It Was Not the Perfect Storm: The Social History of the HIV-2 Virus in Guinea-Bissau.

The perfect storm model that was elaborated for the HIV-1M pandemic has also been used to explain the emergence of HIV-2, a second human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) that became an epidemic in Guinea-Bissau, West Africa. The use of this model creates epidemiological generalizations, ecological oversimplifications and historical misunderstandings as its assumptions-an urban center with explosive population growth, a high level of commercial sex and a surge in STDs, a network of mechanical transport and country-wide, en masse mobile campaigns-are absent from the historical record. This model fails to explain how the HIV-2 epidemic actually came about. This is the first study to conduct an exhaustive examination of sociohistorical contextual developments and align them with environmental, virological and epidemiological data. The interdisciplinary dialogue indicates that the emergence of the HIV-2 epidemic piggybacked on local sociopolitical transformations. The war's indirect effects on ecological relations, mobility and sociability were acute in rural areas and are a key to the HIV-2 epidemic. This setting had the natural host of the virus, the population numbers, the mobility trends and the use of technology on a scale needed to foster viral adaptation and amplification. The present analysis suggests new reflections on the processes of zoonotic spillovers and disease emergence.

The Unlikely Saviour: Portugal's National Health System and the Initial Impact of the COVID-19 Pandemic?

What is the impact of COVID-19 on Portugal's Serviço Nacional de Saúde (SNS), the country's national health service? The story, still unfolding, has all the elements of a recipe for disaster: one of the most elderly populations in the world; a weakened SNS, the result of a litany of policies and interventions by the 'Troika' (the European Commission, the European Central Bank and the International Monetary Fund); a health care delivery system focused on non-communicable diseases and long-term care; the growing public distrust in public services, compared to private, hotel-like health care facilities. We are aware that these are still the early days of the epidemic, yet it is safe to say that algorithmic scenarios of doom and gloom have so far been averted. In the past six months of the pandemic, the level of trust of the Portuguese population in the SNS and its health personnel has significantly improved, while the government has started to provide additional funding and to work for the expansion of the public system. At the very inception of the pandemic, private hospitals practically closed their doors to COVID-19 patients. Unexpectedly a new disease, COVID-19, by definition the foe of any health system, has granted the opportunity for a rare consensus amongst different key political and/or corporate actors in a long-called-for reform of the SNS. Social science and humanities, with their analytical tools and theoretical-conceptual frameworks, are mandatory in providing well-funded answers to such riddles and better grasping the reasons for the twist and turns.

Chasing a ghost: notes on the present distribution and conservation of the sooty mangabey (Cercocebus atys) in Guinea-Bissau, West Africa.

The West-African sooty mangabey (Cercocebus atys) is threatened by habitat loss, hunting for meat consumption, and mortality during crop-foraging events. The species' overall demographic trend is unknown. Presence and distribution in Guinea-Bissau, a country neighbored by Senegal and Republic of Guinea, was confirmed in 1946 but the species was declared extinct in 1989 and not observed in subsequent countrywide expeditions. Narratives of its presence across southern Guinea-Bissau are scattered in reports and occurrence in the eastern part was reported in 2017, but the limits of its distribution are currently unknown. Here, we present recent geo-referenced visual and molecular-based records of the sooty mangabey for three protected areas in southern Guinea-Bissau collected as part of a region-wide survey. Individuals were observed in Cufada Lagoons Natural Park (2015) and Dulombi National Park (NP) (2016) and photographed in Boé NP (2007, 2015 and 2020). Thirty-six samples collected in Boé NP (2017) were identified as sooty mangabey using a 402 base pair fragment of the mitochondrial cytochrome b gene. Our work suggests a wider distribution in Guinea-Bissau than previously described, augments knowledge of the populations' current habitat use and threats, and has implications for efforts to conserve the species in West Africa. Considering the sooty mangabey as the reservoir of the simian immunodeficiency virus that led to the human variant, HIV-2, confirmation that the Guinea-Bissau population is not extinct may lead to a better understanding of early viral jump to humans and consequent epidemic spread, specifically of the HIV-2 Subgroup A. We highlight the need for extra conservation measures by Guinea-Bissau authorities.

Main causes of death in Dande, Angola: results from Verbal Autopsies of deaths occurring during 2009-2012.

BACKGROUND: The Dande Health and Demographic Surveillance System (HDSS) located in Bengo Province, Angola, covers nearly 65,500 residents living in approximately 19,800 households. This study aims to describe the main causes of deaths (CoD) occurred within the HDSS, from 2009 to 2012, and to explore associations between demographic or socioeconomic factors and broad mortality groups (Group I-Communicable diseases, maternal, perinatal and nutritional conditions; Group II-Non-communicable diseases; Group III-Injuries; IND-Indeterminate). METHODS: Verbal Autopsies (VA) were performed after death identification during routine HDSS visits. Associations between broad groups of CoD and sex, age, education, socioeconomic position, place of residence and place of death, were explored using chi-square tests and fitting logistic regression models. RESULTS: From a total of 1488 deaths registered, 1009 verbal autopsies were performed and 798 of these were assigned a CoD based on the 10(th) revision of the International Classification of Diseases (ICD-10). Mortality was led by CD (61.0 %), followed by IND (18.3 %), NCD (11.6 %) and INJ (9.1 %). Intestinal infectious diseases, malnutrition and acute respiratory infections were the main contributors to under-five mortality (44.2 %). Malaria was the most common CoD among children under 15 years old (38.6 %). Tuberculosis, traffic accidents and malaria led the CoD among adults aged 15-49 (13.5 %, 10.5 % and 8.0 % respectively). Among adults aged 50 or more, diseases of the circulatory system (23.2 %) were the major CoD, followed by tuberculosis (8.2 %) and malaria (7.7 %). CD were more frequent CoD among less educated people (adjusted odds ratio, 95 % confidence interval for none vs. 5 or more years of school: 1.68, 1.04-2.72). CONCLUSION: Infectious diseases were the leading CoD in this region. Verbal autopsies proved useful to identify the main CoD, being an important tool in settings where vital statistics are scarce and death registration systems have limitations.

On the contribution of Angola to the initial spread of HIV-1.

Angola borders and has long-term links with Democratic Republic of Congo (DRC) as well as high levels of Human Immunodeficiency Virus (HIV) genetic diversity, indicating a potential role in the initial spread of the HIV-1 pandemic. Herein, we analyze 564 C2V3 and 354 pol publicly available sequences from DRC, Republic of Congo (RC) and Angola to better understand the initial spread of the virus in this region. Phylogeographic analyses were performed with the BEAST software. While our results pinpoint the origin of the pandemic to Kinshasa (DRC) around 1906, the introduction of HIV-1 to Angola could have occurred early between the 1910s and 1940s. Furthermore, most of the HIV-1 migrations out of Kinshasa were directed not only to Lubumbashi and Mbuji-Mayi (DRC), but also to Luanda and Brazzaville. Kinshasa census records corroborate these findings, indicating that the early exportation of the virus to Angola might be related to the high number of Angolans in Kinshasa at that time, originated mostly from the North of Angola. In summary, our results place Angola at the epicenter of the early HIV dissemination, together with DRC and RC.

[Biomedical health care in Angola and in the Companhia de Diamantes de Angola, circa 1910-1970]. / Cuidados biomédicos de saúde em Angola e na Companhia de Diamantes de Angola, c. 1910-1970.

The scope of this paper is to analyze the provision of biomedical care in Angola during the activities of the Companhia de Diamantes de Angola. A comparative analysis of public health policies and practices of various colonial actors, such as the health services of the Company, its state counterpart and other colonial companies, will reveal differences in investment in health, namely in health facilities, personnel and treatment. This survey as well as the living conditions highlight the idiosyncratic and central nature of the health services of the Company in terms of morbidity and mortality in Angola, and the importance of these representations for a caregiving empire.

Cuidados biomédicos de saúde em Angola e na Companhia de Diamantes de Angola, c. 1910-1970 / Biomedical health care in Angola and in the Companhia de Diamantes de Angola, circa 1910-1970

Pretende-se caracterizar a prestação de cuidados biomédicos em Angola durante a atividade da Companhia de Diamantes de Angola. Uma análise comparativa de políticas e práticas de saúde pública de vários atores coloniais, como os serviços de saúde da Companhia, sua congénere do Estado e outras empresas coloniais, revelará diferenças de investimento na saúde, isto é, instalações e pessoal de saúde, e tratamentos. Este escrutínio bem como as condições de vida iluminarão o carácter idiossincrático e central dos serviços de saúde da Companhia em termos de morbimortalidade em Angola, e a centralidade destes para as representações de um império cuidador.

The scope of this paper is to analyze the provision of biomedical care in Angola during the activities of the Companhia de Diamantes de Angola. A comparative analysis of public health policies and practices of various colonial actors, such as the health services of the Company, its state counterpart and other colonial companies, will reveal differences in investment in health, namely in health facilities, personnel and treatment. This survey as well as the living conditions highlight the idiosyncratic and central nature of the health services of the Company in terms of morbidity and mortality in Angola, and the importance of these representations for a caregiving empire.

(Un)healthy relationships: African labourers, profits and health services in Angola's colonial-era diamond mines, 1917-75.

The Companhia de Diamantes de Angola, or Diamang, mined for diamonds in colonial Angola from 1917 until independence in 1975. The enterprise's Health Services Division (SSD) was responsible for supplying mine managers with an African labour force comprised of healthy, and therefore productive, employees. In practice, though, this otherwise 'healthy' system did not always work. While SSD personnel attempted to fulfil their charge by implementing a series of screening measures, production targets and a scarcely-populated regional labour pool regularly prompted senior officials to compel the SSD to clear recruits who were otherwise unfit for mine service. Drawing upon interviews with former SSD staff and African labourers, as well as company and colonial archival sources, this article focuses on the interplay over time between the SSD, the company's production demands and these labourers.

[Monitoring antibiotic consumption in the surgery and orthopaedics]. / Monitorização do consumo de antibióticos: nos serviços de cirurgia e de ortopedia de seis hospitais SA.

Monitoring antibiotic consumption is a valuable tool which has been increasingly used in the last years due to the current concern with the emergence of resistant microbial strains. The present study aimed at monitoring antibiotic consumption, evaluating the economic impact of hospital antibiotic prescription and assessing the relationship between the prescribed antibiotics and the indications for either prophylactic or therapeutic use. This was a longitudinal pilot-study for which data were collected in six privately managed public hospital units during the month of May 2004, with a resulting sample of 1,122 admitted patients. We observed a prescription incidence rate of 76.9%, corresponding to a total of 1,154 dispensed antimicrobials, with a mean 71.2% of these antimicrobials being dispensed for the prophylaxis of surgical site infection (SSI). The mean cost of antibiotic courses was higher in cases of "suspected infection" (9.09 euro) or "confirmed infection" (8.74 euro) and lower in cases of "prophylaxis" (5.67 euro), a finding which is explained by the shorter mean duration of the later. There was a considerable variation among the different hospital units regarding the type of antibiotic compound that was used for SSI prophylaxis, with a mean duration of antibiotic use of 2.61 days for this indication and about half of the prophylactic regimens lasting longer than 24 hours, a fact that suggests an insufficient observation of the current recommendations for antibiotic use in SSI prophylaxis. This finding indicates the need for an investigation on the actual existence of local recommendations for SSI prophylaxis in individual hospital units and also for the evaluation of the compliance of practicing surgeons with eventually existing recommendations.

[Health and Angola's Companhia de Diamantes]. / A saúde e a Companhia de Diamantes de Angola.

Ever more studies have been devoted to the use of medicine in colonial contexts, a topic that serves to illustrate the more subtle ways in which a colonial State may spread its power. Countering the studies of colonial mining companies conducted to date, the case of the Companhia de Diamantes de Angola (Diamang) brings something new to the issue of colonial relations. Diamang was extraordinarily cautious when it came to the health of its workers and local population. However, this sanitary vigilance was closely linked to company concerns about productivity and about the need to constantly enhance human resource management.

A saúde e a Companhia de Diamantes de Angola / Health and Angola's Companhia de Diamantes

O uso da medicina em contextos coloniais é um tópico cada vez mais estudado e ilustra formas mais sutis de disseminação de poder por parte do Estado colonial. A Diamang contraria os estudos de empresas mineiras coloniais realizados até agora, trazendo algo de novo para as relações coloniais. Neste caso houve um cuidado extremo com a saúde dos trabalhadores e das populações da região. No entanto essa vigilância sanitária encontrava-se intimamente ligada com idéias de produtividade e constante melhoria na gestão dos recursos humanos disponíveis.

A Experiência de Reforma do Sistema Hospitalar de Portugal.

Apresentação sobre a reforma do sistema hospitalar de Portugal que tem por objetivo delinear todo o processo de mudança ocorrido no sistema de saúde daquele país, no intuito de configurar um modelo de atenção básica de respeito, de qualidade e eficiente com maior foco nos hospitais, baseado na realidade brasileira. Este trabalho é resultado do convênio firmado entre a ENSP e o projeto EUROBRASIL 2000 que visa identificar temas relevantes, financiar a vinda de especialistas para intercâmbio de informações e incentivar os profissionais de cada país a fazer cursos de aperfeiçoamento. Faz uma radiografia da economia, da saúde e do crescimento populacional desde a década de 70, identificando os pontos que levaram a crise no sistema hospitalar de Portugal. Analisa o caso de três unidades de saúde onde foram atingidos os níveis de qualidade e eficiência pretendidos e que acabaram se tornando um marco do novo modelo de gestão da saúde em Portugal. Indica vários pontos que devem ser observados para que o sistema de saúde brasileiro torne-se eficaz.