Factors related to transmission of and infection with Schistosoma mansoni in a village in the South-eastern Region of Brazil.

In this transversal study, factors related to infection with and transmission of Schistosoma mansoni were explored. Based on stool examinations of two Kato-Katz smears of a single sample, the prevalences of schistosomiasis and geohelminths were established. In a multivariable analysis, sets of demographic, socio-economic and water contact pattern variables were tested for strength of relation with infection. Males presented a 3.39-times higher risk for infection than females. The age groups between 10-19 years and 20-30 years showed risks of infection 7.1- and 7.5-times higher, respectively, than the control age group between 0-10 years. Individuals practicing leisure activities had a 1.96-times higher risk than those without these activities. The malacological survey identified snails of the species Biomphalaria glabrata, Biomphalaria straminea and Biomphalaria tenagophila. Two exemplars of B. glabrata (0.53%) proved positive for S. mansoni. The socio-economic improvements observed in the locality suggest a protective and preventive effect towards infection with schistosomiasis, which requires further investigation with a longitudinal and more detailed study design. Considering our findings, a proposal for an integrated control program should be based on two pillars: one horizontal, which involves social empowerment and health education, and another more vertical, which delivers treatment and infrastructure improvements.

[Hortênsia de Hollanda: the art of health education to prevent and control epidemics in Brazil]. / Hortênsia de Hollanda: a arte da educação em saúde para prevenção e controle das endemias no Brasil.

The article presents the transcription of a class given by Brazilian educator Hortênsia Hurpia de Hollanda entitled: "Educação sanitária na profilaxia das endemias rurais" [Sanitary education in the prophylaxis of rural epidemics], in a refresher course on rural epidemics and included in the Anais da Faculdade Fluminense de Medicina in December 1956. The annotated publication of the manuscript seeks to prove the pioneering efforts of Hollanda, whose work has been seldom investigated, considering the dimension of her role in the area of health education in Brazil. Sensitivity to social problems, the importance of the population's participation and an experimental attitude are some of the aspects presented in the educator's text, revealing an advanced theoretical grounding for her times and an original and pioneering practice that remains to this day as an ideal to be achieved.

Development of a natural molluscicide prototype kit (MoluSchall) for the control of schistosomiasis mansoni transmission.

INTRODUCTION: In Brazil, Biomphalaria glabrata, B. tenagophila, and B. straminea are intermediate hosts of Schistosoma mansoni, the etiological agent of schistosomiasis mansoni. Molluscicide use is recommended by the WHO for controlling the transmission of this parasite. Euphorbia milii latex has shown promising results as an alternative molluscicide. Thus, a natural molluscicide prototype kit based on freeze-dried E. milii latex was developed and evaluated against Biomphalaria spp. METHODS: E. milii latex was collected, processed, and lyophilized. Two diluents were defined for freeze-dried latex rehydration, and a prototype kit, called MoluSchall, was produced. A stability test was conducted using prototype kits stored at different temperatures, and a toxicity assay was performed using Danio rerio. Additionally, MoluSchall was tested against B. glabrata under semi-natural conditions according to defined conditions in the laboratory. RESULTS: MoluSchall was lethal to three Brazilian snail species while exhibiting low toxicity to D. rerio. Regardless of storage temperature, MoluSchall was stable for 24 months and was effective against B. glabrata under semi-natural conditions, with the same LD100 as observed under laboratory conditions. CONCLUSIONS: MoluSchall is a natural, effective, and inexpensive molluscicide with lower environmental toxicity than existing molluscicides. Its production offers a possible alternative strategy for controlling S. mansoni transmission.

A combined strategy to improve the control of Schistosoma mansoni in areas of low prevalence in Brazil.

Results of stool examinations for infections with Schistosoma mansoni among schoolchildren, living in a village of Minas Gerais State, Brazil, were used as an indicator to identify schistosomiasis-positive individuals within the entire population. This new approach is based on dividing the community into schoolchildren, members of households of schistosomiasis-positive and -negative schoolchildren, and members of households without schoolchildren. Each subgroup was evaluated comparing different sampling efforts with the predetermined "gold standard" to find the best relationship between detection rate and sampling effort. Consequently these results were combined, and a proposal for a new strategy, valid for an entire community, was elaborated. This alternative approach during the screening process permits to treat a similar proportion of positives as detected with 6 Kato-Katz slides of 3 stool samples, with 3-fold reduced sampling effort, enhancing the efficiency of schistosomiasis control programs in low-endemic areas.

[Aesthetics of the grotesque and audiovisual production for health education: segregation or empathy? The case of leishmaniasis in Brazil]. / A estética do grotesco e a produção audiovisual para a educação em saúde: segregação ou empatia? O caso das leishmanioses no Brasil.

In order to understand audiovisual production on health and disease and the pedagogical effects of health education mediated by educational videos, this article analyzes the audiovisual production on leishmaniasis in Brazil. Fourteen educational videos showed the hegemony of TV aesthetics, particularly a journalistic paradigm with constant use of voice-over, inducing the fixation of meanings. Rather than stimulating critical reflection on the social circumstances of leishmaniasis, the videos' discourse and images promote a banal, non-critical, stigmatized representation of the disease. Individuals with the disease are subjected to visual exposure rather than being involved critically and sensitively as protagonists in prevention and treatment. The article thus presents approaches based on studies of visual and health anthropology, arguing in favor of an innovative approach to the production and utilization of educational videos in health education, mediated through audiovisuals. Health education should respect and engage in dialogue with various cultures, subjectivity, and citizenship, developing an audiovisual aesthetics (in terms of narrative and image) that fosters an educational praxis in the field of collective health.

Evaluation of an improved approach using residences of schistosomiasis-positive school children to identify carriers in an area of low endemicity.

School children were used as indicators for the identification of schistosomiasis-positive family members in a area of low endemicity. This study was designed to improve current schistosomiasis control programs by applying this strategy to identify schistosomiasis-positive individuals in a more efficient way. The initial prevalence among school children was 8.6%. However, the prevalence among the family members of these school children increased to 15.5%. In contrast to these findings the prevalence in family members of schistosomiasis-negative school children was 3.8%. Although the applied methodology showed a relatively low sensitivity (50.0%), the high negative predictive value (87.7%) indicates that a few positive family members of school children with a negative stool result will be missed. This shows that this method of evaluation could be a strategy for a more efficient and cheaper identification of schistosomiasis-positive individuals in areas of low endemicity.

Schistosoma mansoni infection and related knowledge among schoolchildren in an endemic area of Minas Gerais, Brazil, prior to educational actions.

As a signatory to World Health Assembly Resolution WHA65.21 on eliminating schistosomiasis, the Brazilian Ministry of Health (MoH) recommends early identification and timely treatment of the infection carriers for morbidity control, plus complementary preventive measures, such as health education, for transmission control. This study reports infection and awareness of schistosomiasis among schoolchildren before the implementation of school-based educational actions in an endemic municipality with persisting moderate prevalence levels despite successive control campaigns since the late 1990s. A questionnaire was applied in April 2013 to schoolchildren in the middle years of schooling (6th to 8th year) of Malacacheta municipality to assess baseline knowledge and risk behaviour related to schistosomiasis. A stool survey was conducted in May/June 2013 in 2519 schoolchildren from all years of fundamental education (first to 9th year) to identify the infection carriers, as well as to assess baseline prevalence and intensity of infection using the Kato-Katz method (one sample, two slides). The infected schoolchildren were treated promptly with single-dose praziquantel 60mg/kg and followed up after 45days for treatment efficacy. Relevant outcomes from baseline stool survey, treatment and follow-up were statistically evaluated in relation to area of residence (rural/urban), gender, age group (<11/≥years) and infection. Adherence to baseline survey was 81.2%, and prevalence of infection was 21.4%. Of the 539 positives, 60 (11.1%) had ≥400 eggs per gram of faeces (heavy-intensity infection). Prevalence of infection was significantly higher among rural residents and≥11year olds, whereas intensity of infection was higher among rural residents,≥11year olds and boys. Adherence by the positives to treatment was 93.3% and adherence by the treated children to 45-day follow-up was 72.2%. At 45days after treatment, 97.0% of the 363 children surveyed were egg-negative; the egg reduction rate was 99.4%. Of the 924 children who responded to the questionnaire, 95.5% showed awareness of schistosomiasis, although 76.2% reported contact with natural, unsafe bodies of water. Reported contact with water was significantly more frequent among infected than non-infected, and boys than girls. The results show persisting infection and risk behaviour among schoolchildren, regardless of their basic knowledge about schistosomiasis. These are grounds for implementing specific educational actions to improve awareness and behavioural change, jointly with other control measures, to attain the MoH goals.

Evaluation of a pamphlet on visceral leishmaniasis as a tool for providing disease information to healthcare professionals and laypersons.

Although educational materials are frequently produced and used as part of control programs in Brazil, little is known about the efficacy of this type of information. This study evaluated the potential for disseminating information on visceral leishmaniasis using a pamphlet. The sample consisted of 551 healthcare workers and 379 laypeople from a metropolitan area located in southeast Brazil. Both before and after reading the pamphlet, subjects completed a multiple-choice questionnaire. Overall baseline knowledge of the disease was estimated by the proportion of correct answers before reading the pamphlet. Although specific knowledge among zoonosis control workers was higher (90.0% on average), overall baseline knowledge of the disease varied from 45.0% to 77.0%. After reading the pamphlet, the levels increased to 71.0% and 96.0%, respectively. Before reading, the lowest proportion of correct answers in all groups related to the disease symptoms. Analysis of incorrect answers showed that visceral leishmaniasis is mainly confused with leptospirosis. The increased proportion of correct answers after reading the pamphlet is evidence of its potential as an educational tool.

[Validation of Diabetes Mellitus Knowledge (DKN-A) and Attitude (ATT-19) Questionnaires]. / Validação dos questionários de conhecimento (DKN-A) e atitude (ATT-19) de Diabetes Mellitus.

OBJECTIVE: To present the cross-cultural adaptation of the Diabetes Knowledge Scale and Attitudes Questionnaires targeted to evaluate Brazilian Diabetes Mellitus patients. METHODS: These questionnaires underwent the following steps: presentation, translation, back translation, semantic and idiomatic assessments, cultural and conceptual similarities and a pilot test. They were administered in two opportunities a month apart in a sample of 61 Diabetes Mellitus type-2 patients from a university hospital. The study design included a test-retest reliability of the answers, which were analyzed and estimated by means of the Kappa coefficient. RESULTS: The findings suggested an adequacy of the instruments to the Portuguese language and Brazilian cultural identity. The Kappa coefficient in the reliability analysis showed levels of concordance from moderate to high (0.44 to 0.69) for most questions. CONCLUSIONS: The questionnaires proved to be of very easy understanding for the studied subjects and reliable and valid for use in the evaluation of diabetes educational programs in the reality of Brazil.

[Experience with games in operative groups as part of health education for diabetics]. / A experiência de jogos em grupos operativos na educação em saúde para diabéticos.

This paper presents and discusses an educational strategy implemented in a specialized hospital clinic. The goal was to stimulate individuals to reflect on their everyday lifestyles as related to their disease, specifically diabetes mellitus. The strategy can be characterized as an educational tool from the perspective of health promotion and disease prevention and control. The experience was implemented on an interactive basis (health professionals and individual patients) with educational games in operative groups. Pedagogical techniques were used: orientation concerning diabetes mellitus, individual consultation, the operative group, and educational games (communications and learning). The techniques enabled participants to improve knowledge and exchange experiences. In addition, the health professionals gained a better understanding of the participants' experience with their illness.

Evaluation of informative materials on leishmaniasis distributed in Brazil: criteria and basis for the production and improvement of health education materials.

Based on categories related to structure, content, language, and illustrations, the present study provides an evaluation of the quality of educational materials on leishmaniasis available to health services in Brazil. The 18 publications evaluated consisted of four handbooks, four guided studies, four booklets, and six leaflets. Of the total publications assessed, nine were produced by the Brazilian National Health Foundation (FUNASA), five by State and Municipal Health Departments jointly with FUNASA, and one by the Pan-American Health Organization. The evaluations were also performed by three professionals: a physician specialized in leishmaniasis, a parasitologist, and an information/communications expert. The publications failed to specify key items such as target public, objective, and bibliography. The illustrations, especially in the booklets and leaflets, failed to clarify the text, portrayed biased concepts, and omitted credits and scale. According to this study, informative materials on leishmaniasis distributed in Brazil present major limitations which jeopardize the quality of information they contain.

Development of a natural molluscicide prototype kit (MoluSchall) for the control of schistosomiasis mansoni transmission

Abstract INTRODUCTION In Brazil, Biomphalaria glabrata, B. tenagophila, and B. straminea are intermediate hosts of Schistosoma mansoni, the etiological agent of schistosomiasis mansoni. Molluscicide use is recommended by the WHO for controlling the transmission of this parasite. Euphorbia milii latex has shown promising results as an alternative molluscicide. Thus, a natural molluscicide prototype kit based on freeze-dried E. milii latex was developed and evaluated against Biomphalaria spp. METHODS E. milii latex was collected, processed, and lyophilized. Two diluents were defined for freeze-dried latex rehydration, and a prototype kit, called MoluSchall, was produced. A stability test was conducted using prototype kits stored at different temperatures, and a toxicity assay was performed using Danio rerio. Additionally, MoluSchall was tested against B. glabrata under semi-natural conditions according to defined conditions in the laboratory. RESULTS MoluSchall was lethal to three Brazilian snail species while exhibiting low toxicity to D. rerio. Regardless of storage temperature, MoluSchall was stable for 24 months and was effective against B. glabrata under semi-natural conditions, with the same LD100 as observed under laboratory conditions. CONCLUSIONS MoluSchall is a natural, effective, and inexpensive molluscicide with lower environmental toxicity than existing molluscicides. Its production offers a possible alternative strategy for controlling S. mansoni transmission.

Effect of a participatory educational program on primary school teachers' knowledge of malaria.

OBJECTIVE: To describe a participatory educational program for building up knowledge on malaria among primary school teachers in a highly endemic city. METHODS: An observational study was conducted. A 40-hour course with a multidisciplinary and problematizing approach was held in 2008, including 46 teachers mainly from rural areas of the city of Barcelos, Northern Brazil. The participatory educational process was comprised of workshops and practical classes. A previously validated questionnaire was applied before and after the course to assess teachers' knowledge and subsequently analyzed using qualitative and quantitative approaches and open-response thematic analysis. RESULTS: Prior to the course, teachers had little information about the transmission mechanisms, means of prevention, and the association between malaria and its vectors, and their health concepts were limited. After the course, teachers' knowledge of malaria increased and they reflected on their role in society. CONCLUSIONS: The effect of the educational program on the construction of contextualized knowledge of malaria and health indicates the potential of the strategy developed. Continuing education processes are required for the maintenance of new knowledge and practices directed towards health promotion.

A abstração do risco e a concretude dos sujeitos: uma reflexão sobre os comportamentos de risco no contexto da adolescência / The abstraction of risk and the concreteness of the subject: a reflection of risk behaviors in the context of adolescence

Resumo Em tempos em que se multiplicam as enfermidades decorrentes de hábitos de vida poucos saudáveis, característicos do estilo de vida moderno, a noção de comportamento de risco faz-se cada vez mais presente no discurso e nas práticas em saúde. No contexto da adolescência, esse tema vem sendo estudado através de investigações relacionadas ao consumo de álcool e outras drogas, ao tabagismo, à alimentação inadequada, ao sedentarismo, à atividade sexual desprotegida, entre outros comportamentos que, observados entre os adolescentes, somam-se ao risco atribuído a essa fase do desenvolvimento. Este artigo objetiva discutir criticamente a construção do risco e da adolescência enquanto objetos de investigação e intervenção na área da saúde, a partir de um estudo qualitativo realizado por meio de entrevistas em profundidade com 12 adolescentes de Lagoa Santa, Minas Gerais. Os resultados apontam para diferentes aspectos pessoais e emocionais geralmente não contemplados nas pesquisas na área, que, no entanto, influenciam sobremaneira as condutas dos adolescentes. Conclui-se que, para o aprimoramento e a resolutividade das políticas públicas e ações voltadas para a temática dos comportamentos de risco, torna-se necessário ampliar o escopo de investigações sobre os riscos e as perspectivas teóricas que lhes dão sustentação.

Abstract In times when a diversity of conditions resulting from unhealthy lifestyles and habits, characteristic of modern lifestyle, the notion of risk behavior becomes more and more present in the discourse and in health practices. In the context of adolescence studies, this issue has been analyzes by a series of investigations related to alcohol and other drugs use, smoking, inadequate diet, sedentary lifestyle, unprotected sexual activity and other behaviors that, when observed among young people, increase the risk to this particular phase of development. This article aims to critically discuss the construction of risk and adolescence as a concept and as an object of investigation in intervention and health care. It is structured as a qualitative study with individual and in depth interviews with 12 adolescents from Lagoa Santa city in Minas Gerais state, Brazil. The results point to different personal and emotional aspects raised by the youth usually not included in the research in the area, which nevertheless greatly influences the behavior of adolescents. We conclude that for the improvement and the resolution of public policies and actions towards the theme of risk behaviors, it is necessary to expand the scope of research on the concept of risks and theoretical perspectives that give them support.

[An evaluation of health learning during a visit to the Museum of Life]. / Avaliação da aprendizagem sobre saúde, em visita ao Museu da Vida.

Museums offer visitors both play and interactive activities that allow for learning. Yet it is challenging to understand learning in this context. How does it actually influence the learning process? This article stems from research on how a visit to a science museum may contribute to shaping the health concepts held by young people. The results identify the context of the museum as an environment favorable to meaningful learning and how meanings are grasped from the content explored during activities. Another important aspect of learning for these young people was the exploration of topics like the history of health, the relation between health and environment, science as a human product, and the role of the scientist within society.

The organization of health services and visceral leishmaniasis: an integrated intervention to improve diagnosis and treatment.

The objective of this study, carried out in municipalities located in a metropolitan region of Brazil, was to promote the early diagnosis and prompt treatment of visceral leishmaniasis. In the intervention model a health professional underwent training that covered all procedures involved in assisting patients with suspected visceral leishmaniasis. The professionals then returned to their municipalities where they implemented a workplan with the following aims: (a) at least one physician able to diagnose and treat patients; (b) training of professionals for the laboratorial diagnosis of visceral leishmaniasis; (c) delivery of information on visceral leishmaniasis to the health workers. The implementation process was evaluated by follow-up meetings. Attendance of health professionals at the meetings, implementation of the workplan, and the visceral leishmaniasis case fatality rate before (1998-1999) and after (2001-2002) implementation of the model were used in the analysis. Among the 36 municipalities in the region, 22 were enrolled. Eight (36.3%) guaranteed at least 50% attendance in the meetings, and 14 (63.6%) had less than 50% attendance with no activities implemented. The fatality rate decreased in the municipalities that implemented the activities.

Relações de gênero e a atuação de psicólogos na oncologia: subsídios para a saúde masculina / Relationship between gender and the action of psychologists in oncology: subsidies to the masculine healthcare / Relaciones de género y la práctica de los psicólogos en la oncología: subsidios para la salud masculina

O câncer vem sendo considerado um problema de saúde pública com maior índice de mortalidade entre a população masculina. Este estudo tem como objetivo identificar e analisar os relatos de psicólogos sobre a assistência voltada ao público masculino no âmbito da oncologia. Na perspectiva da Pesquisa Descritiva e Exploratória e dos Estudos de Gênero, foi elaborado um questionário semiestruturado respondido por 113 psicólogos de diferentes regiões do Brasil. Observou-se a incipiência de ações voltadas para o público masculino e um maior reconhecimento das necessidades específicas das mulheres. Os entrevistados apontaram para dificuldades de adesão dos homens às atividades dos serviços de psicologia e ao tratamento oncológico, revelando implicações dos aspectos socioculturais e institucionais. Os dados apontam para o processo de genderificação das instituições de saúde e a necessidade de inclusão do tema das masculinidades no âmbito do SUS.

Cancer has been considered a problem of public health with the highest mortality ratings among the male population. This paper aims to identify and analyze the report of psychologists about the specialized attention towards the male public in the field of oncology. According to the Descriptive and Exploratory Research and the Gender Studies’ perspective, a semi-structured questionnaire was elaborated and it was answered by 113 Brazilian psychologists. Through the answers, the lack of specific actions to the male public was observed in comparison to the recognition of the specific women’s necessity. The interviewed ones pointed out the difficulties that men have to join the psychology services with the oncological treatment, exposing implications from the social-cultural and institutional aspects. The results points to the process of genderization of the health institutions and the necessity to include the theme of masculinity in the ambit of SUS.

El cáncer ha sido considerado un problema de salud pública con tasas de mortalidad más elevadas entre los hombres. Este estudio buscó identificar y analizar las opiniones de psicólogos sobre la asistencia dirigida al público masculino en la oncología. A la vista de la investigación descriptiva y exploratoria y de los estudios de género, fue criado un cuestionario semi-estructurado, respondido por 113 psicólogos del Brasil. Se observó una escasez de acciones dirigidas al público masculino y un mayor reconocimiento de las necesidades de las mujeres. Los entrevistados informaron las dificultades en la adhesión de los hombres a las actividades de los servicios de psicología y al tratamiento oncológico, revelando implicaciones de los aspectos socioculturales e institucionales. Los resultados relevan el proceso de genderificación de las instituciones de salud y la necesidad de inclusión de la cuestión de las masculinidades en él SUS.

Dengue prevention at the household level: preliminary evaluation of a mesh cover for flowerpot saucers.

The effectiveness of a polyester mesh cover (evidengue), aimed at preventing the access of female Aedes aegypti mosquitoes to flowerpot saucers, was evaluated in laboratory. Two saucers of flowerpot with water were individually wrapped with the cover was placed with their respective pots in two entomological cages. One identical set of flowerpot and saucer was placed in a third cage. In each cage, 20 gravid females, fed on mouse blood, were released. Results show that the cover was effective to prevent access of females. Further tests are necessary to assess cover effectiveness as a device to prevent saucer oviposition.

Women's perceptions and practices regarding prevention and health promotion in primary healthcare.

OBJECTIVE: To analyze the perceptions and participation of female basic health unit users with regard to prevention and health promotion. METHODOLOGICAL PROCEDURES: Qualitative study with 20 users of a family health unit in the municipality of Belo Horizonte, Southeastern Brazil, in 2007. The interview script included questions about the health-disease process and prevention and health promotion. The content analysis technique was used to analyze the reports. RESULTS ANALYSIS: The perception of disease prevention was influenced by Leavell & Clark's theory, which is expressed as actions that avoid the appearance, progression or worsening of disease. Health promotion was regarded as a level of prevention and associated with the individual responsibility and the positive concept of health. Prevention and health promotion practices were influenced by the positive health concept, the possibility of causing pleasure/displeasure, the way in which they might interfere in daily life, by the concept of will-power and the value attributed to life. CONCLUSIONS: The discourse about disease prevention and health promotion is marked by traditional concepts. However, the inclusion of the positive health concept, allied to pleasure and will-power, are the main behavior determinants. Strategies based on a more comprehensive approach to the health-disease process are needed, thus reflecting the modern principles of health promotion.

[Evaluation of group and individual strategies in a diabetes education program]. / Avaliação estratégica de educação em grupo e individual no programa educativo em diabetes.

OBJECTIVE: To compare the effectiveness of individual and group strategies in a diabetes education program. METHODS: A total of 104 type-2 diabetes outpatients enrolled in an education program of a teaching hospital in Belo Horizonte, Southeastern Brazil, were randomly selected and assigned to two different education strategies: group education (54 subjects) and individual education (50 subjects). Group education comprised three monthly sessions, which involved play and interactive dynamics. In parallel, a second group received individual education. Subjects were follow up for six months during 2006 and they were evaluated using specific questionnaires: knowledge of diabetes, psychological attitudes, change in behavior, quality of life. Clinical evaluation was performed at baseline, three and six months of intervention. RESULTS: Mean age was 60.6 years. The results of group and individual education were similar in the assessment tests of attitude, change of behavior and quality of life. A reduction in HbA1c levels was seen in both groups, but a statistically significant difference (p=0.012) was found only in the group education. CONCLUSIONS: Both strategies of diabetes education were effective, however, group education was more effective than individual education for blood glucose control.