Modeling the hepatitis A epidemiological transition in Brazil and Mexico.

BACKGROUND: Many low- to middle-income countries have completed or are in the process of transitioning from high or intermediate to low endemicity for hepatitis A virus (HAV). Because the risk of severe hepatitis A disease increases with age at infection, decreased incidence that leaves older children and adults susceptible to HAV infection may actually increase the population-level burden of disease from HAV. Mathematical models can be helpful for projecting future epidemiological profiles for HAV. METHODS: An age-specific deterministic, dynamic compartmental transmission model with stratification by setting (rural versus urban) was calibrated with country-specific data on demography, urbanization, and seroprevalence of anti-HAV antibodies. HAV transmission was modeled as a function of setting-specific access to safe water. The model was then used to project various HAV-related epidemiological outcomes in Brazil and in Mexico from 1950 to 2050. RESULTS: The projected epidemiological outcomes were qualitatively similar in the 2 countries. The age at the midpoint of population immunity (AMPI) increased considerably and the mean age of symptomatic HAV cases shifted from childhood to early adulthood. The projected overall incidence rate of HAV infections decreased by about two thirds as safe water access improved. However, the incidence rate of symptomatic HAV infections remained roughly the same over the projection period. The incidence rates of HAV infections (all and symptomatic alone) were projected to become similar in rural and urban settings in the next decades. CONCLUSION: This model featuring population age structure, urbanization and access to safe water as key contributors to the epidemiological transition for HAV was previously validated with data from Thailand and fits equally well with data from Latin American countries. Assuming no introduction of a vaccination program over the projection period, both Brazil and Mexico were projected to experience a continued decrease in HAV incidence rates without any substantial decrease in the incidence rates of symptomatic HAV infections.

Adolescent injuries in Argentina, Bolivia, Chile, and Uruguay: Results from the 2012-2013 Global School-based Student Health Survey (GSHS).

OBJECTIVES: The goals of this study were to identify the proportion of early adolescents in southern South America who were injured in the past year, to identify risk behaviours and other exposures associated with injuries, and to evaluate the most common types and causes of injury in this population. METHODS: We used complex samples analysis to examine cross-sectional data from more than 35,000 students from all four countries in South America that participated in the Global School-based Student Health Survey (GSHS) in 2012-2013. RESULTS: The proportion of students reporting at least one injury in the past year that required medical treatment or caused at least one full day of missed school or usual activities was 27.1% in Argentina, 29.5% in Uruguay, 30.9% in Chile, and 36.8% in Bolivia. Significantly more boys than girls reported injuries. Injured students were more likely than non-injured students to report anxiety-induced insomnia, being physically attacked, being in a physical fight, and being lonely in the past year, and they were also more likely to report being bullied, using tobacco, drinking alcohol, and missing school in the past month. For both boys and girls, the most common type of injury reported was a broken bone or dislocated joint and the most common injury cause was the student falling. However, most students were not able to provide a specific answer to either question. CONCLUSION: The GSHS has been conducted in 100 low- and middle-income countries and territories around the world, and new waves of data collection are currently being planned and implemented. The utility of the injury data from the GSHS would be improved if the injury type and cause response items were updated to better capture information about self-harm, sports injuries, and other statistics that will provide a stronger foundation for evidence-based injury prevention interventions in adolescent populations.

Prevalence of cleft lip and cleft palate in rural north-central guatemala.

OBJECTIVE: To estimate the number of new cases of cleft lip and cleft palate in the department (state) of Alta Verapaz, Guatemala, in 2012. DESIGN: Cross-sectional survey of midwives from communities identified through a two-stage cluster-sampling process. Midwives were asked how many babies they had delivered in the past year and how many of those newborns had various types of birth defects, as illustrated in pictures. SETTING: Indigenous Mayan communities in rural north-central Guatemala. PARTICIPANTS: Midwives (n = 129) who had delivered babies in the previous year. MAIN OUTCOME MEASURE: Reports of babies born with cleft lip and cleft palate. RESULTS: A 1-year prevalence rate of 18.9 per 10,000 for cleft lip and 4.7 per 10,000 for cleft palate was estimated for Alta Verapaz. None of the cases of cleft lip also had cleft palate. CONCLUSION: The indigenous communities in north-central Guatemala might have a relatively high cleft lip prevalence rate compared with the global average.

Alcohol consumption and violence among Argentine adolescents.

OBJECTIVE: This study investigated the association between alcohol and violence among Argentine youth. METHODS: Data from the 2007 Argentina Global School-based Student Health Survey (GSHS), a nationally representative survey of middle school students, were examined using age-adjusted logistic regression models. RESULTS: Of the 1,328 participating students aged 13 to 15 years old, 51.9% reported drinking alcohol in the previous month, with higher rates among males (p=0.04) and older students (p<0.01). Both male and female drinkers were nearly twice as likely as non-drinkers to report being physically attacked, being in a physical fight, and having thoughts about self-directed violence. Among drinkers, those who reported poor mental health, were victims of bullying, used tobacco or drugs, or skipped school without permission were approximately twice as likely as other drinkers to have engaged in violent activities. CONCLUSION: Public health interventions targeting violence among young adolescents should be developed in combination with alcohol education programs.

Consumo de álcool e violência entre adolescentes argentinos / Alcohol consumption and violence among Argentine adolescents

OBJETIVO: Este estudo investigou a associação entre álcool e violência na população de jovens argentinos. MÉTODOS: Dados da Global School-based Student Health Survey (GSHS) de 2007, uma pesquisa representativa em termos nacionais com alunos do ensino médio, foram examinados utilizando-se modelos de regressão logística ajustados por idade. RESULTADOS: Dos 1328 alunos participantes entre 13 e 15 anos de idade, 51,9% declararam ter consumido álcool no último mês, com taxas mais elevadas entre meninos (p = 0,04) e alunos mais velhos (p < 0,01). Homens e mulheres que bebem demonstraram estar quase duas vezes mais propensos a relatar agressão física, quando em uma briga física, e pensamentos sobre violência autoinfligida do que aqueles que não bebem. Entre as pessoas que bebem, aquelas que reportaram saúde mental precária, haviam sido vítimas de bullying, fumavam, faziam uso de drogas ou abandonaram a escola sem permissão se mostraram duas vezes mais propensas ao envolvimento em atividades violentas do que outras pessoas que também bebem. CONCLUSÃO: Intervenções de saúde pública quanto à violência entre jovens adolescentes devem ser desenvolvidas em combinação com programas de educação sobre álcool.

OBJECTIVE: This study investigated the association between alcohol and violence among Argentine youth. METHODS: Data from the 2007 Argentina Global School-based Student Health Survey (GSHS), a nationally representative survey of middle school students, were examined using age-adjusted logistic regression models. RESULTS: Of the 1,328 participating students aged 13 to 15 years old, 51.9% reported drinking alcohol in the previous month, with higher rates among males (p = 0.04) and older students (p < 0.01). Both male and female drinkers were nearly twice as likely as non-drinkers to report being physically attacked, being in a physical fight, and having thoughts about self-directed violence. Among drinkers, those who reported poor mental health, were victims of bullying, used tobacco or drugs, or skipped school without permission were approximately twice as likely as other drinkers to have engaged in violent activities. CONCLUSION: Public health interventions targeting violence among young adolescents should be developed in combination with alcohol education programs.

Parenting practices and tobacco use in middle school students in low- and middle-income countries.

BACKGROUND: Parenting practices have been shown to have a strong influence on adolescent tobacco use in high-income countries. This study examined whether parenting practices also were associated with tobacco use by middle school students (approximately ages 13-15) in low- and middle-income countries. METHODS: A secondary analysis was performed on data from 106,041 middle school students in 27 countries who participated in the Global School-Based Health Survey conducted between 2003 and 2007. RESULTS: In nearly all countries, boys and older students were significantly more likely to use tobacco than girls and younger students. In most countries, students who reported a high level of parental understanding or a high level of parental awareness of their children's activities were significantly less likely to use tobacco than other students. The children of parents who used tobacco were significantly more likely to use tobacco than children of non-users. After adjustment for age, sex, and parental tobacco use, the associations between parental understanding and awareness were statistically significant in 16 and 24 countries, respectively, of the 26 countries with parental tobacco use data. CONCLUSION: This multivariate analysis shows that positive parenting practices are significantly associated with decreased tobacco use among adolescents in low- and middle-income countries, which matches previous findings from high-income countries. Educating parents on the importance of their parenting practices may be an effective component of school-based programs aimed at reducing adolescent tobacco use.

Relación entre prácticas alimentarias reportadas por niños chilenos y preferencias de los padres para su consumo / Relationship between reported dietary practices of Chilean children and their parents preferences for their consumption

The objective of this study was to examine agreement between parental preferences and self-reported food intake in Chilean children. In 2008,152 pairs, of 8 to 13 year old schoolchildren and their parents in Santiago were surveyed. Children self-reported their frequency of consumption of foods from various food groups. Parents reported how often they preferred their children to consume foods from these same food groups. Children reported consuming more sweets, high-calorie snacks, and fruit, and fewer grains than their parents reported preferring them to consume. Girls, 10 and 11 year olds, and children who watched television and used the computer for less than 2 hours per day had dietary patterns most closely aligned with their parents' reported preferences. Children 's dietary reports generally follow parental preferences. Intervention programs should include programs that facilitate parental guidance and encourage children to make healthy food choices at home and in school.

Se estudia concordancia entre preferencias de padres y auto-reporte de niños chilenos en consumo de alimentos. En 2008, se encuestaron 152 escolares ente 8 y 13 años de edad y sus padres, en Santiago, Chile. Los niños reportaron frecuencia de consumo de diferentes grupos de alimentos y los padres, frecuencia con que prefieren que sus hijos los consuman. Los niños informaron mayor consumo de dulces, colaciones altas en calorías y frutas y menor consumo de cereales, que lo declarado por sus padres. Los patrones alimentarios más estrechamente alineados con lo reportado por los padres se observan en: niñas; edades entre 10 y 11 años; ver televisión y utilizar computador menos de 2 horas diarias. En general, lo reportado por niños sigue los patrones de los padres. Programas de intervención debieran incluir guía a padres y estimulo a niños para elegir opciones alimentarias saludables en el hogar y en la escuela.

Pyomyositis in Amazonian Ecuador.

Pyomyositis occurs when intramuscular abscesses appear in one or more body sites. Analysis of data from 165 patients with tropical pyomyositis diagnosed at a hospital in rural Amazonian Ecuador from 1980 to 1989 and 1995 to 2005 found that pyomyositis is more likely to affect males than females and more likely to affect children than adults. Abscesses were most commonly located on a lower extremity. Significant changes in patients' profiles between 1980 and 1989 and 1995 and 2005 were not found.

A geographic analysis of access to health services in rural Guatemala.

This paper uses road network analysis to quantify access to health care services in Alta Verapaz, a rural district in Guatemala with a majority Mayan population. Population data from the 2002 Guatemalan census, the location of health care facilities from the Ministry of Public Health and Social Assistance, and road and trail locations from the National Geographic Institute were included in a geographic information system (GIS). We computed the shortest path from each populated place to the nearest health care facility and then estimated the approximate travel time to the health facility based on road surface type. Road network analysis found that approximately 38.1% of residents of Alta Verapaz live within one hour of a hospital and 76.8% live within one hour of a basic care facility. In comparison, a circular buffer method found that 27.5% had access to a hospital and 94.5% had access to a primary care facility. Poverty was correlated with reduced access to care. The use of models that adjust for road types and allow for accurate estimation of travel times are helpful tools to identifying populations with limited access to health care services.

Predictors of compliance with scheduled surgery in rural Guatemala.

A non-governmental organization that helps low-income, rural, indigenous Guatemalans to have free or low-cost surgical care found that fewer than 60% of their patients kept their surgical appointments. The objective of this study was to identify the factors that predict compliance with scheduled surgery. All 690 surgical candidates screened by this organization between April 2008 and March 2009 and scheduled for surgery by August 2009 were included in this analysis. For the 474 adult patients the best predictors of compliance included a shorter time between screening and surgery, knowing someone who has had surgery, and several indicators of low socioeconomic status. For the 216 pediatric patients the best predictors of compliance included a shorter time between screening and surgery, having a parent who speaks Spanish in addition to the local indigenous language, and having a parent who knows someone who has had surgery. These findings suggest that the best ways to improve surgical attendance are to schedule surgery as close to the screening date as possible and to ensure that surgical candidates and their families meet a local resident who has had surgery.

Etiology of acute undifferentiated febrile illness in the Amazon basin of Ecuador.

We conducted a longitudinal observational study of 533 patients presenting to two hospitals in the Ecuadorean Amazon basin with acute undifferentiated febrile illness (AUFI) from 2001 through 2004. Viral isolation, reverse transcription-polymerase chain reaction (RT-PCR), IgM seroconversion, and malaria smears identified pathogens responsible for fever in 122 (40.1%) of 304 patients who provided both acute and convalescent blood samples. Leptospirosis was found in 40 (13.2%), malaria in 38 (12.5%), rickettsioses in 18 (5.9%), dengue fever in 16 (5.3%), Q fever in 15 (4.9%), brucellosis in 4 (1.3%), Ilhéus infection in 3 (1.0%), and Venezuelan equine encephalitis (VEE), Oropouche, and St. Louis encephalitis virus infections in less than 1% of these patients. Viral isolation and RT-PCR on another 229 participants who provided only acute samples identified 3 cases of dengue fever, 2 of VEE, and 1 of Ilhéus. None of these pathogens, except for malaria, had previously been detected in the study area.

Bullying and symptoms of depression in chilean middle school students.

BACKGROUND: The goal of this study was to assess the association between bullying and symptoms of depression among middle school students in Chile. METHODS: Secondary data analysis of Chile's 2004 Global School-Based Health Survey. RESULTS: A total of 8131 middle school students participated in the study. Forty-seven percent of students reported having been bullied in the past month and 30% reported having been sad and hopeless for 2 or more weeks in the past year. Students in the seventh and eighth grades were more likely to report having been bullied in the past month than students in ninth grade. Ninth grade students reported higher levels of loneliness, difficulty sleeping, and suicidal thoughts than students in the seventh and eighth grades. Boys were more likely than girls to report being bullied in the past month, but girls were more likely than boys to report symptoms of depression, such as prolonged feelings of sadness and hopelessness, loneliness, difficulty sleeping, and suicidal thoughts. Students who reported being bullied in the past month were more likely than nonbullied students to report symptoms of depression. A higher number of days of being bullied in the past month was associated with a statistically significant increase in reported rates of sadness and hopelessness (p < .001). CONCLUSIONS: Bullying is common among middle school children in Chile, and bullying and symptoms of depression are strongly linked. This finding is consistent with studies of bullying and depression in adolescents from other parts of the world.

Prevalence of intestinal parasites in young Quichua children in the highlands of rural Ecuador.

The prevalence of intestinal parasites in young Quichua children was assessed in 20 rural communities in the highlands of Ecuador in August 2005. The caregivers of 293 children aged 12-60 months were interviewed about the status of child health, household socioeconomic and environmental factors, and water-use practices and were requested to collect a faecal sample from the study child. Two hundred three (69.3%) of the 293 children provided faecal samples that were tested for parasites. The overall prevalences of infection for specific agents were Entamoeba histolytica or dispar 57.1%, Ascaris lumbricoides 35.5%, Entamoeba coli 34.0%, Giardia intestinalis (lamblia) 21.1%, Hymenolepis nana 11.3%, Cryptosporidium parvum 8.9%, Chilomastix mesnili 1.7%, Hymenolepis diminuta 1.0%, Strongyloides stercoralis 0.7%, and Trichuris trichiura 0.5%. The prevalence of parasites increased with age. Water storage, water treatment, consistent latrine-use, and participation in a community-based clean water project were not strongly associated with the prevalence of intestinal parasites, although having dirt floors was a risk factor for infection with E. histolytica or dispar and G. intestinalis.