An assessment of vulnerability to HIV infection of boatmen in Teknaf, Bangladesh

<p>Abstract</p> <p>Background</p> <p>Mobile population groups are at high risk for contracting HIV infection. Many factors contribute to this risk including high prevalence of risky behavior and increased risk of violence due to conflict and war. The Naf River serves as the primary border crossing point between Teknaf, Bangladesh and Mynamar [Burma] for both official and unofficial travel of people and goods. Little is known about the risk behavior of boatmen who travel back and forth between Teknaf and Myanmar. However, we hypothesize that boatmen may act as a bridging population for HIV/AIDS between the high-prevalence country of Myanmar and the low-prevalence country of Bangladesh.</p> <p>Methods</p> <p>Methods included initial rapport building with community members, mapping of boatmen communities, and in-depth qualitative interviews with key informants and members from other vulnerable groups such as spouses of boatmen, commercial female sex workers, and injecting drug users. Information from the first three stages was used to create a cross-sectional survey that was administered to 433 boatmen.</p> <p>Results</p> <p>Over 40% of the boatmen had visited Myanmar during the course of their work. 17% of these boatmen had sex with CSW while abroad. There was a significant correlation found between the number of nights spent in Myanmar and sex with commercial sex workers.</p> <p>In the past year, 19% of all boatmen surveyed had sex with another man. 14% of boatmen had participated in group sex, with groups ranging in size from three to fourteen people. Condom use was rare {0 to 4.7% during the last month}, irrespective of types of sex partners. Regression analysis showed that boatmen who were 25 years and older were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the boatmen aged less than 25 years. Similarly deep-sea fishing boatmen and non-fishing boatmen were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the day long fishing boatmen adjusting for all other variables. Boatmen's knowledge regarding HIV transmission and personal risk perception for contracting HIV was low.</p> <p>Conclusion</p> <p>Boatmen in Teknaf are an integral part of a high-risk sexual behaviour network between Myanmar and Bangladesh. They are at risk of obtaining HIV infection due to cross border mobility and unsafe sexual practices. There is an urgent need for designing interventions targeting boatmen in Teknaf to combat an impending epidemic of HIV among this group. They could be included in the serological surveillance as a vulnerable group. Interventions need to address issues on both sides of the border, other vulnerable groups, and refugees. Strong political will and cross border collaboration is mandatory for such interventions.</p

The AIDS epidemic in the Amazon region: a spatial case-control study in Rondonia, Brazil

OBJECTIVE To analyze spatial changes in the risk of AIDS and the relationship between AIDS incidence and socioeconomic variables in the state of Rondonia, Amazon region. METHODS A spatial, population case-control study in Rondonia, Brazil, based on 1,780 cases reported to the Epidemiological Surveillance System and controls based on demographic data from 1987 to 2006. The cases were grouped into five consecutive four-year periods. A generalized additive model was adjusted to the data; the dependent variable was the status of the individuals (case or control), and the independent variables were a bi-dimensional spline of the geographic coordinates and some municipality-level socioeconomic variables. The observed values of the Moran’s I test were compared to a reference distribution of values generated under conditions of spatial randomness. RESULTS AIDS risk shows a marked spatial and temporal pattern. The disease incidence is related to socioeconomic variables at the municipal level in Rondônia, such as urbanization and human capital. The highest incidence rates of AIDS are in municipalities along the BR-364 highway and calculations of the Moran’s I test show positive spatial correlation associated with proximity of the municipality to the highway in the third and fourth periods (p = 0.05). CONCLUSIONS Incidence of the disease is higher in municipalities of greater economic wealth and urbanization, and in those municipalities bisected by Rondônia’s main roads. The rapid development associated with the opening up of once remote regions may be accompanied by an increase in these risks to health

Meanings and vulnerability to HIV/AIDS among long-distance truck drivers in Brazil

ABSTRACT OBJECTIVE To understand the meanings assigned by long-distance truck drivers to HIV/AIDS and its transmission and prevention, bearing in mind different contexts of vulnerability. METHODS Qualitative research with 22 truck drivers. Semi-structured interviews and participant observation were conducted in highways of the state of Bahia in 2013. We selected male truck drivers, with one year or more of work experience in long-distance routes. We carried out the thematic analysis of the interviews, to identify different contexts of vulnerability. RESULTS The results showed that the insertion of truck drivers in contexts of high social vulnerability (poor working conditions, violence on the roads, and use of alcohol and other drugs) along with the advances in access and effectiveness of treatment for AIDS promote a reduced perception of the risk and severity of this disease. In addition, the notion of &#8220;risk group&#8221; and the symbolic division between &#8220;home space&#8221; (protected) and &#8220;street space&#8221; (unprotected) intensified a restricted and specific use of condoms, guided by the opposition between &#8220;woman of the street&#8221; (unknown women, prostitutes, among others) and &#8220;woman of the house&#8221; (wives, girlfriends). CONCLUSIONS The meanings assigned by truckers to AIDS incorporated elements of recent transformations of the expanded social context, such as the development of health technologies (especially anti-retroviral drugs) and the guarantee of free access to treatment in the Brazilian public health system; but also incorporated old elements of social vulnerability context &#8211; such as the poor working conditions on Brazilian highways

A simheuristic algorithm for the stochastic permutation flow-shop problem with delivery dates and cumulative payoffs

[EN] This paper analyzes the permutation flow-shop problem with delivery dates and cumulative payoffs (whenever these dates are met) under uncertainty conditions. In particular, the paper considers the realistic situation in which processing times are stochastic. The main goal is to find the permutation of jobs that maximizes the expected payoff. In order to achieve this goal, the paper first proposes a biased-randomized heuristic for the deterministic version of the problem. Then, this heuristic is extended into a metaheuristic by encapsulating it into a variable neighborhood descent framework. Finally, the metaheuristic is extended into a simheuristic by incorporating Monte Carlo simulations. According to the computational experiments, the level of uncertainty has a direct impact on the solutions provided by the simheuristic. Moreover, a risk analysis is performed using two well-known metrics: the value-at-risk and conditional value-at-risk.This work was supported by the Brazilian Coordination for the Improvement of Higher Level Personnel (CAPES) under grant (number 001); the Brazilian National Council for Scientific and Technological Development (CNPq) under grant (number 307403/2019-0); the Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro (FAPERJ) under grants (numbers 202.673/2018, E-26/010.002576/2019 and 211.086/2019) and Spanish Ministry of Science (PID2019-111100RB-C21, RED2018-102642-T).Villarinho, PA.; Panadero, J.; Pessoa, LS.; Juan, AA.; Oliveira, FLC. (2021). A simheuristic algorithm for the stochastic permutation flow-shop problem with delivery dates and cumulative payoffs. International Transactions in Operational Research. 28(2):716-737. https://doi.org/10.1111/itor.1286271673728

Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes

Submitted by Repositório Arca ([email protected]) on 2019-04-24T16:52:06Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-07-09T22:59:48Z (GMT) No. of bitstreams: 2 ve_Serafim_Rodrigo_etal_INI_2012.pdf: 403949 bytes, checksum: 3625dddb671d77191057eb13efeb5bba (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-07-09T22:59:48Z (GMT). No. of bitstreams: 2 ve_Serafim_Rodrigo_etal_INI_2012.pdf: 403949 bytes, checksum: 3625dddb671d77191057eb13efeb5bba (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2012Copa D’Or Hospital. Ventilatory Intensive Care Unit. Rio de Janeiro, RJ, Brazil / D’Or Institute of Research and Education. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Department of Internal Medicine and Post-graduated Program. Rio de Janeiro, RJ, Brazil.Copa D’Or Hospital. Surgical Intensive Care Unit. Rio de Janeiro, RJ, Brazil.Copa D’Or Hospital. Ventilatory Intensive Care Unit. Rio de Janeiro, RJ, Brazil.D’Or Institute of Research and Education. Rio de Janeiro, RJ, BrazilCopa D’Or Hospital. Ventilatory Intensive Care Unit. Rio de Janeiro, RJ, Brazil.Copa D’Or Hospital. Ventilatory Intensive Care Unit. Rio de Janeiro, RJ, Brazil.Copa D’Or Hospital. Ventilatory Intensive Care Unit. Rio de Janeiro, RJ, Brazil.D’Or Institute of Research and Education. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Federal University of Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Department of Internal Medicine and Post-graduated Program. Rio de Janeiro, RJ, Brazil.Background: Delirium features can vary greatly depending on the postoperative population studied; however, most studies focus only on high-risk patients. Describing the impact of delirium and risk factors in mixed populations can help in the development of preventive actions. Methods: The occurrence of delirium was evaluated prospectively in 465 consecutive nonventilated postoperative patients admitted to a surgical intensive care unit (SICU) using the confusion assessment method (CAM). Patients with and without delirium were compared. A multiple logistic regression was performed to identify the main risk factors for delirium in the first 24 h of admission to the SICU and the main predictors of outcomes. Results: Delirium was diagnosed in 43 (9.2%) individuals and was more frequent on the second and third days of admission. The presence of delirium resulted in longer lengths of SICU and hospital stays [6 days (3–13) vs. 2 days (1–3), p < 0.001 and 26 days (12–39) vs. 6 days (3–13), p <0.001, respectively], as well as higher hospital and SICU mortality rates [16.3% vs. 4.0%, p = 0.004 and 6.5% vs. 1.7%, p = 0.042, respectively]. The risk factors for delirium were age (odds ratio (OR), 1.04 [1.02-1.07]), Acute Physiologic Score (APS; OR, 1.11 [1.04-1.2]), emergency surgery (OR, 8.05 [3.58-18.06]), the use of benzodiazepines (OR, 2.28 [1.04-5.00]), and trauma (OR, 6.16 [4.1-6.5]). Conclusions: Delirium negatively impacts postoperative nonventilated patients. Risk factors can be used to detect high-risk patients in a mixed population of SICU patients