Interest in coinfection with multiple types of human papillomavirus (HPV) has increased in response to the possibility of vaccination and the discovery that the host immune response appears to be mainly type specific. This study attempts to document the occurrence of coinfection with multiple HPV types and to determine whether these coinfections predicted acquisition or persistence of other HPV types in a prospective cohort of women in Brazil. Multiple HPV types were detected at the same visit in one-fifth of all women who tested positive for HPV at any time. Acquisition of an HPV infection was more likely among women with any HPV type detected on study entry. Persistence of HPV infection, the true precursor of cervical abnormalities, was independent of coinfection with other HPV types. Given the increasing prominence of HPV vaccination as a potential preventive approach, it is imperative that additional insights on cross-type protection be obtained from longer-term longitudinal investigations.

ObjectiveTo compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening.DesignWe used Portuguese national clinical and economic data to conduct a model-based assessment.MethodsWe compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/μL, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost €6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness. ResultsOne-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs) to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER) of €28,000 per quality-adjusted life year (QALY). Screening more frequently in higher-risk groups was cost-effective: for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of €21,000/QALY and €34,000/QALY, respectively.ConclusionsOne-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal’s challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.

RESUMO -Avaliou-se a função respiratória de 40 parkinsonianos (P), entre 50 e 80 anos, nos estágio I a III da Escala de Hoehn e Yahr e de 40 não parkinsonianos (NP), com características semelhantes. A amplitude torácica de 1,8±0,8 cm nos P foi menor que 4,3±1,0 cm nos NP (p=0,00001), assim como os percentuais das capacidades vital e vital forçada de 66,8±20,3% e 69,6±22,2% nos P e de 82,3±15,7% e 82,7±16,6% nos NP (p=0,00001 e p=0,0023 Os estudos sobre as alterações da função respiratória na doença de Parkinson (DP) vêm merecendo destaque ao longo do tempo, embora não haja unanimidade quanto aos fatores de comprometimento nem quanto à limitação funcional imposta aos pacientes. Comprovou-se a presença de alteração da respiração nos portadores da DP, por diminuição da amplitude do tórax e dos volumes pulmonares 1 . A complacência pulmonar diminui pela limitação na extensão de tronco e da amplitude articular do tórax e da coluna vertebral, secundária a artrose e outras alterações torácicas como a cifoescoliose 2,3 ou fibrose pleural 4 . Portanto, a amplitude torá-cica diminuída em decorrência da postura em flexão do tronco 5 e a degeneração ósteo-articular, alteram o eixo da coluna vertebral, o que repercute na inspiração e na expiração 6 . Com o envelhecimento, o sistema respiratório apresenta alterações estruturais, perda de elasticidade, dilatação alveolar, diminuição do estímulo neural para os músculos respiratórios e alterações de volumes, capacidades e fluxos respiratórios 7 . A reabilitação dos portadores da DP tem sido direcionada especialmente para as limitações motoras, fazendo-se necessária avaliação funcional respiratória a fim de identificar as disfunções e estabelecer programa de tratamento direcionado. MÉTODOForam selecionados, aleatoriamente, 40 indivíduos parkinsonianos (P) entre 50 e 80 anos, sendo 21 deles do

Cawthorne and Cooksey exercises were able to promote significant improvement in the balance of this sample and they can be applied as prevention and treatment in balance disturbances in elderly people.

The use of the Nintendo Wii has been considered a good alternative in the motor rehabilitation of individuals with Parkinson’s disease (PD), requiring simultaneous interaction to develop strategies for physical, visual, auditory, cognitive, psychological and social activities in the performing of virtual activities, resulting in improvement in functional performance and gait. The aim of this study was to analyze the effect of virtual sensorimotor activity on gait disorders in people with PD. Fifteen subjects with a clinical diagnosis of PD were submitted to the Unified Parkinson’s Disease Rating Scale (UPDRS III), Schwab and England Activities of Daily Living Scale (SE), Functional Independence Measure (FIM), and biomechanical gait analysis using digital images taken with a video camera before and after the treatment program. The activities with the Nintendo Wii virtual platform were standardized into three categories: aerobics, balance and Wii plus exercises. Participants carried out separate virtual exercises for 40 min, twice a week, for a total of 14 sessions. The program improved sensorimotor performance in PD gait, with an increase in stride length and gait speed, in addition to a reduction in motor impairment, especially in items of rigidity and flexibility of the lower limbs evaluated by UPDRS III, and greater functional independence, as evidenced in the SE and FIM scales. Improvements in items related to locomotion and stair climbing were also observed. The training was effective in motor recovery in chronic neurodegenerative diseases, showing improvement in motor performance and functional independence in individuals with PD.

Alzheimer's (AD) and Parkinson's diseases (PD) share clinical and pathological features, suggesting that they could have common pathogenic mechanisms, as well as overlapping genetic modifiers. Here, we performed a case-control study in a Brazilian population to clarify whether the risk of AD and PD might be influenced by shared polymorphisms at PICALM (rs3851179), CR1 (rs6656401) and CLU (rs11136000) genes, which were previously identified as AD risk factors by genome-wide association studies. For this purpose, 174 late-onset AD patients, 166 PD patients and 176 matched controls were genotyped using TaqMan assays. The results revealed that there were significant differences in genotype and allele frequencies for the SNP PICALM rs3851179 between AD/PD cases and controls, but none for CR1 rs6656401 and CLU rs11136000 intronic polymorphisms. After stratification by APOE ε4 status, the protective effect of the PICALM rs3851179 A allele in AD cases remains evident only in APOE ε4 (-) carriers, suggesting that the APOE ε4 risky allele weakens its protective effect in the APOE ε4 (+) subgroup. More genetic studies using large-sized and well-defined matched samples of AD and PD patients from mixed populations as well as functional correlation analysis are urgently needed to clarify the role of rs3851179 in the AD/PD risk. An understanding of the contribution of rs3851179 to the development of AD and PD could provide new targets for the development of novel therapies.

Vest ibular system is the absolute referential for the maintenance of balance. Functional deficit with aging can result in balance disturbance and in increase of likelihood of falls. Aim: To verify whether specific therapeutic approach of the system can promote motor learning and can contribute to the improvement of balance and to decrease of likelihood of falls.Study design: Clinical prospective. Material and Method: Fifteen women, aged 60 to 69, mean = 64.8 years old (± 2.95), resident in Barra Mansa-RJ, were submitted to Cawthorne and Cooksey exercises during three months, three times a week, during sixty minutes. They were evaluated with Berg Balance Scale (BBS), whose scores determine the possibility of fall (PQ). Results: Comparing the data obtained before and after intervention, we observed significant difference (p< 0.05), showing improvement in BBS scores and decrease in PF. Conclusion: Cawthorne and Cooksey exercises were able to promote significant improvement in the balance of this sample and they can be applied as prevention and treatment in balance disturbances in elderly people.

No abstract