Melanoides tuberculata as intermediate host of Philophthalmus gralli in Brazil

Melanoides tuberculata that naturally harbored trematode larvae were collected at the Pampulha dam, Belo Horizonte (Minas Gerais, Brazil), during malacological surveys conducted from 2006 to 2010. From 7,164 specimens of M. tuberculata collected, 25 (0.35%) were infected by cercariae, which have been morphologically characterized as belonging to the Megalurous group, genus Philophthalmus. Excysted metacercariae were used for successful experimental infection of Gallus gallus domesticus, and adult parasites recovered from the nictitating membranes of chickens were identified as Philophthalmus gralli. This is the first report of P. gralli in M. tuberculata in Brazil

Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Background Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations.publishedVersio

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40.0% (95% uncertainty interval [UI] 39.4-40.7) to 50.3% (50.0-50.5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46.3% (95% UI 46.1-46.5) in 2017, compared with 28.7% (28.5-29.0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88.6% (95% UI 87.2-89.7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76.1% (95% UI 71.6-80.7) of countries from 2000 to 2017, and in 53.9% (50.6-59.6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019

Summary: Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2 center dot 5th and 97 center dot 5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62 center dot 6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Growing up with HIV/AIDS: a study on adolescents with HIV/AIDS and their family caregivers Creciendo con VIH/SIDA: un estudio con adolescentes portadoras de VIH/SIDA y sus cuidadoras familiares Crescendo com HIV/AIDS: estudo com adolescentes portadoras de HIV/AIDS e suas cuidadoras-familiares

This is an exploratory study with a qualitative approach, which looks at the adolescent process with HIV/AIDS. The purpose is to identify how the adolescent process occurs, from the perspective of these teenagers and their family caregivers. The investigation was performed in Porto Alegre, RS between May and July 2005, and the subjects were four adolescents and three caregivers. Data were collected by means of interviews, which were subject to the content analysis technique. The study revealed that both teenagers and family caregivers did not show concern with the changes typical of the period, especially regarding sexuality questions. Yet, the underlying diagnosis and coping with HIV remain in the family core in order to protect these agents against the stigma of the disease.<br>Es un estudio exploratorio con abordaje cualitativo, que trata del proceso de desarrollo de la adolescencia en portadoras de VIH/SIDA, con el objetivo de identificar cómo ocurre el proceso de la adolescencia, en la visión de estas adolescentes y de sus cuidadoras familiares.La investigación se realizó en Porto Alegre-RS, entre los meses de mayo y julio de 2005; los sujetos fueron cuatro adolescentes y tres cuidadoras. La colecta de las informaciones se hizo por medio de entrevistas que fueron sometidas a la técnica de análisis de contenido. El estudio reveló que las adolescentes y sus cuidadoras familiares, manifestaron preocupación con los cambios propios de ese período, especialmente en asuntos relacionados a la sexualidad. Se hizo evidente que el diagnóstico y la convivencia con el VIH permanecen ocultos en el contexto familiar, con el objetivo de proteger, a estos actores, del estigma de la enfermedad.<br>Estudo exploratório com abordagem qualitativa, que trata do processo de adolescer de portadoras de HIV/AIDS, com o objetivo de identificar como ocorre o processo da adolescência, na ótica dessas adolescentes e de suas cuidadoras-familiares. A investigação foi realizada em Porto Alegre, RS, entre os meses de maio e julho de 2005, sendo que os sujeitos foram quatro adolescentes e três cuidadoras. A coleta das informações ocorreu por meio de entrevistas que foram submetidas à técnica de análise de conteúdo. O estudo revelou que tanto as adolescentes quanto suas cuidadoras-familiares não manifestaram preocupação com as transformações próprias do período, especialmente nas questões que envolvem a sexualidade. Evidenciou-se que o diagnóstico e a convivência com o HIV ainda permanecem velados no círculo familiar, visando a proteção desses atores com relação ao estigma da doença

Morbimortalidade por causas externas na população idosa residente em município da região sul do Brasil Morbimortalidad por causas externas en la población anciana residente en municipio de la región sur de Brasil Morbidity and mortality due to external causes among elders in the south of Brazil

A morbimortalidade por causas externas foi analisada para idosos residentes em Município do Sul do Brasil. Os óbitos, de 1979 a 1998, e as internações, de 1995 a 1998, foram obtidos do Sistema de Informação de Mortalidade, do Sistema de Informações Hospitalares do SUS e a população, dos Anuários do IBGE. O coeficiente de mortalidade por causas externas decresceu 16,2%, mas observaram-se valores crescentes com a idade, maiores no sexo feminino. As quedas, atropelamentos e outros acidentes de transporte foram as causas mais freqüentes. O coeficiente de mortalidade no sexo masculino, no último triênio, foi maior por atropelamentos e no feminino por quedas (64,8 e 58,3 óbitos por 100.000 habitantes, respectivamente). As internações por lesões e envenenamentos decresceram no período e entre as 146 ocorridas em 1998, 45,9% foram por quedas. A comunidade deve reconhecer que o idoso está exposto aos acidentes, sendo necessário que medidas preventivas sejam adotadas.<br>La morbimortalidad por causas externas fue analizada para ancianos residentes en un municipio del sur de Brasil. Los óbitos, de 1979 a 1998 y las internaciones, de 1995 a 1998, fueron obtenidos del Sistema de Información de Mortalidad y del Sistema de Informaciones Hospitalarias del Sistema Único de Salud, y la población, de los Anuarios del Instituto Brasileño de Geografía y Estadística. El riesgo de morir por causas externas decreció 16,2%, pero se observó riesgo creciente con la edad, más evidente en el sexo femenino. Las caídas, atropellamientos y otros accidentes de transporte fueron las causas de óbito más frecuentes. En el último trienio, la mortalidad en el sexo masculino fue mayor por atropellamientos y en el femenino por caídas (64,8 y 58,3 óbitos por 100.000 habitantes, respectivamente) Las internaciones por lesiones y envenenamientos decrecieron en el período y, entre las 146 ocurridas en 1998, el 45,9% fue debido a caídas. La comunidad debe reconocer que el anciano está expuesto a accidentes, siendo necesario que medidas preventivas sean adoptadas.<br>We analyzed morbidity and mortality rates due to external causes among elderly persons in a city in the South of Brazil. Data about deaths, from 1979 to 1998, and about hospital admissions, from 1995 to 1998, were obtained from the Mortality Information System and the Hospital Information System of the Brazilian Ministry of Health. Population data were based on the national demographic census. Mortality rates due to external causes decreased 16.2%, but levels increased in advanced ages, especially for women. Falls, pedestrian accidents and other road accidents were the most important external causes of death in this population. In the last three years of this study, mortality rates were higher for pedestrian accidents among men and for falls among women (64.8 and 58.3 per 100.000 inhabitants, respectively). Hospital admissions due to injuries and intoxications decreased in the period. Among the 146 admissions in 1998, 45.9% were due to falls. The community has to recognize that elderly persons are exposed to accidents and that preventive measures are needed

Fatores interferentes no comportamento das parturientes: enfoque na etnoenfermagem Factores que interfieren en el comportamiento de las parturientas: enfoque en la etnoenfermería Factors that interfere in the parturient women's behavior: focus on etnonursing

O estudo objetivou compreender o comportamento das gestantes em trabalho de parto e parto. Participaram sete parturientes que tiveram filhos por parto normal, em uma maternidade pública de Fortaleza-Ceará. A coleta de dados ocorreu nos meses de junho, julho e agosto de 2003. O método de pesquisa utilizado para a coleta e análise dos dados foi a etnoenfermagem. Os dados investigados nos mostraram através das categorias: vivenciando uma gravidez e assistência na maternidade. Concluímos que são vários os fatores que subsidiam o comportamento da mulher na vivência do trabalho de parto e parto e que a assistência dos profissionais de saúde deve estar sempre voltada para o cuidado humanístico unindo o saber cultural ao científico.<br>El estudio objetivó comprender el comportamiento de las embarazadas en trabajo de parto y parto. Participaron siete parturientas que tuvieron hijos por parto normal, en una maternidad pública de Fortaleza-Ceará. La colecta de datos ocurrió en los meses de junio, julio y agosto de 2003. El método de investigación utilizado para la colecta y análisis de los datos fue la etnoenfermería. Los datos investigados nos mostraron a través de las categorías: viviendo un embarazo y asistencia en la maternidad. Concluimos que son varios los factores que subsidian el comportamiento de la mujer en la vivencia del trabajo de parto y parto y que la asistencia de los profesionales de salud debe estar siempre vuelta para el cuidado humanístico añadiendo el saber cultural al científico.<br>This study aimed to understand the behavior of pregnant women in labor and delivery. Seven parturient women who had their children through normal delivery in a public maternity in Fortaleza, Ceará. Data collection was carried out in June to August, 2003. The research method used for the collection and analysis of data was the ethnonursing. The data studied showed us through the categories: experiencing pregnancy and assistance in the maternity. We concluded that there are several factors that justify the woman's behavior during the experience of labor and delivery and that the health professionals' assistance should be always aimed at the humanistic care linking cultural and scientific knowledge