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In interviews with scientists, public health officials, and health professionals, I asked about the particularities of leishmaniasis, about those characteristics that make this disease different from other illnesses also transmitted by insect vectors like Chagas disease or malaria. In the case of malaria, establishing a spatial difference between this disease and leishmaniasis was a little more complicated. Adriana Nieto is a microbiologist, specialized in epidemiology, who has worked for sixteen years leading the public health institution in charge of vector-borne diseases in Candelario. The rural area of this municipality has not only been heavily affected by leishmaniasis and the armed conflict, but also by malaria. Actually, for Adriana, controlling malaria is the absolute priority of her institution because Candelario is often among the five municipalities reporting most of the malaria cases in Colombia. For her, the main difference between these two diseases is that leishmaniasis is more selva; the disease is really selvatica [from the selva]. Instead, malaria has both peri-urban transmission and transmission in rural areas. While leishmaniasis is clearly selvatica, malaria is in both places, but primarily in areas a little bit more populated by people. For leishmaniasis, the reservoir is not the human but the animal that is in the selva. When I asked him to describe the relationship between the disease and the war, he used the following words: Leishmaniasis and the armed conflict are connected through the conditions in which la lucha [the fight or the struggle] takes place. Both leishmaniasis and the war take place far away from the Colombian center, far away from the cities. It is also in peripheral and rural areas of Colombia where people have struggled the most to defend dignified ways of living that run counter to modernizing ideas and development projects brought by corporations and the central government. Leishmaniasis happens there where the armed and social conflict has traditionally occurred. Since the selva is the context of war, and leishmaniasis is the disease of the selva, leishmaniasis has acquired a powerful meaning as a disease of war in Colombia. He explained to me that, unlike other places, the epidemiology of leishmaniasis in Colombia has clearly changed in relation to the armed conflict. Cristian was specifically referring to the human migrations associated with the war, and the resulting and unexpected emergence of leishmaniasis cases in places where this disease was rare or nonexistent before.

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Mystakidou K, Parpa E, Tsilika E, Galanos A, Vlahos L Does quality of sleep mediate the effect of depression on hopelessnessfi Olden M, Rosenfeld B, Pessin H, Breitbart W Measuring depression at end of life: Is the Hamilton depression rating scale a valid instrumentfi Powazki R, Walsh D, Hauser K, Davis M Communication in palliative medicine: A clinical review of family conferences J Palliat Med. Rayner L, Lee W, Price A, et al the clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: cross-sectional survey with four-week follow-up Palliat Med. Holland J, Currier J, Kirkendall A, Keene J, Luna N Sadness, anxiety, and experiences with emotional support among veteran and nonveteran patients and their families at the end of life J Palliat Med. Metzger P, Gray M End-of-life communication and adjustment: Pre-loss communication as a predictor of bereavement-related outcomes Death Stud. Mental Health Eggenberger E, Heimerl K, Bennett M Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings Int Psychogeriatr. Irwin K, Henderson D, Knight H, Pirl W Cancer care for individuals with schizophrenia Cancer 2013;120(3):323-334. Kiely D, Prigerson H, Mitchell S Health care proxy grief symptoms before the death of nursing home residents with advanced dementia Am J Geriatr Psychiatry. Le T, Najolia G, Minor K, Cohen A the effect of limited cognitive resources on communication disturbances in serious mental illness Psychiatry Res 2017;248:98-104 doi:10 1016/j psychres 2016 12 025 Sacco P, Cagle J, Moreland M, Camlin E Screening and assessment of substance use in hospice care: Examining content from a national sample of psychosocial assessments J Palliat Med. Domain 4: Social Aspects of Care Adames H, Chavez-Duenas N, Fuentes M, Salas S, Perez-Chavez J Integration of Latino/a cultural values into palliative health care: A culture centered model Palliat Sup Care. Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters Patient Educ Couns. Allen R, Hilgeman M, Ege M, Shuster J, Burgio L Legacy activities as interventions of approaching the end of life J Palliat Med. Altilio T, Gardia G, Otis-Green S Social work practice in palliative and end of life care J Soc Work End Life Palliat Care. Bern-Klug M A framework for categorizing social interactions related to end-of-life care in nursing homes Gerontologist. Brand S, Fasciano K, Mack J Communication preferences of pediatric cancer patients: talking about prognosis and their future life Support Care Cancer. Dougherty C, Pyper G, Au D, Levy W, Sullivan M Drifting in a shrinking future J Cardiovasc Nurs 2007;22(6):480-487. Hansen L, Rosenkranz S, Mularski R, Leo M Family perspectives on overall care in the intensive care unit Nurs Res.

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These pads are kept wet by water which is pumped from the basin of the cooler to a distribution system at the top of the unit where water gravity feeds through the filter pads back to the basin. If water is allowed to stagnate in the basin of a dormant evaporative cooler, conditions may arise that facilitate the growth of micro-organisms, including Legionella. Air drawn across the wet surfaces of an evaporative cooler may carry fine water droplets through very short lengths of unrestricted duct work into the building being serviced (see Figure 9). This precludes the use of biocides and other water treatment chemicals when the unit is in operation. Figure 9: Evaporative (air) cooler 44 the Prevention of Legionellosis in New Zealand Source: Victorian Government Department of Human Services (2001b) 5. This involves turning off the inlet water, isolating the unit electrically and hosing down the wet surfaces with the drain valve in the open position. The cooler should be allowed to stand in this condition, preferably with a slip-on weatherproof cover. The operation of any overflow, bleed-off or water replacement system should be checked regularly. Water discharge from evaporative coolers should be drained to waste as approved by the territorial authority. This water should not be allowed to discharge into gutters that feed drinking water tanks. Before bringing an evaporative (air) cooler back into service, remove the slip-on cover and thoroughly clean the equipment. Clean all waterways, including the bleed-off system and sump, to ensure free flow of water when the unit is in use. Refit the cleaned filter pads, close the drain valve and open the water inlet valve to allow the unit to fill with fresh water. The Prevention of Legionellosis in New Zealand 45 With the fan isolated and the pump circulating water around the unit, add a small quantity of household bleach (10 mL of 4 percent available chlorine per 10 L of circulating water) and allow the disinfected water to circulate for 30 minutes. Run the water to waste and refill with fresh water, circulate for five minutes, and again run to waste. Repeat this fresh water rinse and dumping and then refill with water and place the unit into normal service. Incoming water quality and airborne debris will have a major influence on the rate of bleed-off required. A recent innovation involves the solenoid operation of the inlet water and drain valves in conjunction with the water pump. Whenever the pump is switched on, the inlet water valve is opened and the drain valve closed. The reverse occurs when the pump is switched off, allowing the unit to be drained rapidly and to remain in a drying-out condition until the water pump is switched on again. These electrically controlled systems can be particularly useful if sedimentation, biological fouling or other water quality problems become evident, and they may be fitted to existing systems.

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Estrategia e perspectivas de controle da leishmaniose tegumentar no Estado de Sao Paulo. Epidemiological studies of na outbreak of cutaneous leishmaniasis in the Rio Jequitinhonha Valley, Minas Gerais, Brazil. A simple procedure for the isolation of leishmanial parasites and for the recovery of parasite in avirulent stocks. Estudo comparativo da reacao indireta de anticorpos fuorescentes em doenca de chagas, leishmanioses tegumentares e calazar com varios antigenos de Leishmania e Trypanosoma. Epidemiology of American cutaneous leishmaniasis due to leishmania braziliensis braziliensis. Transmition of leishmaniosis by the bait of phlebotomine sandfy: possible mechanism. Evaluacion de la respuesta de isotipos de inmunoglobulina especifca a leishmania en leishmaniasis tegumentaria americana. Leishmanias and leishmaniasis of the New World, with particular reference to Brazil. Successful treatment of refractory mucosal leishmaniasis with pentoxifylline plus antimony. Distribuicao de leishmaniose tegumentar e analise da sua ocorrencia em ambientes antropicos no Estado do Parana, Brasil 2000. Oral pentoxifylline combined with pentavalent antimony: a randomized trial for mucosal leishmaniasis. Is leishmania (viannia) braziliensis preferentially restricted to the cutaneous lesions of naturally infected dogsfi. Histologia da leishmaniose tegumentar por Leishmania braziliensis 2: resposta humoral tissular. Histologia da leishmaniose tegumentar por Leishmania braziliensis 4: classifcacao histopatologica. Histopatologia da leishmaniose tegumentar americana por leishmania braziliensis 1: padroes histopatologicos e estudo evolutivo das lesoes. Programa de mudanca do componente cognitivo da atividade de uma populacao da regiao endemica do sul da Bahia diante da leishmaniose tegumentar. Reacao de imunofluorescencia indireta e intradermorreacao para leishmaniose tegumentar americana em moradores na area de Jacarepagua (Rio de Janeiro). Tegumentary and visceral leishmaniasis in Brazil: emerging anthropozoonosis and possibilities for their control. Indirect immunofuorescence test in New World leishmaniasis: serological and clinical relationship.

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