Paradox between adequate sanitation and rainfall in dengue fever cases.

BACKGROUND: Dengue fever is a tropical disease and a major public health concern, and almost half of the world's population lives in areas at risk of contracting this disease. Climate change is identified by WHO and other international health authorities as one of the primary factors that contribute to the rapid spread of dengue fever. METHODS: We evaluated the effect of sanitation on the cross-correlation between rainfall and the first symptoms of dengue in the city of Mato Grosso do Sul, which is in a state in the Midwest region of Brazil, and employed the time-lagged detrended cross-correlation analysis (DCCAC) method. RESULTS: Co-movements were obtained through the time-phased DCCAC to analyze the effects of climatic variables on arboviruses. The use of a time-lag analysis was more robust than DCCAC without lag to present the behavior of dengue cases in relation to accumulated precipitation. Our results show that the cross-correlation between rain and dengue increased as the city implemented actions to improve basic sanitation in the city. CONCLUSION: With climate change and the increase in the global average temperature, mosquitoes are advancing beyond the tropics, and our results show that cities with improved sanitation have a high correlation between dengue and annual precipitation. Public prevention and control policies can be targeted according to the period of time and the degree of correlation calculated to structure vector control and prevention work in places where sanitation conditions are adequate.

Prompting a Fresh Start for Adults With Food Insecurity and Increased BMI: A Case Series of Four Patients in a Food Prescription Program.

Estimates place low intake of fruits and vegetables, physical inactivity, and high BMI (overweight-obesity) as all in the top 12 causes of death. Food and dietary education are becoming a focus in how we approach disease prevention and management, and food prescription programs in particular are showing promise, especially in under-resourced, food-insecure communities. This paper describes a pilot food prescription program in a handful of uninsured patients enrolled in an interprofessional clinical and educational program of a medical school in South Florida. This case series of four patients struggling with food insecurity profiles the demographic and clinical characteristics of the participants and provides the results of standardized assessments of their dietary behaviors, physical activity levels, and attitudes toward food before and after the intervention. This four-month pilot food prescription program, Fresh Start Food Rx, involved a prospective case report of four patients seen on a mobile health center (MHC) for uninsured patients in South Miami, Florida. The MHC is part of an interprofessional health professions education, health care, and social service program of the Herbert Wertheim College of Medicine at Florida International University called the Neighborhood Health Education Learning Program (NeighborhoodHELP). A systematic review of South Miami MHC patient electronic medical records identified eligible participants for the program: patients with food insecurity and a BMI >30, with comorbid health conditions. Patients with greater BMI and more comorbidities were prioritized. Once enrolled, we provided biweekly packages of fresh fruits and vegetables along with monthly dietary education to the participants. Key measures included self-reported fruit and vegetable consumption, attitude toward healthy eating, and level of activity. Pre- and post-intervention focus groups assessed barriers the participants faced to eating healthy and pursuing physical activity, satisfaction with the program, feedback on strengths and weaknesses, and anticipated behavioral changes after completion of the program. Prior to the intervention, participants reported eating fruits on an average of 4.5 days out of the week. Post-survey answers increased to 5.0 days per week. Though the average amount of days per week that participants reported eating vegetables decreased slightly, the average number of vegetable servings that participants reported eating in a week increased. At termination of the program, most participants agreed that a diet rich in fruits and vegetables is good for you, that it is important to eat fruits and vegetables every day, and that a diet rich in fruits and vegetables can protect against cancer. This case study demonstrates that easier access to healthy foods, such as fresh produce delivery, and regular health education have the potential to promote healthier attitudes toward foods like fruits and vegetables. This change in attitude can then influence behavior, such as choosing to try new produce or increasing the amount and frequency of produce consumption. With the lessons learned from this small pilot program, the authors helped facilitate the expansion of a larger food prescription program in conjunction with a community partner hospital in the area. Findings from this experience might prove useful for others attempting to develop or expand a food prescription and health education program of their own.