Health education as a strategy for the promotion of the health of the elderly: an integrative review

Simplified sewerage to prevent urban leptospirosis transmission: a cluster non-randomised controlled trial protocol in disadvantaged urban communities of Salvador, Brazil

INTRODUCTION

Leptospirosis is a globally distributed zoonotic and environmentally mediated disease that has emerged as a major health problem in urban slums in developing countries. Its aetiological agent is bacteria of the genus Leptospira, which are mainly spread in the urine of infected rodents, especially in an environment where adequate sanitation facilities are lacking, and it is known that open sewers are key transmission sources of the disease. Therefore, we aim to evaluate the effectiveness of a simplified sewerage intervention in reducing the risk of exposure to contaminated environments and Leptospira infection and to characterise the transmission mechanisms involved.

METHODS AND ANALYSIS

This matched quasi-experimental study design using non-randomised intervention and control clusters was designed to assess the effectiveness of an urban simplified sewerage intervention in the low-income communities of Salvador, Brazil. The intervention consists of household-level piped sewerage connections and community engagement and public involvement activities. A cohort of 1400 adult participants will be recruited and grouped into eight clusters consisting of four matched intervention-control pairs with approximately 175 individuals in each cluster in baseline. The primary outcome is the seroincidence of Leptospira infection assessed through five serological measurements: one preintervention (baseline) and four postintervention. As a secondary outcome, we will assess Leptospira load in soil, before and after the intervention. We will also assess Leptospira exposures before and after the intervention, through transmission modelling, accounting for residents' movement, contact with flooding, contaminated soil and water, and rat infestation, to examine whether and how routes of exposure for Leptospira change following the introduction of sanitation.

ETHICS AND DISSEMINATION

This study protocol has been reviewed and approved by the ethics boards at the Federal University of Bahia and the Brazilian National Research Ethics Committee. Results will be disseminated through peer-reviewed publications and presentations to implementers, researchers and participating communities.

TRIAL REGISTRATION NUMBER

Brazilian Clinical Trials Registry (RBR-8cjjpgm).

Experiencing the education process in physical rehabilitation

OBJECTIVE

To interpret and build a theoretical model of the user's experience in the education process in physical rehabilitation settings.

METHOD

Qualitative research, based on the Grounded Theory. The setting was a Rehabilitation Center of Rede Lucy Montoro, located in an inland city of the State of São Paulo. Data collection took place from January to October 2019, based on 28 interviews with three sample groups. The collection and analysis process was guided by theoretical sampling.

RESULTS

A total of 122 conceptual codes emerged. The main category established was "Experiencing education in rehabilitation"; as Conditions, the categories: relying on team support, and considering the group dynamics; as Actions-Interactions, the category: experiencing instructions; and as Consequences, the categories: promoting change of habits, and finding resistance in the follow-up.

CONCLUSION

The experience in the education process in rehabilitation indicates that this is an action that requires adequate communication and acceptance by the team. In group activities, although there are experiences exchanges among the members, the heterogeneity of situations shall be considered.