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Resumo: O objetivo deste estudo foi conhecer a opinião dos profissionais participantes da implantação-piloto de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae no Sistema Único de Saúde (SUS). Determinou-se a taxa de detecção de C. trachomatis e/ou N. gonorrhoeae e os fatores associados à infecção. A estratégia contou com laboratórios pertencentes à rede de carga viral de HIV e hepatites virais. A testagem teve como público-alvo pessoas mais vulnerabilizadas às infecções sexualmente transmissíveis, com coleta de amostras de urina e/ou swabs vaginal, endocervical e/ou uretral masculino. Questionários foram enviados aos gestores estaduais e profissionais de laboratório sobre a implantação-piloto. De maneira geral, as avaliações foram positivas. Entre as fraquezas, citou-se dificuldades na mudança do processo de trabalho, carência de recursos humanos, pouca sensibilidade de profissionais da assistência e ausência de tubo primário de urina, único insumo não fornecido. Como fortaleza, destaca-se aquisição centralizada de testes, compartilhamento de equipamentos e armazenamento de amostras à temperatura ambiente. Das 16.177 pessoas testadas, 1.004 (6,21%) foram positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae e 239 (1,48%) para C. trachomatis/N. gonorrhoeae. A detecção de infecção ocorreu mais em pessoas jovens (≤ 24 vs. > 24 anos) (aOR = 2,65; IC95%: 2,38-2,96), do sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), pardas/pretas (aOR = 1,06; IC95%: 1,05-1,11), na Região Sudeste (aOR = 1,08; IC95%: 1,02-1,13) e em amostras de secreção uretral (aOR = 1,46; IC95%: 1,41-1,52). Os resultados deste estudo demonstraram a importância da disponibilização da testagem em âmbito nacional, os quais subsidiaram a implantação da rede definitiva para detecção de C. trachomatis/N. gonorrhoeae no SUS.

Abstract Preparedness to endure extreme situations such as natural disasters or military conflicts is not commonplace in healthcare training programs. Moreover, multidisciplinary teams in health services rarely (if ever) include experts in security. However, when emergency situations occur, prevailing healthcare demands do not cease to exist, and unexpected demands often surge due to the shortage of other services and supplies or as a consequence of the emergency condition itself. With services in 45 countries, AIDS Healthcare Foundation (AHF) has operated in several conflict zones, facing broad and challenging security demands. Since 2017 AHF has implemented the Global Department of Safety and Security (GDSS), a dedicated intelligence and safety program that had a key role in the security monitoring, preparedness, and defense responses, assisting staff members and clients during recent conflicts. In this manuscript, we describe the experience of AHF’s GDSS in three recent military conflicts in Ethiopia, Myanmar, and Ukraine, and provide insights into steps that can be taken to assure staff safety and support the mission of caring for patients throughout catastrophic events.

Introductionhe challenge was to provide comprehensive health resources to a remote and underserved population living in the Brazil-Colombia-Peru border, amid the most disruptive global crisis of the century.MethodsIn August 2021, Fundação Oswaldo Cruz Amazonia (FIOCRUZ Amazônia) and partner collaborators implemented an overarching provisional program for SARS-CoV-2 detection and lineages characterization, training of laboratory personnel and healthcare providers, donation of diagnostic supplies and personal protective equipment, and COVID-19 vaccination. The expedition was conducted at the Port of Tabatinga, a busy terminal with an intense flux of people arriving and departing in boats of all sizes, located in the Amazon River basin. Local government, non-profit organizations, private companies, and other stakeholders supported the intervention.ResultsThe expedition was accomplished in a convergence point, where migrant workers, traders, army personnel, people living in urban areas, and people from small villages living in riversides and indigenous territories are in close and frequent contact, with widespread cross-border movement. Using a boat as a provisional lab and storage facility, the intervention provided clinical and laboratory monitoring for 891 participants; vaccination for 536 individuals; personal protective equipment for 200 healthcare providers; diagnostic supplies for 1,000 COVID-19 rapid tests; training for 42 community health agents on personal protection, rapid test execution, and pulse oximeter management; and hands-on training for four lab technicians on molecular diagnosis.DiscussionOur experience demonstrates that multilateral initiatives can counterweigh the scarcity of health resources in underserved regions. Moreover, provisional programs can have a long-lasting effect if investments are also provided for local capacity building.

Ukraine stands out among European countries concerning HIV epidemiological data. Since February 2022, the military conflict with Russian forces has posed unprecedented challenges to HIV prevention and care. AIDS Healthcare Foundation (AHF), a global non-profit organisation with operations in Ukraine since 2009, implemented a preparedness plan to protect staff members and support local facilities in the continuity of care throughout the war. In this manuscript, we describe the strategies adopted by AHF to anticipate the risk of military conflict, steps to implement a preparedness plan, main challenges faced by local staff members and managers, adaptations needed as the conflict evolved, and indicators of HIV care 1 year before and 1 year after the onset of the conflict. Our experience shows that safeguarding the organisation’s human resources has been a prerequisite to sustain services throughout the war.

This study analyzed the association and contribution of anxiety, spirituality, coping and burden to quality of life (QOL) in informal caregivers of patients with cervical cancer. The sample included 119 informal caregivers of patients undergoing treatment for cervical cancer at a reference hospital in the state of Amazonas, Brazil. The caregivers answered instruments that assessed sociodemographic variables, burden, coping, anxiety, spirituality, and QOL. Female caregivers used more spirituality (reflection and positive interpretation) than male caregivers. The number of hours of care dedicated by caregivers was positively correlated with their burden. Burden had a positive association with anxiety and was negatively associated with the caregivers’ mental QOL. Spirituality (reflection and positive interpretation) moderated the relationship between anxiety and caregiver’s mental QOL. The results showed the importance of interprofessional teams in oncology to intervene with caregivers, focusing on psychological morbidity to prevent burden and the spirituality as a coping strategy.

Introdução: a epidemiologia das DST, nas regiões de fronteira do interior da Amazônia é pouco estudada. Objetivo: Com o objetivo de se aprofundar no seu conhecimento e de estimular os países vizinhos a desenvolver intervenções comuns, realizou-se trabalho com recursos próprios dos municípios envolvidos. Método: um estudo de corte transversal (prevalência) em amostra representtiva das mulheres gestantes da intrincada região do Alto Solimões, que compreende oito municípios da tríplice fronteira que conformam Brasil, Colômbia e Peru no noroeste da Amazônia Internacional. De um tamanho amostral mínimo necessário de 338 mulheres, alcançou-se incorporar ao finalizar o período do estudo (3 de agosto – 4 de novembro de 2003) um total de 550. A todas aplicou-se um questionário e colheram-se amostras para estudo de tricomoníase vaginal, sífilis e HIV. Resultado: a taxa de prevalência encontrada para o conjunto das três DST investigadas foi de 7,4%, mais elevado no lado peruano que foi superior a 10%. A prevalência para tricomoníase vaginal, sífilis e infecção pelo HIV foi, respectivamente, de 6,3%, 0,92% e 0,2%, com ligeiras diferenças entre as distintas comunidades dos países integrantes do estudo. Conclusão: considera-se muito provável que as DST curáveis representem um importante problema de saúde e que medidas de controle comuns devem ser implementadas a fim de evitar uma rápida propagação da epidemia de HIV-aids, que se encontra, neste momento, numa fase precoce do seu desenvolvimento. Este trabalho evidenciou que é possível a colaboração entre países vizinhos no controle das DST.

Vaccination is effective in preventing severe COVID-19 symptoms. Here the authors monitor patients with hematopoietic malignancy to find the third dose of the mRNA vaccine, BNT162b2, only boosts the humoral immunity in those showing responses to 2nd dose vaccination but can induce an independent T-cell response in a fraction of seronegative patients.

Plain Language Summary Understanding the characteristics of multiple infections is critical in the era of HPV multivalent vaccines for the prevention of cervical carcinomas. Therefore, in this cross-sectional study, we aimed to investigate the pattern of multiple HPV infections and associated factors in 5,268 sexually active unvaccinated women (16–25 years old) who access the Brazilian public health care system. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. A total of 33.00% (95% CI 31.07–34.92) had multiple infections (60.43% of the HPV-positive sample). The number of HPV types in a multiple infection ranged from 2 to 14 different types. The viral types more frequently identified were HPV 16 and 52. All HPV types were detected more frequently in association with other types than alone. The incidence of multiple infections was 1.29 times higher in single than in married or cohabitating participants. Women who had two or more partners in the last year also had higher rates of multiple infections than those who had fewer than two sexual partners. In conclusion, a high prevalence of multiple infections prior to the national HPV immunization program was observed, especially with the increase in less safe behavior factors.

The blue economy has emerged as an influential global concept. It is commonly understood to relate to the development of the ocean in a manner which also addresses concerns about ocean health in the face of increasing demands on ocean resources, marine pollution, and climate change. While the blue economy holds potential to act as an integrating policy framework for the sustainable development of the ocean, to date, there are limited examples of implementation in practice to test the usefulness of the concept. Based on a typology of “good governance” adapted from existing global typologies, we investigated the role of blue economy governance in enabling integration. We used a mixed methods approach to explore the experience of Seychelles, a blue economy early adopter, combining policy and institutional analysis, semistructured interviews with key actors and partners, and country fieldwork. Our analysis shows that from its inception, Seychelles' vision of blue economy was a transformative model of development based on the protection and sustainable use of ocean resources for the benefit of Seychellois, consistent with the SDGs. Thanks to early political leadership and international engagement, the adoption of the blue economy concept was successful in raising awareness of the ocean health and its connection to people and the economy, and in establishing the basis of a national blue economy “architecture,” which helped secure innovative finance for implementation. Transitioning to implementation, several governance challenges emerged, which included maintaining high-level political momentum, stakeholder engagement, and institutional coordination and capacity. While some governance barriers to effective integration may be unique to Seychelles, some are common to SIDS, and others are found in a range of governance settings. Seychelles international visibility has brought high expectations, not always commensurate with local aspirations, capabilities, and jurisdictional responsibilities. Bridging the gap between global expectations and local realities will require support for locally driven institutional reforms, which take account of issues of scale, culture, and capacity.

The proliferation of the blue economy in political discourse has gained traction in recent years, however, there remains no standardized definition. The triple bottom line goals of economic development, social equity, and environmental conservation are at the center of the blue economy vision. Yet the ambiguities surrounding the term have resulted in considerable variation in how the blue economy is implemented and what is prioritized. This paper takes a global snapshot of current approaches to national level blue economy governance. In doing so this paper provides the first global assessment of blue economy implementation approaches, through the development of a global blue economy database. Using the best available information from policy documents, media releases and other publicly available online information, we comparatively analyzed each country’s governance strategy to assess the level of blue economy development in coastal states around the world. Throughout this paper we outline the novel methodological approach we took in order to develop a tool for analyzing national level blue economy implementation on the global scale. This approach will allow for ongoing and continued analysis of blue economy operationalization as the concept continues to evolve.

Summary: Background: While air pollution is a major issue due to its harmful effects on human health, few studies focus on its impact on the immune system and vulnerability to viral infections. The lockdown declared following the COVID-19 pandemic represents a unique opportunity to study the large-scale impact of variations in air pollutants in real life. We hypothesized that variations in air pollutants modify Th1 response represented by interferon (IFN) γ production. Methods: We conducted a single center paired pilot cohort study of 58 participants, and a confirmation cohort of 320 participants in Nice (France), with for each cohort two samplings at six months intervals. We correlated the variations in the production of IFNγ after non-specific stimulation of participants’ immune cells with variations in key regulated pollutants: NO2, O3, PM2.5, and PM10 and climate variables. Using linear regression, we studied the effects of variations of each pollutant on the immune response. Findings: In the pilot cohort, IFNγ production significantly decreased by 25.7% post-lockdown compared to during lockdown, while NO2 increased significantly by 46.0%. After the adjustment for climate variations during the study period (sunshine and temperature), we observed a significant effect of NO2 variation on IFNγ production (P=0.03). In the confirmation cohort IFNγ decreased significantly by 47.8% and after adjustment for environmental factors and intrinsic characteristics we observed a significant effect of environmental factors: NO2, PM10, O3, climatic conditions (sunshine exposure, relative humidity) on variation in IFNγ production (P=0.005, P

The SARS-CoV-2 infection has spread rapidly around the world causing millions of deaths. Several treatments can reduce mortality and hospitalization. However, their efficacy depends on the choice of the molecule and the precise timing of its administration to ensure viral clearance and avoid a deleterious inflammatory response. Here, we investigated IFN-γ, assessed by a functional immunoassay, as a predictive biomarker for the risk of hospitalization at an early stage of infection or within one month prior to infection. Individuals with IFN-γ levels below 15 IU/mL were 6.57-times more likely to be hospitalized than those with higher values (p65 years, and no vaccination were independently associated with hospitalization. In addition, we found a significant inverse correlation between low IFN-γ response and high level of IL-6 in plasma (Spearman’s rho=-0.38, p=0.003). Early analysis of the IFN-γ response in a contact or recently infected subject with SARS-CoV-2 could predict hospitalization and thus help the clinician to choose the appropriate treatment avoiding severe forms of infection and hospitalization.

The ocean supports many livelihoods, but this is currently not sustainable with pressures on the climate and ecosystems. Here, in this perspective, the authors outline the barriers and solutions for financing a sustainable ocean economy.