Resipientunderdsøkelse av Begna, Randselva og Tyrifjorden i 2010 i forbindelse med utslipp fra Norske Skog Follum ASA og Huhtamaki Norway AS

Norske Skog Follum og Huhtamaki Norway AS har foretatt en resipientundersøkelse i henhold til vanndirektivet for å dokumentere effektene av sine utslipp til Begna, Randselva og Tyrifjorden. Virkningen av utslippene på vannkjemien (tot P, tot N, NO3, KOF, Mn, Al) var liten eller ikke påvisbar. Begroingsalgene indikerer god eller svært god tilstand på elvestasjonene, bunndyrene indikerer god eller svært god tilstand med unntak av moderat tilstand ved Hønefossen. Det biologiske mangfoldet varierte mye, med høyest mangfold på referansestasjonene. For Tyrifjoden var den økologiske tilstanden svært god der konsentrasjonene av fosfor og klorofyll a var de lavest som er målt siden 1978. Resultatene fra burforsøk med lokal ørret indikerer at aluminium i utslippet ved Follum Fabrikker foreligger på en lite giftig form og er lite gjelle-reaktivt.Norske Skog Follum AS

Sensibilidad y especificidad de la fiebre como predictor clínico de malaria en Loreto, Perú

Introduction: Malaria is a parasitic disease caused by Plasmodium sporozoites. Peruvian National Regulations for Malaria and Severe Malaria state that active surveillance of febrile patients is the main activity to perform, since it allows early case detection. Objective: To determine the usefulness of fever as a clinical predictor for malaria in endemic areas of Loreto; sensitivity and specificity of fever were also assessed. Material and Method: We prospectively included 400 febrile patients who presented to the Malaria Program at Loreto Regional Hospital from October to December 2002. Results: We found a 42.1% sensitivity (95% CI: 31.6-53.3), 62.7% specificity (95% CI: 57.3-67.7), 20.9% positive predictive value (95% CI: 15.2-28.0), 82.2% negative predictive value 82.2 (95% CI: 76.9-86.5), 58,8% accuracy (95% IC: 53,9-63,5). Fever (axillary temperature > 37,5 degrees Celsius) was associated to a final diagnosis of malaria (OR = 1,22; 95% CI = 0,73 2,03). In our study, fever does not have enough sensitivity nor specificity for detecting malaria cases; thus, it is not a good clinical predictor in endemic areas. Health facilities could mistakenly withhold antimalarial treatment to 57,9% of patients with a positive thick blood smear because of not having fever (false negatives), leaving an important human reservoir perpetuating transmission. Also, they could provide antimalarial treatment to 37,3 % of patient with a negative thick blood smear, only because of having fever (false positives). Conclusion: Malaria diagnosis requires of more sensitive and more specific clinical criteria. Improved case definitions for malaria must be elaborated, so they may be used particularly in endemic areas for malaria where no microscopy is available.Introducción: la malaria es una enfermedad parasitaria causada por esporozoitos de Plasmodium. La Norma Técnica de Malaria y Malaria Grave en el Perú refiere que la búsqueda e identificación del febril es la actividad primordial, básica e inicial de la atención curativa ya que permite la identificación precoz del caso. Objetivo: evaluar la utilidad de la fiebre como predictor clínico de malaria en áreas endémicas de Loreto, se estudió la sensibilidad y especificidad de dicho signo. Material y método: se incorporó prospectivamente al estudio 400 pacientes captados en el Programa Malaria del Hospital Regional de Loreto desde octubre a diciembre del 2002. Resultados: se encontró una sensibilidad de 42,1 (95% IC 31,6-53,3), especificidad 62,7 (95% IC 57,3-67,7), valor predictivo positivo 20,9 (95% IC 15,2-28,0), valor predictivo negativo 82,2 (95% IC 76,9-86,5), agudeza 5,8 % (95% IC 53,9-63,5). La fiebre (temperatura axilar mayor a 37.5 grados Celsius) se asoció a un diagnóstico final de malaria (OR = 1,22; 95% IC = 0,73 2,03). En nuestro estudio la fiebre no tiene suficiente sensibilidad ni especificidad para detectar casos de malaria, por ello no es buen predictor clínico en áreas endémicas. Los servicios de salud podrían dejar de proporcionar tratamiento antimalárico al 57,9 % de pacientes gota gruesa positiva por no presentar fiebre (falsos negativos), dejando un importante reservorio humano que perpetúa la transmisión. Asimismo, podrían proporcionar tratamiento antimalárico a un 37,3% de pacientes gota gruesa negativa, por el hecho de presentar fiebre, (falsos positivos). Conclusión: el diagnóstico de malaria requiere de criterios clínicos más sensibles y específicos. Se debe elaborar mejores definiciones de caso de malaria para aplicarse preferentemente en áreas de transmisión de malaria que no cuenten con microscopía óptica

Dengue hemorrágico en el Hospital Regional de Loreto: Reporte de un caso

Se describe el caso de un paciente varón, de 13 años de edad, procedente de la ciudad de Iquitos con cuadro clínico de Dengue y que cumplía con los criterios de dengue hemorrágico. La gravedad de este caso de dengue hemorrágico fue de grado II. El diagnóstico fue confirmado por serología. El serotipo encontrado fue el tres. Este es el primer caso de dengue hemorrágico documentado ocurrido el Hospital Regional de Loreto. (Rev Med Hered 2008;19:)

Dengue hemorrágico en el Hospital Regional de Loreto. Reporte de un caso.

Se describe el caso de un paciente varón, de 13 años de edad, procedente de la ciudad de Iquitos con cuadro clínico de Dengue y que cumplía con los criterios de dengue hemorrágico. La gravedad de este caso de dengue hemorrágico fue de grado II. El diagnóstico fue confirmado por serología. El serotipo encontrado fue el tres. Este es el primer caso de dengue hemorrágico documentado ocurrido el Hospital Regional de Loreto

Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: a mixed-methods study on caregivers’ perceptions

Abstract Background Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents’ limited education and their difficulties in recognizing the severity of the illness. The “three delays” was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers’ perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework. Methods There were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children’s caregivers. Results Half of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians. Conclusion According to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia

Long-term and seasonal dynamics of dengue in Iquitos, Peru.

IntroductionLong-term disease surveillance data provide a basis for studying drivers of pathogen transmission dynamics. Dengue is a mosquito-borne disease caused by four distinct, but related, viruses (DENV-1-4) that potentially affect over half the world's population. Dengue incidence varies seasonally and on longer time scales, presumably driven by the interaction of climate and host susceptibility. Precise understanding of dengue dynamics is constrained, however, by the relative paucity of laboratory-confirmed longitudinal data.MethodsWe studied 10 years (2000-2010) of laboratory-confirmed, clinic-based surveillance data collected in Iquitos, Peru. We characterized inter and intra-annual patterns of dengue dynamics on a weekly time scale using wavelet analysis. We explored the relationships of case counts to climatic variables with cross-correlation maps on annual and trimester bases.FindingsTransmission was dominated by single serotypes, first DENV-3 (2001-2007) then DENV-4 (2008-2010). After 2003, incidence fluctuated inter-annually with outbreaks usually occurring between October and April. We detected a strong positive autocorrelation in case counts at a lag of ∼ 70 weeks, indicating a shift in the timing of peak incidence year-to-year. All climatic variables showed modest seasonality and correlated weakly with the number of reported dengue cases across a range of time lags. Cases were reduced after citywide insecticide fumigation if conducted early in the transmission season.ConclusionsDengue case counts peaked seasonally despite limited intra-annual variation in climate conditions. Contrary to expectations for this mosquito-borne disease, no climatic variable considered exhibited a strong relationship with transmission. Vector control operations did, however, appear to have a significant impact on transmission some years. Our results indicate that a complicated interplay of factors underlie DENV transmission in contexts such as Iquitos