Habitat for Humanity: Calibrating Best Practice Against the MDGs

Poverty alleviation lies at the heart of contemporary international initiatives on development. The key to development is the creation of an environment in which people can develop their potential, leading productive, creative lives in accordance with their needs, interests and faith. This entails, on the one hand, protecting the vulnerable from things that threaten their survival, such as inadequate nutrition, disease, conflict, natural disasters and the impact of climate change, thereby enhancing the poor’s capabilities to develop resilience in difficult conditions. On the other hand, it also requires a means of empowering the poor to act on their own behalf, as individuals and communities, to secure access to resources and the basic necessities of life such as water, food, shelter, sanitation, health and education. ‘Development’, from this perspective, seeks to address the sources of human insecurity, working towards ‘freedom from want, freedom from fear’ in ways that empower the vulnerable as agents of development (not passive recipients of benefaction).

Recognition of the magnitude of the problems confronted by the poor and failure of past interventions to tackle basic issues of human security led the United Nations (UN) in September 2000 to set out a range of ambitious, but clearly defined, development goals to be achieved by 2015. These are known as the Millennium Development Goals (MDGs). The intention of the UN was to mobilise multilateral international organisations, non-governmental organisations and the wider international community to focus attention on fulfilling earlier promises to combat global poverty. This international framework for development prioritises: the eradication of extreme poverty and hunger; achieving universal primary education; promoting gender equality and empowering women; reducing child mortality; improving maternal health; combating HIV/AIDS, malaria and other diseases; ensuring environmental sustainability; and developing a global partnership for development. These goals have been mapped onto specific targets (18 in total) against which outcomes of associated development initiatives can be measured and the international community held to account. If the world achieves the MDGs, more than 500 million people will be lifted out of poverty. However, the challenges the goals represent are formidable. Interim reports on the initiative indicate a need to scale-up efforts and accelerate progress.
Only MDG 7, Target 11 explicitly identifies shelter as a priority, identifying the need to secure ‘by 2020 a significant improvement in the lives of at least 100 million slum dwellers’. This raises a question over how Habitat for Humanity’s commitment to tackling poverty housing fits within this broader international framework designed to allievate global poverty. From an analysis of HFH case studies, this report argues that the processes by which Habitat for Humanity tackles poverty housing directly engages with the agenda set by the MDGs. This should not be regarded as a beneficial by-product of the delivery of decent, affordable shelter, but rather understood in terms of the ways in which Habitat for Humanity has translated its mission and values into a participatory model that empowers individuals and communities to address the interdependencies between inadequate shelter and other sources of human insecurity. What housing can deliver is as important as what housing itself is.

Examples of the ways in which Habitat for Humanity projects engage with the MDG framework include the incorporation of sustainable livelihoods strategies, up-grading of basic infrastructure and promotion of models of good governance. This includes housing projects that have also offered training to young people in skills used in the construction industry, microfinanced loans for women to start up their own home-based businesses, and the provision of food gardens. These play an important role in lifting families out of poverty and ensuring the sustainability of HFH projects. Studies of the impact of improved shelter and security of livelihood upon family life and the welfare of children evidence higher rates of participation in education, more time dedicated to study and greater individual achievement. Habitat for Humanity projects also typically incorporate measures to up-grade the provision of basic sanitation facilities and supplies of safe, potable drinking water. These measures not only directly help reduce mortality rates (e.g. diarrheal diseases account for around 2 million deaths annually in children under 5), but also, when delivered through HFH project-related ‘community funds’, empower the poor to mobilise community resources, develop local leadership capacities and even secure de facto security of tenure from government authorities.

In the process of translating its mission and values into practical measures, HFH has developed a range of innovative practices that deliver much more than housing alone. The organisation’s participatory model enables both direct beneficiaries and the wider community to tackle the insecurities they face, unlocking latent skills and enterprise, building sustainable livelihood capabilities. HFH plays an important role as a catalyst for change, delivering through the vehicle of housing the means to address the primary causes of poverty itself. Its contribution to wider development priorities deserves better recognition. In calibrating the success of HFH projects in terms of units completed or renovated alone, the significance of the process by which HFH realises these outcomes is often not sufficiently acknowledged, both within the organisation and externally. As the case studies developed in the report illustrate, the methodologies Habitat for Humanity employs to address the issue of poverty housing within the developing world, place the organisation at the centre of a global strategic agenda to address the root causes of poverty through community empowerment and the transformation of structures of governance.

Given this, the global network of HFH affiliates constitutes a unique organisational framework to faciliate sharing resources, ideas and practical experience across a diverse range of cultural, political and institutional environments. This said, it is apparent that work needs to be done to better to faciliate the pooling of experience and lessons learnt from across its affiliates. Much is to be gained from learning from less successful projects, sharing innovative practices, identifying strategic partnerships with donors, other NGOs and CBOs, and engaging with the international development community on how housing fits within a broader agenda to alleviate poverty and promote good governance.

Determination of the Maximum Rate of Eccrine Sweat Glands’ Ion Reabsorption Using the Galvanic Skin Conductance to Local Sweat Rate Relationship

Purpose The purpose of the present study was to develop and describe a simple method to evaluate the rate of ion reabsorption of eccrine sweat glands in human using the measurement of galvanic skin conductance (GSC) and local sweating rate (SR). This purpose was investigated by comparing the SR threshold for increasing GSC with following two criteria of sweat ion reabsorption in earlier studies such as 1) the SR threshold for increasing sweat ion was at approximately 0.2 to 0.5 mg/cm2/min and 2) exercise-heat acclimation improved the sweat ion reabsorption ability and would increase the criteria 1. Methods Seven healthy non-heat-acclimated male subjects received passive heat treatment both before and after 7 days of cycling in hot conditions (50% maximum oxygen uptake, 60 min/day, ambient temperature 32°C, and 50% relative humidity). Results Subjects became partially heat-acclimated, as evidenced by the decreased end-exercise heart rate (p<0.01), rate of perceived exhaustion (p<0.01), and oesophageal temperature (p=0.07), without alterations in whole-body sweat loss, from the first to the last day of training. As hypothesised, we confirmed that the SR threshold for increasing GSC was near the predicted SR during passive heating before exercise heat acclimation, and increased significantly after training (0.19 ± 0.09 to 0.32 ± 0.10 mg/cm2/min, p<0.05). Conclusions The reproducibility of sweat ion reabsorption by the eccrine glands in the present study suggests that the relationship between GSC and SR can serve as a new index for assessing the maximum rate of sweat ion reabsorption of eccrine sweat glands in humans.

Caracterização da adesão terapêutica dos doentes seguidos no Centro Hospitalar Lisboa Norte, EPE, no decurso do tratamento da, Esclerose Múltipla, Esclerose Lateral Amiotrófica, Artrite Reumatóide, Espondilite Anquilosante, Artrite Psoriática, Artrite Idiopática Juvenil Poliarticular, Psoríase em Placas, Polineuropatia Amiloidótica Familiar (Paramiloidose) e HIV/Sida : análise retrospetiva

RESUMO - Objetivos: Caracterizar a adesão à terapêutica nos doentes do CHLN, na área do VIH/SIDA, Esclerose, Artrite Reumatóide, Psoríase e Paramiloidose e avaliar a hipótese de ser possível prever o risco de um doente se tornar, num doente sem adesão. Metodologia: Estudo retrospetivo, observacional e longitudinal, realizado entre Janeiro de 2010 a 31 de Dezembro de 2013, a 4.761 doentes, em que a adesão à terapêutica foi calculada com base nos registos informáticos das dispensas de medicação, efectuados pelos Serviços Farmacêuticos, com recurso à Compliance Rate (CR) e utilizada como variável dependente. A estatística descritiva foi utilizada para caracterizar os doentes e os seus levantamentos e a regressão logística para avaliar o efeito das variáveis (idade, sexo, distrito de residência, período de observação, número de interrupções superiores a trinta dias e tempo até à primeira interrupção) sobre a adesão à terapêutica. Resultados e Conclusões: A percentagem de doentes com adesão foi de 64%, no entanto no HIV/Sida e na Artrite Reumatóide e Psoríase esta percentagem foi significativamente mais baixa, 42% dos doentes interromperam a terapêutica por períodos superiores a 30 dias, ocorrendo essa interrupção maioritariamente entre o primeiro e segundo ano de terapêutica. O modelo de regressão logística permitiu verificar que só com as variáveis sociodemográficas não é possível prever o risco de um doente se tornar num doente sem adesão, sendo para tal necessário adicionar ao modelo a variável número de interrupções superiores a 30 dias que foi identificada como importante factor preditivo da não adesão (OR=15,9, p=0,000).

Cohorte de patients avec le VIH/SIDA : échecs virologiques et effets de thérapies antirétrovirales sur la fonction rénale et l'hyperbilirubinémie

Le virus de l'immunodéficience humaine (VIH) est à l’origine d’une infection chronique, elle-même responsable du développement du syndrome d'immunodéficience acquise (SIDA), un état de grande vulnérabilité où le corps humain est à la merci d’infections opportunistes pouvant s’avérer fatales. Aujourd’hui, 30 ans après la découverte du virus, même si aucun vaccin n’a réussi à contrôler la pandémie, la situation s’est grandement améliorée. Conséquemment à l’arrivée de traitements antirétroviraux hautement actifs (HAART) à la fin des années 1990, la mortalité associée au VIH/SIDA a diminué et un plus grand nombre de personnes vivent maintenant avec l'infection. La présente thèse avait pour objectif d’aborder trois situations problématiques, en dépit de l’efficacité reconnue des HAART, plus particulièrement la faible charge virale persistante (LLV) et sa relation avec l’échec virologique, ainsi que les effets de certains antirétroviraux (ARV) sur les fonctions rénale et hépatique. Les objectifs précis étaient donc les suivants : 1) étudier le risque d’échec virologique à long terme chez les patients sous HAART dont la charge virale est indétectable comparativement aux patients affichant une LLV persistante; 2) évaluer sur le long terme la perte de fonction rénale associée à la prise de ténofovir (TDF) 3) étudier sur le long terme l'hyperbilirubinémie associée à la prise d’atazanavir (ATV) et ses autres déterminants possibles. Afin d’atteindre les trois objectifs susmentionnés, une cohorte de 2 416 patients atteints du VIH/SIDA, suivis depuis juillet 1977 et résidant à Montréal, a été utilisée. Pour le premier objectif, les résultats obtenus ont montré un risque accru d’échec virologique établi à >1000 copies/ml d’ARN VIH chez tous les patients qui présentaient une LLV persistante de différentes catégories durant aussi peu que 6 mois. En effet, on a observé qu’une LLV de 50-199 copies/ml persistant pendant six mois doublait le risque d’échec virologique (Hazard ratio (HR)=2,22, Intervalle de confiance (CI) 95 %:1,60–3,09). Ces résultats pourraient modifier la façon dont on aborde actuellement la gestion des patients affichant une LLV, et plus particulièrement une LLV de 50-199 copies/ml, pour laquelle aucune recommandation clinique n’a encore été formulée en raison du manque de données. Pour le deuxième objectif, on a observé une augmentation du risque de perte de fonction rénale de l’ordre de 63 % (HR=1,63; 95% CI:1,26–2,10) chez les patients sous TDF comparativement aux patients traités avec d’autres ARV. La perte de fonction rénale directement attribuable à la prise de TDF, indique que cette perte est survenue au cours des premières années de l’exposition du patient au médicament. D’une perspective à long terme, cette perte est considérée comme modérée. Enfin, pour ce qui est du troisième objectif, on a constaté que l’incidence cumulative d’hyperbilirubinémie était très élevée chez les patients sous ATV, mais que cette dernière pouvait régresser lorsque l’on mettait fin au traitement. L’hyperbilirubinémie à long terme observée avec la prise d’ATV n’a été associée à aucun effet néfaste pour la santé. Dans l’ensemble, la présente thèse a permis de mieux comprendre les trois situations problématiques susmentionnées, qui font actuellement l’objet de débats au sein de la communauté scientifique, et d’éclairer sous un jour nouveau la gestion des patients séropositifs sous traitement médicamenteux.

Comparaison des réponses physiologiques lors d’un exercice incrémental maximal sur vélo immergé et sur terrain sec : aspects biomécaniques, cardiopulmonaires et hémodynamiques.

L’exercice en immersion dans l'eau peut générer des réponses hémodynamiques et cardiorespiratoires différentes à celles de l’exercice sur terraine sec. Cependant, aucune étude n’a comparé ces réponses sur vélo aquatique (VA) à celles sur vélo sur terrain sec (VS) à une même puissance mécanique externe (Pext). À cet égard, le premier travail de cette thèse visait, d’abord, à trouver les équivalences de Pext lors du pédalage sur VA en immersion à la poitrine par rapport au VS au laboratoire, en considérant que cela restait non déterminé à ce jour. Une équation de mécanique des fluides fut utilisée pour calculer la force déployée pour le système de pédalage (pales, leviers, pédales) et des jambes à chaque tour de pédale. Ensuite, cette force totale a été multipliée par la vitesse de pédalage pour estimer la Pext sur VA. Ayant trouvé les équivalences de Pext sur VA et VS, nous nous sommes fixés comme objectif dans la deuxième étude de comparer les réponses hémodynamiques et cardiorespiratoires lors d'un exercice maximal progressif sur VS par rapport au VA à une même Pext. Les résultats ont montré que le VO2 (p<0.0001) et la différence artério-veineuse (C(a-v)O2) (p<0.0001) étaient diminués lors de l’exercice sur VA comparativement à celui sur VS. Parmi les variables hémodynamiques, le volume d’éjection systolique (VES) (p˂0.05) et le débit cardiaque (Qc) (p˂0.05) étaient plus élevés sur VA. En plus, on nota une diminution significative de la fréquence cardiaque (FC) (p˂0.05). Étant donné qu’à une même Pext les réponses physiologiques sont différentes sur VA par rapport à celles sur VS, nous avons effectué une troisième étude pour établir la relation entre les différentes expressions de l'intensité relative de l'exercice (% du VO2max,% de la FCmax,% du VO2 de réserve (% de VO2R) et % de la FC réserve (% FCR)). Les résultats ont démontré que la relation % FCR vs % VO2R était la plus corrélée (régression linéaire) et la plus proche de la ligne d’identité. Ces résultats pourraient aider à mieux prescrire et contrôler l’intensité de l'exercice sur VA pour des sujets sains. Finalement, une dernière étude comparant la réactivation parasympathique après un exercice maximal incrémental effectué sur VA et VS en immersion au niveau de la poitrine a montré que la réactivation parasympathique à court terme était plus prédominante sur VA (i,e. t, delta 10 à delta 60 et T30, p<0.05). Cela suggérait, qu’après un exercice maximal sur VA, la réactivation parasympathique à court terme était accélérée par rapport à celle après l'effort maximal sur VS chez de jeunes sujets sains. En conclusion, nous proposons une méthode de calcul de la puissance mécanique externe sur VA en fonction de la cadence de pédalage. Nous avons démontré que pendant l’exercice sur VA les réponses hémodynamiques et cardiorespiratoires sont différentes de celles sur VS à une même Pext et nous proposons des équations pour le calcul du VO2 dans l’eau ainsi qu’une méthode pour la prescription et le contrôle de l’exercice sur VA. Finalement, la réactivation parasympathique à court terme s’est trouvée accélérée après un effort maximal incrémental sur VA comparativement à celle sur VS.

Ansiedad, depresión y calidad de vida en personas adultas con VIH/SIDA y deterioro cognitivo leve

El Virus de la Inmunodeficiencia Humana (VIH) y el Síndrome de Inmunodeficiencia Adquirida (SIDA) han tenido a lo largo de los años un comportamiento epidemiológico que muestra la tendencia al aumento, de tal forma que ha llegado a considerarse como un problema de salud pública a nivel mundial. Sin embargo los tratamientos antiretrovirales han permitido que las personas con esta infección tengan una tasa de supervivencia mayor; pero ligado a esto, se han presentado efectos secundarios tales como problemas con la memoria y el funcionamiento cognitivo de estas personas. Además se ha encontrado que las personas con VIH/SIDA tienen algunas alteraciones en su área afectiva y generalmente ven afectada su calidad de vida. Este es un estudio exploratorio descriptivo que tuvo por objeto describir la ansiedad, depresión y percepción de calidad de vida en 35 pacientes con VIH/SIDA con deterioro cognitivo leve, seleccionados por conveniencia. Se aplicaron tres cuestionarios, el BDI-II para evaluar la sintomatología depresiva; el BAI para evaluar la sintomatología ansiosa y el MOS-SF30 para evaluar la calidad de vida. Además, se realizó una entrevista semiestructurada para profundizar en la evaluación de estas tres variables. Dentro de los resultados se evidenció que todos los paciente presentan algún nivel de ansiedad y de depresión, evalúan su calidad de vida en un punto medio; ni óptima ni baja. Se discuten estos y otros resultados.

Respuesta aguda de presión arterial, frecuencia cardiaca y percepción del esfuerzo en hipertensos

Objetivo: Medir y comparar el comportamiento agudo de la presión arterial (TA), la frecuencia cardiaca (FC) y la percepción subjetiva del esfuerzo físico (PSE) durante un circuito de pesas de resistencia variable (CRV) versus ejercicio aeróbico submáximo en cicloergómetro (EA) en hipertensos estados I y II.Métodos: Se evaluaron 21 individuos (8 hombres y 13 mujeres) hipertensos controlados de estados I y II (15 activos y 6 sedentarios, 56±5.9 años). Todos recibieron inducción sobre calentamiento, manejo de escala de PSE, técnica respiratoria y uso de máquinas de pesas durante el ejercicio. Con intervalos de una semana se sometieron a una sesión de CRV en seis estaciones al 50% de 1RM, y a una sesión de EA a intensidades de 70%-80% de la FCmax, en intervalos de una semana. Durante ambas sesiones se realizaron mediciones de FC, PA y PSE.Resultados: Se aplicó una Prueba t pareada para comparar las respuestas a ambos tipos de ejercicio. Se encontró un incremento menor de la FC (p<0.001), PA sistólica (p<0.005) y PSE (p<0.005) durante el CRV. La elevación de la PA diastólica fue mayor con las pesas, pero no significativa (P=0.139). Los sedentarios mostraron incrementos mayores. Entre cada estación de pesas el comportamiento de las variables fue similar (P>0.05).Conclusión: El estudio evidenció que la respuesta cardiovascular aguda y la PSE de hipertensos durante un CRV fueron similares a las observadas con EA. Se observó que la respuesta presora al circuito de pesas fue menor en pacientes con entrenamiento aeróbico previo.

Effects of exercise training on autonomic dysfunction management in an experimental model of menopause and myocardial infarction

Objective: The aim of this study was to investigate the effects of exercise training on cardiovascular autonomic dysfunction in ovariectomized rats submitted to myocardial infarction. Methods: Female Wistar rats were divided into the following ovariectomized groups: sedentary ovariectomized (SO), trained ovariectomized (TO), sedentary ovariectomized infarcted (SOI), and trained ovariectomized infarcted (TOI). Trained groups were submitted to an exercise training protocol on a treadmill (8 wk). Arterial baroreflex sensitivity was evaluated by heart rate responses to arterial pressure changes, and cardiopulmonary baroreflex sensitivity was tested by bradycardic and hypotension responses to serotonin injection. Vagal and sympathetic effects were calculated by pharmacological blockade. Results: Arterial pressure was reduced in the TO in comparison with the SO group and increased in the TOI in relation to the SOI group. Exercise training improved the baroreflex sensitivity in both the TO and TOI groups. The TOI group displayed improvement in cardiopulmonary reflex sensitivity compared with the SOI group at the 16 mu g/kg serotonin dose. Exercise training enhanced the vagal effect in both the TO (45%) and TOI (46%) animals compared with the SO and SOI animals and reduced the sympathetic effect in the TOI (38%) in comparison with the SOI animals. Significant correlations were obtained between bradycardic baroreflex responses and vagal (r = -0.7, P < 0.005) and sympathetic (r = 0.7, P < 0.001) effects. Conclusions: These results indicate that exercise training in ovariectomized rats submitted to myocardial infarction improves resting hemodynamic status and reflex control of the circulation, which may be due to an increase in the vagal component. This suggests a homeostatic role for exercise training in reducing the autonomic impairment of myocardial infarction in postmenopausal women.

Is gender crucial for cardiovascular adjustments induced by exercise training in female spontaneously hypertensive rats?

Evidence of mild hypertension in women and female rats and our preliminary observation showing that training is not effective to reduce pressure in female as it does in male spontaneously hypertensive rats (SHR) prompt us to investigate the effects of gender on hemodynamic pattern and microcirculatory changes induced by exercise training. Female SHR and normotensive controls (Wistar- Kyoto rats) were submitted to training (55% VO2 peak; 3 months) or kept sedentary and instrumented for pressure and hindlimb flow measurements at rest and during exercise. Heart, kidney, and skeletal muscles (locomotor/ nonlocomotor) were processed for morphometric analysis of arterioles, capillaries, and venules. High pressure in female SHR was accompanied by an increased arteriolar wall: lumen ratio in the kidney (+30%; P < 0.01) but an unchanged ratio in the skeletal muscles and myocardium. Female SHR submitted to training did not exhibit further changes on the arteriolar wall: lumen ratio and pressure, showing additionally increased hindlimb resistance at rest (+29%; P < 0.05). On the other hand, female SHR submitted to training exhibited increased capillary and venular densities in locomotor muscles (+50% and 2.3- fold versus sedentary SHR, respectively) and normalized hindlimb flow during exercise hyperemia. Left ventricle pressure and weight were higher in SHR versus WKY rats, but heart performance (positive dP/dt(max) and negative dP/dt(max)) was not changed by hypertension or training, suggesting a compensated heart function in female SHR. In conclusion, the absence of training- induced structural changes on skeletal muscle and myocardium arterioles differed from changes observed previously in male SHR, suggesting a gender effect. This effect might contribute to the lack of pressure fall in trained female SHRs.

New treatment of cellulite with infrared-LED illumination applied during high-intensity treadmill training

Phototherapy improves cellular activation which is an important factor for the treatment of cellulite. The objective of this research was to develop and evaluate the effects of a new (noninvasive and nonpharmacological) clinical procedure to improve body aesthetics: infrared-LED (850 nm) plus treadmill training. Twenty women (25-55 years old) participated in this study. They were separated in two groups: the control group, which carried out only the treadmill training (n = 10), and the LED group, with phototherapy during the treadmill training (n - 10). The training was performed for 45 minutes twice a week over 3 months at intensities between 85% and 90% maximal heart rate (HR(max)). The irradiation parameters were 39 mW/cm(2) and a fluence of 106 J/cm(2). The treatment was evaluated by interpreting body composition parameters, photographs and thermography. This was primarily a treatment for cellulite with a reduction of saddlebag and thigh circumference. At the same time, the treadmill training prevented an increase of body fat, as well as the loss of lean mass. Moreover, thermal images of the temperature modification of the thighs are presented. These positive effects can result in a further improvement of body aesthetics using infrared-LED together with treadmill training.

Effectiveness of commercial inhibitors against subtype F HIV-1 protease

Subtype F wild type HIV protease has been kinetically characterized using six commercial inhibitors (amprenavir, indinavir, lopinavir, nelfinavir, ritonavir and saquinavir) commonly used for HIV/AIDS treatment, as well as inhibitor TL-3 and acetylpepstatin. We also obtained kinetic parameters for two multi-resistant proteases (one of subtype B and one of subtype F) harboring primary and secondary mutations selected by intensive treatment with ritonavir/nelfinavir. This newly obtained biochemical data shows that all six studied commercially available protease inhibitors are significantly less effective against subtype F HIV proteases than against HIV proteases of subtype B, as judged by increased K(i) and biochemical fitness (vitality) values. Comparison with previously reported kinetic values for subtype A and C HIV proteases show that subtype F wild type proteases are significantly less susceptible to inhibition. These results demonstrate that the accumulation of natural polymorphisms in subtype F proteases yields catalytically more active enzymes with a large degree of cross-resistance, which thus results in strong virus viability.

Prevalence of Human Papillomaviruses in Urine Samples of Male Patients Infected With HIV-1 in Sao Paulo, Brazil

Human papillomavirus is a DNA virus that includes 118 genotypes. HPV16 is responsible for 80% of cervical cancer in women. Men are important reservoirs and major transmitters of HPV to their partners. The aim of this study was to detect HPV DNA and to determine the prevalence of HPV types 6, 11, 16, and 18 in urine samples of men infected with HIV-1. This study included 223 patients infected with HIV-1 from the Center of Reference on HIV/AIDS (CRT-SP) and an outpatient clinic of HIV. Urine samples were collected and after DNA extraction real-time PCR was performed for detection of HPV DNA. Positive samples were then tested by conventional PCR using type-specific primers for the four HPV types. A total of 223 men infected with HIV-1 were tested, 81% of whom were on HAART. Four (5.8%) were positive for HPV6, 18 (26.1%) were positive for HPV11, 22 (31.9%) were positive for HPV16 and five (7.2%) were positive for HPV18 by conventional PCR. Twenty (29%) patients had other HPV types and five patients (1.5%) had multiple types. The mean T CD4+cells count was 517 and 441 cells/mm(3) (P=0.30), in HPV negative and positive men, respectively. The HIV viral load was higher in the HPV negative group than for in the men with HPV (P=0.0002). A 30.9% prevalence of HPV was found in asymptomatic urine samples of men infected with HIV-1. This study suggests that urine may be a useful specimen for HPV screening. J. Med. Virol 81:2007-2011, 2009. (C) 2009 Wiley-Liss, Inc.

Avaliação da atenção à saúde de portadores de HIV no centro de referência para o tratamento da Aids em Natal/RN por profissionais e usuários do serviço

Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS

Periurbanização da leishmaniose visceral e emergência da coinfecção HIV/leishimania, no Rio Grande do Norte

Visceral leishmaniasis (VL) has undergone changes in terms of clinical and epidemiological presentation worldwide. Urbanization has been described in different regions of Brazil and the world, as well as in the state of Rio Grande do Norte. These changes have impacted in the clinical outcome of Leishmania infection. A new clinical entity called co-infection of HIV/Leishmania has been described as a consequence of overlapping areas of occurrence of VL and HIV / AIDS in different countries including Brazil. The aim of this study was to define the process of periurbanization of the LV and describe a case series of co-infection HIV / Leishmania in Rio Grande do Norte. A new demographic pattern of VL was detected, with an increase in the number VL adult male subjects. Analysis of spatial distribution of VL in the state of Rio Grande do Norte showed that in the past 20 years VL tends to occur in larger cities and therefore the highest risk disease is greater in the eastern and western regions. The first region included Natal, the state capital, where the process of suburbanization began in 1990, and more recently the city of Mossoró, the second largest state, where periurbanization began in the last five years. In 1990, the emergence of co-infection HIV/Leishmania in the state was observed. Case-control study revealed that the new clinical entity affects adult males, who acquired HIV through sexual intercourse, 40% of those with a preivous history of leishmania infection Relapse and death from LV is increased in HIV positive compared with HIV-negative patients matched by sex and age. This pattern is similar to the observed in Europe, except of the route of transmission, where in Europe occured concomitantly, by parenteral route in drug users. Analysis of spatial distribution identified overlapping new areas of occurrence of HIV / AIDS and LV potentially signaling to increased risk of this new clinical entity as described above. Therefore, epidemiological surveillance for co-infection HIV / Leishmania should be adopted in all areas of risk of VL. At the same time, it is necessary to evaluate drug resistance currently used in the treatment of VL, as well as parenteral transmission of L infantum/ chagasi in areas where drug dependence is a risk factor for HIV acquisition