A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil.

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil / Trajetória de diminuição da solidão entre brasileiros com 50 anos ou mais durante a pandemia de COVID-19: ELSI-Brasil / Trayectoria decreciente de la soledad entre los brasileños de 50 años o más durante la pandemia de COVID-19: ELSI-Brasil

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

Este estudo teve como objetivo estimar a prevalência de solidão entre idosos brasileiros nos primeiros sete meses da pandemia de COVID-19 e identificar os preditores das trajetórias de solidão, usando dados pré-pandemia oriundos de entrevistas presenciais de participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) de 2019-2020, um estudo de representatividade nacional com residentes da comunidade com 50 anos ou mais. Os dados durante a pandemia foram coletados em três rodadas de entrevistas telefônicas com os participantes, realizadas de maio a outubro de 2020. A solidão foi medida por uma questão de item único, considerando os casos com pelo menos duas medidas repetidas. As variáveis explicativas incluíram depressão, morar sozinho, sair de casa na última semana e conexão virtual no último mês. A regressão logística de efeitos mistos foi utilizada para estimar as razões de chances com seus intervalos de 95% de confiança (IC95%) e investigar trajetórias de solidão e seus preditores. Foram incluídos 5.108 participantes. A prevalência global de solidão no período pré-pandemia foi de 33,1% (IC95%: 29,4-36,8), um valor superior ao período pandêmico (rodada 1: 23,6%, IC95%: 20,6-26,9; rodada 2: 20,5%, IC95%: 17,8-23,5; rodada 3: 20,6%, IC95%: 17,1-24,6). Uma interação significativa (p ≤ 0,05) foi encontrada apenas entre depressão e tempo; participantes com depressão apresentaram maior redução dos níveis de solidão. Embora os níveis de solidão no Brasil tenham diminuído durante a pandemia, esse padrão não se aplica a todos os idosos. Indivíduos com depressão tiveram uma redução mais significativa provavelmente por se sentirem mais próximos aos membros de suas redes sociais durante as recomendações de ficar em casa.

Este estudio tuvo como objetivo estimar la prevalencia de la soledad entre los adultos mayores brasileños durante los primeros siete meses de la pandemia de COVID-19 e identificar los predictores de las trayectorias de la soledad. Los datos prepandémicos proceden de entrevistas cara a cara de los participantes del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil) de 2019-2020, que es un estudio nacionalmente representativo de los habitantes de la comunidad de 50 años o más. Los datos de la pandemia se basaron en tres rondas de entrevistas telefónicas entre esos participantes, realizadas de mayo a octubre de 2020. La soledad se midió con una pregunta de un solo ítem, teniendo en cuenta los que tenían al menos dos indicativos repetidos. Las variables explicativas incluían la depresión, el hecho de vivir solo, salir de casa en la última semana y la conexión virtual en el último mes. Se utilizó una regresión logística de efectos mixtos para estimar las odds ratios con sus intervalos del 95% de confianza (IC95%) y para investigar las trayectorias de la soledad y sus predictores. Se incluyeron 5.108 participantes. La prevalencia global de la soledad en el periodo prepandémico fue del 33,1% (IC95%: 29,4-36,8), superior a la del periodo pandémico (ronda 1: 23,6%, IC95%: 20,6-26,9; ronda 2: 20,5%, IC95%: 17,8-23,5, ronda 3: 20,6; IC95%: 17,1-24,6). Sólo se evidenció una interacción significativa (p ≤ 0,05) entre la depresión y el tiempo; los participantes con depresión mostraron una mayor reducción de los niveles de soledad. Aunque los niveles de soledad en Brasil han disminuido durante la pandemia, este patrón no se da en todos los adultos mayores. Aquellos individuos con depresión tuvieron una reducción más significativa, probablemente debido a que se sintieron más cerca de los miembros de su red social durante las recomendaciones de quedarse en casa.

Ecology of Rhodnius robustus Larrousse, 1927 (Hemiptera, Reduviidae, Triatominae) in Attalea palm trees of the Tapajós River Region (Pará State, Brazilian Amazon).

BACKGROUND: The rising number of acute cases of Chagas disease in the State of Pará, reported in the past two decades, has been associated, in part, with the ingestion of juice of local palm tree fruits, mainly açaí berry and bacaba. Near the study area, in Santarém, Pará State, an outbreak of Chagas disease has been notified and investigations suggest the consumption of bacaba juice as the main source of infection with T. cruzi. The purpose of this study is to assess the aspects associated to the ecology of Rhodnius robustus in palm trees of three communities of the Tapajós region, in the State of Pará, Brazil. METHODS: Palm trees were cut down and dissected to search for triatomines. DNA from triatomines was extracted to investigate natural infection by Trypanosoma cruzi and T. rangeli. For statistical analyzes, data from infestation of palm trees, as well as the rates of natural infection by T. cruzi and T. rangeli were compared by Chi-square test. Triatomine density values were analyzed by the nonparametric Kruskal Wallis test and then comparisons between each pair of variables were made by the Mann-Whitney test assuming a confidence interval of 95%. RESULTS: We dissected 136 palm trees, 60 at the end of the rainy period and 76 at the end of the dry period. Seventy-three of them (53.7%) were infested with triatomines and three species were found, namely: Rhodnius robustus, Rhodnius pictipes and Panstrongylus lignarius. We collected 743 triatomines, and R. robustus was predominant (n = 739). The identification of natural infection of the insects by trypanosomatids revealed that 125 triatomines were infected by T. cruzi, 69 by T. rangeli and 14 presented both parasites, indicating the presence of mixed infection in the same vector. CONCLUSION: The results suggest that São Tomé is the community with greater density of triatomines and infestation of palm trees; also, it demonstrates the existence of an intense sylvatic cycle in the region, which demands intensive surveillance to prevent human transmission.

Quality of life of leprosy sequelae patients living in a former leprosarium under home care: univariate analysis.

INTRODUCTION: Quality of life (QoL) is a broad concept that has become more important during the last decades. Despite this fact, few studies have been conducted to evaluate leprosy patients, none of which has specifically addressed patients with leprosy sequels submitted to home care. PURPOSE: To evaluate the QoL of leprosy sequel bearers and the factors that may affect their perception of their condition. METHODS: WHOQoL-BREF, a questionnaire developed by the World Health Organization, was administered to 32 people living in the coverage area of a former leprosarium. Patient socio-demographic and care-related caregiver data were collected. Activities of daily living and Instrumental Activities of Daily Living Scales were used to evaluate autonomy. Mini-Mental Status Examination was used to evaluate cognitive status. Simple linear regression analyses were conducted using SPSS Statistical Software and the non-standardized beta values were presented. RESULTS: The patients were mainly female, widowed, elderly, with bone sequels; all had impairment of at least one Instrumental Daily Living Activity. QoL scores were 12.35 in a 4-20 scale (52.18 %) in the physical domain, 12.95 (55.94 %) in the psychological health domain, 13.18 (57.40 %) in the environment domain, and 16.09 (75.56 %) in the social domain. Univariate analysis suggests that instrumental daily activity "capacity of shopping," marital status, and caregiver age were associated with self-perceived QoL. Data were also compared to those from other studies. CONCLUSION: Individuals affected by leprosy had low QoL scores in the physical and psychological health domains and high scores in the social domain. The factors that impact their QoL seem to be related to specific conditions found in the leprosarium and the previous isolation practices.

Evaluation of two coproscopic techniques for the diagnosis of schistosomiasis in a low-transmission area in the state of Minas Gerais, Brazil.

This population study, which evaluated two parasitological methods for the diagnosis of schistosomiasis mansoni, was performed in a low-transmission area in Pedra Preta, Montes Claros, Minas Gerais, Brazil. A total of 201 inhabitants of the rural area participated in this research. Four stool samples were obtained from all participants and analysed using the Kato-Katz method (18 slides) and a commercial test, the TF-Test®, which was performed quantitatively. The data were analysed to determine prevalence, the sensitivity of the diagnostic methods, the worm burden and the definition of the "gold standard", which was obtained by totalling the results of all samples examined using the Kato-Katz technique and the TF-Test®. The results showed that the prevalence obtained from the examination of one Kato-Katz slide (the methodology adopted by the Brazilian control programme) was 8% compared to 35.8% from the "gold standard", which was a 4.5-fold difference. This result indicates that the prevalence of schistosomiasis in so-called low-transmission areas is significantly underestimated.

Evaluation of two coproscopic techniques for the diagnosis of schistosomiasis in a low-transmission area in the state of Minas Gerais, Brazil

This population study, which evaluated two parasitological methods for the diagnosis of schistosomiasis mansoni, was performed in a low-transmission area in Pedra Preta, Montes Claros, Minas Gerais, Brazil. A total of 201 inhabitants of the rural area participated in this research. Four stool samples were obtained from all participants and analysed using the Kato-Katz method (18 slides) and a commercial test, the TF-Test®, which was performed quantitatively. The data were analysed to determine prevalence, the sensitivity of the diagnostic methods, the worm burden and the definition of the "gold standard", which was obtained by totalling the results of all samples examined using the Kato-Katz technique and the TF-Test®. The results showed that the prevalence obtained from the examination of one Kato-Katz slide (the methodology adopted by the Brazilian control programme) was 8 percent compared to 35.8 percent from the "gold standard", which was a 4.5-fold difference. This result indicates that the prevalence of schistosomiasis in so-called low-transmission areas is significantly underestimated.

Factors related to transmission of and infection with Schistosoma mansoni in a village in the South-eastern Region of Brazil.

In this transversal study, factors related to infection with and transmission of Schistosoma mansoni were explored. Based on stool examinations of two Kato-Katz smears of a single sample, the prevalences of schistosomiasis and geohelminths were established. In a multivariable analysis, sets of demographic, socio-economic and water contact pattern variables were tested for strength of relation with infection. Males presented a 3.39-times higher risk for infection than females. The age groups between 10-19 years and 20-30 years showed risks of infection 7.1- and 7.5-times higher, respectively, than the control age group between 0-10 years. Individuals practicing leisure activities had a 1.96-times higher risk than those without these activities. The malacological survey identified snails of the species Biomphalaria glabrata, Biomphalaria straminea and Biomphalaria tenagophila. Two exemplars of B. glabrata (0.53%) proved positive for S. mansoni. The socio-economic improvements observed in the locality suggest a protective and preventive effect towards infection with schistosomiasis, which requires further investigation with a longitudinal and more detailed study design. Considering our findings, a proposal for an integrated control program should be based on two pillars: one horizontal, which involves social empowerment and health education, and another more vertical, which delivers treatment and infrastructure improvements.

Factors related to transmission of and infection with Schistosoma mansoni in a village in the South-eastern Region of Brazil

In this transversal study, factors related to infection with and transmission of Schistosoma mansoni were explored. Based on stool examinations of two Kato-Katz smears of a single sample, the prevalences of schistosomiasis and geohelminths were established. In a multivariable analysis, sets of demographic, socio-economic and water contact pattern variables were tested for strength of relation with infection. Males presented a 3.39-times higher risk for infection than females. The age groups between 10-19 years and 20-30 years showed risks of infection 7.1- and 7.5-times higher, respectively, than the control age group between 0-10 years. Individuals practicing leisure activities had a 1.96-times higher risk than those without these activities. The malacological survey identified snails of the species Biomphalaria glabrata, Biomphalaria straminea and Biomphalaria tenagophila. Two exemplars of B. glabrata (0.53 percent) proved positive for S. mansoni. The socio-economic improvements observed in the locality suggest a protective and preventive effect towards infection with schistosomiasis, which requires further investigation with a longitudinal and more detailed study design. Considering our findings, a proposal for an integrated control program should be based on two pillars: one horizontal, which involves social empowerment and health education, and another more vertical, which delivers treatment and infrastructure improvements.

The effect of the number of stool samples on the observed prevalence and the infection intensity with Schistosoma mansoni among a population in an area of low transmission.

Examination of faecal material by Kato Katz (KK) technique is a widely used approach for the diagnosis of intestinal schistosomiasis, particularly in epidemiological surveys. However, this technique lacks diagnostic sensitivity in individuals with low infection intensity or in low endemic areas. In the total population (TP) of 1265 individuals prevalence and infection intensity were established by examining two KK slides. A representative subset of 305 individuals, denominated experimental group (EG), was defined to assess the comparative advantage of an increased sampling effort using the KK technique. In addition stools of the participants of the EG were examined by the formol ether centrifugation technique. The proportion of all positive stool examinations detected by both methods among the experimental group served as reference value for prevalence (diagnostic 'gold' standard). Prevalence of schistosomiasis among TP based on two KK slides was 12.5%. Prevalence among the EG varied from 13.8%, based on one KK slide, over 27.2 based on 10 KK slides of three stool samples to 35.4% as value for the diagnostic 'gold' standard. The comparison of values for prevalence, stratified by age, revealed significant elevated numbers for all age groups, and interestingly, an extension of the highest prevalence levels until an age of 50 years. The overall infection intensity in eggs per gram (epg), calculated as geometric mean, was 83 epg for the TP based on one KK slide, 78 epg for the GE based on one KK slide and 28 epg based on 10 KK slides of three stool samples. In summary our data demonstrate that control programmes based on the examination of a single KK slide, as it is the case in Brazil, tend to underestimate significantly the prevalence and overestimate infection intensity. This applies especially for low endemic areas, where the efficacy and cost-effectiveness of such programmes become questionable. Our data also indicate that the possible solution of this problem lies in targeted mass treatment including age groups with the highest proportions of those infected. This will give high sensitivity together with sustainability and suitability under field conditions.

A combined strategy to improve the control of Schistosoma mansoni in areas of low prevalence in Brazil.

Results of stool examinations for infections with Schistosoma mansoni among schoolchildren, living in a village of Minas Gerais State, Brazil, were used as an indicator to identify schistosomiasis-positive individuals within the entire population. This new approach is based on dividing the community into schoolchildren, members of households of schistosomiasis-positive and -negative schoolchildren, and members of households without schoolchildren. Each subgroup was evaluated comparing different sampling efforts with the predetermined "gold standard" to find the best relationship between detection rate and sampling effort. Consequently these results were combined, and a proposal for a new strategy, valid for an entire community, was elaborated. This alternative approach during the screening process permits to treat a similar proportion of positives as detected with 6 Kato-Katz slides of 3 stool samples, with 3-fold reduced sampling effort, enhancing the efficiency of schistosomiasis control programs in low-endemic areas.