Identification of a HIV-1 circulating BF1 recombinant form (CRF75_BF1) of Brazilian origin that also circulates in Southwestern Europe.

Introduction: The high recombinogenic potential of HIV-1 has resulted in the generation of countless unique recombinant forms (URFs) and around 120 reported circulating recombinant forms (CRFs). Here we identify through analyses of near full-length genomes (NFLG) a new HIV-1 CRF derived from subtypes B and F1. Methods: HIV-1 protease-reverse transcriptase (Pr-RT) sequences were obtained by RT-PCR amplification from plasma RNA. Near full-length genome sequences were obtained after amplification by RT-PCR in 5 overlapping fragments. Phylogenetic sequence analyses were performed via maximum likelihood. Mosaic structures were analyzed by bootscanning and phylogenetic analyses of genome segments. Temporal and geographical estimations of clade emergence were performed with a Bayesian coalescent method. Results: Through phylogenetic analyses of HIV-1 Pr-RT sequences obtained by us from samples collected in Spain and downloaded from databases, we identified a BF1 recombinant cluster segregating from previously reported CRFs comprising 52 viruses, most from Brazil (n = 26), Spain (n = 11), and Italy (n = 9). The analyses of NFLG genomes of 4 viruses of the cluster, 2 from Spain and 2 from Italy, allowed to identify a new CRF, designated CRF75_BF1, which exhibits a complex mosaic structure with 20 breakpoints. All 4 patients harboring CRF75_BF1 viruses studied by us had CD4+ T-cell lymphocyte counts below 220/mm3 less than one year after diagnosis, a proportion significantly higher (p = 0.0074) than the 29% found in other patients studied in Spain by us during the same period. The origin of the clade comprising CRF75_BF1 and related viruses was estimated around 1984 in Brazil, with subsequent introduction of CRF75_BF1 in Italy around 1992, and migration from Italy to Spain around 1999. Conclusion: A new HIV-1 CRF, designated CRF75_BF1, has been identified. CRF75_BF1 is the 6th CRF of South American origin initially identified in Western Europe, reflecting the increasing relationship of South American and European HIV-1 epidemics. The finding of low CD4+ T-cell lymphocyte counts early after diagnosis in patients harboring CRF75_BF1 viruses warrants further investigation on the virulence of this variant.

Identification of CRF89_BF, a new member of an HIV-1 circulating BF intersubtype recombinant form family widely spread in South America.

Circulating recombinant forms (CRFs) contribute substantially to the HIV-1 pandemic. Among 105 CRFs described in the literature, 16 are BF intersubtype recombinants, most of South American origin, of which CRF12_BF is the most widely spread. A BF recombinant cluster identified in Bolivia was suggested to represent a new CRF_BF. Here we find that it belongs to a larger cluster incorporating 39 viruses collected in 7 countries from 3 continents, 22 of them in Spain, most from Bolivian or Peruvian individuals, and 12 in South America (Bolivia, Argentina, and Peru). This BF cluster comprises three major subclusters, two associated with Bolivian and one with Peruvian individuals. Near full-length genome sequence analyses of nine viruses, collected in Spain, Bolivia, and Peru, revealed coincident BF mosaic structures, with 13 breakpoints, 6 and 7 of which coincided with CRF12_BF and CRF17_BF, respectively. In a phylogenetic tree, they grouped in a clade closely related to these CRFs, and more distantly to CRF38_BF and CRF44_BF, all circulating in South America. These results allowed to identify a new HIV-1 CRF, designated CRF89_BF. Through phylodynamic analyses, CRF89_BF emergence was estimated in Bolivia around 1986. CRF89_BF is the fifth CRF member of the HIV-1 recombinant family related to CRF12_BF.

Experimental impacts of a teacher professional development program in Chile on preschool classroom quality and child outcomes.

We assessed impacts on classroom quality and on 5 child language and behavioral outcomes of a 2-year teacher professional-development program for publicly funded prekindergarten and kindergarten in Chile. This cluster-randomized trial included 64 schools (child N = 1,876). The program incorporated workshops and in-classroom coaching. We found moderate to large positive impacts on observed emotional and instructional support as well as classroom organization in prekindergarten classrooms after 1 year of the program. After 2 years of the program, moderate positive impacts were observed on emotional support and classroom organization. No significant program impacts on child outcomes were detected at posttest (1 marginal effect, an increase in a composite of self-regulation and low problem behaviors, was observed). Professional development for preschool teachers in Chile can improve classroom quality. More intensive curricular approaches are needed for these improvements to translate into effects on children.

[Functional evolution in elderly individuals with hip fracture surgery]. / Evaluación funcional en ancianos intervenidos de fractura de cadera.

This prospective study was performed in patients aged 65 years or older who underwent hip fracture surgery. The objective was to determine the functional evolution in a group of patients three months after hospital discharge, to identify the variables related to this functional recovery and to describe the associated mortality and institutionalization process. We analyzed demographic variables such as age, sex, and living situation. Other aspects considered included: comorbidity, cognitive impairment, walking ability, dependency level according to Barthel's Index, institutionalization, and mortality. The information was collected on admission and three months after discharge. Considering the entire sample, 89.6% was female and the average age was 83.56 years; 40% of patients regained their prior independence and a 16.7% mortality rate was registered, together with a slight progression toward institutionalization. The functional capacity and cognitive impairment of patients before the fracture are determinants of functional recovery and subsequent recovery of independence.

Evaluación funcional en ancianos intervenidos de fractura de cadera / Avaliação funcional em idosos intervindos de fratura de quadril / Functional evolution in elderly individuals with hip fracture surgery

Estudio observacional prospectivo en pacientes mayores de 65 años intervenidos de fractura de cadera. El objetivo fue conocer la evolución funcional de los pacientes a los tres meses del alta hospitalaria, identificar variables relacionadas con dicha recuperación funcional, describir la mortalidad e institucionalización asociadas al proceso. Se analizaron variables demográficas como edad, sexo, convivencia. Otros aspectos registrados fueron: comorbilidad, deterioro cognitivo, capacidad para caminar, nivel de dependencia según índice de Barthel, institucionalización y mortalidad. Se recogió la información al ingreso y a los 3 meses del alta. El 89,6% de la muestra, fueron mujeres, la edad media fue de 83,56 años. El 40% de los pacientes recuperaron la independencia previa registrándose una mortalidad del 16,7% así como una leve progresión hacia la institucionalización. La capacidad funcional y el deterioro cognitivo del paciente, previos a la fractura condicionan su recuperación funcional y dependencias posteriores.

Estudo prospectivo de observação, abrangendo doentes com idade superior a 65 anos, submetidos à intervenção cirúrgica por fratura do quadril. O objetivo deste trabalho foi conhecer a evolução funcional dos doentes três meses após a alta hospitalar, identificar as variáveis que influenciaram essa recuperação e descrever a mortalidade e institucionalização. Foram analisadas variáveis como idade, sexo e convivío. Outros aspectos: comorbilidade, deterioração cognitiva, capacidade para se deslocar, nível de dependência segundo índice de Barthel, institucionalização e mortalidade. A informação foi recolhida no momento da admissão e três meses após a alta. Da amostra, 89,6% foram constituídos por mulheres com idade média de 83,56 anos; 40% dos doentes recuperaram a independência anterior, registando-se uma mortalidade de cerca de 16,7% bem como uma ligeira tendência à institucionalização. A capacidade funcional e o grau de deterioração cognitiva antes da fratura condicionam posterior recuperação funcional e consequente nível de dependência.

This prospective study was performed in patients aged 65 years or older who underwent hip fracture surgery. The objective was to determine the functional evolution in a group of patients three months after hospital discharge, to identify the variables related to this functional recovery and to describe the associated mortality and institutionalization process. We analyzed demographic variables such as age, sex, and living situation. Other aspects considered included: comorbidity, cognitive impairment, walking ability, dependency level according to Barthel's Index, institutionalization, and mortality. The information was collected on admission and three months after discharge. Considering the entire sample, 89.6% was female and the average age was 83.56 years; 40% of patients regained their prior independence and a 16.7% mortality rate was registered, together with a slight progression toward institutionalization. The functional capacity and cognitive impairment of patients before the fracture are determinants of functional recovery and subsequent recovery of independence.

Aftershocks of Chile's earthquake for an ongoing, large-scale experimental evaluation.

Evaluation designs for social programs are developed assuming minimal or no disruption from external shocks, such as natural disasters. This is because extremely rare shocks may not make it worthwhile to account for them in the design. Among extreme shocks is the 2010 Chile earthquake. Un Buen Comienzo (UBC), an ongoing early childhood program in Chile, was directly affected by the earthquake. This article discusses (a) the factors the UBC team considered for deciding whether to put on hold or continue implementation and data collection for this experimental study; and (b) how the team reached consensus on those decisions. A lesson learned is that the use of an experimental design for UBC insured that the evaluation's internal validity was not compromised by the earthquake's consequences, although cohort comparisons were compromised. Other lessons can be transferred to other contexts where external shocks affect an ongoing experimental or quasi-experimental impact evaluation.

[Screening of scoliosis in a school population of 8 to 12 years in the province of Granada (Spain)]. / Cribado de la escoliosis en una población escolar de 8 a 12 años de la provincia de Granada.

The scoliosis is a disease that affects the three-dimensional shape of the spine, which may occur at any stage of life but mainly arises from 10 years of age, and it is everyone's job (doctors, physiotherapists and teachers) responsible for managing the schoolchild to detect this spinal deformity. Therefore, we included a number of objectives in our study; first to detect the spinal disorder (scoliosis) in the school population from 8 to 12 years of Granada province; to establish the relationships between age groups and gender in people with scoliosis in the province of Granada; and finally to determine whether the occurrence of such changes have a greater impact on certain geographical areas in Granada province. Thus, this is a descriptive and cross-sectional study of a school population (n=2,956) in the province of Granada analyzed the positive clinical signs using the Adams Test on individuals with scoliosis. Of the 16 % (n=472) of schoolchildren who had scoliosis, 57.6 % (n=272) were male. The distribution of children from 8 to 12 years is fairly homogeneous with no differences seen (p=0.62) and highlight areas of higher incidence of scoliosis in zone 5 (Alpujarra-Valle of Lecrín). We conclude that there are no significant differences in scoliosis as regards age group (8 to 12 years), but there is an increasing trend towards the male gender. Differences can also be observed in the seven areas of study defined by work, environmental, genetic and consanguinity factors.