Leishmania and HIV co-infection: first naturally Leishmania strain presenting decreased susceptibility to miltefosine, recovered from a patient in Portugal.

BACKGROUND: In Europe, up to 70% of visceral leishmaniasis (VL) cases occurring in adults living with HIV. People living with HIV with VL co-infection often display persistent parasitemia, requiring chronic intermittent anti-Leishmania therapies. Consequently, frequent VL relapses and higher mortality rates are common in these individuals. As such, it is of paramount importance to understand the reasons for parasite persistence to improve infection management. METHODS: To outline possible causes for treatment failure in the context of HIV-VL, we followed a person living with HIV-VL co-infection for nine years in a 12-month period. We characterized: HIV-related clinicopathological alterations (CD4+ T counts and viremia) and Leishmania-specific seroreactivity, parasitemia, quantification of pro-inflammatory cytokines upon stimulation and studied a Leishmania clinical isolate recovered during this period. RESULTS: The subject presented controlled viremia and low CD4+ counts. The subject remained PCR positive for Leishmania and also seropositive. The cellular response to parasite antigens was erratic. The isolate was identified as the first Leishmania infantum case with evidence of decreased miltefosine susceptibility in Portugal. CONCLUSION: Treatment failure is a multifactorial process driven by host and parasite determinants. Still, the real-time determination of drug susceptibility profiles in clinical isolates is an unexplored resource in the monitoring of VL.

Transição para a creche e bem-estar emocional dos bebês em Portugal / Transition to childcare and infants' well-being in Portugal / Transición a la guardería y bienestar emocional de los bebés en Portugal

O presente estudo analisa a relação entre a implementação de práticas de transição do contexto familiar para a creche e o bem-estar emocional dos bebês durante o primeiro de mês de frequência neste contexto extrafamiliar. Foram recolhidos dados, antes e após a entrada do bebê na creche, junto das mães e das educadoras de 90 bebês.Os resultados indicaram que o número de práticas de transição reportadas pelas educadoras se revela positivamente associado ao bem-estar emocional dos bebês durante o primeiro mês de frequência da creche. Estes resultados recomendam a implementação de um conjunto diversificado de práticas de transição, antes e após a entrada na creche, no sentido de facilitar a adaptação dos bebês ao novo contexto desenvolvimental.

The present study analyzes the relationship between the implementation of transition practices from home to day care center and the emotional well-being of the infants during the first month of attendance in this extrafamiliar environment. Data were collected, before and after the infant entered the day care center, with the mothers and teachers of 90 infants. The results indicated that the number of transition practices reported by teachers is positively associated with the emotional well-being of infants during the first month of day care attendance. These results recommend the implementation of a diversified set of transition practices, before and after entry into the day care center, to facilitate the infants' adaptation to the new developmental setting.

En el presente estudio se analiza la relación entre la implementación de prácticas de transición del contexto familiar a la guardería y el bienestar emocional de los bebés, durante el primer mes de frecuencia de este contexto extra-familiar. Se recolectaron datos, antes y tras la entrada del bebé en la guardería, por intermedio de las madres y de las educadoras de 90 bebés. Los resultados indicaron que el número de prácticas de transición reportadas por las educadoras se revela positivamente asociado al bienestar emocional de los bebés durante el primer mes de frecuencia a la guardería. Estos resultados recomiendan la implementación de un conjunto diversificado de prácticas de transición, antes y tras la entrada en la guardería, en el sentido de facilitar la adaptación de los bebés al nuevo contexto de desarrollo.

Estilos interactivos de educadoras do Ensino Especial em contexto de educação-de-infância / Special Education teachers' interactive styles in early education

Este estudo pretendeu caracterizar os estilos interactivos das educadoras do Ensino Especial ao se relacionarem com crianças com Necessidades Educativas Especiais (NEE) integradas em creches/jardins-de-infância do Porto. Participaram 50 educadoras e 50 crianças. Os comportamentos interactivos foram avaliados utilizando a Escala de Avaliação dos Estilos de Ensino. O envolvimento das crianças foi codificado por meio do EQUAL-III. A análise de clusters identificou dois sub-grupos: (i) educadoras que utilizam mais frequentemente comportamentos directivos; (ii) educadoras nas quais predominam comportamentos elaborativos e responsivos. Os subgrupos distinguiram-se em características de qualidade estrutural da sala, da educadora e do envolvimento da criança. As crianças com NEE parecem se beneficiar de interacções baixas em directividade. Interacções elaborativas-responsivas tendem a promover níveis mais sofisticados de envolvimento, pelo que são recomendadas.

This study intended to characterize special education teachers' interactive styles while interacting with children with disabilities, in day care/preschool contexts in Porto. Fifty special education teachers and 50 children with disabilities participated in the study. Interactive behaviours were rated based on the Teaching Styles Rating Scale. Child engagement was coded by means of the E-QUAL III. Using cluster analysis, two subgroups of teachers were identified: (i) teachers using more frequently directive behaviours; (ii) teachers with predominance of elaborative and responsive behaviours. Subgroups differences were found for classroom structural quality, teachers' characteristics and children's observed engagement. Children with disabilities seem to benefit from low directive interactions. Elaborative-responsive teacher's interactions tend to promote more sophisticated levels of children's engagement, and are thus recommended.

Estilos interactivos de educadoras do Ensino Especial em contexto de educação-de-infância / Special Education teachers' interactive styles in early education

Este estudo pretendeu caracterizar os estilos interactivos das educadoras do Ensino Especial ao se relacionarem com crianças com Necessidades Educativas Especiais (NEE) integradas em creches/jardins-de-infância do Porto. Participaram 50 educadoras e 50 crianças. Os comportamentos interactivos foram avaliados utilizando a Escala de Avaliação dos Estilos de Ensino. O envolvimento das crianças foi codificado por meio do EQUAL-III. A análise de clusters identificou dois sub-grupos: (i) educadoras que utilizam mais frequentemente comportamentos directivos; (ii) educadoras nas quais predominam comportamentos elaborativos e responsivos. Os subgrupos distinguiram-se em características de qualidade estrutural da sala, da educadora e do envolvimento da criança. As crianças com NEE parecem se beneficiar de interacções baixas em directividade. Interacções elaborativas-responsivas tendem a promover níveis mais sofisticados de envolvimento, pelo que são recomendadas.(AU)

This study intended to characterize special education teachers' interactive styles while interacting with children with disabilities, in day care/preschool contexts in Porto. Fifty special education teachers and 50 children with disabilities participated in the study. Interactive behaviours were rated based on the Teaching Styles Rating Scale. Child engagement was coded by means of the E-QUAL III. Using cluster analysis, two subgroups of teachers were identified: (i) teachers using more frequently directive behaviours; (ii) teachers with predominance of elaborative and responsive behaviours. Subgroups differences were found for classroom structural quality, teachers' characteristics and children's observed engagement. Children with disabilities seem to benefit from low directive interactions. Elaborative-responsive teacher's interactions tend to promote more sophisticated levels of children's engagement, and are thus recommended.(AU)