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Like in most Western countries, regional health inequalities are also present in the Netherlands. Explaining these inequalities is necessary for policymakers to target interventions to reduce them. Regional health inequalities are usually attributed to demographic and socio-economic factors, while lifestyle and psychosocial factors are increasingly shown to impact individuals’ health. Therefore, this study analyses the role of lifestyle, loneliness, and self-mastery in explaining regional inequalities, in addition to demographic factors and SES, for self-rated health, presence of chronic diseases, and psychological distress. Analyses are performed in the linked dataset from the Dutch Public Health Services, Statistics Netherlands, and the National Institute for Public Health and the Environment for the year 2016 (n = 334,721). The results show that lifestyle, loneliness and self-mastery contribute to the regional health inequalities in self-rated health and presence of chronic diseases. For psychological distress, both loneliness and self-mastery contribute to the regional health inequalities. Addressing lifestyle and psychosocial factors can offer policymakers additional pathways to bridge regional health inequalities. In this study, the region of Zuid-Limburg represents the reference region. Use compare regions for health and healthcare costs (Regiovergelijker gezondheid en zorgkosten [1]) in order to select all other Dutch regions as reference region.

UNLABELLED: Healthcare costs in the Netherlands are rising and vary considerably among regions. Explaining regional differences in healthcare costs can help policymakers in targeting appropriate interventions in order to restrain costs. Factors usually taken into account when analyzing regional differences in healthcare costs are demographic structure and socioeconomic status (SES). However, health, lifestyle, loneliness and mastery have also been linked to healthcare costs. Therefore, this study analyzes the contribution of health, lifestyle factors (BMI, alcohol consumption, smoking and physical activity), loneliness, and mastery to regional differences in healthcare costs. Analyses are performed in a linked dataset (n = 334,721) from the Dutch Public Health Services, Statistics Netherlands, the National Institute for Public Health and the Environment (year 2016), and the healthcare claims database Vektis (year 2017) with Poisson and zero-inflated binomial regressions. Regional differences in general practitioner consult costs remain significant even after taking into account health, lifestyle, loneliness, and mastery. Regional differences in costs for mental, pharmaceutical, and specialized care are less pronounced and can be explained to a large extent. For total healthcare costs, regional differences are mostly explained through the factors included in this study. Hence, addressing lifestyle factors, loneliness and mastery can help policymakers in restraining healthcare costs. In this study, the region of Zuid-Limburg represents the reference region. Use compare regions for health and healthcare costs (Regiovergelijker gezondheid en zorgkosten) in order to select all other Dutch regions as reference region.SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s12508-022-00369-4) contains supplementary material, which is available to authorized users.

This chapter provides insights into the complex and adaptive nature of systems and illustrates key characteristics of such systems. These contribute to an understanding of the challenges in health promotion and imply a need for more context-specific research to evaluate the health promotion interventions. CARA can address this need as it can be used to evaluate and support change in complex adaptive systems. To support and inspire other health promotion researchers who want to adopt CARA as their research approach, we have discussed our experiences and provided some guiding principles. Overall, complexity thinking can help to understand the challenges in health promotion, whereby CARA provides a possible strategy for health promotion researchers when dealing with the challenges of evaluating health promotion interventions in complex adaptive systems.

As populações silvestres são constantemente ameaçadas devido ao aumento global da população humana e à consequente perda dos habitats originais, bem como à poluição, ao aumento do trânsito de pessoas e animais e à introdução de espécies exóticas. Estudos hematológicos, bioquímicos, toxicológicos e parasitológicos vêm sendo utilizados para o entendimento do estado de saúde de muitas espécies silvestres. Especialmente em relação à avaliação de parâmetros fisiológicos, existe dificuldade na interpretação dos valores observados, visto que fatores condizentes ao indivíduo e ao ambiente, bem como ao aprisionamento dos animais e à utilização de drogas para sedação, influenciam na hematimetria e nas dosagens bioquímicas. Neste contexto, dados sobre parasitismo e saúde dos mamíferos silvestres do Pantanal foram compilados por meio de bibliometria e discutidos em termos de resiliência e sustentabilidade de suas populações. A conclusão deste artigo é de que a comunidade científica deveria trabalhar em conjunto com a sociedade organizada, a fim de incentivar a criação e a aplicação de políticas públicas de conservação, no sentido de manter a biodiversidade e a continuidade dos seus processos ecológicos.

Subacute ruminal acidosis (SARA) is an important nutritional disorder affecting animal welfare and economy of milk production. Definitions rely on ruminal pH but due to limitations of its measurement, indicators reflecting low pH are highly desirable. The aim of this study was to investigate the relationship between reticular pH and 18 on-farm indicators in milk, blood, faeces, urine and chewing behaviour in early lactating dairy cows. Ten farms were visited for 3 weeks and in total samples of 100 cows (10 per farm) were taken. The statistics and graphical visualization were performed using Pearson correlation and linear regression models on an animal individual level as well as with linear mixed models. Eight indicators (milk fat, fat-to-protein ratio, rumination time, feed intake time, rumination frequency, rumination boluses, lying time and faecal pH) were statistically significant associated with the daily animal individual reticular pH average. However, none of the models including the potential explanatory variables explained more than 5% of the pH variations. The study confirms the necessity of pH measurement to detect SARA risk animals in early lactation dairy cows.

SamenvattingNederland kent gezondheidsverschillen tussen regio’s. Het verklaren van deze verschillen kan beleidsmakers helpen om gericht te interveniëren en deze verschillen te verkleinen. Bij het verklaren van deze regionale gezondheidsverschillen wordt veelal gekeken naar de bijdrage van verschillen in demografische opbouw en sociaaleconomische status (SES). Tegelijkertijd worden leefstijl en psychosociale factoren ook in verband gebracht met de gezondheid van het individu. Daarom analyseert dit onderzoek, naast demografie en SES, de bijdrage van leefstijl, eenzaamheid en zelfregie aan de verklaring van regionale verschillen in zelfervaren gezondheid, aanwezigheid van chronische ziekten en het risico op het ontwikkelen van een angststoornis of depressie. We gebruiken daarvoor een gekoppelde dataset van de GGD, het CBS en het RIVM voor het jaar 2016 (n = 334.721). Uit de resultaten blijkt dat leefstijl, eenzaamheid en zelfregie ook bijdragen aan het verklaren van regionale verschillen in zelfervaren gezondheid (prevalentieratio’s (PR) variërend van 0,72–0,93 tot 0,83–0,95) en chronische ziekten (PR’s van 0,81–0,95 tot 0,85–0,96). Voor het risico op een angststoornis of depressie blijken vooral eenzaamheid en zelfregie bij te dragen aan de verklaring van regionale gezondheidsverschillen (oddsratio’s van 0,65–1,27 tot 0,76–1,22). Leefstijl- en psychosociale factoren kunnen dan ook beleidsmatige aanknopingspunten bieden voor de aanpak van regionale gezondheidsverschillen. In dit artikel is de regio Zuid-Limburg de referentieregio. Met de Regiovergelijker gezondheid en zorgkosten kunnen alle regio’s als referentieregio worden gekozen.

Background The study of the ecology of Trypanosoma cruzi is challenging due to its extreme adaptive plasticity, resulting in the parasitism of hundreds of mammal species and dozens of triatomine species. The genetic analysis of blood meal sources (BMS) from the triatomine vector is an accurate and practical approach for gathering information on which wild mammal species participate in a local transmission network. South American coatis, Nasua nasua, act as important reservoir host species of T. cruzi in the Pantanal biome because of their high rate of infection and elevated parasitemia, with the main discrete typing unit (DTU) lineages (TcI and TcII). Moreover, the carnivore coati is the only mammal species to build high arboreal nests for breeding and resting that can be shared by various vertebrate and invertebrate species. Herein, we applied the sensitive and specific methodology of DNA barcoding and molecular cloning to study triatomines found in a coati nest to access the diversity of mammal species that explore this structure, and therefore, may be involved in the parasite transmission network. Methods Twenty-three Triatoma sordida were collected in one coati’s nest in the subregion of Nhecolândia, Pantanal. The DNA isolated from the gut of insects was subjected to BMS detection by PCR using universal primers that flank variable regions of the cytochrome b (cytb) and 12S rDNA mitochondrial genes from vertebrates. The Trypanosoma spp. diagnosis and DTU genotyping were based on an 18S rDNA molecular marker and also using new cytb gene primers designed in this study. Phylogenetic analyses and chord diagrams were constructed to visualize BMS haplotypes, DTU lineages detected on vectors, and their interconnections. Results Twenty of 23 triatomines analyzed were PCR-positive (86.95%) showing lineages T. cruzi DTU TcI (n = 2), TcII (n = 6), and a predominance of TcI/TcII (n = 12) mixed infection. Intra-DTU diversity was observed mainly from different TcI haplotypes. Genetic analyses revealed that the southern anteater, Tamandua tetradactyla, was the unique species detected as the BMS of triatomines collected from the coati’s nest. At least three different individuals of T. tetradactyla served as BMS of 21/23 bugs studied, as indicated by the cytb and 12S rDNA haplotypes identified. Conclusions The identification of multiple BMS, and importantly, different individuals of the same species, was achieved by the methodology applied. The study demonstrated that the southern anteaters can occupy the South American coati’s nest, serving as the BMS of T. sordida specimens. Since anteaters have an individualist nonsocial behavior, the three individuals detected as BMS stayed at the coati’s nest at different times, which added a temporal character to BMS detection. The TcI and TcII infection, and significantly, a predominance of TcI/TcII mixed infection profile with different TcI and TcII haplotypes was observed, due to the discriminatory capacity of the methodology applied. Tamandua tetradactyla, a host which has been little studied, may have an important role in the T. cruzi transmission in that Pantanal subregion. The data from the present study indicate the sharing of coatis’ nests by other mammal species, expanding the possibilities for T. cruzi transmission in the canopy strata. We propose that coatis’ nests can act as the true hubs of the T. cruzi transmission web in Pantanal, instead of the coatis themselves, as previously suggested. Graphical Abstract

Bats are infected with several trypanosomatid species; however, assessing the diversity of this interaction remains challenging since there are species apparently unable to grow in conventional culture media. Accordingly, the ecology and biology of the Molecular Operational Taxonomic Units (MOTUs) Trypanosoma spp. Neobats are unknown. Therefore, we performed the molecular characterization targeting the 18S small subunit rDNA from the blood clot of 280 bats of three Brazilian regions (Paraiba, Rio de Janeiro and Acre states), bypassing the selective pressure of hemoculture. From 68 (24%) positive blood clot samples, we obtained 49 satisfactory sequences. Of these successfully sequenced results, T. spp. Neobats (1, 3 and 4) represented 67%, with the most abundant T. sp. Neobat 4 (53%). Our results show: (1) high abundance and wide geographic range of T. sp. Neobat 4, restricted to Carollia bats; (2) high infection rate of T. sp. Neobat 4 in Carollia perspicillata populations (mean 26%); (3) infection with the monoxenous Crithidia mellificae; and (4) a new MOTU (T. sp. Neobat 5) in Artibeus cinereus, positioning in the Trypanosoma wauwau clade. These data corroborate the importance of bats as hosts of many Trypanosoma species and C. mellificae. They also show that the diversity of the T. wauwau clade is underestimated and warn about the high magnitude of trypanosomes we overpass with the hemoculture. Our findings combined with previous data show that T. spp. Neobats include host-specific and host-generalist species, probably playing different ecological roles: T. sp. Neobat 1 shows broad host range; T. spp. Neobat 3 and 4 are restricted to Artibeus and Carollia, respectively. Finally, T. Neobat 4 seems to be a well-succeeded parasite, especially within C. perspicillata metapopulations across a wide geographical distribution. This work is a step forward to understand the biology and life history of T. spp. Neobats.

This study gives an overview of the performance and accuracy of devices used for the fast measurement of β-hydroxybutyrate (BHBA) in blood for the on-farm indication of subclinical ketosis. Data were collected on ten dairy farms. In each farm, blood samples were taken from ten cows on four test days (2, 4, 9 and 11), resulting in 400 samples. The reference method was the BHBA concentration in blood serum (BHBALAB). Four different devices that measure BHBA in whole blood were tested. The thresholds applied for identifying subclinical ketosis were ≥1.0, ≥1.2 and ≥1.4 mmol/L in blood serum. The BHBALAB was assigned in three classes: low—≤0.9 mmol/L; high—>0.9 mmol/L; and total—all values unclassified. Due to initial negative effects on the health and performance of cows with BHBA levels ≥0.9 mmol/L, this cut-off was chosen. The Passing–Bablok regression revealed different constant as well as absolute biases for each device in the aforementioned classes. The area under the receiver operating characteristics curve indicated highly accurate results, with 94–97% accuracy levels. As an overall conclusion, the performance of the devices was good and supports their use by farmers for the detection of subclinical ketotic cows in their herds.

Crithidia mellificae, a monoxenous trypanosomatid considered restricted to insects, was recently reported to infect a bat. Herein, C. mellificae has been demonstrated to have a wider range of vertebrate hosts and distribution in Brazilian biomes than once thought. Parasites isolated from haemocultures were characterized using V7V8 SSU rDNA and glyceraldehyde 3-phosphate dehydrogenase genes. Coatis (Nasua nasua) in the Cerrado; marmosets (Callithrix sp.) and bats (Carollia perspicillata, Myotis lavali, M. izecksohni, Artibeus lituratus) in the Atlantic Forest; crab-eating foxes (Cerdocyon thous) and ocelot (Leopardus pardalis) in the Pantanal biomes were infected by trypanosomatids that displayed choanomastigote forms in haemoculture in Giemsa-stained slide smears. Molecular characterization and phylogenetic inference confirmed the infection of C. mellificae in these animals. Moreover, slight differences in C. mellificae sequences were observed. Crithidia mellificae growth curves were counted at 27°C, 36°C and 37°C, and the morphotypes were able to grow and survive for up to 16 days. Serological titers for C. mellificae were observed in nonhuman primates, demonstrating that this parasite is able to induce a humoral immune response in an infected mammal. These results showed that host specificity in trypanosomatids is complex and far from understood., Graphical abstract Image 1, Highlights • Crithidia mellificae infection was observed in different mammal species. • C. mellificae is a thermotolerant parasite. • C. mellificae was capable to induce humoral immune response. • Trypanosomatids host specificity is far from been known.

Universidade Católica Dom Bosco (UCDB). Programa de Pós-Graduação em Ciências Ambientais e Sustentabilidade Agropecuária. Campo Grande, MS, Brasil. Universidade Federal do Mato Grosso do Sul. Programa de Pós-Graduação em Ecologia e Conservação. Campo Grande, MS, Brasil. Universidade Católica Dom Bosco (UCDB). Programa de Pós-Graduação em Ciências Ambientais e Sustentabilidade Agropecuária. Campo Grande, MS, Brasil / Universidade Católica Dom Bosco. Programa de Pós-Graduação em Biotecnologia. Campo Grande, MS, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia de Tripanossomatídeos. Rio de Janeiro, RJ, Brasil. Universidade Católica Dom Bosco (UCDB). Programa de Pós-Graduação em Ciências Ambientais e Sustentabilidade Agropecuária. Campo Grande, MS, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia de Tripanossomatídeos. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Programa de Pós-Graduação em Biologia Parasitária. Rio de Janeiro, RJ, Brasil. Universidade Católica Dom Bosco. Programa de Pós-Graduação em Biotecnologia. Campo Grande, MS, Brasil. Universidade Católica Dom Bosco (UCDB). Programa de Pós-Graduação em Ciências Ambientais e Sustentabilidade Agropecuária. Campo Grande, MS, Brasil / Universidade Católica Dom Bosco. Programa de Pós-Graduação em Biotecnologia. Campo Grande, MS, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia de Tripanossomatídeos. Rio de Janeiro, RJ, Brasil. Universidade Católica Dom Bosco (UCDB). Programa de Pós-Graduação em Ciências Ambientais e Sustentabilidade Agropecuária. Campo Grande, MS, Brasil. / Universidade Federal do Mato Grosso do Sul. Programa de Pós-Graduação em Ecologia e Conservação. Campo Grande, MS, Brasil / Universidade Católica Dom Bosco. Programa de Pós-Graduação em Biotecnologia. Campo Grande, MS, Brasil. Universidade Católica Dom Bosco (UCDB). Programa de Pós-Graduação em Ciências Ambientais e Sustentabilidade Agropecuária. Campo Grande, MS, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia de Tripanossomatídeos. Rio de Janeiro, RJ, Brasil. Kinetoplastids include species economically important in agriculture, livestock, and human health. We evaluated the richness of kinetoplastids that infect small mammals in patches of unflooded forests in the Pantanal biome, an area where we hypothesize that its diversity is higher than currently recognized. Hemocultures (HC) and Next Generation Sequencing (NGS) targeting the 18S rDNA gene were employed for the detection of kinetoplastids. We grouped the positive samples into pools for each small mammal species (Monodelphis domestica, Thylamys macrurus, Oecomys mamorae, Thrichomys fosteri, Clyomys laticeps, and Holochilus chacarius). Eight parasite species were identified: Leishmania amazonensis, L. infantum; Trypanosoma cascavelli (HC + NGS), T. cruzi, T. lainsoni, T. rangeli (HC + NGS), Trypanosoma sp. DID, and Neobodo sp. The use of a tool as sensitive as NGS has increased our awareness of the diversity of kinetoplastids, as well as their host range, with emphasis on the species O. mamorae (seven kinetoplastid species, excepting T. cascavelli in a pool of nine individuals) and T. macrurus (four kinetoplastid species in a single individual). Furthermore, L. infantum and L. amazonensis infections were described in small mammals from this region for the first time. These findings make it mandatory to revisit the kinetoplastids/host associations proposed so far.

Summary Socioeconomic status and health are strongly related to the ability of a person to participate in society. Acting upon activation and employment possibilities is difficult for several groups. One group described as especially hard to activate is long-term welfare recipients. In the current study, the role of an activation broker was studied as a supplementary practice to regular support practices. A qualitative research design using an analysis of the administrative logbook of the activation broker and interviews with professionals ( n = 8) and long-term welfare recipients ( n = 10) was carried out. To structure the retrieved data, the Activation Broker Wheel was developed. Findings Seven core behaviours were identified and categorized in three determinants; capabilities, opportunities and motivation. Contextual factors supporting the activation broker approach were selected. The activation broker approach was found to be successful in activating long-term welfare recipients. Applications The behaviours, determinants and context made visible within the Activation Broker Wheel provided insight into workable elements that may help future activation brokers to optimize their support.

Parasites are important components of the immense n-dimensional trophic network that connects all living beings because they, among others, forge biodiversity and deeply influence ecological evolution and host behavior. In this sense, the influence of Trypanosomatidae remains unknown. The aim of this study was to determine trypanosomatid infection and richness in rats, opossums, and dogs in the semiarid Caatinga biome. We submitted DNA samples from trypanosomatids obtained through axenic cultures of the blood of these mammals to mini exon multiplex-PCR, Sanger, and next-generation sequencing targeting the 18S rDNA gene. Phylogenetic analyses were performed to identify genetic diversity in the Trypanosomatidae family. Shannon, Simpson, equability, and beta-diversity indices were calculated per location and per mammalian host. Dogs were surveyed for trypanosomatid infection through hemocultures and serological assays. The examined mammal species of this area of the Caatinga biome exhibited an enormous trypanosomatid species/genotypes richness. Ten denoised Operational Taxonomic Units (ZOTUs), including three species (Trypanosoma cruzi, Trypanosoma rangeli and Crithidia mellificae) and one Trypanosoma sp. five genotypes/lineages (T. cruzi DTU TcI, TcII, and TcIV; T. rangeli A and B) and four DTU TcI haplotypes (ZOTU1, ZOTU2, ZOTU5, and ZOTU10 merged), as well as 13 Amplicon Sequence Variants (ASVs), including five species (T. cruzi, T. rangeli, C. mellificae, Trypanosoma dionisii, and Trypanosoma lainsoni), five genotypes/lineages (same as the ZOTUs) and six DTU TcI haplotypes (ASV, ASV1, ASV2, ASV3, ASV5 and ASV13), were identified in single and mixed infections. We observed that trypanosomatids present a broad host spectrum given that species related to a single host are found in other mammals from different taxa. Concomitant infections between trypanosomatids and new host-parasite relationships have been reported, and this immense diversity in mammals raised questions, such as how this can influence the course of the infection in these animals and its transmissibility. Dogs demonstrated a high infection rate by T. cruzi as observed by positive serological results (92% in 2005 and 76% in 2007). The absence of positive parasitological tests confirmed their poor infectivity potential but their importance as sentinel hosts of T. cruzi transmission.

Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia de Tripanosomatídeos. Rio de Janeiro, RJ, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Bioquímica de Tripanossomatídeos. Rio de Janeiro, RJ, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunomodulação e Protozoologia. Rio de Janeiro, RJ, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Bioquímica de Tripanossomatídeos. Rio de Janeiro, RJ, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia de Tripanosomatídeos. Rio de Janeiro, RJ, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia de Tripanosomatídeos. Rio de Janeiro, RJ, Brasil. Although Leishmania transmission in nature is associated with the bite of an infected sandfly vector, other possible transmission routes are speculated to occur, such as the oral route. We evaluated the possibility of infection by this route in golden hamsters (Mesocricetus auratus) using Leishmania braziliensis (Lb) and Leishmania infantum (Li). Hamsters were exposed to experimental oral or intragastrical infection with axenic promastigotes, besides oral ingestion of a suspension of cultivated macrophages infected with amastigotes, lesion-fed Lutzomyia longipalpis, skin lesion or infective spleen fragment. The parasite’s isolation, besides a positive PCR and IFAT, confirmed the intragastric infection by promastigote parasites. The oral ingestion of macrophages infected with L. braziliensis amastigotes was also infective. These results confirmed that Leishmania parasites could infect mammals by the intragastric route through the ingestion of promastigote forms (what can happen after a sandfly ingestion) and by the oral ingestion of infected macrophages (what can happen in nature in a predator–prey interaction). The better understanding of these alternative routes is essential to understand their transmission dynamics in nature. As far as we know, this is the first time that oral and intragastric Leishmania transmission has been experimentally demonstrated, constituting new infection routes, at least for L. infantum and L. braziliensis.

Hoewel steeds meer scholen het vignet Gezonde School hebben behaald, is weinig bekend over de factoren, kenmerken en processen, ofwel condities, die de effectiviteit van het programma Gezonde School beïnvloeden. Daarom wordt een evaluatieonderzoek uitgevoerd op drie niveaus: de leerling, de school en de regio. De drie centrale onderzoeksvragen zijn gericht op: 1) condities voor leerlinguitkomsten, 2) condities voor implementatie op school, en 3) condities voor regionale ondersteuning. Daarbij worden de school en de regio beschouwd als complexe adaptieve systemen. Condities voor beoogde uitkomsten op leefstijl, gezondheid en schoolprestaties van leerlingen worden onderzocht met een combinatie van bestaande databronnen waaraan schoolcodes kunnen worden toegevoegd. Goed en minder goed presterende scholen worden geselecteerd voor een overwegend kwalitatieve vervolganalyse om verschillen in uitkomsten verder te verklaren. Om inzicht te krijgen in condities voor implementatie op school en de regionale ondersteuning in negen GGD-regio’s wordt met een vragenlijst de implementatiegraad bepaald, om daarna scholen te selecteren voor overwegend kwalitatief vervolgonderzoek. Dit onderzoek biedt niet alleen inzicht in de huidige stand van zaken op de drie niveaus, maar kan ook verschillen in uitkomsten tussen leerlingen, scholen en regio’s verklaren. Zo kunnen concrete aangrijpingspunten worden gegeven om de implementatie van Gezonde School verder te versterken.An increasing number of schools obtained a Healthy School certificate, yet little is known about factors, characteristics, and processes, i.e. conditions, influencing the effectiveness of the Healthy School program. Therefore, a mixed methods evaluation study will be conducted on three levels: the student, the school, and the region. The research questions are focused on: 1) conditions for student outcomes, 2) conditions for implementation in schools, and 3) conditions for regional support. For the evaluation, the school and region are considered complex adaptive systems. Conditions for intended outcomes on student lifestyle, health, and academic achievement will be examined using a combination of existing datasets including school codes. Based on student outcomes, best and worst performing schools will be selected for predominantly qualitative analysis to further explain differences. To get insight into conditions for implementation in schools and regional support in nine regions, the degree of implementation will be determined with a questionnaire to select schools for predominantly qualitative analysis. Combined, this study will not only provide insight into the current situation on the three levels, but also explain differences between regions, schools, and students. Consequently, it will be possible to provide concrete advice to strengthen implementation of the Healthy School program.

Canis lupus familiaris (domestic dog) represents a reliable sentinel for the occurrence of a well-established transmission cycle of Trypanosoma cruzi among wild mammals in the surroundings and, consequently, where the risk of human infection exists. Serological diagnosis is the chosen method to identify T. cruzi infection in dogs that, in Brazil, rarely present positive parasitological tests. The use of recombinant chimeric parasitic antigens results in a sensitive and specific serological diagnostic test in contrast to the use of crude T. cruzi antigens. Our objective was to evaluate the Chagas/Bio-Manguinhos Lateral Flow Immunochromatographic Rapid Test (Chagas-LFRT) for the diagnosis of T. cruzi infection in domestic dogs and the potential of application of this diagnostic platform to wild canid species. Two recombinant proteins (IBMP-8.1 and IBMP-8.4) that displayed the best performance in the enzyme immunoassay (ELISA) in previous studies were tested in a platform with two diagnostic bands. A panel of 281 dog serum samples was evaluated: 133 positive for T. cruzi by serological diagnosis, including 20 samples with positive blood cultures belonging to different discrete typing units (DTUs); 129 negative samples; and 19 samples from dogs infected by other trypanosomatids: Leishmania infantum, Trypanosoma rangeli, Trypanosoma caninum and Crithidia mellificae, in addition to samples infected by Anaplasma platys, Dirofilaria immitis and Erlichia sp. that were employed to evaluate eventual cross-reactions. We also evaluated the Chagas-LFRT to detect T. cruzi infection in 9 serum samples from six wild canid species. We observed that the intensity pattern of the bands was directly proportional to the serological titer observed in IFAT. The sensitivity was 94%, the specificity was 91% according to the ROC curve, and the defined cutoff was an optical density of 4.8. The agreement obtained was considered substantial by the kappa analysis (84%). From T. cruzi positive hemoculture samples, 88.9% were positive by Chagas-LFRT. The test was efficient in recognizing infections by five of the six T. cruzi DTUs. Cross-reactions were not observed in infections by L. infantum, T. rangeli, T. caninum and D. immitis; however, they were observed in sera of dogs infected by Crithidia mellificae, Anaplasma sp. and Erlichia sp. A strong reaction was observed when serum samples from wild canids were submitted to the Protein A affinity test, confirming its applicability for these species. This test will allow rapid preventive actions in areas with high risk to the emergence of Chagas disease in a safer, reliable, low-cost and immediate manner, without the need for more complex laboratory tests.

Trypanosomatids are hemoflagellate parasites that even though they have been increasingly studied, many aspects of their biology and taxonomy remain unknown. The aim of this study was to investigate the Trypanosoma sp. transmission cycle in nonflying small mammals in an area where a case of acute Chagas disease occurred in Mangaratiba municipality, Rio de Janeiro state. Three expeditions were conducted in the area: the first in 2012, soon after the human case, and two others in 2015. Sylvatic mammals were captured and submitted to blood collection for trypanosomatid parasitological and serological exams. Dogs from the surrounding areas where the sylvatic mammals were captured were also tested for T. cruzi infection. DNA samples were extracted from blood clots and positive hemocultures, submitted to polymerase chain reaction targeting SSU rDNA and gGAPDH genes, sequenced and phylogenetic analysed. Twenty-one wild mammals were captured in 2012, mainly rodents, and 17 mammals, mainly marsupials, were captured in the two expeditions conducted in 2015. Only four rodents demonstrated borderline serological T. cruzi test (IFAT), two in 2012 and two in 2015. Trypanosoma janseni was the main Trypanosoma species identified, and isolates were obtained solely from Didelphis aurita. In addition to biological differences, molecular differences are suggestive of genetic diversity in this flagellate species. Trypanosoma sp. DID was identified in blood clots from D. aurita in single and mixed infections with T. janseni. Concerning dogs, 12 presented mostly borderline serological titers for T. cruzi and no positive hemoculture. In blood clots from 11 dogs, T. cruzi DNA was detected and characterized as TcI (n = 9) or TcII (n = 2). Infections by Trypanosoma rangeli lineage E (n = 2) and, for the first time, Trypanosoma caninum, Trypanosoma dionisii, and Crithidia mellificae (n = 1 each) were also detected in dogs. We concluded that despite the low mammalian species richness and degraded environment, a high Trypanosoma species richness species was being transmitted with the predominance of T. janseni and not T. cruzi, as would be expected in a locality of an acute case of Chagas disease.

Made available in DSpace on 2021-06-25T11:23:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-10-20 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundacao de Amparo a Pesquisa do Estado deMato Grosso do Sul Urbanization results in loss of natural habitats and, consequently, reduction of richness and abundance of specialist to the detriment of generalist species. We hypothesized that a greater richness of trypanosomatid inDidelphis albiventriswould be found in fragments of urban forests in Campo Grande, Mato Grosso do Sul, Brazil, that presented a larger richness of small mammals. We used parasitological, molecular, and serological methods to detectTrypanosomaspp. infection inD. albiventris(n = 43) from forest fragments. PCR was performed with primers specific for 18S rDNA, 24S alpha rDNA, mini-chromosome satellites, and mini-exon genes. IFAT was used to detect anti-Trypanosoma cruziIgG. All hemoculture was negative. We detected trypanosomatid DNA in blood of 35% of opossum. Two opossums were seropositive forT. cruzi. The trypanosomatid species number infectingD. albiventriswas higher in the areas with greater abundance, rather than richness of small mammals. We foundD. albiventrisparasitized byT. cruziin single and co-infections withLeishmaniaspp., recently described molecular operational taxonomic unit (MOTU) named DID, andTrypanosoma lainsoni. We concluded that (i) trypanosome richness may be determined by small mammal abundance, (ii)D. albiventrisconfirmed to be bio-accumulators of trypanosomatids, and (iii)T. lainsonidemonstrated a higher host range than described up to the present. Univ Catolica Dom Bosco, Posgrad Ciencias Ambientais & Sustentabilidade Ag, Av Tamandare 6000, BR-79117900 Campo Grande, MS, Brazil Univ Fed Mato Grosso do Sul, Posgrad Ecol & Conservacao, Campo Grande, MS, Brazil Univ Estadual Paulista, Fac Ciencias Agr & Vet, Sao Paulo, Brazil Fundacao Oswaldo Cruz, Inst Oswaldo Cruz, Lab Biol Tripanosomatideos, Rio De Janeiro, RJ, Brazil Univ Catolica Dom Bosco, Posgrad Biotecnol, Campo Grande, MS, Brazil Univ Fed deMato Grosso Sul, Posgrad Recursos Nat, Campo Grande, MS, Brazil Univ Estadual Paulista, Fac Ciencias Agr & Vet, Sao Paulo, Brazil CAPES: 88887.149231/2017-00 CNPq: 308768/2017-5 CAPES: 001 CAPES: 88887.369261/2019-00 Fundacao de Amparo a Pesquisa do Estado deMato Grosso do Sul: FUNDECT 03/2016 PPSUS-MS 59/300.069/2017

SamenvattingDe school wordt door veel organisaties beschouwd als een goede ingang om de gezondheid van de jeugd te bevorderen. Scholen hebben echter primair een onderwijstaak. Om gezondheidsbevordering toch in scholen te integreren, zijn sinds het begin van deze eeuw tal van initiatieven ontwikkeld, zowel regionaal als landelijk. Regionale innovaties met een stevig draagvlak kunnen verdergaande veranderingen doorvoeren met een grotere impact op de gezondheid van de jeugd. Landelijk beleid kan dergelijke veranderingen niet afdwingen en is genoodzaakt tot compromissen. Van belang is dat landelijke en regionale partijen elkaar blijven inspireren.

Many previous studies have shown a great phylogenetic and biological variability of Trypanosoma cruzi using different molecular and biochemical methods. Populations of T. cruzi were initially clustered into two main lineages called TcI and TcII by the size of the mini-exon PCR product. In the present study, 33 isolates derived from three triatomine taxa, which belong to the Triatoma brasiliensis species complex (Triatoma juazeirensis, Triatoma melanica and Triatoma sherlocki); collected in three distinct areas of Bahia state were characterized by PCR. The isolates were identified by the size of the mini-exon gene, 18S rRNA and 24Sα rRNA amplicons. T. cruzi isolates obtained in sylvatic and intradomiciliar ecotopes, derived from T. juazeirensis and T. melanica, were identified as TcI while the parasites originated from T. sherlocki were characterized as TcI and TcII genotypes, respectively. Those species are present in sylvatic ecotopes but are able to infest intradomiciliar areas. Therefore, it would be important to maintain studies in those localities of Bahia and further investigate the possibilities of Chagas disease transmission. Human disease may occur by any T. cruzi genotype and not only by TcII as it is the case in Amazonia.

This paper investigates whether encouraging children to become more physically active in their everyday life affects their primary school performance. We use data from a field quasi- experiment called the Active Living Program, which aimed to increase active modes of transportation to school and active play among 8- to 12-year-olds living in low socioeconomic status (SES) areas in the Netherlands. Difference-in-differences estimations reveal that while the interventions increase time spent on physical activity during school hours, they negatively affect school performance, especially among the worst-performing students. Further analyses reveal that increased restlessness during instruction time is a potential mechanism for this negative effect. Our results suggest that the commonly found positive effects of exercising or participating in sports on educational outcomes may not be generalizable to physical activity in everyday life. Policymakers and educators who seek to increase physical activity in everyday life need to weigh the health and well-being benefits against the probability of increasing inequality in school performance.

Parasitism is a dynamic ecological phenomenon that is constantly influenced by the environment and intrinsic factors of the host. We aimed to evaluate the influence of vegetation, environmental temperature, reproductive conditions, sex, and body condition (BC) on the detection of Trypanosoma spp. in the blood of Thrichomys fosteri in the Pantanal region, an enzootic area for trypanosomiasis. Whole blood was collected from the tip of the tail, and nPCR was performed for Trypanosoma spp. detection from the DNA extracted from the resultant blood clot. Statistical analyses were performed using generalized linear models. Our results showed that there is a greater probability of detection of Trypanosoma spp. in the bloodstream of animals with the highest BC values in periods with mild temperatures. Since T. fosteri is an abundant and common prey for carnivores, even in periods with low temperatures and consequent decrease in the reproduction and activities of the blood-sucking arthropod vectors, the maintenance of Trypanosoma spp. in the studied area would be guaranteed via predation (trophic network) of T. fosteri individuals with good BC and patent parasitemia. Furthermore, T. fosteri, which displays Trypanosoma spp. in the bloodstream, would be reproducing adequately because we found no influence between the reproductive condition and the detection of Trypanosoma spp. in T. fosteri. The caviomorph rodent T. fostei is an important species for the maintenance of Trypanosoma spp. in the Pantanal biome.

Valedictory Lecture, Maastricht University, 15-07-2022

Mixed infections by different Trypanosoma species or genotypes are a common and puzzling phenomenon. Therefore, it is critical to refine the diagnostic techniques and to understand to what extent these methods detect trypanosomes. We aimed to develop an accessible strategy to enhance the sensitivity of the hemoculture, as well as to understand the limitations of the hemoculture and the blood clot as a source of parasitic DNA. We investigated trypanosomatid infections in 472 bats by molecular characterization (18S rDNA gene) of the DNA obtained from the blood clot and, innovatively, from three hemoculture sample types: the amplified flagellates (“isolate”), the pellet of the culture harvested in its very initial growth stage (“first aliquot”), and the pellet of non-grown cultures with failure of amplification (“sediment”). We compared (a) the characterization of the flagellates obtained by first aliquots and isolates; and (b) the performance of the hemoculture and blood clot for trypanosomatid detection. We observed: (i) a putative new species of Bodo in Artibeus lituratus; (ii) the potential of Trypanosoma cruzi selection in the hemoculture; (iii) that the first aliquots and sediments overcome the selective pressure of the hemoculture; and (iv) that the blood clot technique performs better than the hemoculture. However, combining these methods enhances the detection of single and mixed infections.

SamenvattingDe Euregio Maas-Rijn (EMR) bestaat uit vijf grensregio’s in Nederland, België en Duitsland. Vanwege overeenkomsten als grensligging en een industrieel (mijn)verleden is hun gezondheidssituatie waarschijnlijk vergelijkbaar. Hoe ziet de gezondheidssituatie van de EMR eruit en welke factoren spelen een rol wanneer er toch gezondheidsverschillen blijken te zijn? We hebben een mixed method study uitgevoerd, waarbij we gebruikmaakten van een unieke Euregionale dataset met gegevens over aantal inwoners, geslacht, leeftijd, opleiding, werk, levensverwachting bij geboorte, mortaliteit, doodsoorzaken en overgewicht/obesitas. We hebben semigestructureerde interviews afgenomen bij 22 deskundigen uit de publieke gezondheidszorg en aanverwante beleidsterreinen, allen werkzaam binnen de EMR. Vooral de levensverwachting bij geboorte blijkt te verschillen: inwoners van de Provincie Limburg (B) leven gemiddeld 2,7 jaar langer dan de inwoners van de Provincie Luik (B) (82,5 jaar versus 79,9 jaar). Volgens stakeholders kunnen sociaal-culturele en sociaaleconomische factoren (zoals grensbarrières, een lage sociaaleconomische status) de gezondheidsverschillen binnen de EMR verklaren. De gezondheidssituatie in de EMR kan verbeterd worden door inzet op integraal beleid en het versterken van gezondheidsvaardigheden bij de lage SES-populatie.

Although personality is associated with the onset of substance use (i.e., conventional smoking, alcohol use, and cannabis use) during adolescence, it is unclear whether personality traits are also associated with the onset of use of alternative tobacco products (ATPs), i.e., electronic cigarettes, shisha-pens, and water pipes. This study examines whether personality traits are associated with the onset of use of both conventional cigarettes and ATPs. Longitudinal data (baseline and 18-month follow-up) were used. The sample consisted of 1114 non-user adolescents (mean age = 13.36, SD = 0.93, 56% female) at baseline. To measure personality traits, the Substance Use Risk Profile Scale was used with four subscales: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Structural equation models were conducted using Mplus 7.3. Results showed that both hopelessness and sensation seeking were associated with the onset of use of e-cigarettes and conventional cigarettes. Further, sensation seeking and impulsivity were associated with the onset of use of shisha-pens and water pipes. In conclusion, to prevent adolescents from using ATPs and/or conventional cigarettes, it is important to take their personality traits into account. More research on other (shared) risk factors and on more advanced stages of ATP use is needed before effective prevention strategies can be developed.