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Integrated Care in the Community: The Case of the Programa Maior Cuidado (Older Adult Care Programme) in Belo Horizonte-Minas Gerais, BRA
No full textInternationally, there is a large body of scientific evidence concerning the benefits of integrating health and social care to ensure that frail older people living in the community receive the assistance they need to maintain independence. In the Brazilian city of Belo Horizonte, located in the state of Minas Gerais, an integrated care intervention has been developed: the Programa Maior Cuidado - Older Adult Care Programme (PMC). This programme represents a pioneering example in Brazil of the provision of carers for highly vulnerable older people, through integrated action between public health and social service agencies. This paper draws on the first phase of a mixed method evaluation of PMC, including data from documentary sources, focus groups, empirical observation and expert workshops, to examine the processes that led to the establishment of programme. The origins of the PMC are discussed and its operational processes, with a particular emphasis on integrated activities and the roles of different actors. The paper situates PMC within comparable international experiences of integrated provision for older people and considers how it has been affected by unique context and challenging of a middle-income country
ChimLeish, a new recombinant chimeric protein evaluated as a diagnostic and prognostic marker for visceral leishmaniasis and human immunodeficiency virus coinfection
No full textVisceral leishmaniasis (VL) is a neglected tropical disease of global importance caused by parasites of the genus Leishmania, and coinfection with human immunodeficiency virus (HIV) is common in countries where both diseases are endemic. In particular, widely used immunological tests for VL diagnosis have impaired sensitivity (Se) and specificity (Sp) in VL/HIV coinfected patients and there is also cross-reactivity with other endemic diseases, e.g., Chagas disease, malaria, and tuberculosis. To develop new antigens to improve the diagnosis of VL and VL/HIV coinfection, we predicted eight specific B-cell epitopes of four Leishmania infantum antigens and constructed a recombinant polypeptide chimera antigen called ChimLeish. A serological panel of 195 serum samples was used to compare the diagnostic capabilities of ChimLeish alongside the individual synthetic peptides. ChimLeish reacted with sera from all VL and VL/HIV coinfected patients [Se = 100%; Sp = 100%; area under the curve (AUC) = 1.0]. Peptides showed lower reactivities (Se = 76.8 to 99.2%; Sp = 67.1 to 95.7%; AUC between 0.87 and 0.98) as did a L. infantum antigenic preparation used as an antigen control (Se = 56.8%; Sp = 69.5%: AUC = 0.45). Notably, ChimLeish demonstrated a significant reduction (p < 0.05) of anti-ChimLeish antibodies after treatment and cure of a small number of patients. Although only a limited serological panel was tested, preliminary data suggest that ChimLeish should be evaluated in larger sample studies for the diagnosis of VL and VL/HIV coinfection
A loop-mediated isothermal amplification assay for Schistosoma mansoni detection in Biomphalaria spp. from schistosomiasis-endemic areas in Minas Gerais, Brazil
No full textBackground: Schistosomiasis a neglected tropical disease endemic in Brazil. It is caused by the trematode Schistosoma mansoni, which is transmitted by snails of the genus Biomphalaria. Among measures used to control and eliminate schistosomiasis, accurate mapping and monitoring of snail breeding sites are recommended. Despite the limitations of parasitological methods, they are still used to identify infected snails. Loop-mediated isothermal amplification (LAMP) is a sensitive, rapid, and cost-effective diagnostic method for the identification of infected snails. In the work reported here, we aimed to validate the use of LAMP for the detection of S. mansoni in snails of the genus Biomphalaria.
Methods: Snails were collected in five municipalities of the Mucuri Valley and Jequitinhonha Valley regions in the state of Minas Gerais, Brazil. Snails were pooled according to collection site and then squeezed for the detection of S. mansoni and other trematode larvae. Pooled snails were subjected to pepsin digestion and DNA extraction. Molecular assays were performed for species-specific identification and characterization of the samples. A previously described LAMP assay was adapted, evaluated, and validated using laboratory and field samples.
Results: Using the parasitological method described here, S. mansoni cercariae were detected in snails from two collection sites, and cercariae of the family Spirorchiidae were found in snails from one site. The snails were identified by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP). Biomphalaria glabrata, the main snail host of S. mansoni in Brazil, was detected in 72.2% of the collection sites. Biomphalaria kuhniana, which is resistant to S. mansoni infection, was found in the remaining sites. Multiplex, low stringency (LS), and conventional PCR allowed the detection of positive snails in four additional sites. Trematodes belonging to the families Strigeidae and Echinostomatidae were detected by multiplex PCR in two sites. The LAMP assay was effective in detecting the presence of S. mansoni infection in laboratory (7 days post-infection) and field samples with no cross-reactivity for other trematodes. When compared to LS and conventional PCR, LAMP showed 100% specificity, 85.7% sensitivity, and a κ index of 0.88.
Conclusions: Our findings suggest that LAMP is a good alternative method for the detection and monitoring of transmission foci of S. mansoni, as it was three times as effective as the parasitological examination used here for the detection of infection, and is more directly applicable in the field than other molecular techniques
Vernonia brasiliana (L.) Druce induces ultrastructural changes and apoptosis-like death of Leishmania infantum promastigotes
No full textThe present study aimed to evaluate the antileishmanial effect, the mechanisms of action and the association with miltefosine of Vernonia brasiliana essential oil against Leishmania infantum promastigotes. This essential oil was obtained by hydrodistillation and its chemical composition was determined by gas chromatography-mass spectrometry (GC–MS). The antileishmanial activity against L. infantum promastigotes and cytotoxicity on DH82 cells were evaluated by MTT colorimetric assay. Ultrastructural alterations were evaluated by transmission electron microscopy. Changes in mitochondrial membrane potential, in the production of reactive oxygen spe cies, and analysis of apoptotic events were determined by flow cytometry. The association between the essential oil and miltefosine was evaluated using the modified isobologram method. The most abundant component of the essential oil was β-caryophyllene (21.47 %). Anti-Leishmania assays indicated an IC50 of 39.01 ± 1.080 μg/mL for promastigote forms after 72 h of treatment. The cytotoxic concentration for DH82 cells was 63.13 ± 1.211 μg/mL after 24 h of treatment. The effect against L. infantum was proven through the ultrastructural changes caused by the oil, such as kinetoplast and mitochondrial swelling, vesicles in the flagellar pocket, discontinuity of the nuclear membrane, nuclear fragmentation and condensation, and loss of organelles. It was observed that the oil leads to a decrease in the mitochondrial membrane potential (35.10 %, p = 0.0031), increased reactive oxygen species production, and cell death by late apoptosis (17.60 %, p = 0.020). The combination of the essential oil and miltefosine exhibited an antagonistic effect. This study evidences the antileishmanial action of V. brasiliana essential oil against L. infantum promastigotes
SARS-CoV-2 seroprevalence and associated factors in Manaus, Brazil: baseline results from the DETECTCoV-19 cohort study
No full textSince January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.Antecedentes: Manaus, localizada na floresta tropical brasileira, passou por dois colapsos do sistema de saúde devido à pandemia da doença de coronavírus 2019 (COVID-19). No entanto, pouco se sabe sobre quais grupos entre a população em geral foram os mais afetados. Métodos: Uma estratégia de amostragem de conveniência por meio de publicidade online recrutou 3.046 adultos entre 19 de agosto de 2020 e 2 de outubro de 2020. Características sociodemográficas, sintomas relacionados ao COVID-19, COVID-19 testes, automedicação e medicamentos prescritos foram registrados. Soro anti-respiratório agudo grave anticorpos da imunoglobulina G do nucleocapsídeo da síndrome coronavírus-2 (SARS-CoV-2) foram medidos com um ensaio imunossorvente ligado a enzima. As razões de prevalência (RP) foram obtidas usando correção de cluster e modelos de regressão de Poisson ajustados. Resultados: A taxa bruta de positividade entre indivíduos assintomáticos e sintomáticos foi estimada em 29,10%, com soroprevalência máxima possível de 44,82% corrigida pelas características do teste e taxa de decaimento de anticorpos de 32,31%. Os modelos de regressão demonstraram uma forte associação com os marginalizados. moradores de baixa renda e vulneráveis com acesso limitado aos cuidados de saúde. A presença de um COVID-19 caso [RP 1,39, intervalo de confiança de 95% (IC) 1,24–1,57] ou morte (RP 2,14, IC 95% 1,74–2,62) em uma família aumentou muito o risco de outros membros da família adquirirem infecção. A soroprevalência de O SARS-CoV-2 foi maior entre aqueles que se automedicaram para prevenir a infecção (PR 1,36, IC 95% 1,27–1,46). Conclusões: Observou-se disparidade socioeconômica desproporcional entre os participantes do estudo. O natureza sindêmica do COVID-19 na região amazônica precisa de políticas diferenciadas e soluções urgentes para controlar a pandemia em curso.Background: Manaus, located in the Brazilian rainforest, has experienced two health system collapses due to the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about which groups among the general population have been most affected. Methods: A convenience sampling strategy via online advertising recruited 3046 adults between 19 August 2020 and 2 October 2020. Sociodemographic characteristics, COVID-19-related symptoms, COVID-19 testing, self-medication and prescribed medications were recorded. Serum anti-severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleocapsid immunoglobulin G antibodies were measured with an enzyme-linked immunosorbent assay. Prevalence ratios (PR) were obtained using cluster-corrected and adjusted Poisson’s regression models. Results: A crude positivity rate among asymptomatic and symptomatic individuals was estimated at 29.10%, with maximum possible seroprevalence of 44.82% corrected by test characteristics and an antibody decay rate of 32.31%. Regression models demonstrated a strong association towards marginalized low-income and vulnerable residents with limited access to health care. The presence of a COVID-19 case [PR 1.39, 95% confidence interval (CI) 1.24–1.57] or death (PR 2.14, 95% CI 1.74–2.62) in a household greatly increased the risk of other household members acquiring infection. The seroprevalence of SARS-CoV-2 was higher among those who self-medicated to prevent infection (PR 1.36, 95% CI 1.27–1.46). Conclusions: Disproportionate socio-economic disparity was observed among the study participants. The syndemic nature of COVID-19 in the Amazon region needs differential policies and urgent solutions to control the ongoing pandemic
Tracing the distribution of european lactase persistence genotypes along the Americas
No full textUniversidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Laboratório de Genética Molecular Humana. Curitiba, PR, Brasil Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Programa de Pós-Graduação em Genética. Curitiba, PR, Brasil. Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Laboratório de Genética Molecular Humana. Curitiba, PR, Brasil. Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Laboratório de Genética Molecular Humana. Curitiba, PR, Brasil. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Genética, Ecologia e Evolução. Laboratório de Diversidade Genética Humana. Belo Horizonte, MG, Brasil. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Genética, Ecologia e Evolução. Laboratório de Diversidade Genética Humana. Belo Horizonte, MG, Brasil. Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Laboratório de Genética Molecular Humana. Curitiba, PR, Brasil / Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Programa de Pós-Graduação em Genética. Curitiba, PR, Brasil. Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Programa de Pós-Graduação em Genética. Curitiba, PR, Brasil / Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Laboratório de Polimorfismos e Ligação. Curitiba, PR, Brasil. Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Laboratório de Genética Molecular Humana. Curitiba, PR, Brasil / Universidade Federal de Santa Catarina. Departamento de Biologia Celular, Embriologia e Genética, Centro de Ciências Biológicas. Laboratório de Polimorfismos Genéticos. Florianópolis, SC, Brasil. Instituto Nacional de Salud. Laboratorio de Biotecnología y Biología Molecular. Lima, Peru. Universidad Peruana Cayetano Heredia. School of Public Health and Administration. Emerging Diseases and Climate Change Research Unit. Lima, Peru. University of Maryland School of Medicine. Institute for Genome Sciences. Baltimore, MD, United States. Division of Cancer Epidemiology and Genetics, National Cancer Institute. National Institutes of Health. Bethesda, MD, United States. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Genética, Ecologia e Evolução. Laboratório de Diversidade Genética Humana. Belo Horizonte, MG, Brasil. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States / Division of Public Health Sciences. Fred Hutchinson Cancer Research Center. Seattle, WA, United States. Department of Epidemiology, Gillings School of Global Public Health. The University of North Carolina at Chapel Hill. Chapel Hill, NC, United States. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School. Boston, MA, United States. Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil. Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, Brasil / Universidade Federal de Minas Gerais. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil. Instituto Nacional de Salud. Laboratorio de Biotecnología y Biología Molecular. Lima, Peru / Universidad de Huánuco. Facultad de Ciencias de la Salud. Huánuco, Lima, Peru. Instituto Nacional de Salud. Laboratorio de Biotecnología y Biología Molecular. Lima, Peru / Universidad Científica del Sur. Facultad de Ciencias de la Salud. Carrera de Medicina Humana. Lima, Peru. Instituto Nacional de Salud. Laboratorio de Biotecnología y Biología Molecular. Lima, Peru. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas. Departamento de Genética, Ecologia e Evolução. Laboratório de Diversidade Genética Humana. Belo Horizonte, MG, Brasil. Veterans Affairs Puget Sound Health Care System. Seattle, WA, United States / University of Washington. Department of Neurology. Seattle, WA, United States / Lerner Research Institute, Genomic Medicine. Cleveland Clinic. Cleveland, OH, United States. Universidad de la República. Neurology Institute. Montevideo, Uruguay. Universidad de la República. Facultad de Medicina. Department of Genetics. Montevideo, Uruguay. Universidad de la República. Neurology Institute. Montevideo, Uruguay. Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil. Universidade Federal de São Paulo. Departamento de Neurologia e Neurocirurgia. Unidade de Distúrbios do Movimento. São Paulo, SP, Brasil. Universidade Federal de São Paulo. Departamento de Neurologia e Neurocirurgia. Unidade de Distúrbios do Movimento. São Paulo, SP, Brasil. Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Neurologia, Porto Alegre, RS, Brasil. Serviço de Neurologia. Hospital de Clínicas de Porto Alegre. Porto Alegre, RS, Brasil / Universidade Federal do Rio Grande do Sul. Departamento de Farmacologia. Porto Alegre, RS, Brasil. Universidade Federal do Pará. Instituto de Ciências da Saúde. Belém, PA, Brasil. Universidad de Santiago de Chile. Facultad de Ciencias Médicas. CETRAM. Santiago, Chile. Universidad Nacional de Colombia. Medical School and Genetic Institute. Neuroscience and Cell Death Research Groups. Bogotá, Colombia. Universidad Nacional de Colombia. Medical School and Genetic Institute. Neuroscience and Cell Death Research Groups. Bogotá, Colombia. Universidad Nacional de Colombia. Medical School and Genetic Institute. Neuroscience and Cell Death Research Groups. Bogotá, Colombia. Universidad Nacional de Colombia. Medical School and Genetic Institute. Neuroscience and Cell Death Research Groups. Bogotá, Colombia. University of Maryland School of Medicine. Institute for Genome Sciences. Baltimore, MD, United States / University of Maryland. School of Medicine. Program for Personalized and Genomic Medicine. Baltimore, Baltimore, MD, United States / University of Maryland. School of Medicine. Baltimore. Department of Medicine. Baltimore, MD, United States. Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Laboratório de Genética Molecular Humana. Curitiba, PR, Brasil / Universidade Federal do Paraná. Departamento de Genética. Setor de Ciências Biológicas. Programa de Pós-Graduação em Genética. Curitiba, PR, Brasil. University of Maryland School of Medicine. Institute for Genome Sciences. Baltimore, MD, United States.In adulthood, the ability to digest lactose, the main sugar present in milk of mammals, is a phenotype (lactase persistence) observed in historically herder populations, mainly Northern Europeans, Eastern Africans, and Middle Eastern nomads. As the –13910∗T allele in the MCM6 gene is the most well-characterized allele responsible for the lactase persistence phenotype, the –13910C > T (rs4988235) polymorphism is commonly evaluated in lactase persistence studies. Lactase non-persistent adults may develop symptoms of lactose intolerance when consuming dairy products. In the Americas, there is no evidence of the consumption of these products until the arrival of Europeans. However, several American countries’ dietary guidelines recommend consuming dairy for adequate human nutrition and health promotion. Considering the extensive use of dairy and the complex ancestry of Pan-American admixed populations, we studied the distribution of –13910C > T lactase persistence genotypes and its flanking haplotypes of European origin in 7,428 individuals from several Pan-American admixed populations. We found that the –13910∗T allele frequency in Pan-American admixed populations is directly correlated with allele frequency of the European sources. Moreover, we did not observe any overrepresentation of European haplotypes in the –13910C > T flanking region, suggesting no selective pressure after admixture in the Americas. Finally, considering the dominant effect of the –13910∗T allele, our results indicate that Pan-American admixed populations are likely to have higher frequency of lactose intolerance, suggesting that general dietary guidelines deserve further evaluation across the continent
The Usefulness of a Duplex RT-qPCR during the Recent Yellow Fever Brazilian Epidemic: Surveillance of Vaccine Adverse Events, Epizootics and Vectors
No full textFrom 2016 to 2018, Brazil faced the biggest yellow fever (YF) outbreak in the last 80 years,
representing a risk of YF reurbanization, especially in megacities. Along with this challenge, the
mass administration of the fractionated YF vaccine dose in a naïve population brought another
concern: the possibility to increase YF adverse events associated with viscerotropic (YEL-AVD) or
neurological disease (YEL-AND). For this reason, we developed a quantitative real time RT-PCR
(RT-qPCR) assay based on a duplex TaqMan protocol to distinguish broad-spectrum infections caused
by wild-type yellow fever virus (YFV) strain from adverse events following immunization (AEFI)
by 17DD strain during the vaccination campaign used to contain this outbreak. A rapid and more
accurate RT-qPCR assay to diagnose YFV was established, being able to detect even different YFV
genotypes and geographic strains that circulate in Central and South America. Moreover, after testing
around 1400 samples from human cases, non-human primates and mosquitoes, we detected just two
YEL-AVD cases, confirmed by sequencing, during the massive vaccination in Brazilian Southeast
region, showing lower incidence than AEFI as expected
A survey and evaluation of mobile apps in science centers and museums
No full textLicença atribuída ao artigo pela revista: CC BY-NC-ND.This paper studies how science centers and museums around the world have used mobile apps with museum guide characteristics and tries to identify the best interface design principles to improve their use as a tool for interaction with the public. For this purpose, we mapped mobile apps from science centers and museums and applied an evaluation tool for each one to identify good practices. This allowed us to produce guidelines for identifying good practices in the development of apps as a way of expanding visitors’ experience in these institutions through these devices
Cadernos CRIS - Fiocruz: Saúde Global e Diplomacia da Saúde - Informe 5 - Março/Abril - 2021
No full textFrailty Modifies the Association of Hypertension With Cognition in Older Adults: Evidence From the ELSI-Brazil
No full textBackground: The relationship between hypertension and cognition in later life is controversial. We investigated whether the association of hypertension with cognition differs in older adults according to the frailty status using cross-sectional data from the Brazilian Longitudinal Study of Aging, a nationally representative sample of adults aged ≥50 years.
Method: Hypertension was defined by a medical diagnosis or measured blood pressure ≥140/90 mm Hg. Frailty status was assessed using the Cardiovascular Health Study criteria. We estimated the association of hypertension and systolic and diastolic blood pressure with global cognition, orientation, memory, and verbal fluency z-scores, using multiple linear regression models. We also investigated interactions between hypertension and frailty on cognitive performance and impairment.
Results: We evaluated 8609 participants (mean age = 61.9 ± 9.6 years, 53% women). Participants with hypertension (59% of adults aged 50-64 and 77% of those aged ≥65 years) had poorer scores for global cognitive performance than those without hypertension, especially among adults aged 50-64 years (β = -0.09; 95% confidence interval = -0.15, -0.04; p = .001). However, frailty modified the associations of hypertension with cognitive performance and impairment in those aged ≥65 years (p-values for interaction = .01 and .02, respectively). Among nonfrail older adults, hypertension was associated with cognitive impairment. In contrast, among frail older adults, hypertension was related to better global and memory cognitive z-scores.
Conclusions: Hypertension was associated with worse cognitive performance. Among older adults, hypertension was related to cognitive impairment only in nonfrail participants. Frailty evaluation may help clinicians offer personalized hypertension management in older adults