[Keshan disease--endemic myocardial disease].
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The control of endemic diseases has not attained the desired level of effectiveness in spite of the use of modern efficient technologies. The classic interventionist approach for the control of schistosomiasis is centered on systemic control of the snail hosts combined to large scale medical treatment and is usually carried out without social preoccupation due to the assisted communities. It is easy to understand the interest and the ethical compromise of public health research while producing studies in which the biological and social determinants as well as the cultural components should be considered and also encompass the historical dimensions and symbolic representations. In face of the recent political decision in favor of decentralizations of health administration to municipal level, we suggest, in the present paper, an integrated approach for the epidemiological diagnosis of an endemic situation at local level. Theoretical and methodological aspects from both, epidemiology and anthropology are discussed. Epidemiological methods can be used to detect the dependent variables (those related to the human infection) and the independent variables (demographic, economic, sanitary and social). Another methodological approach of anthropological/ethnographic nature can be conducted in order to make an articulation of the knowledge on the various dimensions or determinant levels of the disease. Mutual comprehension, between researchers and the people under investigation, on the dynamic transmission process would be relevant for a joint construction, at local level, of programmed actions for the control of endemic diseases. This would extend reflections on the health/disease process as a whole.
Just more than 2,000 cases of Plasmodium falciparum malaria are reported in the United Kingdom annually, with a mortality rate of approximately 1%. Some studies suggest that patients with malaria who originate from disease-endemic areas are less likely to develop severe disease; such patients are often treated at home. We have prospectively examined 99 patients with imported P. falciparum malaria and categorized them according to severity as defined by World Health Organization criteria. There was no significant difference between those who developed severe disease and those who did not in terms of their ethnicity, residence in a malaria-endemic area, or history of previous episodes of malaria. To assume a patient has clinical immunity to malaria simply because they originate from or have lived for a long time in a malaria-endemic area may be inappropriate and unsafe.
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This paper investigates the socio-economic inequities in healthcare seeking in the treatment of common communicable endemic diseases, with an emphasis on the use of primary health care (PHC) centres, where most endemic disease control activities take place. A questionnaire was used to collect information on occurrence of diseases and healthcare seeking from randomly selected households in four local government areas in Southeast Nigeria. Principal components analysis was used to create a socio-economic status (SES) index, which was divided into quartiles. The ratio of the values for the poorest quartile to that of the least poor quartile (bottom/top quartile) together with concentration indices for the variables under consideration was used as the measures of inequity. Logistic analysis was used to examine the determinants of use of PHC centres. The poorest quartile was more likely to use low-level providers (patent medicine dealers, shops, herbalists) and least likely to use the PHC centres. The concentration indices were -0.10, -0.06, -0.37, 0.11 and 0.04 for the use of herbalists, patent medicine dealers, community-health workers, PHC centres and hospitals, respectively. Also, the poorest quartile was more likely to lose person-days when ill. Logistic analysis showed that SES, availability of good services, proximity of the centres to the homes and polite health workers increased the use of the PHC centres. As such, improvement of quality of PHC services and improved geographic access could increase the overall use of PHC centres. Furthermore, in the long-term, a decrease in the amount of user fees, enhanced physical access and improved quality of services could decrease inequity in use of PHC centres and hospitals in the treatment of endemic diseases. The bottom/top quartile ratios and concentration indices produced similar results and hence both methods hence complement each other.
Community participation (CP) is considered one of the most important elements for the control of endemic diseases in poor countries, particularly for prevention and epidemiological surveillance. Mainly affecting the poorest segments of the population, endemic diseases are costly and require specific government action aimed at efficient, egalitarian, universal health system, where CP acts in a guardian, monitoring capacity and entails other specific tasks. Despite its rationality, CP has not been encouraged in countries like Brazil, due to the highly centralized nature of political power and activity. Several examples and situations of CP in Brazilian endemic diseases are described and discussed in the article. CP for endemic disease control should be seen as an ongoing social process, a profound social exercise, and a great challenge for the country as a whole and the new Unified Health System now being implemented in Brazil.
Eight recreational parks located in a Lyme disease endemic area of southern New York State were surveyed for the presence of ticks during the summer of 1985 by drag sampling. Ixodes dammini, the primary vector of Lyme disease in the northeast, was found in all but one park and accounted for 580 (91.8 per cent) of the 632 ticks collected. Of these, 18 per cent were larvae, 80 per cent were nymphs, and 2 per cent were adults. An I. dammini encounter distance, defined as the mean number of meters traveled before encountering a nymphal or adult I. dammini on a drag cloth, ranged from 36 m in high-risk parks, to infinity (no tick encounters). Generally, areas of high use presented higher encounter distances (lower risk) than those of the entire park. Two of the three parks with the highest annual attendance also had the highest I. dammini population indices as projected from our sampling regimen. These results indicate that recreational parks in Lyme disease endemic areas represent a substantial human risk for tick bites and Lyme disease.
The objective of this study is to elucidate the association between high-arsenic artesian well water and cancers in endemic area of blackfoot disease, a unique peripheral vascular disease related to continuous arsenic exposure. As compared with the general population in Taiwan, both the standardized mortality ratio (SMR) and cumulative mortality rate were significantly high in blackfoot disease-endemic areas for cancers of bladder, kidney, skin, lung, liver, and colon. The SMRs for cancers of bladder, kidney, skin, lung, liver, and colon were 1100, 772, 534, 320, 170, and 160, respectively, for males, and 2009, 1119, 652, 413, 229, and 168, respectively, for females. A dose-response relationship was observed between SMRs of the cancers and blackfoot disease prevalence rate of the villages and townships in the endemic areas. SMRs of cancers were greater in villages where only artesian wells were used as the drinking water source than in villages using both artesian and shallow wells, and even greater than in villages using shallow wells only.
Ticks of nine small mammal species were studied in an area of endemic Lyme disease in Hailin County, Heilongjiang Province, from 1 May to 10 October 1986. The bulk (93%) total small mammal captures were Apodemus speciosus (45%), Clethrionomys rufocanus (31%), A. agrarius (11%) and Eutamias sibiricus; (5%): these host species accounted for 97% of the 162 ticks collected. Ixodes persulcatus Schulze were most abundant on E. sibiricus (0.64 larvae and 0.08 nymphs/squirrel), and less abundant on A. agrarius (1.16 larvae/mouse), A. speciosus (0.38 larvae/mouse) and C. rufocanus (0.37 larvae and nymphs/vole). The seasonal abundance pattern of larval I. persulcatus on four small mammal species appears as a bimodal peak (June and September), but nymphal I. persulcatus has a monomodal peak during spring. The prevalence of immature I. persulcatus on four small mammal species may play an important role in the epidemiology of Lyme disease in Hailin County.
Ticks of eight medium-sized mammal species were studied in an area of endemic Lyme disease in Westchester County, N.Y., from 1 April 1984 to 31 March 1985. Most (81%) of the 266 total mammal captures were raccoon, Procyon lotor (L.) (47%), opossum, Didelphis virginiana (Kerr) (19%), and striped skunk, Mephitis mephitis Schreber (15%); these host species accounted for 91% of the 1,519 ticks collected. Although the total number of ticks was rather evenly distributed among these mammals, species composition of ticks on each host species differed markedly. Ixodes dammini Spielman, Clifford, Piesman, and Corwin was the most abundant tick species and accounted for 45% (690) of the total ticks collected. Immatures were most prevalent (56%) on opossum, and nearly all (86%) adults were found on this host species. I. cookei Marx was second in abundance (34%) and was most prevalent (60%) on skunk. I. texanus Banks and Dermacentor variabilis (Say) were less abundant (less than 20% collectively) and were most prevalent on raccoon. I. dentatus Marx on eastern cottontail, Sylvilagus floridanus (Allen), and I. marxi Banks on gray squirrel, Sciurus carolinensis Gmelin, were least abundant (less than 2% collectively). The prevalence of I. dammini on medium-sized mammals in southern New York may influence the epizoötiology of Lyme disease.
A total of 206 serum samples from children (3-14 years old) living in the Amador County (La Chorrera District, Province of Panama) were screened by indirect immunofluorescence antibody test (IFAT) for the presence of antibodies against Trypanosoma cruzi. Positive sera were confirmed by recombinant enzyme-linked immunosorbent assay (ELISA) and Western blot analysis. The presence of blood trypanosomes was investigated by hemoculture and subsequently identify by a duplex polymerase chain reaction (PCR) followed by dot blot hybridization. The results indicated a prevalence of 9.7% for trypanosome infections, a seroprevalence of 2.9% against T. cruzi and a predominance of T. rangeli infection (6.8%). The immunological and clinical implications of these findings are discussed.
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