Enteroparasites, demographic profile, socioeconomic status and education level in the rural population of the Recôncavo of Bahia, Brazil

Demographic and social studies, as well as economic and cultural factors in a community are important regarding public health. This study identified demographic, socioeconomic and cultural aspects correlated with intestinal parasites in the population of Santo Antônio de Jesus, Bahia-Brazil, from July to October 2015. 53 semi-structured questionnaires were applied to the rural population of the municipality with previous clarification on the purpose of the study. There were questions related to the individual's gender, family income and parental level of education. Laboratory parasitological analyzes were performed to investigate enteroparasites and produced the following results: 53.7% (n=58) were female; 62.8% (n=66) with monthly family income lower or equal to the minimum wage and 48% (n=48) of adults with incomplete basic education. The main enteroparasites found in this population were: Iodamoeba butschlii, Entamoeba histolytica/Entamoeba dispar complex, Giardia intestinalis, Entamoeba coli and Endolimax nana in addition to some geohelminths, such as hookworms and Enterobius vermicularis. The profile visualized can be understood as a risk factor for the development of certain parasitic infections that are intrinsically associated to the social and economic aspects of vulnerable populations.

Presence of enteroparasites in the environment and the resident population in a rural community in Santo Antonio de Jesus in the reconcavo da Bahia, Brazil

Studies show environmental contamination as a decisive factor for the perpetuation of the epidemiological triad of infection by parasites, posing a risk to human health. This work identified parasitic contamination in peridomestic soils, enteroparasite infection in humans and domestic animals in the Riacho Dantas and Rio do Onha, rural communities of Santo Antônio de Jesus (Bahia, Brazil). Analyses were performed in 53 homes, with soil samples collected in four points as well as collection of human and domestic animals feces from July to October 2015. Soil samples as well as human and domestic animal feces were analyzed. For the analysis of human fecal samples, four methods were used, including spontaneous sedimentation, Baermann-Moraes, Kato-Katz and Graham. For animal fecal samples three methods were used: spontaneous sedimentation, Willis and Rugai. For soil samples, two methods were used: spontaneous sedimentation and Rugai. Of the 636 samples of soil analyzed, 68.7% were positive for some parasitic form, especially non-ciliated protozoa, ciliate protozoa; adults and larvae of the nematodes and hookworms. Of the 144 samples of human feces, 75% were positive, especially for: Endolimax nana, Entamoeba coli, hookworms, Giardia duodenalis, Entamoeba histolytica/E. dispar and Enterobius vermicularis. Of the 21 animal feces samples, 85.7% were positive, especially for the genera Ancylostoma, Toxocara, Trichuris and Giardia. The studied soil samples presented biological contaminants (for example, Toxocara and Ancylostoma) some of which pathogenic for humans and domestic animals. The lack of information regarding the care of domestic soil and direct contac

Uso regular de plantas medicinais para fins terapêuticos em famílias residentes na zona rural de Santo Antônio de Jesus ­ Bahia ­ Brasil / Regular use of plants for therapeutic purposes in families resident in the rural area of Santo Antônio de Jesus - Bahia - Brazil

Introdução: O uso de plantas medicinais é uma prática comum de cuidado primário nas populações em geral. Foi introduzido no Brasil, por influência das culturas indígena, africana e europeia e caracteriza-se por ser oriundo do conhecimento e da tradição popular. Objetivos: Sendo o Recôncavo da Bahia uma região de forte influência africana, o objetivo deste estudo foi investigar o uso das principais plantas medicinais e identificar seu uso pela população de um de seus municípios, valorizando o acervo cultural e o saber popular de seus moradores quanto aos benefícios que essas plantas trazem para a população. Metodologia: Para a obtenção dos dados, foi aplicado um questionário sociodemográfico, contendo questões sobre o uso de plantas para fins medicinais em chás ou xaropes com 154 entrevistados. Resultados: Desse universo de pessoas, 74,71% tinham o costume de usar remédios caseiros e 60,0% eram do gênero feminino. Os vegetais mais citados para fins medicinais foram: Lippia alba (n=71), Cymbopogon citratus (n=31), Pimpinella anisum (n=30), Peumus boldus (n=14), Plantago major e Ocimum basilicum (n=13 cada); sendo utilizados principalmente como calmante, dores em geral e contra gases. Quanto ao local de obtenção dos vegetais, os entrevistados cultivavam a planta (94,6%), pegavam do cultivo de amigos e vizinhos (1,8%), compravam na feira livre (1,8%), compravam em farmácia ou adquiriam de outros lugares (0,9%). Conclusões: Os dados evidenciam a relevância da prática do uso de plantas para manutenção da saúde dos moradores do município pesquisado, sendo parte integrante de seu contexto sociocultural. As diferentes finalidades do uso de plantas para fins medicinais mostram que mais estudos são necessários para avaliar as propriedades dessas plantas e seus efeitos no organismo humano. (AU)

Introduction: The use of medicinal plants is a common practice of primary care in general populations. It was introduced in Brazil, influenced by the indigenous, african and european cultures and it is characterized by being derived from knowledge and popular tradition. Objective: The Recôncavo Baiano is an exceptionally fertile region located on the coast of the state of Bahia, an area of strong African influence; the objective of this study was to investigate the use and identify the main medicinal plants used by the population of one of its municipalities, valuing the cultural heritage and the popular knowledge of its residents regarding the benefits of these plants. Methodology: To obtain the data, a sociodemographic questionnaire was applied, containing questions about the use of medicinal plants in teas or syrups, with 154 interviewees. Results: From this universe of people, 74.71% had a habit of using home remedies and 60.0% were female. The most frequently mentioned plants for medicinal purposes were: Lippia alba (n=71), Cymbopogon citratus (n=31), Pimpinella anisum (n=30), Peumus boldus (n=14), Plantago major and Ocimum basilicum (n=13 each), and they were used mainly as soothing, in pains in general and against gases. As to the location of the vegetables, the interviewees cultivated the plant (94.6%), obtained the cultivation from friends and neighbors (1.8%), bought it at the fair (1.8%), bought in a pharmacy or acquired from other places (0.9%). Conclusions: The data show the relevance of the practice of using plants for the maintenance of the health of the residents of the studied municipality, being part of their sociocultural context. The different purposes of the use of plants for medicinal purposes show that more studies are needed to evaluate their properties and their effects on the human body. (AU)

Effect of a multifaceted intervention on use of evidence-based therapies in patients with acute coronary syndromes in Brazil: the BRIDGE-ACS randomized trial.

CONTEXT: Studies have found that patients with acute coronary syndromes (ACS) often do not receive evidence-based therapies in community practice. This is particularly true in low- and middle-income countries. OBJECTIVE: To evaluate whether a multifaceted quality improvement (QI) intervention can improve the use of evidence-based therapies and reduce the incidence of major cardiovascular events among patients with ACS in a middle-income country. DESIGN, SETTING, AND PARTICIPANTS: The BRIDGE-ACS (Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes) trial, a cluster-randomized (concealed allocation) trial conducted among 34 clusters (public hospitals) in Brazil and enrolling a total of 1150 patients with ACS from March 15, 2011, through November 2, 2011, with follow-up through January 27, 2012. INTERVENTION: Multifaceted QI intervention including educational materials for clinicians, reminders, algorithms, and case manager training, vs routine practice (control). MAIN OUTCOME MEASURES: Primary end point was the percentage of eligible patients who received all evidence-based therapies (aspirin, clopidogrel, anticoagulants, and statins) during the first 24 hours in patients without contraindications. RESULTS: Mean age of the patients enrolled was 62 (SD, 13) years; 68.6% were men, and 40% presented with ST-segment elevation myocardial infarction, 35.6% with non-ST-segment elevation myocardial infarction, and 23.6% with unstable angina. The randomized clusters included 79.5% teaching hospitals, all from major urban areas and 41.2% with 24-hour percutaneous coronary intervention capabilities. Among eligible patients (923/1150 [80.3%]), 67.9% in the intervention vs 49.5% in the control group received all eligible acute therapies (population average odds ratio [OR(PA)], 2.64 [95% CI, 1.28-5.45]). Similarly, among eligible patients (801/1150 [69.7%]), those in the intervention group were more likely to receive all eligible acute and discharge medications (50.9% vs 31.9%; OR(PA),, 2.49 [95% CI, 1.08-5.74]). Overall composite adherence scores were higher in the intervention clusters (89% vs 81.4%; mean difference, 8.6% [95% CI, 2.2%-15.0%]). In-hospital cardiovascular event rates were 5.5% in the intervention group vs 7.0% in the control group (OR(PA), 0.72 [95% CI, 0.36-1.43]); 30-day all-cause mortality was 7.0% vs 8.4% (ORPA, 0.79 [95% CI, 0.46-1.34]). CONCLUSION: Among patients with ACS treated in Brazil, a multifaceted educational intervention resulted in significant improvement in the use of evidence-based therapies. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00958958.

A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial.

Translating evidence into clinical practice in the management of acute coronary syndromes (ACS) is challenging. Few ACS quality improvement interventions have been rigorously evaluated to determine their impact on patient care and clinical outcomes. We designed a pragmatic, 2-arm, cluster-randomized trial involving 34 clusters (Brazilian public hospitals). Clusters were randomized to receive a multifaceted quality improvement intervention (experimental group) or routine practice (control group). The 6-month educational intervention included reminders, care algorithms, a case manager, and distribution of educational materials to health care providers. The primary end point was a composite of evidence-based post-ACS therapies within 24 hours of admission, with the secondary measure of major cardiovascular clinical events (death, nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke). Prescription of evidence-based therapies at hospital discharge were also evaluated as part of the secondary outcomes. All analyses were performed by the intention-to-treat principle and took the cluster design into account using individual-level regression modeling (generalized estimating equations). If proven effective, this multifaceted intervention would have wide use as a means of promoting optimal use of evidence-based interventions for the management of ACS.