David Soeiro Barbosa

A systematic review and meta-analysis of the factors associated with Leishmania infantum infection in dogs in Brazil

The risk factors associated with canine visceral leishmaniosis (CVL) in Brazil are unclear and controversial. The objectives of this systematic review and meta-analysis were to identify the best evidence available in this field and to determine the gaps in existing knowledge. Literature searches were carried out using four databases, the reference lists within articles, and references provided by experts in the field. Theoretical discussions or separate and independent meta-analyses of p-values or of effect sizes were used to pool information about each variable. Thirty-six articles were selected for detailed review, including 31 cross-sectional, two ecological and three cohort studies. The variables showing significant association with CVL were short hair, purebred, peri-domestic restricted (as compared with domestic-restricted dogs), and presence of green areas adjacent to home. The occurrence of CVL was also associated with the presence of domestic fowl in the home environment, with free dogs (as compared with restrained dogs), with male gender and with dogs >1 or 2 years of age, although these associations were not statistically significant. Due to the small number of publications, consistent results could not be obtained concerning the role of other factors. Most studies did not describe the criteria of eligibility and the process of selection of participants in sufficient detail and employed only one diagnostic test as proof of infection. Few studies controlled for confounding variables. No statistical evidence of publication bias was detected, but a great deal of information contained in the primary articles was lost because the results were not adequately described. The results of this review contribute to a better understanding of CVL and should assist in optimizing the development and implementation of control policies. Continuous actions, prioritizing dogs at higher risk and areas with higher abundance of green vegetation, together with policies to promote responsible dog ownership are mandatory. Problems concerning study design and data analysis described in the present study need to be taken into consideration in future studies. These must follow clear procedures to select participants and utilize standardized, valid and reliable diagnostic methods. The development of multivariate models and the use of the STROBE statement for description of the results should also be encouraged. Further research should investigate the patterns identified and prioritize CVL-related factors that have not been fully recognized or elucidated. Finally, ecological and cohort studies of CVL and investigations in other countries of Latin America are urgently required.

Risk factors for adverse prognosis and death in American visceral leishmaniasis: a meta-analysis.

Background In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented. Methods/Principal Findings The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40–50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far. Conclusions/Significance Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.

Spatial analysis for identification of priority areas for surveillance and control in a visceral leishmaniasis endemic area in Brazil.

Spatial analysis of epidemiological data may be used to assist in the implementation of surveillance and control measures against visceral leishmaniasis (VL) in endemic areas. This ecological study aimed to identify priority areas for surveillance and control of VL in São Luís, the capital of the state of Maranhão in northeast Brazil, a highly endemic area for the disease. We evaluated the spatial structure of the incidence rates of human VL and of the mean number of human and canine cases occurring between 2005 and 2007 in 355 neighborhoods (aggregated into 203 geographical analytical units) within the municipality. The presence of spatial autocorrelation was explored using global and local Morans I statistics. A local indicator of spatial autocorrelation was used to generate maps for the identification of VL clusters. The global Morans I index revealed a weak, but statistically significant spatial autocorrelation for human VL incidence rates (I=0.138). A total of 43 geographical analytical units, encompassing 121 neighborhoods, were identified as priority areas for implementing surveillance and control actions. For the purpose of defining an action plan for the delivery of these measures, those 16 geographical analytical units (encompassing 54 neighborhoods) identified as clusters with high incidence rates of human VL should receive the highest priority. An additional nine geographical analytical units (comprising 28 neighborhoods) showed non-significant clustering of high rates of human, and might be considered as the next priority for VL management. Finally, a further 18 geographical analytical units (covering 39 neighborhoods) had records of coexisting human and canine VL cases during the study period, and these should receive priority attention when resources become available. Spatial data analysis is a valuable tool for defining priority areas for VL surveillance in high transmission areas contributing to a more effective management of financial and technical resources, increasing the sustainability and efficiency of control efforts.

Leishmania infection in humans, dogs and sandflies in a visceral leishmaniasis endemic area in Maranhão, Brazil

Leishmania infection in humans, dogs and sandflies was examined in the endemic visceral leishmaniasis (VL) municipality of Raposa, state of Maranhão, Brazil. In this study, we examined Leishmania chagasi infection in the blood serum of both humans and Canis familiaris and the natural Leishmania sp. infection rate in the sandfly vector, Lutzomyia longipalpis. Enzyme-linked immunosorbent assay, indirect immunofluorescence reaction and polymerase chain reaction were performed to detect Leishmania infections in humans, dogs and sandflies, respectively. Overall, 186 out of 986 studied human beings were infected with L. chagasi parasites, representing an infection prevalence of 18.9%. An even higher infection rate was detected in dogs, where 66 (47.8%) out of 138 were infected. Among all Lu. longipalpis captured (n = 1,881), only 26.7% were females. The Leishmania infection frequency for the vector Lu. longipalpis was 1.56%. Remarkably, all infected sandflies were found in the peridomiciliary area. Furthermore, a high incidence of asymptomatic forms of VL in the human and canine populations was observed. The results of this study suggest autochthonous transmission of L. chagasi in this endemic area for visceral leishmaniasis because infection by Leishmania sp. was identified in all important elements of the transmission chain.

Population Estimation Methods for Free-Ranging Dogs: A Systematic Review.

The understanding of the structure of free-roaming dog populations is of extreme importance for the planning and monitoring of populational control strategies and animal welfare. The methods used to estimate the abundance of this group of dogs are more complex than the ones used with domiciled owned dogs. In this systematic review, we analyze the techniques and the results obtained in studies that seek to estimate the size of free-ranging dog populations. Twenty-six studies were reviewed regarding the quality of execution and their capacity to generate valid estimates. Seven of the eight publications that take a simple count of the animal population did not consider the different probabilities of animal detection; only one study used methods based on distances; twelve relied on capture-recapture models for closed populations without considering heterogeneities in capture probabilities; six studies applied their own methods with different potential and limitations. Potential sources of bias in the studies were related to the inadequate description or implementation of animal capturing or viewing procedures and to inadequacies in the identification and registration of dogs. Thus, there was a predominance of estimates with low validity. Abundance and density estimates carried high variability, and all studies identified a greater number of male dogs. We point to enhancements necessary for the implementation of future studies and to potential updates and revisions to the recommendations of the World Health Organization with respect to the estimation of free-ranging dog populations.

A inserção do Médico Veterinário nos Núcleos de Apoio à Saúde da Família (NASF): novos caminhos de atuação na saúde pública

O objetivo desse artigo e oferecer ao Tecnico em Saude Bucal subsidios cognitivos sobre Modelos de Atencao a Saude como forma de suprir as lacunas deixadas pelos cursos de formacao, os quais muitas vezes focam nos aspectos biologicos, no reconhecimento e atuacao da doenca e na reabilitacao do doenteO objetivo desse artigo e conduzir o Tecnico em Saude Bucal, a partir do modelo de atencao e da logica adotados pelo Sistema Unico de Saude, a reflexao e orientacao de suas praticas cotidianas na vigilância a saudeNo mundo, meio milhao de mulheres morrem por complicacoes da gravidez, parto e puerperio. O objetivo e descrever o indicador de qualidade da assistencia pre-natal no Hospital Regional Materno Infantil de Imperatriz-MA. Apenas 17,29% das mulheres receberam atendimento adequado no pre-natal. Medidas devem ser adotadas para melhorar a qualidade dessa assistencia.Objetivos: Abordar os desafios e as perspectivas do Controle Social no campo da saude com vistas ao desenvolvimento de politicas publicas no Brasil. Metodologia: Revisao literaria na base de dados Scielo, onde foram selecionados artigos completos em lingua portuguesa publicados entre os anos de 1999 a 2012 atraves dos descritores: Controle Social, Mobilizacao Social, Politicas Publicas e Promocao da Saude. Resultados: Apesar de legitimar a participacao popular nas decisoes politicas virtualmente democraticas, as Politicas em Saude marginalizam a construcao simbolica de sujeitos epistemicos capazes de repensar sua realidade e construir dispositivos de mudancas sociais, criando estruturas rigidas incapazes de se moldar conforme a os desejos socialmente construidos. Fica o desafio da construcao de sensibilidade e vinculo, alem de sua introjecao nas instituicoes e Politicas Publicas em Saude, flexiveis ao conhecimento auto-reflexivo e empoderamento sociais. Conclusao: Cabe ampliar o olhar para a construcao de instrumentos e sensibilidades capazes de mobilizar coletivos na luta pelo direito a saude e aos bens coletivos, investindo em metodologias relacionais de construcao da cidadania.Tomando por base as normas regulamentadoras do processo de formacao do curso de graduacao em enfermagem, espera-se que o egresso desse curso desenvolva habilidades e competencias para desempenhar todas as funcoes, descritas nesta pesquisa, visando a reorganizacao da Atencao Basica no pais, de acordo com os preceitos do Sistema Unico de Saude. Esta pesquisa teve como objetivo conhecer o perfil do egresso do curso de graduacao de enfermagem, de uma Instituicao Privada de Ensino Superior (IES) de Brasilia/DF, e sua percepcao sobre atencao basica a saude: formacao, motivacao e perspectiva para o mercado de trabalho. A pesquisa do tipo exploratorio e descritivo, com abordagem quantitativa, teve coleta de dados no mes de junho de 2013, por aplicacao de questionario semiestruturado a uma populacao de 61 academicos matriculados no ultimo semestre do curso de graduacao em enfermagem, com curriculos compostos por 08 semestres letivos, contado com 37 desses como amostra para a pesquisa. Foram identificadas diversas atividades durante o curso na abordagem da atencao basica a saude, dentre elas teorica e pratica. Os resultados sustentam discussoes para avaliacao curricular, formacao de docentes e formacao de academicos. Recomenda-se maior insercao do academico em atividades que fomentem seu direcionamento para esse campo de atuacao profissional.

A lógica produtivista e a avaliação quantitativa na pós-graduação em saúde: um olhar sobre os efeitos danosos na formação profissional

A lógica produtivista e a avaliação quantitativa na pós-graduação em saúde: um olhar sobre os efeitos danosos na formação profissional Academic productivism and quantitative evaluation in graduation studies in health: a view of harmful effects on professional training La lógica productivista y la evaluación cuantitativa en los posgrados en salud: perspectiva sobre los efectos dañinos en la formación profesional

La lógica productivista y la evaluación cuantitativa en los posgrados en salud: perspectiva sobre los efectos dañinos en la formación profesional

A lógica produtivista e a avaliação quantitativa na pós-graduação em saúde: um olhar sobre os efeitos danosos na formação profissional Academic productivism and quantitative evaluation in graduation studies in health: a view of harmful effects on professional training La lógica productivista y la evaluación cuantitativa en los posgrados en salud: perspectiva sobre los efectos dañinos en la formación profesional

[Academic productivism and quantitative evaluation in graduation studies in health: a view of harmful effects on professional training].

A lógica produtivista e a avaliação quantitativa na pós-graduação em saúde: um olhar sobre os efeitos danosos na formação profissional Academic productivism and quantitative evaluation in graduation studies in health: a view of harmful effects on professional training La lógica productivista y la evaluación cuantitativa en los posgrados en salud: perspectiva sobre los efectos dañinos en la formación profesional