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Objectives: The primary aim of this study is to assess the relationship between different aspects of physical activity (PA) and dementia occurrence in older adults from Brazil.
Methods: It is a secondary analysis of the first wave data derived from the ELSI-Brazil study, a longitudinal study of aging in Brazil with a representative sample of Brazilians aged 50 years and older (n = 9,412). We employed two distinct approaches to assess PA. First, participants’ levels of PA were classified in low, moderate and high based on their reported physical exertion over the preceding seven days at the time of interview. Also, PA was classified as sufficient or not sufficient, according to the World Health Organization (WHO) recommendation. Dementia was defined as those who were 60 years and older, had a cognitive performance ≤1.5 z-score compared to a sub- sample defined as control-group, and also had an impairment in instrumental activity of daily living. Logistic regression was used to estimate the association between physical activity and dementia (crude and adjusted for age, gender, schooling, marital status, smoking and alcoholconsumption).
Results: After excluding those younger than 60 years old and had missing data to any of the variables analyzed, our sample was composed by 4,994 individuals (table 1), with a mean age of 69.7 (SD = 7 .5), 4.7 years of schooling (SD = 4.3) and 214 (4.1%) classified as living with dementia. We also found that higher levels of PA were associated with lower occurrences of dementia (table 2) (moderate OR 0.57 95% CI 0.37 –0 .90, p < 0.05; high OR 0.32 95% CI 0.19 –0.56, p < 0.001). Also, practicing the level of PA recommended by WHO had an inverse association with dementia (table 3) (OR 0.49 95% CI 0.30 – 0.79, p < 0.05).
Conclusions: The main limitation of our study is its cross-sectional nature. Therefore, we cannot determine the direction of relationships between variables. Our findings show a significant inverse association between levels of PA and dementia occurrence. Additionally, adherence to the WHO’s recommendation for PA also showed a significant inverse association with dementia occurrence. These results underscore the importance of promoting regular physical activity as a potential preventive measure against dementia among older Brazilian adults.
The objectives of this experiment were to determine the digestible indispensable amino acid score (DIAAS) for eggs cooked in different forms and in traditional egg-bread or egg-hash brown combinations, and to test the hypothesis that DIAAS in eggs is greater than in breads or potatoes. Nine ileal cannulated gilts (average initial body weight: 51.1 ± 6.0 kg) were allotted to a 9 × 6 Youden square design with nine diets and six 7-day periods. Fried egg, boiled egg, scrambled egg, English muffin, Texas toast, and hash brown were included in the experiment. Six diets each contained one source of protein and three diets were combinations of fried eggs and English muffin, boiled eggs and Texas toast, or scrambled egg and hash brown. A nitrogen-free diet was also used and fed to all pigs in one period. The standardised ileal digestibility (SID) of crude protein (CP) and amino acids (AA) was calculated, and DIAAS was calculated for the individual ingredient and combined meals for children between 6 and 36 months and individuals older than 3 years. For both age groups, all cooked eggs had greater (P < 0.001) DIAAS compared with the other foods, and hash brown had greater (P < 0.001) DIAAS than both breads. All combined meals had DIAAS greater than 75 and there were no differences between measured and predicted DIAAS for the combined meals. In conclusion, eggs have ‘excellent’ protein quality for individuals older than 6 months and can compensate for the lower protein quality in plant-based foods, and DIAAS obtained from individual ingredients are additive in mixed meals.
From early on, infants show a preference for infant-directed speech (IDS) over adult-directed speech (ADS), and exposure to IDS has been correlated with language outcome measures such as vocabulary. The present multi-laboratory study explores this issue by investigating whether there is a link between early preference for IDS and later vocabulary size. Infants’ preference for IDS was tested as part of the ManyBabies 1 project, and follow-up CDI data were collected from a subsample of this dataset at 18 and 24 months. A total of 341 (18 months) and 327 (24 months) infants were tested across 21 laboratories. In neither preregistered analyses with North American and UK English, nor exploratory analyses with a larger sample did we find evidence for a relation between IDS preference and later vocabulary. We discuss implications of this finding in light of recent work suggesting that IDS preference measured in the laboratory has low test-retest reliability.
Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor.
Methods
This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury).
Results
The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt.
Conclusion
Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.
Immersive technologies have the potential to control cognitive and behavioural symptoms in people with dementia. A safe environment can be designed through a specific interactive scenario, according to the preferences and experiences of each user.
Objective:
Mapping neuro-emotional responses during the interactive scenario therapy experience in a case study, with dementia, using electroencephalography (EEG).
Methods:
A participant, 78 years old and diagnosed with moderate to severe Alzheimer's disease (female; Mini Mental State Examination score of 17 points; frontal assessment battery score of 8 points), underwent EEG analysis (EMOTIV EPOC X) using a protocol with interactive scenarios tailored to the participant's needs and preferences, the scenarios were designed from reminiscence strategies. The protocol included a stimulus that alternated between motor and cognitive activities (3 minutes), and breath-centered relaxation (1 minute). The scenarios used in this study were: setting up a living room; composing a cake recipe; shopping in the market to make a cake; looking for objects in the park; organizing a birthday party. These variables are provided, on a scale of 0 to 100, after processing by the algorithms of the EmotivPRO v3.0 software.
Results:
The values found in the EEG analysis will be described without stimulus and with stimulus respectively. Thus, engagement (68.57 to 71.86); arousal (57.86 to 49.86), focus (61.57 to 57.00), interest (54.86 to 49.57), relaxation (33.86 to 30.86), and stress (53.71 to 43.00). The EEG data showed an increase in engagement when the patient was stimulated (68.57 to 71.86). Relaxation also increased (30.86 to 33.86) when the stimulus was removed. The stress level, as analysed by the EEG, was also higher in the period without stimulus and reduced in the period with the stimulus (53.71 to 43).
Conclusion:
During a stimulus period in interactive therapy, there was an increase in engagement, which was related to an increasing focus during the stimulus. Lower values were observed compared to the period without stimulus, indicating a period of recovery after a period of concentration/arousal. Therefore, therapy with an interactive and familiar scenario, using a circuit of stimulus-breathing exercises, promotes a positive and adequate neuro-emotional response in a person with dementia.
The use of music in older people with advanced dementia is possible because perception, sensitivity, emotion, and memory of music may remain intact after other types of memory disappear. Previous literature is controversial about stress biomarkers response to music introduction in therapy routines for people with severe cognitive impairment and neural-behavioural disorders. Particularly, for these patients, it is possible that they feel lower pleasure levels with music-based therapies.
Objective:
To characterize the immediate physiological effects of listening to music during psychomotor stimulation in an old participant with combined dementia and depression disorder and in a participant with a dementia diagnosis.
Methods:
Two study cases with dementia diagnosis participated in this study (P1: 84yrs; male Parkinson; FAB=9; P2: 85 yrs; female; Alzheimer; FAB=11; depression diagnosis) and were submitted to psychomotor stimulation (2 sessions). The first 20 min. of each session was dedicated to psychomotor stimulation without music (A), followed by 20 minutes with music (B). Heart rate was monitored (H10 Polar sensor) in a continuous mode. Cortisol levels were collected at the beginning of the session (T0) and then repeated at periods A and B (μg/dL). The range between minimum and maximum HR values (beats per minute- bpm) and mean values for cortisol levels were considered for the stress response analysis.
Results:
Salivary cortisol levels were higher at T0 for P1 (0.393 vs 0.203). During period A, the P1 slightly decreased their values (↓0,076) and P2 had no changes. After introducing music, both P1 and P2 increased cortisol levels (↑0,085; 0,162↑). For both P1 and P2, a wide range of HR was detected during period B (P1: 13 vs 23 bpm) vs (P2: 15 vs 41 bpm).
Conclusion:
Immediate responses to the music inclusion in a psychomotor intervention caused an augmented stress response in elderly participants with dementia, especially in P2. In specific, the depression diagnosis in this participant may be associated with a low capacity to handle emotions during new experiences, causing a higher stress response.
The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.
Methods
The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.
Results
About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.
Conclusions
The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
Immersion in water is a non-pharmacological method for pain relief during childbirth. The aim was to describe the experiences, values and preferences of women regarding water immersion during childbirth identified in the evidence.
Methods
A systematic review and thematic synthesis of qualitative evidence was conducted. Databases were searched from 2009 to 2022 and screened for inclusion using pre-determined criteria. Studies that used qualitative methods for data collection and analysis to investigate the opinions of women or health professionals in hospital settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Programme Qualitative Research Checklist was used to assess study quality and findings were synthesized using thematic synthesis, as described by Thomas and Harden.
The final report was reviewed by several categories of health professionals that care for mothers and infants, as well women.
Results
Thirteen studies met inclusion criteria and were included in this review. Nine studies have been identified that reflect the experience of women in relation to immersion in water during childbirth, a study exploring the factors that determine the use of immersion during childbirth according to the point of view of both women and midwives, and three more studies on midwives’ experience with water immersion during childbirth. In the qualitative studies the following key themes emerged: Reasons identified by the women/professionals for choosing a water birth, benefits experienced in water births and barriers and facilitators of immersion in water during childbirth.
Conclusions
The evidence from qualitative studies indicates that women associated water birth with a sense of autonomy and control over labor, and a lower level of associated pain. Further, a water birth was considered a positive experience. From the point of view of midwives, to make water births safe, there is a need for adequate resources, as well as rigorous standardized protocols.
Certain doubts about immersion in water during birth mainly regarding the safety of the infant, warrant analysis of the data to determine whether immersion in water during childbirth is safe and effective. The aim is to describe the situation regarding the use of water immersion during childbirth in hospitals of the Spanish National Health System across Spanish Autonomous Regions and Cities.
Methods
A questionnaire was developed to assess the use of water immersion on maternity wards of National Health System hospitals. The survey was reviewed by several categories of health professionals and stakeholders. The online questionnaire was distributed via email. A database was created using the Microsoft Excel 365® computer program. Quantitative results were described through percentages and frequency distributions. In the case of free responses, a content analysis was performed, coding the responses into different categories.
Results
Regarding the status of water birth in Spain, the availability of the option of water birth varies across hospitals of the National Health System. Forty-six hospitals in 13 autonomous regions indicated that they had birthing pools on their delivery wards. Among these hospitals, 20 percent reported having more than 10 years of experience in water births, 45 percent between five and 10 years and 35 percent less than five years. Of the 46 responses received, 78 percent of the hospitals indicated that there was a demand for information on waterbirth by pregnant women. Regarding the existence of criteria for the adequate selection of pregnant women who could opt for immersion in water during childbirth, 89 percent of the hospitals indicated that these did exist, while 11 percent indicated that they did not have agreed criteria for the selection of candidates for water birth.
Conclusions
The availability of the option of water birth varies in hospitals across the Spanish National System. All the hospitals that have birthing pools offer them in the first stage of labor (dilation), while 32 percent also use them in the pushing stage and 15 percent during delivery of the placenta. It would be advisable to have standardized protocols and training to ensure the possibility that all pregnant women, regardless of their place of residence, can safely opt for water immersion during childbirth with satisfactory results.
The aim of the present study was to conduct a preliminary study of the Stanford Gender-Related Variables for Health Research (GVHR) adapted to the Spanish population, testing its factor structure, sex factorial invariance and relationship with health variables. Participants were 438 adults between 19–73 years old (M = 31.90, SD = 12.12) who completed the GVHR and measures of health-related quality of life, psychological health, and health-risk behaviors. The confirmatory factorial analysis of the GVHR indicated an acceptable fit to the 7-factor structure as proposed for the North American population. Emotional intelligence and independence factors had low internal consistency, therefore, a five-factor model was tenable in the Spanish population. Sex scalar invariance was tenable, indicating that the factors latent means can be meaningfully compared across sex. Univariate logistic regressions indicated that women reported worse mental and physical health and more health limitations, but this effect dissipated when gender variables were considered. Caregiver and work strain stood out as the variables related to gender that predicted worse health-related quality of life, psychological health, and health-risk behaviors. In conclusion, factorial structure of the GVHR may differ from one culture to another. Additionally, the variables related to gender in the GVHR give a better account of the differences in health compared to biological sex.
The increasing popularity of cognitive interventions for patients with psychosis calls for further exploration on how these interventions may benefit functional outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness of cognitive interventions (i.e. Cognitive Remediation, Cognitive Training, Social Cognition, and their combination) on functioning of patients with recent onset psychosis, established as the period within the first five years from the first episode. The following databases were searched: Proquest, PUBMED/MEDLINE, PsycINFO, WOS, Scopus for research published until January 2022. In total, 12 studies were eligible. The total number of participants was 759, of which 32.2% in the intervention and 30.8% in the control group were female. We extracted data to calculate the standardized mean change from pre-test to post-test comparing the intervention with the control conditions. Overall, there was no effect of any of the cognitive intervention types on functioning. None of the examined factors (intervention type, length, and modality; control condition, follow-up time; cognitive functions; medication; symptoms) seemed to moderate these findings. Our results indicate that cognitive interventions as standalone interventions do not appear to improve functioning in patients with recent onset psychosis. Given the small number of eligible studies, further RCTs with larger and more refined samples are needed to test whether these interventions should be applied as single interventions with these patients.
The Asteropyginae Delo, 1935 is a group of phacopid trilobites in the family Acastidae Delo, 1935 that has served as the focus for several studies due to their distinctive morphologies and diversity. However, despite an interest in these characteristic morphologies, there have been no studies that have examined this group using morphometric techniques. Our investigation utilized both geometric morphometric and elliptical Fourier methods to quantify the morphology of cephalic sclerites of asteropyginid specimens representing wide taxonomic sampling of the clade. We constructed a phylomorphospace that shows temporal and spatial patterns of phenotypic evolution within the framework of a novel tip-dated phylogenetic tree generated using Bayesian inference. We recovered similar patterns in disparity regardless of the morphometric approach. Both analyses illustrated a marked expansion into morphospace throughout the temporal range of the clade, peaking in disparity in the Emsian and with European taxa exhibiting the highest disparity in glabellar morphospace. Additionally, glabellar shape showed low phylogenetic signal and no major patterns in phylomorphospace. This study highlights the utility of employing different methodologies to quantitatively explore the disparity of fossil taxa. It also illustrates some of the patterns of morphological change occurring during one of the final and major evolutionary radiations within Phacopida.
Wasted tires are the great source of fuel and valuable components but could be a cause of environmental and land pollution. This study shows the detailed method for the determination of radiocarbon isotope (14C) concentration in tires and their pyrolysis products. Samples are taken from truck and passenger car tires in the form of shredded rubber, pyrolysis oil and recovered carbon black. Liquid scintillation counting (LSC) and accelerator mass spectrometry (AMS) techniques were used for the investigation at Gliwice Radiocarbon and Mass Spectrometry Laboratory, and National Laboratory for Age Determination, Trondheim, Norway. The results are in good agreement. Radiocarbon concentration of the rubber varies significantly because of its complex structure and composition within the tires. The 14C concentration values were found to be higher in pyrolytic oil compared to rubber, and greater in truck tires rather than car tires.
Glyphosate-resistant weeds are difficult to manage and can serve as hosts for pests that threaten cultivated crops. Chrysodeixis includens (Walker) (Lepidoptera: Noctuidae) is one of the main polyphagous pests of soybean in Brazil that can benefit from weeds' presence during season and off-season. Despite its pest status, little is known about C. includens survival and development on alternative hosts, including those resistant to glyphosate. Therefore, we assessed the biology, reproduction, preference, and survival at different feeding periods of C. includens on seven glyphosate-resistant weeds (Sumatran fleabane, Italian ryegrass, sourgrass, goosegrass, smooth pigweed, wild poinsettia, hairy beggarticks) commonly found in Brazilian agroecosystems, under laboratory conditions. Our results showed that C. includens survival and reproduction were similar on soybean and wild poinsettia. Survival and reproduction were lower on smooth pigweed and hairy beggarticks. Also, these plants prolonged the larval stage. Larvae did not pupate when fed on sourgrass, goosegrass, Italian ryegrass, and Sumatran fleabane. However, on Sumatran fleabane their biomass was higher. The mean generation time was lower on wild poinsettia. This weed was preferred to soybean. An antifeeding factor was observed on Sumatran fleabane. Larvae fed for 11 days on soybean, wild poinsettia and smooth pigweed developed into pupae. In agricultural systems, farmers must pay attention to the management of these weeds, especially wild poinsettia, smooth pigweed, and hairy beggarticks, to interrupt the cycle of this pest, since these plants can serve as main sources of infestation for the soybean crop.
We assessed the effectiveness of lyophilised banked human milk (HM) as a fortifier to feed very-low-birth-weight infants (VLBWI). This study aimed to evaluate the safety and tolerability of HM with HM lyophilisate as an additive compared with the standard additive (cows’ milk protein). In this phase I double-blind randomised controlled clinical trial, set in the intensive and intermediate care units of a tertiary hospital, forty VLBWI were enrolled and allocated into two groups: HM plus HM lyophilisate (LioNeo) or HM plus commercial additive (HMCA). The inclusion criteria were preterm infants, birth weight 750–1500 g, small or adequate for gestational age, exclusively receiving donor HM, volume ≥ 100 ml/kg per d and haemodynamically stable. Participants were followed up for 21 consecutive days. The primary outcome measures were necrotising enterocolitis (NEC), late-onset sepsis (LOS), death, gastrointestinal (GI) bleeding or perforation, diarrhoea, regurgitation, vomiting and abdominal distension. The LioNeo and HMCA groups had similar weights at baseline. The regression models showed no differences between the groups in terms of the primary outcomes. Diarrhoea, GI perforation, NEC and LOS were absent in the LioNeo group (one LOS and one NEC in the HMCA group). Multiple regression analysis with the total volume of milk as a covariate did not show significant differences. The lyophilisation of donor HM was considered safe and tolerable for use in stable haemodynamically VLBWI.
Socio-relational aspects are essential for mental wellbeing (MWB), especially in the oldest old age. Our study aims to explore the socio-relational aspects related to MWB in accordance with the experiences of the oldest old of four European countries; and to examine how these differ between Mediterranean and Nordic people. A total of 117 participants aged 80+ years old were recruited, and 23 focus groups were performed. Qualitative content analysis identified five main themes. Family seemed to be the most important driver of the MWB of the oldest old, followed by relationships with close friends. Participants felt better when they had a sense of being needed, cared for, and connected. Loneliness and isolation negatively affected MWB, although solitude was appreciated. Differences appeared between Mediterranean and Nordic regions. Initiatives to promote positive interactions with family and friends, as well as social activities within the community, may contribute to strengthening MWB in the oldest old.
A crossover trial was conducted to compare hand rub and hand scrub-brush methods for reducing bacterial loads when using propan-1-ol-60% according to European regulations. Both methods significantly reduced the bacterial load immediately after antisepsis, but only the hand rub method achieved significant bacterial load reduction 3 hours after the procedure.
With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.
Aim:
This study assesses this model of response and evaluates it within the context of periop disaster exercises.
Methods:
The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.
Results:
Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.
Discussion:
Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.
Since its rediscovery in 1998, two major threats have been mentioned for the enigmatic Austral Rail Rallus antarcticus: cattle management by burning grass and rushes and predation by American mink Neovison vison. Added to the lack of a protocol to monitor this secretive bird, ever-growing threats make it necessary to study its global situation in depth to take accurate and urgent management decisions. We firstly studied how threats to the Austral Rail currently impact their occupancy and relative density (RD) at a wetland scale and habitat features associated with its presence at survey site scale inside wetlands in Santa Cruz province, Argentina. We additionally developed a monitoring protocol to detect the rail effectively and promptly by studying responses to playback with two different vocalisations at different times of the day and season. Both threats evaluated were negatively related to occupancy and RD of the Austral Rail, especially mink presence appearing to have an additive effect. We propose American mink control as crucial for Austral Rail conservation, while it would also be necessary to conserve a portion of wetlands exempt from burning and cattle presence. At survey sites, its presence was positively related with c.1–1.5 m tall rushes, whilst rails avoided low- density rush areas that resulted after management of rushes with fire to create pasture. To detect rails, both vocalisations can be confidently used at any time of the day and season. The poor knowledge about species ecology, mismanagement of vegetation in wetlands, expansion of American mink in Patagonia, construction on two dams in the Santa Cruz river basin, added to the already modified humidity conditions due to global climate change, force us to suggest that the Austral Rail should be considered as globally ‘Endangered’ (EN), to ensure the consideration of the species in management decisions.
Our objective was to determine the frequency of zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) virus coinfection and describe the mortality cases that occurred during the epidemiologic surveillance of the ZIKV epidemic in Colombia. We analysed all cases of suspected ZIKV infection that were reported to the National Institute of Health (October 2015–December 2016). DENV, CHIKV and ZIKV RNA were detected in serum or tissue samples using polymerase chain reaction assay. Medical records of the fatal cases were reviewed. We identified that 23 871 samples were processed. The frequency of viral agents was 439 (1.84%) for DENV, 257 (1.07%) for CHIKV and 10118 (42.38%) for ZIKV. Thirty-four (0.14%) cases of coinfection were identified. The CHIKV–ZIKV coinfection was present in 28 cases (82.3%), DENV–CHIKV in three (8.8%) and DENV–ZIKV in three (8.8%). Seven (20.6%) coinfection cases were fatal (two DENV–CHIKV cases and five CHIKV–ZIKV cases). Two cases were foetal deaths and the others were related to neurological syndrome and sepsis. In conclusion, the frequency of arbovirus coinfection during epidemic of ZIKV was low, and CHIKV–ZIKV coinfection was the most common. Mortality was high among coinfection patients. The role of each virus in the mortality cases of coinfection warrants further studies.