Content analysis of the Measure of the Quality of the Environment by linkage with the International Classification of Functioning, Disability and Health.

BACKGROUND: This study explores the linkage between the Measurement of Environmental Quality (MQE) and the International Classification of Functioning, Disability, and Health (ICF). Stemming from the Human Development Model-Disability Creation Process (HDM-DCP), MQE enhances understanding of how environmental quality impacts disability development across diverse socio-cultural contexts. Integrating MQE with ICF expands the perspective on disability formation beyond HDM-DCP, encompassing ICF's functioning approach. OBJECTIVE: To link the MQE with the concepts and categories of the ICF. METHODS: Two health professionals with adequate taxonomic knowledge of the ICF performed the initial linkage, which was based on updated standardized rules considering all hierarchical levels of the ICF. Linkage agreement between the first two assessors was measured using the Kappa (k) coefficient and respective 95% confidence intervals. In the absence of a consensus between the two assessors (k > 0.60), a third assessor was consulted to make the arbitrary decision of the final categories linked to the MQE. RESULTS: Insufficient agreement between the two assessors was found for the linkage process (k = 0.52; p < 0.001), requiring the final decision from the third assessor. At the end of the process, 26 ICF categories were linked to the main concepts (MC) measured by the 26 items of the short version of the MQE. Ten ICF categories were linked to the additional concepts (AC) measured by the MQE. Moreover, the MQE addresses the five domains of the ICF component "environmental factors," with a predominance of the "services, systems and policies" domain (MC = 45.8% and AC = 40%). CONCLUSION: The linkage of the concepts measured by the MQE to ICF categories enabled mapping the content of the MQE, identifying it as a promising tool for measuring environmental factors in accordance with ICF percepts.

Effectiveness of single-lead ECG devices for detecting atrial fibrillation: An overview of systematic reviews.

BACKGROUND: Individuals with atrial fibrillation (AF) are at an increased risk for stroke. Early detection of undiagnosed AF by screening is recommended. Single-lead electrocardiogram (ECG) is the most widely used technology in AF detection. Several systematic reviews on the diagnostic accuracy of single-lead ECG devices for AF detection have been performed but have yielded inconclusive results. AIMS: The aim of this study was to synthesize the available evidence on the effectiveness of single-lead ECG devices in detecting AF. METHODS: An overview of systematic reviews was conducted. Five English databases (Cochrane Database of Systematic Reviews, PubMed, Embase, Ovid, and Web of Science) and two Chinese databases (Wanfang and CNKI) were searched from inception to July 31, 2021. Systematic reviews that examined the accuracy of tools based on single-lead ECG technology for detecting AF were included. A narrative data synthesis was performed. RESULTS: Eight systematic reviews were finally included. Systematic reviews with meta-analysis showed that single-lead ECG-based devices had good sensitivity and specificity (both ≥90%) in detecting AF. According to subgroup analysis, the sensitivities of tools used in populations with a history of AF were all >90%. However, among handheld and thoracic placed single-lead ECG devices, large variations in diagnostic performance were observed. LINKING EVIDENCE TO ACTION: Single-lead ECG devices can potentially be used for AF detection. Due to the heterogeneity in the study population and tools, future studies are warranted to explore the suitable circumstances in which each tool could be applied for AF screening in an effective and cost-effective manner.

Boas práticas sobre o gerenciamento de residuos em saúde: uma revisão integrativa / Good practices on health waste management: an integrative review / Buenas prácticas sobre la gestión de los desechos de salud: un examen integrativo

Objetivo: objetivo identificar na literatura científica as boas práticas utilizadas em ambientes hospitalares sobre o processo de gerenciamento de resíduos em saúde. Método: trata-se de uma revisão integrativa, realizada nas bases de dados LILACS, MEDLINE/PubMed, Scopus e Web of Science, em abril de 2022. Utilizaram-se os descritores Waste Management, Medical Waste, Solid Waste Processing, Hospitals, combinados com o operador booleano AND. Foram encontrados 95 artigos e selecionados 12. Resultados: as boas práticas utilizadas pelos profissionais em ambientes hospitalares que auxiliam no processo de gerenciamento de resíduos em saúde foram: implementação de política de gestão sobre resíduos em saúde e presença de orçamento especial para a gestão de resíduos, estabelecimento de subcomitês de descarte em diferentes departamentos para monitorar o descarte de resíduos médicos, presença de comitê de gerenciamento de resíduos de saúde, comitê de proteção contra radiações e de comitê de prevenção e controle de infecção, disponibilização de equipamentos de proteção individual, fichas de informação de gerenciamento de resíduo químico perigoso hospitalar, diretrizes de prevenção e controle de infecção e de instrumentos educativos, além de treinamentos específicos sobre a temática e disponibilização de locais de armazenamento de resíduos separados de resíduos perigosos. Conclusão: a gestão segura dos RSS se mostra cada dia mais muito importante no que diz respeito ao meio ambiente e à saúde pública. Porém, entre os artigos citados percebe-se a implementação de boas práticas mas, de forma incipiente.

Objective: objective: to identify in the scientific literature the good practices used in hospital environments on the process of waste management in health. Method: This is an integrative review, carried out in the LILACS, MEDLINE/PubMed, Scopus and Web of Science databases in April 2022. The descriptors Waste Management, Medical Waste, Solid Waste Processing, Hospitals, combined with the Boolean operator AND were used. 95 articles were found and 12 were selected. Results: the good practices used by professionals in hospital environments that assist in the process of waste management in health were: implementation of management policy on waste in health and presence of special budget for waste management, establishment of disposal subcommittees in different departments to monitor the disposal of medical waste, presence of health waste management committee, radiation protection committee and infection prevention and control committee, provision of personal protection equipment, information sheets for management of hazardous chemical waste in hospital, guidelines for infection prevention and control and educational instruments, besides specific training on the subject and provision of separate waste storage sites for waste from hospital waste dangerous. Conclusion: the safe management of SSR is becoming increasingly important in terms of the environment and public health. However, the articles mentioned include the implementation of good practices, but in a nascent way.

Propósito: identificar en la literatura científica las mejores prácticas utilizadas en los ambientes hospitalarios en el proceso de manejo de residuos en salud. Método: Se trata de una revisión integrada realizada en las bases de datos LILACS, MEDLINE/PubMed, Scopus y Web of Science en abril de 2022. Se utilizaron los descriptores Gestión de Residuos, Residuos Médicos, Procesamiento de Residuos Sólidos, Hospitales, combinados con el operador Y booleano. Se encontraron 95 artículos y se seleccionaron 12. Resultados: las buenas prácticas utilizadas por los profesionales en los entornos hospitalarios que ayudan en el proceso de gestión de los desechos en la salud fueron: aplicación de la política de gestión de los desechos en la salud y presencia de un presupuesto especial para la gestión de los desechos, establecimiento de subcomités de eliminación en diferentes departamentos para supervisar la eliminación de los desechos médicos, presencia de comités de gestión de los desechos sanitarios, comité de protección radiológica y comité de prevención y control de las infecciones, suministro de equipo de protección personal, información sobre la gestión de los desechos químicos peligrosos hospitalarios herramientas educativas, así como capacitación específica sobre el tema y suministro de sitios de almacenamiento de desechos separados para desechos peligrosos. En conclusión, la gestión segura de las denuncias de infecciones de transmisión sexual es cada vez más importante en lo que respecta al medio ambiente y la salud pública. Sin embargo, entre los artículos citados figura la aplicación de buenas prácticas, pero de manera incipiente.

Self-medication in hospitalized patients with COVID-19: A cross-sectional study in northern Peru.

Introduction: This study aimed to identify factors associated with self-medication in patients with COVID-19. Methods: A cross-sectional study was conducted using medical records of patients with COVID-19 who self-medicated before admission to a hospital in Piura, Peru. Prevalence ratios and 95% confidence intervals were estimated using generalized linear models with Poisson distribution family, log link function, and robust variance. Results: Out of 301 patients, 165 (54.8%) self-medicated before hospital admission, being more frequent self-medication with ivermectin (85.5%) and azithromycin (71.5%). The frequency of self-medication in those aged between 30-59 years was 2.53-fold higher than in those between 18-29 years. Male patients, dyslipidemia, smoking, and hepatic steatosis were associated with self-medication. Clinical characteristics associated with self-medication were fever, cough, headache, anosmia, dysgeusia, nausea/vomiting, and gastroesophageal reflux. Conclusions: A high frequency of self-medication before hospital admission was observed in Peruvian patients with COVID-19, mainly of drugs without proven efficacy.

Evaluation of a pre-exposure prophylaxis (PrEP) program for HIV prevention in a federally qualified health center (FQHC).

BACKGROUND: Preventing new cases of the human immunodeficiency virus (HIV) is key to the Centers for Disease Control and Prevention (CDC) Ending the HIV Epidemic: A Plan for America initiative. In 2012, Truvada became the first medication approved in the United States to prevent HIV infection, yet it has not seen widespread use. AIM: This study aimed to allow for the incorporation of an HIV risk assessment into the primary care provider (PCP) visit and promote increased numbers of patients screened for pre-exposure prophylaxis of HIV (PrEP). METHODS: An educational program and an electronic HIV risk assessment tool were provided to the healthcare providers in an urban federally qualified health center to decrease barriers to providing PrEP. RESULTS: Provider likelihood to prescribe PrEP increased among the internal medicine/family medicine (p = .0001, p = .0001) and obstetrics/gynecology providers (p = .0034, p = .0034), but there was no significant change among the pediatric providers (p = .4227, p = .1965). LINKING EVIDENCE TO ACTION: Improvement among most providers demonstrated the success of this effort. Additional assessments and interventions are warranted among pediatric providers. Continued efforts are needed to progress to the incorporation of PrEP in the PCP visit.

Analyzing the Performance of the Population Health Environment on the Promotion of Provincial Governors in China.

China's economy has achieved rapid growth, but the change has also brought about serious environmental degradation, which is the main factor endangering human health. This study empirically investigates the impact of the population health environmental index on the promotion of provincial governors using an ordered probit model. The sample of the study consists of regions where provincial governors, municipal mayors, and autonomous region chairmen were stationed from 1995 to 2015. The results show that the population health environmental index had a significant and positive impact on governors' promotions, especially in the eastern region. The reformation of the population health environmental index assessment system for government officials was the initial factor that brought about these effects.

Fatores associados ao bem-estar em profissionais da atenção primária / Factors associated with well-being in primary care professionals / Factores asociados con el bienestar de profesionales de la atención primaria

Objetivo: Investigar fatores associados ao bem-estar subjetivo (BES) em profissionais da Atenção Primária a Saúde (APS). Métodos: Estudo transversal realizado em 2017 com 142 profissionais da APS de um município paulista que responderam aos instrumentos: Escala de BES (EBES), Escala de Conexão com a Natureza (ECN); Maslach Burnout Inventory (MBI); Estado de Saúde Autorreferido (ESA); Questionário sociodemográfico. Aplicou-se análise estatística, ajustados modelos de regressão linear múltipla, com resposta normal para explicar pontuações dos 3 domínios da escala EBES, em função das variáveis independentes estatisticamente mais fortes (p<0,20), em análise prévia bivariada. Considerou-se estatisticamente significativo se p<0,05. Resultados: Amostra com predomínio de pessoas do sexo feminino (n=116; 81,7%), cor da pele autoatribuída branca (n=123;86,6%), idade até 35 anos (n=77; 54,2%), casadas ou em união estável (n= 91; 64,1%), com graduação ou pós (n=83; 58,5%) e trabalhadoras da saúde há mais de 5 anos (n= 102; 71,8). Maiores níveis de BES associados à escolaridade (ter graduação ou pós, p=0,039) e menores à idade (acima de 35 anos, p=0,025), ESA ruim ou muito ruim (p=0,005 para satisfação com a vida e p=0,028 para afetos positivos), hospitalização no último ano (p=0,017), morar sozinho (p=0,007) e burnout (p=0,004 na pontuação geral e p=0,030 na dimensão despersonalização" do MBI). Conclusão: Aspectos sociodemográficos (idade acima de 35 anos e residir sozinho) impactam negativamente o bem-estar dos profissionais investigados, assim como condição ruim de saúde e grau de estresse relacionado ao trabalho. Ter graduação ou pós pode favorecer a satisfação com a vida.

Objective: To investigate factors associated with subjective well-being (SWB) in Primary Health Care (PHC) professionals. Methods: Cross-sectional study conducted in 2017 with 142 PHC professionals from a city in São Paulo State who answered the instruments: SWB Scale (SWBS), Connectedness to Nature Scale (CNS); Maslach Burnout Inventory (MBI); Self-Reported Health Status (SRHS); sociodemographic questionnaire. Statistical analysis was applied and adjusted for multiple linear regression models, with normal responses to explain scores of the three domains of the SWBS scale as a function of the statistically stronger independent variables (p<0.20) in former bivariate analysis. It was considered statistically significant if p<0.05. Results: Sample with a predominance of females (n=116; 81.7%), white self-assigned skin colour (n=123; 86.6%), aged up to 35 years (n=77; 54.2%), married or in a stable relationship (n=91; 64.1%), graduated or postgraduate (n=83; 58.5%) and health workers for more than 5 years (n= 102; 71.8). Higher levels of SWB associated with schooling (being undergraduate or graduate, p=0.039) and underage (over 35 years, p=0.025), bad or very bad SRHS (p=0.005 for life satisfaction and p=0.028 for positive affects), hospitalization in the last year (p=0.017), living alone (p=0.007) and Burnout (p=0.004 in the overall score and p=0.030 in the depersonalization dimension of the MBI). Conclusion: Sociodemographic aspects (over 35 years old and living alone) negatively impact the well being of the professionals investigated as poor health status and work-related stress level. Having an undergraduate or graduate degree can promote life satisfaction.

Objetivo: Investigar los factores asociados con el bienestar subjetivo (BES) de profesionales de la Atención Primaria de Salud (APS). Métodos: Estudio transversal realizado en 2017 con 142 profesionales de la APS de un municipio de São Paulo que contestaron a los siguientes instrumentos: la Escala de BES (EBES), la Escala de Conexión con la Naturaleza (ECN); el Maslach Burnout Inventory (MBI); el Estado de Salud Auto referido (ESA); el Cuestionario sociodemográfico. Se aplicó el análisis estadístico, ajustados modelos de regresión linear múltiple con respuesta normal para explicar las puntuaciones de los 3 dominios de la escala EBES, según las variables independientes estadísticamente más fuertes (p<0,20), en análisis previo bivariado. Se há considerado estadísticamente significativo si p<0,05. Resultados: Hubo el predominio de personas del sexo femenino (n=116; 81,7%), del color de piel blanco auto atribuido (n=123; 86,6%), edad hasta los 35 años (n=77; 54,2%), casadas o en unión estable (n= 91; 64,1%), con graduación o post grado (n=83; 58,5%) y trabajadoras del área de la salud desde hace más de 5 años (n= 102; 71,8). Mayores niveles de BES asociados con la escolaridad (tener graduación o post grado p=0,039) y los menores de edad (por encima de los 35 años, p=0,025), malo o muy malo ESA (p=0,005 para la satisfacción con la vida y la p=0,028 para los afectos positivos), la hospitalización del último año (p=0,017), vivir solo (p=0,007) y burnout (p=0,004 para la puntuación general y p=0,030 para la dimensión "despersonalización" del MBI). Conclusión: Los aspectos socio demográficos (por encima de los 35 años y vivir solo) impactan negativamente en el bienestar de los profesionales investigados, así como la mala condición de salud y el grado de estrés relacionado con el trabajo. Tener graduación o post grado puede favorecer la satisfacción con la vida.

Características dos Recursos Humanos e desafios no trabalho de coordenadores de Vigilância em Saúde no interior de Pernambuco / Characteristics of Human Resources and challenges in the Work of Surveillance coordinators of Health in the Inland of Pernambuco

Introdução: A formação e qualificação dos recursos humanos em saúde afetam, diretamente, a qualidade dos serviços ofertados à coletividade. Objetivo: Caracterizar o perfil de formação dos coordenadores de Vigilância em Saúde do interior de Pernambuco e identificar as principais fragilidades e potencialidades no cotidiano dos processos de trabalho. Método: A produção de informações ocorreu por meio de entrevista com auxílio de instrumento semiestruturado. Resultados: Os resultados revelaram uma variedade de fragilidades nos recursos humanos da Vigilância em Saúde na região, entre elas, a deficiência na formação acadêmica dos trabalhadores, condições de trabalho deficientes e ausência de recursos financeiros. Por outro lado, como ponto positivo, foi identificada uma grande oferta de ações de Educação Permanente em Saúde. Conclusões: Sugere-se aos gestores em saúde, a busca por alternativas que atendam à situação dos profissionais atualmente inseridos no sistema e minimizem os efeitos da formação deficiente, assim como a necessidade de discussões para revisão das Diretrizes Curriculares Nacionais dos cursos da área da saúde, fomentando a formação de profissionais para a promoção em saúde, além de distribuição adequada e melhorias na alocação de recursos para a Vigilância em Saúde.

Introduction: The professional qualification of human resources in health affects directly the quality of the services offered to the community. Objective: This study aimed to characterize the formation of managers of health surveillance in the inland of Pernambuco State, Brazil and identify the main fragilities and potentialities in the daily prosses of work. Method: The data was collected by interview using a semi structured questionnaire. Results: The results revealed a variety of problems in human resources in health surveillance in the region, like the absence or incompatible education level, poorly work conditions and precarious financial resources. On the other hand, some positive points, was identified a good offer in actions of permanent education in health. Conclusions: Should find alternatives that meet the situation of professionals into the system and minimize the effects of lack of training and inadequate training, as well as the necessity to discuss the review of the national curricular guidelines of health sciences courses, promoting educational institutions to train professionals for health surveillance, as well promote the better distribution of financial resources.

Classification of Heat-Related Illness Symptoms Among Florida Farmworkers.

BACKGROUND: Farmworkers working in hot and humid environments have an increased risk for heat-related illness (HRI) if their thermoregulatory capabilities are overwhelmed. The manifestation of heat-related symptoms can escalate into life-threatening events. Increasing ambient air temperatures resulting from climate change will only exacerbate HRI in vulnerable populations. We characterize HRI symptoms experienced by farmworkers in three Florida communities. METHODS: A total of 198 farmworkers enrolled in 2015-2016 were asked to recall if they experienced seven HRI symptoms during the previous work week. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between selected sociodemographic characteristics and reporting three or more symptoms. Latent class analysis was used to identify classes of symptoms representing the HRI severity range. We examined sociodemographic characteristics of the farmworkers across the latent classes. RESULTS: The mean age (±SD) of farmworkers was 38.0 (±8) years; the majority were female (60%) and Hispanic (86%). Most frequently reported symptoms were heavy sweating (66%), headache (58%), dizziness (32%), and muscle cramps (30%). Females had three times the odds of experiencing three or more symptoms (OR = 2.86, 95% CI 1.18-6.89). Symptoms fell into three latent classes, which included mild (heavy sweating; class probability = 54%), moderate (heavy sweating, headache, nausea, and dizziness; class probability = 24%), and severe (heavy sweating, headache, nausea, dizziness, muscle cramps; class probability = 22%). CONCLUSIONS: Farmworkers reported a high burden of HRI symptoms that appear to cluster in physiologic patterns. Unrecognized accumulation of symptoms can escalate into life-threatening situations if untreated. Our research can inform interventions to promote early recognition of HRI, on-site care, and appropriate occupational health policy. Administrative or engineering workplace controls may also reduce the manifestation of HRI. CLINICAL RELEVANCE: This study advances the current knowledge of HRI symptoms in farmworkers and moves beyond reporting individual symptoms by utilizing latent class analysis to identify how symptoms tend to co-occur together in this population. It acknowledges multiple symptoms occurring as a result of occupational heat exposure and highlights the importance of symptom recognition.

Development of a Course on Complex Humanitarian Emergencies: Preparation for the Impact of Climate Change.

PURPOSE: The effects of climate change are far-reaching and multifactorial, with potential impacts on food security and conflict. Large population movements, whether from the aftermath of natural disasters or resulting from conflict, can precipitate the need for humanitarian response in what can become complex humanitarian emergencies (CHEs). Nurses need to be prepared to respond to affected communities in need, whether the emergency is domestic or global. The purpose of the article is to describe a novel course for nursing students interested in practice within the confines of CHEs and natural disasters. METHODS AND FRAMEWORK: The authors used the Sphere Humanitarian Charter and Minimum Standards as a practical framework to inform the course development. They completed a review of the literature on the interaction on climate change, conflict and health, and competencies related to working CHEs. Resettled refugees, as well as experts in the area of humanitarian response, recovery, and mitigation from the Centers for Disease Control and Prevention and nongovernmental organizations further informed the development of the course. CLINICAL RELEVANCE: This course prepares the nursing workforce to respond appropriately to large population movements that may arise from the aftermath of natural disasters or conflict, both of which can comprise a complex humanitarian disaster. Using The Sphere Project e-learning course, students learn about the Sphere Project, which works to ensure accountability and quality in humanitarian response and offers core minimal standards for technical assistance. These guidelines are seen globally as the gold standard for humanitarian response and address many of the competencies for disaster nursing (http://www.sphereproject.org/learning/e-learning-course/).

Environmental parasitology: soil analysis for geohelminth larvae contamination in Ilhéus, Bahia

The study of parasitic soil contamination is important for monitoring biohazards in densely populated areas or those with high anthropic activities. The present study quantified geohelminth larvae in two estuaries in the urban area of Ilhéus, Bahia; one to the north, formed by the Almada River and another to the south, in the Pontal Bay. The collections were performed following standard methodology considering climactic conditions and local tide tables; the Rugai method with modifications was used to analyze soil sediments. Morphological results showed a significantly higher number of Strongyloides stercoralis larvae in the estuary of the Almada River from September to December, coinciding with higher temperatures and lower rainfall and humidity. However, there was significant variation in climatic conditions and in the classification of anthropic activity interfering in the frequency and diversity of soiltransmitted helminth larvae, which justifies its monitoring to ensure environmental health in areas frequented by residents and tourists in Ilhéus, Bahia.

Spatial gradient of human health risk from exposure to trace elements and radioactive pollutants in soils at the Puchuncaví-Ventanas industrial complex, Chile.

The Punchuncaví Valley in central Chile, heavily affected by a range of anthropogenic emissions from a localized industrial complex, has been studied as a model environment for evaluating the spatial gradient of human health risk, which are mainly caused by trace elemental pollutants in soil. Soil elemental profiles in 121 samples from five selected locations representing different degrees of impact from the industrial source were used for human risk estimation. Distance to source dependent cumulative non-carcinogenic hazard indexes above 1 for children (max 4.4 - min 1.5) were found in the study area, ingestion being the most relevant risk pathway. The significance of health risk differences within the study area was confirmed by statistical analysis (ANOVA and HCA) of individual hazard index values at the five sampling locations. As was the dominant factor causing unacceptable carcinogenic risk levels for children (<10-4) at the two sampling locations which are closer to the industrial complex, whereas the risk was just in the tolerable range (10-6 - 10-4) for children and adults in the rest of the sampling locations at the study area. Furthermore, we assessed gamma ray radiation external hazard indexes and annual effective dose rate from the natural radioactivity elements (226Ra, 232Th and 40K) levels in the surface soils of the study area. The highest average values for the specific activity of 232Th (31 Bq kg-1), 40K (615 Bq kg- 1), and 226Ra (25 Bq kg-1) are lower than limit recommended by OECD, so no significant radioactive risk was detected within the study area. In addition, no significant variability of radioactive risk was observed among sampling locations.

Os condicionantes de saúde na legislação vigente sobre licenciamento ambiental / The health determinants in the current legislation on environmental licensing

Os empreendimentos sujeitos ao licenciamento ambiental trazem consequências não só ao meio ambiente, mas também à saúde das populações vizinhas. O presente artigo tem como objetivo analisar como os condicionantes de saúde são tratados pelas leis federais e normas infralegais vigentes sobre o tema. A metodologia consistiu na pesquisa bibliográfica por meio de análise de conteúdo e estudo de caso, sendo esta última feita em processo de licenciamento ambiental realizado pelo IBAMA, referente ao empreendimento para aproveitamento hidrelétrico do complexo do Rio Madeira. Como resultados, observouse que não há uma inserção sistemática dos condicionantes de saúde nos processos de licenciamento ambiental, o que torna necessária uma revisão e sistematização das normas referentes com uma visão interdisciplinar para melhor gerenciamento e mitigação dos impactos à saúde decorrentes de grandes empreendimentos.

The enterprises subject to environmental licensing bring consequences not only for the environment but also to the health of neighboring populations. This article aims to analyze how the determinants of health are addressed by federal laws and regulatory provisions on the subject. The methodology consisted of bibliographical search through content analysis and case study, the latter being made in the environmental licensing process conducted by IBAMA, for the hydroelectric development of the Madeira River complex. As a result, it was observed that there was no systematic inclusion of health conditions in the environmental licensing process, which makes it necessary a review and systematization of standards related with an interdisciplinary vision for better management and mitigation of the health impacts resulting from large enterprises.

Los proyectos sujetos a licenciamiento ambiental traen consecuencias no sólo para el medio ambiente, sino también a la salud de las poblaciones vecinas. Este artículo tiene como objetivo analizar cómo los determinantes de la salud son abordados por las leyes federales y las disposiciones reglamentarias sobre la materia. La metodología consistió en la búsqueda bibliográfica a través de análisis de contenido y estudio de caso, siendo este último hecho en el proceso de licenciamiento ambiental llevado a cabo por el IBAMA, en referencia a aventurarse al complejo hidroeléctrico en el "Rio Madeira". Como resultado, se observó que no existía la integración sistemática de las condiciones de salud en el proceso de licenciamiento ambiental, lo que hizo necesaria una revisión y sistematización de las normas relativas a un mejor enfoque interdisciplinario p

Qualidade ambietal e saúde da população em canvieiras - Bahia: aspectos epidemiológicos de saneamento básico e prevalência de parasitoses numa reserva extrativista / Calidad amientall y la salud de la población en canavieira - bahia: aspecctos epidemiológicos de saneamiento básico y la prevalencia de parásitos en una reserva extractiva / Environmental qaality and population health in canavieiras - baia: epidemiologgical aspects of basic sanitation and the prevalence of parasites in an extractive reserve

Pretende-se discutir os nexos entre a degradação ambiental e o predomínio de parasitos específicos numa reserva extrativista. Trata-se de uma pesquisa epidemiológica com abordagem baseada num estudo epidemiológico, descritivo, com corte transversal, realizada com auxílio do mapeamento georreferenciado, na zona urbana da cidade de Canavieiras, Bahia, Brasil. Os resultados coprológicos foram correlacionados com variáveis ambientais e analisados pelo teste de Tukey com 5% de probabilidade. A investigação assinalou uma positividade de mais de 90% de parasitoses em toda a população amostral, com ocorrência do Ascaris lumbricoides em mais de 50% em cada um dos setores analisados. A alta ocorrência de parasitoses nesta comunidade, formada predominantemente por pescadores e marisqueiros, aponta para a falta de saneamento básico e a degradação dos recursos naturais indispensáveis para manutenção do modo de vida local, corroborando a indissociabilidade entre a saúde da população e a qualidade ambiental do seu entorno.

This article intends to discuss the links between environmental degradation and the prevalence of specific parasites in an extractive reserve. This is an epidemiological research with an approach of occurrence, based on an individual, observational and cross-sectional study, with the aid of geo-referenced mapping in the urban area of Canavieiras, Bahia, Brazil. The parasitological results were correlated with environmental variables and analyzed by Tukey test with 5% margin of error. The investigation reported a positivity of more than 90% of parasites across the sample population, with occurrence of Ascaris lumbricoides more than 50% in each of the sectors analyzed. The high incidence of parasitic infections in this community, made up predominantly of fishermen and shellfish gatherers, points to the lack of sanitation and degradation of natural resources essential to maintaining the local way of life, supporting the inseparability between population health and environmental quality of their surroundings.

Se trata de discutir aquí los vínculos entre la degradación ambiental y la prevalencia de parásitos específicos en una reserva extractiva en Brasil. Se trata de un estudio epidemiológico con un enfoque basado en el estudio epidemiológico, descriptivo, transversal, realizado con recursos de la cartografía georeferenciada en el área urbana de la ciudad de Canavieiras, en el Estado de Bahia, Brasil. Los resultados del examen coprológico se correlacionaron con variables ambientales analizadas mediante la prueba de Tukey con 5% de margen de error. La investigación ha indicado un resultado positivo para más de 90% de parásitos en toda la muestra de la población, con la aparición de Ascaris lumbricoides en más de 50% en cada uno de los sectores analizados. La alta incidencia de parásitos en esta comunidad, formada principalmente por pescadores y marisqueros, apunta a la falta de saneamiento y la degradación de los recursos naturales esenciales para el mantenimiento de la forma de vida local, ratificando la inseparabilidad entre la salud de la población y la calidad ambiental de su entorno.

Empowering peer group leaders for HIV prevention in Malawi.

PURPOSE: Behavioral change interventions using peer group leaders are effective and widely used, but few studies have examined how being a peer group leader affects the leaders. This study describes how participants felt being a peer group leader affected their lives. DESIGN: This descriptive qualitative study interviewed 18 experienced peer group leaders who had conducted a multisession human immunodeficiency virus (HIV) prevention peer group intervention in rural Malawi. METHODS: We used inductive content analysis and comparisons within and between cases. FINDINGS: Three major themes were identified. All leaders said they experienced personal changes in their knowledge, attitudes, or HIV prevention behaviors. They described interacting with family, neighbors, and friends, and speaking at church or community meetings, to discuss HIV prevention issues. They increased their self-efficacy to engage others in sensitive HIV prevention issues, developed a self-identity as a change agent, and came to be recognized in their community as trustworthy advisors about HIV and acquired immunodeficiency syndrome. These three themes, taken together, form the meta-theme of psychological empowerment. CONCLUSION: Being a peer group leader empowered the leaders as change agents for HIV prevention and had impacts in the community after the intervention ended, potentially increasing the long-term effectiveness and cost effectiveness of peer group interventions. CLINICAL RELEVANCE: Healthcare workers and community volunteers who led HIV prevention sessions continued HIV prevention activities in the community and workplace after the program ended. Training health workers as volunteer HIV prevention leaders offers a strategy to bring HIV prevention to limited-resource settings, despite health worker shortages.

The biological control of the malaria vector.

The call for malaria control, over the last century, marked a new epoch in the history of this disease. Many control strategies targeting either the Plasmodium parasite or the Anopheles vector were shown to be effective. Yet, the emergence of drug resistant parasites and insecticide resistant mosquito strains, along with numerous health, environmental, and ecological side effects of many chemical agents, highlighted the need to develop alternative tools that either complement or substitute conventional malaria control approaches. The use of biological means is considered a fundamental part of the recently launched malaria eradication program and has so far shown promising results, although this approach is still in its infancy. This review presents an overview of the most promising biological control tools for malaria eradication, namely fungi, bacteria, larvivorous fish, parasites, viruses and nematodes.

O aterro sanitário como fator de risco para doenças respiratórias em crianças / Landfills as risk factors for respiratory disease in children

OBJETIVO: Avaliar a relação entre a exposição a um aterro sanitário fechado há 6 anos e os sintomas respiratórios em crianças de até 13 anos de idade. MÉTODO: Estudo transversal realizado em Várzea Paulist a, estado de São Paulo, Brasil. Um adulto cada um dos domicílios localizados no bairro próximo ao aterro sanitário e de uma amostra aleatorizada de domicílios de outro bairro com características socioeconômicas semelhantes foram entrevistados, perguntando-se sobre sintomas respiratórios, bem como sobre outras variáveis em crianças de até 13 anos de idade. O modelo de regressão logística foi utilizado para estudar essa relação. RESULTADOS: A chance de uma criança apresentar sintoma respiratório foi função de: -2,36 + 0,43 se a criança tem menos de 2 anos de idade; + 0,24 se a criança morar no bairro em que fica o aterro sanitário; -0,67 se, no domicílio, houver computador; + 0,54 se houvesse consumo de lenha no último ano; + 0,94 se a criança fora diagnosticada com asmática; + 0,87 foi ao serviço de saúde nos últimos 30 dias. CONCLUSÃO: Os autores concluem que morar próximo a um aterro sanitário fechado há 6 anos pode ser um fator de risco para doenças respiratórias em crianças.

OBJECTIVE: To investigate the relationship between exposure to a landfill site closed 6 years previously and respiratory symptoms in children aged up to 13 years. METHOD: This was a cross-sectional study conducted in Várzea Paulista, in the state of São Paulo, Brazil. One adult in every household in a neighborhood close to the landfill and from a randomized sample of households in another neighborhood with similar socioeconomic characteristics but no landfill were interviewed and asked about respiratory symptoms and other variables relating to children aged up to 13. A logistic regression model was used to study this relationship. RESULTS: The likelihood of a child having respiratory symptoms was a function of -2.36 + 0.43 if the child was less than 2 years old; + 0.24 if the child lived in the landfill area; -0.67 if there was a computer at home; + 0.54 if firewood was burnt in the home in the last year; + 0.94 if the child was diagnosed with asthma; + 0.87 if the child visited a health service in the previous 30 days. CONCLUSION: The authors conclude that living near to a landfill closed 6 years previously may be a risk factor for respiratory disease in children.

Municipal wastewater effluents as a source of listerial pathogens in the aquatic milieu of the Eastern Cape Province of South Africa: a concern of public health importance.

We evaluated the effluent quality of an urban wastewater treatment facility in South Africa and its impact on the receiving watershed for a period of 12 months. The prevalence and antimicrobial susceptibility of potential Listeria pathogens (L. ivanovii and L. innocua) and the physicochemical quality of the treated wastewater effluent was assessed, with a view to ascertain the potential health and environmental hazards of the discharged effluent. Total listerial density varied between 2.9 x 10(0) and 1.2 x 10(5) cfu/mL; free living Listeria species were more prevalent (84%), compared to Listeria species attached to planktons (59-75%). The treated effluent quality fell short of recommended standards for turbidity, dissolved oxygen, chemical oxygen demand, nitrite, phosphate and Listeria density; while pH, temperature, total dissolved solids and nitrate contents were compliant with target quality limits after treatment. The Listeria isolates (23) were sensitive to three (15%) of the 20 test antibiotics, and showed varying (4.5-91%) levels of resistance to 17 antibiotics. Of seven resistance gene markers assayed, only sulII genes were detected in five (22%) Listeria strains. The study demonstrates a potential negative impact of the wastewater effluent on the receiving environment and suggests a serious public health implication for those who depend on the receiving watershed for drinking and other purposes.

La Pontificia Universidad Javeriana como un escenario para la promoción de la salud / Pontificia Universidad Javeriana: a suitable setting for health promotion

La Pontificia Universidad Javeriana inició el proceso de convertirse en una universidad saludable en 2003. El proceso lo ha realizado en tres fases: en la preparación, se discutió el marco conceptual y se creó el equipo asesor; la puesta en operación incluyó la obtención de información sobre el perfil de riesgo y la situación de salud, la articulación de las diferentes instancias universitarias, la integración a los currículos y la ejecución de acciones específicas de promoción y prevención de la educación para el autocuidado; en la fase de consolidación, se planteó la formulación de políticas institucionales y la implementación de un sistema de evaluación permanente. La generación de una cultura saludable no depende únicamente de las personas y, por esta razón, ha sido fundamental trabajar en la estructura, las políticas y las decisiones estratégicas. Éste es un proyecto construido con la participación de la comunidad universitaria y con el que se espera mejorar los estilos de vida y reforzar valores como la solidaridad y la responsabilidad.

The Pontificia Universidad Javeriana started a process to become a healthy university in 2003. The process was defined in three phases: preparation that includes building a framework and establishing a multidisciplinary advisory team; implementation that includes gathering information about risk profiles and health situation, articulating university departments and faculties, integrating self-care education intoacademic curricula, and developing specific health promotion and preventive activities; consolidationphase, the last one which includes corporate health promotion policy formulation and implementationof evaluation systems. Promoting a new culture depends not only on people´s behavior but on political stewardship, infrastructure, and suitable strategies properly coordinated. Healthy University´s success depends on the participation of the entire community; it is expected to improve lifestyles by reinforcing values such as solidarity,and responsibility.

The influence of communication - health education intervention to knowledge, attitude and practice on environmental sanitation/three hygiene constructions of people in Tan Trao commune, Thanh Mien districs, Hai Duong province

Survey was conducted 11 months before and after the intervention, concerning the communication-education of health. Household samples were selected from 6 villages of Tan Trao commune, Thanh Mien district, Hai Duong province. The model of communication – health communication in Cultural village was established after intervention. It improved the knowledge, the attitude and the practice of the people on enviromental sanitation/ 3 hygiene constructions. The knowledge was enhanced dramatically. The attitude on sanitation/3 hygiene construction was also improved, the rate of people who concern to the sanitation and 3 hygiene constructions increased from 17.1% to 59.5%; hygienic drinking water source increased from 55.1% to 73.7%; the rate of good sanitation household increased from 10.9% to 27.3%; good drainage of liquid waste from 7% to 25.3%. In average, each household had had 1.39% times to reconstruct or to repair the constructions of hygiene and the sanitation facilities during the intervention.