Handmade face mask can be sterilized without compromising their efficacy / Máscara facial artesanal pode ser esterilizada sem comprometer sua eficácia / La mascarilla facial hecha a mano se puede esterilizar sin comprometer su eficácia

Background and Objectives: COVID-19 caused by SARS-CoV-2 is transmitted by contact, droplets and aerosols. The World Health Organization recommends the mandatory use of surgical masks for health professionals and encourages countries to adhere to their use, en masse, in order to minimize the transmission of the virus. Since the lack of this personal protective equipment is a cause for concern, the objective of this study was to evaluate the characteristics of facial masks regarding (i) the mechanical properties of elongation, rupture stress and resistance to air passage and (ii) the morphometric properties of thickness, fiber diameter and pore distribution after autoclave sterilization. Methods: The masks were made in TNT Spunbonded (100% polypropylene, 60 g/m2 ), autoclaved at 70 ºC for 5 minutes and stored in plastic films at room temperature. Then, the mechanical properties were determined in an Instron universal testing machine and Gurley type automatic densimeter and the morphometric properties in a semi-automatic thickness gauge and scanning electron microscope. Results: It was observed that a cycle of sterilization of facial masks, by moist heat under pressure, increased the blanket's stiffness, did not produce physical damage and did not reduce the blanket's barrier capacity. Conclusion: The sterilization of face masks made of TNT can be considered a strategy to increase safety in their production and use.(AU)

Justificativa e Objetivos: A COVID-19 causada pelo SARS-CoV-2 é transmitida pelo contato, por gotículas e por aerossóis. A Organização Mundial da Saúde recomenda a obrigatoriedade do uso de máscaras cirúrgicas aos profissionais da saúde e incentiva os países a aderirem ao seu uso, em massa, a fim de minimizar a transmissibilidade do vírus. Posto que a falta desse equipamento de proteção individual causa preocupação, o objetivo deste trabalho foi avaliar as características de máscaras faciais quanto (i) às propriedades mecânicas alongamento, tensão de ruptura e resistência a passagem de ar e (ii) às propriedades morfométricas espessura, diâmetro das fibras e distribuição de poros após esterilização em autoclave. Métodos: As máscaras foram confeccionadas em TNT Spunbonded (100% polipropileno, 60 g/m2), autoclavadas a 70 ºC por 5 minutos e armazendadas em filmes plásticos a temperatura ambiente. Na sequência, as propriedades mecânicas foram determinadas em máquina de teste universal Instron e densímetro automático tipo Gurley e as propriedades morfométricas em medidor de espessura semiautomático e microscópio eletrônico de varredura. Resultados: Observou-se que um ciclo de esterilização das máscaras faciais, por calor úmido sob pressão, promoveu o aumento da rigidez da manta, não produziu danos físicos e não diminuiu a capacidade de barreira da manta. Conclusão: A esterilização de máscaras faciais confeccionadas em TNT pode ser considerada uma estratégia para aumentar a segurança na sua produção e uso.(AU)

Antecedentes y objetivos: El COVID-19 causado por el SARS-CoV-2 se transmite por contacto, gotitas y aerosoles. La Organización Mundial de la Salud recomienda el uso obligatorio de mascarillas quirúrgicas para los profesionales de la salud y alienta a los países a adherirse a su uso, en masa, con el fin de minimizar la transmisión del virus. Dado que la falta de este equipo de protección personal es motivo de preocupación, el objetivo de este estudio fue evaluar las características de las máscaras faciales en cuanto a (i) las propiedades mecánicas de elongación, tensión de rotura y resistencia al paso del aire y (ii) la morfometría propiedades de espesor, diámetro de fibra y distribución de poros después de la esterilización en autoclave. Métodos: Las máscaras se fabricaron en TNT Spunbonded (100% polipropileno, 60 g / m2), se esterilizaron en autoclave a 70 ºC durante 5 minutos y se almacenaron en películas plásticas a temperatura ambiente. Posteriormente, se determinaron las propiedades mecánicas en una máquina de ensayo universal Instron y densímetro automático tipo Gurley y las propiedades morfométricas en un medidor de espesor semiautomático y microscópio electrónico escaneando.Resultados: Se observó que un ciclo de esterilización de mascarillas faciales, por calor húmedo a presión, incrementó la rigidez de la manta, no produjo daño físico y no redujo la capacidad barrera de la manta. Conclusión: La esterilización de mascarillas faciales fabricadas con TNT puede considerarse una estrategia para aumentar la seguridad en su producción y uso.(AU)

What county-level factors influence COVID-19 incidence in the United States? Findings from the first wave of the pandemic.

Effective control of the COVID-19 pandemic via appropriate management of the built environment is an urgent issue. This study develops a research framework to explore the relationship between COVID-19 incidence and influential factors related to protection of vulnerable populations, intervention in transmission pathways, and provision of healthcare resources. Relevant data for regression analysis and structural equation modeling is collected during the first wave of the pandemic in the United States, from counties with over 100 confirmed cases. In addition to confirming certain factors found in the existing literature, we uncover six new factors significantly associated with COVID-19 incidence. Furthermore, incidence during the lockdown is found to significantly affect incidence after the reopening, highlighting that timely quarantining and treating of patients is essential to avoid the snowballing transmission over time. These findings suggest ways to mitigate the negative effects of subsequent waves of the pandemic, such as special attention of infection prevention in neighborhoods with unsanitary and overcrowded housing, minimization of social activities organized by neighborhood associations, and contactless home delivery service of healthy food. Also worth noting is the need to provide support to people less capable of complying with the stay-at-home order because of their occupations or socio-economic disadvantage.

Simulation Modeling for the Economic Evaluation of Population-Based Dietary Policies: A Systematic Scoping Review.

Simulation modeling can be useful to estimate the long-term health and economic impacts of population-based dietary policies. We conducted a systematic scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline to map and critically appraise economic evaluations of population-based dietary policies using simulation models. We searched Medline, Embase, and EconLit for studies published in English after 2005. Modeling studies were mapped based on model type, dietary policy, and nutritional target, and modeled risk factor-outcome pathways were analyzed. We included 56 studies comprising 136 model applications evaluating dietary policies in 21 countries. The policies most often assessed were reformulation (34/136), taxation (27/136), and labeling (20/136); the most common targets were salt/sodium (60/136), sugar-sweetened beverages (31/136), and fruit and vegetables (15/136). Model types included Markov-type (35/56), microsimulation (11/56), and comparative risk assessment (7/56) models. Overall, the key diet-related risk factors and health outcomes were modeled, but only 1 study included overall diet quality as a risk factor. Information about validation was only reported in 19 of 56 studies and few studies (14/56) analyzed the equity impacts of policies. Commonly included cost components were health sector (52/56) and public sector implementation costs (35/56), as opposed to private sector (18/56), lost productivity (11/56), and informal care costs (3/56). Most dietary policies (103/136) were evaluated as cost-saving independent of the applied costing perspective. An analysis of the main limitations reported by authors revealed that model validity, uncertainty of dietary effect estimates, and long-term intervention assumptions necessitate a careful interpretation of results. In conclusion, simulation modeling is widely applied in the economic evaluation of population-based dietary policies but rarely takes dietary complexity and the equity dimensions of policies into account. To increase relevance for policymakers and support diet-related disease prevention, economic effects beyond the health sector should be considered, and transparent conduct and reporting of model validation should be improved.

Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti.

Centre Department, Haiti, was the origin of a major cholera epidemic during 2010-2019. Although no fine-scale spatial delineation is officially available, we aimed to analyze determinants of cholera at the local level and identify priority localities in need of interventions. After estimating the likely boundaries of 1,730 localities by using Voronoi polygons, we mapped 5,322 suspected cholera cases reported during January 2015-September 2016 by locality alongside environmental and socioeconomic variables. A hierarchical clustering on principal components highlighted 2 classes with high cholera risk: localities close to rivers and unimproved water sources (standardized incidence ratio 1.71, 95% CI 1.02-2.87; p = 0.04) and urban localities with markets (standardized incidence ratio 1.69, 95% CI 1.25-2.29; p = 0.0006). Our analyses helped identify and characterize areas where efforts should be focused to reduce vulnerability to cholera and other waterborne diseases; these methods could be used in other contexts.

A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention".

Lencucha and Thow tackle the enormous public health challenge of developing non-communicable disease (NCD) policy coherence within a world structured and ruled by neoliberalism. Their work compliments scholarship on other causal mechanisms, including the commercial determinants of health, that have contributed to creating the risk commodity environment and barriers to NCD prevention policy coherence. However, there remain significant gaps in the understanding of how these causal mechanisms interact within a whole system. As such, public health researchers' suggestions for how to effectively prevent NCDs through addressing the risk commodity environment tend to remain fragmented, incomplete and piecemeal. We suggest this is, in part, because conventional policy analysis methods tend to be reductionist, considering causal mechanisms in relative isolation and conceptualizing them as linear chains of cause and effect. This commentary discusses how a systems thinking approach offers methods that could help with better understanding the risk commodity environment problem, identifying a more comprehensive set of effective solutions across sectors and its utility more broadly for gaining insight into how to ensure recommended solutions are translated into policy, including though transformation at the paradigmatic level.

Built environment for physical activity-An urban barometer, surveillance, and monitoring.

The Lancet Commission on Obesity (LCO), also known as the "syndemic commission," states that radical changes are required to harness the common drivers of "obesity, undernutrition, and climate change." Urban design, land use, and the built environment are few such drivers. Holding individuals responsible for obesity detracts from the obesogenic built environments. Pedestrian priority and dignity, wide pavements with tree canopies, water fountains with potable water, benches for the elderly at regular intervals, access to open-green spaces within 0.5-km radius and playgrounds in schools are required. Facilities for physical activity at worksite, prioritization of staircases and ramps in building construction, redistribution of land use, and access to quality, adequate capacity, comfortable, and well-networked public transport, which are elderly and differently abled sensitive with universal design are some of the interventions that require urgent implementation and monitoring. An urban barometer consisting of valid relevant indicators aligned to the sustainable development goals (SDGs), UN-Habitat-3 and healthy cities, should be considered a basic human right and ought to be mounted for purposes of surveillance and monitoring. A "Framework Convention on Built Environment and Physical Activity" needs to be taken up by WHO and the UN for uptake and implementation by member countries.

Sugar-sweetened beverage consumption in the early years and implications for type-2 diabetes: a sub-Saharan Africa context.

This review aims to explore trends of early consumption of sugar-sweetened beverages (SSB) in sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSB, including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases (NCD). SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSB already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Public health efforts in many high income and some middle-income countries address increasing prevalence of obesity and type-2 diabetes by focusing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of NCD, particularly when contextualised with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSB are necessary to help address this issue.

Evaluation of Get Healthy at Work, a state-wide workplace health promotion program in Australia.

BACKGROUND: Workplace health programs (WHPs) may improve adult health but very little evidence exists on multi-level WHPs implemented at-scale and so the relationship between program implementation factors and outcomes of WHPs are poorly understood. This study evaluated Get Healthy at Work (GHaW), a state-wide government-funded WHP in Australia. METHODS: A mixed-method design included a longitudinal quasi-experimental survey of businesses registered with GHaW and a comparison group of businesses surveyed over a 12-month period. Semi-structured interviews and focus groups with key contacts and employees of selected intervention group businesses and the service providers of the program were conducted to assess program adoption and adaptation. RESULTS: Positive business-level changes in workplace culture were observed over time among GHaW businesses compared with the control group. Multilevel regression modelling revealed perceptions that employees were generally healthy (p = 0.045 timeXgroup effect) and that the workplace promoted healthy behaviours (p = 0.004 timeXgroup effect) improved significantly while the control group reported no change in work culture perceptions. Changes in perceptions about work productivity were not observed; however only one third of businesses registered for the program had adopted GHaW during the evaluation period. Qualitative results revealed a number of factors contributing to program adoption: which depended on program delivery (e.g., logistics, technology and communication channels), design features of the program, and organisational factors (primarily business size and previous experience of WHPs). CONCLUSIONS: Evaluation of program factors is important to improve program delivery and uptake and to ensure greater scalability. GHaW has the potential to improve workplace health culture, which may lead to better health promoting work environments. These results imply that government can play a central role in enabling prioritisation and incentivising health promotion in the workplace.

Healthy Design and Urban Planning Strategies, Actions, and Policy to Achieve Salutogenic Cities.

Starting from a previous experience carried out by the working group "Building and Environmental Hygiene" of the Italian Society of Hygiene and Preventive Medicine (SItI), the aim of the present work is to define new strategic goals for achieving a "Healthy and Salutogenic City", which will be useful to designers, local governments and public bodies, policy makers, and all professionals working at local health agencies. Ten key points have been formulated: 1. climate change and management of adverse weather events; 2. land consumption, sprawl, and shrinking cities; 3. tactical urbanism and urban resilience; 4. urban comfort, safety, and security perception; 5. strengths and weaknesses of urban green areas and infrastructures; 6. urban solid waste management; 7. housing emergencies in relation to socio-economic and environmental changes; 8. energy aspects and environmental planning at an urban scale; 9. socio-assistance and welfare network at an urban scale: importance of a rational and widespread system; and 10. new forms of living, conscious of coparticipation models and aware of sharing quality objectives. Design strategies, actions, and policies, identified to improve public health and wellbeing, underline that the connection between morphological and functional features of urban context and public health is crucial for contemporary cities and modern societies.

What is required to facilitate implementation of Swedish physical activity on prescription? - interview study with primary healthcare staff and management.

BACKGROUND: The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. METHODS: Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. RESULTS: We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management's beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. CONCLUSION: The study provides knowledge regarding requirements to facilitate the implementation of SPAP in healthcare. There was limited knowledge among health professionals regarding core components of SPAP and how to practise the method, which speaks for in-depth training in the SPAP method. The findings highlight the importance of forming policies and guidelines and establishing organisational supporting structures, and ensuring that these are well known and approved in all parts of the healthcare organisation.

Incidência de transmissão vertical do HIV entre gestantes soropositivas cadastradas em um serviço de referência regional / Incidencia de transmisión vertical del VIH entre las gestantes seropositivas registradas en un servicio de referencia regional / Incidence of HIV vertical transmission among HIV-positive pregnant women treated at a regional reference service

surveying and to characterizing the incidence of HIV vertical transmission, from 2004 to 2013, among pregnant women accompanied by a referral service in STD, HIV/AIDS and Viral Hepatitis in the countryside of Minas Gerais. Method: it is a quantitative descriptive study. Data were obtained from the medical records of women infected by HIV registered in the unit. For analysis, there was used the simple descriptive statistics. It was approved by the Research Ethics Committee of the Higher Education Foundation of Passos (FESP), with CAAE: 28399314.8.0000.5112. Results: of the 33 pregnancies treated at the service, 60,6% (20) knew the diagnosis before pregnancy and 39,4% (13) of them obtained it during the prenatal period. In the first group there was no vertical transmission, while in the second group, there was one case, 8%. Conclusion: it is recommended that pregnant women do the test still in the first three months of pregnancy, because late diagnosis makes difficult doing prophylaxis...

levantar e caracterizar a incidência de transmissão vertical do HIV, no período de 2004 a 2013, entre gestantes acompanhadas por serviço de referência em DST, HIV/AIDS e Hepatites Virais no interior de Minas Gerais. Método: estudo quantitativo descritivo. Os dados foram obtidos em prontuários de mulheres soropositivas para o HIV. Para análise utilizou-se a estatística descritiva simples. Aprovado pela Comissão de Ética em Pesquisa da Fundação de Ensino Superior de Passos (FESP), com CAAE: 28399314.8.0000.5112. Resultados: das 33 gestações acompanhadas no serviço, 60,6% (20) conheciam o diagnóstico antes da gravidez e 39,4% (13) o obtiveram durante o pré-natal. No primeiro grupo não houve transmissão vertical, enquanto que no segundo houve um caso, 8%. Conclusão: recomenda-se realização de teste ainda no primeiro trimestre gestacional, pois o diagnóstico tardio dificulta a profilaxia...

conocer y caracterizar la incidencia de la transmisión vertical del VIH, en el período 2004-2013, entre mujeres embarazadas acompañadas en un servicio de referencia de enfermedades de transmisión sexual, VIH/SIDA y la hepatitis viral en Minas Gerais. Método: este es un estudio cuantitativo descriptivo. Los datos se obtuvieron de los registros médicos de mujeres infectadas por el VIH registradas en la unidad. Para el análisis, se utilizó la estadística descriptiva simple. Aprobado por el Comité de Ética en Investigación de la Fundación de la Educación Superior de Passos (FESP), CAEE: 28399314.8.0000.5112. Resultados: de las 33 gestaciones atendidas en el servicio, el 60,6% (20) fueron de mujeres que conocían el diagnóstico antes del embarazo y el 39,4% (13) de mujeres que sólo lo obtuvieron durante el período prenatal. En el primer grupo no hubo ninguna transmisión vertical, mientras que en el segundo hubo un caso, 8%. Conclusión: se recomienda la prueba en el primer trimestre del embarazo, ya que el diagnóstico tardío dificulta el profilaxis...

Review of HealthⅦProject for disease prevention and control by means of health promotion in Shanghai / 上海预防医学

Health ⅦProject was first implemented and financed by the international organizations in Shanghai from 1996 to 2002.It is an innovative, representative and advanced project of preventing and controlling non-communicable disease ( NCD) by means of health promotion.The project subverted the traditional means and methods in chronic disease prevention and control, introduced the advanced international theory and methods, and explored the health promotion methods suitable for China's national conditions in NCD, STD/AIDS and accidental injuries prevention and control.These yielded good project results and effective experiences were expected to be generalized widely. The project consisted of four aspects: organization development and policy reform, human resource development, surveillance and intervention, which were linked up each other and mutually promoted.The strategies design adopted principles of localization focusing on health promotion, intervention different in strategies to specific risk factors and for different targeted population, emphasis on the implementation framework of comprehensive intervention.The project had not only achieved distinct results, but also introduced and localized an advanced international health promotion idea and methods of NCD prevention and control.And innovatively were developed successful integrated NCD control pattern, implementation framework and technical route.Meanwhile, a team of professionals in NCD prevention and control had been trained. Considering the sustainability, the study suggests five critical links and three sustainable development factors in NCD comprehensive prevention.Proposals are given as to how to integrate health education and health promotion into disease prevention and control .

Percepção do homem em relação à infecção por papilomavírus humano - HPV / Man?s perception of the human papillomavirus infection - HPV

Objetivo: descrever a qualidade da percepção do homem quanto à infecção pelo papilomavírus humano em Aracaju, Sergipe. Métodos: trata-se de estudo observacional, transversal, por intermédio da aplicação de questionários abrangendo o conhecimento sobre a infecção pelo vírus do papiloma humano (HPV) a dois grupos de indivíduos: o primeiro, sem algum esclarecimento prévio; e o segundo, após palestras prévias. O primeiro grupo foi entrevistado entre fevereiro e maio de 2012 e o segundo entre abril e junho de 2013. Foram incluídos no estudo os que atendiam aos critérios de inclusão e aceitaram participar da pesquisa a partir de assinatura no termo de consentimento livre e esclarecido. Os resultados obtidos foram analisados pelo programa SPSS. A pesquisafoi submetida ao Comitê de Ética. Resultados: no primeiro grupo, 200 sujeitos responderam aos questionários, enquanto no segundo 90 sujeitos participaram da pesquisa com a omissão de respostas em vários itens do questionário. A respeito do conceito do HPV e quais doenças ele provoca, 42% do primeiro grupo demonstraram conceito correto. Este índice aumentou para 74,6% no segundo grupo. Sobre o conhecimento ea função da peniscopia observou-se diferença importante entre os sujeitos do primeiro e do segundo grupos, sendo que 93,5 e 92,5% no primeiro desconheciam a função e o conceito, respectivamente. E no segundo grupo, 72,6 e 64,6% demonstraram conhecimento, respectivamente. Conclusão: a qualidade da percepção do homem sobre ainfecção pelo HPV melhorou após ministração de palestras educativas acerca do tema, embora mesmo após serem orientados, importante parcela de indivíduos não demonstrou interesse em responder as perguntas sobre o assunto.

Objective: to describe the quality of perception of man over the human papillomavirus infectionin Aracaju, Sergipe. Methods: this was an observational and cross-sectional study,conducted through the use of questionnaires covering the knowledge of infection by the humanpapillomavirus (HPV) to two groups of individuals: the first one without any prior informationabout the subject; and the second one after receiving previous information. The first group was interviewed between February and May of 2012 and the second between April and June of 2013. The study included those who met the inclusion criteria and agreed to participate by signing the volunteer consent form. The results were analyzed using theSPSS software. The study was submitted to the Ethics Committee. Results: 200 subjects in the first group answered the questionnaires, while 90 subjects in the second group participated, including omitting some answers on various items in the questionnaire. Regarding the HPV concept and what diseases it causes, 42% in the first group demonstrated havingthe correct concept. This index increased to 74.6% in the second group. On the basis of knowledge about peniscopy, a significant difference was observed between subjects in the sefirst and second groups; 93.5 and 92.5% in the first group were unaware of the concept and function, respectively.In the second group, 72.6 and 64.6% demonstratedknowledge, respectively. Conclusion: the quality of man?sperception of HPV infection improved after attending educational lectures on the subject, although even after being taught, an important share of individuals showed no interest in answering questions about the matter.

Funcionamiento de las políticas gubernamentales para la prevención y el control del dengue: el caso de Arauca y Armenia en Colombia / Operation of government policies for the prevention and control of dengue: The cases of Arauca and Armenia

Introducción. El dengue es un problema de salud pública en aumento en las zonas urbanas, debido a que su transmisión está asociada con el ambiente y el comportamiento de las personas y las comunidades. El modelo propuesto por Ecosalud para su estudio, incluye el análisis del funcionamiento de las políticas gubernamentales. Objetivo. Describir el funcionamiento de las políticas para prevenir y controlar el dengue en dos ciudades colombianas. Materiales y métodos. Se adelantó un estudio cualitativo, para lo cual se recopiló información mediante entrevistas a funcionarios del sector de la salud y la educación, cuyos contenidos se procesaron en Ethnograph con base en las categorías de análisis propuestas en el modelo de ´implementación desde la base´. Resultados. Se encontró que había desarticulación entre el departamento y el municipio, así como un desarrollo escaso del protocolo de dengue y dengue hemorrágico en cuanto a la participación comunitaria, las estrategias de comunicación y los estudios de conocimientos, actitudes y prácticas de los pobladores. La estrategia de gestión integrada se ve limitada por la inestabilidad del recurso humano, la escasa coordinación entre instituciones y sectores, y la falta de énfasis en las intervenciones de promoción tanto a nivel individual como de la población. Conclusiones. En Arauca es necesario fortalecer la coordinación entre el departamento y el municipio. Tanto en Arauca como en Armenia se requiere mejorar la administración de los recursos humanos y la coordinación interinstitucional, así como fortalecer la promoción y la prevención, para lograr el efecto esperado sobre los factores determinantes del dengue.

Introduction: Dengue is a growing public health problem in urban areas, given that its transmission is associated with the environment, as well as with the behaviour of individuals and communities. The model proposed by Ecohealth to study this problem includes the operation of government policies. Objective: To describe the operation of policies to prevent and control dengue in two Colombian cities. Materials and methods: A qualitative study was conducted. Data was collected through interviews with officials who worked in the health and education sectors. The contents were processed with the Ethnograph software, using the proposals of the bottom-up model of implementation as analytical categories. Results: A lack of coordination was identified between department and municipal offices, with few developments of the protocol for dengue and severe dengue in terms of community participation, communication strategies and studies of inhabitants´ knowledge, attitudes and practices. The integrated management strategy was limited by the instability of human resources, limited intra-institutional and cross-sectorial coordination and little emphasis on promotion interventions, both at the individual and population levels. Conclusions: Coordination between the departament and the municipality needs to be strengthened in the city of Arauca. Both here and in Armenia administration of human resources and interinstitutional coordination should be improved. Promotion of preventative measures should be strengthened to impact on the determinants of dengue.

Middle East respiratory syndrome outbreak and infectious disease control in Korea

After the first diagnosis of Middle East Respiratory Syndrome (MERS) in Korea on May 20th, 2015, significant fear and anxiety surrounding infectious diseases has emerged in the community. Using the recent MERS case in Korea as an example, we hope to identify problems in the governance of infectious diseases management and to suggest improvements. Korean Health authorities have demonstrated inadequacy in several areas in preparing for and responding to emerging infectious diseases threats. There is lack of monitoring or education regarding prevention, and there are no systems for monitoring people visiting or residing in infectious disease risk areas. Moreover, operating a continuous monitoring system by the Korea Centers for Diseases Control and Prevention (KCDC) is very difficult due to the lack of permanent support for a clear command and control system and specialists for responding to public health emergencies. The MERS situation has highlighted the importance of risk communication during public health crises. In order to advance the governance of infectious disease management, the KCDC should be improved as a priority. The Korean government should nurture the development of professional personnel who can respond to global health crises. Furthermore, the expansion of medical isolation facilities within hospital wards and emergency departments is needed. However, the cooperation of the public is a critical factor in this campaign. The public should be educated about appropriate action during disasters and public health crises, including strategies for practicing this action in everyday life.

Leprosy: a review of laboratory and therapeutic aspects - Part 2

Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis.

Modelo de curso para treinamento dos profissionais que atuam nos salões de beleza usando a teleducação interativa / Model training course for beauty salon professionals using interactive tele-education

Introdução: Muitas doenças podem ser transmitidas quando não se seguem os hábitos adequados de higienização das mãos e esterilização de materiais em atividades que podem gerar ferimentos ou traumas na pele, como ocorrem nos salões de beleza. Os profissionais da beleza precisam conhecer e ter a consciência em relação a atitudes simples de higienização e cuidados com o compartilhamento de instrumentos, pela interação com muitas pessoas e pela possibilidade de ocorrer a transmissão de doenças, incluindo as doenças sexualmente transmissíveis, como as verrugas, as hepatites B e C, e o HIV, durante a realização de seus procedimentos. O Serviço Brasileiro de Apoio à Micro e Pequena Empresa apontou, em fevereiro de 2013, a existência de 265 mil estabelecimentos, abertos por pessoas que formalizaram a situação como microempreendedores individuais. Os salões de beleza são, numericamente, expressivos e apesar de não haver dados oficiais sobre o número de trabalhadores no Brasil, estima-se um grande número de pessoas envolvidas. Este estudo objetivou estruturar um curso aplicado por meio de uma dinâmica por teleducação interativa e avaliar o efeito educacional neste segmento profissional. Métodos: Foram selecionadas 4 categorias temáticas (doenças sexualmente transmissíveis, saúde indoor nos salões de beleza, lavagem das mãos e esterilização de materiais) a partir de uma Matriz de Objetivos e Competências, e o curso foi inserido numa plataforma educacional baseada no Moodle, com ambientes interativos de aprendizagem e ferramenta de gestão educacional. A sistemática das atividades foi organizada com metas semanais, encontros síncronos via web e acesso a materiais de forma assíncrona (materiais de leitura, de aprendizagem complementar, áudios e vídeos educacionais, fóruns de discussão, Simulador de Situações Práticas e vídeos do Projeto Homem Virtual sobre as DST/AIDS, higienização das mãos e lavagem, transmissão de doenças por cera depilatória reutilizável e alicate de...

Introduction: Many diseases can be transmitted when professionals do not follow the proper habits of hand washing and material sterilization in activities that may cause skin injury or trauma, as is the case in beauty salons. Beauty professionals need to know and be aware of simple steps to cleaning care and instruments sharing, as they interact with many people, thus increasing the possibility of disease transmission, including sexually transmitted diseases such as warts, hepatitis B and C, and HIV, while carrying out their procedures. The Brazilian Service of Support for Micro and Small Enterprises pointed out the existence of 265,000 establishments in February 2013, opened by people who formalized their business as individual microenterprises. Beauty salons are numerically significant, and although there are no official data on the number of workers in Brazil, a large number is estimated. This study aimed to structure a distance-learning course via interactive tele-education dynamics, and to evaluate the educational effect in this professional segment. Methods: Four thematic categories were selected (sexually transmitted diseases, indoor health in salons, hand washing and material sterilization) from a matrix of objectives and competences. The course was inserted in an educational platform based on Moodle, with interactive learning environments and educational management tools. The activities systematics was organized with weekly goals, synchronous web meetings, and asynchronous access to materials (readings, discussion forums, situation simulator, audio and educational videos as well as 3-D Virtual Human video animation on sexually transmitted infections, hand washing and disease transmission from reusable depilatory wax and contaminated nail pliers). The course started with two face-to-face meetings and, in order to assess participants' practical knowledge, a simulator to practical situations was created, which was an online test...

Mulheres solteiras e casadas e o uso do preservativo: o que sabem, pensam e praticam / Single and married women and condom use: what they know, think and practice

O uso de preservativos se constitui a principal medida preventivapara reduzir e controlar a feminização e heterossexualizaçãoda Aids.Assim, os objetivos do estudo foram: avaliar o conhecimento, a atitude e a prática de mulheres quanto ao uso de preservativos como medida preventiva às IST/HIV; associar fatores sociodemográficos (idade, religião, escolaridade e estado civil) com o conhecimento, atitude e prática do uso de preservativos entre mulheres; e analisar a associação do conhecimento e da atitude com a prática do uso de preservativos entre mulheres solteiras e casadas. Trata-se de uma pesquisa avaliativa de Conhecimento, Atitude e Prática (CAP), de corte transversal e abordagem quantitativa, com amostra de 300 mulheres, residentes em um aglomerado subnormal do município de João Pessoa, maiores de 18 anos e que já tivesse iniciado a vida sexual. O inquérito domiciliar ocorreu de junho a agosto de 2013, seguindo um plano de amostragem sistemática, com salto de três domicílios. O instrumento de coleta de dados incluiu a caracterização sociodemográfica, hábitos de vida, histórico sexual/reprodutivo, bem como perguntas envolvendo conhecimento, atitude e prática adaptado dos modelos de inquérito CAP do Ministério da Saúde e de Nicolau (2010). Os dados foram compilados, armazenados e analisados com o auxílio do programa estatístico Statistical Package for the social sciences (SPSS)versão 20.0. Para as associações entre as variáveis, foi utilizado o Teste Qui-quadrado de Pearson e Teste Exato de Fisher, considerando um resultado estatisticamente significativo quando p≤0,05.

The use of condomsisthe main preventive measure to reduce and control the feminization and heterosexuals of AIDS. The objectives of the study were: to assess the knowledge, attitude and practice of women about the use of condoms as a preventive measure to STIs/HIV; to associate sociodemographic factors (age, religion, education and marital status) with the knowledge, attitude and practice of condom use among women; and to analyze the association between knowledge and attitude with the practice of condom‟suseamong married and single women. This is anevaluative research of Knowledge, Attitude and Practice (KAP) of cross-sectional quantitative approach with a sample of 300 women living in a subnormal region in the city of João Pessoa, over 18 yearsold and thatalready started sexual life. The data collection ocurredfrom June to August 2013, following a plan of systematic sampling, to jump three households. The instrument for data collection included sociodemographic characteristics, lifestyle habits, sexual/reproductive history, as well as questions involving knowledge, attitude and practiceadaptedfromthe models of KAP survey of the Ministry of Health and Nicolau (2010). Data were collected, stored and analyzed with the aid of the Statistical Packagefor Social Sciences (SPSS) version 20.0. Forassociations between variables, the Chi-square test and Fisher's exact test was used, whereas a statistically significant result when p ≤ 0.05.

Análisis de costo-beneficio: prevención del VIH/sida en migrantes en Centroamérica / Cost-benefit analysis: HIV/AIDS prevention in migrants in Central America

OBJETIVO: Cuantificar los costos y beneficios de tres intervenciones de prevención del VIH en migrantes en Centroamérica: consejería y pruebas voluntarias, tratamiento de infecciones de transmisión sexual y distribución de condones. MATERIAL Y MÉTODOS: Este estudio se basa en información proveniente de 11 estaciones de tránsito, ubicadas en las fronteras de cinco países que fue recolectada en el período de marzo de 2007 a marzo de 2009 e incluye datos de atención a pacientes en temas de VIH/sida. El número total de registros recibidos de personas con ITS y que recibieron consejería y pruebas rápidas voluntarias (CPV) es de 3 210 y 4 917 individuos, respectivamente. El análisis de costo-beneficio se realizó en tres etapas: a) identificación y cuantificación de costos; b) cuantificación de beneficios (ahorros potenciales en terapia antirretroviral por casos prevenidos de VIH) y c) estimación de la razón costo-beneficio. RESULTADOS: El modelo estima prevención de 9, 21 y 8 casos del VIH por CPV, TxITS y distribución de condones por cada 10 000 migrantes, respectivamente. En Panamá la distribución de condones y TxITS tienen un retorno de US$131/USD y US$69.8/USD, respectivamente. En El Salvador, los retornos son de US$2.0/USD y US$42.3/USD en CPV y distribución de condones, respectivamente. CONCLUSIÓN: Los ahorros potenciales por prevención varían entre países. Las estimaciones de costo-beneficio sugieren que los programas de prevención del VIH en países centroamericanos representarían ahorros monetarios a largo plazo.

OBJECTIVE: To quantify the costs and benefits of three HIV prevention interventions in migrants in Central America: voluntary counseling and testing, treatment of sexually transmitted infections, and condom distribution. MATERIALS AND METHODS: The methods were: a) identification and quantification of costs; b) quantification of benefits, defined as the potential savings in antiretroviral treatment of HIV cases prevented; and c) estimation of the cost-benefit ratio. RESULTS: The model estimated that 9, 21 and 8 cases of HIV were prevented by voluntary counseling and testing, treatment for sexually transmitted infections and condom distribution per 10 000 migrants, respectively. In Panama, condom distribution and treatment for sexually transmitted infections had a return of US$131/USD and US$69.8/USD. Returns in El Salvador were US$2.0/USD and US$42.3/USD in voluntary counseling and testing and condom distribution, respectively. CONCLUSION: The potential savings on prevention have a large variation between countries. Nevertheless, the cost-benefit estimates suggest that the HIV prevention programs in Central America can potentially result in monetary savings in the long run.

Populations at risk for alveolar echinococcosis, France.

During 1982-2007, alveolar echinococcosis (AE) was diagnosed in 407 patients in France, a country previously known to register half of all European patients. To better define high-risk groups in France, we conducted a national registry-based study to identify areas where persons were at risk and spatial clusters of cases. We interviewed 180 AE patients about their way of life and compared responses to those of 517 controls. We found that almost all AE patients lived in 22 départements in eastern and central France (relative risk 78.63, 95% CI 52.84-117.02). Classification and regression tree analysis showed that the main risk factor was living in AE-endemic areas. There, most at-risk populations lived in rural settings (odds ratio [OR] 66.67, 95% CI 6.21-464.51 for farmers and OR 6.98, 95% CI 2.88-18.25 for other persons) or gardened in nonrural settings (OR 4.30, 95% CI 1.82-10.91). These findings can help sensitization campaigns focus on specific groups.