Geographically widespread and novel hemotropic mycoplasmas and bartonellae in Mexican free-tailed bats and sympatric North American bat species.

Bacterial pathogens remain poorly characterized in bats, especially in North America. We describe novel (and in some cases panmictic) hemoplasmas (12.9% positivity) and bartonellae (16.7% positivity) across three colonies of Mexican free-tailed bats (Tadarida brasiliensis), a partially migratory species that can seasonally travel hundreds of kilometers. Molecular analyses identified three novel Candidatus hemoplasma species most similar to another novel Candidatus species in Neotropical molossid bats. We also detected novel hemoplasmas in sympatric cave myotis (Myotis velifer) and pallid bats (Antrozous pallidus), with sequences in the latter 96.5% related to C. Mycoplasma haemohominis. We identified eight Bartonella genotypes, including those in cave myotis, with 96.7% similarity to C. Bartonella mayotimonensis. We also detected Bartonella rochalimae in migratory Tadarida brasiliensis, representing the first report of this human pathogen in bats. The seasonality and diversity of these bacteria observed here suggest that additional longitudinal, genomic, and immunological studies in bats are warranted.

Ticks without borders: Microbial communities of immature Neotropical tick species parasitizing migratory landbirds along northern Gulf of Mexico.

The long-distance, seasonal migrations of birds make them an effective ecological bridge for the movement of ticks. The introduction of exotic tick species to new geographical regions can lead to the emergence of novel tick-borne pathogens or the re-emergence of previously eradicated ones. This study assessed the prevalence of exotic tick species parasitizing resident, short-distance, and long-distance songbirds during spring and autumn at stopover sites in the northern Gulf of Mexico using the mitochondrial 12S rDNA gene. Birds were captured for tick collection from six different sites from late August to early November in both 2018 and 2019. The highest number of ticks were collected in the 2019 season. Most ticks were collected off the Yellow-breasted Chat (Icteria virens) and Common Yellowthroat (Geothlypis trichas), and 54% of the total ticks collected were from Grand Chenier, LA. A high throughput 16S ribosomal RNA sequencing approach was followed to characterize the microbial communities and identify pathogenic microbes in all tick samples. Tick microbial communities, diversity, and community structure were determined using quantitative insight into microbial ecology (QIIME). The sparse correlations for compositional data (SparCC) approach was then used to construct microbial network maps and infer microbial correlations. A total of 421 individual ticks in the genera Amblyomma, Haemaphysalis, and Ixodes were recorded from 28 songbird species, of which Amblyomma and Amblyomma longirostre was the most abundant tick genus and species, respectively. Microbial profiles showed that Proteobacteria was the most abundant phylum. The most abundant bacteria include the pathogenic Rickettsia and endosymbiont Francisella, Candidatus Midichloria, and Spiroplasma. BLAST analysis and phylogenetic reconstruction of the Rickettsia sequences revealed the highest similarities to pathogenic spotted and non-spotted fever groups, including R. buchneri, R. conorii, R. prowazekii, R. bellii, R. australis, R. parkeri, R. monacensis, and R. monteiroi. Permutation multivariate analysis of variance revealed that the relative abundance of Francisella and Rickettsia drives microbial patterns across the tick genera. We also observed a higher percentage of positive correlations in microbe-microbe interactions among members of the microbial communities. Network analysis suggested a negative correlation between a) Francisella and Rickettsia and, b) Francisella and Cutibacterium. Lastly, mapping the distributions of bird species parasitized during spring migrations highlighted geographic hotspots where migratory songbirds could disperse ticks and their pathogens at stopover sites or upon arrival to their breeding grounds, the latter showing means dispersal distances from 421-5003 kilometers. These findings strongly highlight the potential role of migratory birds in the epidemiology of tick-borne pathogens.

Ecological drivers of sustained enzootic yellow fever virus transmission in Brazil, 2017-2021.

Beginning December 2016, sylvatic yellow fever (YF) outbreaks spread into southeastern Brazil, and Minas Gerais state experienced two sylvatic YF waves (2017 and 2018). Following these massive YF waves, we screened 187 free-living non-human primate (NHPs) carcasses collected throughout the state between January 2019 and June 2021 for YF virus (YFV) using RTqPCR. One sample belonging to a Callithrix, collected in June 2020, was positive for YFV. The viral strain belonged to the same lineage associated with 2017-2018 outbreaks, showing the continued enzootic circulation of YFV in the state. Next, using data from 781 NHPs carcasses collected in 2017-18, we used generalized additive mixed models (GAMMs) to identify the spatiotemporal and host-level drivers of YFV infection and intensity (an estimation of genomic viral load in the liver of infected NHP). Our GAMMs explained 65% and 68% of variation in virus infection and intensity, respectively, and uncovered strong temporal and spatial patterns for YFV infection and intensity. NHP infection was higher in the eastern part of Minas Gerais state, where 2017-2018 outbreaks affecting humans and NHPs were concentrated. The odds of YFV infection were significantly lower in NHPs from urban areas than from urban-rural or rural areas, while infection intensity was significantly lower in NHPs from urban areas or the urban-rural interface relative to rural areas. Both YFV infection and intensity were higher during the warm/rainy season compared to the cold/dry season. The higher YFV intensity in NHPs in warm/rainy periods could be a result of higher exposure to vectors and/or higher virus titers in vectors during this time resulting in the delivery of a higher virus dose and higher viral replication levels within NHPs. Further studies are needed to better test this hypothesis and further compare the dynamics of YFV enzootic cycles between different seasons.

Detection of Trypanosoma cruzi in the saliva of diverse neotropical bats.

Trypanosoma cruzi is widely reported in bats, yet transmission routes remain unclear. We present evidence from metagenomic sequence data that T. cruzi occurs in the saliva of diverse Neotropical bats. Phylogenetic analyses demonstrated that the bat-associated T. cruzi sequences described here formed part of a bat-specific clade, suggesting an independent transmission cycle. Our results highlight the value in repurposing metagenomic data generated for viral discovery to reveal insights into the biology of other parasites. Evaluating whether the presence of T. cruzi in the saliva of two hematophagous bat species represents an ecological route for zoonotic transmission of Chagas disease is an interesting avenue for future research.

Epidemiology and biology of a herpesvirus in rabies endemic vampire bat populations.

Rabies is a viral zoonosis transmitted by vampire bats across Latin America. Substantial public health and agricultural burdens remain, despite decades of bats culls and livestock vaccinations. Virally vectored vaccines that spread autonomously through bat populations are a theoretically appealing solution to managing rabies in its reservoir host. We investigate the biological and epidemiological suitability of a vampire bat betaherpesvirus (DrBHV) to act as a vaccine vector. In 25 sites across Peru with serological and/or molecular evidence of rabies circulation, DrBHV infects 80-100% of bats, suggesting potential for high population-level vaccine coverage. Phylogenetic analysis reveals host specificity within neotropical bats, limiting risks to non-target species. Finally, deep sequencing illustrates DrBHV super-infections in individual bats, implying that DrBHV-vectored vaccines might invade despite the highly prevalent wild-type virus. These results indicate DrBHV as a promising candidate vector for a transmissible rabies vaccine, and provide a framework to discover and evaluate candidate viral vectors for vaccines against bat-borne zoonoses.

Synergistic Effects of Grassland Fragmentation and Temperature on Bovine Rabies Emergence.

In 2007, common vampire bats were the source of the first outbreak of paralytic bovine rabies in Uruguay. The outbreak coincided in space and time with the fragmentation of native grasslands for monospecific forestry for wood and cellulose production. Using spatial analyses, we show that the increase in grassland fragmentation, together with the minimum temperature in the winter, accounts for the spatial pattern of outbreaks in the country. We propose that fragmentation may increase the connectivity of vampire bat colonies by promoting the sharing of feeding areas, while temperature modulates their home range plasticity. While a recent introduction of the virus from neighboring Brazil could have had an effect on outbreak occurrence, we show here that the distribution of rabies cases is unlikely to be explained by only an invasion process from Brazil. In accordance with previous modeling efforts, an increase in connectivity may promote spatial persistence of rabies virus within vampire bat populations. Our results suggest that land use planning might help to reduce grassland fragmentation and thus reduce risk of rabies transmission to livestock. This will be especially important in the context of climatic changes and increasing minimum temperatures in the winter.

Ecological and evolutionary drivers of haemoplasma infection and bacterial genotype sharing in a Neotropical bat community.

Most emerging pathogens can infect multiple species, underlining the importance of understanding the ecological and evolutionary factors that allow some hosts to harbour greater infection prevalence and share pathogens with other species. However, our understanding of pathogen jumps is based primarily around viruses, despite bacteria accounting for the greatest proportion of zoonoses. Because bacterial pathogens in bats (order Chiroptera) can have conservation and human health consequences, studies that examine the ecological and evolutionary drivers of bacterial prevalence and barriers to pathogen sharing are crucially needed. Here were studied haemotropic Mycoplasma spp. (i.e., haemoplasmas) across a species-rich bat community in Belize over two years. Across 469 bats spanning 33 species, half of individuals and two-thirds of species were haemoplasma positive. Infection prevalence was higher for males and for species with larger body mass and colony sizes. Haemoplasmas displayed high genetic diversity (21 novel genotypes) and strong host specificity. Evolutionary patterns supported codivergence of bats and bacterial genotypes alongside phylogenetically constrained host shifts. Bat species centrality to the network of shared haemoplasma genotypes was phylogenetically clustered and unrelated to prevalence, further suggesting rare-but detectable-bacterial sharing between species. Our study highlights the importance of using fine phylogenetic scales when assessing host specificity and suggests phylogenetic similarity may play a key role in host shifts not only for viruses but also for bacteria. Such work more broadly contributes to increasing efforts to understand cross-species transmission and the epidemiological consequences of bacterial pathogens.

Demographic and environmental drivers of metagenomic viral diversity in vampire bats.

Viruses infect all forms of life and play critical roles as agents of disease, drivers of biochemical cycles and sources of genetic diversity for their hosts. Our understanding of viral diversity derives primarily from comparisons among host species, precluding insight into how intraspecific variation in host ecology affects viral communities or how predictable viral communities are across populations. Here we test spatial, demographic and environmental hypotheses explaining viral richness and community composition across populations of common vampire bats, which occur in diverse habitats of North, Central and South America. We demonstrate marked variation in viral communities that was not consistently predicted by a null model of declining community similarity with increasing spatial or genetic distances separating populations. We also find no evidence that larger bat colonies host greater viral diversity. Instead, viral diversity follows an elevational gradient, is enriched by juvenile-biased age structure, and declines with local anthropogenic food resources as measured by livestock density. Our results establish the value of linking the modern influx of metagenomic sequence data with comparative ecology, reveal that snapshot views of viral diversity are unlikely to be representative at the species level, and affirm existing ecological theories that link host ecology not only to single pathogen dynamics but also to viral communities.

Using noninvasive metagenomics to characterize viral communities from wildlife.

Microbial communities play an important role in organismal and ecosystem health. While high-throughput metabarcoding has revolutionized the study of bacterial communities, generating comparable viral communities has proven elusive, particularly in wildlife samples where the diversity of viruses and limited quantities of viral nucleic acid present distinctive challenges. Metagenomic sequencing is a promising solution for studying viral communities, but the lack of standardized methods currently precludes comparisons across host taxa or localities. Here, we developed an untargeted shotgun metagenomic sequencing protocol to generate comparable viral communities from noninvasively collected faecal and oropharyngeal swabs. Using samples from common vampire bats (Desmodus rotundus), a key species for virus transmission to humans and domestic animals, we tested how different storage media, nucleic acid extraction procedures and enrichment steps affect viral community detection. Based on finding viral contamination in foetal bovine serum, we recommend storing swabs in RNAlater or another nonbiological medium. We recommend extracting nucleic acid directly from swabs rather than from supernatant or pelleted material, which had undetectable levels of viral RNA. Results from a low-input RNA library preparation protocol suggest that ribosomal RNA depletion and light DNase treatment reduce host and bacterial nucleic acid, and improve virus detection. Finally, applying our approach to twelve pooled samples from seven localities in Peru, we showed that detected viral communities saturated at the attained sequencing depth, allowing unbiased comparisons of viral community composition. Future studies using the methods outlined here will elucidate the determinants of viral communities across host species, environments and time.

Genetic diversity, infection prevalence, and possible transmission routes of Bartonella spp. in vampire bats.

Bartonella spp. are globally distributed bacteria that cause endocarditis in humans and domestic animals. Recent work has suggested bats as zoonotic reservoirs of some human Bartonella infections; however, the ecological and spatiotemporal patterns of infection in bats remain largely unknown. Here we studied the genetic diversity, prevalence of infection across seasons and years, individual risk factors, and possible transmission routes of Bartonella in populations of common vampire bats (Desmodus rotundus) in Peru and Belize, for which high infection prevalence has previously been reported. Phylogenetic analysis of the gltA gene for a subset of PCR-positive blood samples revealed sequences that were related to Bartonella described from vampire bats from Mexico, other Neotropical bat species, and streblid bat flies. Sequences associated with vampire bats clustered significantly by country but commonly spanned Central and South America, implying limited spatial structure. Stable and nonzero Bartonella prevalence between years supported endemic transmission in all sites. The odds of Bartonella infection for individual bats was unrelated to the intensity of bat flies ectoparasitism, but nearly all infected bats were infested, which precluded conclusive assessment of support for vector-borne transmission. While metagenomic sequencing found no strong evidence of Bartonella DNA in pooled bat saliva and fecal samples, we detected PCR positivity in individual saliva and feces, suggesting the potential for bacterial transmission through both direct contact (i.e., biting) and environmental (i.e., fecal) exposures. Further investigating the relative contributions of direct contact, environmental, and vector-borne transmission for bat Bartonella is an important next step to predict infection dynamics within bats and the risks of human and livestock exposures.

Livestock abundance predicts vampire bat demography, immune profiles and bacterial infection risk.

Human activities create novel food resources that can alter wildlife-pathogen interactions. If resources amplify or dampen, pathogen transmission probably depends on both host ecology and pathogen biology, but studies that measure responses to provisioning across both scales are rare. We tested these relationships with a 4-year study of 369 common vampire bats across 10 sites in Peru and Belize that differ in the abundance of livestock, an important anthropogenic food source. We quantified innate and adaptive immunity from bats and assessed infection with two common bacteria. We predicted that abundant livestock could reduce starvation and foraging effort, allowing for greater investments in immunity. Bats from high-livestock sites had higher microbicidal activity and proportions of neutrophils but lower immunoglobulin G and proportions of lymphocytes, suggesting more investment in innate relative to adaptive immunity and either greater chronic stress or pathogen exposure. This relationship was most pronounced in reproductive bats, which were also more common in high-livestock sites, suggesting feedbacks between demographic correlates of provisioning and immunity. Infection with both Bartonella and haemoplasmas were correlated with similar immune profiles, and both pathogens tended to be less prevalent in high-livestock sites, although effects were weaker for haemoplasmas. These differing responses to provisioning might therefore reflect distinct transmission processes. Predicting how provisioning alters host-pathogen interactions requires considering how both within-host processes and transmission modes respond to resource shifts.This article is part of the theme issue 'Anthropogenic resource subsidies and host-parasite dynamics in wildlife'.

The effects of N-acetylcysteine on spermatogenesis and degree of testicular germ cell apoptosis in an experimental model of varicocele in rats.

INTRODUCTION: The mechanism by which varicocele interferes in spermatogenesis has not been clearly defined. Germ cell apoptosis and oxidative stress appear to be involved in this process and the use of antioxidants has been proposed to counteract upon these effects. The present study evaluated the effects of N-acetylcysteine (NAC) on spermatogenesis and germ cell apoptosis in an experimental model of varicocele in rats. MATERIALS AND METHODS: Twenty 30-day-old animals were randomly divided into three groups: sham operation (Group 1), left experimental varicocele (Group 2) and left experimental varicocele group treated with NAC 50 mg/kg/day (Group 3). After 2 months, spermatogenesis was evaluated by absolute and true count of round spermatids, pachytenes, spermatocytes and Sertoli cells. The different cell relations were also analyzed. Germ cell apoptosis was quantified using the TUNEL method. The apoptotic index (AI) was calculated as the number of apoptotic cells per tubule. Statistical analysis was performed by analysis of variance considering P < 0.05. RESULTS: The absolute and true cell counts were similar among the groups (P > 0.05). The round spermatid/pachytene ratio was significantly smaller in Groups 2 and 3 compared to the Group 1 (P = 0.012). The AI values were 0.207 ± 0.09, 0.138 ± 0.11 and 0.298 ± 0.27, respectively (P = 0.256). CONCLUSION: Experimental varicocele in rats presented an association with the decreased round spermatid/pachytene ratio, suggesting the loss of germ cells during spermatogenesis. These effects were not influenced by the administration of NAC. Germ cell apoptosis was not influenced by experimental varicocele.

Network of healthy communities of Rio de Janeiro--Brazil.

Poor communities in Rio de Janeiro, which are known as favelas, suffer from various problems related to poor housing, poverty, unemployment, violence and organized crime, and lack of access to basic services, such as health care and education. In order to tackle these determinants, and inspired by WHO's international Healthy Communities/Cities movement, the etwork of Healthy Communities of Rio de Janeiro was formed in 2004. The Network is coordinated by the Center for Health Promotion (CEDAPS) and now includes more than 100 community groups and organizations in the state of Rio de Janeiro. Their aim is to promote health, community development and equity through community empowerment, participation, capacity building and advocacy. The paper describes the work that has been done since the Network's inception and the challenges which they face to reach their goals in the context of a country like Brazil. The Network represents an important landmark of how poor populations can organize themselves in a collective, participatory and constructive way to influence public policy and strive for better conditions of life in disadvantaged settings, like the favelas.

Amamentação e promoção da saúde no PSF / Breastfeeding and health promotion in PSF / Promoción de la lactancia materna y la salud en PSF

O objetivo deste trabalho foi analisar aspectos da implementação e operacionalização da promoção da saúde no Programa de Saúde da Família. Para tanto foi utilizada a promoção da amamentação como um traçador da promoção da saúde. Realizou-se uma pesquisa de campo com 156 profissionais das equipes do Programa e com 286 mães de bebês até 6 meses de idade por eles atendidas, descrevendo e contrastando desta forma as diferentes experiências em cinco municípios brasileiros, com características diversas mas apresentando como traço comum o fato de serem consideradas de boa qualidade. Os resultados mostram que os programas pesquisados preocuparam-se com a capacitação das equipes, que foram treinadas em sua grande maioria. Tanto profissionais de nível superior quanto agentes comunitários de saúde tiveram performances bem acima da média na maioria dos testes de conhecimento aplicados, apesar de seu desempenho deixar um pouco a desejar nas questões relacionadas ao manejo clínico da lactação. Os profissionais das equipes estão envolvidos, em sua grande maioria, nas atividades relevantes da promoção da amamentação. O grau de envolvimento e sua efetividade são, no entanto, variáveis, e não correspondem às impressões das mães entrevistadas em aspectos como a visita domiciliar à puérpera e o momento desta atividade, e a observação da mamada. Não foram detectados erros grosseiros na atuação das equipes, mas esta poderia ser mais abrangente; atingir um número mais significativo de mães; e ter a qualidade de suas intervenções melhorada. A maioria significativa das mães de bebês até seis meses sente-se apoiada pela equipe de saúde para amamentar. O sentimento de apoio para amamentar foi associado significativamente a duas variáveis: a da mãe ter sido ensinada a colocar o bebê para mamar, e a de ter recebido ao menos uma visita domiciliar no puerpério. Esta associação destaca o Programa de Saúde da Família como lócus privilegiado da promoção da amamentação. Nossa pesquisa detectou também o que parece ser uma sobrenotificação, pelo SIAB (Sistema de Informação da Atenção Básica), dos índices de Aleitamento Materno Exclusivo aos quatro meses. Com base nos achados, são feitas algumas recomendações relativas a promoção da amamentação no contexto do PSF. Em conclusão, a pesquisa aponta tendências favoráveis com relação à promoção da saúde no contexto do PSF, sugerindo que sua efetividade poderá ser muito ampliada se forem garantidos às equipes tempo, ferramentas metodológicas, treinamento e apoio adequados para esta atuação.

The objective of this work was to analyze aspects of the implementation and operationalization of the promotion of health in the family health program. For both breastfeeding promotion was used as a tracer of health promotion. A field research with 156 professionals and Program teams with 286 mothers of babies up to 6 months of age because they met, describing and contrasting the different experiences in five Brazilian cities, with different characteristics but showing how common trait that they are considered to be of good quality. The results show that the programs surveyed worried with the training of the teams, who were trained in your vast majority. Both top-level professionals about community health agents had performances well above average on most tests of knowledge applied, although your performance leave something to be desired on issues related to the clinical management of breastfeeding. The professionals of the teams are involved, in your most relevant activities for the promotion of breastfeeding. The degree of involvement and your effectiveness are, however, variables, and do not match the prints of the mothers interviewed in aspects such as the domiciliary visit to who has recently given birth and the moment of this activity, and the observation of feeding. Gross errors were not detected in the performance of the teams, but this could be more comprehensive; achieve a more significant number of mothers; and have the quality of their interventions. The significant majority of mothers of infants up to six months feels supported by health team to breastfeed. The feeling of support for breast-feeding was associated with significantly to two variables: the mother have been taught to put the baby to suckle, and having received at least one home visit in the puerperium. This association emphasizes the family health program as a privileged locus for the promotion of breastfeeding. Our research has detected what appears to be a sobrenotificação at SIAB (Information System of the basic attention), rates of exclusive breastfeeding at the age of four months. Based on the findings, recommendations are made concerning the promotion of breastfeeding in the context of the FHP. In conclusion, the research points favourable trends with respect to health promotion in the context of the PSF, suggesting that your effectiveness could be much enlarged if they are guaranteed to teams time, methodological tools, training and support for this performance.

El objetivo de este trabajo fue analizar los aspectos de la implementación y puesta en marcha de la promoción de la salud en el programa de salud de la familia. Por tanto la lactancia materna promoción fue utilizada como trazador de la promoción de la salud. Una investigación de campo con 156 profesionales y equipos de programa con 286 madres de bebés hasta 6 meses de edad ya se conocieron, describir y contrastar las distintas experiencias en cinco ciudades brasileñas, con características diferentes pero mostrando cómo común rasgo que son considerados de buena calidad. Los resultados muestran que los programas encuestados preocuparon con la formación de los equipos, que han sido formados en su gran mayoría. Ambos profesionales de alto nivel sobre agentes de salud comunitarios tuvieron actuaciones muy por encima del promedio en la mayoría de las pruebas de conocimiento aplicado, aunque su rendimiento deja mucho que desear en temas relacionados con el manejo clínico de la lactancia materna. Participan los profesionales de los equipos, en sus actividades más relevantes para la promoción de la lactancia materna. El grado de implicación y su efectividad, sin embargo, son variables y no coinciden con las impresiones de las madres entrevistadas en aspectos tales como la visita domiciliaria a que ha dado a luz recientemente y el momento de esta actividad y la observación de la alimentación. No se detectaron errores gruesos en el desempeño de los equipos, pero esto podría ser más amplia; alcanzar un número más significativo de las madres; y tienen la calidad de sus intervenciones. La gran mayoría de las madres de los bebés hasta seis siente meses apoyado por el equipo de salud para amamantar. La sensación de apoyo para la lactancia materna se asoció con significativamente a dos variables: la madre les ha enseñado a poner al bebé a mamar y haber recibido al menos una visita domiciliaria en el puerperio. Esta asociación hace hincapié en el programa de salud de la familia como un lugar privilegiado para la promoción de la lactancia materna. Nuestra investigación ha detectado lo que parece ser un sobrenotificação en el SIAB (sistema de información de la atención básica), las tasas de lactancia materna exclusiva en la edad de cuatro meses. Basado en los resultados, se formulan recomendaciones relativas a la promoción de la lactancia materna en el contexto de la PSF. en conclusión, la investigación señala las tendencias favorables con respecto a la promoción de la salud en el contexto del PSF, lo que sugiere que su eficacia podría ser ampliada mucho si son garantizado a tiempo de equipos, herramientas metodológicas, capacitación y apoyo para este desempeño.

Network of communities in the fight against AIDS: local actions to address health inequities and promote health in Rio de Janeiro, Brazil.

When combined with major social inequities, the AIDS epidemic in Brazil becomes much more complex and requires effective and participatory community-based interventions. This article describes the experience of a civil society organisation, the Centre for Health Promotion (CEDAPS), in the slum communities (favelas) of Rio de Janeiro, Brazil. Using a community-based participatory approach, 55 community organisations were mobilised to develop local actions to address the increasing social vulnerability to HIV/AIDS of people living in squatter communities. This was done through on-going prevention initiatives based on the local culture and developed by a Network of Communities. The community movement has created a sense of "ownership" of social actions. The fight against AIDS has been a mobilising factor in engaging and organising communities and has contributed to raising awareness of health rights. Local actions included targeting the determinants of local vulnerability, as suggested by health promotion workers.

An innovative geographical approach: health promotion and empowerment in a context of extreme urban poverty.

This article describes and analyses a territorial intervention, the Vila Paciencia Initiative--a local development/health promotion programme implemented in a context of extreme poverty in the western district of Rio de Janeiro. The main goal of the programme was to empower individuals and communities. We emphasise the lessons learned and the potential for integrating them into local and regional health services, which could strengthen community participation and capacity-building and improve the effectiveness and community orientation of primary health care and other public policies directed to geographical development.

Discriminant efficiency of antisocial and borderline personality disorder criteria in Hispanic men with substance use disorders.

The authors examined the discriminant efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) criteria for borderline personality disorder (BPD) and antisocial personality disorder (APD). Subjects were 74 men admitted to an outpatient substance abuse program for monolingual Hispanic adults. All were reliably assessed with the Spanish-language version of the Diagnostic Interview for DSM-IV Personality Disorders. Conditional probabilities were calculated to determine the diagnostic efficiency and discriminant efficiency of BPD and APD symptoms. Twenty-five (34%) subjects met diagnostic criteria for BPD, and 16 (22%) met criteria for APD. The diagnostic co-occurrence of these disorders was statistically significant. Whereas the diagnostic efficiency of the BPD criterion set was comparable to that reported in other clinical studies, these criteria were not significantly more efficient in diagnosing BPD than APD. By contrast, the APD criteria were more efficient in diagnosing APD than BPD; this was true for both the "adult" and the "conduct disorder" APD criterion subsets. In male Hispanic outpatients with substance use disorders, BPD and APD show significant diagnostic overlap. The APD criteria are useful in discriminating these 2 disorders, whereas the BPD criteria are not. These findings have implications for the discriminant validity of the BPD and APD criteria and support the value of the conduct disorder criteria in predicting APD in adulthood.

Empowerment e avaliação participativa em um programa de desenvolvimento local e promoção da saúde / Empowerment and participatory evaluation: lessons from a territorial health promotion program

Este artigo discute o conceito de empowerment em Promoção da Saúde e a importância dos processos de avaliação neste contexto, através da análise de uma intervenção territorial - a Iniciativa de Vila Paciência, realizada na Zona Oeste do Rio de Janeiro. Partindo de uma breve revisão da literatura sobre empowerment e das propostas mais recentes para sua operacionalização e avaliação, descrevem-se as múltiplas estratégias utilizadas para promover a participação da comunidade na construção de um programa de Desenvolvimento Local e Promoção da Saúde. Enfatiza-se o processo avaliativo, estruturado em três níveis complementares: o Diagnóstico Comunitário, seus resultados e implicações; o estudo das intervenções realizadas pelos próprios moradores, capacitados por uma metodologia participativa de planejamento e solução de problemas (Problem Solving for Better Health); e a sistematização de depoimentos e relatos dos participantes sobre as experiências vivenciadas no programa. São discutidos os desafios, limites e perspectivas deste processo, buscando-se contribuir para a melhor compreensão da importância da avaliação para o desenvolvimento pessoal dos moradores e para a mobilização coletiva da comunidade em direção ao empowerment.