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Chikungunya virus (CHIKV) is an arbovirus with a significant global public health burden. Delineating the specific contributions of individual behaviour, household, natural and built environment to CHIKV transmission is important for reducing risk in urban informal settlements but challenging due to their heterogeneous environments. The aim of this study was to quantify variation in CHIKV seroprevalence between and within four urban communities in a large Brazilian city, and identify the respective contributions of individual, household, and environmental factors for seropositivity. A cross-sectional serological survey was conducted in four low-income communities in Salvador, Brazil in 2018 to collect individual, household and CHIKV IgG serology data for 1318 participants. Fine-scale community mapping of high-risk environmental features and remotely sensed environmental data were used to improve characterisation of the microenvironment close to the household. We categorised risk factors into three domains - individual, household, and environmental and used binomial mixed-effect models to identify associations with CHIKV seropositivity. CHIKV seroprevalence was 4.8%, 6.1% and 4.3% in three communities and 22.6% in one community which had a distinct topographical profile. The only individual domain variable associated with seropositivity was male sex (OR 1.67, 95% CI 1.11 - 2.36), but several environmental variables, including living in a house on a steep hillside, at medium to high elevations, and with surface water nearby, were associated with higher seropositivity. Our findings indicate that CHIKV exposure risk can vary significantly between nearby communities and at fine spatial scales within communities and is likely to be driven more strongly by the availability of mosquito breeding sites rather than individual exposure patterns. They suggest that environmental deficiencies and topography, a proxy for several environmental processes including the degree of urbanisation and flooding risk, may play an important role in driving risk at both of these scales.

Host condition is key in understanding disease dynamics. In this study, we investigated the relationship between infection with Leptospira interrogans and helminths, and the hematological and hormone-biochemical stress-related profiles of urban Rattus norvegicus . Rat kidney imprints and urine were used to identify and quantify L. interrogans , while fecal samples were analyzed for helminth eggs and corticosterone metabolites. Blood samples were taken for complete blood counts and specific biochemicals in rats’ sera. Principal Component Analyses were conducted to group rats according to health profiles. A total of 120 rats were captured, and hematological and hormone-biochemical data were obtained from 95 and 61 rats, respectively. Hematological PCA revealed distinct rat groups: typical (T), eosinophil-deficient (Eos-D), eosinophil- and monocyte-deficient (EM-D) and monocyte deficient with high immature neutrophils (Mon-D). No significant association was found between L. interrogans or helminth infections and health profiles, except for Trichiuridae helminths, which had significantly higher mean intensity in the pooled deficient groups compared to the T-group. The poorest condition group was found in areas with fewer rat burrows than the T-group, indicating EM-D had a reduced ability to occupy higher-quality habitats. These findings suggest that hematological profiles may reflect host’s overall condition, instead of responses to specific infections.

Zoonotic spillover from animal reservoirs is responsible for a significant global public health burden, but the processes that promote spillover events are poorly understood in complex urban settings. Endemic transmission of , the agent of leptospirosis, in marginalised urban communities occurs through human exposure to an environment contaminated by bacteria shed in the urine of the rat reservoir. However, it is unclear to what extent transmission is driven by variation in the distribution of rats or by the dispersal of bacteria in rainwater runoff and overflow from open sewer systems. We conducted an eco-epidemiological study in a high-risk community in Salvador, Brazil, by prospectively following a cohort of 1401 residents to ascertain serological evidence for leptospiral infections. A concurrent rat ecology study was used to collect information on the fine-scale spatial distribution of 'rattiness', our proxy for rat abundance and exposure of interest. We developed and applied a novel geostatistical framework for joint spatial modelling of multiple indices of disease reservoir abundance and human infection risk. The estimated infection rate was 51.4 (95%CI 40.4, 64.2) infections per 1000 follow-up events. Infection risk increased with age until 30 years of age and was associated with male gender. Rattiness was positively associated with infection risk for residents across the entire study area, but this effect was stronger in higher elevation areas (OR 3.27 95% CI 1.68, 19.07) than in lower elevation areas (OR 1.14 95% CI 1.05, 1.53). These findings suggest that, while frequent flooding events may disperse bacteria in regions of low elevation, environmental risk in higher elevation areas is more localised and directly driven by the distribution of local rat populations. The modelling framework developed may have broad applications in delineating complex animal-environment-human interactions during zoonotic spillover and identifying opportunities for public health intervention. This work was supported by the Oswaldo Cruz Foundation and Secretariat of Health Surveillance, Brazilian Ministry of Health, the National Institutes of Health of the United States (grant numbers F31 AI114245, R01 AI052473, U01 AI088752, R01 TW009504 and R25 TW009338); the Wellcome Trust (102330/Z/13/Z), and by the Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB/JCB0020/2016). MTE was supported by a Medical Research UK doctorate studentship. FBS participated in this study under a FAPESB doctorate scholarship.

Resumo O artigo apresenta um estudo exploratório descritivo sobre habilidades de Comunicação de Más Notícias (CMN) de internos de Medicina. Investigou-se a percepção discente sobre aprendizagem para CMN com delineamento transversal e abordagem mista. Houve aplicação de questionário, obtendo 176 participantes, e grupo focal com 12 estudantes. Os dados foram analisados pelo cálculo das médias e desvios-padrão para variáveis quantitativas e as falas do grupo focal foram submetidas à Análise de Conteúdo. Observou-se o dobro da frequência com mais habilidade para CMN no grupo que teve treinamento em comparação ao que não teve. No manejo da CMN, considerou-se mais difícil “ser honesto, sem tirar a esperança” (69%) e “lidar com a emoção do paciente” (59%). 99,4% conheciam o protocolo SPIKES, destes 41,5% consideraram a expressão de emoções sua etapa mais difícil. A comunicação e o manejo das emoções foram apontados como desafios na relação médico-paciente, com déficits no ensino de CMN. Obteve-se que a CMN não se limita à técnica, mas envolve atitudes que precisam ser abordadas com metodologias diversas, assim como requerem a implementação de políticas de educação na área médica, sobretudo diante das demandas emergentes da pandemia de Covid-19. Abstract The article presents an exploratory, descriptive study on Bad News Communication skills (CMN) of medical interns. The student’s perception was on learning for the CMN was investigated with a cross-sectional design and a mixed approach. A questionnaire was applied, 176 participants were obtained, and a focus group was held with 12 students. The data were analyzed through the calculation of means and standard deviations for quantitative variables and the focus group reports were subjected to Content Analysis. It was observed that in the group that had training, compared to the one who did not, ocurred twice frequency with more skill for CMN. In the CMN’s management, it was considered harder to be “honest without taking away hope” (69%) and “to deal with the patient’s emotion” (59%). 99.4% knew the SPIKES protocol, of which 41.5% considered the expression of emotions as its most difficult stage. Communication and handling of emotions were pointed out as the main difficulties in the doctor-patient relationship, with deficits in the teaching of CMN. It was found that CMN is not limited to the technical issue, but it involves attitudes that need to be addressed with different methodologies, as well as the implementation of educational policies in the medical field, especially given the demands that emerges with the covid-19 pandemic.

We assessed dairy cows' body postures while they were performing different stationary activities in a loose housing system and then used the variation within and between individuals to identify potential connections between specific postures and the valence and arousal dimensions of emotion. We observed 72 individuals within a single milking herd focusing on their ear, neck and tail positions while they were: feeding from individual roughage bins, being brushed by a mechanical rotating brush and queuing to enter a single automatic milking system. Cows showed different ear, neck and tail postures depending on the situation. When combined, their body posture during feeding was ears back up and neck down, with tail wags directed towards the body, during queuing their ears were mainly axial and forward, their neck below the horizontal and the tail hanging stationary, and during brushing their ears were backwards and asymmetric, the neck horizontal and the tail wagging vigorously. We then placed these findings about cow body posture during routine activities into an arousal/valence framework used in animal emotion research (dimensional model of core affect). In this way we generate a priori predictions of how the positions of the ears, neck and tail of cows may change in other situations, previously demonstrated to vary in valence and arousal. We propose that this new methodology, with its different steps of integration, could contribute to the identification and validation of behavioural (postural) indicators of how positively or negatively cows experience other activities, or situations, and how calm or aroused they are. Although developed here on dairy cattle, by focusing on relevant postures, this approach could be easily adapted to other species.

We address some critical but unknown parameters of individuals and populations of Norway rats (Rattus norvegicus) that influence leptospiral infection, maintenance and spirochetal loads shed in urine, which contaminates the environment ultimately leading to human infection. Our study, conducted in Salvador, Brazil, established the average load of leptospires in positive kidneys to be 5.9 x 10(6) per mL (range 3.1-8.2 x10(6)) genome equivalents (GEq), similar to the 6.1 x 10(6) per ml (range 2.2-9.4 x10(6)) average obtained from paired urines, with a significant positive correlation (R2=0.78) between the two. Based on bivariate and multivariate modeling, we found with both kidney and urine samples that leptospiral loads increased with the age of rats (based on the index of body length to mass), MAT titer and the presence of wounding/scars, and varied with site of capture. Some associations were modified by sex but trends were apparent. Combining with data on the demographic properties and prevalence of leptospiral carriage in rat populations in Salvador, we estimated that daily leptospiral loads shed in the urine of a population of 82 individuals exceeded 9.1 x 10(10) leptospires. These factors directly influence the risk of leptospiral acquisition among humans and provide essential epidemiological information linking properties of rat populations with risk of human infection.

The incidence of hospitalized leptospirosis patients was positively associated with increased precipitation in Salvador, Brazil. However, Leptospira infection risk among a cohort of city residents was inversely associated with rainfall. These findings indicate that, although heavy rainfall may increase severe illness, Leptospira exposures can occur year-round.

Residents of urban slums suffer from a high burden of zoonotic diseases due to individual, socioeconomic, and environmental factors. We conducted a cross-sectional sero-survey in four urban slums in Salvador, Brazil, to characterize how poverty and sanitation contribute to the transmission of rat-borne leptospirosis. Sero-prevalence in the 1,318 participants ranged between 10.0 and 13.3%. We found that contact with environmental sources of contamination, rather than presence of rat reservoirs, is what leads to higher risk for residents living in areas with inadequate sanitation. Further, poorer residents may be exposed away from the household, and ongoing governmental interventions were not associated with lower transmission risk. Residents at higher risk were aware of their vulnerability, and their efforts improved the physical environment near their household, but did not reduce their infection chances. This study highlights the importance of understanding the socioeconomic and environmental determinants of risk, which ought to guide intervention efforts.

Background Nurses’ intention to leave their profession is a worldwide concern. Studies have shown that it can take the form of a chain reaction: many nurses first leave the unit, then the hospital, and finally the profession. Organisation and other labour factors, personal and conjunctural, have been associated with the intention to quit nursing. This study aimed to examine the factors associated with the intention to leave the profession among registered nurses (RNs) at large public hospitals in Brazil. Methods This was a cross-sectional study, conducted from 2010 to 2011: all RNs at Rio de Janeiro’s 18 largest public hospitals (>150 beds) were invited to participate. The study sample comprised 3,229 RNs (82.7% of those eligible), who answered a self-completed, multidimensional paper questionnaire. The outcome was defined as thoughts of leaving the profession sometimes a month or more. We based the analyses on hierarchical logistic regression models, considering three blocks of determinants: socio-demographic data (block I), occupational factors (block II), and health conditions (block III). Results Of the study population, 22.1% indicated the intention to leave the profession. In the final model after adjustment, the variables associated with the intention to leave were as follows: male sex (odds ratio [OR] = 1.65), not holding a leadership position (OR = 1.28), highly demanding work (OR = 2.49), passive work (OR = 2.10), effort-reward imbalance (OR = 2.00), poor self-rated health (OR = 1.92), over-commitment to the job (OR = 1.87), and poor supervisor support (OR = 1.33). The likelihood of expressing the intention to leave increased with age (OR = 0.98 for the oldest). Conclusions Self-rated health and factors connected with the work environment, particularly those that generate psychosocial strain, were most strongly associated with the intention to leave the profession. From the profiles of nurses who wished to leave the profession, we found that for many people who go into nursing—especially men and younger entrants—their prospects of remaining in the profession are poor. The potential role of psychosocial job characteristics and self-rated health indicates the need for long-term action involving all stakeholders, i.e. managers, employers, and workers.

This study investigates the dynamics of play behaviour within groups of four juvenile pigs and uses a novel clustering and statistical modelling approach to describe new details in how individuals play with a familiar object (toy rope). We examined complex state sequence data collected during a 30 min home pen play test, using the package TraMineR, where the states were defined as object play, locomotor/social play and no play. From behavioural observations, and based on the relative proportion of the different types of object play observed, each individual was later categorised as an initiator or joiner type of player. Initiators were found to be more solitary and to show more object play whereas joiners were more social and showed less object play. The majority of groups did not have an initiator type of player, yet on average they played more. Despite strong group and type of player effects, we identified three general individual play patterns. On a group level, our results demonstrate differences in how a period of playing develops, that playing with the object simultaneously occurs more often in groups than expected by chance and that the number of pigs playing together is stable over time.