Multisectoral approach to address Female Genital Mutilation: a case study from Portugal

Issue

Female genital mutilation (FGM) comprises all procedures that injury female genital organs for non-medical reasons, with several health impacts. Due to global migration, FGM has been increasingly recognised as a healthcare issue in Europe, affecting nearly 1 million women. In Portugal it is estimated that 5483 migrant women have undergone FGM in the Lisbon region. Intervention is required to tackle this issue.

Description

Portugal launched the “Healthy Practices: End of FGM”, a multiagency project targeting Lisbon and Tagus Valley region. Project implementation started in Nov 2018 at 5 local public health units (PHU) and was scaled-up to 5 more in Feb 2020. Project comprises 3 main axes: 1) inclusion in public policy instruments; 2) professionals’ education and awareness; and 3) community intervention. We describe inclusion of FGM in public policy, professionals training and changes in FGM recording before and after intervention.

Results

Between 2018-2022, inclusion of FGM in municipalities’ migration policies doubled. Between 2019-2021, 110 training sessions (n = 1722 professionals) were promoted. During pandemic years, only 344 (2020) and 202 (2021) were trained. Raising awareness and empowerment to risk communities happened mainly through local/online open sessions, workshops, flyer distribution, video projections. These occurred in all 10 PHU, mostly through partnerships with Non-Governmental Organizations and municipalities. According to the Portuguese Health Records, until 2018 there were only 300 women registered with FGM. Between 2019-2021, 363 more were added.

Lessons

The multisectoral approach allowed PHU professionals to collaborate directly with external organizations from different society sectors. COVID-19 pandemic posed a challenge to implementation, especially in the community intervention axis. Notification numbers increased after interventions, though causality could not be established and impact evaluation is yet to be performed.

Key messages

• Multisectoral projects for FGM intervention have specific implementation challenges, including how to justify and evaluate them, that must be considered in each setting.

• Training health professionals might increase identification and notification of FGM, but the impact in preventing FGM in the Portuguese reality is still largely unknown.

What do future public health doctors know about the One Health concept in Portugal?

Background

The One Health (OH) approach brings together a transdisciplinary collaboration between human, animal, and environmental health, to tackle emerging zoonotic diseases, antimicrobial resistance, and food safety. Therefore, incorporating of OH principles in the education of health care providers is fundamental.

Methods

To assess OH knowledge, attitudes and practices (KAP), an anonymous, multiple-choice, online self-administered survey was sent to 1st year Portuguese Public Health Medical Residents (PPHMR), during an online congress targeted to them. A descriptive analysis was performed.

Results

A 50.0% response rate was obtained out of the 42 PPHMR attendees. Only 33.3% were familiar with OH concept; 57,1% had heard of it but were not aware of its meaning, and 9.5% had never heard of it. Concerningly, 9,5% believed zoonosis were diseases transmitted between animals and 42.9% considered that “antimicrobial resistance” is applied to antibiotics only. Regarding major zoonosis, etiologic agents were not recognized for Cryptosporidiosis (47.6%), Echinococcosis (42.9%), Toxoplasmosis and Leptospirosis (38.1%), Dermatophytosis (33.3%), Rabies (28.6%), Borreliosis/Brucellosis (23.8%). Half (52.4%) were unaware of the transmission route of Brucellosis/Dermatophytosis, followed by Leptospirosis (38.1%), Toxoplasmosis (28.6%) and Borreliosis/Rabies (23.8%). Remarkably, all participants showed willingness to be informed on OH issues and agreed that prevention and speed of intervention would be higher with greater collaboration between health technicians. About education towards OH throughout their medical curricula, 61.9% classified it as low, 23.8% as absent, 14.3% as sufficient and none classified it as adequate or very adequate.

Conclusions

This is the first study assessing KAP regarding the OH concept among PPHMR. Results highlight the need to bring OH to the Portuguese medical schools’ agenda to better prepare the next generation of PPHMR to the emerging health crisis.

Key messages

• Despite the interest shown by 1st year Portuguese Public Health Medical Residents concerning One Health, a general lack of knowledge on the topic was found.

• The majority qualified as insufficient their training on this subject, highlighting the need for medical schools to improve education and raise awareness regarding this transdisciplinary approach.

Crenosoma vulpis infection in a four-month old puppy

Here we report the case of a diagnostic and treatment challenge in a four-month old dog from England, presented with one-month history of unproductive cough. Antigen blood test for Angiostrongylus vasorum infection was negative. Thoracic radiographs revealed a generalised bronchointerstitial pattern and bronchoscopy showed moving nematodes in the mucus of the bronchial wall. Additionally, Baermann technique revealed a high burden of larvae per gram of faeces. Morphological and molecular analyses confirmed that they were first stage larvae of Crenosoma vulpis. The infection was firstly treated with a spot-on solution containing 10% imidacloprid + 2.5% moxidectin, but the dog was still positive after 13 days. Therefore, a seven-day course of fenbendazole was prescribed. This represents one of the youngest dogs ever reported naturally infected by C. vulpis. The scant number of reported cases of crenosomosis has led practitioners to consider it as a rare parasitic disease in dogs, delaying a correct and targeted on-time diagnosis. Further studies are needed to perceive the real prevalence of this lungworm and to understand if it is a rare parasite or just rarely diagnosed.

The hyaluronate receptor is preferentially expressed on proliferating epithelial cells

In the present study, we have examined the distribution of the hyaluronate receptor as well as hyaluronate itself in a variety of adult tissues. The hyaluronate receptor was localized with a monoclonal antibody, termed K-3, while hyaluronate was localized using proteolytic fragments of cartilage proteoglycan. Staining with the K-3 monoclonal antibody revealed that the hyaluronate receptor was present in a variety of epithelia including the skin, cheek, tongue, esophagus, vagina, intestines, oviduct, and bladder. However, it was notably absent from epithelial cells of the cornea and stomach as well as from endothelial cells of blood vessels. When present, the hyaluronate receptor was preferentially located in regions of active cell growth, such as in the basal layers of stratified epithelium and at the base of the crypts of Lieberkuhn in intestinal epithelium. A similar phenomenon was observed in cultured 3T3 cells. Cultures of 3T3 cells that were actively proliferating were found to have greater amounts of the receptor than their nonproliferating counterparts. When the various tissues were examined for hyaluronate, it was found to have a widespread distribution, being present in most of the basement membranes and between the cells in stratified epithelium. Indeed, in many cases, the distribution of hyaluronate closely paralleled that of the hyaluronate receptor. These results suggest that the interaction between hyaluronate and its receptor is involved in cell-to-substratum adhesion.

Hypothesis: a nicotine-dopamine interaction linking smoking with Parkinson's disease and tardive dyskinesia

1. Nicotine, an important pharmacological component of cigarette smoke, is known to have significant effects on central nervous system (CNS) dopaminergic function. Although acute doses of nicotine have been shown to facilitate dopamine release, recent data indicate that chronic nicotine treatment may actually decrease CNS dopamine turnover in the striatum. 2. A number of epidemiological investigations have demonstrated that individuals who are or who have been smokers are less likely to develop idiopathic Parkinson's disease (a disorder involving a deficit in nigrostriatal dopaminergic neurotransmission). In addition, there is preliminary evidence that individuals with tardive dyskinesia (a hyperkinetic movement disorder observed in some cases of chronic neuroleptic treatment and thought by some to be associated with striatal dopamine receptor supersensitivity) are more likely to be smokers. 3. A unitary hypothesis is presented, proposing that smoking in early adult life may decrease CNS catecholamine turnover, thereby protecting against free radical formation from catecholamine oxidation that in turn damages striatal neurons. These individuals are thereby "protected" from the later development of Parkinson's disease. In this hypothetical scheme, individuals who are given neuroleptics and who also are smokers may develop a greater degree of dopamine receptor supersensitivity due to combined receptor blockade by neuroleptics and a decrease in CNS dopamine turnover caused by nicotine, resulting in an increased prevalence of tardive dyskinesia in this group.

The effect of sympathetic denervation with 6-hydroxydopamine on the ventral prostate of the rat

The effect of chemical sympathectomy with 6-hydroxydopamine (6-OHDA) on the ventral prostate of the rat was studied. A dose of 50 mg/kg i.v., which was repeated after 1 week, was effective enough to produce total disappearance of sympathetic nerves. Reappearance of nerve fibres was evident 2 weeks after treatment. Dilation of prostatic alveoli was noted 1 week after denervation. It is concluded that the absence of normal sympathetic innervation prevents the emptying of the rat prostate.