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Syphilis prevention in the United States continues to be an enduring public health challenge. Although syphilis is a curable infection, if left untreated it can result in severe, debilitating and potentially life-threatening complications. Routine screening for syphilis in high-risk populations remains an important prevention and control measure. Research consistently demonstrates the relative advantage of greater testing frequency in at-risk populations such as men who have sex with men (MSM) using both cost-effectiveness analyses and mathematical modeling. Despite this, frequency of screening for syphilis among MSM remains sub-optimal, and failure to screen MSM at recommended intervals may be attributable to clinicians’ perceptions related to syphilis screening in this population. The Theory of Planned Behavior (TPB) may help to elucidate the attitudes, social and professional norms, and perceived behavioral control that providers experience towards syphilis screening. The extent to which these cognitive-behavioral factors facilitate clinicians’ intentions to screening MSM for syphilis has not been previously evaluated. Using the constructs of the TPB, this study developed and validated a new survey tool with a national sample of physicians (n=123) who treat MSM and recruited through a proprietary email list and through passive recruitment on social media and provider Listservs. Results of the survey revealed variability in providers’ attitudes, social norms and perceived behavioral control, and these differed in association with self-reported syphilis screening intention and behavior. The survey was also used to validate a measurement model based on the TPB. This measurement model consisted of four factors: attitudes, social norms, perceived behavioral control and intention. This model was then used in structural equation modeling analysis to simultaneously test the strength of associations between these factors and a self-reported behavioral outcome. Results indicate that attitudes have a significant indirect effect on self-reported screening behavior mediated though intention. Perceived behavioral control was also strongly associated with self-reported behavior, as was intention to screen. By incorporating the TPB into a model of physician behavior, this study provides a framework for interventions targeted at increasing syphilis testing frequency in clinical practice. / Public Health

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Pre-exposure prophylaxis (PrEP) access is increasing in Latin America. We explored PrEP use among Spanish-speaking, Hornet geosocial networking application users from Latin American countries with limited PrEP data via an online survey completed between December 2018 and February 2019. A total of 718 Hornet users from 10 countries were included, of whom 72.1% reported PrEP awareness. Few (5.6%) were currently taking PrEP, though 32.1% intended to take PrEP in the subsequent 6 months. PrEP awareness was lower in 18–25 year olds compared to 26+ (62.4% vs. 75.6%, aOR 0.67, [95% CI 0.46–0.97]), and higher among those living in larger versus smaller cities (74.4% vs. 58.8%, aOR 1.96, [95% CI 1.25–3.07]) or countries with at least partial versus no PrEP policy adoption (79.1% vs. 60.8%, aOR 2.20, [95% CI 1.56–3.12]). Intention to use PrEP was higher among PrEP-eligible respondents (51.8% vs. 29.6%, aOR 2.26, [95% CI 1.26–4.07]) and those recently tested for a sexually transmitted infection (35.4% vs. 25.5%, aOR 1.58, [95% CI 1.01–2.48]). Efforts to expand PrEP use in Latin America should focus on national PrEP policy adoption, and research should explore barriers to awareness and use among young men who have sex with men. / National Institute of Mental Health / Revisión por pares

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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.

O escopo desse trabalho é identificar, na obra da filósofa Hannah Arendt, os conceitos a partir dos quais o pensamento político de nossa autora se estrutura e se relaciona com um possível pensamento arendtiano sobre o Direito. No percurso do texto, iniciaremos com contexto da compreensão do totalitarismo, passaremos a análise dos elementos desse fenômeno que conduziram a crise do Estado-Nação e do fracasso dos Direitos Humanos, estabelecidos a partir das Revoluções Americana e Francesa no século XVIII. Em seguida, faremos uma restruturação dos conceitos filosóficos apropriados por Arendt a partir do mundo pré-filosófico dos poetas e historiadores e da tríade de filósofos gregos Sócrates, Platão e Aristóteles para a construção de seu pensamento político em contraposição ao pensamento político da tradição que sofreu uma ruptura e não conseguiu fornecer um arcabouço teórico para o fenômeno sem precedentes - o totalitarismo. Nossa autora além de realizar sua crítica, também estabelece uma proposta de Direitos Humanos a partir do conceito direitos a ter direitos estritamente relacionada aos conceitos de sua teoria política e seu novo modo de pensar os assuntos humanos, como por exemplo, a pluralidade. No entanto, nossa autora não se restringe apenas a uma nova fundamentação dos Direitos Humanos, a partir crítica aos Tribunais de Nuremberg e Jerusalém, também se direciona a uma discussão de mecanismos internacionais que possam realmente fornecer eficácia a tais direitos Tribunais ad hoc ou de Exceção, Cortes Internacionais, princípios de jurisdição territorial, personalidade passiva e universal, tipificação dos crimes de genocídio e contra a humanidade. / The goal of this work is to identify, in the work of the philosopher Hannah Arendt, the concepts from which her political thinking is structured and related to a possible Arendtian thinking about the Law. In the text, we will begin a restructuring of Arendt\'s philosophical concepts from the pre-philosophical world of poets and historians and the triad of Greek philosophers - Socrates, Plato and Aristotle - to construct his political thought in opposition to political thought of the tradition that suffered a rupture and failed to provide a theoretical framework for the unprecedented phenomenon - totalitarianism. In the context of the understanding of totalitarianism, we will analyze the elements of this phenomenon that led us to the crisis of the Nation State and the failure of Human Rights, established from the American and French Revolutions in the eighteenth century. Our author, besides performing her critique, also establishes a proposal for Human Rights from the concept of \"rights to have rights\" strictly related to the concepts of her political theory and her new way of thinking about human affairs, such as plurality. However, our author is not restricted only to a new grounding of human rights, from criticism to the Nuremberg and Jerusalem Courts, it also addresses a discussion of international mechanisms that can really provide effectiveness to such rights - ad hoc or Exception, International Courts, principles of jurisdiction territorial, passive and universal personality, typification of crimes of genocide and against humanity.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-11-23T18:51:47Z No. of bitstreams: 1 Ricardo Pietrowski Ferreira.pdf_.pdf: 856058 bytes, checksum: fdb920f07ee487b8a59983386cdb174d (MD5) / Made available in DSpace on 2015-11-23T18:51:47Z (GMT). No. of bitstreams: 1 Ricardo Pietrowski Ferreira.pdf_.pdf: 856058 bytes, checksum: fdb920f07ee487b8a59983386cdb174d (MD5) Previous issue date: 2015-08-25 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / PROSUP - Programa de Suporte à Pós-Gradução de Instituições de Ensino Particulares / O presente trabalho se propõe a fazer uma análise crítica de como a fundamentação dos direitos humanos se esvaiu perante o evento do totalitarismo e de como o pensamento de Hannah Arendt pode contribuir para se pensar a (re)construção de tais direitos. Pretende-se compreender como se deu o processo de enfraquecimento do pensamento sobre direitos humanos, diagnosticado por Hannah Arendt, e como suas reflexões se fazem indispensáveis para uma construção dos direitos humanos pautados em ação política, liberdade, pluralidade e igualdade, dentro de um espaço público que possa garantir a dignidade humana. Este trabalho contemplará diretamente o pensamento da filósofa alemã; contudo, serão consideradas algumas leituras do comentador da filosofia arendtiana Celso Lafer, cujas obras convidam a compreender melhor o tema dos direitos humanos. Para melhor esclarecer tal problemática, o presente trabalho se organiza em três momentos: o primeiro objetiva demonstrar como os direitos humanos justificados e baseados nas declarações de 1776 e 1789, que tornaram o homem como fonte de toda lei e por isso inalienável, mostraram-se insuficientes frente ao fenômeno totalitário (fenômeno de ruptura), principalmente no que se refere à questão dos apátridas. Já o segundo momento está diretamente vinculado à explanação dos principais conceitos de Arendt, tais como: espaço público e privado, ação e discurso, relações humanas e responsabilidade, e, por fim, o sentido da política e da liberdade. Finalmente, o terceiro momento dessa investigação volta-se à concepção de Arendt sobre a ideia de cidadania, a qual conceitua como “direito a ter direitos”. Quando desenvolvida, a cidadania torna possível a existência da liberdade que, segundo ela, pode ser exercida através do sistema de conselhos. Para concluir os apontamentos, as considerações finais da pesquisa demonstram como a atividade do “juízo reflexivo”, que Arendt busca em Kant, pode ajudar na orientação do pensamento político-filosófico como afirmação de liberdade e, dessa maneira, ser de suma importância para administração da justiça e da História. / This dissertation aims to perform a critical analysis of how human rights’ foundation faded with the establishment of totalitarianism, and how Hannah Arendt’s thought can contribute to reflecting on (re)building such rights. It is intended to understand how the weakening of human rights ideas, diagnosed by Hannah Arendt, has developed, as well as how her reflections are essential for a construction of human rights guided by political action, freedom, plurality and equality, in a public space that guarantees human dignity. This study covers mainly the German philosopher’s thoughts; however, it is also considered some readings made by Celso Lafer, a scholar of Arent philosophy, whose works contribute to better understand human rights issues. In order to properly clarify this problem, this dissertation is organized in three parts: the first one aims at demonstrating how human rights justified and based on the declarations published in 1776 and 1789, which consider men as the source of every law and therefore as inalienable individuals, were insufficient before the totalitarian phenomena (rupture phenomenon), especially concerning stateless persons issues. The second part concerns the explanation of Arendt’s main concepts, such as: public and private space, action and discourse, human relations and responsibility, and, finally, the purpose of politics and freedom. The third part if this study focuses on Arendt’s concept of citizenship, which is defined by her as “the right to have rights”. When properly developed, citizenship enables the existence of freedom, which may be exercised through a council system. To conclude these considerations, the closing comments demonstrate how the activity of “reflective judgment”, formulated by Kant and taken into consideration by Arendt, may help with reviewing the political and philosophical thought as an assertion of freedom; therefore, it can be extremely important for administration of justice and History.