Search

Dengue is recognized as a major health issue in large urban tropical cities but is also observed in rural areas. In these environments, physical characteristics of the landscape and sociodemographic factors may influence vector populations at small geographic scales, while prior immunity to the four dengue virus serotypes affects incidence. In 2019, a rural northwestern Ecuadorian community, only accessible by river, experienced a dengue outbreak. The village is 2-3 hours by boat away from the nearest population center and comprises both Afro-Ecuadorian and Indigenous Chachi households. We used multiple data streams to examine spatial risk factors associated with this outbreak, combining maps collected with an unmanned aerial vehicle (UAV), an entomological survey, a community census, and active surveillance of febrile cases. We mapped visible water containers seen in UAV images and calculated both the green-red vegetation index (GRVI) and household proximity to public spaces like schools and meeting areas. To identify risk factors for symptomatic dengue infection, we used mixed-effect logistic regression models to account for the clustering of symptomatic cases within households. We identified 55 dengue cases (9.5% of the population) from 37 households. Cases peaked in June and continued through October. Rural spatial organization helped to explain disease risk. Afro-Ecuadorian (versus Indigenous) households experience more symptomatic dengue (OR = 3.0, 95%CI: 1.3, 6.9). This association was explained by differences in vegetation (measured by GRVI) near the household (OR: 11.3 95% 0.38, 38.0) and proximity to the football field (OR: 13.9, 95% 4.0, 48.4). The integration of UAV mapping with other data streams adds to our understanding of these dynamics.

La hidatidosis es una enfermedad zoonótica de escala mundial. Afecta a varias especies de mamíferos, incluído el hombre, los cerdos actuán como hospedadores intermediarios del quiste hidatídico. En este trabajo se hallaron quistes hidatídicos fértiles (viables) en porcinos faenados en el matadero municipal de la ciudad.

Leptospirosis and dengue fever are infectious diseases that co-occur during rainy seasons and both produce similar clinical signs. The purpose of this study was to assess the relative frequency of leptospirosis and dengue fever during a rainy season and the clinical difficulty to distinguish them. Blood samples from febrile patients in Guayaquil were obtained during the rainy season of 2008 and were analyzed by IgM ELISA for both diseases. Additionally, retrospective data (2003-2007) from febrile patients who attended one of largest public hospitals in Guayaquil were obtained. From 135 febrile patients samples, 15 (11.1%) were positive to leptospirosis; 36 (26,7%) to dengue fever; 3 (2.2%) to both pathogens and 81 (60%) were negative for both. Based on clinical diagnosis, cases were classified 68.1% as dengue fever; 20.7% as leptospirosis; 9.6% as malaria and 1.5% as other. However, 60% of patients clinically diagnosed as dengue had only antibodies against Leptospira and 25% patients diagnosed as leptospirosis had antibodies to dengue virus. The hospital archives indicated that 72.8% of patients clinically diagnosed as dengue fever had antibodies to Leptospira and not to dengue virus. The results suggest the two diseases are often misidentified which is a serious problem because both diseases require different medical treatment.

Purpose – This paper aims to investigate the formation of an inter-organizational collaboration network that made it possible to repair 2,516 mechanical respirators that were inoperative in Brazil during the first wave of the COVID-19 pandemic. Design/methodology/approach – A qualitative approach was used in a single case study with semi-structured interviews. The interviewee selection process was non-probabilistic through snowball sampling. Findings – The results suggest that society, through different social groups with their different roles, can organize itself quickly through the formation of collaborative networks, and this organizational configuration can be an alternative for facing crises where actions isolated would be insufficient or slow to urgently address complex situations. Practical implications – This paper aims to (1) demonstrate that society, through different social groups with their different roles, can organize itself quickly through the formation of collaborative networks; (2) favor the understanding and dynamics of the formation of a network; and (3) contribute to a possible replication of this initiative in future contexts. Originality/value – The case portrays an unprecedented formation of a collaboration network involving more than 144 organizations that mobilized quickly in a complex context of a pandemic and that generated remarkable results through the reintroduction of equipment that were responsible for the preservation of thousands of lives during the year from 2020.

IntroductionObesity is a chronic medical condition that affects, among others, the cardiovascular and respiratory systems. Interventions for its treatment focus on sustained weight reduction and general health improvement, leaving respiratory management aside. Our objective was to determine the effects of inspiratory muscle training (IMT) in patients with obesity.MethodsA systematic review was performed in Embase, Cochrane Library (CENTRAL), CINAHL, Web of Science, and PubMed/MEDLINE on June 26, 2023. Randomized clinical trials (RCTs), and quasi-randomized clinical trials investigating the effects of IMT in people with obesity were included. Selected studies were screened by two independent reviewers who extracted data and assessed the quality of the evidence.ResultsThe initial search returned 705 potential studies were included. Ultimately, eight studies met the criteria for eligibility and were included in the review. IMT improves physical capacity [6-minute walk test (6MWT): 44.5 m, 95% CI: 30.5 to 58.5; p

Background: Effective treatments for obstructive sleep apnoea (OSA) include positive pressure, weight loss, oral appliances, surgery, and exercise. Although the involvement of the respiratory muscles in OSA is evident, the effect of training them to improve clinical outcomes is not clear. We aimed to determine the effects of respiratory muscle training in patients with OSA. Methods: A systematic review was conducted in seven databases. Studies that applied respiratory muscle training in OSA patients were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results: Of the 405 reports returned by the initial search, eight articles reporting on 210 patients were included in the data synthesis. Seven included inspiratory muscle training (IMT), and one included expiratory muscle training (EMT). Regarding IMT, we found significant improvement in Epworth sleepiness scale in −4.45 points (95%CI −7.64 to −1.27 points, p = 0.006), in Pittsburgh sleep quality index of −2.79 points (95%CI −4.19 to −1.39 points, p < 0.0001), and maximum inspiratory pressure of −29.56 cmH2O (95%CI −53.14 to −5.98 cmH2O, p = 0.01). However, the apnoea/hypopnea index and physical capacity did not show changes. We did not perform a meta-analysis of EMT due to insufficient studies. Conclusion: IMT improves sleepiness, sleep quality and inspiratory strength in patients with OSA.

Obstructive sleep apnoea (OSA) constitutes a public health problem, with various systemic consequences that can increase cardiovascular morbidity and mortality as well as increase healthcare expenditure. This review discusses the rationale and effects of using general physical exercise, oropharyngeal exercises, and respiratory muscle training as an adjunctive treatment for patients with sleep apnoea. The recommended treatment for OSA is the use of continuous positive airway pressure, which is a therapy that prevents apnoea events by keeping the airways open. In the last decade, coadjuvant treatments that aim to support weight loss (including diet and physical exercise) and oropharyngeal exercises have been proposed to lower the apnoea/hypopnoea index among patients with OSA. Based on the available evidence, health professionals could decide to incorporate these therapeutic strategies to manage patients with sleep apnoea.

BackgroundCongenital heart disease (CHD) entails structural defects in the morphogenesis of the heart or its main vessels. Analyzing exercise capacity of children and adolescents with CHD is important to improve their functional condition and quality of life, since it can allow timely intervention on poor prognostic factors associated with higher risk of morbidity and mortality.ObjectiveTo describe exercise capacity in children and adolescents with CHD compared with healthy controls.MethodsA systematic review was carried out. Randomized clinical trials and observational studies were included assessing exercise capacity through direct and indirect methods in children and adolescents between 5 and 17 years-old. A sensitive analysis was performed including studies with CHD repaired participants. Additionally, it was sub-analyzed by age range (< and ≥ 12 years old). Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence.Results5619 articles were found and 21 were considered for the review. Eighteen articles used the direct exercise capacity measurement method by cardiopulmonary exercise test (CPET). The CHD group showed significant differences in peak oxygen consumption (VO2peak) with a value of −7.9 ml/Kg/min (95% CI: −9.9, −5.9, p = 0.00001), maximum workload (Wmax) −41.5 (95% CI: −57.9, −25.1 watts, p = 0.00001), ventilatory equivalent (VE/VCO2) slope 2.6 (95% CI: 0.3, 4.8), oxygen pulse (O2 pulse)−2.4 ml/beat (95% CI: −3.7, −1.1, p = 0.0003), and maximum heart rate (HRmax) −15 bpm (95% CI: −18, −12 bpm, p = 0.00001), compared with healthy controls. Adolescents (≥ 12 yrs) with CHD had a greater reduction in VO2peak (−10.0 ml/Kg/min (95% CI: −12.0, −5.3), p < 0.00001), Wmax (−45.5 watts (95% CI: −54.4, −36.7), p < 0.00001) and HRmax (−21 bpm (95% CI: −28, −14), p

Background:. Women treated for breast cancer are facing a lifetime risk of developing lymphedema, which occurs in up to 40% of this population. There is a lack of evidence and limited knowledge regarding the treatment of breast cancer–related lymphedema (BCRL). The aim of this study was to identify, describe, and organize the currently available evidence in the treatment of BCRL. Methods:. We conducted an evidence mapping review study according to the methodology proposed by Global Evidence Mapping. We performed a systematic search in Medline, Embase, Central (Cochrane), and Epistemonikos, from 2000–2020. We included studies about all treatment types for BCRL, including surgical and nonsurgical treatment. Results were summarized in narrative and tabular forms. Results:. A total of 240 studies were included in this mapping review, distributed as follows: 147 experimental studies [102 randomized clinical trials (RCTs) and 45 quasi-experimental clinical trials], 48 observational studies (34 prospective and 14 retrospective studies), and 45 systematic reviews (17 of them with metanalysis). Most of the RCTs were on nonsurgical interventions. Only two RCTs addressed surgical intervention. Conclusions:. In the last 20 years, there were an average of 12 publications per year on the treatment of BCRL. Recently this lack of attention has been partially corrected, as the majority were published in the past 5 years. However, most of them were on nonsurgical interventions. Well-designed RCTs on surgery are needed to measure the effectiveness of the applied interventions.

As the number of automated vehicles in our transportation system increases, it becomes increasingly important to understand how automation affects their driving behavior. This study defines and tests a methodology based on optimization methods to incorporate the longitudinal driving behavior of automated vehicles in the Wiedemann 99 car-following model. A pilot study was recently conducted in Portugal using a Mercedes-Benz of 2017 assisted with level 2 driving automation to gather empirical data. In total, 61 car-following events were used to support the calibration and validation tasks. The calibration error sustains the methodology’s descriptive capability to simulate the driving behavior of AVs, and the validation error sustains that the calibrated model parameters can reproduce the dynamic driving behavior of AVs with reasonable consistency and robustness. A total of seven model parameters were estimated and are in line with the trends often described in the literature on automated vehicles but also highlight differences that can be explained by different development and deployment strategies. Nevertheless, since empirical data from automated vehicles are hard to get, the presented work findings are also valuable for improving and validating future modeling efforts.

Background Coronavirus disease has provoked much discussion since its first appearance. Despite it being widely studied all over the world, little is known about the impact of the disease on functional ability related to performing activities of daily living (ADL) in patients post COVID-19 infection. Objectives To understand the impact of COVID-19 on ADL performance of adult patients and to describe the common scales used to assess performance of ADL on patients post-COVID-19. Methods A systematic review was conducted. We included studies that applied a physical capacity test in COVID-19 patients, post-infection. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence. Results A total of 1,228 studies were included, after removing duplicates, 1,005 abstracts were screened and of those 983 were excluded. A final number of nine studies which met the eligibility criteria were included. The findings revealed worsening of physical function and ADL performance in all patients post COVID-19 infection. Conclusion All included studies found a reduction of ADL beyond the test or scale used, revealing a vital worsening of functional ability in ADL performance and consequently loss of independence in COVID-19 patients after the acute phase of infection. Functional ability status previous to COVID-19 is crucial for predicting the severity of the disease and mortality. Barthel Index and ADL score were the most used assessment tools across subjects with different intrinsic capacity and context levels.

The article presents the author's views on a study conducted for analyzing women congregations of active life in the religious history of Luxembourg from 1840 to 2012. Various topics discussed include congregational works that were published since 1945, perspectives on the congregations' research and studies on urbanism.

It is well known that road accidents tend to be more frequent in locations where a sudden change in road characteristics violates the driver's expectations. Most methods used to assess the design consistency are based on simplified speed profiles that give a coarse description of the vehicle dynamics along the road. This paper presents a new approach to quantify the road design consistency, based on continuous operating speed profiles. These profiles are based on the Gipps’ car-following equations, adapted to simulate the driver behaviour in the vicinity of horizontal curves under free-flow conditions. A methodology to calibrate and validate the Gipps’ behavioural parameters from field data is presented and applied to predict the speed profiles of three drivers for a set of rural road segments. The calibration is based on trajectory data collected with an instrumented vehicle and it follows an automated procedure that aims to minimize the differences between the predicted and observed speed profiles. The new consistency index is based on the deceleration distances and it allows to overcome some limitations of the existing methods.

Measurement of respiratory muscles strength such as maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) are used to detect, diagnose and treat respiratory weakness. However, devices used for these measurements are not widely available and are costly. Currently, the use of a digital manometer is recommended. In industry, several inexpensive devices are available, but these have not been validated for clinical use. Our objective was to determine the agreement between maximal respiratory pressures obtained with a clinical digital manometer and that with a non-clinical digital manometer in healthy volunteers. We assessed the height, weight, lung function, MIP, and MEP of healthy volunteers. To compare pressures obtained by each type of digital manometer, a parallel approach configuration was used. The agreement was measured with the Intraclass Coefficient Correlation (ICC) and the Bland-Altman plot. Twenty-seven participants (14 men) were recruited with a median age of 22 (range: 21-23) years. Each participant underwent three measurements to give a total of 81 measurements. The mean MIPs were 90.8 ± 26.4 (SEM 2.9) and 91.1 ± 26.4 (SEM 2.9) cmH2O for the clinical and non-clinical digital manometers, respectively. The mean MEPs were 113.8 ± 40.4 (SEM 4.5) and 114.5 ± 40.5 (SEM 4.5) cmH2O for the clinical and non-clinical digital manometers, respectively. We obtained an ICC of 0.998 (IC 0.997-0.999) for MIP and 0.999 (IC 0.998-0.999) for MEP. There is a high agreement in the values obtained for MIP and MEP between clinical and non-clinical digital manometers in healthy volunteers. Further validation at lower pressures and safety profiling among human subjects is needed.

Capacity models based on the gap acceptance theory are widely used in unsignalised intersections and roundabout capacity analysis. These models are based on the statistical distribution of major vehicle headways. In this field, Cowan’s M3 distribution is usually recognized as the most adequate, but the estimation of its parameters is not trivial. In this paper, the main estimation methods are reviewed and a new method (Simultaneous Numerical Estimation – SNE) is proposed. The SNE method was used to develop a calibrated relation between parameters, using field data collected in Portuguese roads and roundabouts. It was determined that the new formula improves capacity estimates, either in one-lane or in two-lane roundabouts. The paper also addresses the importance of each input variable and parameter in the resulting capacity model, through a sensitivity analyses.

Nenhum resumo disponível