This study examines the legal battles of the three Ayahuasca religious groups. Once founded in Brazil, they waged a long campaign to gain freedom by the government to practice their beliefs. The three groups are: Santo Daime, Barquinha, and União do Vegetal (UDV). This work also provides the historical background of each group, its principal beliefs and rites, and the social status of its members. Extensive references and bibliography are included.
Profiles Bachelet, Chiles first female president. Her so-called feminine style is considered before providing background on her. It is argued that while she may be more sensitive to gender issues, she may not have a gender-based agenda; in fact, her victory was not occasioned by women as male & female vote counts for her were nearly equal. Her cabinet & program are described, attending to her desire to convert Chile into a welfare state. The challenges she faces are discussed, including the need to address Chiles inequality. D. Edelman
This study investigated the influence of sociocontextual factors on maternal caregiving behaviors in 27 Mexican American families with both a mother and father and a toddler. Observations of family and dyadic tasks or interactional scenarios in laboratory settings were used to assess the coparenting relationship and the mothers' sensitivity, intrusiveness, and disengagement with their children. Mothers also completed demographic and acculturation questionnaires. Results showed that the mothers' generation level significantly predicted sensitivity. Findings further revealed that coparental competition was significant in predicting intrusiveness in the mothers' caregiving. Results show how culture, family, and characteristics of mothers collaborate to predict the mothers' caregiving behaviors.
Objective: Quantify the effect of thermal stressors on human performance. Background: Most reviews of the effect of environmental stressors on human performance are qualitative. A quantitative review provides a stronger aid in advancing theory and practice. Method: Meta-analytic methods were applied to the available literature on thermal stressors and performance. A total of 291 references were collected. Forty-nine publications met the selection criteria, providing 528 effect sizes for analysis. Results: Analyses confirmed a substantial negative effect on performance associated with thermal stressors. The overall effect size for heat was comparable to that for cold. Cognitive performance was least affected by thermal stressors, whereas both psychomotor and perceptual task performance were degraded to a greater degree. Other variables were identified that moderated thermal effects. Conclusion: Results confirmed the importance of task type, exposure duration, and stressor intensity as key variables impacting how thermal conditions affect performance. Results were consistent with the theory that stress forces the individual to allocate attentional resources to appraise and cope with the threat, which reduces the capacity to process task-relevant information. This represents a maladaptive extension of the narrowing strategy, which acts to maintain stable levels of response when stress is first encountered. Application: These quantitative estimates can be used to design thermal tolerance limits for different task types. Although results indicate the necessity for further research on a variety of potentially influential factors such as acclimatization, the current summary provides effect size estimates that should be useful in respect to protecting individuals exposed to adverse thermal conditions.
Objective:To honor Tom Waters's work on emerging occupational health issues, we review the literature on physical along with chemical exposures and their impact on functional outcomes.Background:Many occupations present the opportunity for exposure to multiple hazardous exposures, including both physical and chemical factors. However, little is known about how these different factors affect functional ability and injury. The goal of this review is to examine the relationships between these exposures, impairment of the neuromuscular and musculoskeletal systems, functional outcomes, and health problems with a focus on acute injury.Method:Literature was identified using online databases, including PubMed, Ovid Medline, and Google Scholar. References from included articles were searched for additional relevant articles.Results:This review documented the limited existing literature that discussed cognitive impairment and functional disorders via neurotoxicity for physical exposures (heat and repetitive loading) and chemical exposures (pesticides, volatile organic compounds [VOCs], and heavy metals).Conclusion:This review supports that workers are exposed to physical and chemical exposures that are associated with negative health effects, including functional impairment and injury. Innovation in exposure assessment with respect to quantifying the joint exposure to these different exposures is especially needed for developing risk assessment models and, ultimately, preventive measures.Application:Along with physical exposures, chemical exposures need to be considered, alone and in combination, in assessing functional ability and occupationally related injuries.
As the US faced its lowest levels of reported trust in government, the COVID-19 crisis revealed the essential service that various federal agencies provide as sources of information. This Element explores variations in trust across various levels of government and government agencies based on a nationally-representative survey conducted in March of 2020. First, it examines trust in agencies including the Department of Health and Human Services, state health departments, and local health care providers. This includes variation across key characteristics including party identification, age, and race. Second, the Element explores the evolution of trust in health-related organizations throughout 2020 as the pandemic continued. The Element concludes with a discussion of the implications for agency-specific assessments of trust and their importance as we address historically low levels of trust in government. This title is also available as Open Access on Cambridge Core. ; This material is based upon work supported by the National Science Foundation under grant no. RAPID-2026763. The authors would also like to thank the offices of the Senior Vice President and Provost and the Vice President for Research and Partnerships for their financial support. This support allowed us to make this volume available as Open Access permanently so that as many people as possible have access to the volume. ; Yes
AbstractIntroductionIn order to end the tuberculosis (TB) epidemic by 2035, countries must achieve a 10% annual decline in tuberculosis incidence rates by 2025. Provision of antiretroviral therapy (ART) has been associated with population level decreases in TB notification rates. We aimed to assess whether the progressive scale‐up of ART provision over the past nine years has had an effect on population level trends of TB notification in Uganda stratified by sex and HIV status.MethodsThe study area consisted of Kampala and eight surrounding districts. Annual TB notifications and mid‐year populations were used to calculate notification rates per 100,000 population from the study area. Numbers alive and retained on ART were used to calculate ART coverage, overall and by sex. TB notification rates (TBNRs) overall and stratified by sex and HIV status were calculated for the period 2009 to 2017. Trends in TBNRs before and after rollout of universal ART for pregnant women in 2013 were examined using Poisson regression models. To gain insight into the trends in CD4+ T‐cell counts at ART initiation over the study period, we performed a sub analysis of patient level data from the Infectious Diseases Institute clinic.ResultsFrom 2009 to 2017, ART coverage increased by 27.6% among men and by 35.4% among women. TBNRs declined during the same period. Overall, the average annual percentage decline in TBNRs was −3.5% (95%CI −3.7% to −3.3%), (−2.3% (95%CI −2.6% to −1.9%) in men and −5.4% (95%CI −5.7% to −5.0%) in women). ART coverage increased after 2013 but this was not associated with an accelerated decline in overall TBNRs among HIV‐positive persons −3.6% before 2013 and −5.2% after 2013; p = 0.33. The proportion of patients initiating ART with CD4+ T‐cell count ≤ 200 cells/mL did not decrease significantly after 2013 (42.2% to 32.2%, p = 0.05).ConclusionsAlthough ART scale‐up was temporally associated with a decline in TB notification rates, the achieved rates of decline are below those required to achieve the End TB Targets. Additional investments in tuberculosis control should include efforts to promote earlier care seeking and ART initiation among HIV‐positive persons.
IntroductionHepatitis C virus (HCV) and HIV infection frequently co‐occur due to shared transmission routes. Co‐infection is associated with higher HCV viral load (VL), but less is known about the effect of HCV infection on HIV VL and risk of onward transmission.MethodsWe undertook a systematic review comparing 1) HIV VL among ART‐naïve, HCV co‐infected individuals versus HIV mono‐infected individuals and 2) HIV VL among treated versus untreated HCV co‐infected individuals. We performed a random‐effects meta‐analysis and quantified heterogeneity using the I2 statistic. We followed Cochrane Collaboration guidelines in conducting our review and PRISMA guidelines in reporting results.Results and discussionWe screened 3925 articles and identified 17 relevant publications. A meta‐analysis found no evidence of increased HIV VL associated with HCV co‐infection or between HIV VL and HCV treatment with pegylated interferon‐alpha‐2a/b and ribavirin.ConclusionsThis finding is in contrast to the substantial increases in HIV VL observed with several other systemic infections. It presents opportunities to elucidate the biological pathways that underpin epidemiological synergy in HIV co‐infections and may enable prediction of which co‐infections are most important to epidemic control.
AbstractIntroduction: Achieving the UNAIDS goals of 90–90‐90 will require more than doubling the number of people accessing HIV care in Uganda. Community‐based programmes for entry into HIV care are effective strategies to expand access to HIV care, but few programmes have been evaluated with a particular focus on scale‐up.Methods: Integrated Community Based Initiatives, a Uganda‐based non‐governmental organization, designed and implemented a programme of community‐based HIV counselling and testing and facilitated linkage to care utilizing community health extension workers (CHEWs) in rural Sheema District, Uganda. CHEWs performed programme activities during 1 October 2015 through 31 March 2016. Outcomes for this evaluation were (1) the number of people tested for HIV, and (2) the proportion of those testing positive who were seen at an ART clinic within three months of their positive test, and (3) the cost of the programme per person newly diagnosed with HIV. Microcosting methods were used to calculate the programme costs. Program scalability factors were evaluated using a published framework.Results: Sixty‐two CHEWs attended a five‐day training that introduced the biology of HIV, the conduct of confidential HIV testing, HIV prevention messages, and linkage, referral, and reporting requirements. CHEWs received a $30 monthly stipend and a field testing kit that included a bicycle, field bag, umbrella, gumboots, reporting booklet, pens, and HIV testing materials. Trained CHEWs tested 43,696 persons for HIV infection during the six‐month programme period. Nine‐hundred seventy‐four participants (2.2%) were identified as HIV positive, and 623 participants (64%) were linked to HIV care. An estimated 69% of adult residents received testing as part of this campaign. The programme cost $3.02 per person test, $135.70 per positive person identified, and $212.15 per HIV‐positive person linked to care.Conclusions: Lay community health extension workers (CHEWs) can be rapidly trained to scale‐up home‐based HIV testing and counselling (HTC) and linkage to care in a high‐quality and low‐cost manner to large numbers of people in a rural, high burden setting. A combination HIV testing approach, such as adding partner testing to community‐based testing, could increase the proportion of HIV‐positive persons identified.
