Nutrition morbidity interactions in pre-school children

Background & objectives: Research studies in the 1970s reported that in pre-school children, undernutrition increased the risk of infections and infections aggravated undernutrition. Over decades, there has been a reduction in prevalence of undernutrition and improvement in access to healthcare for treatment of infections. A mixed longitudinal study was undertaken to assess whether over time there were any changes from the earlier reported effect of undernutrition prior to infection on the risk of morbidity and effect of morbidity on nutritional status in pre-school children. Methods: Pre-school (0-59 months of age) children from urban low- and middle-income families whose parents were willing to allow their participation in the study were enrolled. Information on sociodemographic profile of the families was collected at enrolment. Weight of all children and length in infants were recorded every month; length/height in children 12-59 months of age was recorded once in three months. Morbidity information was collected through fortnightly visits. Results: 3888 pre-school children were followed up in 74636 home visits. Among these children, underweight and wasting were associated with a small increase in risk of infections. The odds ratio for risk of infection for underweight children was 1.09 (95% CI: 1.02 to 1.16) and for wasting was 1.18 (95% CI: 1.08 to 1.29). The deterioration in Z scores for weight-for-age and body mass index-for-age in children during illness and convalescence was small but significant (P<0.001). Interpretation & conclusions: The increased risk of infections in undernourished children living in overcrowded tenements in areas with poor environmental hygiene was not significant, perhaps because the risk of infection in normally nourished children was also high. The deterioration in nutritional status following infection was small because of the ready access to and utilization of health and nutrition care.

Intención de aceptación a la vacunación contra la COVID-19 en sectores vulnerables del Ecuador

Introducción: La COVID-19 causó que varios sectores profesionales hayan tenido que enfrentarlo en primera línea, viéndose afectados ante la vulnerabilidad de contraer el virus. A pesar de la baja tasa de mortalidad de los momentos actuales y la poca saturación de pacientes con COVID-19 en los centros de salud, la aplicación de una cuarta dosis de inoculación ha generado posturas diferentes entre varios países. Objetivo: Determinar si el personal considerado con altos riesgos de vulnerabilidad de la ciudad de Santo Domingo de los Colorados, en Ecuador, tiene intenciones favorables para la aplicación de la cuarta dosis de la vacuna contra la COVID-19. Método: Se desarrolló un estudio cuantitativo de alcance correlacional y diseño transversal. Un cuestionario conformado por 16 preguntas midió las variables: riesgo de contagio, conocimiento percibido sobre la vacuna, confianza sobre la vacuna e intención de vacunarse; el cual fue aplicado a 375 participantes. Los análisis estadísticos fueron desarrollados a través de Excel y Statistical Package for Social Sciences 21 (SPSS 21). Resultados: Los análisis estadísticos evidenciaron que el riesgo de contagio (β=0,178**), el conocimiento percibido sobre la vacuna (β=0,218**) y la confianza sobre la vacuna (β=0,192**) se correlacionan significativamente con la intención de vacunarse, ante lo cual se evidencia la necesidad de recibir una cuarta dosis de inoculación por parte de los sectores vulnerables. Conclusiones: Esta es la primera investigación que expone resultados respecto a la intención de vacunación en las personas vulnerables y pone en evidencia la intención de acceder a una cuarta dosis de inoculación.

Introduction: COVID-19 caused healthcare professional workers have faced the pandemic on the frontline at the risk of being infected with the virus. Despite the low mortality rate at present and the low presence of patients with COVID-19 in health care centers, the application of a fourth booster dose has generated different positions among several countries. Objective: To determine whether personnel considered being at high risk of vulnerability in the city of Santo Domingo de los Colorados, Ecuador, have favorable intentions for receiving the fourth booster dose of the COVID-19 vaccine. Method: A quantitative study of correlational scope and cross-sectional design was developed. A questionnaire consisting of 16 questions measured the following variables: risk of infection, perceived knowledge of the vaccine, confidence in the vaccine and intention to be vaccinated; this questionnaire was applied to 375 participants. Statistical analyses were developed using the microsoft Excel spreadsheed and Statistical Packagefor Social Sciences 21 (SPSS 21). Results: Statistical analyses showed that the risk of infection (β=0.178**), perceived knowledge about the vaccine (β=0.218**) and confidence about the vaccine (β=0.192**) are significantly correlated with the intention to be fully vaccinated, thus showing the need for a fourth booster dose by vulnerable sectors. Conclusion: This is the first research that presents results regarding the intention to vaccinate vulnerable people and highlights the intention to access a fourth booster dose.

Introdução: O COVID-19 fez com que diversos setores profissionais o enfrentassem na linha de frente, sendo afetados pela vulnerabilidade de contrair o vírus. Apesar da baixa taxa de mortalidade atual e da baixa saturação de pacientes com COVID-19 nos centros de saúde, a aplicação de uma quarta dose de inoculação gerou posições diferentes entre vários países. Objetivo: Determinar se o pessoal considerado de alto risco de vulnerabilidade na cidade de Santo Domingo de los Colorados, no Equador, tem intenções favoráveis para a aplicação da quarta dose da vacina contra COVID-19. Método: Foi desenvolvido um estudo quantitativo com escopo correlacional e delineamento transversal. Um questionário composto por 16 questões mediu as variáveis: risco de contágio, conhecimento percebido sobre a vacina, confiança sobre a vacina e intenção de se vacinar; que foi aplicado a 375 participantes. As análises estatísticas foram realizadas no Excel e no Statistical Package for the Social Sciences 21 (SPSS 21). Resultados: As análises estatísticas mostraram que o risco de contágio (β=0,178**), o conhecimento percebido sobre a vacina (β=0,218**) e a confiança sobre a vacina (β=0,192**) estão significativamente correlacionados com a intenção de ser vacinado, o que evidencia a necessidade de receber uma quarta dose de inoculação por setores vulneráveis. Conclusões: Esta é a primeira pesquisa que expõe resultados sobre a intenção de vacinação em pessoas vulneráveis e evidencia a intenção de acessar uma quarta dose de inoculação.

Risk to human health from protozoan (oo)cysts in water treatment plants / Risco à saúde humana por (oo)cistos de protozoários em estações de tratamento de água

ABSTRACT The presence of waterborne pathogens, when associated with the water supply system, poses risks to public health. This study investigated the occurrence of (oo)cysts of Cryptosporidium spp. and Giardia spp. in two Water Treatment Plants, with full-cycle technology, and assessed the microbiological risk to consumers' health. The membrane filtration technique was employed to identify the protozoan load in 24 samples of raw and filtered water. Physicochemical and bacteriological parameters were also analyzed. The Quantitative Microbial Risk Assessment model was used to determine the risk of daily and annual infection associated with the ingestion of filtered water. A total of 66.67% of raw water samples were positive for Cryptosporidium; and 33.33%, for Giardia. The maximum concentrations of 200 (oo)cysts/L and 50 cysts/L were detected in the Cerrado stream (located in Sanclerlândia, state of Goiás, Brazil), due to the predominance of grazing areas and intense agricultural activity. Water Treatment Plants did not completely remove the protozoa and the retention efficiency was lower than that recommended by the United States Environmental Protection Agency, with average values of 1.27 log for cysts and 1.04 log for oocysts. The probability of annual infection by cysts (100%) was higher than that of oocysts (86.61 - 98.32%) as for consumption of filtered water, and in the dry season, there was a higher risk of infection, due to the low performance of the Water Treatment Plants and higher concentration of pathogens. According to the results, the continuous intake of filtered water above the warning level can cause infectious diseases in the supplied population.

RESUMO A presença de patógenos de veiculação hídrica quando associados ao sistema de abastecimento de água causam risco à saúde pública. Esse estudo investigou a ocorrência de (oo)cistos de Cryptosporidium spp. e Giardia spp. em duas Estações de Tratamento de Água com tecnologia do tipo ciclo completo e avaliou o risco microbiológico à saúde dos consumidores. Utilizou-se a técnica de filtração em membranas para identificar a carga dos protozoários nas 24 amostras de água bruta e filtrada. Os parâmetros físico-químicos e bacteriológicos também foram analisados. O modelo de Avaliação Quantitativa de Risco Microbiológico foi empregado para determinar o risco de infecção diária e anual associada à ingestão de água filtrada. Um total de 66.67% das amostras de água bruta foram positivas para Cryptosporidium; e 33.33% para Giardia. As concentrações máximas de 200 oocistos/L e 50 cistos/L foram detectadas no ribeirão Cerrado (localizado em Sanclerlândia, Estado de Goiás, Brasil), devido ao predomínio de área de pastagens e à intensa atividade agropecuária. As Estações de Tratamento de Água não removeram completamente os protozoários e a eficiência de retenção foi inferior ao recomendado pela Agência de Proteção Ambiental dos Estados Unidos, com valores médios de 1,27 log para cistos e 1,04 log para oocistos. A probabilidade de infecção anual por cistos (100%) foi superior aos oocistos (86,61% a 98,32%) para o consumo da água filtrada, sendo que a estação seca, o risco de infecção foi maior, devido ao baixo desempenho das Estações de Tratamento de Água e à maior concentração de patógenos. Esses resultados indicam que a ingestão contínua de água filtrada acima do nível de alerta pode provocar doenças infecciosas na população abastecida.

Conocimientos y prácticas del personal estomatológico sobre la prevención de enfermedades transmisibles. Marianao. 2015-2016 / Knowledge and practice of the dental staff about the prevention of communicable diseases. Marianao. 2015-2016

Introducción: La profesión estomatológica ha sido catalogada dentro de las disciplinas biomédicas como la de mayor riesgo de infección durante la práctica clínica. Objetivo:Determinar el nivel de conocimientos y prácticas del personal estomatológico para la prevención de las enfermedades transmisibles y su relación con los años de experiencia profesional, en las consultas estomatológicas del Municipio Marianao. Material y Métodos: Se realizó un estudio descriptivo de corte transversal. El universo de estudio estuvo constituido por 119 estomatólogos y 83 técnicos de atención estomatológica. Se estudió una muestra de 139. La información se obtuvo a través de un cuestionario y una guía de observación. Resultados: El nivel de conocimientos que poseen los estomatólogos y técnicos fue suficiente, con 69.7 por ciento y 71.4 por ciento respectivamente, y demostró mayor conocimiento los de menor años de graduados con 30.3 por ciento en los estomatólogos y 28.6 por ciento los técnicos. Un 57.9 por ciento de los estomatólogos presentan buena práctica para la prevención y 57.1 por ciento de los técnicos mala práctica. Conclusiones: Predomina el nivel de conocimiento suficiente. El grupo de 1 a 5 años de graduados presenta los mejores niveles de conocimientos, mientras el grupo con más años de graduados pone mejor en práctica las normas de prevención. En general se muestra un deficiente empleo de las prácticas de prevención(AU)

Human Papillomavirus Infection and Increased Risk of HIV Acquisition:A Meta-analysis of Case-control Studies / 现代检验医学杂志

Objective To evaluate the impact of human papillomavirus(HPV)infection on the risk of HIV acquisition in the female group.Methods Searched PubMed,EMbase,Coehrane Library,CNKI,wanfang database and Chinese Biomedical Lit-erature Database etc for articles about HIV-acquisition in HPV infected female patients.The quality of the literature were e-valuated according to standards of inclusion and exclusion.Data was extracted and methodologically quality evaluated by two independent investigators.Meta-analysis was accomplished using RevMan4.2 software.Results 6 articles were included,all of them were randomized controlled trials,a total of 9 606 cases studied.HIV infection risk was doubled in women with any HPV infection(OR= 2.02,95% CI:1.48 ~ 2.77),demonstrating High-risk HPV-positive (OR= 2.50,95% CI:1.73 ~3.61)and low-risk HPV-positive (OR=2.10,95% CI:1.48~2.96)respectively.Funnel plot analysis revealed no signifi-cant publication bias on HPV genotypes.Conclusion The analysis of selected research suggests the risk of HIV infection was increased in HPV-positive women.HPV vaccine may have some preventive effect on HIV infection.

Impact of flushing uterine cavity with metronidazole solution at different temperatures on postpartums with high risk of infections during cesarean section / 现代临床护理

Objective To explore the effect of flushing uterine cavity with metronidazole solution at different temperatures on postpartums with high risk of infections during cesarean section.Methods One hundred and two puerperas with high risks of infections undergoing caesarean section were randomized according to random sampling into three groups equally.Groups A,B and C were treated with uterine cavity flushing with metronidazole solution at three temperatures of 22~24℃,39~40℃and 37.5~37.8℃respectively.Comparisons were done between the three groups in terms of vaginal bleeding 2h after operation,heart rates 15 min before operation and 15 min after operation and the temperatures.Results The differences in temperature and heart rate 15 min after operation were significantly different arnong the groups(P0.05).In group A,the temperature and heart rate after operation were significantly lower and faster than those before operation(P0.05).The vaginal bleeding volume 2 h after operation in groups A and B was significantly more than group C(P<0.05)and that of group B was significantly smaller than group A(P<0.05).Conclusion Uterine cavity flushing using metronidazole at the temperature of 37.5~37.8℃after cesarean section can reduce postpartum hemorrhage and relieve patient’s discomfort.

Circuncisión masculina para la disminución del riesgo de infección por virus de inmunodeficiencia humana e infecciones de transmisión sexual / Male circumcision for reducing risk of infection with human immunodeficiency virus and sexually transmitted infections

La circuncisión consiste en cortar una porción del prepucio del pene que cubre al glande para dejarlo permanentemente al descubierto. Los motivos más frecuentes para circuncidar son religiosos, culturales o médicos. Muchos científicos, al igual que los autores de este artículo, justifican la circuncisión masculina para la disminución del riesgo de infección por virus de inmunodeficiencia humana e infecciones de transmisión sexual. A tales efectos se realizó una revisión bibliográfica para completar así la información disponible en las bases de datos nacionales al respecto.

The circumcision involves cutting a portion of the penis foreskin that covers the glans to leave it permanently exposed. The most common reasons for circumcision are religious, cultural or medical. Many scientists, as the authors of this article, justify male circumcision for reducing risk of infection with human immunodeficiency virus and sexually transmitted infections. For this purpose a literature survey was conducted to complete the information available in national databases.

Evaluación clínico-nutricional y del funcionamiento familiar en niños con alto nivel de riesgo de padecer inmunodeficiencia primaria / Family functioning, nutritional and clinical assessment of children with high risk of primary immunodeficiency

Antecedentes. Los estados de inmunodeficiencia impactan en el funcionamiento familiar. Objetivo. Comparar el funcionamiento familiar y aspectos clínico-nutricionales entre niños con alto nivel de sospecha de inmunodeficiencias primarias y aquellos con menor nivel de sospecha. Lugar de aplicación. Clínica de atención primaria. Diseño. Estudio transversal con grupos comparados. Población. 400 niños entre 1 año y 7 años 11 meses de edad, asignados a dos grupos, uno integrado por aquellos con puntaje ≥25 en la escala PRIDE (primary immunodeficiency disease evaluation), n=9 y otro integrado por aquellos que alcanzaron un puntaje ≤25 en la evaluación con la escala PRIDE, n=391. Material y métodos. Los grupos se compararon con respecto a funcionamiento familiar, estado nutricional y criterios clínicos de riesgo para inmunodeficiencias primarias. Resultados. Se encontraron asociaciones estadísticamente significativas de puntaje PRIDE con infecciones respiratorias altas >8, episodios de otitis media aguda ≥4, episodios de sinusitis aguda ≥2, infecciones de vías respiratorias bajas ≥2, no respuesta a ≥3 esquemas de antibióticos para un mismo cuadro de infección, infecciones urinarias >6, infecciones del sistema nervioso central, enfermedades alérgicas o autoinmunes concomitantes, caída del cordón umbilical > 30 días y funcionamiento familiar. Las áreas más dañadas del funcionamiento familiar fueron roles y armonía. Conclusiones. Hubo diferencias en el funcionamiento familiar y factores de riesgo relacionados con infección y predisposición a ella entre los niños con puntaje PRIDE ≥25 y aquellos con puntaje <25. (AU)

Background. Immunodeficiency states impact on family functioning. Objective. To compare family functioning, clinical and nutritional status among children with high suspicion of primary immunodeficiencies versus those in which the level of suspicion is lower. Design. Cross-sectional study with compared groups. Population. 400 children between 1 year and 7 years 11 months of age, assigned to two groups according to PRIDE (primary immunodeficiency disease evaluation) ³25 average, n=9 and the other composed of those who scored below 25 on the assessment with that scale, n = 391. Material and methods. The groups were compared regarding: family functioning, nutritional status and clinical risk criteria for primary immunodeficiencies. Results. Statistically significant associations were found among PRIDE scoring with following variables: upper respiratory infections >8, episodes of acute media otitis ³4, two o more episodes of lower respiratory infections, sinusitis ³ 2, three or more schedules of antibiotics to treat the same infection, more than six urinary tract infections in the past year, central nervous system infections, allergic or autoimmune concomitant diseases, drop of umbilical cord > 30 days and family functioning. The most damaged areas of family functioning were roles and harmony. Conclusions. There were differences in family functioning and related risk factors for both infection and predisposition to that between children receiving 25 or more points after PRIDE evaluation and those with PRIDE score below 25(AU)

Prevalencia de reactores tuberculínicos en trabajadores del Instituto de Medicina Tropical “Pedro Kourí”, 1996-2000 / Prevalence of tuberculin reactors among the workers of “Pedro Kourí” Tropical Medicine Institute, 1996-2000

Se realizó prueba tuberculínica según técnica estándar de la Organización Mundial de la Salud a los trabajadores del Instituto de Medicina Tropical “Pedro Kourí” en 2 ocasiones, distribuidos según las áreas de trabajo, para determinar la prevalencia de reactores y estimar la proporción de conversión a la tuberculina. En el primer corte se encuestaron 472 trabajadores durante 1996-1997 y en el segundo corte se encuestaron 217 trabajadores en octubre de 2000. El número de no reactores disminuyó de 58,4 % en la primera encuesta a 24,6 % en la segunda, mientras que la cantidad de positivos (diámetro ³ 10 mm) aumentó de 33,5 a 55,2 % de la primera a la segunda encuesta. También se incrementó la media de las induraciones de 5,2 a 9,6 mm. Un total de 42 trabajadores (14,6 %) sufrieron viraje tuberculínico en este período. En las áreas expuestas a mayor riesgo fue donde mayor cantidad de virajes tuberculínicos se produjeron. La prevalencia de infección tuberculosa aumentó de una encuesta a la otra en la mayoría de las subdirecciones.

Tuberculin tests according to WHO standard technique were twice performed on the workers of “Pedro Kourí” Institute, distributed according to workstations, with the objective of determining the prevalence of reactors and estimating the proportion of tuberculin converters. In the first test, 472 workers were surveyed during 1996-1997 and in the second one 217 workers in October 2000. The number of non reactors decreased from 58.4% in the first survey to 24.6% in the second one whereas the quantity of positive cases (diameter ≥10 mm) increased from 33.5% to 55.2%. The Induration diameter mean also increased from 5.2 mm to 9.6 mm. A total of 42 workers (14.6%) suffered tuberculin conversion in that period. The highest amount of tuberculin conversions was found in areas exposed to higher risks. The prevalence of tuberculosis infection increased from the first to the second survey in most of the areas.