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The state of Ceará, in the Northeast Region of Brazil, presents the simultaneous circulation of Zika (ZIKV), dengue (DENV) and chikungunya (CHIKV) viruses. In 2017 there were a high number of cases of these three arboviruses, especially CHIKV. Here, we detected the presence of arboviruses ZIKV, DENV and CHIKV and their coinfections in women in endemic regions of the city of Fortaleza, Ceará in a post-Zika epidemic year. Sociodemographic and environmental characteristics associated with arbovirus positivity were also analyzed. Women (n = 1289) between 15 and 39 years old were included. RT-qPCR was performed for virus detection and IgM antibody positivity was also analyzed. One hundred and six (8.3%) participants were positive for one or more arboviruses. Monoinfections (76; 5.9%) were distributed between 22 (1.7%) for ZIKV, 39 (3.1%) for DENV and 15 (1.2%) for CHIKV. Co-infections were detected in 30 (2.3%) of the positive participants and one case with triple infection was found. IgM positivity was found in 2.4% of ZIKV RT-qPCR, 9.6% of DENV and 16.3% of CHIKV. RT-qPCR positivity for arboviruses was associated with low socioeconomic class and presence of a water box sealing in the household. A higher positivity to the three viruses occurred in the month with the lowest wind velocity, which was also preceded by the highest peak of rain and humidity. We identified the simultaneous circulation and co-infection of ZIKV, DENV and CHIKV in Fortaleza in a post-Zika epidemic year. We also highlight the need for continuous epidemiological surveillance combined with molecular diagnostic tools.

Estimation of m + a′ and d is a promising strategy to guide the selection of crop populations and lines. This study aimed to predict the contribution of homozygous loci (m + a′) to agronomic characters of commercial hybrids of yellow melon. Seven single-cross commercial hybrids (F1) of yellow melon were used (H1, H2, H3, H5, H4, H6, and H7), as well as their self-pollinated progenies (F2), totaling 14 populations. The experimental design was a randomized complete block with three replications. Fruit number, average fruit weight, yield, pulp thickness, pulp firmness, and soluble solids content were assessed. The data were subjected to a likelihood ratio test, deviance analysis, m + a′ and d estimation, and correlation analysis. Five of the six characters evaluated showed m + a′ values close to or greater than 90%. These values suggest that most loci are fixed for these traits. Inbreeding depression for fruit number, average fruit weight, pulp thickness, pulp firmness, and soluble solids is minimal. Hybrids H6, H4, and H5 showed promise for the selection of superior lines.

As a response to the rise in microcephaly cases in 2015, Brazilian health authorities recommended a number of Zika virus (ZIKV) prevention behaviors. This study explores the contrast between the Brazilian health authorities’ health promotion response to the epidemic and the context in which the epidemic unfolded. Rapid Anthropological Assessment was used to assess how women in Fortaleza, Brazil, perceive ZIKV, ZIKV prevention recommendations, and the feasibility of adhering to these recommendations. Semi-structured interviews, informational interviews, and observations were used. The ZIKV recommendations and prevention did not represent best practices in health communication and promotion and failed to achieve their goals. Prevention recommendations were delivered without actionable steps and without considering cultural, socioeconomic, or environmental contexts. It is imperative to take advantage of this interepidemic period to apply best practices in health communication, education, and promotion to ensure populations at risk have adequate awareness, information, and resources to prevent infection.

O objetivo deste artigo é sistematizar as ações de (re)organização da Atenção Primária à Saúde disparadas pela Secretaria Município de Sobral (CE) no enfrentamento da COVID-19. A (re)organização dos serviços de APS em Sobral centraram-se no desenvolvimento de ações de territorialização e vigilância em saúde para bloquear e reduzir o risco de expansão da epidemia; a continuidade das ações próprias na sua rotina de promoção da saúde, prevenção de agravos e provisão de cuidados à população e o compartilhamento do cuidado em rede. Assim, a experiência de Sobral evidencia a importância do fortalecimento da APS, em especial do modelo assistencial ancorado na abordagem familiar e comunitária.

In 2016, a Public Health Emergency of International Concern (PHEIC) was declared in response to the rise of microcephaly cases among newborns in Northeastern Brazil. A common reactionary measure by public health authorities was to recommend women postpone pregnancy to avoid the possible perinatal transmission of Zika virus (ZIKV).The purpose of this study was to assess how women in Fortaleza, Brazil conceptualize pregnancy; experience facilitators and barriers to pregnancy avoidance; perceive the authorities' recommendation to postpone pregnancy due to the ZIKV outbreak; and recall their experiences during the ZIKV epidemic. Qualitative methods, specifically a Rapid Anthropological Assessment (RAA), were utilized in this study. Data collection included semi-structured interviews, triangulated with observations and informal interviews with community members.The sample included 35 women (18-39 years old) who exclusively utilized the national public health care system. Findings indicated that all participants perceived the ZIKV pregnancy-postponement recommendation to be counter-cultural to Brazilian social norms. Overall women's self-perceived agency to prevent pregnancy was low due to social expectations and lack of trust for contraceptives. ZIKV prevention was not seen as a reason to utilize contraceptives. Interestingly, only women who self-perceived as more affluent were willing to attempt pregnancy prevention for educational, occupational, or financial opportunity.Pregnancy postponement as a response to a ZIKV epidemic ignores gaps in reproductive agency and defies social norms, making it unrealistic and counter-cultural. Future ZIKV health recommendations must be culturally aligned with the population, and address barriers and motivators for family planning.

Domestic Violence involving children and adolescents is a complex multi-causal phenomenon. This research aims to determine the predictors’ factors for children and adolescents’ victims and perpetra...

Background Outbreaks of Chikungunya virus (CHIKV) occurred in Brazil during 2015–2017. Fortaleza was the city that reported the most cases. Methods The first round of a cohort study was conducted among women aged 15–39 y in Fortaleza, Brazil, in 2018 (Zika in Fortaleza). We collected sera to detect CHIKV IgG and IgM antibodies. Factors for CHIKV infection were identified using a Poisson regression model. Results We evaluated 1466 serum samples and 13.8% and 37.2% of women were found positive for CHIKV IgM and IgG antibodies, respectively. Living with more than four others in the same house and having an abandoned house nearby were associated with CHIKV infection. Being currently pregnant was associated with a decreased probability of CHIKV infection, which was also associated with pregnant women reporting using more repellent, both inside and outside the house, than non-pregnant women. Conclusions Crowding in households and abandoned houses nearby can increase potential transmission. Policies providing better living conditions and regulation of abandoned sites and buildings are necessary to control the mosquito population. Programmes providing repellant at low or no cost to pregnant women should be implemented in the neighbourhoods where arbovirus infections are endemic.

A carência de médicos no Brasil tem sido minimizada por meio do Programa Mais Médicos. Durante a permanência no programa, os médicos participam de processos de aperfeiçoamento profissional, como a Supervisão Acadêmica, por meio da qual é concedido apoio pedagógico para o fortalecimento de habilidades e competências necessárias ao trabalho na Atenção Básica. Em 2015, foram realizadas visitas in loco e atividades longitudinais de supervisão, além de encontros locorregionais, nos quais foram abordadas temáticas relacionadas às doenças crônicas não transmissíveis, às doenças tropicais negligenciadas, ao panorama do programa, à Saúde Mental e ao processo de trabalho na Atenção Básica. O elenco desses conteúdos converge com o perfil epidemiológico prevalente na população, bem como com a dinâmica de trabalho na Atenção Básica. Assim, a Supervisão Acadêmica tem se mostrado uma ferramenta potente para a qualificação do programa e da Atenção Básica. The shortage of physicians in Brazil has been alleviated by the More Doctors Program. As part of the program, physicians participate in professional enhancement processes, such as academic supervision, through which pedagogical support is given to strengthen the necessary skills and competencies for working in Primary Care. In 2015, onsite visits and longitudinal supervisory activities took place, in addition to regional meetings, which addressed topics related to noncommunicable chronic diseases, neglected tropical diseases, an overview of the program, Mental Health, and Primary Care work process. This list of themes is consistent with the prevalent epidemiological profile of the population, as well as work dynamics in Primary Care. In short, Academic Supervision has proven to be a powerful tool for the program qualification and Primary Care. La carencia de médicos en Brasil ha sido minimizada por medio del Programa Más Médicos. Durante la permanencia en el Programa, los médicos participan de procesos de perfeccionamiento profesional, como la supervisión académica por medio de la cual se proporciona apoyo pedagógico para el fortalecimiento de habilidades y competencias necesarias para el trabajo en la Atención Básica. En 2015, se realizaron visitas in situ y actividades longitudinales de supervisión, además de encuentros regionales in situ, en donde se abordaron temáticas relacionadas a las enfermedades crónicas no transmisibles, a las enfermedades tropicales negligenciadas, al panorama del Programa, a la salud mental y al proceso de trabajo en la Atención Básica. El conjunto de estos contenidos converge con el perfil epidemiológico prevalente en la población, así como con la dinámica de trabajo en la Atención Básica. Por lo tanto, la supervisión se ha mostrado una herramienta potente para la calificación del Programa y de la Atención Básica.

A violência dirigida à criança e ao adolescente causa transtornos não apenas físicos, mas também emocionais e psicológicos. Objetivou-se descrever o perfil da violência promovida, do agressor e da vítima. Estudo Transversal com amostra aleatória de 840 processos dos 3926 processos dos Conselhos Tutelares de Fortaleza – CE de 2011. Análise realizada pelo EPIINFO por meio de porcentagens. Seguiu-se os princípios éticos da Resolução 196/96. Características da Violência: Evidenciado alta prevalência de violência doméstica e psicológica. Denuncias não anônimas em sua maioria por pessoas da comunidade, ou familiares. Características da vítima: Crianças foram mais vitimadas que adolescentes. Em sua maior parte do sexo feminino. 12,56% fazem algum uso de drogas. Características do agressor: O agressor, na maioria dos casos é a mãe ou pai. 34,36% são usuários de drogas. 34,49% usaram substância química durante a agressão. Elevada historia anterior de promover agressão, bem como de sofrer abuso. Dados que demonstram a violência como problemática multifatorial, ajudam a prevenção da violência e intentam diálogo entre o ECA e a saúde para que por responsabilidade mútua haja implementação de políticas públicas na área da infância e adolescência.

A hanseníase é um importante problema de saúde pública, que vem acometendo e mutilando física e socialmente inúmeros sujeitos. O estudo objetivou realizar avaliação epidemiológica e operacional da hanseníase no município de Cariré - Ceará, a partir de uma pesquisa epidemiológica, descritiva e temporal, com os casos notificados no período de primeiro de janeiro de 2001 a 31 de dezembro de 2010, da base de dados do Sistema de Informação de Agravos de Notificação (SINAN) da Secretaria Municipal da Saúde de Cariré, em 116 casos, residentes no município. Observou-se que nos últimos anos houve uma elevação no número de casos novos de hanseníase e da taxa de incidência e do coeficiente de prevalência, principalmente no ano de 2010, devido a uma maior busca ativa, melhoria na capacidade diagnóstica e avaliação dos contatos. Tais achados são importantes, se considerarmos a endemia oculta existente. Apesar da hiperendemicidade do município estudado, ações para eliminação da hanseníase vêm sendo desenvolvidas de forma efetiva.