Doctor-patient

No abstract

BackgroundThis study intended to implement a novel intervention strategy, in Brazil, using an ecohealth approach and analyse its effectiveness and costs in reducing Aedes aegypti vector density as well as its acceptance, feasibility and sustainability. The intervention was conducted from 2012 to 2013 in the municipality of Fortaleza, northeast Brazil.MethodologyA cluster randomized controlled trial was designed by comparing ten intervention clusters with ten control clusters where routine vector control activities were conducted. The intervention included: community workshops; community involvement in clean-up campaigns; covering the elevated containers and in-house rubbish disposal without larviciding; mobilization of schoolchildren and senior inhabitants; and distribution of information, education and communication (IEC) materials in the community.ResultsDifferences in terms of social participation, commitment and leadership were present in the clusters. The results showed the effectiveness of the intervention package in comparison with the routine control programme. Differences regarding the costs of the intervention were reasonable and could be adopted by public health services.ConclusionsEmbedding social participation and environmental management for improved dengue vector control was feasible and significantly reduced vector densities. Such a participatory ecohealth approach offers a promising alternative to routine vector control measures.

Empowerment is a process whereby people achieve mastery over their lives, acquiring knowledge to make decisions about their health. Chronic diseases are increasingly common in the health service, requiring the attention of health professionals and empowering those affected by them. The scope of this study was to analyze the perceptions of users with chronic diseases and monitored by the Family Health Program with respect to empowerment. This was a qualitative study in which open interviews and systematic observations were conducted and NVIVO software was used for data analysis. Users indicate the existence of some geographical barriers in access to health, which caused fatigue, discouragement and low continuity of care. It was noted that adherence and practices of care were linked to differentiated service, based on trust and respect for the wishes of users. This includes healthcare guidance and education as key elements to encourage the practice of self-care. It is necessary to restructure the conduct of health professionals involved in the Family Health Strategy because its function is to promote health in a logical intersectoral and interdisciplinary manner.

BackgroundDengue is an increasingly important public health problem in most Latin American countries and more cost-effective ways of reducing dengue vector densities to prevent transmission are in demand by vector control programs. This multi-centre study attempted to identify key factors associated with vector breeding and development as a basis for improving targeted intervention strategies.MethodsIn each of 5 participant cities in Mexico, Colombia, Ecuador, Brazil and Uruguay, 20 clusters were randomly selected by grid sampling to incorporate 100 contiguous households, non-residential private buildings (businesses) and public spaces. Standardized household surveys, cluster background surveys and entomological surveys specifically targeted to obtain pupal indices for Aedes aegypti, were conducted in the dry and wet seasons.ResultsThe study clusters included mainly urban low-middle class populations with satisfactory infrastructure and –except for Uruguay- favourable climatic conditions for dengue vector development. Household knowledge about dengue and “dengue mosquitoes” was widespread, mainly through mass media, but there was less awareness around interventions to reduce vector densities. Vector production (measured through pupal indices) was favoured when water containers were outdoor, uncovered, unused (even in Colombia and Ecuador where the large tanks used for household water storage and washing were predominantly productive) and –particularly during the dry season- rainwater filled. Larval infestation did not reflect productive container types. All productive container types, including those important in the dry season, were identified by pupal surveys executed during the rainy season.ConclusionsA number of findings are relevant for improving vector control: 1) there is a need for complementing larval surveys with occasional pupal surveys (to be conducted during the wet season) for identifying and subsequently targeting productive container types; 2) the need to raise public awareness about useful and effective interventions in productive container types specific to their area; and 3) the motivation for control services that-according to this and similar studies in Asia- dedicated, targeted vector management can make a difference in terms of reducing vector abundance.

O termo "má notícia" designa qualquer informação transmitida ao paciente ou a seus familiares que implique, direta ou indiretamente, alguma alteração negativa na vida destes. Por ser uma tarefa tão estressante, muitos médicos a evitam ou a realizam de maneira inadequada. Esse fato traz inúmeras consequências negativas para o paciente e seus familiares. Embora seja objeto de estudo em diversos cursos de Medicina em nível internacional, o tema ainda é pouco abordado por professores e estudantes no contexto brasileiro. O protocolo Spikes descreve de maneira didática seis passos para comunicar más notícias. Esses passos foram utilizados em aula para alunos do terceiro semestre do curso de Medicina da Universidade Estadual do Ceará. Em seguida, os alunos avaliaram o método por meio de perguntas abertas. De maneira geral, foi considerado um modelo válido, apesar de serem consideradas possíveis limitações, como a necessidade de ser individualizado e adaptado a cada situação.

Despite increased vector control efforts, dengue fever remains endemic in Fortaleza, Northeast Brazil, where sporadic epidemic outbreaks have occurred since 1986. Multiple factors affect vector ecology such as social policy, migration, urbanization, city water supply, garbage disposal and housing conditions, as well as community level understanding of the disease and related practices. This descriptive study used a multi-disciplinary approach that bridged anthropology and entomology. A multiple case study design was adopted to include research in six study areas, defined as blocks. The water supply is irregular in households from both under-privileged and privileged areas, however, clear differences exist. In the more privileged blocks, several homes are not connected to the public water system, but have a well and pump system and therefore irregularity of supply does not affect them. In households from under-privileged blocks, where the water supply is irregular, the frequent use of water containers such as water tanks, cisterns, barrels and pots, creates environmental conditions with a greater number of breeding areas. In under-privileged homes, there are more possible breeding areas and environmental conditions that may improve the chances of Aedes aegypti survival.

Background: The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year. Although most dengue infections are asymptomatic, patients can present with a wide spectrum of clinical symptoms ranging from mild febrile illness through to severe manifestations of bleeding, organ impairment, and hypovolaemic shock due to a systemic vascular leak syndrome. Clinical diagnosis of dengue and identification of which patients are likely to develop severe disease remain challenging. This study aims to improve diagnosis and clinical management through approaches designed a) to differentiate between dengue and other common febrile illness within 72 h of fever onset, and b) among patients with dengue to identify markers that are predictive of the likelihood of evolving to a more severe disease course.