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BACKGROUND: Stigma is a major barrier to health care access and impacts the quality of life for individuals affected by tuberculosis (TB). Assessing TB stigma is essential to addressing health disparities. However, no such instrument was available in Mexico at the time of our study. This study examined the adaptability of the TB and human immunodeficiency virus (HIV) stigma scales previously used in Thailand. METHODS: The original scale, developed in English, was linguistically adapted to Spanish and administered to 217 individuals affected by TB in five states in Mexico. The TB-HIV stigma subscales were designed to assess individual and community perspectives. Additional data collected included general information and socio-demographics. Assessment of psychometric properties included basic statistical tests, evaluation of Cronbach's alpha and factor analysis. RESULTS: We found no significant statistical differences associated with higher stigma scores by location, age, marital status, education and stigma scores. Factor analysis did not create any new factors. Internal consistency reliability coefficients were satisfactory (Cronbach α = 0.876-0.912). CONCLUSION: The use of the stigma scales has implications for 1) health improvements, 2) research on stigma and health disparities, and 3) TB and HIV stigma interventions. Further research is needed to examine transferability among larger and randomly selected Spanish-speaking populations.
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BACKGROUND: The prevalence of occult HBV, defined by the presence of HBV DNA in individuals with antibodies to HBV core antigen and with absence of HBV surface antigen, but its clinical significance and virological features in HIV-infected patients is still unclear. AIM: To investigate the prevalence, clinical significance and molecular characterization of occult hepatitis B virus infection in ART-Naive HIV-positive individuals. MATERIAL AND METHODS: Among the 1077 HIV-infected patients with different risk factors for HIV infection, 297 were HBsAg-ve ART-naive, of them 112 was randomly selected for the study. HBV DNA was tested by in-house PCR and quantified by qPCR. Molecular characterization was performed by sequencing the envelope and overlapping polymerase genes. RESULTS: We found the prevalence of occult HBV to be 10.7% among a randomly selected group of HBsAg-ve/antiHBc+ve HIV-infected patients. Overall 33.9% (38 of 112) of the patients were antiHBc positive indicating exposure to HBV infection. HBV DNA was detected in 12/38 (31.5%) antiHBc positive samples and 50% of them had CD4 T cell count < 200 cells/mm(3). HCV coinfection was low (2.7%). No surrogate marker for OBI could be identified. Presence of antiHBs antibodies did not rule out OBI. Liver biopsy in six cases showed varying stages of chronic hepatitis. Several mutations were detected but not the common immune escape mutant G145R. CONCLUSION: In conclusion the prevalence of OBI was significantly high among HIV coinfected patients, which highlights the importance of HBV DNA testing in these patients and indicates need for further prospective studies in larger cohorts to assess its clinical significance.
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Coinfección , Infecciones por VIH/epidemiología , Antígenos del Núcleo de la Hepatitis B/sangre , Virus de la Hepatitis B/inmunología , Hepatitis B/epidemiología , Derivación y Consulta , Adolescente , Adulto , Biomarcadores/sangre , Biopsia , Recuento de Linfocito CD4 , Distribución de Chi-Cuadrado , ADN Viral/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Infecciones por VIH/diagnóstico , Hepatitis B/diagnóstico , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/genética , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Mutación , Reacción en Cadena de la Polimerasa , Valor Predictivo de las Pruebas , Prevalencia , ARN Viral/sangre , Análisis de Secuencia de ADN , Adulto JovenRESUMEN
Poverty is a complex issue, which must be understood in a holistic manner. Low and variable income is certainly a key element, but it is far from enough to portray poverty. The various characteristics of poverty and their relative strength are determined through contextually specific circumstances, in terms of history, environmental preconditions, socio-cultural traits, etc. Much of this context is made up of local and national circumstances. The consequences of globalisation must, however, increasingly to be taken into account. At a larger scale, it is also relevant to mention that climate change will have a negative, although largely unpredictable, impact for the people in some parts of the world. For those who are already living on marginal lands or who are exposed to water problems, climate change is likely to create considerable adverse effects.
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Ambiente , Efecto Invernadero , Pobreza , Abastecimiento de Agua/economía , Humanos , Renta , Propiedad , Condiciones Sociales , Abastecimiento de Agua/legislación & jurisprudenciaRESUMEN
In the current revolution in water management; issues that must be addressed include both urbanisation and ruralisation, water quality, and globalisation and energy policy. Water management must struggle against inappropriate research, myths and inadequate data.