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The mental health impacts of HIV have evolved significantly over the last four decades, in parallel with changes in the virus's overall health consequences. This study charts transformation in narratives about mental health problems associated with HIV over the course of the epidemic, as outlined by people with HIV (40%), professional carers (45%) and activists (25%) in the UK. In particular, our study examines evolving mental health impacts and changing service provision during three key periods: The early days of the epidemic; after the introduction of effective antiretroviral therapy (ART) in 1996; and in more recent times as HIV came to be regarded as a chronic manageable condition. Fifty-three participants were recruited: Male (68%), female (32%), White (90%), African/Afro Caribbean (6%) and South Asian (4%). Results indicate that despite important changes in the severity and nature of the mental health impacts of HIV, there were persistent challenges, related to the long-term mental health consequences of HIV among earlier generations of people with HIV. There were additional challenges associated with: ageing with HIV; the development of sexual dysfunction; and the possibility of neurocognitive impairment. The organization of mental health care for people with HIV moved from specialist teams to general practice, presenting challenges of mainstreaming care. The commissioning and delivery of mental health services need to be sensitive to the ever-changing social contexts and the potential for ‘left behind’ people living with HIV, despite the overall ‘naturalisation’ of HIV.

Abstract Introduction A person‐centred model of care, developed in the early days of the HIV epidemic when there were no effective treatments for HIV, led to relatively close relationships between carers and people living with HIV (PLWH). Our study examines the experiences of carers using a relational framework, exploring the traumas and challenges involved, coping practices instigated by carers and the emergence of ‘relational traumatic growth’ opportunities. Methods Twenty‐two UK healthcare workers and charity volunteers working with PLWH from the early years of the epidemic were recruited. Semistructured interviews were used to elicit participants' own stories of working with PLWH, from their initial involvement to the present time, and their reflections on the personal impact of working in the field of HIV. Data were analysed using a thematic approach employing relational categories. Results The impact of care was related to the formation of close relationships, identification with PLWH, high numbers of deaths and the difficulties and challenges encountered relationally. Participants described attempts to cope through informal and formal support, as well as endeavours to manage professional boundaries. Various ways of making sense of experiences were described, ranging from denial to abandoning the HIV field, to intense commitment. For some, traumatic experiences lead to validation, a search for personal meaning and managing the sense of loss with an exploration of further ventures, contributing to the achievement of relational traumatic growth. Conclusion The intensity of relationships in HIV work, developed through the emotional and practical work of caring for PLWH, led healthcare workers and volunteers to experience a range of psychological consequences, both negative (including distress and emotional exhaustion) and also positive (such as acquiring a sense of purpose). Patient or Public Contribution People living with HIV and those working with them were involved in the initial study conceptualization and design. The second and fourth authors of this paper were professionals working in HIV throughout the pandemic and have led on all aspects of the study. People living with HIV and those working with them additionally guided participant selection by suggesting participants and supporting recruitment. Narrative transcripts were checked and amended (if necessary) by participants. Initial findings were presented at the AIDS impact conference, where PLWH and those working with them attended and feedback on important ideas that helped to prioritize and shape the study findings.

Abstract Background Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases. Methods Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values. Results We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative. Conclusions The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries.

Abstract Background The introduction of effective antiretroviral treatment in the late 1990s led to the perception that HIV was a chronic but manageable condition. Nevertheless, stigma remains one of the major hurdles for people living with HIV (PLWH) to accessing healthcare and biomedical preventions. Thus, Fast Track Cities has set a target of zero HIV discrimination by 2030 as part of its strategy to end HIV transmission. Methods Fifty-three participants from the United Kingdom, including PLWH (n = 21, 40%), health and social care workers (n = 24, 45%), and charity workers and activists (n = 13, 25%), were recruited. Semi-structured interviews investigated stigma and discrimination, focusing on both before and after the widespread use of effective antiretroviral treatment in the late 1990s. Data were analysed using a thematic approach. Results Before effective antiretroviral treatment narratives were shaped by two main themes: 1) the media’s role in influencing public opinion and contributing to misunderstandings of HIV transmission; and 2) personal experiences of HIV-related stigma, which for PLWH included incidents of physical violence and aggression, as well as fears of their HIV status being publicised. Contemporary narratives on stigma experiences were organised around four themes: 1) discrimination in healthcare settings; 2) stigma amongst men who have sex with men (MSM); 3) stigma towards African and Afro-Caribbean PLWH; and 4) the limits of change in public HIV-related knowledge and attitudes. Contemporary narratives indicated a reduction in enacted stigma, but continued anticipation of discrimination and self-reported shame, particularly in MSM and African and Afro-Caribbean PLWH. Conclusion The nature of stigma against those with HIV has evolved. The intersection of PLWH and minority groups (e.g. MSM and African and Afro-Caribbean persons) may enhance anticipatory and internalised stigma, with some suggestion that this may contribute to reduced engagement in HIV care and prevention services. Our findings indicate the need for further research in this area, as well as proactive interventions with community groups to enhance knowledge of HIV.

Early life adversity can significantly impact child development and health outcomes throughout the life course. With the COVID-19 pandemic exacerbating preexisting and introducing new sources of toxic stress, social programs that foster resilience are more necessary now than ever. The Helping Us Grow Stronger (HUGS/Abrazos) program fills a crucial need for protective buffers during the COVID-19 pandemic, which has escalated toxic stressors affecting pregnant women and families with young children. HUGS/Abrazos combines patient navigation, behavioral health support, and innovative tools to ameliorate these heightened toxic stressors. We used a mixed-methods approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to evaluate the implementation of the HUGS/Abrazos program at Massachusetts General Hospital from 6/30/2020–8/31/2021. Results of the quality improvement evaluation revealed that the program was widely adopted across the hospital and 392 unique families were referred to the program. The referred patients were representative of the communities in Massachusetts disproportionately affected by the COVID-19 pandemic. Furthermore, 79% of referred patients followed up with the initial referral, with sustained high participation rates throughout the program course; and they were provided with an average of four community resource referrals. Adoption and implementation of the key components in HUGS/Abrazos were found to be appropriate and acceptable. Furthermore, the implemented program remained consistent to the original design. Overall, HUGS/Abrazos was well adopted as an emergency relief program with strong post-COVID-19 applicability to ameliorate continuing toxic stressors while decreasing burden on the health system.

This article draws on life-history interviews with older (aged 50+) people living with HIV in England to uncover the interpretive practices in which they engaged as they evaluated their own quality of life (QoL). Our paper highlights the distinctive insights that biographical and narrative approaches can bring to QoL research. While accounts of subjectively ‘poor’ QoL were relatively straightforward and unequivocally phrased, accounts of subjectively ‘good’ and ‘OK’ QoL were produced using complex interpretive and evaluative practices. These practices involved biographical reflection and contextualization, with participants weighing up and comparing their current lives' ‘pros’ and ‘cons’, their own lives with the lives of others, and their present lives with lives they had imagined having at the time of interview. Thus, ‘good’ and ‘OK’ QoL were constructed using practical, relational, and interpretive work – features of QoL analytically unavailable in quantitative data gathered through standardised measures (including our own survey data collected from these same participants). Our findings underscore the uneasy fit between QoL's quantitative measurement and its subjective understandings and evaluations, on the one hand, and the interpretive work that goes into achieving these understandings and evaluations, on the other.

Resumo Os países europeus estão experimentando uma redução nas taxas de imunização em um momento de expansão dos movimentos antivacinas. Nesse contexto, a mídia pode desempenhar um papel crucial, tanto na difusão de crenças, quanto na circulação de informações confiáveis sobre o tema. Este estudo analisou a cobertura jornalística sobre vacinas na imprensa portuguesa. Foi realizada uma análise de conteúdo em uma amostra de 300 artigos publicados no Diário de Notícias e no Jornal de Notícias de 2012 a 2017. Houve uma predominância de textos relacionados às vacinas contra a gripe, sarampo e meningite. Os temas mais frequentes foram: estoque de vacinas, pesquisa sobre vacinas, cobertura vacinal e campanha de vacinação. A maioria dos artigos apresentou um tom positivo e neutro em relação à imunização. Os jornais colocaram as vacinas em sua agenda midiática, possivelmente influenciados pelas políticas de saúde pública presentes em Portugal. Tais achados reforçam a percepção que a mídia pode ser um instrumento na divulgação de informação confiável sobre o tema. Apesar de o tom negativo ser pouco presente, títulos de notícias com ênfase nas reações adversas das vacinas poderiam contribuir para despertar ou aumentar a desconfiança nos seus benefícios.

Abstract Background Translating evidence-based interventions from study conditions to actual practice necessarily requires adaptation. We implemented an evidence-based Hospital at Home (HaH) intervention and evaluated whether adaptations could avoid diminished benefit from “voltage drop” (decreased benefit when interventions are applied under more heterogeneous conditions than existing in studies) or “program drift.” (decreased benefit arising from deviations from study protocols). Methods Patients were enrolled in HaH over a 6-month pilot period followed by nine quarters of implementation activity. The program retained core components of the original evidence-based HaH model, but adaptations were made at inception and throughout the implementation. These adaptations were coded as to who made them, what was modified, for whom the adaptations were made, and the nature of the adaptations. We collected information on length of stay (LOS), 30-day readmissions and emergency department (ED) visits, escalations to the hospital, and patient ratings of care. Outcomes were assessed by quarter of admission. Selected outcomes were tracked and fed back to the program leadership. We used logistic or linear regression with an independent variable included for the numerical quarter of enrollment after the initial 6-month pilot phase. Models controlled for season and for patient characteristics. Results Adaptations were made throughout the implementation period. The nature of adaptations was most commonly to add or to substitute new program elements. HaH services substituting for a hospital stay were received by 295 patients (a mean of 33, range 11–44, per quarter). A small effect of quarter from program inception was seen for escalations (OR 1.09, 95% CI 1.01 to 1.18, p = 0.03), but no effect was observed for LOS (− 0.007 days/quarter; SE 0.02, p = 0.75), 30 day ED visit (OR 0.93, 95% CI 0.86 to 1.01, p = 0.09), 30-day readmission (OR 1.00, 95% CI 0.93 to 1.08, p = 0.99), or patient rating of overall hospital care (OR for highest overall rating 0.99, 95% CI 0.93 to 1.05, p = 0.66). Conclusions We made adaptations to HaH at inception and over the course of implementation. Our findings indicate that adaptations to evidence-based programs may avoid diminished benefits due to potential ‘program drift’ or ‘voltage drop.’ Trial registration Not applicable. This study is not a clinical trial by the International Committee of Medical Journal Editors (ICMJE) definition because it is an observational study “in which the assignment of the medical intervention is not at the discretion of the investigator.”

Ante el escaso número de estudios en este ámbito, el objetivo es analizar el contenido visual en la prensa durante la crisis sanitaria del Ébola en España que ocasionó gran alarma en la sociedad en 2014. En una muestra nacional de diarios, se identifica contenido visual en el 92% (n=160) de artículos sobre el Ébola y en el 87,5% (n=14) de portadas. La fotografía es el recurso más usado (69,2%), seguido de gráficos (9,2%) e infografías (8,8%), mientras que ‘conflicto’ es el encuadre más frecuente (42%). Se detecta un aumento rápido del contenido visual en los primeros dos días de la crisis que disminuye paulatinamente a partir del quinto día (p

É escassa a produção de revisão de literatura sobre a cobertura jornalística de temas de interesse para a Saúde Coletiva. O presente estudo teve como objetivo caracterizar o perfil da produção científica, publicada de 2000 a 2015, voltada para a análise de notícias que tratam de temas da saúde das populações. Os 64 manuscritos incluídos foram organizados nas seguintes categorias: tema, produção de dados, métodos de análise e meios de comunicação investigados. A temática predominante foi a cobertura midiática sobre as enfermidades, com destaque para as infecciosas. Prevaleceram os estudos qualitativos, a pesquisa documental e análises de discurso e de conteúdo. O jornal foi o meio de comunicação mais pesquisado. Conclui-se que são importantes desafios deste campo: a baixa diversidade de temas e enfoques adotados, bem como de meios investigados, e a necessidade de se ampliar o escopo de estratégias metodológicas.

Valores-notícia são atributos intrínsecos aos fatos que os potencializam como candidatos à notícia. Este trabalho tem como proposta refletir sobre as bases teórico-conceituais que cercam a notícia e podem sustentar escolhas analíticas para se estudar a cobertura jornalística sobre o Sistema Único de Saúde. Discute, comparativamente, as tipificações desenvolvidas pelos autores Traquina e Silva sobre os valores-notícia de seleção. Silva atualiza a classificação de Traquina ao acrescentar os valores-notícia: ‘conhecimento’, ‘entretenimento/curiosidade’, ‘governo’ e ‘justiça’. Essa autora considera que alguns valores atuam como pré-requisitos na seleção noticiosa, sendo considerados, por isso, como macrovalores-notícia. Destacamos ainda os valores ‘interessante’ e ‘importante`, que abrangem todo o campo da noticiabilidade. Essas variáveis podem dizer muito sobre a realidade social, mostrando-se categorias potentes de análise da cobertura jornalística em saúde.

Four sesquiterpene lactones, mikanolide, deoxymikanolide, dihydromikanolide and scandenolide, were isolated by a bioassay-guided fractionation of Mikania variifolia and Mikania micrantha dichloromethane extracts. Mikanolide and deoxymikanolide were the major compounds in both extracts (2.2% and 0.4% for Mikania variifolia and 21.0% and 6.4% for Mikania micrantha respectively, calculated on extract dry weight). Mikanolide, deoxymikanolide and dihydromikanolide were active against Trypanosoma cruzi epimastigotes (50% inhibitory concentrations of 0.7, 0.08 and 2.5 μg/mL, for each compound respectively). These sesquiterpene lactones were also active against the bloodstream trypomastigotes (50% inhibitory concentrations for each compound were 2.1, 1.5 and 0.3 μg/mL, respectively) and against amastigotes (50% inhibitory concentrations for each compound were 4.5, 6.3 and 8.5 μg/mL, respectively). By contrast, scandenolide was not active on Trypanosoma cruzi. Besides, mikanolide and deoxymikanolide were also active on Leishmania braziliensis promastigotes (50% inhibitory concentrations of 5.1 and 11.5 μg/mL, respectively). The four sesquiterpene lactones were tested for their cytotoxicity on THP 1 cells. Deoxymikanolide presented the highest selectivity index for trypomastigotes (SI = 54) and amastigotes (SI = 12.5). In an in vivo model of Trypanosoma cruzi infection, deoxymikanolide was able to decrease the parasitemia and the weight loss associated to the acute phase of the parasite infection. More importantly, while 100% of control mice died by day 22 after receiving a lethal T. cruzi infection, 70% of deoxymikanolide-treated mice survived. We also observed that this compound increased TNF-α and IL-12 production by macrophages, which could contribute to control T. cruzi infection.

Objective: To assess body perception of teenagers in school environments. Methods: We conducted a qualitative study in a secondary public school from the city of Fortaleza-CE, Brazil, with students from the ninth grade, aged 14 to 16 years old, independent of sex, from March to June, 2009. The first phase consisted of the selection of ten students, using a schematic drawing of the human body. In the second phase, there was a focal group with guiding questions about body awareness and desire for change. Results: For the students, the idea of good posture would be a person who had good education and to be straight when walking and sitting. We perceived dissatisfaction and important misunderstanding in relation to their body and posture, and there was unanimity concerning the desire of achieving changes. Conclusion: There are mixed feelings related to the body, by teenage students, when you inquire about their image and desire to change. If, on one hand, they refer to perceive themselves with proper and correct posture, on the other hand, they are eager for change, easily identified with present standard body reported in the media and worshiped as “ideal body”. It is urgent and necessary to consolidate the culture of health promotion in schools as well as build healthy educational environment.

Este estudo objetivou apresentar a estrutura informatizada que viabiliza a utilização do Nursing Activities Score (NAS) em tecnologia móvel. Trata-se de um projeto de desenvolvimento de produção tecnológica baseado na engenharia de software, fundamentada na teoria do ciclo de vida de desenvolvimento de sistema. O Sistema NAS foi construído em dois módulos: módulo de pesquisa, cujo acesso é realizado através de computador pessoal (PC) e módulo de coleta de dados, acessado por meio de dispositivo móvel (smartphone). O Sistema NAS foi construído de modo a permitir que outros formulários, além do instrumento NAS, sejam incluídos futuramente. Assim, entende-se que o desenvolvimento do Sistema NAS permitirá a aproximação entre os enfermeiros e a tecnologia móvel facilitando o acesso imediato aos dados do instrumento referentes aos pacientes, auxiliando na tomada de decisão e na adequação do quantitativo de pessoal de enfermagem para prestação da assistência.

Objective: To assess body perception of teenagers in school environments. Methods: We conducted a qualitative study in a secondary public school from the city of Fortaleza-CE, Brazil, with students from the ninth grade, aged 14 to 16 years old, independent of sex, from March to June, 2009. The first phase consisted of the selection of ten students, using a schematic drawing of the human body. In the second phase, there was a focal group with guiding questions about body awareness and desire for change. Results: For the students, the idea of good posture would be a person who had good education and to be straightwhen walking and sitting. We perceived dissatisfaction and important misunderstanding in relation to their body and posture, and there was unanimity concerning the desire of achieving changes. Conclusion: There are mixed feelings related to the body, by teenage students, when you inquire about their image and desire to change. If, on one hand, they refer to perceive themselves with proper and correct posture, on the other hand, they are eager for change, easily identified with present standard body reported in the media and worshiped as “ideal body”. It is urgent and necessary to consolidate the culture of health promotion in schools as well as build healthy educational environment.

Trata-se de investigação sobre a utilização de objetos educacionais digitais nas formas de hipertexto, jogo educativo e simulação sobre o tema oxigenoterapia junto a docentes do curso de graduação em enfermagem. Estudo transversal do tipo exploratório, com 10 docentes selecionados de forma intencional, realizado na Universidade Federal do Rio Grande do Sul em 2006. Para coleta de dados foi utilizado um questionário, utilizando-se uma escala do tipo Likert para avaliar a adequação dos conteúdos, da apresentação visual e a utilização dos objetos educacionais. Os dados foram organizados e processados pela estatística descritiva. Os resultados apontaram que os docentes foram favoráveis à apresentação dos objetos educacionais, assim como à adequação dos conteúdos mostrados e a utilização dos mesmos com o conteúdo sobre oxigenoterapia. Não foi significativa a relação da opinião dos professores com a faixa etária ou com o seu conhecimento em informática, assim como o tempo de docência e os conteúdos ministrados.Se trata de investigación sobre la utilización de objetos educacionales digitales en las formas de hipertexto, juegos educativos y simulación sobre oxigenoterapia junto a docentes del curso de graduación en enfermería. Estudio transversal del tipo exploratorio con 10 docentes seleccionados de forma intencional, realizado en la Universidad Federal de Río Grande del Sur en 2.006. Para recolectar los datos fue utilizado un cuestionario, utilizándose la escala de tipo likert para evaluar la adecuación de los contenidos, de la presentación visual y la utilización de los objetos educacionales. Los datos fueron organizados y procesados por la estadística descriptiva. Los resultados apuntaron que los docentes fueron favorables a la presentación de los objetos educacionales así como a la adecuación de los contenidos mostrados y a la utilización de los mismos en el contenido sobre oxigenoterapia. No fue significativa la relación de la opinión de los profesores con el intervalo de edad, con su conocimiento en informática, así como con el tiempo de docencia y los contenidos ministrados.This study addresses the use of digital learning materials in the format of hypertext, educational games and simulations about oxygen therapy with professors of an Undergraduate Nursing Course. It is a cross-sectional exploratory study that was carried out at the Federal University of Rio Grande do Sul in 2006 with 10 intentionally selected professors. Data collection was performed by means of a questionnaire, using a Likert scale to assess the suitability of the content, visual presentation and use of learning materials. Descriptive statistics was used to organize and process the data. Results showed that the professors approved of the presentation of educational materials, they agreed with the suitability of the contents presented and with using the materials with the content regarding oxygen therapy. There was no significant relation between the professors' opinion and their age group, nor with their computer technology knowledge, their time in teaching and the addressed contents.

OBJECTIVE: Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity. METHODS: HTLV-I/II seropositive (n=135), indeterminate (n=167) and seronegative blood donors (n=116) were enrolled in an open prevalence prospective cohort study. A cross-sectional epidemiological study of positive, indeterminate and seronegative HTLV-I/II subjects was conducted to assess behavioral and environmental risk factors for seropositivity. HTLV-I/II serological status was confirmed using enzyme-linked immunosorbent assay (EIA) and Western blot (WB). RESULTS: The three groups were not homogeneous. HTLV-I/II seropositivity was associated to past blood transfusion and years of schooling, a marker of socioeconomic status, and use of non-intravenous illegal drugs. CONCLUSIONS: The study results reinforce the importance of continuous monitoring and improvement of blood donor selection process.

OBJECTIVE: Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity. METHODS: HTLV-I/II seropositive (n=135), indeterminate (n=167) and seronegative blood donors (n=116) were enrolled in an open prevalence prospective cohort study. A cross-sectional epidemiological study of positive, indeterminate and seronegative HTLV-I/II subjects was conducted to assess behavioral and environmental risk factors for seropositivity. HTLV-I/II serological status was confirmed using enzyme-linked immunosorbent assay (EIA) and Western blot (WB). RESULTS: The three groups were not homogeneous. HTLV-I/II seropositivity was associated to past blood transfusion and years of schooling, a marker of socioeconomic status, and use of non-intravenous illegal drugs. CONCLUSIONS: The study results reinforce the importance of continuous monitoring and improvement of blood donor selection process.OBJETIVO: Doadores de sangue no Brasil têm sido avaliados sorologicamente para o HTLV-I/II desde 1993. Assim, realizou-se estudo para estimar a prevalência dessa infecção em população de baixo risco e para melhor compreender os determinantes associados à soropositividade. MÉTODOS: Doadores de sangue soropositivos (n=135), soroindeterminados (n=167) e soronegativos (n=116) foram arrolados como participantes de uma coorte aberta e prevalente. Estudo transversal dos participantes desses três grupos avaliou fatores de risco comportamentais e ambientais para soropositividade. O status sorológico foi definido usando a reação de EIA (enzyme linked immunosorbent assay) e o teste Western blot (WB). RESULTADOS: Os três grupos apresentaram heterogeneidade entre si. A soropositividade mostrou-se associada à história pregressa de transfusão de sangue, em nível educacional, como um marcador de condição socioeconômica e ao uso de drogas ilegais não endovenosas. CONCLUSÕES: Os resultados confirmam a importância de um monitoramento e refinamento do processo de seleção dos doadores de sangue.

OBJECTIVE: Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity. METHODS: HTLV-I/II seropositive (n=135), indeterminate (n=167) and seronegative blood donors (n=116) were enrolled in an open prevalence prospective cohort study. A cross-sectional epidemiological study of positive, indeterminate and seronegative HTLV-I/II subjects was conducted to assess behavioral and environmental risk factors for seropositivity. HTLV-I/II serological status was confirmed using enzyme-linked immunosorbent assay (EIA) and Western blot (WB). RESULTS: The three groups were not homogeneous. HTLV-I/II seropositivity was associated to past blood transfusion and years of schooling, a marker of socioeconomic status, and use of non-intravenous illegal drugs. CONCLUSIONS: The study results reinforce the importance of continuous monitoring and improvement of blood donor selection process.

Vinte anos após o isolamento do vírus linfotrópico humano tipo I, muitos aspectos epidemiológicos, patogênicos e filogenéticos já estão esclarecidos. Sabe-se que em regiões endêmicas a prevalência aumenta com a idade e é maior no sexo feminino. Três patologias estão claramente relacionadas a ele: paraparesia espástica tropical / mielopatia associada ao HTLV, leucemia de células T do adulto e uveíte. Os modos de infecção, semelhantes aos dos outros retrovírus, são: transfusão de sangue, relações sexuais não protegidas, transplacentária e durante o aleitamento materno. A história natural das doenças relacionadas ao HTLV-I ainda não está bem estabelecida. O risco de portadores da infecção desenvolverem patologias depende de mais estudos de incidência para serem corretamente estimados. Menos se conhece sobre o HTLV-II. A despeito do alto grau de homologia entre os dois tipos, os vírus interagem de forma bem diversa com os infectados, não havendo uma associação clara de doença com o HTLV-II. Relatos recentes têm apontado sua participação em casos de mielopatia crônica semelhante à TSP/HAM. As implicações incertas do prognóstico para pessoas infectadas pelo vírus linfotrópico humano (HTLV-I/II) e suas formas de transmissão constituem um problema de saúde pública, principalmente em áreas consideradas endêmicas para esse vírus.Twenty years after the discovery of the human T-cell lymphotropic virus type I, quite great progress has been achieved and many epidemiological, clinical and phylogenetic features are well known. Seroprevalence increases with age in endemic regions and is higher in women. Three diseases are clearly associated to the virus: tropical spastic paraparesis/myelophathy, adult T cell leukemia and uveitis. The transmission is similar to other retroviruses: contact with contaminated blood, sexual intercourse, and mother to child transmission, mainly through breastfeeding. The natural history of diseases associated to the human lymphotropic virus has not been well established yet. Further studies are required to estimate correctly the risk of infected carriers developing diseases in their life-time. In the last 5 years, reports have pointed towards the association of a syndrome like tropical spastic paraparesis and the human lymphotropic virus type II. The uncertain prognosis for people infected with both types of viruses and the transmission through sexual contact, blood transfusion and from mother to child make this infection a public health problem, mainly in endemic regions.

O uso de objetos educacionais na área da Enfermagem é um recurso que apóia o ensino presencial e ao mesmo tempo respeita a autonomia do aluno. No intuito de desenvolver materiais motivadores que pudessem auxiliar o ensino na área da saúde da mulher foram desenvolvidos sete objetos educacionais digitais, sendo quatro hipertextos, um quizz e duas simulações. Os referenciais pedagógicos da aprendizagem, baseados em problemas e no construtivismo interacionista, foram empregados na concepção dos materiais. Os materiais digitais desenvolvidos agregam hipertexto, vídeo e animação por meio de softwares como o Macromedia Flash MX ® e CS3 ® , além de editores de imagens como o Fireworks ® , e de vídeos como Windows Movie Maker ® , por oferecer amplos recursos de animação e de interação. Os hipertextos, disponibilizados no ambiente virtual de aprendizagem Moodle ®, exploram os temas desde conhecimentos prévios que colaborem na sua compreensão até indicações de leituras complementares e exercícios de revisão. As simulações possibilitam a execução virtual dos procedimentos pelos alunos. Espera-se com esse relato compartilhar com a comunidade científica as experiências no que diz respeito à produção de objetos de aprendizagem digitais, bem como às conquistas e aos desafios que permeiam esse trabalho, incentivando a utilização de tecnologias alternativas no ensino.

OBJECTIVE: Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity. METHODS: HTLV-I/II seropositive (n=135), indeterminate (n=167) and seronegative blood donors (n=116) were enrolled in an open prevalence prospective cohort study. A cross-sectional epidemiological study of positive, indeterminate and seronegative HTLV-I/II subjects was conducted to assess behavioral and environmental risk factors for seropositivity. HTLV-I/II serological status was confirmed using enzyme-linked immunosorbent assay (EIA) and Western blot (WB). RESULTS: The three groups were not homogeneous. HTLV-I/II seropositivity was associated to past blood transfusion and years of schooling, a marker of socioeconomic status, and use of non-intravenous illegal drugs. CONCLUSIONS: The study results reinforce the importance of continuous monitoring and improvement of blood donor selection process.

Brazil may have the highest absolute number of HTLV-I/II seropositive individuals in the world. Screening potential blood donors for HTLV-I/II is mandatory in Brazil. The public blood center network accounts for about 80.0% of all blood collected. We conducted a cross-sectional study to assess the geographic distribution of HTLV-I/II serological screening prevalence rates in blood donors from 27 large urban areas in the various States of Brazil, from 1995 to 2000. Enzyme immunoassay (EIA) was used to test for HTLV-I/II. The mean prevalence rates ranged from 0.4/1,000 in Florianópolis, capital of Santa Catarina State, in the South, to 10.0/1,000 in São Luiz, Maranhão State, in the Northeast. EIA prevalence rates are lower in the South and higher in the North and Northeast. The reasons for such heterogeneity may be multiple and need further studies.

Brazil may have the highest absolute number of HTLV-I/II seropositive individuals in the world. Screening potential blood donors for HTLV-I/II is mandatory in Brazil. The public blood center network accounts for about 80.0% of all blood collected. We conducted a cross-sectional study to assess the geographic distribution of HTLV-I/II serological screening prevalence rates in blood donors from 27 large urban areas in the various States of Brazil, from 1995 to 2000. Enzyme immunoassay (EIA) was used to test for HTLV-I/II. The mean prevalence rates ranged from 0.4/1,000 in Florianópolis, capital of Santa Catarina State, in the South, to 10.0/1,000 in São Luiz, Maranhão State, in the Northeast. EIA prevalence rates are lower in the South and higher in the North and Northeast. The reasons for such heterogeneity may be multiple and need further studies.