Gene/Protein Disease Symptom Drug Enzyme Compound
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Early passive case finding and treatment compliance are the cornerstones of tuberculosis (TB) control programs. As human behavior plays a critical role in both strategies, a better understanding of it is important for the planning and implementation of a successful TB programme, especially for the health education component, Our qualitative study in Uasin Gishu, Kenya, aimed at a better understanding of the community's beliefs and perceptions of TB, recognition of early symptoms and health-seeking behavior. Five focus groups with a total of 49 people were held: on with hospitalized TB patients, two with rural and two with urban participants. Tuberculosis is well known in the communities and many vernacular names for the disease exist. TB is perceived as a contagious, 'sensitive' disease difficult to diagnose and treat. Community members believe that TB should be diagnosed and treated in a hospital or by a medical doctor and not at the peripheric level. TB treatment is perceived as long, agonising and cumbersome. Traditional treatment is considered a valid alternative to modern treatment, believed to be as effective and much shorter. Initial symptoms such as cough and fever are often overlooked and/or confused with malaria or a common cold. Symptoms associated with the disease refer to the later stage of TB. TB is attributed to causes such as smoking, alcohol, hard work, exposure to cold and sharing with TB patients. Many participants believe TB is hereditary. Prolonged self-treatment and consultation with the traditional health sector as well as the social stigma attached to the disease increase patient's delay. Only after symptoms persist for some time and/or the suspect's health deteriorates, are modern health services consulted. These social conditions necessitate culturally sensitive health education, taking into account local perceptions of TB.
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PMID:From their own perspective. A Kenyan community's perception of tuberculosis. 929 51

More assertive political leadership in the global response to AIDS in both poor and rich countries culminated in June 2001 at the UN General Assembly Special Session on AIDS. Delegates made important commitments there, and endorsed a global strategy framework for shifting the dynamics of the epidemic by simultaneously reducing risk, vulnerability and impact. This points the way to achievable progress in the fight against HIV/AIDS. Evidence of success in tackling the spread of AIDS comes from diverse programme areas, including work with sex workers and clients, injecting drug users, and young people. It also comes from diverse countries, including India, the Russian Federation, Senegal, Thailand, the United Republic of Tanzania, and Zambia. Their common feature is the combination of focused approaches with attention to the societywide context within which risk occurs. Similarly, building synergies between prevention and care has underpinned success in Brazil and holds great potential for sub-Saharan Africa, where 90% reductions have been achieved in the prices at which antiretroviral drugs are available. Success also involves overcoming stigma, which undermines community action and blocks access to services. Work against stigma and discrimination has been effectively carried out in both health sector and occupational settings. Accompanying attention to the conditions for success against HIV/AIDS is global consensus on the need for additional resources. The detailed estimate of required AIDS spending in low- and middle-income countries is US$ 9.2 billion annually, compared to the $ 2 billion currently spent. Additional spending should be mobilized by the new global fund to fight AIDS, tuberculosis and malaria, but needs to be joined by additional government and private efforts within countries, including from debt relief. Commitment and capacity to scale up HIV prevention and care have never been stronger. The moment must be seized to prevent a global catastrophe.
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PMID:International response to the HIV/AIDS epidemic: planning for success. 1208 Sep 56

An estimated 800,000 children acquired HIV-infection in 2002, most as a result of mother-to-child transmission (MTCT), and vertically-acquired HIV infection continues to be of major public health importance. Prevention of MTCT is possible with a combination of interventions including antiretroviral therapy (ART) (usually in highly active combinations), elective caesarean section and avoidance of breastfeeding, and where infected women are identified before or in pregnancy and have access to these interventions, risk of MTCT is now below 1-2%. However, prompt identification of pregnant women with HIV infection remains pressing in many developed countries; additionally, concerns have arisen regarding adherence to complex treatment regimens in pregnancy and the potential impact of HIV drug resistance. More disturbingly, most HIV-infected women live in developing countries where many pregnant women even when tested do not return for their HIV results for a variety of reasons including stigma, and where most, if not all, strategies for prevention of MTCT have been of limited accessibility and/or feasibility. However, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other initiatives including pharmaceutical companies' donation programmes and generic antiretroviral drug production have made prevention of MTCT in resource-poor settings an increasingly realistic goal, coupled with new evidence from clinical trials on the efficacy of abbreviated regimens of antiretroviral prophylaxis, including combination therapy, to prevent MTCT. Research is additionally focussing on reducing the risk of postnatal transmission through breastfeeding, with exclusive breastfeeding, early cessation and antiretroviral prophylaxis to breastfeeding women or breastfed infants under investigation. However, the key to prevention of paediatric HIV infections is adequate prevention of infection in women of reproductive age.
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PMID:Mother-to-child transmission of HIV infection and its prevention. 1504 30

The objective of this study was to learn about the travel health practices of Nigerians in Houston, Texas, and to describe factors affecting adherence to recommendations for the prevention of malaria, typhoid, and hepatitis A set forth by the Centers for Disease Control and Prevention (CDC). Data were collected through focus group discussions and one-on-one interviews with travelers and health care providers. Data collection and analysis relied on a process-based framework that included questions about health and health-maintenance strategies before, during, and after travel. The cost of travel health services and the availability of vaccines and medications were important structural barriers to adherence. Perceptions of individual susceptibility and disease severity varied across the infections of interest. Travelers perceive themselves to be at risk for malaria, but are generally not concerned about its consequences. A notable exception is the fear of becoming symptomatic post-travel in the United States. Typhoid was less salient than malaria, and few had heard of or worried about acquiring hepatitis A. Stigma associated with the acquisition of travel-related conditions and the perceived incompetence of physicians to treat illnesses related to overseas travel, and malaria in particular, also affect preventive decisions and strategies. The results of the study have broad relevance for the traveling public and for programs and services that seek to improve travel health and travel health care.
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PMID:Adherence to travel health guidelines: the experience of Nigerian immigrants in Houston, Texas. 1622

Harm reduction (HR) interventions began in Central-Eastern Europe and Central Asia in the mid-1980s with the establishment of substitution treatment (ST) in Yugoslavia. In the mid-1990s, the first needle and syringe programmes (NSPs) opened in selected countries following the outbreaks of HIV among injecting drug users (IDUs). The number of NSPs continues to increase via a combination of international and state funding with large expansions made possible via the Global Fund to Fight AIDS, Tuberculosis and Malaria. While ST is still unaccepted in several countries, others have made some progress which is especially visible in South Eastern and Central Europe and the Baltic States. Development of regional networking including Central and Eastern European HR Network and a number of national networks helped to coordinate joint advocacy effort and in some cases sustain HR services. Activism of drug users and people living with HIV (PLWH) increased in the region in the last several years and helped to better link HR with the affected communities. Still a number of challenges remain important for the movement today such as repressive drug policies; stigma and discrimination of IDUs, PLWH, sex workers and inmates, including poor access to prevention and treatment; lack of important components of HR work such as naloxone distribution and hepatitis B vaccination, prevention in prisons; issues of quality control; sustaining services after finishing of major international projects; reaching of adequate coverage and others.
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PMID:Implementation of harm reduction in Central and Eastern Europe and Central Asia. 1768 55

Cutaneous Leishmaniasis (CL), a disfiguring disease, is prevalent in many parts of Pakistan and neighboring Afghanistan. Leishmaniasis is second only to malaria in terms of the number of people affected; it is a major public health issue with significant social stigma. Although the different methods to diagnose and treat the disease are well discussed in the literature, the role of vector control in the prevention of CL has been underemphasized. Both Pubmed and Ovid search engines were used to obtain articles on prevention and control of cutaneous leishmaniasis. These materials were then screened for articles pertaining to vector control only. The World Health Organization's website along with the Cochrane database were also searched for relevant text. From this qualitative review, it can be seen that many effective interventions exist. Considering the multitude of factors involved in transmission of CL and the various effective control measures tried and tested by investigators, an interdisciplinary approach involving more than one of the above interventions would make sense. The interventions selected would then depend on the incidence of CL in that particular area, the population being targeted, the reservoir, the particular vector, the environment, the acceptability/popularity of the intervention, and the availability of funds.
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PMID:Vector control in cutaneous leishmaniasis of the old world: a review of literature. 1871 82

Among parasitic diseases, morbidity and mortality caused by leishmaniasis are surpassed only by malaria and lymphatic filariasis. However, estimation of the leishmaniasis disease burden is challenging, due to clinical and epidemiological diversity, marked geographic clustering, and lack of reliable data on incidence, duration, and impact of the various disease syndromes. Non-health effects such as impoverishment, disfigurement, and stigma add to the burden, and introduce further complexities. Leishmaniasis occurs globally, but has disproportionate impact in the Horn of Africa, South Asia and Brazil (for visceral leishmaniasis), and Latin America, Central Asia, and southwestern Asia (for cutaneous leishmaniasis). Disease characteristics and challenges for control are reviewed for each of these foci. We recommend review of reliable secondary data sources and collection of baseline active survey data to improve current disease burden estimates, plus the improvement or establishment of effective surveillance systems to monitor the impact of control efforts.
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PMID:Complexities of assessing the disease burden attributable to leishmaniasis. 1895 80

The emergence of opportunities for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for HIV-related projects has so far generated funding of over US$75 million for three proposals in Peru. The size of this investment creates the need for close monitoring to ensure a reasonable impact. This paper describes the effects of collaboration with the GFATM on key actors involved in HIV-related activities and on decision-making processes; on health sector divisions; on policies and sources of financing; on equity of access; and on stigma and discrimination of vulnerable and affected populations. Data analysed included primary data collected through interviews with key informants, in-depth interviews and group discussions with vulnerable and affected populations, as well as several public documents. Multisectorality, encouraged by the GFATM, is incipient; centralist proposals with limited consultation, a lack of consensus and short preparation times prevail. No accountability mechanisms operate at the Country Coordinating Mechanism (CCM) level regarding CCM members or society as a whole. GFATM-funded activities have required significant input from the public sector, sometimes beyond the capacity of its human resources. A significant increase in HIV funding, in absolute amounts and in fractions of the total budget, has been observed from several sources including the National Treasury, and it is unclear whether this has implied reductions in the budget for other priorities. Patterns of social exclusion of people living with HIV/AIDS are diverse: children and women are more valued; while transgender persons and sex workers are often excluded.
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PMID:Implementation effects of GFATM-supported HIV/AIDS projects on the health sector, civil society and affected communities in Peru 2004-2007. 2039 Jun 30

Plants of the Verbenaceae family, like L. camara, have called the attention of researchers, not only because of its high diversity and its distribution around the world, but also for its variable use as popular medicine to treat diseases like tetanus, rheumatism and malaria, and as bactericide and insecticide. To assess this, the morphology and ontogeny of the inflorescences of Lantana camara and the chemical composition of volatile secondary metabolites were analyzed at three different ontogeny stages. Plants were collected from the experimental crop area in CENIVAM, Bucaramanga, Colombia. Fresh inflorescence stages were established and analyzed using a stereoscopic microscope, fixed in FAA and included in parafine. Transversal and longitudinal 10 microm thick sections were prepared using a rotative microtome, safranine-fastgreen stained and were observed and photographed using a light microscope. The chemical composition of volatile secondary metabolites were analyzed for each stage. The analytes, obtained from 0.7 g of plant, were isolated by solid phase micro-extraction in the headspace mode (HS-SPME) and were placed in 20 ml vials. The components were analyzed by gas chromatography coupled to mass spectrometry (GC-MS). Stage I was microscopically characterized by an immature development in which the meristematic differentiation begins with a mass of cells. In Stage II, the morphogenetic movement gives way to the formation of the respective floral sexual structures, calyx and corolla. In Stage III, the different organs are conspicuous: four stamens epipetals and didynamous, monocarpelar, biloculate and globose gynoecium, upper ovary and lateral stigma; the flowers are hermaphroditic. The main secondary metabolites detected by GC-MS were bicyclosesquiphellandrene, E-beta-farnesene, E-beta-caryophyllene, gamma-muurolene + gamma-curcumene and alpha-zingiberene. Nevertheless, this study reports for the first time in plant species alpha-gurjunene, gamma-amorphene, alpha-muurolene, sesquithujene, alpha-trans-bergamotene and trans-cadina-1,4-diene. The diversity of compounds found can be only explained by the extraction methods employed, the developmental stages and section of the plant, the geographic conditions, collection time and the genetic constitution of the evaluated species.
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PMID:[Microscopic anatomy and volatile secondary metabolites at three stages of development of the inflorescences of Lantana camara (Verbenaceae)]. 2151 61

HIV testing and counseling services in Africa began in the early 1990s, with limited availability and coverage. Fears of stigma and discrimination, complex laboratory systems, and lack of available care and treatment services hampered expansion. Use of rapid point-of-care tests, introduction of services to prevent mother-to-child transmission, and increasing provision of antiretroviral drugs were key events in the late 1990s and early 2000s that facilitated the expansion of HIV testing and counseling services. Innovations in service delivery included providing HIV testing in both clinical and community sites, including mobile and home testing. Promotional campaigns were conducted in many countries, and evolutions in policies and guidance facilitated expansion and uptake. Support from President's Emergency Plan for AIDS Relief and national governments, other donors, and the Global Fund for AIDS, Tuberculosis, and Malaria contributed to significant increases in the numbers of persons tested in many countries. Quality of both testing and counseling, limited number of health care workers, uptake by couples, and effectiveness of linkages and referral systems remain challenges. Expansion of antiretroviral treatment, especially in light of the evidence that treatment contributes to prevention of transmission, will require greater yet strategic coverage of testing services, especially in clinical settings and in combination with other high-impact HIV prevention strategies. Continued support from President's Emergency Plan for AIDS Relief, governments, and other donors is required for the expansion of testing needed to achieve international targets for the scale-up of treatment and universal access to knowledge of HIV status.
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PMID:"What took you so long?" The impact of PEPFAR on the expansion of HIV testing and counseling services in Africa. 2279 42


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