Health Agents Research Articles

The Amazonian kambô frog Phyllomedusa bicolor (Amphibia: Phyllomedusidae): Current knowledge on biology, phylogeography, toxinology, ethnopharmacology and medical aspects.

Phyllomedusa bicolor (Phyllomedusidae), popularly known as the kambô in Brazil, is a tree frog that is widely distributed in South American countries and is known for producing a skin secretion that is rich in bioactive peptides, which are often used in indigenous rituals. The biological effects of the skin secretion were observed in the first studies with indigenous communities. Over the last six decades, researchers have been studying the chemical composition in detail, as well as the potential pharmacological applications of its constituents. For this reason, indigenous communities and health agents fear the misuse of the kambô, or the inappropriate use of the species, which can result in health complications or even death of users. This article seeks to provide a transdisciplinary review that integrates knowledge regarding the biology of P. bicolor, ethnoknowledge about the ritual of the kambô, and the chemistry and pharmacology of the skin secretion of this species, in addition to medical aspects of the indiscriminate use of the kambô. Furthermore, this review seeks to shed light on perspectives on the future of research related to the kambô.

Prevention is a Neglected Aspect in the Eradication Policies Against Tuberculosis

Tuberculosis remains unapparent in about 80% of the infected cases. It turns symptomatic in cases of stress, undernourishment, i.e., weakening of the immune defenses, hygiene deficits, or massive exposure of fragile and/or stressed populations, including overworked health agents, to the pathogen. It is, thus, mostly a disease of the stressed, the poor, and the indigents. Prevention demands a detection of unapparent infections at risk of turning symptomatic. Diagnostic tests based on the detection of the antigen in sputum and occasionally in other organs have their use but need to be completed with the detection of asymptomatic cases. It is possible by the monitoring of immunoglobulin G (IgG) antibodies during the early process of infection, before the bacillus has reached a mass able to vigorously suppress the immune capacities of the patient. Some drugs are immune depressive and impair the recovery of successfully treated patients. At consultation, the patient is often already fully immune depressed; a monitoring of his IgG-specific antibodies shows that the level of antibodies is very low and will rise if the treatment is successful. The monitoring of the immune status of the patients and the application of immunostimulating products to those patients who show a need therefore will complete the chemotherapy. Nothing of this is currently applied and the serodiagnostic, so useful in rural areas, has been banned, to be replaced by an expensive and inaccurate antigen-test. In addition, the continuing use of an iatrogenic vaccine defeats the purpose.

Lower Fracture Rates in Patients Treated with Radium-223, Abiraterone or Enzalutamide, When Given Concurrently with Bone Health Agents: A Real-World Analysis.

The phase 3 trial ERA223 demonstrated an increased fracture rate and no survival advantage for metastatic castration resistant prostate cancer (mCRPC) patients on Radium-223 (Ra-223) with abiraterone, leading to regulatory restrictions on combination therapy. However, less than half of trial patients received bone health agents (BHA). We reviewed electronic health record (EHR) data evaluating fracture rates for patients on BHA receiving Ra-223, androgen deprivation therapy and either abiraterone or enzalutamide. We conducted a retrospective, cohort analysis of EHR data of mCRPC patients on Ra-223 treated at a single community center by a single provider between 2010 and 2018. The primary objective was evaluating fracture rates for patients on BHA receiving Ra-223 and abiraterone. We conducted a secondary analysis for enzalutamide. One hundred seventy-seven patients received Ra-223 concurrently with abiraterone or enzalutamide between November 2010 and August 2018. The median age was 73 at first Ra-223 dose (range 40-93). The median follow-up time from last Ra-223 dose was 30 months (range 2-106). One hundred sixty-four patients (93%) received BHAs. One hundred fifty-nine patients (89%) were on a BHA before and/or during Ra-223. Sixty-seven patients received denosumab (38%), 63 received zoledronic acid (36%), and 29 received both nonconcurrently (16%). Eleven patients (6.2%) experienced a fracture after starting Ra-223, 9 of which occurred while on prior and/or concurrent BHA. We observed a 5.7% fracture rate for mCRPC patients who received combination therapy and denosumab or zoledronic acid. This real-world analysis demonstrating a low fracture rate in patients with mCRPC receiving a BHA while on Ra-223 and abiraterone or enzalutamide may inform current clinical practice.

Assessing the Impact of Conversational Artificial Intelligence in the Treatment of Stress and Anxiety in Aging Adults: Randomized Controlled Trial.

BackgroundWhile mental health applications are increasingly becoming available for large populations of users, there is a lack of controlled trials on the impacts of such applications. Artificial intelligence (AI)-empowered agents have been evaluated when assisting adults with cognitive impairments; however, few applications are available for aging adults who are still actively working. These adults often have high stress levels related to changes in their work places, and related symptoms eventually affect their quality of life.ObjectiveWe aimed to evaluate the contribution of TEO (Therapy Empowerment Opportunity), a mobile personal health care agent with conversational AI. TEO promotes mental health and well-being by engaging patients in conversations to recollect the details of events that increased their anxiety and by providing therapeutic exercises and suggestions.MethodsThe study was based on a protocolized intervention for stress and anxiety management. Participants with stress symptoms and mild-to-moderate anxiety received an 8-week cognitive behavioral therapy (CBT) intervention delivered remotely. A group of participants also interacted with the agent TEO. The participants were active workers aged over 55 years. The experimental groups were as follows: group 1, traditional therapy; group 2, traditional therapy and mobile health (mHealth) agent; group 3, mHealth agent; and group 4, no treatment (assigned to a waiting list). Symptoms related to stress (anxiety, physical disease, and depression) were assessed prior to treatment (T1), at the end (T2), and 3 months after treatment (T3), using standardized psychological questionnaires. Moreover, the Patient Health Questionnaire-8 and General Anxiety Disorders-7 scales were administered before the intervention (T1), at mid-term (T2), at the end of the intervention (T3), and after 3 months (T4). At the end of the intervention, participants in groups 1, 2, and 3 filled in a satisfaction questionnaire.ResultsDespite randomization, statistically significant differences between groups were present at T1. Group 4 showed lower levels of anxiety and depression compared with group 1, and lower levels of stress compared with group 2. Comparisons between groups at T2 and T3 did not show significant differences in outcomes. Analyses conducted within groups showed significant differences between times in group 2, with greater improvements in the levels of stress and scores related to overall well-being. A general worsening trend between T2 and T3 was detected in all groups, with a significant increase in stress levels in group 2. Group 2 reported higher levels of perceived usefulness and satisfaction.ConclusionsNo statistically significant differences could be observed between participants who used the mHealth app alone or within the traditional CBT setting. However, the results indicated significant differences within the groups that received treatment and a stable tendency toward improvement, which was limited to individual perceptions of stress-related symptoms.Trial RegistrationClinicalTrials.gov NCT04809090; https://clinicaltrials.gov/ct2/show/NCT04809090

P464 Feline sporotrichosis: an emerging disease in the Brazilian side of the Southern Triple Border

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMSporotrichosis is a neglected tropical disease caused by fungi of the genus Sporothrix spp. Transmission can occur through sapronotic, enzootic, and zoonotic pathways. Sporothrix schenckii and S. brasiliensis are the most common etiologic agents in human and animal diseases in Brazil.ObjectivesThe objective of this work is to alert about the emergence of feline sporotrichosis on the Brazilian side of the Southern Triple Border (Brazil, Paraguay, and Argentina).MethodsFrom July 2021 to March 2022, biological samples and clinical-epidemiological data were collected from 57 domestic cats with typical sporotrichosis lesions and residents of Iguassu Falls (Foz). The cats were selected through notification of the citizens themselves, health agents of Zoonosis Control Center of Iguassu Falls (CCZ–Foz), veterinarians from private veterinary clinics and hospitals, and the receipt of suspected animals by CCZ–Foz. From the samples, direct mycological examinations and fungal culture were performed and a set of 10 fungal isolates from the microbiological tests were selected for molecular analysis based on calmodulin (CAL) gene sequences. From each collection point, the geographic coordinate was taken using the Google Earth® software and the Quantus Gis software (QGIS) was used to assemble the maps.ResultsOf the 57 samples collected, 45 were considered positive in the microbiological tests (Fig. 1), and the first 10 isolates were identified as S. brasiliensis. Based on clinical-epidemiological, and geographic data (Fig. 2), the following problems associated with feline sporotrichosis in this region were identified: the presence of sporotrichosis positive cats in high-density regions population of Foz; the epidemic profile of the disease with cases spreading quickly by neighborhoods in the South region of the city to neighborhoods in the North region; the easy access to the street and other homes of infected cats, which facilitates the zoonotic and enzootic transmission cycle of this disease; the free movement of animals positive for backyards and vacant lots where they can defecate and even come to death the that feeds the sapronotic cycle; and the profile most associated with the animal positive being that of an uncastrated male, not vaccinated and with little or no access to veterinary services.ConclusionFor being a region of the Triple Frontier, there are many differences in political, administrative, and operational between the Public Health Systems of the three countries, with Paraguay and Argentina, the political-administrative-operational centralization is configured as a great node critical for the development of health actions in an adequate way to the needs at a loco-regional level and, above all, on time for the implementation thereof. With the situational diagnosis provided for this study it is possible to understand the factors that influence the emergence of the disease in Iguassu Falls contributing to the development of programs and specific strategies, focusing on raising the population's awareness of safekeeping practices for your animals; free diagnosis for animals (dogs and cats) suspected of sporotrichosis, and treatment with a free supply of medication for patients animals with a confirmed diagnosis of sporotrichosis.

Midwives in Health Sciences as a Sociocultural Phenomenon: Legislation, Training and Health (XV-XVIII Centuries).

Background and Objectives: The first inquisitorial processes were developed against Muslims and Jews. Then, they focused on women, especially those dedicated to care. Progressively, they were linked to witchcraft and sorcery due to their great assistance, generational and empirical knowledge. The health historiography of the 15th–18th centuries still has important bibliographic and interpretive gaps in the care provided by women. The main objective was to analyse the care provided by midwives in the legislative and socio-sanitary context of New Castile, in the inquisitorial Spain of the 15th–18th centuries. Materials and Methods: A historical review was conducted, following the Dialectical Structural Model of Care. Historical manuals, articles and databases were analysed. Results: The Catholic Monarchs established health profession regulations in 1477, including midwives. However, all legislations were annulled by Felipe II in 1576. These were not resumed until 1750. Midwives assumed a huge range of functions in their care commitment (teaching, care and religion) and were valued in opposing ways. However, many of them were persecuted and condemned by the Inquisition. They used to accompany therapeutic action with prayers and charms. Midwives were usually women in a social vulnerability situation, who did not comply with social stereotypes. Conclusions: Midwives, forerunners of current nursing and health sciences, overcame sociocultural difficulties, although they were condemned for it. Midwives achieved an accredited title, which was taken from them for two centuries. They acted as health agents in a society that demanded them while participating in a “witch hunt”.

Black American Muslims: a study of religious identity and mental health

ABSTRACT Racism is a salient societal-level factor that adversely impacts the mental health of Black Americans. Although religiosity and racial identity have been studied in this population as protective factors, few studies have specifically considered Black American Muslims. We assessed the relationship between religious and racial identity on mental health-related factors among 499 Black American Muslims, utilising data from a cross-sectional study of Muslims in America conducted by the Yaqeen Institute for Islamic Research. Cluster analysis results indicated a five-cluster solution. Differential associations were identified between cluster membership and psychological health outcomes. Participants in profiles characterised by a belief in the low societal regard for Muslims and Blacks had significantly worse mental health than did those in other profiles. The analysis further identified religiosity, gratitude, and private regard as buffering mental health agents, with uncertainty intolerance and John Henryism being related risk factors. Implications for future research are discussed.

Analyzing GAVI the Vaccine Alliance as a Global Health Partnership Model: A Constructivist Analysis of the Global Health Crisis

The ongoing debate on the conceptual underpinnings of constructivism and global health partnerships (GHPs) in global health studies has a dimension that deserves closer attention. This paper attempts to draw attention to a few aspects of the debate using Finnemore’s constructivist analysis. According to this study, global actors need to rethink their paradoxical notions of pandemic crisis survival in light of the growing demand for mobilizing diverse global health agents and the necessity of constructing complex GHPs to address challenges of international significance. A global response based on solidarity and multilateralism is the only way to effectively combat this pandemic. Against this backdrop, the article analyses this development through an ideational ontological case study of the GAVI, the Vaccine Alliance. This article contributes to the debate by explaining how the GAVI Alliance fostered global collaboration and can serve as a template for future GHPs.

Residual effect of Citrus sinensis and Syzygium aromaticum essential oils in association with temephos on Aedes aegypti Linn. larvae (Diptera: Culicidae) in laboratory

The increase of Ae. aegypti resistance to conventional insecticides and growing public concern about the environmental impact has resulted in the development of alternatives to mosquito control. Thus, the use of essential oils (EOs) in combination with larvicides may be a strategy used to reduce the phenomenon of resistance. Controlling larvae with insecticides for a prolonged period is important for interrupting transmission of vector-borne viruses, as long lasting larvicidal formulations reduce health agents visits with a consequent reduction in the global cost for controlling mosquito spread. Previous studies have shown that synergistic interactions between temephos and EOs exhibited increased larvae lethality when compared to temephos alone. Therefore, the goal of this work was to evaluate the residual effects of associations between temephos and EOs of Citrus sinensis and Syzygium aromaticum homogenized in hydrogel and impregnated in ceramic supports on Ae. aegypti larvae. After application of the products in 1,000 mL beakers, 25 larvae were deposited in each beaker and every five days half of the beakers were emptied to 200 mL, the original volume was replaced and new batches of larvae were added. Mortality was observed after 48 h of larval exposure. There was equivalence in the residual effect of association temephos/EOs when compared with temephos alone.

PAC APPLICATION: CLINICAL SUPPORT PLATFORM

<h3>Objectives</h3> Oral squamous cell carcinoma is a major challenge for all health professionals, particularly for general dentists. These challenges include the management of this malignancy and the early diagnosis to minimize sequelae and mortality. There are several methods for early detection for squamous cell carcinoma. The objective of this research is the development of an app capable of assisting the dental surgeon in the early diagnosis of oral cancer. <h3>Study Design</h3> This system was based on convolutional neural networks. Initially, a survey of the database of images of potentially malignant lesions and squamous cell carcinomas was performed. In the selected images, the marking occurred to delimit the lesions; therefore, the system was trained from the markings. <h3>Results</h3> In total, 493 cases were marked: 248 squamous cell carcinomas and 245 potentially malignant lesions. This app will identify the lesions, marking squamous cell carcinomas in red, potentially malignant oral lesions in green, and normal mucosa in blue. <h3>Conclusions</h3> The system developed should be used in collaboration with health agents, mainly dental surgeons, to guide the clinical diagnosis of these injuries.

Finding social (mis)alignment in older adult and opioid health policy implementation with corpus-assisted discourse analysis

• Attends to beliefs of stakeholders in health policy implementation pathway. • Argues for “policies” as social activities rather than objects. • Confirms that health systems and their agents often have conflicting policy beliefs. • Corpus-assisted discourse analysis of both documents (text) and interviews (talk). • Policymakers could use these findings and methods to align language use in policy. The effective implementation of health policies addressing opioid addiction may be jeopardized by the complex and sometimes mismatched beliefs and discourses held by policymakers, agency administrators, case managers, and ultimately target populations. Policies must be “aligned” socially across service levels, but misalignment by well-meaning stakeholders becomes a potential hindrance to implementation at different administrative levels. This observation motivates the study to ask, what do health policies and agents actually say? Data for this study come from policy documents (n = 100; words = 571,481) and ethnographic interviews (n = 29; words = 171,492) collected from rural, older adult health service offices. Results and analysis focus on comparing linguistic features, keywords and collocations, between policy texts and agents’ talk. Findings show a complex, socially mediated relationship between priorities and stances in official documents and the enacting agents, especially regarding the causes and effects of the opioid epidemic.

Multifunctional Fiber-Enabled Intelligent Health Agents.

The application of wearable devices is promoting the development toward digitization and intelligence in the field of health. However, the current smart devices centered on human health have disadvantages such as weak perception, high interference degree, and unfriendly interaction. Here, an intelligent health agent based on multifunctional fibers, with the characteristics of autonomy, activeness, intelligence, and perceptibility enabling health services, is proposed. According to the requirements for healthcare in the medical field and daily life, four major aspects driven by intelligent agents, including health monitoring, therapy, protection, and minimally invasive surgery, are summarized from the perspectives of materials science, medicine, and computer science. The function of intelligent health agents is realized through multifunctional fibers as sensing units and artificial intelligence technology as a cognitive engine. The structure, characteristics, and performance of fibers and analysis systems and algorithms are reviewed, while discussing future challenges and opportunities in healthcare and medicine. Finally, based on the above four aspects, future scenarios related to health protection of a person's life are presented. Intelligent health agents will have the potential to accelerate the realization of precision medicine and active health.

Community Health Agents Advancing Women’s Empowerment: A Qualitative Data Analysis

Community health agents (CHAs) play a critical role in primary healthcare delivery and health promotion in low-resource settings. Though there is substantial evidence of the benefits of CHAs in achieving targeted community health outcomes, there is limited research into the impact of empowerment experienced by CHAs themselves. This study examined how working as a CHA impacts the lives and self-perceptions of women in Peru volunteering with Catholic Medical Mission Board’s (CMMB) markedly successful robust CHA model. We conducted six focus group discussions (FGDs) of 53 CHAs who implement CMMB programming in Trujillo and Huancayo, Peru. The FGDs were designed to explore themes related to empowerment, changes in women’s lives, and perceptions of themselves. We identified four major themes related to women’s empowerment: achievements, agency, meaningfulness, and resources. The most common empowerment theme was achievements, expressed through subthemes of changes in family behavior, self worth, education, health and nutrition, and rights and politics. The second most common empowerment theme was agency, with subthemes related to increases in using their voice, confidence, decision making, and participation. CHAs also reported experiencing empowerment through enhanced meaningfulness. CMMB’s CHA model is an example of how well-structured community programs can facilitate women’s empowerment. Providing meaningful community leadership opportunities can have far-reaching effects on women’s perceptions of themselves as valuable, capable, and empowered leaders. This work deepens our understanding of how to practically improve community health through empowering women to catalyze gender equality in communities with disproportionate barriers and limited opportunities burdening them.

Serological screening in wild ruminants in Germany, 2021/2022: No evidence of SARS-CoV-2, bluetongue virus or pestivirus spread but high seroprevalences against Schmallenberg virus.

Wildlife animals may be susceptible to multiple infectious agents of public health or veterinary relevance, thereby potentially forming a reservoir that bears the constant risk of re‐introduction into the human or livestock population. Here, we serologically investigated 493 wild ruminant samples collected in the 2021/2022 hunting season in Germany for the presence of antibodies against the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and four viruses pathogenic to domestic ruminants, namely, the orthobunyavirus Schmallenberg virus (SBV), the reovirus bluetongue virus (BTV) and ruminant pestiviruses like bovine viral diarrhoea virus or border disease virus. The animal species comprised fallow deer, red deer, roe deer, mouflon and wisent. For coronavirus serology, additional 307 fallow, roe and red deer samples collected between 2017 and 2020 at three military training areas were included. While antibodies against SBV could be detected in about 13.6% of the samples collected in 2021/2022, only one fallow deer of unknown age tested positive for anti‐BTV antibodies, and all samples reacted negative for antibodies against ruminant pestiviruses. In an ELISA based on the receptor‐binding domain (RBD) of SARS‐CoV‐2, 25 out of 493 (5.1%) samples collected in autumn and winter 2021/2022 scored positive. This sero‐reactivity could not be confirmed by the highly specific virus neutralisation test, occurred also in 2017, 2018 and 2019, that is, prior to the human SARS‐CoV‐2 pandemic, and was likewise observed against the RBD of the related SARS‐CoV‐1. Therefore, the SARS‐CoV‐2 sero‐reactivity was most likely induced by another hitherto unknown deer virus belonging to the subgenus Sarbecovirus of betacoronaviruses.

Formative Research to Tailor Maternal Nutrition Services Introducing Multiple Micronutrient Supplements (MMS) for Pregnant Women in Rural Madagascar

ObjectivesTo develop tailored social marketing approaches for introducing multiple micronutrient supplements (MMS) to pregnant women in rural Madagascar. MethodsDesign. This formative study utilized a Rapid Assessment Procedures approach conducted over two iterative phases in Itasy and Vatovavy Fitovinany, Madagascar from October 2020 – March 2021. Data collection and sampling. Phase 1 utilized community workshops, focus groups, and market observations to generate community inputs for developing culturally appropriate and tailored MMS programming. Phase 2 included free lists and semi-structured interviews among pregnant women and health workers for an ethnographic understanding of pregnancy-related practices in this setting. Analysis. Textual data from interviews were thematically analyzed using Dedoose software. Numerical data from market observations and community workshops were summarized using descriptive statistics. Findings were grounded in a social marketing framework and triangulated across methods and participant types to enhance data credibility. ResultsFormative findings can be conceptualized using the ‘4ps’ of social marketing: Product. In this setting, women voted for an orange-colored MMS box design because the color reflects locally-available fruits such as mangoes and oranges. Red and white colors were secondary preferences. Price. Pregnant women explained some willingness to pay for MMS, suggesting that 500 to 600 Ar/30-day supply may be appropriate, but emphasizing the need for free provision to increase coverage among more vulnerable groups. Placement. Distributing MMS using a combination of both facility-based and community-based approaches was suggested by participants for ensuring optimal program coverage and reach. Promotion. Pregnant women suggested the need for community-based, interpersonal communications using health agents and health workers as the primary communication channels to promote MMS compliance. Several local language (Malagasy) phrases were generated through participatory workshops to promote MMS specifically to pregnant women in this setting. ConclusionsParticipatory formative research in rural Madagascar provided context-specific, social marketing inputs that may help improve MMS acceptability and compliance in Madagascar. Funding SourcesSight and Life Foundation.

Mental Health of Unaccompanied Immigrant Youth

The number of UMY in Spain is increasing, since the early 1990s, mostly coming from the Maghreb, although the number of those coming from different sub-Saharan African countries has gradually increased. Most of them leave their countries fleeing poverty, violence, and in search of better opportunities. They may be influenced by traumatic experiences and social stressors that can lead to emotional distress and mental health problems. They have particular needs and characteristics, so the local Child Protection Systems need to adapt their procedures to facilitate the youngsters’ social Integration and psychosocial development. This presentation will describe an ongoing project being carried out in Catalonia, the main objective is to guarantee the right to mental health of UMY in the Protection System through culturally competent biopsychosocial care, and to effectively coordinate care between the public mental health network and the Child Protection System. Finally, through training and the acquisition of competencies, the aim is to avoid burnout in professionals who care for these youths on the front line. The approach is consistent with the cultural consultation models developed in Montreal and London with the goal of providing structural support for localized and culturally competent responses. This project, to be developed over two years, has four main subprojects: 1. On-line training for professionals in “Cultural competence in mental health and psychosocial intervention”. 2. Training of “peer” UMY as “Community Mental Health Agents”. 3. Creation and implementation of multidisciplinary groups of psychosocial intervention. 4. Culturally competent psychiatric and psychological assessment.DisclosureNo significant relationships.

Peer Counseling in a Community Based Intervention for Unaccompanied Immigrant Youth

Abstract BodyUaccompanied migrant youth represent an at-risk population given the complexity of negotiating adolescence in a new culture, isolated from family and friends, without a secure base and subject to discrimination. In addition, many unaccompanied migrant youth have been subject to considerable trauma prior to, during, and post migration. In Spain, as in many countries, the residential, care, and mental health services are not adapted to the specific and complex needs of this population, and to that end complex not only are the youth not well served but providers are increasingly frustrated. The figure of the community health agent has been widely recognized as one that can function as an effective bridge between systems/institutions and marginalized and vulnerable populations. In this presentation we will describe an ongoing project that trains unaccompanied migrant youth who show promise in their cultural adaptation in the areas of cultural competence, mental health care and substance abuse to function as community health agents (or peer counselors) consistent with models of cultural consultation.DisclosureNo significant relationships.

Lessons Learned: The Varied Responses of Massachusetts' Local Health Departments During the COVID-19 Pandemic.

Context:Massachusetts' decentralized public health model holds tightly to its founding principle of home rule and a board of health system established in 1799. Consequently, Massachusetts has more local health departments (n = 351) than any other state. During COVID-19, each health department, steeped in centuries of independence, launched its own response to the pandemic.Objectives:To analyze local public health resources and responses to COVID-19.Design:Semistructured interviews and a survey gathered quantitative and qualitative information about communities' responses and resources before and during the pandemic. Municipality demographics (American Community Survey) served as a proxy for community health literacy. We tracked the frequency and content of local board of health meetings using minutes and agendas; we rated the quality of COVID-19 communications on town Web sites.Setting:The first 6 months of the COVID-19 pandemic in Massachusetts: March-August 2020.Participants:Health directors and agents in 10 south-central Massachusetts municipalities, identified as the point of contact by the Academic Public Health Corps.Main Outcome Measures:We measured municipality resources using self-reported budgets, staffing levels, and demographic-based estimates of community health literacy. We identified COVID-19 responses through communities' self-reported efforts, information on town Web sites, and meeting minutes and agendas.Results:Municipalities excelled in communicating with residents, local businesses, and neighboring towns but lacked the staffing and funding for an efficient and coordinated response. On average, municipal budgets ranged from $5 to $16 per capita, and COVID-19 consumed 75% of health department staff time. All respondents noted extreme workload increases. While municipal Web sites received high scores for Accurate Information, other categories (Navigability; Timeliness; Information Present) were less than 50%.Conclusions:Increased support for regionalization and sustained public health funding would improve local health responses during complex emergencies in states with local public health administration.

Territory, neglected diseases and the action of community and endemic combat agents.

ABSTRACTOBJECTIVE To characterize knowledge, practices, and professional experience of community health agents (ACS) and endemic combat agents (ACE) on leprosy and Chagas disease (DC), during participation in an integrated training workshop in the IntegraDTNs-Bahia project.METHODS Descriptive and exploratory case study, involving health agents and endemic combat agents participating in a training workshop on the shared role of these professionals in health care and surveillance processes. The project was developed in the municipalities of Anagé, Tremedal and Vitória da Conquista, in the southwestern State of Bahia, 2019–2020. A specific instrument was applied, with questions related to knowledge and practices of surveillance and care for leprosy and Chagas disease. Descriptive analysis of the data, in addition to consolidation of the lexical analysis, was performed.RESULTS Out of a total of 135 participants (107 ACS and 28 ACE), 80.7% of them have been working for at least 12 years, without previous participation in joint training processes. Only 17.9% of endemic combat agentes reported having participated in training on leprosy and none reported developing specific actions to control the disease. For Chagas disease, 36.4% of community health agents participated in training more than a decade before, while for 60.7% of endemic combat agents the last training was carried out in the last five years. The development of educational actions for Chagas disease was more frequent for endemic combat agents (64.3%). When asked about ways of recognizing diseases, the term “skin spots” was the most reported (38 times) for leprosy and, for Chagas disease, the term “I don’t know” (17 times).CONCLUSION Processes of health agents and endemic combat agents action in realities endemic for leprosy and Chagas disease in the interior of Bahia proved to be fragmented in the territories. For these diseases, the distance between surveillance and health care actions is reinforced, including in training processes. The importance of innovative permanent and integrated education actions is reiterated to actually promote changes in practices.

An Update on the Implications of New Psychoactive Substances in Public Health.

The emergence of new psychoactive substances has earned a great deal of attention, and several reports of acute poisoning and deaths have been issued involving, for instance, synthetic opiates. In recent years, there have been profound alterations in the legislation concerning consumption, marketing, and synthesis of these compounds; rapid alert systems have also been subject to changes, and new substances and new markets, mainly through the internet, have appeared. Their effects and how they originate in consumers are still mostly unknown, primarily in what concerns chronic toxicity. This review intends to provide a detailed description of these substances from the point of view of consumption, toxicokinetics, and health consequences, including case reports on intoxications in order to help researchers and public health agents working daily in this area.