Addressing Mental Health Needs in Low- and Middle-Income Countries: The case of São Caetano do Sul, Brazil.

São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a CAPS-II, CAPS-AD, outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal Project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in LMICs developing mental health programs.

Impact of Human Immunodeficiency Virus Drug Resistance on Treatment of Human Immunodeficiency Virus Infection in Children in Low- and Middle-Income Countries.

Children living with human immunodeficiency virus (HIV) in low- and middle-income countries (LMICs) experience higher rates of virologic failure than adults. Human immunodeficiency virus drug resistance (HIVDR) plays a major role in pediatric HIV treatment failure because nonsuppressive maternal antiretroviral therapy (ART) during pregnancy and breastfeeding as well as infant antiretroviral prophylaxis lead to high rates of pretreatment drug resistance to regimens most commonly used in children living with HIV. Lack of availability of durable, potent drugs in child-friendly formulations in LMICs and adherence difficulties contribute to acquired drug resistance during treatment. Optimizing drugs available for treating children living with HIV in LMICs, providing robust adherence support, and ensuring virologic monitoring for children receiving ART are essential for reducing HIVDR and improving treatment outcomes for children living with HIV in LMICs.

Palhaços: uma revisão acerca do uso dessa máscara no ambiente hospitalar / Payasos: una revisión sobre el uso de esa máscara en el ambiente hospitalario / Clowns: a review about using this mask in the hospital environment

Grupos de artistas profissionais ou voluntários têm-se formado com o intuito de visitar, como palhaços, pacientes em hospitais ao redor do mundo, fazendo uso do humor como ferramenta a favor do cuidado e do processo de recuperação. Há poucos estudos relacionados ao tema na literatura científica. Assim, a construção de um campo teórico capaz de subsidiar essas atuações ainda é incipiente. Realizamos, portanto, uma revisão bibliográfica, a partir de 33 artigos, sobre a atuação de diferentes grupos de palhaços em vários hospitais do mundo, a fim de compreender melhor como se dão estas visitas e de que modo podem efetivamente trazer resultados positivos. Foi observado que estes encontros podem estabelecer relações profundas capazes de ressignificar o ambiente hospitalar, empoderar os pacientes e servir como modelo de relação para toda a equipe de saúde envolvida...

Se han formado grupos de artistas profesionales o voluntarios con el objetivo de visitar, como payasos, pacientes en hospitales del mundo entero, utilizando el humor como herramienta en favor del cuidado y del proceso de recuperación. Hay pocos estudios relacionados a ese tema en la literatura científica. Por lo tanto, la construcción de un campo teórico capaz de subsidiar esas actuaciones todavía es incipiente. Siendo así, realizamos una revisión bibliográfica a partir de 33 artículos sobre la actuación de diferentes grupos de payasos en diversos hospitales del mundo, para entender mejor cómo se realizan esas visitas y de qué modo pueden efectivamente brindar resultados positivos. Se observó que esos encuentros pueden establecer relaciones profundas capaces de dar un nuevo significado al ambiente hospitalario, de dar poder a los pacientes y de servir como modelo de relación para todo el equipo de salud involucrado...

Groups of voluntary or professional artists have been formed in order to visit patients in hospitals around the world, as clowns, using humor as a tool to promote the care and recovery process. There are few studies on this topic in the scientific literature. Thus, construction of a theoretical field that is able to support this activity is only just beginning. Therefore, we conducted a bibliographic review based on 33 papers about different clown groups acting in different hospitals worldwide, in order to better comprehend how these visits take place and how they can effectively achieve good results. It was observed that these encounters can establish deep relationships that are capable of creating new meanings for the hospital environment, empowering patients and serving as a relationship model for all the healthcare staff involved...

Direct stringency comparison of two macaque models (single-high vs. repeat-low) for mucosal HIV transmission using an identical anti-HIV chemoprophylaxis intervention.

BACKGROUND: In our previous work, oral chemoprophylaxis with tenofovir disoproxil fumarate (TDF) provided partial protection in rhesus macaques against repeated low-dose (RL) intrarectal SHIV162p3 exposure. METHODS: Here, we make a direct comparison of these previous findings with data generated using a single high (SH)-dose challenge strategy. RESULTS: All 5 (100%) control macaques were infected after a SH challenge and only three of five (60%) TDF-treated macaques became infected. The remaining two TDF-treated macaques remained virus-negative and were susceptible to virus infection upon re-challenge in the absence of oral TDF. Thus, two of five (40%) TDF-treated macaques were protected by the pre-exposure chemoprophylaxis regimen. By comparison with the RL challenge system, only one of four (25%) of TDF-treated macaques were protected from infection, whereas four of four (100%) control macaques became infected using RL challenges. CONCLUSION: Taken together, these findings indicate that the stringency of the RL challenge model for testing antiretroviral interventions is not lower and possibly greater than that of the SH challenge model.

Chemoprophylaxis with tenofovir disoproxil fumarate provided partial protection against infection with simian human immunodeficiency virus in macaques given multiple virus challenges.

We examined the efficacy of tenofovir disoproxil fumarate (TDF) in blocking simian human immunodeficiency virus (SHIV) infection in Chinese rhesus macaques. Once weekly for 14 weeks or until a macaque became infected, 12 male macaques were inoculated intrarectally with amounts of SHIV(SF162P3) (10 median tissue culture infective doses; 3.8 x 10(5) virus particles) that were approximately 5-fold higher than the human immunodeficiency virus type 1 RNA levels noted in human semen during an acute infection. Of the 12 macaques, 4 received oral TDF daily, 4 received oral TDF once weekly, and 4 (control animals) received no TDF. The control animals became infected after receiving a median of 1.5 virus inoculations; macaques receiving TDF daily (1 macaque remained uninfected after 14 inoculations) and those receiving TDF weekly became infected after a median duration of 6.0 and 7.0 weeks, respectively. Although infection was delayed in treated macaques, compared with control macaques, the differences were not statistically significant (P=.315); however, the study was limited by the small numbers of animals evaluated and the variability in blood levels of TDF that resulted from oral dosing. These data demonstrate that treatment with oral TDF provided partial protection against SHIV infection but ultimately did not protect all TDF treated animals against multiple virus challenges.

In vitro comparison of topical microbicides for prevention of human immunodeficiency virus type 1 transmission.

A standardized protocol was used to compare cellular toxicities and anti-human immunodeficiency virus type 1 (HIV-1) activities of candidate microbicides formulated for human use. The microbicides evaluated were cellulose acetate phthalate (CAP), Carraguard, K-Y plus nonoxynol-9 (KY-N9), PRO 2000 (0.5 and 4%), SPL7013 (5%), UC781 (0.1 and 1%), and Vena Gel, along with their accompanying placebos. Products were evaluated for toxicity on cervical and colorectal epithelial cell lines, peripheral blood mononuclear cells (PBMCs), and macrophages (MPhi) by using an ATP release assay, and they were tested for their effect on transepithelial resistance (TER) of polarized epithelial monolayers. Anti-HIV-1 activity was evaluated in assays for transfer of infectious HIV-1 from epithelial cells to activated PBMCs and for PBMC and MPhi infection. CAP, Carraguard, PRO 2000, SPL7013, and UC781 along with their placebos were 20- to 50-fold less toxic than KY-N9 and Vena Gel. None of the nontoxic product concentrations disrupted the TER. Transfer of HIV-1(Ba-L) from epithelial cells to PBMCs and PBMC and MPhi infection with laboratory-adapted HIV-1(Ba-L) and HIV-1(LAI) isolates were inhibited by all products except Carraguard, KY-N9, and Vena Gel. KY-N9, Vena Gel, and Carraguard were not effective in blocking PBMC infection with primary HIV-1(A), HIV-1(C), and HIV-1(CRF01-AE) isolates. The concordance of these toxicity results with those previously reported indicates that our protocol may be useful for predicting toxicity in vivo. Moreover, our systematic anti-HIV-1 testing provides a rational basis for making better informed decisions about which products to consider for clinical trials.