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.

The control of Aedes aegypti for water access in households: Case studies towards a school-based education programme through the use of net covers.

We report the progress made so far towards developing a school-based education programme for controlling Aedes aegypti oviposition in household flowerpots through the use of a net cover (evidengue®) to seal off the flowerpot saucer. A core feature of this programme is the association of evidengue® delivery with a basic package of oral and written information on dengue in classrooms. The flowerpot saucer is one of the most common type of water-bearing containers positive for the larvae of Ae. aegypti in the south-eastern region of Brazil. We present the results of a preliminary laboratory efficacy evaluation of evidengue® and of an inter-group, experimental, exploratory trial in which the evidengue® delivery was associated with educational information by means of a lecture and/or a leaflet in a school situated in a dengue-endemic area. The results are encouraging in both cases: (i) evidengue® has shown to be an efficacious tool to prevent ovipositing female access to flowerpot saucers in the laboratory; and (ii) despite the small numbers of students involved in the trial, one of the experimental groups yielded 85.7% of evidengue®-user households among those students whose households had flowerpot saucers. Use of evidengue® was maintained for at least 60 days, the period of data collection.

Câncer pediátrico: o olhar da família/cuidadores / Pediatric cancer: under the look of the family/caregivers

O câncer infantil causa um grande impacto na vida de uma família e, freqüentemente, um indivíduo fica responsável pelo cuidado intensivo da criança. O objetivo deste artigo é relatar como estes cuidadores da família vivenciam a experiência de ter uma criança com câncer, desde o momento do diagnóstico até o enfrentamento da doença. Foram entrevistados 16 cuidadores hospedados em casas de apoio para tratamento de crianças com câncer em Belo Horizonte/ MG e as entrevistas foram analisadas na perspectiva da Fenomenologia de Merleau-Ponty. A análise permitiu identificar três unidades temáticas: cuidadores diante do diagnóstico, cuidadores em busca de uma explicação para a doença e cuidadores na tentativa de enfrentar a doença. O trabalho mostrou que os familiares buscam diferentes estratégias de enfrentamento e atribuem significados à experiência de ter uma criança com câncer a partir do conceito biomédico, psicossocial e da fé. O esclarecimento sobre os diversos aspectos da doença permite melhor elaboração pelos cuidadores acerca deste problema, contribuindo para uma melhor vivência do câncer infantil e de seu tratamento.

[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.

Validação dos questionários de conhecimento (DKN-A) e atitude (ATT-19) de Diabetes Mellitus / Validation of Diabetes Mellitus knowledge (DKN-A) and attitude (ATT-19) questionnaires

OBJETIVO: Apresentar a adaptação transcultural dos instrumentos Diabetes Knowledge Scale e Attitudes Questionnaires, específicos para avaliação do conhecimento e atitudes de pacientes com Diabetes Mellitus. MÉTODOS: Os instrumentos foram submetidos às seguintes etapas: apresentação, tradução, back-translation, avaliação das equivalências semântica e idiomática, cultural e conceitual, e pré-teste. Os questionários foram aplicados em duas oportunidades, com intervalos de um mês, em uma amostra de 61 pacientes com Diabetes Tipo 2 cadastrados num hospital universitário. Utilizou-se um desenho de estudo de confiabilidade teste-reteste das respostas, que foram analisadas e estimadas pelo Coeficiente de Kappa. RESULTADOS: Os achados sugerem adequação do processo de adaptação cultural dos instrumentos para a língua portuguesa. Na análise de confiabilidade, o coeficiente de Kappa alcançou nível de concordância de moderada a forte (0,44 a 0,69) em grande parte das questões. CONCLUSÕES: Os instrumentos mostraram ser de fácil compreensão pelos sujeitos do estudo e confiáveis e válidos para uso na avaliação de programas educativos em Diabetes Mellitus na realidade brasileira.

Rural tourism as risk factor for the transmission of schistosomiasis in Minas Gerais, Brazil.

Recently, the booming rural tourism in endemic areas of the state of Minas Gerais was identified as a contributing factor in the dissemination of the infection with Schistosoma mansoni. This article presents data from six holiday resorts in a rural district approximately 100 km distant from Belo Horizonte, MG, Brazil, where a possibly new and until now unperceived way of transmission was observed. The infection takes place in swimming pools and little ponds, which are offered to tourists and the local population for fishing and leisure activities. The health authorities of the district reported cases of schistosomiasis among the local population after visiting these sites. As individuals of the non-immune middle class parts of the society of big urban centers also frequent these resorts, infection of these persons cannot be excluded. A malacological survey revealed the presence of molluscs of the species Biomphalaria glabrata and Biomphalaria straminea at the resorts. The snails (B. glabrata) of one resort tested positive for S. mansoni. In order to resolve this complex problem a multidisciplinary approach including health education, sanitation measures, assistance to the local health services, and evolvement of the local political authorities, the local community, the tourism association, and the owners of the leisure resorts is necessary. This evidence emphasizes the urgent need for a participative strategic plan to develop the local tourism in an organized and well-administered way. Only so this important source of income for the region can be ensured on the long term without disseminating the disease and putting the health of the visitors at risk.

Rural tourism as risk factor for the transmission of schistosomiasis in Minas Gerais, Brazil

Recently, the booming rural tourism in endemic areas of the state of Minas Gerais was identified as a contributing factor in the dissemination of the infection with Schistosoma mansoni. This article presents data from six holiday resorts in a rural district approximately 100 km distant from Belo Horizonte, MG, Brazil, where a possibly new and until now unperceived way of transmission was observed. The infection takes place in swimming pools and little ponds, which are offered to tourists and the local population for fishing and leisure activities. The health authorities of the district reported cases of schistosomiasis among the local population after visiting these sites. As individuals of the non-immune middle class parts of the society of big urban centers also frequent these resorts, infection of these persons cannot be excluded. A malacological survey revealed the presence of molluscs of the species Biomphalaria glabrata and Biomphalaria straminea at the resorts. The snails (B. glabrata) of one resort tested positive for S. mansoni. In order to resolve this complex problem a multidisciplinary approach including health education, sanitation measures, assistance to the local health services, and evolvement of the local political authorities, the local community, the tourism association, and the owners of the leisure resorts is necessary. This evidence emphasizes the urgent need for a participative strategic plan to develop the local tourism in an organized and well-administered way. Only so this important source of income for the region can be ensured on the long term without disseminating the disease and putting the health of the visitors at risk.

Rural tourism as risk factor for the transmission of schistosomiasis in Minas Gerais, Brazil

Recently, the booming rural tourism in endemic areas of the state of Minas Gerais was identified as a contributing factor in the dissemination of the infection with Schistosoma mansoni. This article presents data from six holiday resorts in a rural district approximately 100 km distant from Belo Horizonte, MG, Brazil, where a possibly new and until now unperceived way of transmission was observed. The infection takes place in swimming pools and little ponds, which are offered to tourists and the local population for fishing and leisure activities. The health authorities of the district reported cases of schistosomiasis among the local population after visiting these sites. As individuals of the non-immune middle class parts of the society of big urban centers also frequent these resorts, infection of these persons cannot be excluded. A malacological survey revealed the presence of molluscs of the species Biomphalaria glabrata and Biomphalaria straminea at the resorts. The snails (B. glabrata) of one resort tested positive for S. mansoni. In order to resolve this complex problem a multidisciplinary approach including health education, sanitation measures, assistance to the local health services, and evolvement of the local political authorities, the local community, the tourism association, and the owners of the leisure resorts is necessary. This evidence emphasizes the urgent need for a participative strategic plan to develop the local tourism in an organized and well-administered way. Only so this important source of income for the region can be ensured on the long term without disseminating the disease and putting the health of the visitors at risk.

Acute schistosomiasis outbreak in the metropolitan area of Belo Horizonte, Minas Gerais: alert about the risk of unnoticed transmission increased by growing rural tourism.

The present article describes the occurrence of 17 cases of acute schistosomiasis in the metropolitan area of Belo Horizonte, state of Minas Gerais, Brazil. All individuals affected took a bath in a swimming pool of a holiday resort that was provided with water from a nearby brook. The apparently clean water and the absence of snails in the pool gave the wrong impression that there was no risk for infection. During a malacological survey at the site snails of the species Biomphalaria glabrata were found and tested positive for Schistosoma mansoni. All the patients live in the middle-class area of Barreiro, metropolitan area of Belo Horizonte and have medium grade school education. The difficulties in establishing the right diagnosis is expressed by the search for medical attention in 17 different medical facilities, the wide range of laboratory test and the inadequate treatment administration. A lack of knowledge about the disease was found in all groups studied. The booming rural tourism in endemic areas is identified as a probable risk factor for infection, especially for individuals of the non-immune middle and upper class parts of the society in urban centers. Special attention is given to a multidisciplinary approach to the complex issue of disease control and prevention.

Acute schistosomiasis outbreak in the metropolitan area of Belo Horizonte, Minas Gerais: alert about the risk of unnoticed transmission increased by growing rural tourism

The present article describes the occurrence of 17 cases of acute schistosomiasis in the metropolitan area of Belo Horizonte, state of Minas Gerais, Brazil. All individuals affected took a bath in a swimming pool of a holiday resort that was provided with water from a nearby brook. The apparently clean water and the absence of snails in the pool gave the wrong impression that there was no risk for infection. During a malacological survey at the site snails of the species Biomphalaria glabrata were found and tested positive for Schistosoma mansoni. All the patients live in the middle-class area of Barreiro, metropolitan area of Belo Horizonte and have medium grade school education. The difficulties in establishing the right diagnosis is expressed by the search for medical attention in 17 different medical facilities, the wide range of laboratory test and the inadequate treatment administration. A lack of knowledge about the disease was found in all groups studied. The booming rural tourism in endemic areas is identified as a probable risk factor for infection, especially for individuals of the non-immune middle and upper class parts of the society in urban centers. Special attention is given to a multidisciplinary approach to the complex issue of disease control and prevention

Evaluation of the molluscicidal properties of Euphorbia splendens var. hislopii (N.E.B.) Latex: experimental test in an endemic area in the state of Minas Gerais, Brazil

Following the positive results obtained regarding the molluscicidal properties of the latex of Euphorbia splendens that were corroborated in laboratory and field tests restrited conditions, a field study was conducted in experimental streams located in an endemic area. After recording the average annual fluctuation of vectors in three streams, a solution of E. splendens latex at ppm was applied in stream A, a solution of niclosamide at 3 ppm that applied in stream B and a third stream (C) remained untreated for negative control. Applications of E. splendens and niclosamide resulted in a mortality of 100 per cent among the snails collected in the streams A and B. No dead snails were found in the negative control stream. A monthly follow-up survey conducted during three consecutive months confirmed the return of vectors to both experimental streams treated with latex and niclosamide. This fact has called for a need to repeat application in order to reach the snails that remained buried in the mud substrate or escaped to the water edge, as well as, newly hatched snails that did not respond to the concentration of these molluscicides. Adults snails collected a month following treatment led us to believe that they had migrate from untreated areas of the streams to those previously treated.

Concepts of health and illness among students and teachers from public schools: a survey in Belo Horizonte, Minas Gerais State, Brazil

Considering the important role of the school in the formation of concepts and as a co-factor responsible for the development of attitudes, it is relevant to investigate what teachers and students think about health and illness. This information enables the verification of trends in health education at school, with a real possibility of understanding the multicausal determination of health and of stimulating helath promotion and disease prevention. On this basis, a study was carried out on the health concepts of teachers and students at four elementary schools in the outskirts of Belo Horizonte, where the authors developed a health education program. The data analysis for the answers given by teachers and students showed an emphasis on the biological and physiological aspects of health in their concepts. The most frequent response of the teachers referred to health as "physcial, bodily and organic equilibrium"(61.0 percent). Among students, the predominant idea of health was the possibility of performing activities (76.8 percent for 3rd and 4th grade students, and 41.2 percent for the 1st and 2nd grade ones), characterized by lists of actions or rules for maintaining health or avoiding illness. One third of the sample associated health with positive feelings and/or sensations. The data demonstrated an agreement of answers between the sampled investigated and North American schoolchildren, in contrast to those by the students from Rio de Janeiro, a fact linked to the historical and sociocultural characteristics of each place. The data also indicated that the majority of the students has a good level of cognitive development, broadening the possibility of working on more complex notions of health and illness, since the teachers can construct broader concepts of greater significance for their own life and the life of the students, which requires their better formation/information.

Knowledge of forests and their representation among urban children (elementary school children in the municipality of Rio de Janeiro): considerations about environmental education

The relation of the urban child with the forest environment has been investigated in a health education project aimed at primary schools in order to understand the child's knowledge and feelings towards this environment. Among the students who stated having visited a forest, 35,3 per cent from the North Zone (NZ) and 37.5 per cent from the South Zone (SZ) failed to characterize it adequately, mentioning instead, leisure sites in the urban area such as the Zoo or parks. Among the students who described a forest, 44.1 per cent (NZ) and 47.9 per cent (SZ) refer to the occurrence of the trees and animals in the environment. Out of these 49.3 per cent (NZ) and 61.2 per cent (SZ) refer positively to what they had experienced. The negative records are rare and generally attached to fear of animals, which demonstrates insufficient knowledge of the national fauna. The previous comprehension of the students'knowledge and their relation with the natural environment enables us to re-address the question of environmental education, raising questions which may stimulate more participation and constructive action by children.

Health education, public information, and communication in schistosomiasis control in Brazil: a brief retrospective and perspectives

In recent years, the strategy for the control of schistosomiasis has placed increased emphasis on the role of health education, public information, and communication. This should, not only bring about specific changes in behavior aiming at disease prevention, but also stimulate participation of the community in health programs. Beyond this, it is desirable that both community members and researchers should seek better life conditions through a transformative social action. The present paper addresses these concerns; first, by critically reviewing some health education programs that were developed in Brazil, and, secondly, by analyzing and suggesting ways to improve this area.

Environmental and health education for school age children: a transdisciplinary approach

Apresenta uma breve análise crítica e sugestoes quanto à orientaçäo da educaçäo ambiental e em saúde na escola de primeiro grau, baseado em experiências pedagógicas recentes e algumas reflexoes teórico-filosóficas. Säo discutidos no texto: a importância da transdisciplinaridade; da educaçäo participativa na qual os conhecimentos populares säo considerados ao se construir novos conceitos científicos; o planejamento de experiências concretas que estimulem sensaçoes de prazer e admiraçäo pela natureza e pela vida; a análise e busca de soluçoes para problemas que afetam a realidade local dos alunos, sem perder de vista as questoes globais. Aponta-se como fundamental o investimento na formaçäo dos professores, através de cursos e oficinas criativas, que associem a construçäo de novos conhecimentos à reflexäo crítica sobre o papel da escola que deve estar comprometida com a busca de maior igualdade social e manutençäo do equilíbrio nas relaçoes entre o homem e a natureza, abrindo espaço para o exercício da cidadania entre os alunos.