No description available.

No / In this study, we assessed if the superimposition of incident sexually transmitted infections (STIs) on HIV phylogenetic analyses could reveal possible sexual behaviour misclassifications in our HIV-infected population. HIV-1 sequences collected between 1997 and 2014 from 1169 individuals attending a HIV clinic in Antwerp, Belgium were analysed to infer a partial HIV transmission network. Individual demographic, clinical and laboratory data collected during routine HIV follow-up were used to compare clustered and non-clustered individuals using logistic regression analyses. In total, 438 (37.5%) individuals were identified in 136 clusters, including 76 transmission pairs and 60 clusters consisting of three or more individuals. Individuals in a cluster were more likely to have a history of syphilis, Chlamydia and/or gonorrhoea (P < 0.05); however, when analyses were stratified by HIV transmission risk groups (heterosexual and men who have sex with men [MSM]), this association only remained significant for heterosexuals with syphilis (P = 0.001). Under closer scrutiny, this association was driven by six heterosexual men who were located in six almost exclusively MSM clusters. A parsimonious conclusion is that these six individuals were potentially misclassified as heterosexual. Improving the accuracy of sexual behaviour reporting could improve care.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

No description available.

Thesis (MTh)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The HIV and AIDS epidemic has affected the whole South African society, including the church. The dilemma of adequate reaction to the effects of HIV andAIDS on the pastoral responsibilities of the church is posing serious questions to the church in South Africa as it deals with the care of those affected by the epidemic. The HIV and AIDS epidemic is challenging the church to re-investigate its own traditional way of help and support and to realise that the Christian faith community needs to be part of the team-approach in the fight against HIV and AIDS.A holistic approach to healing will lead us to a new and different understanding of the diakonia of the church (nuwe en anderverstaan van diakonaat). This study will investigate how care can be administered in such a way that it becomes meaningful to both the infected, affected and those involved in administering care. It will require an ecclesiology that is informed, formulated and structured from the bottom-up rather than the traditional top-down approach. It will be what we can call a ―base-community‖ ecclesiology. This thesis will therefore, in the light of the challenges that the HIV and AIDSepidemic presents, put forward an ecclesiology formulated on the ground, a grassroots ecclesiology other than the official or traditional formal ecclesiology: an ecclesiology not only directed towards the members of the specific church (membership diakonia), but an ecclesiology focused on the broader community in which the church is located: a communal diakonia. This thesis argues that in light of the HIV and AIDSepidemic, this is a wake-up call for a new ecclesiology that will lead to the kind of diaconate described above. A bold new manner of ecclesiological being/structure is required: a new openness, frankness, boldness (parrhēsia) in dealing with HIV and AIDS. This parrhēsiawill come from the empowered members of the church as they become the caregivers in the community. Home-based care as it is practised at present runs the risk of a one-sided approach with its main focus on the physical wellbeing of the person. An ecclesiology of grassroots care and identity-formation is needed to fill this void. The research investigates how a theology of affirmation can be integrated into the system/practice of home-based care to become a meaningful part of the help or assistance given to the individual and his/her household. Furthermore, the study explores how pastoral care and counselling to the HIV positive person and his/her household can be enriched through the application of a paradigm of praxis to the least in society in home-based diakonia by applying a theology of affirmation, so as to affirm and restore dignity, give meaning to life and the process of death and ultimately provide answers to the quest for identity and affirmation through an ecclesiology of grassroots care. This study is also a call for a paradigm shift with regard to ecclesiology and diakonia in the South African church that may have a profound effect on the church in South Africa. This shift must happen in three areas: 1. The church must become actively involved in home-based care as part of its ministry and calling to the world amidst the HIV and AIDSepidemic. The church can no longer be a bystander or advisor, or at best a supporter of government and civil actions. Every congregation needs to become active within the community they serve through joint/combined and innovative ways with other churches in their areas in establishing an ecclesiology of grassroots care. 2. The diakonia of the church must change. Every member must realise their full potential of utilising their Holy Spirit gifts and fruit in order to serve/minister in the Kingdom of God. Diakonia can no longer be the responsibility of a few ordained or commissioned for the diaconate. The whole church must become active in service to their community and those living around the church. The church needs to break the chains of membership-diakonia and open the arms of Christian love to everyone in need, even those who hates us. 3. Perhaps the biggest challenge is the call to change our way of being church in South Africa: our ecclesiology. We must admit that we have come to love the church more than we love God and that we forgot that God so loved the world not the church! This realisation will make it possible to become open to the proposal of this thesis: that we become church from the bottom up, that we start to practice a grassroots ecclesiology. / AFRIKAANSE OPSOMMING: Die MIV en VIGS epidemie het ʼn invloed op die ganse Suid Afrikaanse samelewing, insluitend die kerk. Die dilema van voldoende reaksie op die gevolge van MIV en VIGS op die pastorale verantwoordelikheid van die kerk stel enstige vrae aan die kerk in haar versorging van diegene wat deur die epidemie geaffekteer word. Die MIV en VIGS epidemie daag die kerk uit tot ʼn herondersoek van tradisionele maniere van hulpverlening en ondersteuning asook tot ʼn gewaarwording dat die Christelike geloofsgemeenskap deel moet vorm van ʼn span verband in die stryd teen MIV en VIGS. ʼn Holistiese benadering tot genesing sal lei tot ʼn nuwe en ander verstaan van diakonaat. Hierdie studie is dus ʼn ondersoek na hoe sorg op so ʼn wyse bedien kan word dat dit betekenisvol vir beide die geinfekteerde, ge-affekteerde en diegene betrokke in die hulpverlening kan wees. So ʼn benadering vereis ʼn ekklesiologie wat belig, geformuleer en gestruktureer word vanaf grondvlak in plaas van die tradisionele bo-na-onder benadering. Ons kan so ʼn benadering ʼn basis-gemeenskap (―base-community‖) ekklesiologie noem. Hierdie tesis sal dus, in die lig van die uitdagings wat die MIV en VIGS epidemie stel, ʼn ekklesiologie geformuleer op grondvlak (―a grassroots ecclesiology‖) anders as die amptelike of tradisioneel formele ekklesiologie aanbied: ʼn ekklesiologie wat nie slegs gerig is op lidmate van ʼn spesifieke kerk (lidmaatskap-diakonia) nie, maar ʼn ekklesiologie gefokus op die breë gemeenskap waarin die gemeente haarself bevind: ʼn gemeenskaps-diakonia. Die argument in die tesis is dat die MIV en VIGS epidemie ʼn wekroep is tot ʼn nuwe ekklesiologie wat mag lei tot die soort diakonia hierbo beskryf. ʼn Brawe, nuwe manier van ekklesiologie word dus vereis: ʼn nuwe openheid, waaragtigheid, moedigheid (parrhēsia) in die wyse waarop ons met MIV en VIGS omgaan. Hierdie parrhēsia sal tot stand kom deur die bemagtigde lede van die kerk soos wat hulle versorgers van die gemeenskap word. Tuisversorging soos wat dit tans bedryf word, loop die risiko van ʼn eensydige benadering wat hoofsaaklik konsentreer/fokus op die fisieke gesondheid van die persoon. Ons benodig n voetsoolvlak-ekklesiologie wat gerig is op identiteits-formering en –bevestiging om hierdie gaping te vul. Die navorsing ondersoek dus hoe ʼn teologie van bevestiging (theology of affirmation) geintegreer kan word in die sisteem of bedryf van tuisversorging om sodoende ʼn beduidende deel van die hulpverlening of bystand aan die individu en sy/haar huishouding uit te maak. Verder ondersoek die navorsing hoe pastorale sorg en berading aan die MIV en VIGS positiewe persoon en sy/haar huishouding verryk kan word deur die toepassing van ʼn paradigma van praksis (diakonia) aan die minste in die samelewing deur tuisversorging en die toepassing van ʼn teologie van bevestiging, sodat menswaardigheid opnuut bevestig of/en herstel kan word; die lewe en die proses van sterwe en dood betekenisvol kan wees, en daar uiteindelik antwoorde gevind kan word in die soeke na identiteits-bevestiging deur ʼn diakonia vanuit n ekklesiologie op voetsoolvlak. Die navorsing is ook ʼn oproep tot ʼn paradigma-skuif met betrekking tot ekklesiologie en diakonia in die Suid Afrikaanse kerk wat verreikende gevolge vir die kerk in Suid Afrika inhou. Hierdie skuif moet in drie areas plaasvind: 1. Die kerk moet aktief betrokke word in tuisversorging as deel van haar bediening en roeping in die wêreld temidde van die MIV en VIGS epidemie. Die kerk kan nie langer voortgaan om toeskouer of raadgewer, of ten beste ʼn ondersteuner van staats- en siviele aksies te wees nie. Elke gemeente moet aktief binne haar gemeenskap dien deur gesamentlike en innoverende aksies ten opsigte van versorging en hulpverlening met ander kerke in die selfde area/gebied sodat ʼn grondvlak ekklesiologie tot stand gebring word. 2. Die diakonia van die kerk moet verander. Elke lid moet sy/haar potensiaal besef en die gawes en vrug van die Heilige Gees aanwend in diens van die Koninkryk. Diakonia mag nie langer die verantwoordelikheid van ʼn paar bevestigdes of gekommandeerdes vir diakonie wees nie. Die hele kerk moet diensbaar word in die gemeenskap en diegene wat rondom die kerk bly. Die kerk moet dus die kettings van lidmaat-diakonia breek en hul arms van Christelike liefde oopmaak vir elke persoon in nood, selfs diegene wat ons haat. 3. Miskien is die grootste uitdaging die oproep om die wyse waarop ons kerk bedryf in Suid Afrika te verander: ons ekklesiologie. Ons sal moet erken dat ons die kerk meer lief het as vir God en dat ons vergeet het dat God die wêreld liefhet en nie net die kerk nie! Hierdie gewaarwording sal dit moontlik maak om onsself ontvanklik te kan maak vir die voorstel van die tesis: dat ons kerk word van die grond-af-op in plaas van kerk van-bo-af—dat ons begin om ʼn voetsoolvlak ekklesiologie in werking te stel.

Thesis (DTh)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: This thesis deals with the concept of Ũtugi in relation to the HIV and AIDS pandemic and its contribution to the ecclesial praxis of the Anglican Church of Kenya. The thesis scrutinizes the HIV and AIDS context in Kenya, examines the origins, the nature, the characteristics and the definition of Ũtugi and its role in socio-economic, political, cultural, moral and religious life of the Agĩkũyũ community in Central Kenya and assesses the ecclesial praxis of the Anglican Church of Kenya. This concern is prompted by the need for the Anglican Church of Kenya to marshal Ũtugi (traditional resources) to complement Christian hospitality (church resources), to enhance human dignity of PLWHA and to fight the HIV and AIDS pandemic. By employing a hermeneutical tool as a praxis approach to pastoral care and counselling to interpret theological and assess the Agĩkũyũ cultural concepts and using a non-empirical research method (a qualitative research) based on conceptual analysis, the study explores critically the role of Ũtugi within the context of HIV and AIDS and its appropriateness as a tool for pastoral care and counselling in the Anglican Church of Kenya. The study poses the following research questions: In which way can the Agĩkũyũ concept of Ũtugi be used to create a healing space? How can Ũtugi be used to reframe the prevailing ecclesiological paradigms applied by the Anglican Church of Kenya? How can Ũtugi as a cultural concept help the Anglican Church of Kenya to become relevant and contextual in her endeavour to respond to the challenges posed by the HIV and AIDS pandemic in the twenty-first century? The thesis unveils that the principles of Ũtugi can complement Christian hospitality to network and help the church to carry the burden of PLWHA, thus, enhancing their human dignity, sharing their joy and comfort, and journeying with them in their pain, sorrow and healing. It was also found that Ũtugi as a contextual model which is culturally rooted, is relevant to the Agĩkũyũ people and that it can help in transforming the existing ecclesial praxis of the Anglican Church of Kenya. Drawing from Daniël Louw's existential model for spiritual healing, the study assesses the appropriateness of Ũtugi as a model for pastoral care and counselling to PLWHA. It is revealed that Ũtugi is not only a paradigm that can augment their physical, social, psychological, economic, moral and spiritual aspects but that it has the capacity to deal with the existential threat of anxiety, guilt and shame, disillusionment and anger, despair and doubt, helplessness and vulnerability. Thus it can enable them to shift from their existential threats to a position of love, care, support, compassion, accommodativeness, liberation and hope. / AFRIKAANSE OPSOMMING: Hierdie navorsing gaan oor die kultuur-bepaalde konsep Ũtugi met betrekking tot die MIV en VIGS - pandemie en oor die bydrae van hierdie konsep tot die kerklike gebruike en ekklesiologiese-self-verstaan van die Anglikaanse Kerk in Kenia. In die navorsing word indringend gekyk na die MIV en VIGS konteks in Kenia, en die oorsprong, aard, eienskappe en definisie van Ũtugi en sy rol in die sosio-ekonomiese, politieke, kulturele, morele en godsdienstige lewe van die Agĩkũyũ-gemeenskap in Sentraal-Kenia gekyk. Die navorsing evalueer voorts die gemeentelike bediening van die Anglikaanse Kerk in Kenia. Hierdie ondersoek is noodsaaklik gemaak deur die behoefte van die Anglikaanse Kerk in Kenia om Ũtugi (tradisionele hulpbronne) te gebruik in aanvulling tot die Christelike verstaan van gasvryheid (kerklike hulpbronne) om die menswaardigheid van mense wat met MIV en VIGS saamleef, te verhoog en die MIV- en VIGS pandemie te beveg. Die navorsing sluit metodologies aan by die hermeneutiek. Die volg 'n praktykbenadering tot pastorale versorging en berading. Dit wil teologiese konsepte en die Agĩkũyũ se kulturele konsepte interpreteer, en deur middel van kwalitatiewe, kritiese analises vir die pastorale bediening aan mense wat positief met MIV getoets is, help sorg. In die lig van konseptuele analise, word daar in hierdie hierdie studie krities gekyk na die rol van Ũtugi binne die konteks van MIV en VIGS en na die gepastheid daarvan as instrument vir pastorale versorging en berading in die Anglikaanse Kerk van Kenia. In hierdie studie word die fundamentele vraag gestel: Hoe kan die Agĩkũyũ-konsep Ũtugi gebruik word om ruimte vir heling te skep en die heersende ekklesiologiese paradigmas in die Anglikaanse Kerk in Kenia omskep word sodat dit relevant en kontekstueel kan wees in die strewe om te reageer op die uitdagings van die MIV en VIGS pandemie in die 21ste eeu? Die navorsing toon aan dat die beginsels van Ũtugi Christelike gasvryheid kan aanvul om netwerke te vorm en die kerk te help om die las van mense wat met MIV en VIGS saamleef, te help dra. Só kan hulle menswaardigheid verhoog word, in hulle vreugde en gerief gedeel word, en saam met hulle deur hulle pyn, hartseer en soeke na heling pastoraal gereis word. Daar is ook bevind dat Ũtugi as 'n kontekstuele model wat kultureel gegrond is, relevant is vir die Agĩkũyũ-mense. Dit kan inderdaad bydra en kan help om die bestaande kerklike gebruike van die Anglikaanse Kerk in Kenia te verander. Deur gebruik te maak van Daniël Louw se eksistensiële model vir christelik-spirituele geestelike heling, word die gepastheid van Ũtugi as 'n model vir pastorale versorging en berading aan mense wat positief met MIV en VIGS saamleef, evalueer. Daar is bevind dat Ũtugi nie net 'n paradigma is wat hulle liggaamlike, sosiale, sielkundige, ekonomiese, morele en spirituele lewe kan versterk nie, maar dat dit ook die vermoë het om die eksistensiële bedreiging van angstigheid, skuld en skaamte, ontnugtering en woede, wanhoop en twyfel, hulpeloosheid en kwesbaarheid, pastoraal te hanteer. Dit kan 'n verskuiwing vanaf eksistensiële bedreigings na 'n posisie van liefde, sorg, medelye ondersteuning, tegemoetkomendheid, vryheid en hoop meebring.

Introdução: A reativação da doença de Chagas crônica, descrita em aproximadamente 20% dos pacientes co-infectados por HIV/Trypanosoma cruzi (T. cruzi), apresenta-se geralmente como doença grave, com meningoencefalite e miocardite. O diagnóstico baseia-se em métodos diretos, no sangue ou outro material biológico, podendo ser estabelecido em exame histopatológico, sendo associado à elevada parasitemia ou a multiplicação de T. cruzi nos tecidos comprometidos. A letalidade é elevada principalmente nos pacientes que não receberam pelo menos 30 dias de terapêutica. Dessa forma métodos mais sensíveis e mais rápidos são necessários visando a detecção precoce do parasito. A proposta deste estudo é avaliar o papel da PCR em tempo real na determinação do nível de parasitemia em pacientes infectados por HIV com e sem reativação da doença de Chagas. Métodos: Noventa e uma amostras coletadas de pacientes com doença de Chagas 57 com doença de Chagas crônica (CR), 34 com co-infecção HIV-T cruzi, destes, 29 sem reativação (CO) e 5 com reativação da doença de Chagas foram analisadas por provas qualitativas: PCR para seqüência de DNA do cientoplasto (kDNA), hemocultura e xenodiagnóstico, e provas quantitativas: PCR em tempo real (qPCRTR), PCR competitiva (PCR-C), hemocultura considerando % de tubos positivos e xenodiagnóstico com % de ninfas positivas. As variáveis quantitativas moleculares e parasitológicas foram avaliadas pelo coeficiente de correlação de Spearman, bem como as variáveis moleculares, número de T. cruzi/mL e carga viral HIV, número de T. cruzi/mL e nível de células CD4 +/mm3, CD8 +/mm3 e razão CD4 +/CD8 +. Resultados: Foram observadas diferenças significantes entre pacientes co-infectados com e sem reativação. A maior parasitemia, detectada por qRT-PCR, foi em pacientes com reativação da doença de Chagas crônica (média 102235,3; mediana 51333,3 e número de T. cruzi/mL de sangue entre 939 e 352000), seguido pelos pacientes com co-infecção (média 255; mediana 54,3 e parasitemia entre 0 e 2405 T. cruzi/mL de sangue) e finalmente pelo grupo de pacientes com doença crônica (média 14,3; mediana 1; e parasitemia entre 0 e 146 T. cruzi/mL de sangue). O coeficiente de correlação de Spearman mostrou correlação entre xenodiagnostico x hemocultura, e entre xenodiagnostico x PCR competitiva ou PCR em tempo real. Houve maior correlação entre PCR competitiva x PCR em tempo real, e número de parasitos e as variáveis: carga viral do HIV, número de células T CD4 + ou razão CD4 +/CD8 +. Conclusões: RT-PCR foi capaz de distinguir entre pacientes co-infectados HIV/T. cruzi com e sem reativação sendo proposta sua utilização como marcador para terapia preemptiva na reativação da doença de Chagas em pacientes com HIV/T. cruzi. Adicionalmente, o nível de parasitemia foi correlacionado positivamente com carga viral e negativamente com nível de células T CD4+/mm3 de sangue e razão CD4+/CD8+ / Background. The reactivation of chronic Chagas disease, described in approximately 20% of HIV/Trypanosoma cruzi infected patients, is commonly expressed by severe and lethal meningoencephalitis and myocarditis. The gold standard for the reactivation diagnosis is based on direct methods, the parasite is observed by direct microscopic examination of fresh buffy coat or through the Quantitative Buffy Coat, wich can be applied to samples of cerebrospinal fluid or blood. The diagnosis of reactivation can be achieved by histological study, showing large numbers of parasites in tissue and acute inflamatory infiltrate. However diagnosis of reactivation is often difficult, it has been established in patients with high parasitemia, usually with severe clinical symptoms, this patients death before or during therapy. The purpose of this study was to evaluate the role of real time PCR for evaluation of the level of parasitemia on patients with HIV and T.cruzi infection with and without reactivation of Chagas disease. Methods. Ninety-one samples from patients with Chagas disease, 57 with chronic Chagas\' disease (CR), 34 with infection HIV/T. cruzi, 29 without reactivation (CO) and 5 with reactivation of Chagas\' disease, were analyzed by qualitative methods: Polymerase chain reaction with kDNA S35/S36 sequence, xenodiagnosis and blood culture, and quantitative methods: Real-time PCR, competitive PCR, blood culture considering % of positive tubes, xenodiagnosis with % of positive nymphs. Results: There were significant differences between groups, the highest parasitemia was observed in patients with reactivation of chronic Chagas\' disease (mean 102,235.3; median 51,333.3 and number of T. cruzi/ml of blood between 939 and 352,000), followed by patients with co-infection (mean 255, median 54.3 and parasitemia 0 to 2405 T. cruzi/mL of blood) and finally by the group of patients with chronic disease (mean 14.3, median 1 and parasitemia 0 to 146 T. cruzi/ml of blood). Spearman correlation coefficient showed correlation between xenodiagnosis x blood culture and between xenodiagnosis x competitive PCR or real time PCR. Stronger Spearman correlation index was found between cPCR x RTPCR, number of parasites and the variables: HIV viral load or CD4 + number or CD4 +/CD8 + ratio Conclusions. RT-PCR is able to distinguish between HIV/T. cruzi infected patients with or without reactivation and is proposed as a marker for preemptive therapy in Chagas disease reactivation. Additionally, the level of parasitemia was correlated positively with viral HIV load and negatively with CD4+/mm3 of the blood and CD4+/CD8+ ratio

Em decorrência dos avanços científicos e tecnológicos da última década, a aids passou a ser considerada como doença crônica. O grande benefício gerado pelo uso da terapia anti-retroviral é o prolongamento da sobrevida e a redução da mortalidade; entretanto, o impacto psicossocial da doença e dos efeitos adversos associados a esta terapia pode provocar alterações na qualidade de vida. Objetivos: avaliar a qualidade de vida de portadores do HIV/aids e suas relações com os fatores demográficos, clínicos e psicossociais, utilizando o WHOQOL HIV bref e o HATQoL. Metodologia: Trata-se de um estudo analítico correlacional, de corte transversal, realizado em dois serviços de atendimento especializado em aids, no município de Ribeirão Preto-SP. Cinco instrumentos foram utilizados para a coleta de dados: Instrumento para caracterização sociodemográfica, Inventário de Sintomas de Depressão de Beck, Escala de auto-estima de Rosemberg, WHOQOL HIV bref e o HATQoL. Resultados: Dos 228 portadores do HIV/aids, 122 (53,5%) eram homens e 106 (46,5%), mulheres, com idade média de 39 anos. Com relação aos domínios do WHOQOL HIV bref, não se observaram importantes diferenças, nas médias deste instrumento, que variaram de 58,0 a 69,2. O domínio Espiritualidade apresentou os maiores escores de qualidade de vida, seguido pelos domínios Físico, Psicológico, Relações Sociais, Nível de Independência e Meio Ambiente. Quanto às dimensões da escala HATQoL, os valores médios encontrados variaram de 31,6 a 95,7. Os domínios que apresentaram maiores escores foram: Confiança no Médico, Questões Relativas à Medicação, Atividade Geral e Satisfação com a Vida. Dentre os domínios mais comprometidos do HATQoL, destacam-se: Preocupação com o Sigilo, seguido de Preocupação Financeira, Preocupação com a Saúde. Diferentes variáveis influenciaram na qualidade de vida. Quanto às sociodemográficas, destaca-se que as mulheres apresentaram pior qualidade de vida, quando comparadas com os homens em vários domínios. Os indivíduos analfabetos e com menos de oito anos de escolaridade, aqueles sem renda e sem vínculo empregatício apresentaram qualidade de vida considerada prejudicada em diversos domínios. Sobre as variáveis clínicas, identificou-se que os portadores de aids, com baixa contagem de CD4 e alta carga viral, apresentaram pior qualidade de vida. Com referência às variáveis psicossociais, identificaram-se menores escores entre os portadores que não têm parceria afetivo-sexual e que apresentam sintomas depressivos. A depressão e o gênero constituíram-se nos preditores mais associados com pior qualidade de vida, e, ao contrário, a auto-estima associou-se com melhor qualidade de vida em vários domínios. Conclusão: O presente estudo constatou diversas variáveis que influenciam na qualidade de vida de pessoas que vivem com o HIV/aids. Este estudo oferece importante contribuição para a equipe de saúde, pois fornece subsídios para compreender melhor os fatores que podem influenciar a qualidade de vida destes indivíduos. Aponta, ainda, os domínios mais prejudicados, o que contribui para que sejam implementadas intervenções específicas pelos profissionais de saúde, bem como pelos gestores de políticas públicas. / As a result of last decades scientific and technological advances, AIDS is now regarded as a chronic disease. The great benefit of the antiretroviral therapy is the prolongation of survival and reduction of mortality; nevertheless, the psychosocial impact of the disease and the adverse effects associated to this therapy can cause changes in the quality of life. Objective: to evaluate the quality of life of HIV/AIDS carriers and their relations to demographic, clinical and psychosocial factors, using the WHOQOL HIV bref and the HATQoL. Methodology: Correlational analytical cross-sectional study, carried out at two specialized care services in Ribeirão Preto-SP. Five instruments were used for the data collection: Instrument for sociodemographic characterization, Beck Depression Inventory, Rosemberg Self- Esteem Scale, WHOQOL HIV bref and the HATQoL. Results: Of the 228 HIV/AIDS carriers, 122 (53,5%) were men and 106 (46,5%) women, with average age of 39 years. Regarding the WHOQOL HIV bref domains, it was not observed important differences on the means of this instrument, which vary from 58,0 to 69,2. The domain Spirituality had the highest quality of life score, followed by the domains Physical, Psychological, Social relations, Independence level and Environment. Regarding the HATQoL scale dimensions, the mean values vary from 31,6 to 95,7. The domains which presented the highest scores were: Trust in Doctor, Questions Related to Medication, General Activity and Satisfaction with Life. The domains highlighted at the HATQoL were: Concern about secrecy, Financial worry and Concern with health. Different variables influenced on the quality of life. Regarding the sociodemographic variables, it is highlighted that in many domains women present worse quality of life when compared to men. Analphabets, people who have studied for less than 8 years, the ones without income and not legally employed presented quality of life impaired in many domains. About the clinical variables, it was identified that AIDS carriers with low CD4 count and high viral load presented worse quality of life. Regarding the psychosocial variables, it was identified lower scores among the carriers who do not have affective-sexual partner and who present depressive symptoms. Depression and gender were the predictors most associated to worse quality of life, on the contrary, in many domains self-esteem was associated to better quality of life. Conclusion: The present study evidenced many variables which influence on quality of life of people living with HIV/AIDS. This study provides important contribution for the health team, since it offers support for better comprehension of the factors which can influence the quality of life of these individuals. The study also shows the most impaired domains, what contributes for the implementation of specific interventions by the health personnel and the public policies managers.

A migração pendular consiste na mobilidade diária que pessoas fazem entre duas diferentes cidades, tradicionalmente, por motivos de trabalho e estudo, porém também ocorre para a busca por serviços de saúde. Esse movimento acontece em todo o mundo dentro dos territórios nacionais de cada país, como o movimento entre cidades pequenas com poucos recursos humanos e tecnológicos em saúde, para cidades maiores próximas que contenham esses recursos. Essa mobilidade é chamada de migração pendular regional. No entanto, ela assume diversas particularidades quando esse movimento leva as pessoas a cruzarem periodicamente uma fronteira internacional para essa finalidade, o que configura a migração pendular internacional. Esse movimento transfronteiriço pode afetar a adesão dos pacientes aos tratamentos de doenças crônicas, como é o caso da infecção pelo HIV, o que pode modificar o seu prognóstico. O objetivo desta dissertação é comparar o prognóstico de pacientes HIV+ moradores de Foz do Iguaçu que fazem acompanhamento no Serviço de Assistência Especializada (SAE), com pacientes que fazem migração pendular regional e internacional e fazem acompanhamento no mesmo serviço. / Pendulum migration is a daily mobility between two different cities that is made, traditionally, to work or study. However, it also can happen to look for healthcare. This kind of human mobility is common around the world inside the national territory of each country, like the movement between a small city with a lack of health human and technological resources and the major city next to it that contains these resources. It is called regional pendulum migration. But it has many particularities when this movement is responsible for people crossing periodically an international border for this end, which represents the international pendulum migration. This crossborder healthcare may influence the adherence to the treatment of chronic diseases like HIV infection and, for this reason, modify the prognosis of these patients. The aim of this dissertation is to compare the prognosis of HIV+ patients living in the city of Iguazu Falls that makes the follow-up in the Specialized Assistance Service (SAS) of this city with patients who makes regional and international pendulum migration for healthcare in the same health facility.

Este estudo avaliou a prevalência de colonização e infecção bucal por Candida, bem como a de cárie não-tratada em crianças com aids atendidas no ambulatório de Infectologia, Instituto da Criança do HC-FMUSP. Foram examinados 117 pacientes em idade de 3-15 anos (média 9,4 anos) para o estudo da prevalência de Candida, e 125 na mesma faixa de idade para a avaliação da necessidade de tratamento de restauração dentária. Condições clínicas gerais, medicação em uso e dados laboratoriais foram obtidos do prontuário médico referente a cada paciente. O exame bucal seguiu as normas da OMS (1996); questionário sócio-demográfico foi respondido pelos cuidadores. A prevalência de cárie foi avaliada em relação às condições socioeconômicas, comportamentais e clínicas dos pacientes. Para o estudo de associação entre as variáveis foi utilizada a análise de regressão de Poisson com ajuste por idade. Os resultados indicaram 62% de prevalência de colonização bucal por Candida (54%-72%, intervalo de confiança 95%). A manifestação clínica da candidose bucal foi baixa entre os pacientes avaliados (7%), considerando que a maioria das crianças apresentava baixa contagem CD4, alta carga viral e colonização por Candida. Foi identificada associação entre cultura positiva com uso freqüente de antibióticos (razão de prevalência RP = 1,44), sulfa (RP = 1,23), alteração de mucosa bucal (RP = 1,55) e prevalência de cárie nãotratada (RP = 1,93); associação negativa ocorreu quando em uso de medicamentos anti-retrovirais (RP = 0,65). Candida albicans foi a espécie mais isolada (80%); espécies não-albicans corresponderam a 18%. Nenhum caso de colonização por C. dubliniensis foi identificado através de testes fenotípicos. A freqüência de cárie nãotratada em ao menos um dente decíduo ou permanente foi de 58% dentre os pacientes, porcentagem mais elevada que a verificada entre crianças sem aids de mesma idade no Estado de São Paulo. Cuidador familiar com ensino secundário completo representou fator de redução da prevalência de cárie, (RP = 0,51), enquanto aglomeração domiciliar (RP = 1,53) e freqüência diária de ingestão de açúcar (RP = 1,44) associaram com prevalência mais elevada. Carga viral maior que 100.000 cóp/ml (RP = 1,41) e manifestação de sintomas severos da aids (RP = 1,39) também associaram com pior condição dentária. O presente estudo mostra baixa prevalência de lesão bucal, indicativo de que as terapias anti-retrovirais para a doença aids produz resultados clínicos bem satisfatórios, e que crianças com aids têm maior necessidade de tratamento dentário do que crianças HIV negativas. A elevada prevalência de colonização por Candida e de cárie não-tratada em crianças com aids reforça a necessidade e importância da integração do dentista na equipe multiprofissional que atende a esses pacientes. / This study assessed the prevalence of oral colonization and infection caused by Candida, as well of untreated caries in pediatric patients with aids attended at the Clinic for Infection Diseases, Child Institute, Clinic Hospital of the University of São Paulo, Brazil. The prevalence of colonization and infection by Candida was evaluated among hundred seventeen, 3 to 15-years-old (mean age of 9.4 years) children, and the requirement for dental treatment among 125 children of the same age group. General clinical condition, medications in use and laboratories findings were obtained from the medical chart of each patient. Dental examination followed WHO guidelines for oral health surveys; data on demographic conditions were extracted from questionnaires filled in by familial caregivers. Prevalence of untreated caries were evaluated in relation to socioeconomic, behavioral and clinical conditions. Poisson regression analysis adjusted by age assessed covariates for the prevalence of untreated dental caries and Candida colonization. Results indicated 62% of prevalence of oral colonization by Candida (54%-72%, confidence interval 95%). Clinical manifestation of oral candidosis was low (7%) despite of low CD4, and both high viral load and Candida colonization detected among most children. Positive result for Candida colonization associates with frequent use of antibiotics (prevalence ratio PR = 1.44), sulfa drugs (PR = 1.23), alteration on the oral mucosa (PR = 1.55), and untreated dental caries (PR = 1.93); negative association occurred with the use of antiretroviral therapies (PR = 0.65). Candida albicans was the most frequent species (80%); non-albicans species 18%. Phenotipic testes did not allowed to detect any colonization by C. dubliniensis. Prevalence of untreated dental caries either on one deciduous or one permanent tooth affected 58% of the patients, a rate higher than that registered among the same group age, non-HIV-children in the state of São Paulo, Brazil. Being attended by high school graduated caregivers represented a reduction factor of prevalence of caries (PR = 0.51), while household crowding (PR = 1.53) and daily sugar intake (PR = 1.44) was associated with a higher prevalence of caries. Viral load higher than 100,000 copies/ml (PR = 1.41) and severe symptom of aids manifestations (PR = 1.39) also associated with poorer dental status. The present study revealed low prevalence of oral lesions, an indicative that antiretroviral therapies results satisfactory for aids treatment and HIV+/aids-children, and that aids-affected children have higher prevalence of untreated caries than in non-affected children in the same group age. The high prevalence of both Candida colonization and untreated caries in HIV+/aids-children reinforces the importance of a health-care professional to the interdisciplinary team that assists those patients.