Deaths from surgical conditions in Malawi - a randomised cross-sectional Nationwide household survey

Background Relatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility. Methods The study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey. Results The survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care. Conclusion In Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.publishedVersio

The unmet need for treatment of children with musculoskeletal impairment in Malawi

Background More than a billion people globally are living with disability and the prevalence is likely to increase rapidly in the coming years in low- and middle-income countries (LMICs). The vast majority of those living with disability are children residing in LMICs. There is very little reliable data on the epidemiology of musculoskeletal impairments (MSIs) in children and even less is available for Malawi. Previous studies in Malawi on childhood disability and the impact of musculoskeletal impairment (MSI) on the lives of children have been done but on a small scale and have not used disability measurement tools designed for children. Therefore in this study, we aimed to estimate the MSI prevalence, causes, and the treatment need among children aged 16 years or less in Malawi. Methods This study was carried out as a national cross sectional survey. Clusters were selected across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the national distribution of the population. Clusters were distributed around all 27-mainland districts of Malawi. Population of Malawi was 18.3 million from 2018 estimates, based on age categories we estimated that about 8.9 million were 16 years and younger. MSI diagnosis from our randomized sample was extrapolated to the population of Malawi, confidence limits was calculated using normal approximation. Results Of 3792 children aged 16 or less who were enumerated, 3648 (96.2%) were examined and 236 were confirmed to have MSI, giving a prevalence of MSI of 6.5% (CI 5.7–7.3). Extrapolated to the Malawian population this means as many as 576,000 (95% CI 505,000-647,000) children could be living with MSI in Malawi. Overall, 46% of MSIs were due to congenital causes, 34% were neurological in origin, 8.4% were due to trauma, 7.8% were acquired non-traumatic non-infective causes, and 3.4% were due to infection. We estimated a total number of 112,000 (80,000-145,000) children in need of Prostheses and Orthoses (P&O), 42,000 (22,000-61,000) in need of mobility aids (including 37,000 wheel chairs), 73,000 (47,000-99,000) in need of medication, 59,000 (35,000-82,000) in need of physical therapy, and 20,000 (6000-33,000) children in need of orthopaedic surgery. Low parents’ educational level was one factor associated with an increased risk of MSI. Conclusion This survey has uncovered a large burden of MSI among children aged 16 and under in Malawi. The burden of musculoskeletal impairment in Malawi is mostly unattended, revealing a need to scale up both P&O services, physical & occupational therapy, and surgical services in the country.publishedVersio

Prevalence, causes and impact of musculoskeletal impairment in Malawi: A national cluster randomized survey

Background There is a lack of accurate information on the prevalence and causes of musculoskeletal impairment (MSI) in low income countries. The WHO prevalence estimate does not help plan services for specific national income levels or countries. The aim of this study was to find the prevalence, impact, causes and factors associated with musculoskeletal impairment in Malawi. We wished to undertake a national cluster randomized survey of musculoskeletal impairment in Malawi, one of the UN Least Developed Countries (LDC), that involved a reliable sampling methodology with a case definition and diagnostic criteria that could clearly be related to the classification system used in the WHO International Classification of Functioning, Disability and Health (ICF) Methods A sample size of 1,481 households was calculated using data from the latest national census and an expected prevalence based on similar surveys conducted in Rwanda and Cameroon. We randomly selected clusters across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the distribution of the population. In the field, randomization of households in a cluster was based on a ground bottle spin. All household members present were screened, and all MSI cases identified were examined in more detail by medical students under supervision, using a standardized interview and examination protocol. Data collection was carried out from 1st July to 30th August 2016. Extrapolation was done based on study size compared to the population of Malawi. MSI severity was classified using the parameters for the percentage of function outlined in the WHO International Classification of Functioning (ICF). A loss of function of 5–24% was mild, 25–49% was moderate and 50–90% was severe. The Malawian version of the EQ-5D-3L questionnaire was used, and EQ-5D index scores were calculated using population values from Zimbabwe, as a population value set for Malawi is not currently available. Chi-square test was used to test categorical variables. Odds ratio (OR) was calculated with a linear regression model adjusted for age, gender, location and education. Results A total of 8,801 individuals were enumerated in 1,481 households. Of the 8,548 participants that were screened and examined (response rate of 97.1%), 810 cases of MSI were diagnosed of which 18% (108) had mild, 54% (329) had moderate and 28% (167) had severe MSI as classified by ICF. There was an overall prevalence of MSI of 9.5% (CI 8.9–10.1). The prevalence of MSI increased with age, and was similar in men (9.3%) and women (9.6%). People without formal education were more likely to have MSI [13.3% (CI 11.8–14.8)] compared to those with formal education levels [8.9% (CI 8.1–9.7), p<0.001] for primary school and [5.9% (4.6–7.2), p<0.001] for secondary school. Overall, 33.2% of MSIs were due to congenital causes, 25.6% were neurological in origin, 19.2% due to acquired non-traumatic non-infective causes, 16.8% due to trauma and 5.2% due to infection. Extrapolation of these findings indicated that there are approximately one million cases of MSI in Malawi that need further treatment. MSI had a profound impact on quality of life. Analysis of disaggregated quality of life measures using EQ-5D showed clear correlation with the ICF class. A large proportion of patients with moderate and severe MSI were confined to bed, unable to wash or undress or unable to perform usual daily activities. Conclusion This study has uncovered a high prevalence of MSI in Malawi and its profound impact on a large proportion of the population. These findings suggest that MSI places a considerable strain on social and financial structures in this low-income country. The Quality of Life of those with severe MSI is considerably affected. The huge burden of musculoskeletal impairment in Malawi is mostly unattended, revealing an urgent need to scale up surgical and rehabilitation services in the country.publishedVersio

Avaliação da potencialidade de argilas do Rio Grande do Norte – Brasil

DUTRA, Ricardo Peixoto Suassuna ; SILVA, Jaquelígia Brito da ; MORAES, Márcio Luiz Varela Nogueira de ; NASCIMENTO, R. M. ; GOMES, Uilame Umbelino ; PASKOCIMAS, Carlos Alberto . Avaliação da potencialidade de argilas do Rio Grande do Norte. Cerâmica Industrial, v. 13, p. 47-50, 2008.Foram estudadas argilas de diferentes regiões do estado do Rio Grande do Norte, Brasil, visando uma caracterização completa e indicar potencialidades industriais. A composição mineralógica das argilas foi identificada por difração de raios X. A composição química foi determinada por fluorescência de raios X. Foi determinada por difração de laser a distribuição do tamanho de partículas das argilas. Os limites de Atterberg foram utilizados para classificar as amostras quanto à plasticidade. Os efeitos térmicos presentes nas amostras foram estudados por análise térmica diferencial. A predominância do mineral argiloso ilita, de composição química homogênea, com duas distribuições de tamanho de partículas e com plasticidades muito diferentes, foram os resultados predominantes. O exame das variáveis de processamento e das características intrínsecas de cada material indica o uso destas argilas para fabricação de blocos e telhas, bem como para fabricação de pavimentos e revestimentos, podendo ser uma nova área industrial no Estad

Tertiary urban wastewater treatment with microalgae natural consortia in novel pilot photobioreactors

The aim of this work was to evaluate the efficiency of the new GreenDune photobioreactors for tertiary wastewater treatment, treated wastewater reuse and biomass application, using naturally occurring microalgae consortia. The study was conducted on a pilot installation in a wastewater treatment plant in Portugal and different operational conditions were tested. The system was capable to remove up to 95% of NH4+, the main pollutant in wastewater after secondary treatment using hydraulic retention times as low as 24 h. The application of a non-conservative scenario allowed the reuse of treated wastewater for seed production, and irrigation of naturally restricted use areas. The produced biomass was rich in proteins and carbohydrates with potential for biofuel production such as biogas or use as biofertilizers, closing the energy and nutrients cycle. Finally, the life cycle assessment of both the GreenDune and existing nitrification/denitrification systems were compared revealing that the operation of the GreenDune are more environmentally favourable than the existing system.info:eu-repo/semantics/publishedVersio

Conhecimento de mães sobre vacinação infantil em um Município do Litoral Piauiense / Mothers' knowledge about childhood vaccination in a Municipality of Piauí's coast

Introdução: Apesar da divulgação sobre a importância da vacinação infantil como método imunizador e preventivo de extrema importância, e sua disponibilidade nos serviços públicos de saúde da Atenção Básica, ainda há desconhecimento das mães sobre a importância da atualização da caderneta de vacinação infantil e das doenças imunopreveníveis, principalmente pelo distanciamento dos profissionais de saúde com relação a um dos seus objetos de trabalho primordiais, a educação em saúde. Objetivo: Diante desta problemática, este estudo tem como objetivo investigar o conhecimento de mães de um município do litoral piauiense sobre vacinação infantil. Método: Trata-se de uma pesquisa de campo com caráter exploratório- descritivo com abordagem qualitativa, realizada através de entrevista com 15 (quinze) se encontravam em Unidades Básicas de Saúde (UBS) do município de Luís Correia –PI, para imunização de crianças menores de 5 anos. Resultados: Através dos discursos foi evidenciado que as mães apresentam uma deficiência de conhecimento relacionado à imunização, incluindo os eventos adversos e suas condutas, se constando, por outro lado, a fragilidade das ações de educação em saúde com foco na imunização infantil. Considerações Finais: Julga-se necessário a adesão de estratégias eficientes por parte dos profissionais de enfermagem para facilitar o conhecimento das mães sobre a vacinação infantil, respeitando seu espaço, suas fragilidades, repassando confiança e informações importantes, com o intuito de despertar nessas mães o interesse por medidas preventivas essenciais no combate das doenças infectocontagiosas e imunopreveníveis tanto para as suas crianças como para a comunidade em geral

QUALIFICAÇÃO EM TECNOLOGIA PARA JOVENS ATRAVÉS DO ENSINO LÚDICO E DA ROBÓTICA

O programa visa promover capacitações na área de desenvolvimento de software e robótica para jovens do ensino fundamental e médio da região do Alto Vale do Itajaí – SC. É composto por quatro pilares fundamentais que são trabalhados pelos alunos, utilizando de estratégias lúdicas e práticas que possibilitam construir e incrementar o conhecimento ao longo do tempo. O primeiro pilar visa ensinar a lógica computacional, e sua aplicação principalmente nos campos da robótica. O segundo pilar é o treinamento para competições anuais na região de Santa Catarina, como a preparação de jovens para Olimpíada Brasileira de Robótica (OBR) e First Lego League (FLL). O terceiro pilar seria a formação de docentes para que os mesmos possam praticar o ensino de pensamento computacional. Por fim, o desenvolvimento de software livre, onde os bolsistas e voluntários trabalham em softwares que posteriormente podem ser utilizados por toda a comunidade científica. O Labot (Laboratório de Robótica) visa iniciar um processo educacional dedicado aos jovens de ensino fundamental e médio, na área de computação, com o propósito de introduzi-los nesse meio para que assim, seja possível despertar o interesse às carreiras científico-tecnológicas, promover a curiosidade e atualizações no processo de ensino-aprendizagem brasileiro

Zika virus exposure affects neuron-glia communication in the hippocampal slices of adult rats

Zika virus (ZIKV) infection during pregnancy was associated with microcephaly in neonates, but clinical and experimental evidence indicate that ZIKV also causes neurological complications in adults. However, the changes in neuron-glial communication, which is essential for brain homeostasis, are still unknown. Here, we report that hippocampal slices from adult rats exposed acutely to ZIKV showed significant cellular alterations regarding to redox homeostasis, inflammatory process, neurotrophic functions and molecular signalling pathways associated with neurons and glial cells. Our findings support the hypothesis that ZIKV is highly neurotropic and its infection readily induces an inflammatory response, characterized by an increased expression and/or release of pro-inflammatory cytokines. We also observed changes in neural parameters, such as adenosine receptor A2a expression, as well as in the release of brain-derived neurotrophic factor and neuron-specific enolase, indicating plasticity synaptic impairment/neuronal damage. In addition, ZIKV induced a glial commitment, with alterations in specific and functional parameters such as aquaporin 4 expression, S100B secretion and glutathione synthesis. ZIKV also induced p21 senescence-associated gene expression, indicating that ZIKV may induce early senescence. Taken together, our results indicate that ZIKV-induced neuroinflammation, involving nuclear factor erythroid 2-related factor 2 (Nrf2) and nuclear factor κB (NFκB) pathways, affects important aspects of neuron-glia communication. Therefore, although ZIKV infection is transient, long-term consequences might be associated with neurological and/or neurodegenerative diseases

DISTRIBUIÇÃO ESPACIAL DAS MACROALGAS ASSOCIADAS ÀS FLORESTAS DE MANGUE NA PENÍNSULA DE AJURUTEUA, BRAGANÇA-PARÁ

Este estudo objetivou caracterizar a comunidade de macroalgas presentes na península de Ajuruteua e na Ilha de Canelas, Bragança, Pará. As coletas foram realizadas nos seguintes substratos: tronco, pneumatóforo e rizóforo. Três réplicas por substrato foram coletadas em cada um dos nove pontos amostrais para a identificação das espécies. Foram registradas 11 espécies de macroalgas pertencentes a sete gêneros ao longo de um gradiente de salinidade, que variou de 16 a 42,  e cujo número de espécies não apresentou diferença significativa na sua distribuição espacial. As comunidades algais ao longo da península até a Ilha de Canelas mostraram alta similaridade entre si, com valores acima de 80%, com exceção do Furo do Taici (65%) e da Ilha de Canelas (60%). Além do mais, a flora algal registrada para o Estado do Pará mostrou-se mais similar à flora do litoral do Estado do Maranhão (~ 63%) do que àquela do Estado do Amapá (~ 48%). Embora alguns estudos já tenham caracterizado a comunidade de macroalgas em algumas áreas da costa norte, tais informações devem ainda ser consideradas como preliminares, haja vista a grande extensão dos manguezais amazônicos e o pequeno esforço amostral empregado para determinar a distribuição espacial dessa flora associada aos manguezais da Amazônia brasileira.   Abstract   Spatial distribution of macroalgae associated with mangrove forests in the ajuruteua peninsula, Bragança-Pará   This study aimed to characterize the macroalgae community in the Ajuruteua peninsula and on Canelas Island, Bragança, Pará. Macroalgae were collected from the following substrata: trunk, pneumatophore and rhizophore. Three replicates of each substratum were collected at nine sample stations for species identification. Twelve species from seven genera of macroalgae were recorded in a salinity gradient, ranging from 16 to 42, in which the number of species did not present any significant difference on its spatial distribution. Algae communities along the peninsula until Canelas Island showed high similarities with values over 80%, but Furo do Taici (65%) and Canelas Island (60%). In addition, algae flora recorded in the state of Pará showed to be more similar to that one on the coastline of the state of Maranhão (~ 63%) than the species found in the state of Amapá (~ 48%). Although some studies have already characterized the macroalgae community in some areas in the northern coast of Brazil, such information must be considered as preliminary ones, due to the large extension of the Amazon mangrove forests and the small sampling effort employed to determine the spatial distribution of this flora associated with mangals in the Brazilian Amazon. Key words - spatial distribution, macroalgae, mangal, Ajuruteua peninsula, Pará