Recent trends in hepatitis A incidence in Brazil.

Hepatitis A incidence has been decreasing in Brazil since child vaccination was implemented in 2014. This trend was interrupted by an outbreak among adult male in São Paulo in 2017. This study was outlined to estimate whether the increase of hepatitis A cases among adult men in Brazil was restricted to São Paulo. Cases reported to the national surveillance system from 14 large cities of all Brazilian regions were analyzed. Trends in time series from 2012 to 2018 were estimated by Prais-Winsten regression. The outbreak in São Paulo extended to 2018. In Rio de Janeiro, the number of cases rose again, achieving the same levels reported before the vaccination era. Three of six cities from South and Southeast regions showed an upward trend in the number of cases among adult men (P < .005). The large cities in the other three Brazilian macroregions showed a decrease or stabilization of cases without an increase among male adults. The increase of hepatitis A virus (HAV) cases in Brazil has happened not only in São Paulo, but also in other cities of South and Southeast regions. The northernmost cities were not affected. A change in the epidemiological pattern of HAV infection is emerging in Southern Brazil.

Older people's perceptions of teleconsultation via telephone during the COVID-19 pandemic: a qualitative study / Percepção de idosos sobre teleconsulta por telefone durante a pandemia de COVID-19: um estudo qualitativo

OBJECTIVES: In March/2020, our geriatric outpatient clinic implemented teleconsultation via telephone due to the COVID-19 pandemic. This study aimed to understand older patients' perceptions of this experience through their narratives. METHODS: A qualitative study with Thematic Oral History and thematic analysis. We conducted open-ended interviews in which older patients narrated their perceptions of this experience. RESULTS: Twelve patients were interviewed from December/2021 to January/2022, and 2 themes emerged: older patients' experience of teleconsultation and possibilities and challenges of telemedicine. Some patients did not identify the call as a teleconsultation. Regarding possibilities, patients reported satisfaction and convenience in specific circumstances. As for challenges, patients reported concerns about the effectiveness of communication and need for physical examination. CONCLUSION: Teleconsultation is well accepted, as long as situations that require face-to-face interactions are considered. Considering person-centered medicine, listening to the narratives of older people contributes to a better structuring of telemedicine services in geriatrics

OBJETIVOS: Em março/2020, nosso ambulatório de geriatria iniciou a teleconsulta por telefone em virtude da pandemia de COVID-19. O objetivo desta pesquisa foi conhecer a percepção dessa experiência por esses pacientes, por meio de suas narrativas. METODOLOGIA: Pesquisa qualitativa com História Oral Temática e análise temática. Realizadas entrevistas abertas, nas quais os idosos narraram suas percepções sobre essa experiência. RESULTADOS: Doze pacientes foram entrevistados de dezembro/2021 a janeiro/2022 e dois temas emergiram: vivência ante a teleconsulta e possibilidades e desafios da telemedicina. Alguns não identificaram que se tratava de uma teleconsulta. Nas possibilidades, afirmaram satisfação e conveniência em circunstâncias específicas. Nos desafios, apontaram preocupações com eficácia de comunicação e com necessidade de exame físico. CONCLUSÃO: Existe uma boa recepção da teleconsulta, desde que respeitadas situações que demandem atendimento presencial. Considerando uma medicina centrada na pessoa, a escuta das narrativas dos idosos contribui para melhor estruturação de serviços de telemedicina em geriatria

High prevalence of enteroinvasive Escherichia coli isolated in a remote region of northern coastal Ecuador.

Enteroinvasive Escherichia coli (EIEC) causes dysentery; however, it is less widely reported than other etiological agents in studies of diarrhea worldwide. Between August 2003 and July 2005, stool samples were collected in case-control studies in 22 rural communities in northwestern Ecuador. Infection was assessed by PCR specific for LT and STa genes of enterotoxigenic E. coli (ETEC), the bfp gene of enteropathogenic E. coli (EPEC), and the ipaH gene of both enteroinvasive E. coli and Shigellae. The pathogenic E. coli most frequently identified were EIEC (3.2 cases/100 persons) and Shigellae (1.5 cases/100 persons), followed by ETEC (1.3 cases/100 persons), and EPEC (0.9 case/100 persons). EIEC exhibited similar risk-factor relationships with other pathotypes analyzed but different age-specific infection rates. EIEC was the predominant diarrheagenic bacteria isolated in our community-based study, a unique observation compared with other regions of the world.

Leitura e discussão de clássicos da literatura aplicados a pessoas com quadro psiquiátrico grave: uma análise winnicottiana / Reading and discussion of literature classics applied to people with a severe psychiatric condition: a winnicottian analysis / Lectura y discusión de clásicos aplicados a personas con cuadro psiquiátrico grave: un análisis winnicottian

O presente artigo tem como objetivo apresentar parte dos resultados de uma investigação realizada com pessoas com quadro psiquiátrico grave de um grupo psicoterapêutico. Partindo da metodologia do Laboratório de Leitura (LabLei), foram realizadas duas experiências literárias: 1) Leitura da obra "O Alienista" de Machado de Assis, com 11 encontros; e 2) Leitura da obra "O sonho de um homem ridículo", de Fiódor Dostoiévski, com oito encontros. No total, 25 pessoas participaram, sendo 17 usuários em sofrimento mental, seis terapeutas e dois pesquisadores. Posteriormente, foram realizadas seis entrevistas de História Oral de Vida que puderam ser analisadas a partir de uma compreensão winnicottiana. Como resultado, o Laboratório de Leitura (LabLei) se mostrou efetivo como um coadjutor do espaço terapêutico, favorecendo um modo de comunicação não repetitiva e reveladora de outros materiais psíquicos, proporcionando um espaço potencial integrador do mundo externo e interno, além de fomentar a expressão artística e a criatividade.(AU)

This article aims to present part of the results of an investigation carried out with people with a severe psychiatric condition who participate in a psychotherapeutic group. Based on the methodology of the Reading Laboratory (LabLei), two literary experiences were held: 1) Reading of the work "The Alienist", by Machado de Assis, with 11 meetings; and 2) Reading of the work "The Dream of a Ridiculous Man, by Fyodor Dostoyevsky, with eight meetings. Overall, 25 people participated: 17 users in mental distress, six therapists, and two researchers. Subsequently, the researchers conducted six Oral History interviews, which were analyzed from a winnicottian perspective. As a result, the Reading Laboratory (LabLei) proved to provide effective help for the therapeutic space, favoring a mode of non-repetitive communication that revealed other psychological materials, enabling the creation of a space with potential for integrating the external and internal worlds, and fostering artistic expression and creativity.(AU)

El objetivo del presente artículo es presentar parte de los resultados de una investigación realizada con personas con cuadro psiquiátrico grave de un grupo psicoterapéutico. Partiendo de la metodología del Laboratorio de Lectura (LabLei), se realizaron dos experiencias literarias: 1) "El alienista" de Machado de Assis, con 11 encuentros, y 2) "El sueño de un hombre ridículo" de Fiódor Dostoiévski, con ocho encuentros. En total, participaron 25 personas, siendo 17 de ellas usuarios en sufrimiento mental, seis terapeutas y dos investigadores. Posteriormente, se realizaron seis entrevistas de Historia Oral de Vida que pudieron analizarse a partir de una comprensión winnicottiana. Como resultado, el LabLei se mostró efectivo como un coadjutor del espacio terapéutico, favoreciendo un modo de comunicación no-repetitiva y reveladora de otros materiales síquicos, proporcionando un espacio potencial integrador del mundo externo e interno, además de fomentar la expresión artística y la creatividad.(AU)

Entomological evaluation by pool screen polymerase chain reaction of Onchocerca volvulus transmission in Ecuador following mass Mectizan distribution.

The prevalence of infected and infective black flies was estimated by pool screen polymerase chain reaction (PCR) amplification in the three river basins in Ecuador endemic for onchocerciasis. Mass distribution of ivermectin (Mectizan) resulted in dramatic declines in the prevalence of infected and infective flies. In the Rio Santiago river basin, no infections were detected, suggesting that transmission had ceased. The ratio of infected to infective flies in Simulium exiguum was 10-fold lower than the corresponding ratio for Simulium quadrivittatum, suggesting that S. exiguum is a more-competent vector for Onchocerca volvulus than S. quadrivittatum. However, the prevalence of infective flies in the two species was not different, suggesting that S. quadrivittatum may play an important vectorial role where it is the dominant human-biting species. The data demonstrate that pool screen PCR is an efficient way to monitor transmission in areas subject to control, and to certify an area as free of O. volvulus transmission.

Environmental change and infectious disease: how new roads affect the transmission of diarrheal pathogens in rural Ecuador.

Environmental change plays a large role in the emergence of infectious disease. The construction of a new road in a previously roadless area of northern coastal Ecuador provides a valuable natural experiment to examine how changes in the social and natural environment, mediated by road construction, affect the epidemiology of diarrheal diseases. Twenty-one villages were randomly selected to capture the full distribution of village population size and distance from a main road (remoteness), and these were compared with the major population center of the region, Borbón, that lies on the road. Estimates of enteric pathogen infection rates were obtained from case-control studies at the village level. Higher rates of infection were found in nonremote vs. remote villages [pathogenic Escherichia coli: odds ratio (OR) = 8.4, confidence interval (CI) 1.6, 43.5; rotavirus: OR = 4.0, CI 1.3, 12.1; and Giardia: OR = 1.9, CI 1.3, 2.7]. Higher rates of all-cause diarrhea were found in Borbón compared with the 21 villages (RR = 2.0, CI 1.5, 2.8), as well as when comparing nonremote and remote villages (OR = 2.7, CI 1.5, 4.8). Social network data collected in parallel offered a causal link between remoteness and disease. The significant and consistent trends across viral, bacterial, and protozoan pathogens suggest the importance of considering a broad range of pathogens with differing epidemiological patterns when assessing the environmental impact of new roads. This study provides insight into the initial health impacts that roads have on communities and into the social and environmental processes that create these impacts.