictive of the likelihood of evolving to a more severe disease course. METHOD/DESIGN: This is a prospective multi-centre observational study aiming to enrol 7-8000 participants aged ≥ 5 years presenting with a febrile illness consistent with dengue to outpatient health facilities in 8 countries across Asia and Latin America. Patients presenting within 72 h of fever onset who do not exhibit signs of severe disease are eligible for the study. A broad range of clinical and laboratory parameters are assessed daily for up to 6 days during the acute illness, and also at a follow up visit 1 week later. DISCUSSION: Data from this large cohort of patients, enrolled early with undifferentiated fever, will be used to develop a practical diagnostic algorithm and a robust clinical case definition for dengue. Additionally, among patients with confirmed dengue we aim to identify simple clinical and laboratory parameters associated with progression to a more severe disease course. We will also investigate early virological and serological correlates of severe disease, and examine genetic associations in this large heterogeneous cohort. In addition the results will be used to assess the new World Health Organization classification scheme for dengue in practice, and to update the guidelines for "Integrated Management of Childhood Illness" used in dengue-endemic countries. TRIAL REGISTRATION: NCT01550016. Registration Date: March 7, 2012.
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Dengue/epidemiologia , Adolescente , Adulto , Ásia/epidemiologia , Criança , Dengue/diagnóstico , Dengue/tratamento farmacológico , Vírus da Dengue/isolamento & purificação , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
The main challenge in disk laser design is the realization of efficient heat removal from the pumped area by optimizing the heat spreader design and the water impingement cooling. This generally requires the calculation of the temperature distribution in the disk by numerically solving the heat conduction equation using finite element algorithms. We have developed a simple method to calculate disk temperature profiles that is based on analytically solving the heat conduction equation in Hankel transform space. This method can be applied to disks that are mounted on multi-layered, water-cooled heat spreaders, which may include glue or solder layers and dielectric coating layers. The temperature and heat fluxes at the interfaces of the layers are connected via a heat transfer matrix, which allows for straightforward incorporation of additional heat sink layers or an undoped cap into the model. This generalized model allows for the parametric optimization of the heat distribution in pumped solid-state laser and semiconductor laser disks.
RESUMO
Temperature profiles in pumped solid-state laser disks are generally calculated numerically by using finite-element programs to solve the heat conduction equation in the disk and the heat spreader. Analytical expressions exist for the longitudinal temperature profile in the case of an infinitely thick heat spreader or in the limit of zero thickness of the disk. We are presenting a simplified, semi-analytical method to calculate the three-dimensional temperature profiles for any disk or heat spreader dimensions by solving the heat conduction equation using Hankel transforms. This method allows for straightforward optimization of the cooling properties of heat-sink-mounted solid-state and semiconductor disk lasers.
RESUMO
BACKGROUND: Dengue is an increasingly important public health problem in most Latin American countries and more cost-effective ways of reducing dengue vector densities to prevent transmission are in demand by vector control programs. This multi-centre study attempted to identify key factors associated with vector breeding and development as a basis for improving targeted intervention strategies. METHODS: In each of 5 participant cities in Mexico, Colombia, Ecuador, Brazil and Uruguay, 20 clusters were randomly selected by grid sampling to incorporate 100 contiguous households, non-residential private buildings (businesses) and public spaces. Standardized household surveys, cluster background surveys and entomological surveys specifically targeted to obtain pupal indices for Aedes aegypti, were conducted in the dry and wet seasons. RESULTS: The study clusters included mainly urban low-middle class populations with satisfactory infrastructure and -except for Uruguay- favourable climatic conditions for dengue vector development. Household knowledge about dengue and "dengue mosquitoes" was widespread, mainly through mass media, but there was less awareness around interventions to reduce vector densities. Vector production (measured through pupal indices) was favoured when water containers were outdoor, uncovered, unused (even in Colombia and Ecuador where the large tanks used for household water storage and washing were predominantly productive) and -particularly during the dry season- rainwater filled. Larval infestation did not reflect productive container types. All productive container types, including those important in the dry season, were identified by pupal surveys executed during the rainy season. CONCLUSIONS: A number of findings are relevant for improving vector control: 1) there is a need for complementing larval surveys with occasional pupal surveys (to be conducted during the wet season) for identifying and subsequently targeting productive container types; 2) the need to raise public awareness about useful and effective interventions in productive container types specific to their area; and 3) the motivation for control services that-according to this and similar studies in Asia- dedicated, targeted vector management can make a difference in terms of reducing vector abundance.
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Aedes/crescimento & desenvolvimento , Cidades/estatística & dados numéricos , Dengue/transmissão , Insetos Vetores/crescimento & desenvolvimento , Controle de Mosquitos , Adulto , Animais , Cruzamento , Meio Ambiente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Habitação/estatística & dados numéricos , Humanos , Larva , América Latina , Masculino , Pessoa de Meia-Idade , Controle de Mosquitos/estatística & dados numéricos , Pupa , Chuva , Saneamento , Estações do Ano , Saúde da População Urbana , Uruguai , Abastecimento de ÁguaRESUMO
Social media usage is growing globally, with an exponential increase in low- and middle-income countries. Social media changes the ways in which information-sharing occurs, intensifying the population's exposure to misinformation, including fake news. This has important repercussions for global health. The spread of fake news can undermine the implementation of evidence-based interventions and weaken the credibility of scientific expertise. This is particularly worrisome in countries, such as Brazil, in a sociopolitical context characterized by a lack of popular trust in public institutions. In this project report, we describe our experience with the spread of fake news through the social media platform WhatsApp during the implementation of a cluster randomized controlled trial aimed at reducing dengue incidence in children in Fortaleza (Brazil). During initial visits to selected clusters, the research team was met with resistance. Then, soon after data collection started, fake news began circulating about the study. As a result, the research team developed strategies to dispel suspicion and further promote the study. However, the climate of violence and mistrust, coupled with the COVID-19 pandemic, forced the interruption of the study in 2019. The lessons learned from our experience in Fortaleza can be useful to other researchers and practitioners implementing large-scale interventions in this era of health-related misinformation.
Assuntos
COVID-19 , Dengue , Mídias Sociais , Criança , Humanos , COVID-19/epidemiologia , Saúde Global , Brasil/epidemiologia , Pandemias , Desinformação , Dengue/epidemiologiaRESUMO
BACKGROUND: Improvements in the early diagnosis of dengue are urgently needed, especially in resource-limited settings where the distinction between dengue and other febrile illnesses is crucial for patient management. METHODS: In this prospective, observational study (IDAMS), we included patients aged 5 years and older with undifferentiated fever at presentation from 26 outpatient facilities in eight countries (Bangladesh, Brazil, Cambodia, El Salvador, Indonesia, Malaysia, Venezuela, and Viet Nam). We used multivariable logistic regression to investigate the association between clinical symptoms and laboratory tests with dengue versus other febrile illnesses between day 2 and day 5 after onset of fever (ie, illness days). We built a set of candidate regression models including clinical and laboratory variables to reflect the need of a comprehensive versus parsimonious approach. We assessed performance of these models via standard measures of diagnostic values. FINDINGS: Between Oct 18, 2011, and Aug 4, 2016, we recruited 7428 patients, of whom 2694 (36%) were diagnosed with laboratory-confirmed dengue and 2495 (34%) with (non-dengue) other febrile illnesses and met inclusion criteria, and were included in the analysis. 2703 (52%) of 5189 included patients were younger than 15 years, 2486 (48%) were aged 15 years or older, 2179 (42%) were female and 3010 (58%) were male. Platelet count, white blood cell count, and the change in these variables from the previous day of illness had a strong association with dengue. Cough and rhinitis had strong associations with other febrile illnesses, whereas bleeding, anorexia, and skin flush were generally associated with dengue. Model performance increased between day 2 and 5 of illness. The comprehensive model (18 clinical and laboratory predictors) had sensitivities of 0·80 to 0·87 and specificities of 0·80 to 0·91, whereas the parsimonious model (eight clinical and laboratory predictors) had sensitivities of 0·80 to 0·88 and specificities of 0·81 to 0·89. A model that includes laboratory markers that are easy to measure (eg, platelet count or white blood cell count) outperformed the models based on clinical variables only. INTERPRETATION: Our results confirm the important role of platelet and white blood cell counts in diagnosing dengue, and the importance of serial measurements over subsequent days. We successfully quantified the performance of clinical and laboratory markers covering the early period of dengue. Resulting algorithms performed better than published schemes for distinction of dengue from other febrile illnesses, and take into account the dynamic changes over time. Our results provide crucial information needed for the update of guidelines, including the Integrated Management of Childhood Illness handbook. FUNDING: EU's Seventh Framework Programme. TRANSLATIONS: For the Bangla, Bahasa Indonesia, Portuguese, Khmer, Spanish and Vietnamese translations of the abstract see Supplementary Materials section.
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Febre , Humanos , Masculino , Feminino , Estudos Prospectivos , América Latina/epidemiologia , Ásia , Biomarcadores , Bangladesh , Febre/etiologia , Febre/diagnósticoRESUMO
BACKGROUND: We used surveillance data from Brazil and Colombia during 2007-2017 to assess the presence of socioeconomic inequalities on dengue, chikungunya and Zika at the neighborhood level in two Latin American cities. METHODS: To quantify the inequality, we estimated and decomposed the relative concentration index of inequality (RCI) accounting for the spatiotemporal distribution of the diseases. RESULTS: There were 281 426 arboviral cases notified in Fortaleza, Brazil, and 40 889 in Medellin, Colombia. The RCI indicated greater concentration of dengue cases among people living in low socioeconomic settings in both sites. The RCIs for chikungunya in Fortaleza covered the line of equality during their introduction in 2014, while the RCIs for Zika and chikungunya in Medellin indicated the presence of a small inequality. The RCI decomposition showed that year of notification and age were the main contributors to this inequality. In Medellin, the RCI decomposition showed that age and access to waste management accounted for 75.5%, 72.2% and 54.5% of the overall inequality towards the poor for dengue, chikungunya and Zika, respectively. CONCLUSIONS: Our study presents estimates of the socioeconomic inequality of arboviruses and its decomposition in two Latin American cities. We corroborate the concentration of arboviral diseases in low socioeconomic neighborhoods and identify that year of occurrence, age, presence of healthcare facilities and waste management are key determinants of the heterogenous distribution of endemic arboviruses across the socioeconomic spectrum.
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Arbovírus , Febre de Chikungunya , Dengue , Infecção por Zika virus , Zika virus , Brasil/epidemiologia , Febre de Chikungunya/epidemiologia , Colômbia/epidemiologia , Dengue/epidemiologia , Humanos , Fatores Socioeconômicos , Infecção por Zika virus/epidemiologiaRESUMO
Aedes aegypti is a cosmopolitan vector for arboviruses dengue, Zika and chikungunya, disseminated in all Brazilian states. The Eco-Bio-Social (EBS) strategy is vital in Aedes aegypti control as it mobilizes stakeholders (government, professionals, society, and academics) to promote healthy environments. This paper describes the rationale and methods of expanding the EBS strategy for Aedes aegypti control in Fortaleza, Northeast Brazil. A cluster, non-randomized controlled clinical trial was developed to analyze the strategy's effectiveness in vulnerable territories (high incidence of dengue and violent deaths; low HDI; substandard urban infrastructure, high population density, and water scarcity). We selected two intervention and two control groups, resulting in a sample of approximately 16,000 properties. The intervention consisted of environmental management by sealing large elevated water tanks, introduction of beta fish in waterholes, elimination of potential breeding sites, and mobilization and training of schoolchildren, endemic disease workers, health workers, social mobilizers, and community leaders; community surveillance of arboviruses; construction and validation of a booklet for the prevention of arboviruses in pregnant women. We analyzed the costs of arboviruses to government and households, the intervention cost-effectiveness, chikungunya's chronicity, and acceptance, sustainability, and governance of vector control actions. The primary outcome (infestation) was analyzed using the house, container, and Breteau indices. We hope that this study will help us understand how to scale up strategies to fight Aedes aegypti in vulnerable areas.
Assuntos
Aedes , Dengue , Infecção por Zika virus , Zika virus , Animais , Brasil/epidemiologia , Criança , Dengue/epidemiologia , Dengue/prevenção & controle , Feminino , Humanos , Controle de Mosquitos , Mosquitos Vetores , Gravidez , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controleRESUMO
BACKGROUND: Serological diagnosis of Zika virus (ZIKV) infection is challenging because of the antibody cross-reactivity among flaviviruses. At the same time, the role of Nucleic Acid Testing (NAT) is limited by the low proportion of symptomatic infections and the low average viral load. Here, we compared the diagnostic performance of commercially available IgM, IgAM, and IgG ELISAs in sequential samples during the ZIKV and chikungunya (CHIKV) epidemics and co-circulation of dengue virus (DENV) in Brazil and Venezuela. METHODOLOGY/PRINCIPAL FINDINGS: Acute (day of illness 1-5) and follow-up (day of illness ≥ 6) blood samples were collected from nine hundred and seven symptomatic patients enrolled in a prospective multicenter study between June 2012 and August 2016. Acute samples were tested by RT-PCR for ZIKV, DENV, and CHIKV. Acute and follow-up samples were tested for IgM, IgAM, and IgG antibodies to ZIKV using commercially available ELISAs. Among follow-up samples with a RT-PCR confirmed ZIKV infection, anti-ZIKV IgAM sensitivity was 93.5% (43/46), while IgM and IgG exhibited sensitivities of 30.3% (10/33) and 72% (18/25), respectively. An additional 24% (26/109) of ZIKV infections were detected via IgAM seroconversion in ZIKV/DENV/CHIKV RT-PCR negative patients. The specificity of anti-ZIKV IgM was estimated at 93% and that of IgAM at 85%. CONCLUSIONS/SIGNIFICANCE: Our findings exemplify the challenges of the assessment of test performance for ZIKV serological tests in the real-world setting, during co-circulation of DENV, ZIKV, and CHIKV. However, we can also demonstrate that the IgAM immunoassay exhibits superior sensitivity to detect ZIKV RT-PCR confirmed infections compared to IgG and IgM immunoassays. The IgAM assay also proves to be promising for detection of anti-ZIKV seroconversions in sequential samples, both in ZIKV PCR-positive as well as PCR-negative patients, making this a candidate assay for serological monitoring of pregnant women in future ZIKV outbreaks.
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Febre de Chikungunya/diagnóstico , Dengue/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Testes Sorológicos/métodos , Infecção por Zika virus/diagnóstico , Adolescente , Adulto , Anticorpos Antivirais/sangue , Sangue/virologia , Brasil , Criança , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Estudos Prospectivos , RNA Viral/sangue , Reação em Cadeia da Polimerase em Tempo Real , Venezuela , Adulto JovemRESUMO
BACKGROUND: Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil. METHODS: The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of anti-dengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants. DISCUSSION: The results of our study will provide evidence on community mobilization as an intervention for dengue control. We anticipate that if community mobilization is effective in Fortaleza, the results of this study will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases. TRIAL REGISTRATION: ISRCTN66131315, registration date: 1 October 2018.
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Aedes/virologia , Participação da Comunidade , Dengue/prevenção & controle , Controle de Mosquitos/organização & administração , Mosquitos Vetores/virologia , Adulto , Animais , Brasil , Criança , Pré-Escolar , Cidades , Pesquisa Participativa Baseada na Comunidade/métodos , Pesquisa Participativa Baseada na Comunidade/organização & administração , Dengue/transmissão , Dengue/virologia , Feminino , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Controle de Mosquitos/métodos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Aedes aegypti is currently a critical disease agent and is responsible for viruses such as Zika, Chikungunya and Dengue's four serotypes. This mosquito's relevance to the current social body has come to the fore and triggered urgent EcoHealth investigations since this approach aims to articulate different theoretical fields to understand the historical linkages between nature, society and health. Based on an ethnographic premise, this study considered the unequal and unfair conditions that make women's health vulnerable to dengue, analyzing their practices and perceptions about the potential breeding grounds in the public space. A semi-structured interview and participant observation, as well as a field diary, were used to compose the study. The research included the participation of ten women living in the outskirts of Fortaleza, Ceará, Brazil, from January to August 2014. The category "Social inequality, context and practices in the public space" emerged from the content analysis. The narratives revealed that unstable living conditions and evident social inequality might influence in a context permeated by waste, with great potential for dengue's mosquito proliferation.
O Aedes aegypti é um importante agente transmissor de afecções na atualidade, sendo o responsável por enfermidades como Zika, Chikungunya e os quatro sorotipos do Dengue. Por ocasião da relevância desse mosquito para o corpo social atual, investigações em Ecossaúde se tornam prementes, já que essa abordagem visa articular diferentes campos teóricos para entender as conexões históricas entre a natureza, a sociedade e a saúde. Partindo de uma premissa etnográfica, este estudo considerou as condições de desigualdade e injustiça que tornam vulneráveis a saúde de mulheres em torno do dengue, analisando práticas e percepções destas acerca dos potencias criadouros existentes no espaço público. Para compor o estudo, utilizou-se a entrevista semiestruturada e a observação participante, com uso de diário de campo. A pesquisa contou com a participação de dez mulheres moradoras de um bairro periférico da cidade de Fortaleza, Ceará, Brasil, tendo ocorrido no período de janeiro a agosto de 2014. Da Análise de Conteúdo emergiu a categoria "Iniquidade social, contexto e práticas no espaço público". A partir das narrativas, constatou-se que condições precárias de vida e evidente iniquidade social poderão influenciar em um contexto permeado por lixo, com grande potencial para a proliferação do mosquito causador da dengue.
Assuntos
Febre de Chikungunya/prevenção & controle , Dengue/prevenção & controle , Controle de Mosquitos/métodos , Infecção por Zika virus/prevenção & controle , Adulto , Aedes/virologia , Idoso , Animais , Brasil , Febre de Chikungunya/transmissão , Dengue/transmissão , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Mosquitos Vetores/virologia , Fatores Socioeconômicos , Adulto Jovem , Infecção por Zika virus/transmissãoRESUMO
BACKGROUND: In recent decades, studies that evaluate training programmes have shown that continuing education for physicians is not very effective in improving performance and behavioural changes. One of our goals was to create a Continuing Medical Education Programme (CMEP) that would result in changing the behaviour of health professionals. In early 2005, a new CMEP was offered to emergency medical services and emergency room professionals to introduce an Emergency Critical Pathway (ECP) for the management of acute stroke patients. This paper illustrates the main characteristics of the educational model and the strategies and activities adopted to realize it. METHODS: The training programme was planned and organized applying the concepts and tools of experiential learning. It was organised in three successive phases: 1) interviews with health professionals to identify their learning needs; 2) training the ECP coordinators/facilitators in a residential setting; and 3) on-site training in small groups of health professionals (6-8), led by a coordinator/facilitator. RESULTS: The CME involved 324 emergency health professionals. Participants positively evaluated both the educational programme and the clinical indications of the protocols. Over six months of the ECP training, health professionals treated 657 stroke patients: 153 (23.3%) were transferred to the stroke unit where 15 (9.8%) were thrombolysed. In the same period of the previous year, the professionals treated 638 patients: 99 (15.5%) were transferred to the stroke unit and no patients were thrombolysed. CONCLUSION: The application of the new educational methodology has contributed to improved management of stroke patients in Latium.
Assuntos
Educação Médica Continuada/métodos , Medicina de Emergência/educação , Medicina de Emergência Baseada em Evidências/educação , Educação Baseada em Competências/métodos , Humanos , Itália , Modelos Educacionais , Acidente Vascular Cerebral/terapiaRESUMO
BACKGROUND: More than half of the world's population currently lives in urban settlements that grow both in size and number. By 2050, approximately 70% of the global population will be living in urban conglomerations, mainly in low- and middle-income countries. Mobility, poverty, different layers of inequalities as well as climate variability and change are some of the social and environmental factors that influence the exposure of human populations in urban settings to vector-borne diseases, which pose eminent public health threats. Accurate, consistent, and evidence-based interventions for prevention and control of vector-borne and other infectious diseases of poverty in urban settings are needed to implement innovative and cost-effective public policy and to promote inclusive and equitable urban health services. MAIN BODY: While there is growing awareness of vector-borne diseases epidemiology at the urban level, there is still a paucity of research and action being undertaken in this area, hindering evidence-based public health policy decisions and practice and strategies for active community engagement. This paper describes the collaboration and partnership of the Special Programme for Research and Training in Tropical Diseases (TDR) hosted by the World Health Organization (WHO) and the "VEctor boRne DiseAses Scoping reviews" (VERDAS) Research Consortium as they joined efforts in response to filling this gap in knowledge and evidence by supporting the development of a series of scoping reviews that highlight priority research gaps and policy implications to address vector-borne and other infectious diseases at the urban level. CONCLUSIONS: The set of scoping reviews proposed in this special issue presents a critical analysis of the state-of-the-art of research on urban health interventions for the prevention and control of vector-borne and other infectious diseases of poverty. The authors of the 6 reviews highlighted severe gaps in knowledge and identified organizational and theoretical limitations that need to be urgently tackled to improve cities preparedness and vector control response. The more pressing need at present is to ensure that more implementation research on vector-borne diseases in urban settings is conducted, addressing policy and practice implications and calling for more political commitment and social mobilization through adequate citizen engagement strategies.
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Pesquisa Biomédica/economia , Controle de Doenças Transmissíveis , Doenças Transmissíveis/economia , Saúde da População Urbana/economia , Animais , Controle de Doenças Transmissíveis/economia , Doenças Transmissíveis/transmissão , Vetores de Doenças , Humanos , PobrezaRESUMO
Prior to the current public health emergency following the emergence of chikungunya and Zika Virus Disease in the Americas during 2014 and 2015, multi-country research investigated between 2011 and 2013 the efficacy of novel Aedes aegypti intervention packages through cluster randomised controlled trials in four Latin-American cities: Fortaleza (Brazil); Girardot (Colombia), Acapulco (Mexico) and Salto (Uruguay). Results from the trials led to a scaling up effort of the interventions at city levels. Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and foster policy and program development in a sustainable way. The different scenarios represent examples for a 'vertical approach' and a 'horizontal approach'. This paper presents the analysis of a preliminary process evaluation of the scaling up efforts in the mentioned cites, with a focus on challenges and enabling factors encountered by the research teams, analysing the main social, political, administrative, financial and acceptance factors.
Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Controle de Mosquitos/métodos , Controle de Mosquitos/organização & administração , População Urbana , Aedes/crescimento & desenvolvimento , Animais , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/prevenção & controle , Cidades/epidemiologia , Humanos , América Latina/epidemiologia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/prevenção & controleRESUMO
Este artigo apresenta um recorte dos resultados da experiência pedagógica realizada com estudantes por meio da interlocução entre saúde e escola, permeada pela educação e promoção da saúde enquanto potencializadores do protagonismo infantojuvenil. Trata-se de um estudo qualitativo, pesquisa-ação, realizado com 55 estudantes em minicursos em duas escolas municipais de Fortaleza (CE). Esta pesquisa versa sobre a implementação de uma abordagem ecossistêmica em ambiente escolar para a promoção da saúde, prevenção e controle do Aedes aegypti. Observa-se que as ações de controle contra o vetor dependerão de ampla participação de diversos grupos e comunidades. Os estudantes perceberam a necessidade de intensificar ações de promoção da saúde no cotidiano e promover o protagonismo e a autonomia dos sujeitos para coletivamente compreender a saúde como resultante das condições de vida para um desenvolvimento social mais equitativo. Conclui-se que o incremento de atividades dirigidas à mudança comportamental dos alunos, concentrando-se em componentes educativos, e a compreensão de que a saúde resulta de múltiplos determinantes alinham-se a uma articulação de ações de promoção de saúde fomentadoras de um saber coletivo, que estimula no indivíduo e na coletividade sua autonomia e emancipação para o cuidado de si e de seu entorno.
This paper presents the results of a pedagogical experience carried out with students via dialogue between healthcare and school, based on health education and promotion as potentiators of youth leadership. To investigate the implementation of an ecosystem approach in a school environment for health promotion, and Aedes aegypti control and prevention, a qualitative action research was carried out with 55 students attending mini-courses in two municipal schools in Fortaleza, Ceará, Brazil. Results show that action aimed at vector control depend on the broad participation of different groups and communities. Students realized the need to enhance daily health promotion actions and to promote youth leadership and autonomy to collectively understand health as a result of living conditions, seeking more equitable social development. In conclusion, the increased activities aimed at behavioral change, focusing on educational components, and the understanding that health results from multiple determinants, assumes an articulation of health promotion actions that foster collective knowledge to stimulate individual and community autonomy and emancipation in caring for themselves and their surroundings.
Este artículo presenta un extracto de los resultados de la experiencia pedagógica realizada con estudiantes a través del diálogo entre salud y escuela, permeada por la educación y la promoción de la salud como potenciadoras del protagonismo infantil. Se trata de un estudio cualitativo, investigación acción realizada con 55 alumnos en minicursos en dos escuelas municipales de Fortaleza (CE), Brasil. Se trata de la implementación de un enfoque ecosistémico en un ambiente escolar para la promoción de la salud, prevención y control del Aedes aegypti. Se observa que las acciones de control del vector dependerán de la amplia participación de diferentes grupos y comunidades. Los estudiantes percibieron la necesidad de intensificar las acciones de promoción de la salud en el cotidiano y promover el protagonismo y la autonomía de los sujetos para comprender colectivamente la salud como resultado de condiciones de vida para un desarrollo social más equitativo. Se concluye que el aumento de actividades dirigidas al cambio de comportamiento de los estudiantes, con foco en los componentes educativos, y la comprensión de que la salud resulta de múltiples determinantes, se alinean con una articulación de acciones de promoción de la salud que fomenten el conocimiento colectivo que estimule en el individuo y la colectividad su autonomía y emancipación para cuidar de sí mismos y de su entorno.
Assuntos
Educação em Saúde , Aedes , Promoção da SaúdeRESUMO
Este estudo objetiva implementar ações de vigilância comunitária no controle do vetor Aedes aegypti em ambiente escolar à luz da promoção da saúde e da abordagem ecobiossocial. Trata-se de uma análise qualitativa que versa sobre os pressupostos de uma pesquisa-ação. Para a produção de dados, utilizou-se um minicurso agregado à técnica Photovoice, concluído com grupos focais. Os dados empíricos foram processados pelo software Iramuteq® e submetidos à análise de conteúdo de Minayo. A pesquisa foi realizada em duas escolas municipais de Fortaleza, Ceará, Brasil, com a participação de 55 estudantes. Os resultados mostraram o incentivo à reflexão das práticas de participação e corresponsabilidade social nas ações de vigilância comunitária e cuidado com o meio ambiente como aliados do controle vetorial. O Photovoice mostra-se propulsor no alinhavo dessas temáticas, desperta o espírito cooperativo e integrativo, possibilitando sua difusão e continuação em outras escolas. (AU)
El objetivo de este estudio es implementar acciones de vigilancia comunitaria en el control del vector Aedes aegypti en el ambiente escolar bajo la óptica de la promoción de la salud y de un abordaje eco-bio-social. Se trata de un estudio cualitativo que trata sobre las presuposiciones de una investigación-acción. Para la producción de datos, se utilizó un minicurso agregado a la técnica Photovoice, concluido con grupos focales. Los datos empíricos fueron procesados por el software Iramuteq® y sometidos al análisis de contenido de Minayo. El estudio se realizó en dos escuelas municipales de Fortaleza, Ceará, Brasil, con la participación de 55 estudiantes. Los resultados mostraron el incentivo a la reflexión de las prácticas de participación y corresponsabilidad en las acciones de vigilancia comunitaria y cuidado con el medio ambiente como aliados del control vectorial. El Photovoice se muestra propulsor en el esbozo de esas temáticas, despierta el espíritu cooperativo e integrador y sugiere su difusión y continuación en otras escuelas. (AU)
This study aims to implement community surveillance actions for Aedes aegypti vector control in the school environment in the light of health promotion and the eco-bio-social approach. This qualitative study addresses the assumptions of action research. Data was collected through a short course coupled with the Photovoice technique, and the collection was completed with focus groups. The empirical data were processed by Iramuteq® software and submitted to Minayo's content analysis. The research was conducted in two municipal schools of Fortaleza, Ceará, Brazil, with the participation of 55 students. The results showed the incentive to reflect participation and socially-shared accountability practices in the community surveillance and environmental care actions as vector control allies. Photovoice proves to be a driver in the alignment of these themes, awakening the cooperative and integrative spirit, and its dissemination and continuation are suggested in other schools. (AU)
Assuntos
Humanos , Serviços de Saúde Escolar , Aedes , Promoção da Saúde , Estudantes , Voz , Ensino Fundamental e Médio , Pesquisa Qualitativa , FotografiaRESUMO
BACKGROUND: Five studies were conducted in Fortaleza (Brazil), Girardot (Colombia), Machala (Ecuador), Acapulco (Mexico), and Salto (Uruguay) to assess dengue vector control interventions tailored to the context. The studies involved the community explicitly in the implementation, and focused on the most productive breeding places for Aedes aegypti. This article reports the cost analysis of these interventions. METHODS: We conducted the costing from the perspective of the vector control program. We collected data on quantities and unit costs of the resources used to deliver the interventions. Comparable information was requested for the routine activities. Cost items were classified, analyzed descriptively, and aggregated to calculate total costs, costs per house reached, and incremental costs. RESULTS: Cost per house of the interventions were $18.89 (Fortaleza), $21.86 (Girardot), $30.61 (Machala), $39.47 (Acapulco), and $6.98 (Salto). Intervention components that focused mainly on changes to the established vector control programs seem affordable; cost savings were identified in Salto (-21%) and the clean patio component in Machala (-12%). An incremental cost of 10% was estimated in Fortaleza. On the other hand, there were also completely new components that would require sizeable financial efforts (installing insecticide-treated nets in Girardot and Acapulco costs $16.97 and $24.96 per house, respectively). CONCLUSIONS: The interventions are promising, seem affordable and may improve the cost profile of the established vector control programs. The costs of the new components could be considerable, and should be assessed in relation to the benefits in reduced dengue burden.
Assuntos
Aedes/fisiologia , Dengue/economia , Controle de Mosquitos/economia , Animais , Dengue/prevenção & controle , Humanos , Insetos Vetores/fisiologia , América Latina , Controle de Mosquitos/métodosRESUMO
BACKGROUND: This study intended to implement a novel intervention strategy, in Brazil, using an ecohealth approach and analyse its effectiveness and costs in reducing Aedes aegypti vector density as well as its acceptance, feasibility and sustainability. The intervention was conducted from 2012 to 2013 in the municipality of Fortaleza, northeast Brazil. METHODOLOGY: A cluster randomized controlled trial was designed by comparing ten intervention clusters with ten control clusters where routine vector control activities were conducted. The intervention included: community workshops; community involvement in clean-up campaigns; covering the elevated containers and in-house rubbish disposal without larviciding; mobilization of schoolchildren and senior inhabitants; and distribution of information, education and communication (IEC) materials in the community. RESULTS: Differences in terms of social participation, commitment and leadership were present in the clusters. The results showed the effectiveness of the intervention package in comparison with the routine control programme. Differences regarding the costs of the intervention were reasonable and could be adopted by public health services. CONCLUSIONS: Embedding social participation and environmental management for improved dengue vector control was feasible and significantly reduced vector densities. Such a participatory ecohealth approach offers a promising alternative to routine vector control measures.
Assuntos
Serviços de Saúde Comunitária/organização & administração , Dengue/prevenção & controle , Reservatórios de Doenças/parasitologia , Controle de Mosquitos/organização & administração , Aedes/parasitologia , Animais , Atitude Frente a Saúde , Brasil/epidemiologia , Análise por Conglomerados , Ecossistema , Entomologia , Estudos de Viabilidade , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/organização & administração , Habitação , Humanos , Insetos Vetores/patogenicidade , Participação SocialRESUMO
This work aims to contribute to the current discussion on the relationship between health and disease, taking a hermeneutic perspective on the issue. The first section, referring to the discussion among the hermeneutic, phenomenological, and existential lines of philosophy, analyzes the work of two philosophers, Kierkegaard and Heidegger, who profoundly influenced contemporary hermeneutics. The article discusses the concept of anguish, which for Kierkegaard (contrary to the biomedical approach) is a constitutive component of human beings: for Kierkegaard, as subsequently for Heidegger, anxiety is not a pathological symptom but a state that allows for privileged access to self-knowledge. In the second section, we approach how hermeneutics, and especially the work of Gadamer, developed the concepts of health, illness, and suffering; we also analyze how in recent years this perspective has influenced the social sciences (and particularly medical anthropology) in their approach to health problems. The third and final section discusses the implications of hermeneutics for clinical training and practice, demonstrating the applicability of Heidegger's and Gadamer's thinking for work by physicians and nurses.