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1.
Infectio ; 25(4): 256-261, oct.-dic. 2021. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286719

RESUMO

Resumen Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para CO VID-19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sinto matología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32-9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6-436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de CO VID-19 en población rural andina de Perú.


Abstract Objective: To determine the risk factors in adults with COVID-19 in the rural Andean population during 2020. Methods: This multicenter retrospective cohort study included 184 adult patients (≥18 years) with COVID-19's serological and molecular tests from three Hospitals in the Peruvian mountains (Ancash and Apurímac) included with clinical suspicion between April and June. Descriptive analysis and univariate logistic regression were used to explore the risk factors associated with patients with COVID-19. Results: Of total of patients, 14 (7.6%) had a SARS-CoV-2. In infected patients 12 (85.7%) were men with an average age of 47.3±21 years. Comorbidities were present in about a third of patients, with hypertension and diabetes being the most frequent (both 14.3%), and the most frequent symptoms were fever and hea dache (57.2%). Univariate regression showed higher probabilities of infection with SARS-CoV-2 in the rural Andean population associated with advanced age (OR: 1.1 95% CI 0.7 - 1.8; p = 0.019), previous comorbidities (OR: 1.7, 95%CI 0.32 - 9.39; p = 0.006), and previous symptoms (OR: 49.8, 95%CI 5.6 - 436.9; p = 0.0011). Conclusions: Possible risk factors such as advanced age, comorbidities and previous symptoms are related to the development of COVID-19 in the rural Andean population of Peru.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , COVID-19 , Peru , População Rural , Fatores de Risco , Estudos de Coortes , SARS-CoV-2 , Cefaleia , Hospitais , Hipertensão , Infecções
2.
BMC Health Serv Res ; 21(1): 925, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488746

RESUMO

BACKGROUND: Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions: How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? How can video consultations be used to reduce difficulties arising in everyday care? How does implementation of video consultations impact day-to-day nursing home care delivery? METHODS: Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis. RESULTS: Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly. CONCLUSIONS: Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.


Assuntos
Telemedicina , Alemanha , Humanos , Casas de Saúde , Encaminhamento e Consulta , População Rural
3.
J Appl Oral Sci ; 29: e20200939, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495104

RESUMO

BACKGROUND: Arsenic contamination in the environment and groundwater is a major global public health problem. Several researchers suggest that the toxicity of arsenic could be related to oral cancer development, usually resulting from potentially malignant lesions. During pathological processes, salivary proteins suffer modifications, which could lead to the discovery of new biomarkers. OBJECTIVE: To analyze the protein profile in human saliva samples from a rural population exposed to high levels of arsenic in drinking water and its association with potentially malignant lesions. METHODOLOGY: This observational, analytic and cross-sectional design included 121 patients from the state of Graneros (Tucumán, Argentina). Arsenic concentration in drinking water was determined and, according to the values obtained, individuals were divided into 2 groups: exposed group and non-exposed group. Saliva samples were obtained, and total protein concentration was measured by Bradford method. Finally, Laemmli SDS-polyacrylamide gel electrophoresis was conducted to obtain the protein profile. RESULTS: Total protein concentration in saliva was lower in the exposed group than in the non-exposed group. Average areas of 20 and 42 KDa bands were significantly lower in exposed group than non-exposed group. CONCLUSION: Chronic intake of high arsenic concentrations in drinking water produces changes in the salivary protein profile, which is associated with the presence of potentially malignant lesions.


Assuntos
Arsênio , Água Potável , Poluentes Químicos da Água , Argentina , Arsênio/análise , Arsênio/toxicidade , Estudos Transversais , Água Potável/análise , Monitoramento Ambiental , Humanos , Projetos Piloto , População Rural , Proteínas e Peptídeos Salivares , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidade
4.
An Acad Bras Cienc ; 93(4): e20191178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495197

RESUMO

To better understand the dispersion strategies of Triatoma infestans (Klug) (Hemiptera: Reduviidae, Triatominae), we evaluated the spatial effect of infested peridomicile and density vegetation cover in a historically endemic area for Chagas disease. The study was conducted in rural houses of the northwest of Córdoba province, Argentine, during 2012-2013. Active search of triatomines were made in domicile and peridomicile habitats. To characterize vegetation coverage, a thematic map was obtained considering five types of vegetation cover (closed/open forest, closed/open shrubland and cultural land). From each house we extracted the area of vegetation coverage, housing density and infested peridomiciles density. We used generalized linear models to evaluate the effect of these variables on the occurrence of infested peridomicile. According to our results, the probability of a peridomicile to be infested increases by 1.34 (95%CI [0.98; 1.90]) times more when peridomicile structures are in environments with higher housing density and by 1.25 (95%CI [0.84; 1.88]) more times when houses are surrounded by open shrublands. Among the multiple ecological determinants of peridomestic infestation, the influence of vegetation cover has been poorly studied. In this study we discussed the effect of the vegetation as a potential modulator of the dispersion strategies of T. infestans.


Assuntos
Doença de Chagas , Triatoma , Animais , Argentina , Habitação , Humanos , Insetos Vetores , População Rural
7.
BMC Pediatr ; 21(1): 390, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493225

RESUMO

BACKGROUND: Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies' Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. METHODS: This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies' Lives programme, which is the intervention. The Saving Babies' Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies' Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. DISCUSSION: Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04663620 . Registered on 11th December 2020, retrospectively registered.


Assuntos
Mortalidade Infantil , População Rural , Camboja , Agentes Comunitários de Saúde , Atenção à Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
BMC Public Health ; 21(1): 1628, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488709

RESUMO

BACKGROUND: Non-communicable diseases are a leading cause of health loss worldwide, in part due to unhealthy lifestyles. Metabolic-based diseases are rising with an unhealthy body-mass index (BMI) in rural areas as the main risk factor in adults, which may be amplified by wider determinants of health. Changes in rural environments reflect the need of better understanding the factors affecting the self-ability for making balanced decisions. We assessed whether unhealthy lifestyles and environment in rural neighbourhoods are reflected into metabolic risks and health capability. METHODS: We conducted a community-based cross-sectional study in 15 Portuguese rural neighbourhoods to describe individuals' health functioning condition and to characterize the community environment. We followed a qualitatively driven mixed-method design to gather information about evidence-based data, lifestyles and neighbourhood satisfaction (incorporated in eVida technology), within a random sample of 270 individuals, and in-depth interviews to 107 individuals, to uncover whether environment influence the ability for improving or pursuing heath and well-being. RESULTS: Men showed to have a 75% higher probability of being overweight than women (p-value = 0.0954); and the reporting of health loss risks was higher in women (RR: 1.48; p-value = 0.122), individuals with larger waist circumference (RR: 2.21; IC: 1.19; 4.27), overweight and obesity (RR: 1.38; p-value = 0.293) and aged over 75 years (RR: 1.78; p-value = 0.235; when compared with participants under 40 years old). Metabolic risks were more associated to BMI and physical activity than diet (or sleeping habits). Overall, metabolic risk linked to BMI was higher in small villages than in municipalities. Seven dimensions, economic development, built (and natural) environment, social network, health care, demography, active lifestyles, and mobility, reflected the self-perceptions in place affecting the individual ability to make healthy choices. Qualitative data exposed asymmetries in surrounding environments among neighbourhoods and uncovered the natural environment and natural resources specifies as the main value of rural well-being. CONCLUSIONS: Metabolic risk factors reflect unhealthy lifestyles and can be associated with environment contextual-dependent circumstances. People-centred approaches highlight wider socioeconomic and (natural) environmental determinants reflecting health needs, health expectations and health capability. Our community-based program and cross-disciplinary research provides insights that may improve health-promoting changes in rural neighbourhoods.


Assuntos
Estilo de Vida , População Rural , Adulto , Idoso , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Circunferência da Cintura
9.
BMC Public Health ; 21(1): 1644, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34496822

RESUMO

BACKGROUND: The study aimed to characterize the prevalence of alcohol consumption and further investigate the relationship between alcohol consumption and type 2 diabetes mellitus (T2DM). METHODS: We studied 39,259 participants aged 18 to 79 years of the Henan Rural Cohort study. The associations between alcohol consumption and T2DM were examined using the logistic regression models and restricted cubic spline. RESULTS: For men, alcohol abstinence was associated with an increased risk of T2DM (1.491(1.265, 1.758)), whereas current drinkers were not associated with T2DM (1.03(0.91, 1.15)). Further analysis of alcohol drinkers revealed that only high-risk drinkers of WHO drinking risk levels increased the risk of T2DM (1.289(1.061,1.566)) compared to never drinkers. The risk of T2DM increased as the age of starting to consume alcohol decreased and as the number of years of consuming alcohol and the alcohol intake increased only in men. We further found that the risk of T2DM decreased as the number of years of abstinence increases and no association between alcohol abstinence and T2DM was found after more than 10 years of abstinence among men. CONCLUSIONS: Our results suggested that reducing the amount of alcohol consumed and adhering to abstinence from alcohol consumption are beneficial in reducing the risk of T2DM. TRIAL REGISTRATION: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06. http://www.chictr.org.cn/showproj.aspx?proj=11375.


Assuntos
Diabetes Mellitus Tipo 2 , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , China/epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etiologia , Humanos , Masculino , Prevalência , Fatores de Risco , População Rural
10.
BMC Public Health ; 21(1): 1645, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503462

RESUMO

BACKGROUND: Given the increasing rates of childhood obesity in Alaska Native children and the understanding that the most effective interventions are informed by and reflect the cultural knowledge of the community in which they are implemented, this project sought to gather the wisdom of local Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim region of Alaska around how to maintain a healthy diet and active lifestyle. METHODS: Perspectives were sought through the use of semi-structured focus groups, which were completed in person in twelve communities. All conversations were recorded, translated, transcribed, and analyzed using a qualitative approach, where key themes were identified. RESULTS: Elders provided a clear and consistent recollection of what their life looked like when they were young and expressed their perspectives related to maintaining a healthy and traditional lifestyle. The key themes the Elders discussed included an emphasis on the nutritional and cultural benefits of traditional foods; concerns around changing dietary patterns such as the consumption of processed foods and sugar sweetened beverages; and concerns on the time and use of screens. Elders also expressed a desire to help younger generations learn traditional subsistence practices. CONCLUSIONS: The risk of obesity in Alaska Native children is high and intervention efforts should be grounded in local knowledge and values. The perspectives from Yup'ik and Cup'ik Elders in the Yukon-Kuskokwim Delta area of Alaska provide a better understanding on local views of how to maintain a healthy diet, physical activities, and traditional values.


Assuntos
Nativos do Alasca , Obesidade Pediátrica , Idoso , Criança , Nível de Saúde , Humanos , Estilo de Vida , População Rural
11.
JNMA J Nepal Med Assoc ; 59(234): 146-151, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506457

RESUMO

INTRODUCTION: Elderly population is more likely to suffer from malnutrition due to aging-associated factors that influence nutritional status like loss of appetite, swallowing difficulties, digestive problems, and chronic illness. There is insufficient information related to the nutritional status of the elderly in Nepal. Hence, this study aims to determine the prevalence of malnutrition among elderly people living in the rural area of the Kavrepalanchok district. METHODS: A descriptive cross-sectional study was conducted among 320 elderly people aged ≥60 years in a rural area of Kavre district from August to October 2019. Ethical approval was taken from the Institutional Review Committee (IRC-KUSMS: 68/19). Convenient sampling was done. Data analysis was performed using the Statistical Program for Social Sciences version 23. RESULTS: The prevalence of malnutrition and risk of malnutrition was 37 (11.6%) and 159 (49.7%), respectively. Of 320 elderly persons, 193 (60.3%) males and 127 (39.7%) females, with a mean age of 68.23±7.38 years, participated in this study. The mean BMI was 22.54±3.25 kg/m2 (Mean±SD). The prevalence of malnutrition was higher among females 19 (15%) compared to males 18 (9.3%). CONCLUSIONS: The prevalence of malnutrition and risk of malnutrition is high in the study population. Interventions to improve the nutritional status of the elderly should focus primarily on older people, females, and those who have co-morbidities.


Assuntos
Desnutrição , Avaliação Nutricional , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Nepal/epidemiologia , Prevalência , População Rural
12.
Reprod Health ; 18(1): 182, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507589

RESUMO

BACKGROUND: Adolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings, which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections, unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contributes to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents' fertility. METHODS: Secondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n = 3666). RESULTS: Overall, 23.1% of adolescents had given birth at least once in the 5 years leading to the survey (n = 3666, 99.4% response), and 49.8% were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR 6-10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (aOR = 2.4, 95% CI: 1.5, 3.7, p < 0.001). Although odds of giving birth were much higher among rural-based married adolescents (aOR = 8.0, 95% CI: 5.4, 11.9, p < 0.001) compared to urban married adolescents (aOR = 5.5, 95% CI: 8.3, 16.0, p < 0.001), and these relationships both statistically significant, higher educational attainment (aOR = 0.7, 95% CI: 0.6, 0.8 p < 0.001) and abortion (aOR = 0.3, 95% CI: 0.1, 0.8, p = 0.020) reduced these odds, particularly for rural-based adolescents. CONCLUSION: Despite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address sexual and reproductive health needs of urban-based adolescents with a lower socioeconomic status.


Assuntos
Fertilidade , População Rural , Adolescente , Feminino , Inquéritos Epidemiológicos , Humanos , Casamento , Gravidez , Classe Social , Fatores Socioeconômicos , Zâmbia/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-34495264

RESUMO

Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being treated in worse clinical conditions. Thus, this study aimed to analyze the prevalence and the factors associated with new confirmed cases of CD identified by serological screening in an endemic region of Minas Gerais State, Brazil. This is an analytical cross-sectional study with data from a project of the Research Center in Tropical Medicine of Sao Paulo- Minas Gerais (SaMi-Trop) conducted in two municipalities. Data collection included a questionnaire with closed questions, a venous blood collection and an ELISA serological test for CD. A total of 2,038 individuals with no previous diagnosis of CD participated in the study. The result of the serological test for CD was adopted as the dependent variable. The independent variables addressed personal issues, health conditions and lifetime housing. A descriptive analysis of individual variables was performed. Subsequently, a bivariate analysis was performed using the Pearson's chi-square test. Households sheltering individuals positive for CD were georeferenced, and the analysis of spatial distribution was performed using the quartic function to estimate the density of the nucleus. Among the participants, 188 (9.2 %) were positive for CD. The profile of participants with CD was associated with place of residence, age, relative/family member with CD and living conditions. It is noteworthy that there are still patients with CD who are unaware of their diagnosis in both, rural and urban areas.


Assuntos
Doença de Chagas , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Estudos Transversais , Humanos , Prevalência , População Rural
14.
N Engl J Med ; 385(11): 982-995, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34496174

RESUMO

BACKGROUND: Universal provision of iron supplements (drops or syrup) or multiple micronutrient powders to young children in low-to-middle-income countries where anemia is prevalent is recommended by the World Health Organization and widely implemented. The functional benefits and safety of these interventions are unclear. METHODS: We conducted a three-group, double-blind, double-dummy, individually randomized, placebo-controlled trial to assess the immediate and medium-term benefits and risks of 3 months of daily supplementation with iron syrup or iron-containing multiple micronutrient powders, as compared with placebo, in 8-month-old children in rural Bangladesh. The primary outcome was cognitive development, as assessed by the cognitive composite score on the Bayley Scales of Infant and Toddler Development, third edition, immediately after completion of the assigned 3-month regimen; scores range from 55 to 145, with higher scores indicating better cognitive performance. Secondary outcomes included the cognitive composite score at 9 months after completion of the assigned regimen; behavioral, language, and motor development, as well as growth and hematologic markers, immediately after completion and at 9 months after completion; and safety. RESULTS: We randomly assigned 3300 infants to receive iron syrup (1101 infants), multiple micronutrient powders (1099), or placebo (1100) daily. After completion of the assigned 3-month regimen, no apparent effect on the cognitive composite score was observed with iron syrup as compared with placebo (mean between-group difference in change in score from baseline, -0.30 points; 95% confidence interval [CI], -1.08 to 0.48) or with multiple micronutrient powders as compared with placebo (mean between-group difference in change in score from baseline, 0.23 points; 95% CI, -0.55 to 1.00). No apparent effect on any other developmental or growth outcome was observed immediately after completion of the assigned regimen or at 9 months after completion. At 9 months after completion of the assigned regimen, the prevalences of anemia, iron deficiency, and iron deficiency anemia increased in all three trial groups but remained lower among the children who received iron syrup or multiple micronutrient powders than among those who received placebo. The risk of serious adverse events and incidence of symptoms of infection were similar in the three trial groups. CONCLUSIONS: In this trial involving infants in Bangladesh, 3 months of daily supplementation with iron syrup or multiple micronutrient powders did not appear to have an effect on child development or other functional outcomes as compared with placebo. (Funded by the National Health and Medical Research Council of Australia; BRISC Australian New Zealand Clinical Trials Registry number, ACTRN12617000660381.).


Assuntos
Anemia Ferropriva/tratamento farmacológico , Desenvolvimento Infantil/efeitos dos fármacos , Suplementos Nutricionais , Micronutrientes/uso terapêutico , Anemia Ferropriva/prevenção & controle , Bangladesh , Cognição/efeitos dos fármacos , Método Duplo-Cego , Feminino , Hemoglobinas/análise , Humanos , Lactente , Desenvolvimento da Linguagem , Masculino , População Rural
15.
J Med Microbiol ; 70(9)2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34486973

RESUMO

Introduction. Prototheca species are non-photosynthetic trebouxiophyte algae ubiquitously distributed in nature and can be found in sewage and soil. This microbial eukaryote causes human protothecosis in immunocompromised individuals. Thus, Prototheca presence in the stool of individuals without gastrointestinal symptoms has been reported only rarely.Hypothesis/Gap statement. There is an absence of detailed characterization of human Prototheca isolates.Aim. The aim of this study was to perform morphological and molecular characterization of Prototheca isolates obtained from human stool.Methodology. Prototheca was isolated from faecal samples of four individuals living in a rural area in Thailand. A combination of bioimaging along with molecular and bioinformatics tools was used to characterize the four strains. The growth rate was tested using four media and three temperature conditions. Phylogenetic analysis using the small subunit ribosomal RNA (SSU rRNA) and cytochrome b (cytb) was also performed.Results. Static and live microscopy demonstrated the various life stages of Prototheca and its major defining cellular characteristics. An optimized DNA extraction methodology that improves DNA yield is provided. Partial fragments of the SSU rRNA and cytb genes were obtained. Phylogenetic analysis placed all four strains in the clade with Prototheca bovis. More broadly, Prototheca was not monophyletic but split into at least two distinct clades instead.Conclusion. The results represent the first molecular characterization of Prototheca in Thailand. The study provides insight into transmission dynamics of the organism and potential caveats in estimating the global prevalence of Prototheca. These will spearhead further investigations on Prototheca occurrence in rural areas of both industrialized and developing nations.


Assuntos
Fezes/microbiologia , Microbioma Gastrointestinal , Prototheca , Voluntários Saudáveis , Humanos , Prototheca/classificação , Prototheca/crescimento & desenvolvimento , Prototheca/isolamento & purificação , População Rural , Tailândia
16.
Folia Med Cracov ; 61(2): 103-115, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34510168

RESUMO

I n t r o d u c t i o n: Mortality from myocardial infarction (MI) is determined by patients' ability to prevent it and, in case of its occurrence, to recognise its symptoms and call an ambulance immediately. There is scarce data on rural populations' knowledge of MI, even though they are disadvantaged in access to medical emergency services. Objective: The aim of the study was to investigate the rural patients' awareness of MI risk factors, symptoms, necessity of calling an ambulance in response to MI symptoms, and its determinants. Materials and Methods: An anonymous and voluntary survey was conducted among 194 patients and their caregivers with median age 68 years at a rural non-public healthcare facility in Poland. R e s u l t s: 60.3% perceive their knowledge of MI as insufficient. Only 26.3% were able to recognise all suggested MI risk factors. 44.8% did not know whether they are at risk of MI. Furthermore, 78% of respondents who had at least three MI risk factors were unaware of being at risk. 45.4% recognised at least three out of four suggested MI symptoms. 76.2% would call an ambulance in response to chest pain suggesting they have MI. Merely 80% were able to provide the emergency phone number. Moreover, among respondents who declared they would not call an ambulance, 38.7% were afraid of in-hospital COVID-19 infection or healthcare system collapse. C o n c l u s i o n s: Rural patients' knowledge of MI risk factors, symptoms, and proper response to them is insufficient. The problem is exacerbated by the COVID-19 pandemic. To improve survival in MI an education campaign is needed.


Assuntos
Serviços Médicos de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Comportamento de Busca de Ajuda , Infarto do Miocárdio/fisiopatologia , População Rural , Idoso , COVID-19 , Dor no Peito , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Polônia , Fatores de Risco , SARS-CoV-2
17.
Med Sci Monit ; 27: e928512, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511593

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) has emerged as a global threat. This study was performed to gain an understanding of COVID-19-related knowledge, attitudes, and practices among susceptible individuals. MATERIAL AND METHODS Patients who had been diagnosed with old myocardial infarction were followed up via telephone survey based on an established follow-up system at the beginning of the COVID-19 outbreak (January 2020) in Chongqing, Southwest China. RESULTS A total of 631 eligible patients participated in this survey, and 40.6% of the rural respondents did not know the transmission routes of SARS-CoV-2, which was higher than the proportion of urban respondents (40.6% vs 31.0). Rural residents had a lower rate of adopting preventive measures than urban residents, such as wearing masks (76.7% vs 90.1%), avoiding meetings and gatherings (58.6% vs 68.5%), and hand washing (56.0% vs 63.8%). A higher percentage of women than men did not take any preventive measures (11.3% vs 7.6%), while a lower percentage of women than men wore masks (77.7% vs 84.5%). Multiple logistic regression revealed that rural patients were more likely to lack knowledge about transmission (odds ratio (OR): 1.51). Rural patients had an increased risk of failing to implement protective measures. CONCLUSIONS Female and rural populations lacked knowledge and failed to adopt protective measures during the beginning of the COVID-19 epidemic. Therefore, these populations may benefit from health education campaigns and policies.


Assuntos
COVID-19 , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Idoso , China , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , População Rural/estatística & dados numéricos , SARS-CoV-2
18.
Rural Remote Health ; 21(3): 5865, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34469693

RESUMO

INTRODUCTION: In various countries, a shortage of general practitioners (GPs) and worrying health statistics on risk factors, morbidity and mortality have been observed in rural areas. However, few comparative data are available on GP activities according to their location. The aim of this study was to analyse French GP activities according to their rural or urban practice location. METHODS: This study was ancillary to the Eléments de la COnsultation en médecine GENérale (ECOGEN) study, which was a cross-sectional, multicentre, national study conducted in 128 French general practices in 2012. Data were collected by 54 interns in training during a period of 20 working days from December 2011 to April 2012. GP practice location was classified as rural area, urban cluster or urban area. The International Classification of Primary Care (ICPC-2) was used to classify reasons for encounter, health problem assessments, and processes of care. Univariate analyses were performed for all dependent variables, then multivariable analyses for key variables, using hierarchical mixed-effect models. RESULTS: The database included 20 613 consultations. The mean yearly number of consultations per GP was higher in rural areas (p<0.0001), with a shorter consultation length (p<0.0001). No difference was found for GP sex (p=0.41), age (p=0.87), type of fees agreement (p=0.43), and type of practice (p=0.19) according to their practice location. Urban patients were younger, and there was a lower percentage of patients over 75 years (p<0.001). GPs more frequently consulted at patients' homes in rural areas (p<0.0001). The mean number of chronic conditions managed was higher in rural areas and urban clusters than in urban areas (p<0001). Hypertension (p<0.0001), type 2 diabetes (p=0.003), and acute bronchitis/bronchiolitis (p=0.01) were more frequently managed in rural areas than in urban clusters and areas. Health maintenance/prevention (p<0.0001) and no disease situations (p<0.0001) were less frequent in rural areas. Drug prescription was more frequent in rural areas than in urban clusters and areas (p<0.0001). Multivariable analysis confirmed the influence of a GP's rural practice location on the consultation length (p<0.0001), the number of chronic conditions per consultation (p<0.0001) and the number of health maintenance/prevention situations (p<0.0001), and a trend towards a higher yearly number of consultations per GP (p=0.09). CONCLUSION: French rural GPs tend to have a higher workload than urban GPs. Rural patients have more chronic conditions to be managed but are offered fewer preventive services during consultations. It is necessary to increase the GP workforce and develop cooperation with allied health professionals in rural areas.


Assuntos
Medicina Geral/estatística & dados numéricos , Clínicos Gerais/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Idoso , Doença Crônica , Estudos Transversais , Diabetes Mellitus Tipo 2 , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Prevenção Primária/organização & administração , População Rural , Fatores de Tempo , População Urbana
19.
Glob Health Action ; 14(1): 1968598, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34482795

RESUMO

BACKGROUND: Levels of obesity are rising in South Africa, notably among adolescent females. Excessive energy-dense diets and physical inactivity are among the factors contributing to this increase. Given that these factors are largely behavioural, understanding young people's views of obesity can contribute to more targeted behavioural interventions. Yet little is known of how rural South African adolescents view obesity. OBJECTIVES: The aim of this study was to explore rural South African adolescents' views of obesity, including their understanding of its causes, consequences, and solutions. METHODS: This qualitative study took place within the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) study area, in rural northeast South Africa. Three focus group discussions were held with male (n = 16) and female adolescents (n = 15), aged 14-19 years in 2018. Data were analysed using thematic analysis and the Social Cognitive Theory used to frame the findings. RESULTS: Participants presented conflicting views of obesity, with both positive and negative opinions expressed. Causes of obesity were seen to be multifactorial, including genetics, diet, lack of physical activity, and HIV treatment. Adolescents proposed medication and hospitalisation as ways to address obesity. When discussing interventions to address obesity, adolescents expressed the need for more information, suggesting that providing information to both themselves and their family members as part of interventions would be important. CONCLUSIONS: Rural South African adolescents have a complex perspective of obesity, likely driven in part by the current nutrition transition underway and do not inherently see individual behaviour as a driver or mitigator of obesity. Complex interventions including the involvement of other household members are needed to change adolescents' views on the role of the individual, and ultimately, change both individual and household behaviour to prevent obesity.


Assuntos
Obesidade , População Rural , Adolescente , Exercício Físico , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Pesquisa Qualitativa , África do Sul
20.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 33(4): 406-410, 2021 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-34505449

RESUMO

OBJECTIVE: To investigate the prevalence and influencing factors of Enterobius vermicularis infections among children in Fanxian County, Henan Province in 2019, so as to provide insights into the management of enterobiasis. METHODS: Five kindergartens were selected in urban and rural areas of Fanxian County, Henan Province using the stratified sampling method in 2019, and a census of E. vermicularis infections was performed among all children in the kindergartens. E. vermicularis eggs were detected using adhesive and scotch cellophane-tape anal swab methods, and the basic characteristics of children and their families, health habits and the kindergartens' information were investigated with questionnaires. Logistic regression analysis was used to investigate the risk factors and protective factors of pinworm infection in children. RESULTS: A total of 671 children were tested, and the mean prevalence of E. vermicularis infections was 15.50% (104/671). The prevalence of E. vermicularis infections was higher among children in rural kindergartens (28.13%, 72/256) than in urban kindergartens (7.71%, 32/415) (χ2 = 50.380, P < 0.01), and greater in private kindergartens (32.26%, 60/186) than in public kindergartens (9.07%, 44/485) (χ2 = 55.183, P < 0.01). There was no gender-specific prevalence of E. vermicularis infections among children (χ2 = 1.442, P > 0.05), and the prevalence of E. vermicularis infections presented a tendency towards a rise with age (χ2trend = 8.373, P < 0.05) and school grade (χ2trend = 30.274, P < 0.05). Logistic regression analysis identified rural kindergartens and high grades as risk factors, and separate washing of children's and adults' cloths, frequent bathing and frequent dinnerware disinfection in kindergartens as protective factors for E. vermicularis infections among children. In addition, there was no significant difference in the detection of E. vermicularis infections among children by using adhesive (73.08%, 76/104) and scotch cellophane-tape anal swab methods (56.73%, 59/104) (χ2 = 3.959, P > 0.05). CONCLUSIONS: The prevalence of E. vermicularis infection is high among children in Fanxian Country, Henan Province. Health education and surveillance of enterobiasis are required to be intensified among children in rural kindergartens and senior grades and their parents and teachers.


Assuntos
Enterobíase , Animais , Criança , Enterobíase/epidemiologia , Enterobius , Humanos , Prevalência , Fatores de Risco , População Rural
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