Scaling up of Eco-Bio-Social Strategy to Control Aedes aegypti in Highly Vulnerable Areas in Fortaleza, Brazil: A Cluster, Non-Randomized Controlled Trial Protocol.

Aedes aegypti is a cosmopolitan vector for arboviruses dengue, Zika and chikungunya, disseminated in all Brazilian states. The Eco-Bio-Social (EBS) strategy is vital in Aedes aegypti control as it mobilizes stakeholders (government, professionals, society, and academics) to promote healthy environments. This paper describes the rationale and methods of expanding the EBS strategy for Aedes aegypti control in Fortaleza, Northeast Brazil. A cluster, non-randomized controlled clinical trial was developed to analyze the strategy's effectiveness in vulnerable territories (high incidence of dengue and violent deaths; low HDI; substandard urban infrastructure, high population density, and water scarcity). We selected two intervention and two control groups, resulting in a sample of approximately 16,000 properties. The intervention consisted of environmental management by sealing large elevated water tanks, introduction of beta fish in waterholes, elimination of potential breeding sites, and mobilization and training of schoolchildren, endemic disease workers, health workers, social mobilizers, and community leaders; community surveillance of arboviruses; construction and validation of a booklet for the prevention of arboviruses in pregnant women. We analyzed the costs of arboviruses to government and households, the intervention cost-effectiveness, chikungunya's chronicity, and acceptance, sustainability, and governance of vector control actions. The primary outcome (infestation) was analyzed using the house, container, and Breteau indices. We hope that this study will help us understand how to scale up strategies to fight Aedes aegypti in vulnerable areas.

Survival of Betta splendens fish (Regan, 1910) in domestic water containers and its effectiveness in controlling Aedes aegypti larvae (Linnaeus, 1762) in Northeast Brazil.

OBJECTIVE: In Northeast Brazil, large domestic containers used to store water are important breeding sites of Aedes aegypti, the main vector of dengue fever. The objective of this study was to estimate the survival of Betta splendens (Perciformes: Osphronemidae) fish in domestic containers in Fortaleza (Ceará State), as well as its effectiveness in the control of premature A. aegypti stages. METHODS: The use of B. splendens was compared to Bacillus thuringiensis israelensis (Bti) in domestic containers. In a first home visit, B. splendens or Bti were applied to water containers. Two follow-up visits were conducted after 3-4 and 5-6 months to assess the presence of viable fish in the containers and infestation by larvae. Betta splendens fish were still present in 97.6% of containers 45-60 days after application. When the fish was present, the infestation rate was significantly higher (P < 0.001) in the Bti group (IR ratio= 21.60; 95% CI: 6.46-72.28). In deposits where the fish remained, efficacy was 85% better than Bti. The permanence of fish was higher in concrete tanks (48.5%) located outside the house (47.5%) and at ground level (53.3%). We conclude that B. splendens may be suitable for biological control of A. aegypti larvae in large domestic water containers, but that appropriate measures should be taken to assure prolonged survival and the presence of fish in the containers.

Impact of depressive symptoms on visceral sensitivity among patients with different subtypes of irritable bowel syndrome.

The etiology of irritable bowel syndrome (IBS) is complex and multifaceted. Psychosocial factors play a role in such a process. Several reports suggest that IBS patients have increased psychopathology scores as compared with population controls. The influence of depressive symptoms on rectal sensitivity thresholds vary across different studies. The influence of predominant bowel habits on rectal sensitivity thresholds as determined by barostat-based investigations is not well established. The present report aimed to investigate the influence of depressive symptoms on rectal sensitivity in different subtypes of IBS patients (diarrhea/constipation-predominant vs. alternating subtypes). Depressive symptoms correlated well with first pain sensitivity threshold in alternating patients (n = 8; [rho] = -0.77; p = 0.02) but not in diarrhea/constipation predominant symptoms (n = 11; [rho] = -0.44; p = 0.27). These data suggest that depressive symptoms might impact pain thresholds differently according to the subtype of IBS.

[Aedes aegypti resistance to temefos in counties of Ceará State]. / Resistência do Aedes aegypti ao temefós em Municípios do Estado do Ceará.

The susceptibility of Aedes aegypti to temefos was evaluated by means of samples of eggs and larvae from four large counties in the state of Ceará (Fortaleza, Barbalha, Juazeiro do Norte and Crato). The technique standardized by the World Health Organization for tests with larvicides was used. The CL50 of eight samples from populations of Aedes was determined, as were their respective resistance ratios, compared to the CL50 of the susceptible Rockefeller strain. All populations submitted to the experiment showed resistance to temefos, with resistance ratios varying between 8 and 16. Analysis of these results reinforces prior evidence regarding the dissemination of temefos resistance in different locations in the state, subjected to considerable pressure for control in recent decades. The larvicide may lose its effectiveness if an urgent attempt is not made to reestablish the susceptibility of Aedes aegypti in these areas, profoundly affecting control campaigns currently under way.

ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH NUTRITIONAL STATUS AND FOOD INTAKE.

INTRODUCTION: the H. pylori infection affects more than half of humanity, being a public health problem. Its prevalence is significantly higher in developing countries like Brazil. It has been suggested that H. pylori infection may influence the intake and caloric homeostasis. PURPOSE: to compare nutritional status and food intake of patients attended by National Health System, with and without H. pylori infection. METHODS: 140 patients were assessed. They performed upper gastrointestinal endoscopy to investigate the presence of H. pylori. Body weight and height of the patients were measured. Food intake was investigated through two 24-hour recalls, with data transformed in grams and analyzed in DietWin Professional 2.0 software. The findings were compared using the chi-square test or Student's t-test, adopting p < 0.05 as significance level. RESULTS: there was predominance of patients with excess weight for both Hp - (60.3%) and Hp + (67.7%), with no difference between them. Food intake of assessed groups was similar. CONCLUSION: no differences were found in nutritional status and food intake between the two studied groups.

Introducción: la infección por H. pylori afecta a más de la mitad de la humanidad, siendo un problema de salud pública. Su prevalencia es significativamente mayor en los países en desarrollo, como Brasil. Se ha sugerido que la infección por H. pylori puede influir en la ingesta y la homeostasis calórica. Propósito: comparar el estado nutricional y la ingesta de alimentos de los pacientes incluidos en el Sistema Nacional de Salud, con y sin infección por H. pylori. Métodos: se evaluarón 140 pacientes. Realizaron la endoscopia digestiva alta para investigar la presencia de H. pylori. Se midieron el peso corporal y la altura de los pacientes. La ingesta de alimentos se investigó a través de dos recordatorios de 24 horas, con los dados transformados en gramos y analizados en el software DietWin Professional 2.0. Los resultados se compararon mediante la prueba de chi-cuadrado o la prueba t de Student. Se adoptó de p < 0,05 como nivel de significación. Resultados: hubo predominio de pacientes con exceso de peso tanto para Hp - (60,3%) como Hp + (67,7%), sin diferencias entre ellos. La ingesta de alimentos de los grupos evaluados fue similar. Conclusiones: no hubo diferencias en el estado nutricional y la ingesta de alimentos entre los dos grupos.