Introducción: La fiebre de Oropouche es una enfermedad infecciosa causada por el virus Oropouche (OROV). El diagnóstico y predicción del cuadro clínico continúa siendo un gran desafío para los médicos quienes manejan a los pacientes con síndrome febril agudo. Se han asociado diversos síntomas con la infección por virus OROV en pacientes con síndrome febril; sin embargo, a la fecha no existe una regla de predicción clínica. Objetivo: Evaluar el rendimiento de un modelo de predicción basado únicamente en signos y síntomas para diagnosticar la infección por el virus de Oropouche en pacientes con síndrome febril agudo. Materiales y Métodos: Estudio de validación, que incluyó a 923 pacientes con síndrome febril agudo registrados en la base de datos de la Vigilancia Epidemiológica de tres zonas del Perú durante los años 2015-2016. Resultados: Un total de 97 (19.0%) pacientes fueron positivos para infección por Oropouche en el grupo de desarrollo y 54 (23.6%) para el grupo de validación. El área bajo la curva fue de 0.65 y la sensibilidad, especificidad, VPP, VPN, LR+ y LR- fueron de 78.2%, 35.1%, 27.6%, 83.6%, 1.20 y 0.62 respectivamente. Conclusión: El desarrollo de un modelo de predicción clínica para el diagnóstico de OROV basado únicamente en signos y síntomas no funcionó bien debido a que la clínica es inespecífica y se relaciona con otras infecciones arbovirales, lo cual dificulta la predicción del diagnóstico, especialmente en áreas endémicas de coinfección de estas enfermedades. Se recomienda la vigilancia epidemiológica de OROV utilizando pruebas como PCR molecular. / Background. Oropouche fever is an infectious disease caused by the Oropouche virus (OROV). The diagnosis and prediction of the clinical picture continue to be a great challenge for clinicians who manage patients with acute febrile syndrome. Several symptoms have been associated with OROV virus infection in patients with febrile syndrome; however, to date, there is no clinical prediction rule. Objective. To assess the performance of a prediction model based solely on signs and symptoms to diagnose Oropouche virus infection in patients with acute febrile syndrome. Materials and Methods. Validation study, which included 923 patients with acute febrile syndrome registered in the Epidemiological Surveillance database of three areas of Peru during the years 2015-2016. Results. A total of 97 patients (19%) were positive for OROV infection in the development group and 23.6% in the validation group. The area under the curve was 0.65 and the sensitivity, specificity, PPV, NPV, LR + and LR- were 78.2%, 35.1%, 27.6%, 83.6%, 1.20 and 0.62, respectively. Conclusions. The development of a clinical prediction model for the diagnosis of Oropouche based solely on signs and symptoms does not work well because the clinic is nonspecific and is related to other arbovirus infections, which makes it difficult to predict the diagnosis, especially in areas co-infection endemics of these diseases. Epidemiological surveillance of OROV using laboratory tests such as molecular PCR is recommended. / Tesis

[Truncated abstract] A functional ecosystem is increasingly being recognised as a requirement for health and well being of resident human populations. Clearing of native vegetation for agriculture has left 1.047 million hectares of south-west Western Australia affected by a severe form of environmental degradation, dryland salinity, characterised by secondary soil salinisation and waterlogging. This area may expand by a further 1.7-3.4 million hectares if current trends continue. Ecosystems in saline affected regions display many of the classic characteristics of Ecosystem Distress Syndrome (EDS). One outcome of EDS that has not yet been investigated in relation to dryland salinity is adverse human health implications. This thesis focuses on one such potential adverse health outcome: increased incidence of Ross River virus (RRV), the most common mosquito-borne disease in Australia. Spatial analysis of RRV notifications did not reveal a significant association with dryland salinity. To overcome inherent limitations with notification data, serological RRV antibody prevalence was also investigated, and again no significant association with dryland salinity was detected. However, the spatial scale imposed limited the sensitivity of both studies. ... This thesis represents the first attempt to prospectively investigate the influence of secondary soil salinity on mosquito-borne disease by combining entomological, environmental and epidemiological data. The evidence collected indicates that RRV disease incidence is not currently a significant population health priority in areas affected by dryland salinity despite the dominant presence of Ae. camptorhynchus. Potential limiting factors include; local climatic impact on the seasonal mosquito population dynamics; vertebrate host distribution and feeding behaviour of Ae. camptorhynchus; and the scarce and uneven human population distribution across the region. However, the potential for increased disease risk in dryland salinity affected areas to become apparent in the future cannot be discounted, particularly in light of the increasing extent predicted to develop over coming decades before any benefits of amelioration strategies are observed. Finally, it is important to note that both dryland salinity and salinity induced by irrigation are important forms of environmental degradation in arid and semi-arid worldwide, with a total population of over 400 million people. Potential health risks will of course vary widely across different regions depending on a range of factors specific to the local region and the complex interactions between them. It is therefore not possible to make broad generalisations. The need is highlighted for similar research in other regions and it is contended that an ecosystem health framework provides the necessary basis for such investigations.