Modeling the Influence of Environment and Intervention on Cholera in Haiti

We propose a simple model with two infective classes in order to model the cholera epidemic in Haiti. We include the impact of environmental events (rainfall, temperature and tidal range) on the epidemic in the Artibonite and Ouest regions by introducing terms in the transmission rate that vary with environmental conditions. We fit the model on weekly data from the beginning of the epidemic until December 2013, including the vaccination programs that were recently undertaken in the Ouest and Artibonite regions. We then modified these projections excluding vaccination to assess the programs' effectiveness. Using real-time daily rainfall, we found lag times between precipitation events and new cases that range from 3.4 to 8.4 weeks in Artibonite and 5.1 to 7.4 in Ouest. In addition, it appears that, in the Ouest region, tidal influences play a significant role in the dynamics of the disease. Intervention efforts of all types have reduced case numbers in both regions; however, persistent outbreaks continue. In Ouest, where the population at risk seems particularly besieged and the overall population is larger, vaccination efforts seem to be taking hold more slowly than in Artibonite, where a smaller core population was vaccinated. The models including the vaccination programs predicted that a year and six months later, the mean number of cases in Artibonite would be reduced by about two thousand cases, and in Ouest by twenty four hundred cases below that predicted by the models without vaccination. We also found that vaccination is best when done in the early spring, and as early as possible in the epidemic. Comparing vaccination between the first spring and the second, there is a drop of about 40% in the case reduction due to the vaccine and about 10% per year after that

A IMPORTÂNCIA DA EDUCAÇÃO PARA SEXUALIDADE NO ENSINO MÉDIO

The theme of this article is the importance of education for sexuality and it aims to investigate the potential of educational activities focused on HIV/AIDS, analyzing their contribution to health promotion in secondary education. It is a subject that has much to be explored and generates great controversy in society, as there are obstacles to be overcome. The study in question is justified because sexuality education seeks to clarify doubts that adolescents normally do not discuss within the family and misinformation can lead to health problems and even unwanted pregnancies. It is important that teachers seek adequate training to include this topic without prejudice and taboos in the classroom. The difference between education for sexuality and sexual orientation is also discussed, as it is a broad topic, but very important and it is up to the school to include this in its teaching program. The theoretical foundation was based on the authors Furlanetto; Lauermann; Coast; & Marin (2018); Higa; Bertolin; Maringolo; Ribeiro; Ferreira; Oliveira (2015); Flora; Rodrigues & Paiva (2013) who, with different approaches, reveal that educators do not feel comfortable talking about the subject for reasons of not having affinities and mastery with the subject, thus taking the approach in a punctual way. The methodology used was the bibliographic review from the content analysis through articles and books. The studies visited indicated that sexuality education is extremely important and of public utility for health promotion.El tema de este artículo es la importancia de la educación para la sexualidad y tiene como objetivo investigar el potencial de las actividades educativas enfocadas en el VIH/SIDA, analizando su contribución a la promoción de la salud en la educación secundaria. Es un tema que tiene mucho por explorar y genera gran controversia en la sociedad, ya que existen obstáculos por superar. El estudio en cuestión se justifica porque la educación sexual busca aclarar dudas que los adolescentes normalmente no intercambian dentro del entorno familiar y la desinformación puede derivar en problemas de salud e incluso embarazos no deseados. Es importante que los docentes busquen una formación adecuada para incluir este tema sin prejuicios ni tabúes en el aula. También se debate la diferencia entre educación sexual y orientación sexual, ya que es un tema amplio, pero muy importante y depende de la escuela incluirlo en su programa de enseñanza. La fundamentación teórica se basó en los autores Furlanetto; Lauermann; Costa; & Marín (2018); Bertolín; Maringolo; Ribeiro; Oliveira (2015); Flora; Rodrigues & Paiva (2013) quienes, con diferentes enfoques, revelan que los educadores no se sienten cómodos al abordar el tema por razones de no tener afinidades y dominio con el tema, por lo que abordan sólo de manera puntual. La metodología utilizada fue la revisión bibliográfica a partir del análisis de contenido a través de artículos y libros. Los estudios visitados indicaron que la educación sexual es sumamente importante y de utilidad pública para la promoción de la salud.O tema deste artigo é a importância da educação para a sexualidade e tem como objetivo investigar as potencialidades de ações educativas com enfoque no HIV/Aids, analisando a sua contribuição para a promoção da saúde no âmbito do ensino médio. É um assunto que tem muito a ser explorado e gera grandes polêmicas na sociedade, pois encontram-se entraves a serem superados. O estudo em questão justifica-se porque a educação para a sexualidade busca esclarecer dúvidas que os adolescentes normalmente não discutem no âmbito familiar e a desinformação pode acarretar problemas de saúde e até gravidez indesejada. É importante que os professores busquem formação adequada para incluir esse tema sem preconceitos e tabus na sala de aula. Discorre-se também a diferença entre educação para a sexualidade e orientação sexual, pois trata-se de uma temática ampla, porém muito importante e cabe à escola incluir isso em seu programa de ensino. A fundamentação teórica teve como base os autores Furlanetto; Lauermann; Costa; & Marin (2018); Higa;  Bertolin; Maringolo; Ribeiro; Ferreira; Oliveira (2015); Flora; Rodrigues & Paiva (2013) que, com enfoques diferenciados, revelam que educadores não se sentem à vontade em versar sobre o tema por questões de não ter afinidades e domínio com o assunto, levando assim a abordagem de forma pontual. A metodologia utilizada foi a revisão bibliográfica a partir da análise de conteúdo através de artigos e livros. Os estudos visitados indicaram que a educação para sexualidade é de extrema importância e de utilidade pública para a promoção da saúde.O tema deste artigo é a importância da educação para a sexualidade e tem como objetivo investigar o potencial de atividades educativas com abordagem não HIV/Aids, analisando sua contribuição para a promoção da saúde no campo da educação médica. É um tema que teme muito ser explorado e gera grandes polêmicas na sociedade, que podemos encontrar superadas. O estudo nessa busca justifica-se porque a educação em sexualidade busca esclarecer dúvidas que os adolescentes normalmente não discutem no ambiente familiar e a desinformação pode acarretar em problemas de saúde e até mesmo em gravidez indesejada. É importante que os professores busquem uma formação adequada para incluir esse tema sem preconceitos e tabus em sala de aula. Há também uma diferença entre educação para sexualidade e orientação sexual, pois é um tema amplo, portanto muito importante e cabe à escola incluí-lo em seu programa de ensino. A fundamentação teórica se baseia nos autores Furlanetto; Lauermann; Costa; & Marin (2018); FIG; Bertolin; maringolo; Ribeiro; Ferreira; Oliveira (2015); Flora; Rodrigues & Paiva (2013) que, com abordagens diferenciadas, revelam que os educadores não se sentem à vontade para falar sobre o assunto por não terem afinidades e domínio com o assunto, levantando assim a questão prontamente. A metodologia utilizada foi uma revisão bibliográfica baseada na análise de conteúdo por meio de artigos e livros. Os estudos visitados indicam que a educação para a sexualidade é extremamente importante e de utilidade pública para a promoção da saúde

Ambivalenzen der Förderung. Erziehungs- und Lernbegleitung für Kinder, Jugendliche und junge Erwachsene durch studentische Mentorinnen und Mentoren

Bezogen auf vier universitäre Projektkonzepte untersucht der Beitrag Dokumentations- und Reflexionsprozesse studentischer Mentorinnen und Mentoren auf wahrgenommene Ambivalenzen, die sich in Projektkonzeptionen, in Mentoringprozessen und in der reflexiven Projektbegleitung zeigen. Insbesondere die Normierung der Zielgruppen und der dadurch unterstellte Unterstützungsbedarf erweisen sich als stark wirkende Auslöser einer professionsbezogenen Auseinandersetzung mit Ambivalenzen im Kontext des Förderns. (DIPF/Orig.

Evaluation of the Effect of Nandrolone Decanoate on Experimental Spinal Cord Injury in Rats

Background: Acute spinal cord injury, a common cause of neurological dysfunction in humans and animals, impairs motor, sensory and autonomic functions and may result in permanent disability. Nandrolone decanoate (ND) is a steroid widely studied for its predominantly anabolic effect and low androgenic potential. Several researchers have described the positive interference of ND in neurological tissue, such as increased synthesis and release of neurotrophic substances, but to date no studies have evaluated the action of this steroid in acute spinal cord injury. The aim of this study was therefore to evaluate the effect of ND in rats subjected to acute spinal cord injury. Materials, Methods & Results: Thirty-two young adult Wistar rats (Rattus norvegicus), weighing between 240 and 260 g, were divided into three groups. The first group (GNAN) (n=13) was subjected to acute spinal cord injury and treated with ND; the control group (GCON) (n=13) was subjected to spinal cord injury without treatment; and the third group (GLAM) (n=6) underwent laminectomy without prior spinal cord injury, in order to control changes caused by the procedure. A 20 g metal device was released from a height of 25 cm to produce the spinal cord injury. After exposing the spinal canal, a 2-mm diameter metal rod was placed directly in contact with the spinal cord, and when the weight was released, the rod was struck, causing the spinal cord injury. An intramuscular injection of 2 mg/kg of ND was administered the immediate postoperative period. The animals were assessed to ascertain the recovery of their motor function on five occasions, namely at 24 h, 48 h, 72 h, 7 and 14 days after undergoing spinal cord injury. This assessment was performed using the Basso, Beattie and Bresnahan (BBB) model. The animals were euthanized 14 days post-op and fragments of the spinal cord and urinary bladder were collected for histological evaluation. Discussion: The animals subjected to spinal cord injury presented paraplegia, failing to score on the BBB scale in the first three assessments. Starting 7 days after surgery, the GNAN (0-13) and GCON (0-5) groups gradually began showing locomotor improvements, with scale variations. On day 14 after spinal cord injury, 22% of the animals in GNAN and 11% in GCON had failed to recover their locomotor function, scoring zero on the BBB scale. After spinal cord injury, all the animals showed urine retention. The urinary function returned on average on day 5 post surgery, with no significant difference between the groups. The locomotor assessment of the animals subjected to acute spinal cord injury revealed that the injury varied in intensity in GNAN and GCON, with signs of pelvic limb paraplegia and asymmetric non-ambulatory paraparesis. Time was a determining factor in the clinical evolution of the animals, with no evidence of the influence of ND. The histological findings revealed variations in the intensity of the injury, with a tendency for lower intensity in the cranial and epicentral segments of the lesion in the animals subjected to ND treatment, albeit without statistically significant evidence (P ≥ 0.05). The spinal cord assessments of the GLAM group indicated that the surgical procedure did not cause histological alterations, since the normal architecture of the neural tissue was preserved. The histopathological evaluations of the urinary bladder revealed an inflammatory response characterized by lymphohistiocytosis and neutrocytosis in the animals of GNAN and GCON, without interference of ND in the change (P ≥ 0.05). The method to elicit spinal cord injury reproduced functional, sensory and motor incapacity heterogeneously in rats. In the dose evaluated here, ND did not significantly influence the return of locomotor function and the intensity of spinal cord histopathological alterations.  

FATORES DE RISCO E DESENVOLVIMENTO MOTOR DE BEBÊS PEQUENOS PARA IDADE GESTACIONAL (PIG) A TERMO E PRÉ-TERMO

Objetivo: descrever e comparar as características socioeconômicas e biológicas e o desempenho motor de bebês nascidos pequenos para idade gestacional a termo e pré-termo. Materiais e Métodos: estudo observacional, de desenho transversal, do qual participaram 41 bebês até quatro meses de idade corrigida, nascidos pequenos para idade gestacional – PIG (peso < 10º percentil). O desempenho motor foi avaliado pelo instrumento Test of Infant Motor Performance (TIMP). O teste avalia o controle motor postural e movimentos seletivos necessários para o desempenho funcional do cotidiano em bebês entre 34 semanas pós-menstrual até 17 semanas de idade corrigida. Medidas de tendência central, distribuição e frequência, bem como os testes de Shapiro-Wilk, Mann-Whitney, qui-quadrado, correlações de Pearson e tau de Kendall foram utilizados. Resultados: a maioria dos bebês da amostra (53,7%) apresentou desempenho motor atípico, e entre os que nasceram prematuros 70% deles exibiram atraso no desenvolvimento motor. Nossos achados mostraram uma associação significativa entre o desenvolvimento motor e a idade gestacional dos bebês PIG (τ = 0,327, p = 0,013). Fatores socioeconômicos, como renda familiar, idade e nível de escolaridade da mãe, não influenciaram o desenvolvimento motor dos bebês da amostra.  Conclusão: bebês nascidos pequenos para a idade gestacional apresentam risco para atraso do desenvolvimento motor, sendo que esse risco aumenta quando está associado a prematuridade

Analysis of Lymphocytic DNA Damage in Early Multiple Sclerosis by Automated Gamma-H2AX and 53BP1 Foci Detection: A Case Control Study

Background In response to DNA double-strand breaks, the histone protein H2AX becomes phosphorylated at its C-terminal serine 139 residue, referred to as γ-H2AX. Formation of γ-H2AX foci is associated with recruitment of p53-binding protein 1 (53BP1), a regulator of the cellular response to DNA double-strand breaks. γ-H2AX expression in peripheral blood mononuclear cells (PBMCs) was recently proposed as a diagnostic and disease activity marker for multiple sclerosis (MS). Objective To evaluate the significance of γ-H2AX and 53BP1 foci in PBMCs as diagnostic and disease activity markers in patients with clinically isolated syndrome (CIS) and early relapsing-remitting MS (RRMS) using automated γ-H2AX and 53BP1 foci detection. Methods Immunocytochemistry was performed on freshly isolated PBMCs of patients with CIS/early RRMS (n = 25) and healthy controls (n = 27) with γ-H2AX and 53BP1 specific antibodies. Nuclear γ-H2AX and 53BP1 foci were determined using a fully automated reading system, assessing the numbers of γ-H2AX and 53BP1 foci per total number of cells and the percentage of cells with foci. Patients underwent contrast enhanced 3 Tesla magnetic resonance imaging (MRI) and clinical examination including expanded disability status scale (EDSS) score. γ-H2AX and 53BP1 were also compared in previously frozen PBMCs of each 10 CIS/early RRMS patients with and without contrast enhancing lesions (CEL) and 10 healthy controls. Results The median (range) number of γ-H2AX (0.04 [0–0.5]) and 53BP1 (0.005 [0–0.2]) foci per cell in freshly isolated PBMCs across all study participants was low and similar to previously reported values of healthy individuals. For both, γ-H2AX and 53BP1, the cellular focus number as well as the percentage of positive cells did not differ between patients with CIS/RRMS and healthy controls. γ-H2AX and 53BP1 levels neither correlated with number nor volume of T2-weighted lesions on MRI, nor with the EDSS. Although γ-H2AX, but not 53BP1, levels were higher in previously frozen PBMCs of patients with than without CEL, γ-H2AX values of both groups overlapped and γ-H2AX did not correlate with the number or volume of CEL. Conclusion γ-H2AX and 53BP1 foci do not seem to be promising diagnostic or disease activity biomarkers in patients with early MS. Lymphocytic DNA double-strand breaks are unlikely to play a major role in the pathophysiology of MS

Natriuretic peptides and integrated risk assessment for cardiovascular disease. an individual-participant-data meta-analysis

BACKGROUND: Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment. METHODS: In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie, <5%, 5% to <7·5%, and ≥7·5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure. FINDINGS: We recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95 617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1·76 (95% CI 1·56-1·98) for the combination of coronary heart disease and stroke and 2·00 (1·77-2·26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0·012 (0·010-0·014) and a net reclassification improvement of 0·027 (0·019-0·036) for the combination of coronary heart disease and stroke and a C-index increase of 0·019 (0·016-0·022) and a net reclassification improvement of 0·028 (0·019-0·038) for the combination of coronary heart disease, stroke, and heart failure. INTERPRETATION: In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention