The distribution of tuberculosis in Porto Alegre: analysis of the magnitude and tuberculosis-HIV coinfection

Objective Analyzing the geographical distribution of the tuberculosis (TB), its incidence and prevalence and TB-HIV coinfection in the districts of Porto Alegre from 2007 to 2011. Method An ecological, descriptive study of time series that used descriptive and geoprocessing techniques. Results In total, were recorded 3,369 incident cases and 3,998 prevalent cases of pulmonary TB. In both contexts, there was predominance of cases in males and in Caucasians. Seventeen districts showed prevalence rates above 79.2 cases/100,000 inhabitants, considering that 15 of them had incidence rates above 73.7 cases/100,000 inhabitants. The TB-HIV coinfection rates reached 67% in some districts, which is above the city average value (30%). Conclusion The distribution analysis showed that the reformulation and restructuring of policies and health services in Porto Alegre are essential.


Performance evaluation of primary care services for the treatment of tuberculosis

Objective Evaluating the performance of primary care services for the treatment of tuberculosis according to the assessment referential of health services (structure/process) in Cabedelo, a port city in the state of Paraíba. Method An evaluation quantitative, cross-sectional study, in which were carried out 117 interviews with health professionals using a structured instrument. The analysis was based on the construction of indicators using a standardized value for the reduced variable (z=1). Results The structural indicators showed regular performance for the following variables: professional training, access to record instruments and coordination with other services. The process indicators related to external actions and information about the disease had unsatisfactory performance. The directly observed treatment and the flows of reference/counter-reference had regular performance. Conclusion The focused professional qualification, the fragmentation of practices and the unsystematic home care constitute obstacles for carrying out actions aimed at providing expanded, continuous and resolute care.



Influence de l'administration des preuves sur l'activit�� mentale menant �� la formation du verdict au cours d'un proc��s p��nal

Abstract : The role of order effects has been widely shown and discussed in areas such as memory and social impression formation. This work focuses in a first half on order effects influencing the verdict chosen at the end of a criminal trial. Contrary to impression formation but according to trial's characteristics, it has been hypothesised that a recency effect would influence the verdict's choice. Three groups of students (N = 576) received a mock trial resume with a specific order stemming from the combination of three witnesses, one expert and two ocular witnesses. Results show a recency effect, the last testimony provoking significantly more acquittals if discriminating, and more condemnations if incriminating. The second half of this work starts from Gestalt and sociopsychological researches presenting numerous insights into cognitive organization of perceptions and opinions. It has been postulated that a witness probative value will change according to the emitted verdict, an incriminating witness or expert possessing a higher probative value in a condemning verdict than in an innocenting one, on the other hand a discriminating witness or expert having a higher probative value in an acquittal than in a condemnation. Results using a seven points scale measuring witnesses' probative value confirm this hypothesis. Argumentations written by the subjects to explain their verdict and refering to the accusing expert also show a congruency effect as categories of arguments are identical in case of condemnation or acquittal, the only difference between both types of verdicts residing in the frequency of these categories following the judgement, higher use of incriminating arguments in case of guiltiness and higher use of discriminating ones if the accused is found innocent. R��sum�� : L'intervention des effets s��riels a fait l'objet de nombreuses recherches dans le domaine de la m��moire et de la formation d'impression en psychologie sociale. Ce travail s'int��resse dans une premi��re partie aux effets d'ordre pouvant influencer le choix du verdict �� la fin d'un proc��s p��nal. Contrairement aux r��sultats obtenus en mati��re de formation d'impression, mais conform��ment aux caract��ristiques d'un proc��s, l'hypoth��se de l'intervention d'un effet de r��cence a ��t�� formul��e, affirmant que les derniers t��moins influencent le plus le choix du verdict. Trois groupes d'��tudiants (N = 576) ont lu le r��sum�� d'un proc��s fictif pr��sentant trois t��moignages, deux t��moins visuels �� d��charge et un expert �� charge. Chaque groupe recevait un ordre sp��cifique de pr��sentation des t��moins de sorte que l'expert se trouvait en premi��re, deuxi��me ou troisi��me position. Les r��sultats montrent un effet de r��cence, le dernier t��moin provoquant davantage d'acquittements s'il est disculpant et davantage de condamnations s'il est inculpant. La seconde partie de ce travail ��mane des recherches effectu��es dans le domaine de la th��orie de la forme et de la psychologie sociale ayant un int��r��t marqu�� pour l'organisation cognitive de nos perceptions et de nos opinions. L'hypoth��se que nous avons pos��e souligne le lien entretenu entre l'��valuation de la force probante d'un t��moin et le verdict ��mis : un t��moignage discriminant poss��dera plus de poids en cas d'acquittement qu'en cas de condamnation, inversement un t��moignage incriminant aura plus de poids en cas de condamnation qu'en cas d'acquittement. L'utilisation d'une ��chelle en sept points mesurant la force probante des deux types de t��moins confirme cette hypoth��se, l'estimation de la valeur accord��e �� un m��me t��moin variant selon le type de verdict choisi. Les argumentations de chaque verdict ont ��galement montr�� que les cat��gories d'arguments se r��f��rant �� l'expert ��taient identiques en cas de condamnation ou d'acquittement de l'inculp��, par contre les fr��quences de ces cat��gories entretiennent un lien congruent avec le verdict, celles inculpantes ��tant majoritairement utilis��es pour asseoir la culpabilit�� mais peu repr��sent��es en cas d'acquittement, inversement celles disculpantes apparaissant bien plus lorsqu'il s'agit d'innocenter l'inculp�� que pour le condamner.

Understanding the experiences of caregivers of children with tuberculosis in directly observed therapy

Objective To understand the situations and communications experienced by caregivers of children with tuberculosis (TB) with regard to directly observed therapy (DOT). Method A descriptive exploratory study with a qualitative approach was applied and developed in the ambulatory of Programa Einstein na Comunidade de Paraisópolis (PECP). The data were collected using semi-structured interviews of 13 caregivers of children with TB in DOT. The Collective Subject Discourse (CSD) method was used to analyze the data. Results Seven CSDs were identified and grouped into four categories: "Living in a difficult situation", "Changing the family routine", "Responsibility almost always fall son the mother", and "Adapting to the DOT". Conclusions The difficulties faced by the caregiver of the child at the beginning of DOT significantly changed the familiar routine. The responsibility for its continuity was assigned to the mother, who must adapt to the demands of the treatment and face the situation.

The Role of Public Administration: A Global Perspective

From my experience with public administration in my country, Cape Verde, and through readings in the area of development administration, I have found that a distinctive role and specific societal goals are usually ascribed to public administration in developing country. In studying American public administration approaches and operation, I was stuck by the fact that the definition of roles and societal goals for public administration seems not to be a forefront concern in the field. How to do things and achieve efficiency, in a managerial and rational perspective, seemed to draw much more attention than the purpose of doing things. Somehow, the contrast with the concept of development administration seemed too sharp, and I became curious about the reasons for such disparate approaches. Historical, cultural, and environmental differences would probably not be the only explanation for that since the concept of development administration was shaped, in the late 50���s and 60���s, by American authors and institutional aid agencies, and then ���offered��� to developing countries. At the same time, looking to poor results of the successive prescriptions of the development administration movement, I was no sure that such a concept and the framework it establishes was worthwhile. What practical answers and arrangement did they bring to the needs and challenges of public administrations in developing countries? ���

Immunization with H1, HASPB1 and MML Leishmania proteins in a vaccine trial against experimental canine leishmaniasis.

The protective capabilities of three Leishmania recombinant proteins - histone 1 (H1) and hydrophilic acylated surface protein B1 (HASPB1) immunized singly, or together as a protein cocktail vaccine with Montanide, and the polyprotein MML immunized with MPL-SE adjuvant - were assessed in beagle dogs. Clinical examination of the dogs was carried out periodically under blinded conditions and the condition of the dogs defined as asymptomatic or symptomatic. At the end of the trial, we were able to confirm that following infection with L. infantum promastigotes, five out of eight dogs immunized with H1 Montanide, and four out of eight dogs immunized with either the combination of HASPB1 with Montanide or the combination of H1+HASPB1 with Montanidetrade mark, remained free of clinical signs, compared with two out of seven dogs immunized with the polyprotein MML and adjuvant MPL-SE, and two out of eight dogs in the control group. The results demonstrate that HASPB1 and H1 antigens in combination with Montanide were able to induce partial protection against canine leishmaniasis, even under extreme experimental challenge conditions.

Intraocular penetration of penciclovir after oral administration of famciclovir: a population pharmacokinetic model.

OBJECTIVES: We developed a population model that describes the ocular penetration and pharmacokinetics of penciclovir in human aqueous humour and plasma after oral administration of famciclovir. METHODS: Fifty-three patients undergoing cataract surgery received a single oral dose of 500 mg of famciclovir prior to surgery. Concentrations of penciclovir in both plasma and aqueous humour were measured by HPLC with fluorescence detection. Concentrations in plasma and aqueous humour were fitted using a two-compartment model (NONMEM software). Inter-individual and intra-individual variabilities were quantified and the influence of demographics and physiopathological and environmental variables on penciclovir pharmacokinetics was explored. RESULTS: Drug concentrations were fitted using a two-compartment, open model with first-order transfer rates between plasma and aqueous humour compartments. Among tested covariates, creatinine clearance, co-intake of angiotensin-converting enzyme inhibitors and body weight significantly influenced penciclovir pharmacokinetics. Plasma clearance was 22.8 �� 9.1 L/h and clearance from the aqueous humour was 8.2 �� 10(-5) L/h. AUCs were 25.4 �� 10.2 and 6.6 �� 1.8 μg �� h/mL in plasma and aqueous humour, respectively, yielding a penetration ratio of 0.28 �� 0.06. Simulated concentrations in the aqueous humour after administration of 500 mg of famciclovir three times daily were in the range of values required for 50% growth inhibition of non-resistant strains of the herpes zoster virus family. CONCLUSIONS: Plasma and aqueous penciclovir concentrations showed significant variability that could only be partially explained by renal function, body weight and comedication. Concentrations in the aqueous humour were much lower than in plasma, suggesting that factors in the blood-aqueous humour barrier might prevent its ocular penetration or that redistribution occurs in other ocular compartments.

La tuberculose extrapulmonaire [Extrapulmonary tuberculosis].

Extrapulmonary tuberculosis represents an increasing proportion of all cases of tuberculosis reaching 20 to 40% according to published reports. Extrapulmonary TB is found in a higher proportion of women, black people and immunosuppressed individuals. A significant proportion of cases have a normal chest X-Ray at the time of diagnosis. The most frequent clinical presentations are lymphadenitis, pleuritis and osteoarticular TB. Peritoneal, urogenital or meningeal tuberculosis are less frequent, and their diagnosis is often difficult due to the often wide differential diagnosis and the low sensitivity of diagnostic tests including cultures and genetic amplification tests. The key clinical elements are reported and for each form the diagnostic yield of available tests. International therapeutic recommendations and practical issues are reviewed according to clinical presentation.

The Vaccine Formulation Laboratory: a platform for access to adjuvants.

Adjuvants are increasingly used by the vaccine research and development community, particularly for their ability to enhance immune responses and for their dose-sparing properties. However, they are not readily available to the majority of public sector vaccine research groups, and even those with access to suitable adjuvants may still fail in the development of their vaccines because of lack of knowledge on how to correctly formulate the adjuvants. This shortcoming led the World Health Organization to advocate for the establishment of the Vaccine Formulation Laboratory at the University of Lausanne, Switzerland. The primary mission of the laboratory is to transfer adjuvants and formulation technology free of intellectual property rights to academic institutions, small biotechnology companies and developing countries vaccine manufacturers. In this context, the transfer of an oil-in-water emulsion to Bio Farma, an Indonesian vaccine manufacturer, was initiated to increase domestic pandemic influenza vaccine production capacity as part of the national pandemic influenza preparedness plan.

Report on a review of selected general and application controls over the Iowa Public Employees��� Retirement System (IPERS) Benefits Administration System for the period April 23, 2007 through May 16, 2007

Report on a review of selected general and application controls over the Iowa Public Employees��� Retirement System (IPERS) Benefits Administration System for the period April 23, 2007 through May 16, 2007

Mycobacterium tuberculosis-specific CD8+ T cells are functionally and phenotypically different between latent infection and active disease.

Protective immunity to Mycobacterium tuberculosis (Mtb) remains poorly understood and the role of Mtb-specific CD8(+) T cells is controversial. Here we performed a broad phenotypic and functional characterization of Mtb-specific CD8(+) T cells in 326 subjects with latent Mtb infection (LTBI) or active TB disease (TB). Mtb-specific CD8(+) T cells were detected in most (60%) TB patients and few (15%) LTBI subjects but were of similar magnitude. Mtb-specific CD8(+) T cells in LTBI subjects were mostly T EMRA cells (CD45RA(+) CCR7(-)), coexpressing 2B4 and CD160, and in TB patients were mostly TEM cells (CD45RA(-) CCR7(-)), expressing 2B4 but lacking PD-1 and CD160. The cytokine profile was not significantly different in both groups. Furthermore, Mtb-specific CD8(+) T cells expressed low levels of perforin and granulysin but contained granzymes A and B. However, in vitro-expanded Mtb-specific CD8(+) T cells expressed perforin and granulysin. Finally, Mtb-specific CD8(+) T-cell responses were less frequently detected in extrapulmonary TB compared with pulmonary TB patients. Mtb-specific CD8(+) T-cell proliferation was also greater in patients with extrapulmonary compared with pulmonary TB. Thus, the activity of Mtb infection and clinical presentation are associated with distinct profiles of Mtb-specific CD8(+) T-cell responses. These results provide new insights in the interaction between Mtb and the host immune response.