Epidemiologic aspects of the relationship between infection with Leishmania chagasi and development of clinical visceral leishmaniasis (VL) were studied in all children < 11 years old in a defined, endemic, rural area of the state of Ceará in northeast Brazil. Antileishmanial antibodies were measured in the same subjects by ELISA on six occasions between May 1987 and August 1989. Seroconversion was documented during this period in 108 children, with a cumulative annual incidence of 4.6%. Twelve (11.1%) of these children developed VL. Age < 4 years, hematocrit < 33%, and living in the mountains predicted the development of clinically apparent VL after seroconversion. Despite a high percentage of dogs serologically positive in the region (38%), there was no increased risk of infection for children living in the same household with dogs. Since children in households with a prior case of VL had a threefold increased risk of infection, human-sandfly-human transmission might have been important.

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.

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.

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Objective: Failure of noninvasive ventilation (NIV) has been associated with short-term adverse effects related to the use of masks. The aim of this study was to compare the incidence, type and intensity of adverse effects, as well as the comfort, of total face masks (TFMs), facial masks (FMs) and nasal masks (NMs) during NIV. Methods: This was a randomized crossover trial involving 24 healthy volunteers submitted to six sessions of NIV in bilevel positive airway pressure mode using the TFM, FM and NM masks at low and moderate-to-high pressure levels. A written questionnaire was applied in order to evaluate eleven specific adverse effects related to the use of the masks. Comfort was assessed using a visual analog scale. The CO 2 exhaled into the ventilator circuit was measured between the mask and the exhalation port. Results: The performance of the TFM was similar to that of the NM and FM in terms of comfort scores. Higher pressure levels reduced comfort and increased adverse effects, regardless of the mask type. When the TFM was used, there were fewer air leaks and less pain at the nose bridge, although there was greater oronasal dryness and claustrophobia. Air leaks were most pronounced when the FM was used. The partial pressure of exhaled CO 2 entering the ventilator circuit was zero for the TFM. Conclusions: The shortterm adverse effects caused by NIV interfaces are related to mask type and pressure settings. The TFM is a reliable alternative to the NM and FM. Rebreathing of CO 2 from the circuit is less likely to occur when a TFM is used.Keywords: Intermittent positive-pressure ventilation; Masks/adverse effects; Respiratory insufficiency; Equipment failure analysis. ResumoObjetivo: Falhas da ventilação não-invasiva (VNI) têm sido relacionadas a efeitos adversos agudos do uso de máscaras. O objetivo deste estudo foi comparar a incidência, tipo e intensidade de eventos adversos e conforto das máscaras facial total (MFT), facial (MF) e nasal (MN). Métodos: Estudo randomizado, tipo cruzado, em 24 voluntá-rios sadios submetidos a seis períodos de VNI, modo bilevel positive airway pressure em ajustes de baixa e moderada a alta pressão. Foi aplicado um questionário de avaliação de onze eventos adversos especificamente relacionados ao uso das máscaras. O conforto foi avaliado por escala visual analógica. O CO 2 exalado no circuito foi medido entre a conexão da máscara e o orifício de exalação. Resultados: A MFT teve desempenho similar a MF e MN quanto a escores de conforto. A aplicação de pressões mais altas reduziu o conforto e aumentou a incidência e a intensidade dos eventos adversos, independentemente do tipo de máscara. A MFT teve melhor desempenho quanto a vazamentos e dor no nariz e pior resultado quanto ao ressecamento oronasal e claustrofobia. A MF teve o pior resultado quanto a vazamentos. A pressão parcial do CO 2 exalado no circuito permaneceu em zero com a MFT. Conclusões: Os eventos adversos agudos causados pelas interfaces de VNI são relacionados ao tipo de máscara e aos parâmetros de press...

The kala-azar control program, adopted by the Fundação Nacional de Saúde-FNS (National Health Foundation) has not been able to reduce to an acceptable level the incidence of human cases. The diagnostic method utilized is a blood eluate immunofluorescence. A dogs diagnosed as infected is eliminated a mean of eighty days after the blood collection. The low sensitivity of the test used and the continuing residence of the infected dog in the region due to the elimination delay may be critical in the lack of success of this program. In this study, the FNS standard canine control method is compared to a strategy based on ELISA identification of infected dog and elimination within 7 days. In both study areas the canine seroprevalence was noted ten months before and ten months after the intervention. In the routine FNS area a 9% decrease in seroprevalence was noted, compared to statistically significant greater 27%, reduction (p = 0.0015) in the ELISA intervention area.

The traditional model for dengue control in Brazil has established that community participation is one of its main strategic pillars. In practice, this strategy has been unable to promote the involvement and behaviour change of the population, which are considered essential to control this endemic disease. In the present study, we carried out an integrative review of articles published in the scientific literature on knowledge, attitudes and practices of the population about the disease. This method was chosen because it allows gathering and synthesizing research findings on the selected theme, thus contributing to enhance knowledge on the investigated subject. We conclude that there is a gap between the government's actions and the population's reality, which suggests the need to implement a less vertical prevention and control policy, in which social knowledge can guide strategies for disease control in accordance with the community's interests, needs, desires and worldviews. In this perspective, the population ceases to be a mere spectator, dependent on previously defined actions, and occupies a prominent position in the process, ensuring the effectiveness and sustainability of the program's activities.

ObjectiveTo study the relation between body mass and blood pressure in a low-income urban population. December 1998, a cross-sectional Methods From July to Results In 1078 dwellings, 1137 eligible individuals resided, and complete information was obtained from 1032 (91%) individuals.The prevalences of arterial hypertension and excessive weight were 22.58% and 51.26%, respectively. Before adjustment, the OR for arterial hypertension for overweight individuals was for obese individuals,