Resumen Introducción. Los problemas en la cadena de suministro aumentaron los costos de las materias primas y redujeron la disponibilidad de materiales para la producción de agentes de control biológico. Esto puede ejercer mayor presión de enfermedades y menores rendimientos en las granjas. Objetivo. Determinar el efecto de diferentes cantidades de almidón y el uso de ingredientes locales en procesos de fermentación a pequeña y gran escala para Trichoderma harzianum. Materiales y métodos. El estudio se ralizó en San José, Costa Rica, entre 2016 y 2018. Se realizaron ensayos en matraces para investigar la reducción o eliminación de almidón en medios de fermentación comerciales. Se llevaron a cabo ensayos en recipientes de fermentación para evaluar la efectividad de un medio local alternativo, que incluyó tres tratamientos: 1) medio comercial como control, 2) melaza al 10 % y 3) melaza al 10 % con 0,5 % de extracto de levadura. Se realizaron recuentos de esporas viables para determinar las unidades formadoras de colonias (UFC/mL). Resultados. La reducción de almidón al 10 % del medio original no tuvo impacto en las UFC/mL. Sin embargo, la ausencia de almidón resultó en un crecimiento desigual durante la fermentación. La melaza produjo aproximadamente la mitad de las UFC/mL en comparación con el medio comercial, pero superó el umbral de 107 UFC/mL utilizado en estudios para el control biológico de patógenos de plantas. Los resultados obtenidos en un fermentador a escala comercial fueron similares a los de la fermentación a escala piloto. Conclusión. La reducción del contenido de almidón en el medio comercial no afectó al crecimiento, pero la ausencia de almidón provocó acumulaciones sólidas de micelio. El uso de un medio de melaza de origen local a escala comercial parece factible mientras se mantenga un recuento de esporas viables requeridas para su uso en el campo.

Abstract Introduction. Supply chain issues have increased the costs of raw material and reduced the availability of materials for the production of biological control agents. This can result in greater disease pressure and lower yields on farms. Objective. To determine the effect of different amounts of starch and the use of local ingredients in small- and large-scale fermentation processes for Trichoderma harzianum. Materials and methods. The study was conducted in San José, Costa Rica, between 2016 and 2018. Flask experiments were performed to investigate the reduction or elimination of starch in commercial fermentation media. Fermentation vessel trials were conducted to evaluate the effectiveness of an alternative local medium, which included three treatments: 1) commercial medium as a control, 2) 10 % molasses medium, and 3) 10 % molasses with 0.5% yeast extract. Viable spore counts were performed to determine colony-forming units (CFU/mL). Results. Reducing starch to 10 % of the original medium had no impact on CFU/mL. However, the absence of starch resulted in uneven growth during fermentation. Molasses produced approximately half the CFU/mL compared to the commercial medium but exceeded the threshold of 107 CFU/mL used in studies for the biological control of plant pathogens. Results obtained in a commercial-scale fermenter were similar to those of pilot-scale fermentation. Conclusion. Reducing starch content in the commercial medium did not affect growth, but the absence of starch led to solid mycelium clumps. The use of a local molasses-based medium on a commercial scale feasible as long as the required viable spore count for field use is maintained.

Abstract Introduction Human papillomavirus-related (HPV +) oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence and presents diagnostic challenges given its unique clinical presentation. Objective The purpose of the present study is to characterize the impact of the unique clinical presentation of HPV-related OPSCC on delays in diagnosis. Methods Retrospective review of presenting symptoms and clinical characteristics of 284 patients with OPSCC treated from 2002-2014. Delay in diagnosis was defined as the presence of any of the following: multiple non-diagnostic fine needle aspirate (FNA) biopsies; two or more courses of antibiotic therapy; surgery with incorrect preoperative diagnosis; evaluation by an otolaryngologist without further workup; or surgery without definitive postoperative diagnosis. Results p16+ tumors demonstrated a distinct clinical presentation that more commonly involved a neck mass (85.1% versus 57.3% of p16-; p < 0.001) and less frequently included odynophagia (24.6% versus 51.7% of p16-; p < 0.001). Patients who experienced diagnostic delay were more likely to have p16+ tumors (77.7% delayed versus 62.8% not delayed; p = 0.006). p16+ primary tumors were more likely to be undetectable by physical examination of the head and neck including flexible laryngoscopy (19.0% versus 6.7% of p16-; p = 0.007) and more frequently associated with nondiagnostic FNA biopsies of a cervical nodal mass (11.8% versus 3.4% of p16-, p = 0.03). Conclusions Compared with non-HPV related OPSCC, the unique clinical presentation and characteristics of HPV+ OPSCC are associated with an increased incidence of diagnostic delay. Targeted education of appropriate care providers may improve time to diagnosis and treatment. papillomavirusrelated papillomavirus HPV + (OPSCC HPVrelated 28 20022014. 20022014 2002 2014. 2014 2002-2014 following non (FNA therapy workup p16 85.1% 851 85 1 (85.1 573 57 3 57.3 p16- 0.001 0001 0 001 24.6% 246 24 6 (24.6 517 51 7 51.7 0.001. . 77.7% 777 77 (77.7 628 62 8 62.8 0.006. 0006 0.006 006 0.006) 19.0% 190 19 (19.0 67 6.7 0.007 0007 007 11.8% 118 11 (11.8 34 4 3.4 p16, , 0.03. 003 0.03 03 0.03) nonHPV treatment 2 2002201 200 201 2002-201 p1 85.1 (85. 5 57. 0.00 000 00 24.6 (24. 51. 77.7 (77. 62. 19.0 (19. 6. 11.8 (11. 3. 0.0 200220 20 2002-20 85. (85 24. (24 77. (77 19. (19 11. (11 0. 20022 2002-2 (8 (2 (7 (1 2002- (

BACKGROUND: In South Africa, initiating and managing insulin in primary care for people living with type 2 diabetes (PLWD) is a major challenge. To address these challenges, a multidisciplinary team from the University of Pretoria (South Africa) developed the Tshwane Insulin project (TIP) intervention AIM: To determine internal and external factors, either facilitators or barriers, that could influence the implementation of the TIP intervention and propose strategies to ensure sustainability SETTING: Tshwane District, Gauteng province, South Africa METHODS: We used the SWOT framework to qualitatively analyse the strengths, weaknesses, opportunities, and threats influencing the implementation of the TIP intervention. Four field researchers and three managers from the TIP team participated in an online group discussion. We also conducted semi-structured interviews with healthcare providers (HCPs) (seven nurses, five doctors) and patients with type 2 diabetes (n = 13 RESULTS: Regardless of the identified weaknesses, the TIP intervention was accepted by PLWD and HCPs. Participants identified strengths including app-enabled insulin initiation and titration, pro-active patient follow-up, patient empowerment and provision of glucose monitoring devices. Participants viewed insulin resistance and the attitudes of HCPs as potential threats. Participants suggested that weaknesses and threats could be mitigated by translating education material into local languages and using the lived experiences of insulin-treated patients to address insulin resistance. The procurement of glucose monitoring devices by national authorities would promote the sustainability of the intervention CONCLUSION: Our findings may help decision-makers and health researchers to improve insulin management for PLWD in resource-constrained settings by using telehealth interventions

BACKGROUND: In South Africa, the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme allows stable patients with non-communicable diseases, including type 2 diabetes mellitus (T2DM), to collect their medication from a pick-up location near their home, thus avoiding long waiting times and travel expenses. The CCMDD programme aims at improving patient retention and adherence through better access to medicines, resulting in better health outcomes. AIM: We assessed whether patients with T2DM enrolled in CCMDD achieved the recommended targets for glycaemic, blood pressure (BP) and lipid control. SETTING: City of Tshwane, South Africa. METHODS: We reviewed the records of 198 T2DM patients enrolled in CCMDD and assessed their control of haemoglobin A1c (HbA1c), BP and lipids. RESULTS: Most of the records reviewed belonged to women (64.7%), African (89.9%), hypertensive (82.7%) and to patients exclusively on oral antidiabetic agents (98.5%). Patients were, on average, 57.7 (s.d. = 12.1) years old and had participated in the CCMDD programme for, on average, 2 years. The mean HbA1c was 8% (s.d. = 2). Glycaemic control was achieved by only 29.2% of patients, and 49% of patients had HbA1c between 7% and 9%. Ninety-three patients (66%) had achieved the total cholesterol target, 57.4% achieved BP targets and 6.9% had achieved the low-density lipoprotein cholesterol target. CONCLUSION: A small group of patients achieved the targets for glycaemic, BP and lipid control. Despite improved accessibility to medication, the CCMDD is not synonymous of improved clinical outcomes. Future research should ascertain the factors associated with suboptimal control for these patients.

We describe the earliest evidence for neoplastic disease in the hominin lineage. This is reported from the type specimen of the extinct hominin Australopithecus sediba from Malapa, South Africa, dated to 1.98 million years ago. The affected individual was male and developmentally equivalent to a human child of 12 to 13 years of age. A penetrating lytic lesion affected the sixth thoracic vertebra. The lesion was macroscopically evaluated and internally imaged through phase-contrast X-ray synchrotron microtomography. A comprehensive differential diagnosis was undertaken based on gross- and micro-morphology of the lesion, leading to a probable diagnosis of osteoid osteoma. These neoplasms are solitary, benign, osteoid and bone-forming tumours, formed from well-vascularised connective tissue within which there is active production of osteoid and woven bone. Tumours of any kind are rare in archaeological populations, and are all but unknown in the hominin record, highlighting the importance of this discovery. The presence of this disease at Malapa predates the earliest evidence of malignant neoplasia in the hominin fossil record by perhaps 200 000 years.

El manatí amazónico (Trichechus inunguis) es un mamífero acuático que habita en ambientes de agua dulce y es endémico de la cuenca del Amazonas. La presencia de Toxoplasma gondii se investigó en 19 manatíes, en una unidad de rescate en la región norte del Perú. Los anticuerpos contra T. gondii fueron detectados en 12 (63,2 %), de 19 animales mediante el uso de la prueba de aglutinación modificada (título, 1:25). No fue observada asociación entre el sexo y edad de los animales con la presencia de anticuerpos de T. gondii (p < 0,05). Los resultados sugieren la contaminación por ooquistes de T. gondii en el medio acuático donde viven estos animales.

The Amazonian manatee (Trichechus inunguis) is an aquatic mammal that inhabits freshwater environments and is endemic to the Amazon Basin. The presence of Toxoplasma gondii antibodies was investigated in 19 manatees in one rescue unit in the northern region of Peru. Antibodies to T. gondii were detected in 12 (63.2 %) of 19 animals by using the modified agglutination test (titer, 1:25), and no association between sex and age of the animals and the presence of T. gondii antibodies was observed (p < 0.05). The results suggest a contamination by T. gondii oocysts in the aquatic environment where these animals live.

Although leprosy is curable with drug treatment, the identification of biomarkers of infection, disease progression and treatment efficacy would greatly help to reduce the overall prevalence of the disease. Reliable biomarkers would also reduce the incidence of grade-2 disability by ensuring that those who are most at risk are diagnosed and treated early or offered repeated treatments in the case of relapse. In this study, we examined the reactivity of sera from lepromatous and tuberculoid leprosy patients (LPs) against a panel of 12 recombinant Mycobacterium leprae proteins and found that six proteins were strongly recognised by multibacillary (MB) patients, while only three were consistently recognised by paucibacillary patients. To better understand the dynamics of patient antibody responses during and after drug therapy, we measured antibody titres to four recombinant proteins, phenolic glycolipid-I and lipoarabinomannan at baseline and up to two years after diagnosis to investigate the temporal changes in the antibody titres. Reactivity patterns to individual antigens and decreases in antibody titres were patient-specific. Antibody titres to proteins declined more rapidly vs. those to carbohydrate and glycolipid antigens. Compared to baseline values, increases in antibody titres were observed during reactional episodes in one individual. Additionally, antibody responses against a subset of antigens that provided a good prognostic indicator of disease progression were analysed in 51 household contacts of MB index cases for up to two years. Although the majority of these contacts showed no change or exhibited decreases in antibody titres, seven individuals developed higher titres towards one or more of these antigens and one individual with progressively higher titres was diagnosed with borderline lepromatous leprosy 19 months after enrolment. The results of this study indicate that antibody titres to specific M. leprae antigens can be used to monitor treatment efficacy in LPs and assess disease progression in those most at risk for developing this disease.

OBJECTIVE: Human papillomavirus (HPV) genotypes and their relative prevalences were determined in a cohort of 310 sexually active women in Trinidad, West Indies. METHODS: Cervical samples were collected with Ayre's spatulas and endocervical brushes. Samples were used for the conventional Papanicolaou test and for determining HPV genotypes by amplification of a section of the viral L1 gene, followed by DNA sequencing and probe hybridization. RESULTS: HPV infections were identified in 126 of 310 (40.6%) women. Of them, 83 (65.8%) were infected with high-risk HPV, 16 (12.7%) with low-risk HPV, and 27 (21.4%) with HPV types of unknown risk. HPV 52 (12.7%) was the most frequently occurring high-risk type, followed by HPV 66 (10.3%), HPV 16 (9.5%), and HPV 18 (8.6%). High-risk types HPV 16 and HPV 66 were each found in 3 (20.0%) and HPV 18 was found in 1 (6.6%) of the 15 women with abnormal cytology. CONCLUSIONS: Cervical HPV prevalence and heterogeneity of HPV genotypes are high in this Trinidad cohort. The relative importance of HPV genotypes in the development of cervical lesions needs further investigation in Trinidad in order to better understand the epidemiology of HPV infections as well as to determine the role of HPV testing in the screening, prevention, and control of cervical cancer. This pilot study provided important information on the prevalence of HPV genotypes, which will be used in future nationwide studies.

OBJETIVO: Se determinaron los genotipos del papilomavirus humano (PVH) y su prevalencia relativa en una cohorte de 310 mujeres sexualmente activas de Trinidad, en la zona de las Indias Occidentales. MÉTODOS: Se tomaron muestras del cuello uterino con espátula de Ayre y cepillo endocervical. Las muestras se usaron para llevar a cabo la prueba convencional de Papanicolaou y para determinar los genotipos de PVH mediante la amplificación de una sección del gen vírico L1, seguida de secuenciación del ADN e hibridación con sonda. RESULTADOS: Se encontró una infección por PVH en 126 de las 310 mujeres (40,6%). De ellas, 83 (65,8%) estaban infectadas con PVH de alto riesgo, 16 (12,7%) con PVH de bajo riesgo, y 27 (21,4%) con tipos de PVH de riesgo desconocido. De los PVH de alto riesgo, el más frecuente fue el PVH 52 (12,7%), seguido por el PVH 66 (10,3%), el PVH 16 (9,5%) y el PVH 18 (8,6%). Entre las 15 mujeres con citología anormal se encontraron los PVH de alto riesgo 16 y 66 en 3 (20,0%) mujeres cada uno, y el PVH 18 en 1 (6,6%). CONCLUSIONES: Tanto la prevalencia de PVH en el cuello uterino como la heterogeneidad de los genotipos de PVH son elevadas en esta cohorte de Trinidad. La importancia relativa de los genotipos de PVH en la aparición de las lesiones cervicales requiere de mayor investigación en Trinidad para conocer más a fondo las características epidemiológicas de las infecciones por PVH, así como para determinar el papel del estudio de los PVH en la detección sistemática, la prevención y el control del cáncer del cuello uterino. Este estudio piloto suministró información importante sobre la prevalencia de los genotipos de PVH, que se usará en futuros estudios que se lleven a cabo en todo el país.

The gamitana is a species of socio-economic importance in the Peruvian Amazon, often intensively produced locally for human consumption. Because of this, more studies concerning parasite populations affecting this species' culture are necessary. In this study, a heavy copepod infestation of Perulernaea gamitanae is reported in a managed culture of gamitana. The prevalence of infection was 100% and mortality of the fish population was complete. The average intensity and abundance of the parasite was 268.8 parasites per individual.

La gamitana constituye una especie de importancia socioeconómica en la Amazonia peruana, que ha llevado a su producción intensiva para el consumo humano, pero se requieren más estudios respecto de la población de parásitos que estén afectando su cultivo. En este estudio se identificó una alta infestación por copépodos de la especie Perulernaea gamitanae en un cultivo de gamitana. La prevalencia fue de 100%, con mortalidad de todos los peces. La intensidad media y la abundancia fue, en ambos casos, de 268.8 parásitos por individuo.

Além das normas de referência provenientes das estatísticas - quando comportamentos da pessoa a ser cuidada ou educada devem ser levados em conta de maneira singular - o posicionamento dos cuidadores é dificultado entre imperativos oriundos de modelos normativos que se referem à doença e não levam em conta os doentes de um lado e, do outro lado, a evidência de dever considerar as particularidades próprias a cada sujeito que se acompanha e que interferem, necessariamente, sobre a saúde pelos comportamentos mas que são fonte de complexidade, portanto difícil de tratar. A transdisciplinaridade convida ao imperativo de mudança paradigmática e de um caminho de dupla face, com essa bipartição não podendo jamais distinguir- se totalmente. Ela se aproxima por um lado - o que corresponde a sua definição clássica - de uma epistemologia que apontaria para a importância nova das fronteiras disciplinares, das zonas imprecisas, não acessíveis aos fechamentos clássicos que definem os objetos disciplinares. Mas ela impõe, por outro lado, a construção de nova epistemologia do sujeito e que participa sempre, de uma maneira ou de outra, da observação pela sua interação mais ou menos forte com o objeto, o que definimos pelo neologismo "antropoformação". Pela mudança que opera, ela permite oferecer, ao mesmo tempo, uma atitude para religar os saberes disciplinares entre eles e uma capacidade de integração do sujeito, sua indisciplina e suas interações. Ela conduz para uma fenomenologia da saúde associando os modos de ser aos modos de compreender. O texto visa a precisar, no campo da saúde, os diferentes pontos levantados por essa mudança paradigmática.

Besides the reference norms from statistics - when the behavior of the person to be cared for or educated has to be taken into account in a singular way - the position of the care takers is difficult because of normative models related to the diseases that do not take in account the patients in one side, and in the other the obligation to consider the particularities of each person that interfere on health by behaviors but are source of complexity, thus difficult to treat. Transdisciplinarity invites to a paradigmal change to a two way road, with this parting being unable to be totally identified. It is close to - corresponding to its traditional meaning - an epistemology that points to the importance of new disciplinary frontiers, of non-defined zones, unreachable by traditional closed scientific objects. But it imposes, on the other hand, the construction of a new epistemology of the subject that always participates, in a way or another, of the observation by his strong interaction with the object, that we define by the neologism "anthropoformation". By the change it causes, it permits to offer, at the same time, an attitude to untie disciplinary knowledges among them and a capacity of integrating the subject, his undiscipline and his interactions. It drives you to a phenomenology of health by associating the ways of being and the ways of understanding. The text aims to precise, in the field of health, different points raised by this paradigmatical change.

Au-delà des normes de référence issues des statistiques, sitôt que les comportements de la personne à soigner ou à éduquer doivent être pris en compte de façon singulière, le positionnement des soignants devient difficile entre impératifs issus des modèles normatifs se référant à la maladie mais ne tenant nul compte des malades d'un côté et de l'autre l'évidence de devoir considérer les particularités propres à chaque sujet que l'on accompagne et qui interfèrent, nécessairement, sur la santé par les comportements mais qui sont source de complexité, donc difficile à traiter. La transdisciplinarité engage à l'impératif d'un changement paradigmatique et d'un cheminement à double face, cette bipartition ne pouvant jamais totalement se distinguer. Elle s'apparente d'une part, ce qui correspond à sa définition classique, à une épistémologie qui pointerait l'importance nouvelle des frontières disciplinaires, des zones floues, non accessibles aux clôtures classiques qui définissent les objets disciplinaires. Mais elle impose d'autre part la construction d'une nouvelle épistémologie du sujet qui participe toujours, d'une manière ou de l'autre, à l'observation par son interaction plus ou moins forte avec l'objet, ce que nous définissons par le néologisme « d'anthropoformation ». Par le changement qui s'opère elle permet d'offrir à la fois une aptitude à relier les savoirs disciplinaires entre eux et une capacité d'intégration du sujet, de son indiscipline et de ses interactions. Elle dirige vers une phénoménologie de la santé associant les modes d'être aux modes de comprendre. Le texte vise à préciser, dans le champ de la santé, les différents points soulevés par ce changement paradigmatique.

Além das normas de referência provenientes das estatísticas - quando comportamentos da pessoa a ser cuidada ou educada devem ser levados em conta de maneira singular - o posicionamento dos cuidadores é dificultado entre imperativos oriundos de modelos normativos que se referem à doença e não levam em conta os doentes de um lado e, do outro lado, a evidência de dever considerar as particularidades próprias a cada sujeito que se acompanha e que interferem, necessariamente, sobre a saúde pelos comportamentos mas que são fonte de complexidade, portanto difícil de tratar. A transdisciplinaridade convida ao imperativo de mudança paradigmática e de um caminho de dupla face, com essa bipartição não podendo jamais distinguir- se totalmente. Ela se aproxima por um lado - o que corresponde a sua definição clássica - de uma epistemologia que apontaria para a importância nova das fronteiras disciplinares, das zonas imprecisas, não acessíveis aos fechamentos clássicos que definem os objetos disciplinares. Mas ela impõe, por outro lado, a construção de nova epistemologia do sujeito e que participa sempre, de uma maneira ou de outra, da observação pela sua interação mais ou menos forte com o objeto, o que definimos pelo neologismo "antropoformação". Pela mudança que opera, ela permite oferecer, ao mesmo tempo, uma atitude para religar os saberes disciplinares entre eles e uma capacidade de integração do sujeito, sua indisciplina e suas interações. Ela conduz para uma fenomenologia da saúde associando os modos de ser aos modos de compreender. O texto visa a precisar, no campo da saúde, os diferentes pontos levantados por essa mudança paradigmática.

Besides the reference norms from statistics - when the behavior of the person to be cared for or educated has to be taken into account in a singular way - the position of the care takers is difficult because of normative models related to the diseases that do not take in account the patients in one side, and in the other the obligation to consider the particularities of each person that interfere on health by behaviors but are source of complexity, thus difficult to treat. Transdisciplinarity invites to a paradigmal change to a two way road, with this parting being unable to be totally identified. It is close to - corresponding to its traditional meaning - an epistemology that points to the importance of new disciplinary frontiers, of non-defined zones, unreachable by traditional closed scientific objects. But it imposes, on the other hand, the construction of a new epistemology of the subject that always participates, in a way or another, of the observation by his strong interaction with the object, that we define by the neologism "anthropoformation". By the change it causes, it permits to offer, at the same time, an attitude to untie disciplinary knowledges among them and a capacity of integrating the subject, his undiscipline and his interactions. It drives you to a phenomenology of health by associating the ways of being and the ways of understanding. The text aims to precise, in the field of health, different points raised by this paradigmatical change.

Au-delà des normes de référence issues des statistiques, sitôt que les comportements de la personne à soigner ou à éduquer doivent être pris en compte de façon singulière, le positionnement des soignants devient difficile entre impératifs issus des modèles normatifs se référant à la maladie mais ne tenant nul compte des malades d'un côté et de l'autre l'évidence de devoir considérer les particularités propres à chaque sujet que l'on accompagne et qui interfèrent, nécessairement, sur la santé par les comportements mais qui sont source de complexité, donc difficile à traiter. La transdisciplinarité engage à l'impératif d'un changement paradigmatique et d'un cheminement à double face, cette bipartition ne pouvant jamais totalement se distinguer. Elle s'apparente d'une part, ce qui correspond à sa définition classique, à une épistémologie qui pointerait l'importance nouvelle des frontières disciplinaires, des zones floues, non accessibles aux clôtures classiques qui définissent les objets disciplinaires. Mais elle impose d'autre part la construction d'une nouvelle épistémologie du sujet qui participe toujours, d'une manière ou de l'autre, à l'observation par son interaction plus ou moins forte avec l'objet, ce que nous définissons par le néologisme « d'anthropoformation ». Par le changement qui s'opère elle permet d'offrir à la fois une aptitude à relier les savoirs disciplinaires entre eux et une capacité d'intégration du sujet, de son indiscipline et de ses interactions. Elle dirige vers une phénoménologie de la santé associant les modes d'être aux modes de comprendre. Le texte vise à préciser, dans le champ de la santé, les différents points soulevés par ce changement paradigmatique.

A ética, como julgamento de apreciação das condutas positivas e negativas, tanto no que diz respeito ao usuário como ao profissional, coloca de início a problemática do desejo e do conhecimento. A educação para a saúde, através dos três modelos classicamente referidos da saúde positiva, da saúde negativa e da saúde global, vai interrogar de variadas maneiras o posicionamento ético em função dos pontos de vista diferentes fortemente ligados às representações sociais. Além disso, o questionamento ético da saúde inscreve-se também naquele, mais largo, da filosofia da educação entre praxis e poïesis. Mas ele impõe também a aceitação do acidente como imperativo que valoriza o erro, com a introdução da complexidade vindo quebrar o dogma das certezas. Reunir as diferentes facetas da saúde e de sua educação sugere então, finalmente, que tomar cuidado é viver o mais autenticamente possível, com o educar para a saúde significando formar e formar-se para a autenticidade.

Ethics, as a value judgement about positive and negative attitudes regarding the users as well as the professional, raises at the onset the issue of desire and knowledge. Through the three models traditionally referred to - positive health, negative health and global health - health education will question the ethical position in differing ways, according to points of view which vary with and are closely linked to socially biased representations. Moreover, the ethical questioning on health also falls within the broader scope of education philosophy, between praxis and poiesis. But it also implies accepting the accident as a necessity that gives value to error, the introduction of complexity then breaking the dogma of certainty. Putting together the various dimensions of health and health education seems to imply that, all things considered, taking care means living as authentically as possible, health education thus meaning training others and oneself to authenticity.

L'éthique, comme jugement d'aprréciation sur les conduites positives et négatives, tant en ce qui concerne l'usager que le professionnel, pose d'emblée la problématique du désir et de la connaissance. L'éducation à la santé, au travers des trois modèles classiquement référencés de la santé positive, de la santé négative et de la santé globale, va interroger différemment le positionnement éthique en fonction des points de vue différents fortement liés aux représentations sociales. Par ailleurs, le questionnement éthique de la santé s'inscrit aussi dans celui, plus large, de la philosophie de l'éducation entre praxis et poiesis. Mais il impose aussi l'acceptation de l'accident comme impératif donnant un prix à l'erreur, l'introduction de la complexité venant briser le dogme des certitudes. réunir les différentes facettes de la santé et de son éducation suggère alors, au bout du compte, que prendre soin c'est vivre le plus authentiquement possible, éduquer à la santé devenant former et se former à l'authenticité.

A ética, como julgamento de apreciação das condutas positivas e negativas, tanto no que diz respeito ao usuário como ao profissional, coloca de início a problemática do desejo e do conhecimento. A educação para a saúde, através dos três modelos classicamente referidos da saúde positiva, da saúde negativa e da saúde global, vai interrogar de variadas maneiras o posicionamento ético em função dos pontos de vista diferentes fortemente ligados às representações sociais. Além disso, o questionamento ético da saúde inscreve-se também naquele, mais largo, da filosofia da educação entre praxis e poïesis. Mas ele impõe também a aceitação do acidente como imperativo que valoriza o erro, com a introdução da complexidade vindo quebrar o dogma das certezas. Reunir as diferentes facetas da saúde e de sua educação sugere então, finalmente, que tomar cuidado é viver o mais autenticamente possível, com o educar para a saúde significando formar e formar-se para a autenticidade.

Ethics, as a value judgement about positive and negative attitudes regarding the users as well as the professional, raises at the onset the issue of desire and knowledge. Through the three models traditionally referred to - positive health, negative health and global health - health education will question the ethical position in differing ways, according to points of view which vary with and are closely linked to socially biased representations. Moreover, the ethical questioning on health also falls within the broader scope of education philosophy, between praxis and poiesis. But it also implies accepting the accident as a necessity that gives value to error, the introduction of complexity then breaking the dogma of certainty. Putting together the various dimensions of health and health education seems to imply that, all things considered, taking care means living as authentically as possible, health education thus meaning training others and oneself to authenticity.

L'éthique, comme jugement d'aprréciation sur les conduites positives et négatives, tant en ce qui concerne l'usager que le professionnel, pose d'emblée la problématique du désir et de la connaissance. L'éducation à la santé, au travers des trois modèles classiquement référencés de la santé positive, de la santé négative et de la santé globale, va interroger différemment le positionnement éthique en fonction des points de vue différents fortement liés aux représentations sociales. Par ailleurs, le questionnement éthique de la santé s'inscrit aussi dans celui, plus large, de la philosophie de l'éducation entre praxis et poiesis. Mais il impose aussi l'acceptation de l'accident comme impératif donnant un prix à l'erreur, l'introduction de la complexité venant briser le dogme des certitudes. réunir les différentes facettes de la santé et de son éducation suggère alors, au bout du compte, que prendre soin c'est vivre le plus authentiquement possible, éduquer à la santé devenant former et se former à l'authenticité.

OBJECTIVE: To describe the characteristics of compatible poliomyelitis cases and to assess the programmatic implications of clusters of such cases in India. METHODS: We described the characteristics of compatible poliomyelitis cases, identified clusters of compatible cases (two or more in the same district or neighbouring districts within two months), and examined their relationship to wild poliovirus cases. FINDINGS: There were 362 compatible cases in 2000. The incidence of compatible cases was higher in districts with laboratory-confirmed poliomyelitis cases than in districts without laboratory-confirmed cases. Of 580 districts, 96 reported one compatible case and 72 reported two or more compatible cases. Among these 168 districts with at least one compatible case, 123 had internal or cross- border clusters of compatible cases. In 27 districts with clusters of compatible cases, no wild poliovirus was isolated either in the same district or in neighbouring districts. Three of these 27 districts presented laboratory-confirmed poliomyelitis cases during 2001. CONCLUSION: Most clusters of compatible cases occurred in districts identified as areas with continuing wild poliovirus transmission and where mopping-up vaccination campaigns were carried out. As certification nears, areas with compatible poliomyelitis cases should be investigated and deficiencies in surveillance should be corrected in order to ensure that certification is justified.

OBJETIVO: Describir las características de los casos de aparente poliomielitis y evaluar las implicaciones programáticas de los agrupamientos de esos casos en la India. MÉTODOS:Identificamos agrupamientos de casos compatibles con el diagnóstico de poliomielitis (dos o más en el mismo distrito o en distritos vecinos en un plazo de dos meses) y su relación con los casos debidos al poliovirus salvaje. RESULTADOS: En 2000 se registraron 362 casos compatibles. La incidencia de casos compatibles fue mayor en los distritos con casos de poliomielitis confirmados en laboratorio. De 580 distritos, 96 notificaron un caso compatible y 72 notificaron dos o más casos compatibles. Entre esos 168 distritos donde hubo al menos un caso compatible, 123 presentaban agrupamientos internos o transfronterizos de casos compatibles. No se aislaron poliovirus salvajes en 27 de los distritos donde se hallaron agrupamientos, ni en ninguno de los distritos vecinos. Tres de esos 27 distritos presentaron casos de poliomielitis confirmados en laboratorio durante 2001. CONCLUSIÓN: La mayoría de los agrupamientos de casos compatibles se dieron en distritos donde seguía habiendo transmisión del poliovirus salvaje y donde se estaban llevando a cabo campañas de vacunación de barrido. A medida que se aproxima la fecha de certificación, habría que investigar las zonas con casos de aparente poliomielitis, y corregir los fallos de la vigilancia detectados a fin de asegurar que la certificación esté justificada.

OBJECTIF: Décrire les caractéristiques des cas compatibles avec un diagnostic de poliomyélite et évaluer les conséquences programmatiques de la présence d'agrégats de tels cas en Inde. MÉTHODES: Nous avons identifié des agrégats de cas compatibles avec un diagnostic de poliomyélite (deux ou plusieurs cas dans le même district ou dans des districts voisins sur une période de deux mois) et examiné leur relation avec les cas dus au poliovirus sauvage. RÉSULTATS: En 2000, 362 cas compatibles ont été dénombrés. L'incidence de ces cas était plus élevée dans les districts comptant des cas de poliomyélite confirmés au laboratoire. Sur 580 districts, 96 ont rapporté un cas compatible et 72 deux ou plusieurs cas. Des agrégats de cas compatibles ont été observés soit à l'intérieur du district soit sur la zone frontalière dans 123 des 168 districts ayant rapporté au moins un cas compatible. Dans 27 des districts possédant des agrégats de cas, aucun poliovirus sauvage n'a été isolé, non plus que dans les districts voisins. Trois de ces 27 districts ont connu des cas de poliomyélite confirmés au laboratoire en 2001. CONCLUSION: La plupart des agrégats de cas compatibles avec un diagnostic de poliomyélite ont été observés dans des districts où la transmission du poliovirus sauvage se poursuit et où des campagnes de vaccination par ratissage sont en cours. Comme le moment de la certification approche, les zones possédant des cas compatibles avec un diagnostic de poliomyélite devront faire l'objet d'investigations et tout défaut de surveillance devra être corrigé afin d'assurer que la certification est justifiée.