Long-term hospital care needs after Bothrops atrox envenomation with hemorrhagic stroke in the Brazilian Amazon: 'From social to physical death' - A case report.

Hemorrhagic stroke is a severe complication reported in cases of Bothrops atrox snakebite envenomation. We report an unusual case of a patient who evolved with an intracranial hemorrhagic stroke and was in a coma for more than five years in a tertiary hospital located in Manaus, Amazonas. 52-year-old man, carpenter, resident in the rural area of the municipality of Tabatinga, located 1106 km from Manaus, capital of Amazonas, Brazil, victim of an accident involving Bothrops atrox evolution with cardiorespiratory arrest, acute kidney injury and hemorrhagic stroke. After 43 days of hospitalization in the ICU, he was transferred to the ward, without contact with the environment and family, sent for home treatment, however, without acceptance by family members. During a long hospital stay for a period of 6 years, totally dependent on special care, in a flexed position, using a tracheostomy and mechanical ventilation, diagnosed and treated for hospital infections throughout his hospitalization, he died due to bacterial pneumonia. Losses of autonomy can result in an individual being completely disconnected from social life - a "social death before physical death".

Acceptability of short message service (SMS) as a tool for malaria treatment adherence in the Brazilian Amazon: a qualitative study.

BACKGROUND: Malaria is one of the leading causes of morbidity worldwide, and patient adherence to prescribed antimalarials is essential for effective treatment. METHODS: This cross-sectional study, with in-depth telephone interviews, analyzed participants' perceptions of short message service (SMS) in adherence to treatment. RESULTS: Five thematic categories emerged: decreased forgetfulness, the novelty of the tool, easy-to-understand language, the impact of SMS messages during treatment, and suggestions for improvement and complaints. CONCLUSIONS: SMS could assist patients in adhering to prescribed antimalarials.

Acceptability of short message service (SMS) as a tool for malaria treatment adherence in the Brazilian Amazon: a qualitative study

ABSTRACT Background: Malaria is one of the leading causes of morbidity worldwide, and patient adherence to prescribed antimalarials is essential for effective treatment. Methods: This cross-sectional study, with in-depth telephone interviews, analyzed participants' perceptions of short message service (SMS) in adherence to treatment. Results: Five thematic categories emerged: decreased forgetfulness, the novelty of the tool, easy-to-understand language, the impact of SMS messages during treatment, and suggestions for improvement and complaints. Conclusions: SMS could assist patients in adhering to prescribed antimalarials.

Teachers as multipliers of knowledge about schistosomiasis: a possible approach for health education programmes.

BACKGROUND: In the past decade, Brazil has significantly reduced the prevalence of schistosomiasis through a combined effort of early treatment of infected people, expansion of basic sanitation infrastructure and educational measures. Despite these efforts, in some areas, prevalence of schistosomiasis exceeds 20% of the school population, who lack knowledge of the risks of the disease. Action can be taken in schools to empower this population about their health condition. This paper describes the role of the teacher as a multiplier of knowledge about schistosomiasis and proposes two different approaches to training these teachers. METHODS: This study used mixed methods to evaluate training of teachers and educational intervention with those teachers' pupils. Two training courses, each with 40 h of face-to-face activity, were offered to 19 teachers, using two different but complementary approaches, based on theoretical references and specific educational strategies: Critical Pedagogical Approach (Training Course I, held in 2013) and Creative Play Approach (Training Course II, held in 2014).The courses included classroom activities, laboratory and field work. After the training, the teachers conducted activities on schistosomiasis with their pupils. These activities involved constructing educational materials and cultural productions. The pupils' knowledge about the disease was evaluated before the activities and 12 months later. The teachers' acceptance and perceptions were assessed through structured interviews and subsequent thematic analysis. The Shistosoma mansoni infection status of teachers and their students was also assessed using the Kato Katz stool test. RESULTS: The parasitological study showed 31.6% of the teachers and 21.4% of the pupils to be positive for S. mansoni. The teachers' knowledge of important aspects of schistosomiasis transmission and prevention was fragmented and incorrect prior to the training. The teachers' knowledge changed significantly after the training and they were strongly accepting of the pedagogical methods used during the training. The level of their pupils' knowledge about the disease had increased significantly (p < 0.05). However, pupils responded that, even after the educational activities, they still had contact with the city's contaminated waters (p > 0.05). CONCLUSIONS: The results of this study underline the importance of schools and teachers as partners in controlling and eliminating schistosomiasis. Teacher training on the disease significantly increases their pupils' knowledge, reflecting empowerment with regard to local health conditions.

Aceitação entre estudantes do ensino básico do desenho animado O X na Xistose para construção de conhecimentos sobre esquistossomose / Acceptance of the cartoon O X na Xistose for the knowledge construction about schistosomiasis among middle school students / Aceptación entre estudiantes del ciclo básico de lo dibujo animado O X na Xistose para el desarrollo del conocimiento sobre la esquistosomiasis

O trabalho dos educadores pode ser enriquecido com o uso de recursos pedagógicos importantes no processo de ensino e aprendizagem. Considerando este aspecto, uma animação baseada no livro O feitiço da lagoa, de Virginia Schall, que trata do tema esquistossomose foi construída para estimular o conhecimento sobre a doença entre escolares e exibida para alunos do ensino básico em quatro municípios endêmicos: Jaboticatubas, Malacacheta e Santa Luzia, em Minas Gerais; e João Pessoa, na Paraíba. Após sua exibição, um questionário foi aplicado com a finalidade de verificar a aceitação e o entendimento do material. De acordo com as respostas, o desenho animado apresentou boa aceitação. Todos identificaram a esquistossomose como a doença retratada e o caramujo como o transmissor do esquistossomo. Os resultados apontaram que o desenho pode ser um importante recurso pedagógico no processo educativo, auxiliando os programas de controle da endemia, especialmente quando desenvolvidos no espaço escolar.

The educators' work can be enriched with the use of pedagogical resources which are important in the teaching and learning process. With this aspect in mind, a cartoon with the theme schistosomiasis was created, so as to promote knowledge about the disease among middle school students, and exhibited in four endemic municipalities - Jaboticatubas, Malacacheta and Santa Luzia in the state of Minas Gerais; and João Pessoa in the state of Paraíba. The animation was based on the book O feitiço da lagoa by Virginia Schall and it was shown to students in those four towns. A questionnaire was answered by them after the respective exhibitions in order to verify the acceptance and understanding of the material that was shown. According to the responses, the cartoon presented good acceptance. Everyone identified schistosomiasis as the disease displayed, and the snail that transmits the schistosome. The results showed that the cartoon can be an important pedagogical resource in the educational process, helping endemic control programs, especially when these programs are developed in the school environment.

El trabajo de los educadores puede ser enriquecido con el uso de recursos pedagógicos importantes en el proceso de enseñanza y aprendizaje. Considerando este aspecto, un dibujo animado sobre el tema esquistosomiasis fue realizado para estimular el conocimiento, entre estudiantes del ciclo básico, acerca de la enfermedad y exhibido en cuatro municipios endémicos: Jaboticatubas, Malacacheta y Santa Luzia en Minas Gerais; y João Pessoa en Paraíba. La animación fue basada en el libro O feitiço da lagoa de Virginia Schall y fue mostrada a alumnos en las cuatro localidades. Un cuestionario fue aplicado, después de cada proyección, con la finalidad de verificar la aceptación y el entendimiento del material exhibido. De acuerdo con las respuestas, el dibujo tuvo buena aceptación. Todos identificaron la esquistosomiasis como la enfermedad retratada y el caracol como el transmisor del esquistosoma. Los resultados indicaran que el dibujo animado puede ser un importante recurso pedagógico en el proceso educativo, auxiliando a los programas de control de la endemia, especialmente cuando desarrollados en el espacio escolar.

Misperceptions of patients and health workers regarding malaria elimination in the Brazilian Amazon: a qualitative study.

BACKGROUND: Brazil has considerably reduced the number of cases of malaria in recent years and aims to eradicate the disease completely, however, vivax malaria continues to be a major challenge for the health system. In this context, the key to building a successful elimination programme may lie in the knowledge and the perceptions of the health agents, the patients affected by the disease and the personnel responsible for malaria diagnosis, treatment and control at the local level. METHODS: A qualitative study was undertaken in Manaus, capital of the state of Amazonas, Western Brazilian Amazon, using a sample of 33 patients who were being treated for malaria and 22 health agents who were working in malaria diagnosis, treatment and control at the local level. A semi-structured interview with a further thematic analysis was performed. RESULTS: There are still many myths regarding malaria transmission and treatment that may hinder the sensitization of the population of this region in relation to the use of current control tools and elimination strategies, such as mass drug administration (MDA). Most health professionals reported that the abandonment of treatment for malaria by the patient is related to poor social conditions, the high incidence of alcoholism and the low level of schooling of the affected population. One negative perception, observed in both groups with regard to the use of insecticide-treated nets, is that they may cause skin irritations and allergies. Most patients and health professionals have described malaria as an impossible disease to eliminate because it is intrinsically associated with forest landscapes, and according to them, elimination would only be possible if there were a vaccine against malaria. CONCLUSION: In the Amazon, cultural perceptions about the etiology of this disease can influence the behaviour and practices that social groups adopt in relation to the different forms of living in a malaria-endemic context. Negative perceptions about malaria elimination can act as a barrier when trying to reach proper coverage for control strategies such as mosquito nets and MDA.

Hymenoptera stings in Brazil: a neglected health threat in Amazonas State.

INTRODUCTION: Hymenoptera injuries are commonly caused by stinging insects. In Amazonas state, Brazil, there is no information regarding distribution, profile, and systemic manifestations associated with Hymenoptera injuries. METHODS: This study aimed to identify risk factors for systemic manifestation using the Brazilian Notifiable Diseases Surveillance System (2007 to 2015). RESULTS: Half of Hymenoptera injuries were caused by bee stings. Hymenoptera injuries were concentrated in Manaus, and 13.36% of cases displayed systemic signs. Delayed medical assistance (4 to 12 hours) presented four times more risk for systemic manifestations. CONCLUSIONS: Simple clinical observations and history of injury are critical information for prognostic improvement.

Hymenoptera stings in Brazil: a neglected health threat in Amazonas State

Abstract INTRODUCTION: Hymenoptera injuries are commonly caused by stinging insects. In Amazonas state, Brazil, there is no information regarding distribution, profile, and systemic manifestations associated with Hymenoptera injuries. METHODS: This study aimed to identify risk factors for systemic manifestation using the Brazilian Notifiable Diseases Surveillance System (2007 to 2015). RESULTS: Half of Hymenoptera injuries were caused by bee stings. Hymenoptera injuries were concentrated in Manaus, and 13.36% of cases displayed systemic signs. Delayed medical assistance (4 to 12 hours) presented four times more risk for systemic manifestations. CONCLUSIONS: Simple clinical observations and history of injury are critical information for prognostic improvement.

[Characterization of printed educational materials about schistosomiasis used in health education in endemic areas in Brazil]. / Caracterização de materiais educativos impressos sobre esquistossomose, utilizados para educação em saúde em áreas endêmicas no Brasil.

OBJECTIVE: to characterize printed educational materials about schistosomiasis produced at federal, state and municipal levels in Brazil. METHODS: the educational materials were characterized considering the following categories: 'format', 'parasite and intermediate host', 'definitive host (ill)' and 'disease'. RESULTS: 60 materials were assessed, three had no information about risk activities and 41 indicated more than one popular name for the disease, thus allowing greater reach among the target audience in diverse endemic areas; the biological cycle was missing or incorrect in 53 materials; the intermediate host (snail) was incorrectly illustrated, with use of stereotyped images in 39 and no image in one material; diagnosis was mentioned in 36 materials. CONCLUSION: the printed educational materials assessed had incorrect content which may compromise health education efforts; little attention was paid to schistosomiasis diagnosis.

Caracterização de materiais educativos impressos sobre esquistossomose, utilizados para educação em saúde em áreas endêmicas no Brasil / Characterization of printed educational materials about schistosomiasis used in health education in endemic areas in Brazil / Evaluación de materiales educativos impresos sobre la esquistosomiasis, utilizados en educación para la salud en zonas endémicas de Brasil

OBJETIVO: caracterizar os materiais educativos impressos sobre esquistossomose produzidos no Brasil, nos níveis federal, estadual e municipal. MÉTODOS: os materiais foram caracterizados considerando-se as categorias 'formato', 'parasito e hospedeiro intermediário', 'hospedeiro definitivo' (doente) e 'doença'. RESULTADOS: dos 60 materiais avaliados, três não traziam informação sobre as atividades de risco e 41 indicavam mais de um nome popular para a doença, possibilitando maior alcance do público-alvo nas diversas áreas endêmicas; em 53 materiais, o ciclo biológico estava ausente ou incorreto; o molusco, hospedeiro intermediário, estava retratado incorretamente, com imagens estereotipadas em 39 materiais, e ausente em um; o diagnóstico foi mencionado em 36 materiais. CONCLUSÃO: os materiais educativos impressos avaliados mostraram incorreções que podem comprometer o trabalho de educação em saúde; ademais, o diagnóstico da esquistossomose foi pouco abordado.

OBJECTIVE: to characterize printed educational materials about schistosomiasis produced at federal, state and municipal levels in Brazil. METHODS: the educational materials were characterized considering the following categories: 'format', 'parasite and intermediate host', 'definitive host (ill)' and 'disease'. RESULTS: 60 materials were assessed, three had no information about risk activities and 41 indicated more than one popular name for the disease, thus allowing greater reach among the target audience in diverse endemic areas; the biological cycle was missing or incorrect in 53 materials; the intermediate host (snail) was incorrectly illustrated, with use of stereotyped images in 39 and no image in one material; diagnosis was mentioned in 36 materials. CONCLUSION: the printed educational materials assessed had incorrect content which may compromise health education efforts; little attention was paid to schistosomiasis diagnosis.

OBJETIVO: evaluar materiales educativos impresos (MEIs) sobre esquistosomiasis producidos en Brasil a nivel Federal, Estatal y Municipal. MÉTODOS: los MEIs fueron sometidos a una evaluación de contenidos teniendo en cuenta las categorías: formato, parásito y hospedero intermediario, hospedero definitivo y enfermedad. RESULTADOS: de los 60 MEIs evaluados, tres no tenían información sobre actividades de riesgo y 41 daban más de un nombre popular a la enfermedad, permitiendo un mayor alcance de público objetivo en diferentes zonas endémicas; en 53 MEIs el ciclo de vida no era mencionado o era incorrectoo; el molusco, hospedero intermediario, era retratado incorrectamente, con imágenes estereotipadas em 39 MEIs y ausente en uno; se daba poca importancia al diagnóstico, siendo mencionado en apenas 36 de ellos. CONCLUSIÓN: los MEIs mostraron inexactitudes que podrían comprometer el trabajo de educación de la salud.

Ecotourism as a source of infection with Schistosoma mansoni in Minas Gerais, Brazil.

BACKGROUND: In recent years, a new pattern of schistosomiasis transmission has been described which is related to recreational activities associated with rural or ecological tourism and migratory flows and accompanying changes in social dynamics in Brazil. The objective of this report is to describe two schistosomiasis outbreaks that occurred during the practice of rural tourism in Minas Gerais, Brazil, and review this pattern of transmission within the wider context of schistosomiasis control. FINDINGS: The first outbreak was characterized by its high infection rate, showing that 59 % of the exposed eco-tourists became positive for infection with Schistosoma mansoni. In addition, all three disease transmitting species of intermediate host snails were found in the area. In the second outbreak, all members of one tourist family were infected and reported contact with water in a well-known tourist area. The malacological survey in the region revealed an infection rate with S. mansoni of 8.3 % among the collected snails. CONCLUSIONS: Infection of urban dwellers that report contact with contaminated water associated with ecotourism represents a new pattern of disease transmission and dissemination. The infection with the disease at these occasions finds its expression in outbreaks of acute schistosomiasis among internal tourists to rural areas. Therefore, epidemiological surveillance in endemic areas should be aware of this schistosomiasis transmission pattern, and a multidisciplinary approach, most of all sanitation and health education measures, is required in order increase the efficiency of control strategies.

Educação em saúde na prevenção e controle da esquistossomose: avaliação de duas abordagens educativas com professores do município endêmico de Malacacheta-Minas Gerais

INTRODUÇÃO: A esquistossomose mansônica é endêmica no Brasil. As crianças em idade escolar detêm as maiores prevalências e cargas parasitárias. Estudos que avaliaram os limites e possibilidades das abordagens educativas para o controle da endemia sugerem que os programas devem investir em estratégias que levem em conta a realidade local, o empoderamento e a integração dos profissionais da saúde e educação e o desenvolvimento de ações com os grupos mais vulneráveis, como os escolares. OBJETIVOS: Este trabalho visa: (a) estimar as taxas de infecção por Schistosoma mansoni entre os profissionais de educação no município de Malacacheta, área endêmica de Minas Gerais; (b) formar professores multiplicadores do conhecimento sobre esquistossomose entre os escolares; (c) avaliar o uso, no ensino fundamental, de duas abordagens educacionais sobre prevenção e controle da esquistossomose; e (d) verificar se as abordagens educacionais contribuem para promover mudanças no nível do conhecimento que aproxime o saber popular e o científico dos professores e alunos de forma sustentável no tempo. METODOLOGIA: A positividade para S. mansoni nos profissionais da educação do município foi estimada através de inquérito parasitológico de fezes (n=522), usando o método de Kato-Katz. Dois cursos de atualização sobre a doença, com abordagens distintas, foram ministrados para professores de diferentes disciplinas do município endêmico de Malacacheta, Minas Gerais. Questionários semiestruturados foram aplicados aos professores e seus alunos, antes e após as ações educativas, para levantar os conhecimentos prévios e adquiridos...

INTRODUCTION: Schistosomiasis mansoni is endemic in Brazil. The highest prevalences and parasite loads are among school-age children. Studies to evaluate the limitations and potential of educational approaches to its control suggest that programmes should invest in strategies that address the local situation and the empowerment and integration of health and education personnel and provide for actions with the most vulnerable groups, such as schoolchildren. OBJECTIVES: This study aims: (a) to assess infection rates by Schistosoma mansoni among education personnel in Malacacheta, a municipality in the endemic area of Minas Gerais; (b) to train teachers as multipliers of knowledge of schistosomiasis among schoolchildren; (c) to evaluate the use, with primary and middle-school teachers, of two educational approaches on schistosomiasis prevention and control; and (d) to ascertain whether the educational approaches contributed to knowledge rearrangement that approximates the popular and scientific know-how of teachers and their pupils and whether that knowledge is sustainable in time. METHODOLOGY: S. mansoni infection among education personnel in the municipality was estimated by parasitology stool test (n=522), using the Kato-Katz method. Two refresher courses using different, but complementary, educational approaches (critical pedagogy and pedagogy of creative play) to the disease were given to teachers of various different subjects. Semi-structured questionnaires were applied to teachers and their pupils, before and after the educational actions, in order to survey prior and acquired knowledge…

Abordagem sobre esquistossomose em livros de ciÊncias e biologia indicados pelo PRograma Nacional do Livro didático (PNLD) - 2011/2012 / The approach to schistosomiasis in science and biology books indicated by the national textbook program - PNLD 2011 and 2012

Analisou-se o conteúdo esquistossomose em livros didáticos de Ciências e de Biologia indicados pelo Guia do Programa Nacional do Livro Didático (PNLD) 2011 e pelo Guia PNLD 2012 - Ensino Médio do Ministério da Educação. Foram examinadas 11 coleções de Ciências e 7 de Biologia. Avaliou-se a qualidade dos conceitos sobre a endemia e a conformidade da informação, das imagens e da linguagem com a faixa etária dos alunos. Os resultados revelaram incorreções em conceitos e imagens e desatualização da temática em todos os livros. Evidenciou-se a necessidade de cuidados na elaboração dos livros para que as informações não sejam discrepantes da realidade das áreas endêmicas. A informação correta contribui para a construção de um pensamento científico e crítico e auxilia na formação de atitudes que minimizem o risco de contrair a doença, fortalecendo a concepção de medidas promotoras de saúde...

In this study the approach to the content on schistosomiasis in Science and Biology textbooks, indicated by the guide of the National Textbook Program (PNLD) 2011 and PNLD - High School – 2012, Ministry of Education, was analyzed. For this analysis eleven science and seven biology collections, all indicated by the program, were selected. The results revealed inaccuracies in concepts, images and thematically outdated content in all the books surveyed. It is emphasized that care is needed in preparing such school material, in order to avoid discrepancies between the information provided and the reality present in endemic areas. The correct information contributes to a better construction of attitudes, which minimizes the risk of contracting the disease, thus strengthening measures that promote health in the communities involved...

A qualidade da informação nos ciclos biológicos de Schistosoma mansoni veiculados na rede mundial de computadores- Internet / Quality of information about biological cycles of Schistosoma mansoni broadcasted on the world wide web – internet

A internet está em expansão na educação, principalmente nas áreas de divulgação, pesquisa e ensino. Por isso, neste trabalho foi avaliada a qualidade da informação nos ciclos de Schistosomamansoni veiculados na internet. Como metodologia foi utilizado o método de busca Google Imagens, por meio do qual foram encontrados 45 diferentes ciclos. Observou-se que há falta de referência de informação de fontes seguras na elaboração destes ciclos, uma vez que os equívocos foram insistentemente repetidos. Com frequência foi utilizada uma imagem do molusco de forma estereotipada ou minimizada, o que leva a representações equivocadas e pedagogicamente inadequadas, impossibilitando o usuário de reconhecer o molusco no ambiente e, consequentemente, expondo-o ao risco de infecção.

Presença de ovos de helmintos intestinais em ônibus de transporte público em Belo Horizonte - Minas Gerais, Brasil / Presence of eggs from intestinal helminths in buses of the public transport system in Belo Horizonte city, Minas Gerais State

Neste trabalho avaliou-se a presença de ovos de helmintos intestinais em amostras coletadas no transporte urbano coletivo por ônibus da cidade de Belo Horizonte (MG). Foi examinado o interior de 30 ônibus de diferentes linhas que circulam por três grandes estações de embarque/desembarque de passageiros, utilizando-se o método de Graham (1941) para a coleta do material. Os resultados indicaram a contaminação de 100 por cento dos veículos analisados. Foram observados ovos de Ascaridae, de Oxyuridae e de Hymenolepis sp., este último presente em 93 por cento dos veículos analisados. Os resultados indicaram a contaminação do ambiente e risco potencial para a população que utiliza este serviço.