Orogenital and anal infection by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and other sexually transmitted infections in men who have sex with men in Lisbon.

BACKGROUND: Men who have sex with men (MSM) are at risk for sexually transmitted infections (STIs), but more data on extragenital carriage are needed. AIM: We assessed the genital and extragenital prevalence of bacterial and other STIs in MSM in a Lisbon sexual health clinic. METHODS: We screened oral, anal, and urine samples of MSM visiting the GAT-CheckpointLX clinic June 2017-December 2021 for Chlamydia trachomatis (including lymphogranuloma venereum, LGV), Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and U. parvum. Ano-oro-genital lesions were tested for LGV, Treponema pallidum, and Herpes Simplex Virus. Blood was tested for HIV and T. pallidum antibodies. RESULTS: N. gonorrhoeae was found in 16.6% of the MSM followed by C. trachomatis (13.2%), M. genitalium (10.3%) and T. vaginalis (0.2%). The most frequent occurrence was anorectal (C. trachomatis, M. genitalium) and oral (N. gonorrhoeae). We found high carriage of U. urealyticum (36.1%) and M. hominis (22.1%). LGV was detected in 21.8% of chlamydia-positive anorectal swabs. Syphilis was detected in 22.6% of tested MSM, while 13.8% had HIV. Gonorrhoea and chlamydia were significantly more prevalent in MSM with concomitant HIV or syphilis. CONCLUSION: The substantial extragenital prevalence of bacterial STIs in MSM, and HIV and syphilis coinfections, suggest screening has value in identifying hidden carriage and in contributing for providing better care.

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.

Early root phenotyping in sweetpotato (Ipomoea batatas L.) uncovers insights into root system architecture variability.

Background: We developed a novel, non-destructive, expandable, ebb and flow soilless phenotyping system to deliver a capable way to study early root system architectural traits in stem-derived adventitious roots of sweetpotato (Ipomoea batatas L.). The platform was designed to accommodate up to 12 stems in a relatively small area for root screening. This platform was designed with inexpensive materials and equipped with an automatic watering system. Methods: To test this platform, we designed a screening experiment for root traits using two contrasting sweetpotato genotypes, 'Covington' and 'NC10-275'. We monitored and imaged root growth, architecture, and branching patterns every five days up to 20 days. Results: We observed significant differences in both architectural and morphological root traits for both genotypes tested. After 10 days, root length, surface root area, and root volume were higher in 'NC10-275' compared to 'Covington'. However, average root diameter and root branching density were higher in 'Covington'. Conclusion: These results validated the effective and efficient use of this novel root phenotyping platforming for screening root traits in early stem-derived adventitious roots. This platform allowed for monitoring and 2D imaging of root growth over time with minimal disturbance and no destructive root sampling. This platform can be easily tailored for abiotic stress experiments, and permit root growth mapping and temporal and dynamic root measurements of primary and secondary adventitious roots. This phenotyping platform can be a suitable tool for examining root system architecture and traits of clonally propagated material for a large set of replicates in a relatively small space.

Safety and Efficacy of Triple Therapy With Dolutegravir Plus 2 Nucleoside Reverse Transcriptase Inhibitors in Treatment-Naive Human Immunodeficiency Virus Type 2 Patients: Results From a 48-Week Phase 2 Study.

BACKGROUND: Integrase strand transfer inhibitor-based regimens are recommended for first-line therapy in human immunodeficiency virus type 2 (HIV-2). Nonetheless, dolutegravir (DTG) clinical trial data are lacking. METHODS: We conducted a phase 2, single-arm, open-label trial to evaluate the safety and efficacy of a triple therapy regimen that included DTG in persons with HIV-2 (PWHIV-2) in Portugal. Treatment-naive adults receive DTG in combination with 2 nucleoside reverse transcriptase inhibitors (NRTIs). Treatment efficacy was evaluated by the proportion of patients who achieved a plasma viral load (pVL) <40 copies/mL and/or by the change from baseline in CD4+ T-cell count and in CD4/CD8 ratio at week 48. RESULTS: A total of 30 patients were enrolled (22 women; median age, 55 years). At baseline, 17 (56.7%) individuals were viremic (median, pVL 190 copies/mL; interquartile range [IQR], 99-445). The median CD4 count was 438 cells/µL (IQR, 335-605), and the CD4/CD8 ratio was 0.8. Three patients discontinued the study. At week 48, all participants (27) had pVL <40 copies/mL. No virological failures were observed. Mean changes in CD4 count and CD4/CD8 ratio at week 48 were 95.59 cells/µL (95% confidence interval [CI], 28-163) and 0.32 (95% CI, .19 to .46). The most common drug-related adverse events were headache and nausea. One participant discontinued due to central nervous system symptoms. No serious adverse events were reported. CONCLUSIONS: DTG plus 2 NRTIs is safe and effective as first-line treatment for PWHIV-2 with a tolerability profile previously known. No virological failures were observed that suggest a high potency of DTG in HIV-2 as occurs in HIV-1. CLINICAL TRIALS REGISTRATION: M NCT03224338.

Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022.

Up to 27 May 2022, Portugal has detected 96 confirmed cases of monkeypox. We describe 27 confirmed cases (median age: 33 years (range: 22-51); all males), with an earliest symptom onset date of 29 April. Almost all cases (n = 25) live in the Lisbon and Tagus Valley health region. Most cases were neither part of identified transmission chains, nor linked to travel or had contact with symptomatic persons or with animals, suggesting the possible previously undetected spread of monkeypox.

Triage hospitalario para las enfermeras: Entre la incertidumbre, la sobrecarga y los desacuerdos / Hospital triage for nurses: Between uncertainty, overload, and disagreements

Resumen Estudio cualitativo, las participantes fueron enfermeras que realizaban triage hospitalario en la ciudad de Medellín Colombia. Objetivo Describir las dificultades que las enfermeras tienen al realizar el triage y cómo las afrontan. Metodología Estudio etnográfico en el que se realizaron siete entrevistas con las cuales se logró la saturación de las categorías y llevó diario de campo; la ética fue parte integral del proceso. Resultados Las dificultades en el triage son la incertidumbre, la sobrecarga y los desacuerdos con las escalas, los médicos, los pacientes y los familiares y están mediadas por la interacción con el paciente, la familia y la institución; las enfermeras para afrontar las dificultades se "resetean", liberan cargas, toman las decisiones que consideran adecuadas, hablan con sus colegas y oran. Conclusiones Las enfermeras reciben presiones que las hace sentirse vulnerables ante la sobrecarga, los problemas de interacción y la incertidumbre llevándola a que tenga que realizar diferentes sistemas de afrontamiento.

Summary Qualitative study, the participants were nurses who performed hospital triage in the city of Medellín Colombia. Objective To describe the difficulties facing by nurses when performing triage and how they deal with them. Methodology An Ethnographic design was conducted, data saturation was achieved after seven interviews, field notes were taken; ethics was part of the research process. Results The difficulties in triage are uncertainty, overload and disagreements with scales, doctors, patients and relatives and are mediated by interaction with the patient, family and institution; nurses to cope with difficulties need to "reset" themselves, release burdens, make the decisions they deem appropriate, talk to their colleagues and pray. Conclusions Nurses receive pressures that make them feel vulnerable to overload, interaction problems and uncertainty leading them to have to perform different coping systems.

HIV Pre-exposure Prophylaxis Education for Clinicians Caring for Spanish-Speaking Men Who Have Sex With Men (MSM).

Introduction: A growing number of Liaison Committee on Medical Education-accredited allopathic medical schools offer formal bilingual (English and Spanish) medical education, and numerous other schools offer medical Spanish through elective workshops as part of their curricula. One significant health disparity in the Hispanic community is the incidence of HIV among Spanish-speaking men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) has emerged as an effective strategy to reduce the risk of HIV transmission. Methods: We developed an education module to train clinicians to discuss PrEP with Spanish-speaking MSM. Our module is adapted from an English module on PrEP education. It includes a Spanish-language PowerPoint slide deck with information about PrEP as well as a Spanish-language videotaped scripted clinical encounter. Results: The module was implemented on three occasions with 18 participants, and learners reported increased comfort in discussing and confidence in prescribing PrEP with Spanish-speaking patients. Discussion: This workshop can be incorporated within medical Spanish curriculums offered at health professional schools and community-based organizations dedicated to reducing the HIV burden in the Spanish-speaking Hispanic community.

The Development and Prototype Feedback of Digital Cancer 101 Videos to Enhance Cancer Education for Marginalized Communities With Limited Health Literacy.

Social media, in the form of digital videos targeted to people with limited health literacy, as well as disadvantaged or marginalized groups, may help reduce cancer health disparities and improve health outcomes in these populations. In this article, we document the process of adapting the content from the Cancer 101 curriculum to create animated scripts about the cancer care continuum that is clear, straightforward, and in plain language. The development of the Cancer 101 digital videos required a multidisciplinary collaboration from-public health, medicine, technology, and expertise in correctional health, smoking cessation, web development, video producers, and individuals directly impacted by cancer disparities. The Cancer 101 videos were showcased at a community health fair where the videos were viewed by attendants waiting to be seen by a medical provider. While waiting for their cancer screening, 13 individuals were selected and invited to watch all 11 videos totaling less than 60-minutes of viewing time. They included 3 Latina women, 2 Latino men, and 8 Haitian women. All participants were between the ages of 40-65 years old. Overall, participants agreed that they would recommend the videos to friends/family (M = 4.77, SD = 0.44) and that they plan to watch other video modules to learn more information about cancer (M = 4.72, SD = 0.47). Additionally, participants enjoyed the graphics and audio of the videos presented (M = 4.85, SD = 0.38). Furthermore, participants noted that Cancer 101 digital videos described cancer in plain language, leading to a better understanding of the disease. Future research is needed to implement Cancer 101 digital videos in healthcare clinics to increase cancer information and improve cancer screening rates in marginalized communities.

PrEP (Pre-Exposure Prophylaxis) Education for Clinicians: Caring for an MSM Patient.

Introduction: Gaps exist in educational materials addressing LGBTQ patient care and LGBTQ health. One such area is prescribing HIV pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM). PrEP awareness, familiarity, and comfort in prescribing are very important in the rollout and success of PrEP as a preventative measure. Our needs assessments showed a lack of familiarity and comfort among clinicians/medical students in prescribing PrEP. Furthermore, studies have shown that since its launch as an effective prevention method of HIV transmission, PrEP has not been widely prescribed to at-risk populations. Educating clinicians about PrEP may increase its use among high-risk MSM populations and reduce the incidence of HIV infections. Methods: For medical students, we developed a didactic presentation and video recording discussing (1) a brief history of HIV prevention, (2) indications for PrEP prescription, (3) medical testing for PrEP onboarding, (4) common PrEP side effects, and (5) appropriate follow-up and testing for PrEP maintenance and discontinuation. We also developed a videotaped clinical encounter demonstrating communication skills used in PrEP counseling. Pre- and postworkshop surveys assessed participants' PrEP attitudes and knowledge. Results: All 43 survey respondents were second- through fourth-year medical students. Pre- and postpresentation evaluation of questions assessing comfort demonstrated a statistically significant improvement in level of comfort with understanding when to prescribe PrEP and in level of knowledge in prescribing PrEP. Discussion: Workshop participants acknowledged their training gaps in PrEP prescribing and acquired knowledge and comfort with prescribing PrEP for at-risk populations.

Harnessing Digital Videos to Promote Cancer Prevention and Education: a Systematic Review of the Literature from 2013-2018.

Social media has transformed the way cancer patients search for information about their chronic health problems. The purpose of this systematic review is to identify the use of online digital videos to increase cancer knowledge and to understand information preference, behavioral changes, and attitudes towards online cancer education videos. The databases used for this review included MedLine, PsychINFO, and PubMed. These medical databases were used to locate peer-reviewed academic journals from 2013-2018 using the following MeSH terms: "cancer education videos," "cancer prevention videos," and "cancer education digital videos." A total of 4996 articles were retrieved from the initial search, and 33 articles were reviewed. Articles were excluded if videos did not (1) focus on cancer education and prevention; (2) posted on an online platform; and (3) assessed participants' knowledge, attitude, or beliefs about cancer. Eleven articles were found to meet inclusion criteria for final review. All of the studies focused on increasing education on preventive health behaviors (i.e., sunscreen use, smoking, and diet) and/or early detection strategies (i.e., screening testing and/or self-skin exams). While online digital health videos have the potential to improve health outcomes, issues related to technology access and health literacy must be considered when developing online health education videos.

Root Branching and Nutrient Efficiency: Status and Way Forward in Root and Tuber Crops.

Plants are immobile organisms that require roots to efficiently and cost-effectively exploit their habitat for water and nutrients. Plant root systems are dynamic structures capable of altering root branching, root angle, and root growth rates determining overall architecture. This plasticity involves belowground plant-root mediated synergies coupled through a continuum of environmental interactions and endogenous developmental processes facilitating plants to adapt to favorable or adverse soil conditions. Plant root branching is paramount to ensure adequate access to soil water and nutrients. Although substantial resources have been devoted toward this goal, significant knowledge gaps exist. In well-studied systems such as rice and maize, it has become evident that root branching plays a significant role in the acquisition of nutrients and other soil-based resources. In these crop species, specific root branching traits that confer enhanced nutrient acquisition are well-characterized and are already being incorporated into breeding populations. In contrast, the understanding of root branching in root and tuber crop productivity has lagged behind. In this review article, we highlight what is known about root branching in root and tuber crops (RTCs) and mark new research directions, such as the use novel phenotyping methods, examining the changes in root morphology and anatomy under nutrient stress, and germplasm screening with enhanced root architecture for more efficient nutrient capture. These directions will permit a better understanding of the interaction between root branching and nutrient acquisition in these globally important crop species.

El quehacer cotidiano de la enfermera significa soportar la carga / O trabalho cotidiano da enfermeira significa suportar a carga / The daily work of nurse means bear the burden

Introducción: Las enfermeras le dan significados a su quehacer cotidiano y la comprensión de estos favorece el diseño de propuestas orientadas a promover la calidad, humanización y gestión de los servicios. El objetivo fue comprender el significado que las enfermeras le dan a su quehacer cotidiano. Materiales y Métodos: Se utilizó la investigación cualitativa con enfoque etnográfico, se realizaron entrevistas grupales y se llevó diario de campo. Resultados: Las enfermeras deben apropiarse del servicio, lo que significa realizar cuidado integral y cargar el servicio. Esta carga del servicio es entendida como soportar la carga de la culpa, los problemas, las interacciones, los indicadores y protocolos sin suficiente tiempo. Discusión: El cuidado genera motivación la cual es una emoción capaz de provocar, mantener y dirigir la conducta hacia un objetivo, la carga laboral ha obligado a las enfermeras a dedicar menos tiempo al cuidado lo cual las lleva a sentimientos de culpa, agotamiento y estrés. Conclusiones: El quehacer de enfermería significa una carga cuando sienten que deben encargarse de tareas que no son de su competencia profesional o que son impuestas limitando su autonomía. Tener que soportarla lleva a las enfermeras a la desmotivación.

Introdução: As enfermeiras dão significados ao seu quefazer cotidiano e a compreensão destes favorece o desenho de propostas orientadas a promover a qualidade, humanização e gestão dos serviços. O objetivo foi compreender o significado que as enfermeiras lhe dão ao seu quefazer cotidiano. Materiais e Métodos: Se utilizou a investigação qualitativa com enfoque etnográfico, se realizaram entrevistas grupais e se fez diário de campo. Resultados: As enfermeiras devem apropriar-se do serviço, o que significa realizar cuidado integral e carregar o serviço. Esta carga do serviço é entendida como suportar a carga da culpa, os problemas, as interações, os indicadores e protocolos sem suficiente tempo. Discussão: O cuidado gera motivação a qual é uma emoção capaz de provocar, manter e dirigir a conduta a um objetivo, a carga laboral há obrigado às enfermeiras a dedicar menos tempo ao cuidado o qual as leva a sentimentos de culpa, esgotamento e estresse. Conclusões: A tarefa de enfermagem significa a carga quando eles sentem que eles devem cuidar de tarefas que não são de sua competência profissional, ou que são impostas, limitando a sua autonomia. Ter que suportar a carga leva às enfermeiras à desmotivação.

Introduction: Nurses give the meaning to their daily work and its comprehension permits the design of proposals oriented to promote quality, humanization and service management. The objective was to understand the meaning that nurses give to their daily work. Materials and Methods: Qualitative study with ethnographic approach; groups interviews were conducted and a field day book was done. Results: Nurses must take ownership of the nurse department, which means to achieve an integral care and hold up the department. The weight of the department is to understand as the ability to hold up guilt, problems, interactions, indicators and protocols without enough time. Discussion: Health care creates motivation, which is a feeling capable to provoke, maintain and manage the behavior to a common objective; the work weight has forced the nurses to spend less time to the health care, which lead them to feel guilty, exhaustion and stress. Conclusions: The task of nursing means a burden when they feel that they must take care of tasks are not of her professional competence or that are imposed by limiting their autonomy. Holding up work weight, lead nurses to the demotivation.

Impact of HIV infection on cardiac deformation.

AIM: The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease. METHODS: An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41 ± 6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking. RESULTS: The mean duration of HIV infection was 10 ± 5 years, CD4 count was 579 ± 286 cells/mm³, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72 ± 0.17 m/s vs. control 0.84 ± 0.16 m/s, p=0.01), longitudinal strain (-19.5 ± 1.9% vs. -21 ± 2%, p=0.005), SRS (-1.1 ± 0.28 s⁻¹ vs. -1.3 ± 0.28 s⁻¹, p=0.02) and SRE (1.8 ± 0.4 s⁻¹ vs. 2.2 ± 0.4 s⁻¹, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI -0.599; -0.168) had independent value. CONCLUSION: In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury.

Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín, Colombia) / Design of a program for the positive development of schoolchildren and characteristics of participants (Medellin, Colombia)

El diseño del Programa para la promoción de potencialidades personales y prevención de conductas de riesgo para la salud en escolares, PILAS! mejores adultos, mejor infancia, se realizó basándose en evidencia local e internacional sobre programas de prevención de violencia basados en la escuela. El programa ofrece formación a padres, madres, maestros y maestras, por medio de metodologías activas, y asesoría durante 10 meses sobre temas que conducen al desarrollo personal de niños/as y a la deslegitimación de la violencia en las interacciones cotidianas. Se beneficiaron 306 maestros y maestras, 800 padres y madres, y 12.800 niños y niñas. La medición inicial a 1751 infantes, según sus cuidadores/as, mostró una media de 80, en una escala de 0 a 100, en competencias sociales, pero una alta frecuencia de agresión. En padres y madres, fallas en la comunicación y supervisión, y uso de castigos con agresión psicológica y física; además, una baja cohesión social en el barrio (AU)

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood (AU)

[Design of a program for the positive development of schoolchildren and characteristics of participants (Medellin, Colombia)]. / Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín, Colombia).

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence.

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.