ObjectiveLockdown has impacts on people’s living conditions and mental health. The study aims to assess the relations between social impact and mental health among adults living in Spain during COVID-19 lockdown measures, taking a gender-based approach into account.Design, setting and participantsWe conducted a cross-sectional study among adults living in Spain during the lockdown of COVID-19 with an online survey from 8 April to 28 May 2020. The main variable was mental health measured by Generalized Anxiety Disorder Scale for anxiety and the Patient Health Questionnaire for depression. Sex-stratified multivariate ordinal logistic regression models were constructed to assess the association between social impact variables, anxiety and depression.ResultsA total of 7053 people completed this survey. A total of 31.2% of women and 17.7% of men reported anxiety. Depression levels were reported in 28.5% of women and 16.7% of men. A higher proportion of anxiety and depression levels was found in the younger population (18–35 years), especially in women. Poorer mental health was mainly related to fear of COVID-19 infection, with higher anxiety levels especially in women (adjusted ordinal OR (aOR): 4.23, 95% CI 3.68 to 4.87) and worsened economy with higher levels of depression in women (aOR: 1.51, 95% CI 1.24 to 1.84), and perceived inadequate housing to cope with lockdown was especially associated with anxiety in men (aOR: 2.53, 95% CI 1.93 to 3.44).ConclusionThe social impact of the lockdown is related to gender, age and socioeconomic conditions. Women and young people had worse mental health outcomes during lockdown. It is urgent to establish strategies for public health emergencies that include mental health and its determinants, taking a gender-based approach into account, in order to reduce health inequities.

SUMMARYThe objective of this survey was to assess the relationships between intestinal parasitism, nutritional status and hemoglobin level in children with Indian ascendancy living in an urban area in Brazilian Amazon. We carried out a cross-sectional survey obtaining anthropometric, parasitological and socioeconomic data, and hemoglobin measurements of children aged six to 84 months. Anthropometric data were expressed as z-scores for weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and mid upper circumference for age (MUACZ) parameters. Parasitological examinations were performed through Ritchie (n = 307), Kato-Katz (n = 278), Baermann-Moraes (n = 238) and Safranin-methylene blue methods (n = 307). Hemoglobin measurements were obtained with a Hemocue ® photometer (n = 282). Socioeconomic data were used in order to classify children in three family income strata (n = 242). Multiple linear regression analysis showed independent interactions between Giardia lamblia and WAZ (beta = -0.195, SE = 0.138, p = 0.003), WHZ (beta = -0.161, SE = 0.133, p = 0.018) and MUACZ (beta = -0.197, SE = 0.143, p = 0.011), controlling for age, sex, family income, Ascaris lumbricoides, and hookworm infection. Also, the multivariate model showed that the only variable associated with hemoglobin levels was age. Intestinal parasitism control should increase children's possibilities of full development in the studied area.

Abstractobjective To investigate risk factors associated with the acquisition of antibodies against Plasmodium vivax Duffy binding protein (PvDBP) -a leading malaria vaccine candidate -in a well-consolidated agricultural settlement of the Brazilian Amazon Region and to determine the sequence diversity of the PvDBP ligand domain (DBP II ) within the local malaria parasite population.methods Demographic, epidemiological and clinical data were collected from 541 volunteers using a structured questionnaire. Malaria parasites were detected by conventional microscopy and PCR, and blood collection was used for antibody assays and molecular characterisation of DBP II .results The frequency of malaria infection was 7% (6% for P. vivax and 1% for P. falciparum), with malaria cases clustered near mosquito breeding sites. Nearly 50% of settlers had anti-PvDBP IgG antibodies, as detected by enzyme-linked immunosorbent assay (ELISA) with subject's age being the only strong predictor of seropositivity to PvDBP. Unexpectedly, low levels of DBP II diversity were found within the local malaria parasites, suggesting the existence of low gene flow between P. vivax populations, probably due to the relative isolation of the studied settlement.conclusion The recognition of PvDBP by a significant proportion of the community, associated with low levels of DBP II diversity among local P. vivax, reinforces the variety of malaria transmission patterns in communities from frontier settlements. Such studies should provide baseline information for antimalarial vaccines now in development.

A parasitological survey was carried out among Terena Indians living in the Tereré

Performance evaluation of diagnostic tests is critical in the search for accurate diagnoses. A gold standard test is usually absent in parasitology, thus rendering satisfactory assessment of diagnostic accuracy difficult. Moreover, reliability (assessed by the study of repeatability) is a rarely studied characteristic of diagnostic tests. This study compared and evaluated the performance (repeatability, concordance and accuracy) of the spontaneous sedimentation technique (SST) and the Paratest for the diagnosis of Giardia lamblia, Entamoeba histolytica complex, Blastocystis spp., Ascaris lumbricoides, hookworm, Trichuris trichiura and Calodium hepaticum. Fecal samples of 143 individuals were separated into three replicates for each test. Concordance and homogeneity of the results between replicates of each test and between tests were evaluated. Proportions of positives, sensitivity and specificity were estimated using a Bayesian Latent Class Model. High repeatability of both tests was found for the detection of intestinal parasites, except for Blastocystis spp. and hookworm. Concordance between tests was generally high (concordance correlation coefficient, 0.72-0.88), except for Blastocystis spp., hookworm and T. trichiura. The Paratest detected more cases of Blastocystis spp. and fewer of hookworm than the SST. The tests were quite discordant in the detection of T. trichiura. A low sensitivity (39.4-49.2% for SST, 35.8-53.8% for Paratest) and a high specificity (93.2-97.2%) were found for both tests. The Paratest presented a slightly higher sensitivity for the diagnosis of Blastocystis spp. (53.8%), and SST did so for hookworm (49.2%). This is the first study on repeatability and accuracy (using a Bayesian approach) of two spontaneous sedimentation techniques. These results suggest underdiagnosis of little dense parasitic forms due to technical limitations in both tests. We conclude that the combined study of repeatability, concordance and accuracy is a key strategy for better evaluation of the performance of tests and is also useful for the identification of technical limitations.

Background: There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including HIV, hepatitis B and C, active tuberculosis, Chagas disease, strongyloidiasis, and schistosomiasis, based on patient characteristics (including variables of country of origin, age, sex). Methods: A pragmatic pilot cluster-randomised controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on ISRCTN (ISRCTN14795012). Results: 15780 migrants registered across the 8 centres had at least one visit during the intervention period (March to December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group (OR:2.08 95%CI 1.63–2.64, p < 0.001). The intervention centres raised their overall monthly diagnosis rate to 5.80 (95%CI 1.23–10.38, p = 0.013) extra diagnoses compared to the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases (2.72,[95%CI 0.43–5.00]; p = 0.02) and was observed as well for the parasitic infections´ group (Chagas disease, strongyloidiasis, and schistosomiasis) 2.58 (95%CI 1.60–3.57; p < 0.001). Conclusions: The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.

Introduction:Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS).Methods and analysis:A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l’Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. Analysis: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out.Ethics and dissemination:This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals.Trial registration:Clinical-Trials.gov: NCT04049006.

Background: Calodium hepaticum (syn. Capillaria hepatica) is a worldwide helminth parasite of which several aspects of transmission still remain unclear. In the Amazon region, the mechanism of transmission based on the ingestion of eggs present in the liver of wild mammals has been suggested as the cause of the spurious infections described. We performed an epidemiological investigation to determine the incidence, risk of spurious infection and the dynamics of transmission of C. hepaticum in a community of the Brazilian Amazon. Methodology/Principal Findings: Stool samples of 135 individuals, two dog feces and liver tissue from a peccary (captured and eaten by the residents) were analyzed by conventional microscopy. Dog feces were collected from the gardens of households presenting human cases of spurious C. hepaticum infections. Community practices and feeding habits related to the transmission of the parasite were investigated. The individual incidence of spurious infection was 6.7% (95% CI: 2.08–11.24). Cases of spurious infection were observed in 7.5% of the families and the household incidence was from 50% to 83.3%. The risk of spurious infection was 10-fold greater in persons consuming the liver of wild mammals (p = 0.02). The liver tissue of a peccary and one feces sample of a dog presented eggs of C. hepaticum. The consumption of the infected liver was the cause of the spurious infections reported in one household. Conclusions/Significance: This is the first identification of a source of spurious infection by C. hepaticum in humans and we describe a high rate of incidence in household clusters related to game liver alimentary habits. The finding of a dog feces contaminating peridomiciliary ground suggests the risk of new infections. We conclude that the mechanism of transmission based on the ingestion of liver is important for the dynamics of transmission of C. hepaticum in the studied area.