A journey without maps—Understanding the costs of caring for dependent older people in Nigeria, China, Mexico and Peru

Purpose of the study: Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effects of caring for an older dependent person, including insight into pathways to economic vulnerability. Design & methods: We carried out a series of household case studies across urban and rural sites in Peru, Mexico, China and Nigeria (n = 24), as part of a cross-sectional study, nested within the 10/66 Dementia Research Group cohort. Case studies consisted of in-depth narrative style interviews (n = 60) with multiple family members, including the older dependent person. Results: Governments were largely uninvolved in the care and support of older dependent people, leaving families to negotiate a ‘journey without maps’. Women were de facto caregivers but the traditional role of female relative as caregiver was beginning to be contested. Household composition was flexible and responsive to changing needs of multiple generations but family finances were stretched. Implications: Governments are lagging behind sociodemographic and social change. There is an urgent need for policy frameworks to support and supplement inputs from families. These should include community-based and residential care services, disability benefits and carers allowances. Further enhancement of health insurance schemes and scale-up of social pensions are an important component of bolstering the security of dependent older people and supporting their continued social and economic participation

Directed Evaluation of Enterotoxigenic Escherichia coli Autotransporter Proteins as Putative Vaccine Candidates

Diarrheal diseases are responsible for more than 1.5 million deaths annually in developing countries. Enterotoxigenic E. coli (ETEC) are among the most common bacterial causes of diarrhea, accounting for an estimated 300,000–500,000 deaths each year, mostly in young children. There unfortunately is not yet a vaccine that can offer sustained, broad-based protection against ETEC. While most vaccine development effort has focused on plasmid-encoded finger-like ETEC adhesin structures known as colonization factors, additional effort is needed to identify conserved target antigens. Epidemiologic studies suggest that immune responses to uncharacterized, chromosomally encoded antigens could contribute to protection resulting from repeated infections. Earlier studies of immune responses to ETEC infection had identified a class of surface-expressed molecules known as autotransporters (AT). Therefore, available ETEC genome sequences were examined to identify conserved ETEC autotransporters not shared by the commensal E. coli HS strain, followed by studies of the immune response to these antigens, and tests of their utility as vaccine components. Two chromosomally encoded ATs, identified in ETEC, but not in HS, were found to be immunogenic and protective in an animal model, suggesting that conserved AT molecules contribute to protective immune responses that follow natural ETEC infection and offering new potential targets for vaccines

A new laboratorial method for the diagnosis of gastrointestinal parasites in dogs

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)In this study, we aimed to introduce a new technique called TF-Test Modified/Dog for the diagnosis of gastrointestinal parasites in dogs. Fecal samples from 106 dogs were processed by the technique TF-Test Modified/Dogand the techniques of centrifugation-flotation in zinc sulfate, simple-flotation by saturated solution of sodium chloride, direct microscopy exam and TF-Test Conventional. Sensitivity was higher in the TF-Test Modified/Dog (98.41%), followed by flotation in saturated zinc sulfate (77.78%), TF-Test Conventional (73.02%), flotation by saturated sodium chloride (55.55%), and direct microscopy exam (30.16%). The diagnostic efficiency varied from 58.49% to 99.06%, with the highest value also obtained by the new proposed technique. Efficiency level of 99.06% with kappa index 0.979 (almost perfect) was obtained with the TF-Test Modified/Dog. These results represent significant statistical gains (P < 0.05) of 20.63% in sensitivity and 12.27% in efficiency over the best among the other techniques flotation by saturated zinc sulfate, whose kappa index was 0.738, much lower than that of the TF-Test Modified/Dog. All techniques presented 100% specificity. In this sense, the high sensitivity of the TF-Test Modified/Dog makes it suitable for epidemiological surveys of gastrointestinal parasitosis in dogs, zoonoses control and preventive surveillance programs.22115Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [2008/57428-4, 2008/50090-8