Social Inequalities in Mental Health and Self-Perceived Health in the First Wave of COVID-19 Lockdown in Latin America and Spain: Results of an Online Observational Study.

COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.

Impacto del confinamiento por la COVID-19 en la salud autopercibida en Chile según género / Impact of COVID-19 lockdown on self-perceived health in Chile by gender

Objetivo: Analizar los factores sociales asociados a la salud autopercibida durante el confinamiento en la población residente en Chile según la perspectiva de género. Método: Estudio transversal realizado mediante encuesta online durante el confinamiento por la COVID-19 entre el 17 de mayo y el 17 de agosto de 2020. Se analizó la salud autopercibida en población de 18 años o más en relación con variables sociales. Se construyeron modelos de regresión logística multivariante para evaluar la asociación entre las variables independientes con la salud autopercibida, a través de odds ratio ajustadas (ORa). Los análisis se estratificaron por sexo (H: hombres; M: mujeres). Resultados: Se analizaron 5981 personas (el 63,9% mujeres). El 29,6% de las mujeres y el 19,2% de los hombres reportaron mala salud autopercibida. En las mujeres, empeora al aumentar la edad. La peor salud autopercibida se asoció principalmente con la falta de apoyo social (ORa H: 2,05; ORa M: 2,34), la preocupación por la convivencia en el hogar (ORa H: 1,66; ORa M: 1,38), percibir inadecuadas condiciones de la vivienda (ORa H: 1,89; ORa M: 2,63) y el desacuerdo con las medidas gubernamentales (ORa H: 2,80; ORa M: 1,82). En las mujeres, además, se asoció al trabajo informal o estar inactivas laboralmente (ORa: 2,11). En los hombres, una peor salud autopercibida se asoció a ser trabajador independiente (autónomo) (ORa: 1,65; intervalo de confianza [IC]: 1,11-2,45) y tener educación secundaria (ORa: 2,81; IC: 1,32-5,98). Conclusiones: El impacto social del confinamiento en la salud autopercibida se relaciona con el género, la edad, el trabajo de cuidados y las condiciones socioeconómicas, así como con el desacuerdo con las medidas implementadas para gestionar la pandemia.

Objective: To analyse the social factors associated with self-perceived health during the COVID-19 lockdown in the Chilean resident population according to gender perspective. Method: Cross-sectional study conducted during the COVID-19 lockdown between May 17 and August 17, 2020 with an online survey. Self-perceived health was analysed in the population aged 18 years or older in relation to social variables. Multivariate logistic regression models were constructed to assess the association between independent variables with self-perceived health, through adjusted odds ratio (aOR). Analyses were stratified by sex (M: men; W: women). Results: 5981 persons were analysed (women: 63.9%). 29.6% of women and 19.2% of men reported poor self-perceived health. In women it worsens with increasing age. Worse self-perceived health was mainly associated with lack of social support (ORa M: 2.05; ORa W: 2.34), concern about living together at home (ORa M: 1.66; ORa W: 1.38), perceived inadequate housing conditions (ORa M: 1.89; ORa W: 2.63), and disagreement with government measures (ORa M: 2.80; ORa W: 1.82). In women, it was also associated with informal work or being inactive in the labour market (ORa: 2.11). In men worse self-perceived health was associated with being self-employed (ORa: 1.65; confidence interval [CI]: 1.11–2.45) and has secondary education (ORa: 2.81; CI: 1.32–5.98). Conclusions: The social impact of lockdown in self-perceived health is related to gender, age, care work, and socioeconomic conditions, as well as, by disagreement with the measures implemented to manage the pandemic. (AU)

[Impact of COVID-19 lockdown on self-perceived health in Chile by gender]. / Impacto del confinamiento por la COVID-19 en la salud autopercibida en Chile según género.

OBJECTIVE: To analyse the social factors associated with self-perceived health during the COVID-19 lockdown in the Chilean resident population according to gender perspective. METHOD: Cross-sectional study conducted during the COVID-19 lockdown between May 17 and August 17, 2020 with an online survey. Self-perceived health was analysed in the population aged 18 years or older in relation to social variables. Multivariate logistic regression models were constructed to assess the association between independent variables with self-perceived health, through adjusted odds ratio (aOR). Analyses were stratified by sex (M: men; W: women). RESULTS: 5981 persons were analysed (women: 63.9%). 29.6% of women and 19.2% of men reported poor self-perceived health. In women it worsens with increasing age. Worse self-perceived health was mainly associated with lack of social support (ORa M: 2.05; ORa W: 2.34), concern about living together at home (ORa M: 1.66; ORa W: 1.38), perceived inadequate housing conditions (ORa M: 1.89; ORa W: 2.63), and disagreement with government measures (ORa M: 2.80; ORa W: 1.82). In women, it was also associated with informal work or being inactive in the labour market (ORa: 2.11). In men worse self-perceived health was associated with being self-employed (ORa: 1.65; confidence interval [CI]: 1.11-2.45) and has secondary education (ORa: 2.81; CI: 1.32-5.98). CONCLUSIONS: The social impact of lockdown in self-perceived health is related to gender, age, care work, and socioeconomic conditions, as well as, by disagreement with the measures implemented to manage the pandemic.

Caracterización epidemiológica de los nuevos diagnósticos de infección por virus de inmunodeficiencia humana en Chile período 2010-2019

Resumen Introducción: Chile lidera el porcentaje de aumento de nuevas infecciones de VIH en Latinoamérica. Objetivo: Caracterizar los nuevos diagnósticos de infección por VIH/SIDA y describir la evolución de las tasas en las regiones durante el período 2010-2019. Métodos: Diseño ecológico. Se utilizó los casos de infección por VIH/SIDA obtenidos del ISP y las estimaciones de población del INE. Las variables fueron año, sexo, edad, nacionalidad y región. Se describió la muestra en número y porcentajes, se estimó la incidencia y se evaluó la tendencia con el modelo Prais Winsten. Se utilizó Stata V.14 y ArcGis versión 10 en los mapas. Resultados: El 84,3% (38.863/46.125) fueron hombres. La mediana de edad fue 30 y 34 años en hombres y mujeres, respectivamente. La incidencia aumentó hasta el año 2018, y presentó una leve disminución en el 2019. Las tasas aumentaron, en ambos sexos, en todas las edades y regiones. A diferencia de la población nacional, los casos en inmigrantes aumentaron y alcanzaron a 40% en el 2019, evidenciando un franco incremento en adultos jóvenes, con predominio de la nacionalidad venezolana 35,2% y haitiana 22%. La tendencia de las tasas mostró un aumento significativo en hombres y una distribución heterogénea en magnitud en todas las regiones. Conclusiones: Existen cambios en la epidemiología del VIH y especial vulnerabilidad en jóvenes, mujeres, inmigrantes y adultos mayores.

Abstract Background: Chile leads the percentage increase of new HIV infections in Latin America. Aim: To characterize new diagnosis of HIV/AIDS and describe the rates evolution in the regions during the 2010-2019 period. Methods: Ecological design. The HIV/AIDS cases used were obtained from the ISP (Instituto de Salud Pública de Chile) and the population estimates from the INE (Instituto Nacional de Estadísticas). The variables studied were year, sex, age, nationality, and region. The sample was described in numbers and percentages, then, the incidence was estimated and the trend was evaluated with the Prais Winsten model. Stata V.14 and ArcGis version 10 were used for the maps. Results: 84.3% (38,863/46,125) were men. The median for age were 30 and 34 years for men and women, respectively. The incidence increased until 2018 and showed a slight decrease in 2019. The rates increased for both sexes and all ages. Unlike the national population, immigrant's cases increased and reached 40% in 2019, with a frank increase in young adults, with a predominance for Venezuelan (35,2) and Haitian (22%) nationals. According to region, all the samples showed a rate increase with a heterogeneous distribution in statistically significant magnitude in men. Conclusions: There are changes in the epidemiology of HIV and special vulnerability in young people, women, immigrants and the elderly.

Infant Mortality in the Metropolitan Region, Chile 2005-2014. / Mortalidad Infantil en las comunas de la Región Metropolitana, periodo 2005-2014.

INTRODUCTION: Infant mortality depends on the economic, social, and cultural level of development of the place of residence. OBJECTIVE: To describe the infant mortality rates (IMR) and the late infant mortality rates (LIMR) of the Metropolitan Region (MR) communes and to evaluate their trend between 2005 and 2014. MATERIAL AND METHOD: Ecological study that describes the rates of the 52 communes of the MR. For the analysis, the IMR and LIMR were elaborated for each year and com mune and were compared using population attributable risk (PAR), attributable risk percent (AR%), and rate ratio (RR). Trends were analyzed through the Prais-Winsten model. A value p < 0.05 was considered a statistically significant trend. RESULTS: The commune 'Independencia' presented the hig hest IMR and LIMR with 12.7 and 4.05 per 1000 live births respectively, 1.75 and 2.05 times more compared with the IMR and LIMR of the MR. The commune 'Las Condes' and 'Vitacura' presented the lowest IMR and LIMR respectively. The IMR trend regarding 2005 increased in Lo Barnechea, Lo Espejo, and Recoleta, and decreased in Las Condes, Macul, Pudahuel and San Bernardo. The LIMR decreased in Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Tala- gante, Pedro Aguirre Cerda, and Quilicura, and increased in Peñaflor. CONCLUSION: The regional IMR and LIMR hide the slight increase in rates and the persistence of heterogeneity among communes. This forces us to explore the causes of these inequities through future analytical studies.

Mortalidad Infantil en las comunas de la Región Metropolitana, periodo 2005-2014 / Infant Mortality in the Metropolitan Region, Chile 2005-2014

Resumen: Introducción: La mortalidad infantil depende del nivel de desarrollo económico, social y cultural del área de residencia. Objetivo: Describir las tasas de mortalidad infantil (TMI) y mortalidad infantil tardía (TMIT) de las comunas de la Región Metropolitana (RM) y evaluar su tendencia en el perio do 2005-2014. Material y Método: Estudio ecológico que describe las tasas en las 52 comunas de la Región Metropolitana (RM). Para el análisis se construyó la TMI y TMIT para cada año y comuna y se compararon mediante riesgo atribuible poblacional (RAP), Riesgo atribuible porcentual (RAP%) y razón de tasas (RT). Las tendencias se evaluaron con el modelo Prais-Winsten. Se consideró una tendencia estadísticamente significativa un valor p < 0,05. Resultados: La comuna de Independencia mostró la TMI y TMIT más altas con 12,7 y 4,05 por mil RNV respectivamente; 1,75 y 2,05 veces comparado con la TMI y TMIT de la RM. Las tasas más bajas se observaron en Las Condes (TMI) y en Vitacura (TMIT). La tendencia de la TMI respecto al 2005 aumentó en Lo Barnechea, Lo Espejo y Recoleta y disminuyó en Las Condes, Macul, Pudahuel y San Bernardo. La TMIT disminuyó en Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Talagante, Pedro Aguirre Cerda y Quilicura y aumentó en Peñaflor. Conclusión: La TMI y la TMIT regional ocultan el leve incremento de las tasas y la persistencia de la heterogeneidad entre las comunas, lo que obliga a explorar las causas de estas inequidades en estudios analíticos a futuro.

Abstract: Introduction: Infant mortality depends on the economic, social, and cultural level of development of the place of residence. Objective: To describe the infant mortality rates (IMR) and the late infant mortality rates (LIMR) of the Metropolitan Region (MR) communes and to evaluate their trend between 2005 and 2014. Material and Method: Ecological study that describes the rates of the 52 communes of the MR. For the analysis, the IMR and LIMR were elaborated for each year and com mune and were compared using population attributable risk (PAR), attributable risk percent (AR%), and rate ratio (RR). Trends were analyzed through the Prais-Winsten model. A value p < 0.05 was considered a statistically significant trend. Results: The commune 'Independencia' presented the hig hest IMR and LIMR with 12.7 and 4.05 per 1000 live births respectively, 1.75 and 2.05 times more compared with the IMR and LIMR of the MR. The commune 'Las Condes' and 'Vitacura' presented the lowest IMR and LIMR respectively. The IMR trend regarding 2005 increased in Lo Barnechea, Lo Espejo, and Recoleta, and decreased in Las Condes, Macul, Pudahuel and San Bernardo. The LIMR decreased in Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Tala- gante, Pedro Aguirre Cerda, and Quilicura, and increased in Peñaflor. Conclusion: The regional IMR and LIMR hide the slight increase in rates and the persistence of heterogeneity among communes. This forces us to explore the causes of these inequities through future analytical studies.

[Deaths due to oral cancer in Chile in the period 2002-2012]. / Mortalidad por cáncer oral en Chile, 2002-2012.

BACKGROUND: Oral cancer is the 15th most common cause of cancer death in the world. In Chile, 1% of all cancer deaths are related to oral and pharyngeal cancer. AIM: To determine mortality rates for oral cancer in Chile and its regions between 2002-2012. MATERIAL AND METHODS: Deaths and their causes between the years 2002-2012 were obtained from the Chilean National Statistics Institute. Crude and adjusted rates by age and sex were calculated for the country and its regions. The denominator was Chilean population on June 30, 2012 and the WHO standard population. RESULTS: In the period studied, 1,611 individuals with a mean age of 67.6 years (63% men) died because of oral cancer. The most common location of the tumor was the tongue in 27% of cases and the parotid gland in 16%. The adjusted mortality rate in Chile was 0.85 / 100,000 inhabitants (1.13 and 0.58 in men and women, respectively). The regions with the highest rates were Antofagasta (1.51), Aysén (1.22) and Magallanes (1.17). Deaths among men occurred at younger ages than women. CONCLUSIONS: Mortality rates due to oral cancer in Chile are lower than abroad. The highest rates observed in some regions may be influenced by environmental factors such as arsenic contamination in Antofagasta and the lack of specialists and specialized care centers in Aysén and Magallanes.

Mortalidad por cáncer oral en Chile, 2002-2012 / Deaths due to oral cancer in Chile in the period 2002-2012

Background: Oral cancer is the 15th most common cause of cancer death in the world. In Chile, 1% of all cancer deaths are related to oral and pharyngeal cancer. Aim: To determine mortality rates for oral cancer in Chile and its regions between 2002-2012. Material and Methods: Deaths and their causes between the years 2002-2012 were obtained from the Chilean National Statistics Institute. Crude and adjusted rates by age and sex were calculated for the country and its regions. The denominator was Chilean population on June 30, 2012 and the WHO standard population. Results: In the period studied, 1,611 individuals with a mean age of 67.6 years (63% men) died because of oral cancer. The most common location of the tumor was the tongue in 27% of cases and the parotid gland in 16%. The adjusted mortality rate in Chile was 0.85 / 100,000 inhabitants (1.13 and 0.58 in men and women, respectively). The regions with the highest rates were Antofagasta (1.51), Aysén (1.22) and Magallanes (1.17). Deaths among men occurred at younger ages than women. Conclusions: Mortality rates due to oral cancer in Chile are lower than abroad. The highest rates observed in some regions may be influenced by environmental factors such as arsenic contamination in Antofagasta and the lack of specialists and specialized care centers in Aysén and Magallanes.

Factores asociados al abandono de tratamiento antituberculoso convencional en Perú / Factors Associated With the Non-Completion of Conventional Anti-Tuberculosis Treatment in Peru

Antecedentes: El abandono del tratamiento antituberculoso se asocia a mayor contagio, resistencia antibiótica, aumento de costes y muerte. Nuestro objetivo fue identificar factores asociados al abandono del tratamiento antituberculoso convencional en Perú. Pacientes y métodos: Estudio de casos y controles no pareado en pacientes diagnosticados de tuberculosis durante 2004-2005 y que finalizaron tratamiento hasta septiembre de 2006. Se definieron como casos los pacientes que abandonaron el tratamiento por ≥ 30 días consecutivos, y como controles los que completaron el tratamiento sin interrupción. Los factores se identificaron mediante regresión logística, calculándose las odds ratios (OR) y los intervalos de confianza al 95% (IC). Resultados: Se estudiaron 265 casos y 605 controles. El abandono del tratamiento en nuestro estudio se asoció al sexo masculino (OR=1,62; IC: 1,07-2,44), al hecho de sentir malestar durante el tratamiento (OR=1,76; IC: 1,19-2,62), al antecedente de abandono previo (OR=7,95; IC: 4,76-13,27) y al consumo de drogas recreativas (OR=3,74; IC: 1,25-11,14). Así mismo, si tenemos en cuenta la interacción antecedente de abandono previo y pobreza, el riesgo de abandono aumenta (OR=11,24; IC: 4-31,62). Por el contrario, recibir buena información sobre la enfermedad (OR=0,25; IC: 0,07-0,94) y poder acceder al sistema sanitario en los horarios ofertados (08.00-20.00h) (OR=0,52; IC: 0,31-0,87) se asociaron a un mejor cumplimiento. Conclusiones: El abandono del tratamiento antituberculoso se asoció a factores no modificables (sexo masculino, abandono previo) y a otros cuyo control mejoraría el cumplimiento (malestar durante el tratamiento, consumo de drogas recreativas y pobreza). Así mismo, es prioritario facilitar el acceso al sistema sanitario y mejorar la información recibida sobre tuberculosis(AU)

Background: The non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru. Patients and methods: An unmatched case-control study in patients diagnosed with tuberculosis from 2004-2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥ 30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). Results: We studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR=1.62; CI: 1.07-2.44), having felt discomfort during treatment (OR=1.76; CI: 1.19-2.62), a prior history of non-compliance (OR=7.95; CI: 4.76-13.27) and illegal drug use (OR=3.74; CI: 1.25-11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR=11.24; CI: 4-31.62). Conversely, having been properly informed about the disease (OR=0.25; CI: 0.07-0.94) and being able to access health-care services within office hours (8am-8pm) (OR=0.52; CI: 0.31-0.87) were associated with better adherence. Conclusions: The non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be priorities(AU)

Factors associated with the non-completion of conventional anti-tuberculosis treatment in Peru.

BACKGROUND: The non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru. PATIENTS AND METHODS: An unmatched case-control study in patients diagnosed with tuberculosis from 2004-2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR=1.62; CI: 1.07-2.44), having felt discomfort during treatment (OR=1.76; CI: 1.19-2.62), a prior history of non-compliance (OR=7.95; CI: 4.76-13.27) and illegal drug use (OR=3.74; CI: 1.25-11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR=11.24; CI: 4-31.62). Conversely, having been properly informed about the disease (OR=0.25; CI: 0.07-0.94) and being able to access health-care services within office hours (8 am-8 pm) (OR=0.52; CI: 0.31-0.87) were associated with better adherence. CONCLUSIONS: The non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be priorities.

Transmisión de Salmonella entre tortugas y niños: experiencia de la enfermería de salud pública a propósito de un caso / Salmonella's transmission from turtle to child: public health nursing experience about a new case

La salmonelosis se relaciona habitualmente con intoxicaciones alimentarias; sin embargo, existen otras fuentes de contagio que pueden pasar inadvertidas, como puede suceder al tener contacto con reptiles. En este estudio se investiga el contagio de salmonelosis a partir de una tortuga. A raíz de la notificación sobre un lactante de 11 meses de edad con diagnóstico de salmonelosis, se inició la investigación epidemiológica. Se entrevistó a todos los familiares sobre signos y síntomas, antecedentes epidemiológicos y fuentes de exposición domiciliaria y comunitaria. Se observó que en el domicilio había una tortuga; la madre era la encargada de su cuidado. Se analizó una muestra de agua del acuario y se aisló Salmonella parathyphi B variedad Java, que coincidía con la especie aislada en el niño. La tortuga como portadora de Salmonella está poco descrita en Europa, por ello la realización de este estudio. La falta de una correcta higiene después de haber estado en contacto con la tortuga o con su medio puede ocasionar casos de salmonelosis, tal como sucedió en este estudio, en el que la madre fue el vehículo de transmisión, dado que el lactante no tenía acceso a la tortuga. Frente a un diagnóstico de salmonelosis, se debe sospechar también una posible exposición a reptiles. Por lo tanto, las familias que tienen o piensan tener una tortuga u otro reptil deberían ser informadas acerca de los riesgos que conlleva. También cabe destacar el importante rol de enfermería en el desarrollo de estudios epidemiológicos (AU)

This is a continuation of the article published in this journal (Enfermeria Clinica), entitled 'Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home'. We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources. Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team (AU)

[Salmonella's transmission from turtle to child: public health nursing experience about a new case]. / Transmisión de Salmonella entre tortugas y niños: experiencia de la enfermería de salud pública a propósito de un caso.

Salmonellosis is usually related to food poisoning however other possible causes such as reptile exposure are often unrecognised. The aim of this study is to describe a case of salmonella infection related to pet exposure. After a salmonella infection in an eleven month old baby was reported to our public health agency, an epidemiological investigation took place. Despite all family members had had clinical symptoms suggesting salmonella infection none of the microbiological analysis was positive. At the infant's home they had an exotic pet: a turtle. We found out that Salmonella was present in a sample of water of its aquarium. Both profiles of S. parathyphi B (from the infant and from the aquaria samples) were identical. Exotic pets are not often recognized as Salmonella infection carriers and vehicles in Europe. As described in this study, an inaccurate hygiene after touching turtles or its habitat can lead to spread salmonella infection in humans. When investigating Salmonella infection exposure to exotic pets has to be addressed. People that have or wish to have a turtle or any other reptile should be informed about its risks. Nursing role is most important in the surveillance and study of such cases.

Pulmonary tuberculosis infection among workers in the informal public transport sector in Lima, Peru.

BACKGROUND: Because a strong association was observed between pulmonary tuberculosis (TB) and the use of public transport, increasing with duration of journey, a study was carried out to assess infection by Mycobacterium tuberculosis and working conditions among workers in this sector. METHODS: A cross-sectional study was conducted between June and September 2008. A total of 104 workers from two public transport minibus ('combi') cooperatives covering marginal areas of the Ate-Vitarte district in Lima were interviewed. Demographic and occupational details were collected as well as prior family and personal history of TB and BCG vaccination. The tuberculin skin test (TST) was administered to each study subject and an induration of ≥ 10 mm was considered positive. Statistical analysis was based on logistic models, ORs and their 95% CIs. RESULTS: TST results were obtained for 70.2% (n=73), of whom 76.6% (n=56) were positive. Positivity was significantly associated with those who had worked for more than 2 years (crude OR 11.04; 95% CI 3.17 to 38.43) and more than 60 h/week (crude OR 9.8; 95% CI 2.85 to 33.72). These associations remained significant in a multivariate model as well. CONCLUSION: The association observed between years of working and weekly work burden among minibus workers suggests an occupational risk in service jobs in low-income countries with high TB prevalence. Consequently, other types of users are at increased risk for TB infection, with a causal relationship between effect and duration of exposure.

Public transportation and pulmonary tuberculosis, Lima, Peru.

The association between public transportation for commuting and pulmonary tuberculosis (TB) was analyzed in workers in Lima, Peru. Traveling in minibuses was a risk factor for pulmonary TB. Preventive measures need to be taken by health services to prevent spread of this disease.