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In these times of strong pressure on aquatic ecosystems and water resources due to climate change and water abstraction, intermittent rivers and ephemeral streams (IRES) (rivers that periodically cease to flow and/or dry) have become valuable assets. Indeed, not only do they supply water but they also offer services for humanity. Despite a growing recognition towards IRES, information for assessing their ecosystem services (ES) remains scarce. In a first step, an international interdisciplinary group of researchers developed a methodological framework to acknowledge ES provided by IRES using 109 indicators. A subset of selected ES indicators was then applied to two case studies: the Rio Seco in the Algarve (Portugal) and the Giofyros River in Crete (Greece). This paper discusses the applicability of these indicators, including the temporal and spatial variability of IRES flow regimes. Aspects of the framework, such as the methods and time required for data collection, the nature (demand or supply) and functionality of each indicator are discussed. The new framework accounts for flow intermittence in ES analyses and can help scientists and water managers to i) increase the ease and justification for IRES use in management approaches and ii) improve their conservation and restoration with a comprehensive set of appropriate indicators for IRES. In addition, the comprehensive nature of the proposed indicators ensures that they can be understood by a broad audience and easily applicable. Since they were designed through a public participation process, the setting has been prepared for holistic stakeholder analysis and education around IRES functions and associated ES. From a management point of view, it would be particularly relevant to perform an economic evaluation with this new framework to understand the value of each ES category and their trade-offs. For the scientific community, however, it is important to consider public preferences to design socially accepted policies. The proposed indicators can successfully bridge these elements, hereby establishing a solid basis for the assessment of ES provided by IRES.

The aim of this work is to investigate how the spatial variability of soil properties and soil erodibility ($K$ factor) were affected by the changes in land use allowed by irrigation with water from a reservoir in a semiarid area. To this end, three areas representative of different land uses (agroforestry grassland, lucerne crop and olive orchard) were studied within a 900 ha farm. The interrelationships between variables were analyzed by multivariate techniques and extrapolated using geostatistics. The results confirmed differences between land uses for all properties analyzed, which was explained mainly by the existence of diverse management practices (tillage, fertilization and irrigation), vegetation cover and local soil characteristics. Soil organic matter, clay and nitrogen content decreased significantly, while the K factor increased with intensive cultivation. The HJ-Biplot methodology was used to represent the variation of soil erodibility properties grouped in land uses. Native grassland was the least correlated with the other land uses. The K factor demonstrated high correlation mainly with very fine sand and silt. The maps produced with geostatistics were crucial to understand the current spatial variability in the Alqueva region. Facing the intensification of land-use conversion, a sustainable management is needed to introduce protective measures to control soil erosion.

A quantificação e o fracionamento da matéria orgânica do solo em carbono solúvel, carbono solúvel em solução salina e matéria orgânica leve podem ser usados como ferramentas para caracterizar a recuperação de áreas degradadas. Para este fim, coletaram-se amostras de solos em talude, submetidos à recuperação em novembro de 1994 com vários tipos de cobertura vegetal, no município de Viçosa. Os tratamentos corresponderam a: solo sem vegetação, solo em recuperação com predomínio de leguminosas, solo revegetado com maior presença de gramíneas, solo sob pastagem natural e solo sob floresta. Os resultados mostraram que o fracionamento do carbono orgânico do solo em carbono solúvel em solução salina, matéria orgânica leve e carbono solúvel em água auxilia na caracterização de áreas degradadas. O carbono solúvel em solução salina foi o procedimento mais sensível para caracterizar áreas degradadas a partir de diferentes coberturas vegetais.

The concept of nature-based solutions (NBSs) has become increasingly popular among urban policymakers and planners to help them tackle the urban challenges arising from urban expansion and climate change. Stakeholders' involvement is a fundamental step, and stakeholders' perceptions and preferences can affect the development of NBS projects. This study aims to identify stakeholders' perceptions of the most critical urban challenges, the priority interventions, the preferred NBSs and the benefits of the NBSs, and to identify the determinants of these perceptions. A survey was administered to assess stakeholders' perceptions and views on implementing NBSs in two Portuguese cities with distinct urban, geographical, and socio-economic contexts. A binary logistic regression model was used to understand the determinants of the likelihood of the stakeholders' answers. According to the stakeholders, climate change is one of the main concerns in the urban context. It is usually associated with the incidence of heatwaves and water scarcity. Additionally, stakeholders are concerned about the low quantity and poor management of green spaces (GSs). They believe that it will be necessary to increase the GS, to recover some degraded areas, and to increase mobility. The preferred NBSs were planting more urban trees, making green shaded areas, and rehabilitating riverbanks. The main expected benefits were benefits for leisure and relaxation, reductions in air temperature, purer air, and improvements in public health. The results showed mostly coherent connections between the main concerns/priorities of the stakeholders and the perceived NBS benefits; however, some stakeholders did not present coherent connections, indicating low awareness of the current policy for implementing NBSs to overcome existing and future urban challenges., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Ecosystem services (ES), as an interconnection of the landscape mosaic pieces, along with temporal rivers (IRES) are an object of research for environmental planners and ecological economists, among other specialists. This study presents (i) a review on the importance of IRES and the services they can provide to agricultural landscapes; (ii) a classification tool to assess the impact of IRES to provide ES by agricultural landscapes; (iii) the application of the proposed classification to the Caia River in order to identify the importance of this intermittent river for its surrounding agricultural landscape. The classification of the ES follows the Common International Classification of Ecosystem (CICES) classification that was adapted for the purposes of this study. Firstly, the list of ES provided by agricultural landscape was elaborated. In the next step, we assessed the potential of IRES to provide ES. Next, IRES impacts to ES within the agricultural landscape were evaluated according to observations from the conducted field monitoring in the study area. This study focuses on the relevance of the intermittent Caia River-a transboundary river in Spain and Portugal-and its ephemeral tributaries in the agricultural landscape. Our study estimates that each hydrological phase of IRES increases the ES provided by the agricultural landscape. However, the dry phase can potentially have negative impacts on several services. The intensification of the agricultural sector is the main provision of the water resource within the Caia River basin, but we were able to identify several other ES that were positively impacted. The present study is in line with the conclusions of other authors who state that IRES constitute a valuable resource which should not be underestimated by society.

Background: Measuring homophobia at country level is important to guide public health policy as reductions in stigma are associated with improved health outcomes among gay men and other men who have sex with men. Methods: We developed a Homophobic Climate Index incorporating institutional and social components of homophobia. Institutional homophobia was based on the level of enforcement of laws that criminalise, protect or recognise same-sex relations. Social homophobia was based on the level of acceptance and justifiability of homosexuality. We estimated the Index for 158 countries and assessed its robustness and validity., Results: Western Europe is the most inclusive region, followed by Latin America. Africa and the Middle East are home to the most homophobic countries with two exceptions: South Africa and Cabo Verde. We found that a 1% decrease in the level of homophobia is associated with a 10% increase in the gross domestic product per capita. Countries whose citizens face gender inequality, human rights abuses, low health expenditures and low life satisfaction are the ones with a higher homophobic climate. Moreover, a 10% increase in the level of homophobia at country level is associated with a 1.7-year loss in life expectancy for males. A higher level of homophobia is associated with increased AIDS-related death among HIV-positive men., Conclusion: The socioecological approach of this index demonstrates the negative social, economic and health consequences of homophobia in low- and middle-income countries. It provides sound evidence for public health policy in favour of the inclusion of sexual minorities.

Many studies examining the quality of life of stoma patients utilize questionnaires that have not been validated specifically for these patients in their native language. Owing to the large and increasing prevalence of intestinal stomas, a cross-sectional study was conducted among patients of a stoma patient health care service in Juiz de Fora, Brazil between September 2014 and August 2015 to validate the Stoma Quality of Life (Stoma-QoL) questionnaire in Portuguese (Brazilian variant). In addition, the effect of sociodemographic, clinical, and eating habit variables on the quality of life of people with a colostomy or ileostomy was assessed. Eating habit variables included eating comfort in the postoperative period, excluding foods for a period of time, fear of eating, and excluding foods that may cause odor, gas, diarrhea, and/or constipation. All patients with a colostomy or ileostomy served by 1 ostomy care center were invited to participate. Patients who were at least 18 years of age, provided signed informed consent, and had the physical and mental capacity to complete the questionnaire were eligible to participate. The sociodemographic, clinical history, eating behavior, and Stoma-QoL questionnaires were administered by trained researchers as part of patient nutritional care. A sample of 11 (10% of all study participants) also completed the 12-item Short Form Health Survey (SF-12), which includes a Mental Component Summary (MCS) and a Physical Component Summary (PCS), to establish convergent validity. All participant response data were collected using a standardized form developed for this study and stored in electronic files. The identities of patients were kept anonymous, and patients had the option to refuse to participate during the assessment. Data were analyzed descriptively; the Mann-Whitney and Kruskal-Wallis tests were used to analyze associations among the variables collected. Normal distribution of the Stoma-QoL total scores was assessed using the Kolmogorov-Smirnov test. Internal consistency was assessed as a whole using Cronbach's alpha, and agreement and reproducibility were determined using the intraclass correlation coefficient. Relationships between the Stoma-QoL and the SF-12 items were examined using the Pearson correlation coefficient. The majority of the 111 participants were men (57, 51.4%), most (94, 84.7%) were 50 years of age or older, 70 (63.1%) had a colostomy, and 41 (36.9%) had an ileostomy. Most stomas (79, 71.2%) were created to treat cancer of the colon and rectum. The mean overall Stoma-QoL score for study participants was 58.7 ± SD 12.0 (range 32.0-78.0). The internal consistency of the translated Stoma-QoL was .87, demonstrating a high degree of reliability. The convergent validity of the Stoma-QoL with the SF-12 confirmed higher correlation among the items regarding emotional aspects, mental health, social aspects, and vitality, with a higher correlation with the MCS (r = .52; P = .02) and lower correlation between the PCS and the items that assess general health, functional capacity, physical aspects, and pain (r = .38; P = .04), although both were significant. A moderate and significant association was noted between the questionnaires. Women (P = .02) and patients who deprived themselves of food for a certain period of time had a lower quality of life (P = .05). Persons who excluded foods out of fear of repercussions also had significantly lower QoL scores (P <.001). Colostomy and ileostomy patients had a similar quality of life. This study confirms the Stoma-QoL is a valid research tool for colostomy and ileostomy patients in Brazil. Further studies are recommended in the field of food and nutrition to verify observed concerns related to the eating behavior of intestinal stoma patients and the relationship to their quality of life.

Objective: To analyze whether the information found on popular Internet sites are in accordance with the steps recommended by the Food Guide for Children Younger than Two Years of the Ministry of Health (2010)., Methods: Descriptive/comparative study, carried out between August and October 2014, which carried out a search for popular sites (for lay people) in Portuguese, containing information on nutrition of children younger than two years. The Google search engine was used. These findings were compared with the Food Guide for Children Younger than Two Years of the Ministry of Health (2010). It was verified whether the information shown on the websites was in accordance with the Guide., Results: A total of 50 sites were analyzed, including blogs, food company websites and websites specialized in child nutrition. Only 10% of those pages correctly showed every step of the Food Guide. The recommendations were: exclusive breastfeeding up to six months of life (80%); complementary feeding from six months of life (36%); baby food consistency according to the guide (48%); encouraging the consumption of fruits and vegetables daily (60%). Regarding the complementary feeding safety and hygiene, 26% contained correct information. Only 36% correctly warned about which foods should be avoided in the first years of life., Conclusions: The information found on the sites is largely in disagreement with the Ministry of Health recommendations, which can lead to misconceptions in the nutritional care of the children younger than two years., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.)

In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually-far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before declining approximately 9% by 2030.

Background: The food environment can have an important influence on the availability of and access to food, which plays a significant role in the health of individuals. The goal of this study was to compare the consumption of fruits, legumes and vegetables (FLV) by adults and the availability of food stores in the context of socioeconomic and geographic space connected to basic health units in a Brazilian capital city., Methods: The study was developed from information obtained through the Risk Factors Surveillance for Non-Communicable Diseases Prevention by Telephone Survey (VIGITEL), using samples from Belo Horizonte from the years 2008 to 2010. A total of 5611 records were geocoded based on the postal code. A score was created based on the weekly and daily frequency of FLV intake of individuals. The coverage area of basic health units was used as a neighborhood unit. Georeferenced data on food stores in the city and neighborhood income were used., Results: As neighborhood income increased, there was an increase in the distribution of food establishments for all of the studied categories. The highest FLV intake scores were observed in areas with higher income levels., Conclusion: The highest concentration of food stores, regardless of supply quality, was observed in geographic areas with higher purchasing power and in those where there was a greater concentration of other types of businesses and services, a different pattern from that found in other countries., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

The number of people living with HIV (PLHIV) continues to increase around the world because of the increasing number on antiretroviral therapy (ART) and their associated increase of life expectancy, in addition to the number of people newly infected with HIV each year. Unless a 'cure' can be found for HIV infection, PLHIV can anticipate the need to take antiretroviral drugs (ARVs) for the rest of their lives. Because ARVs are now being used for HIV prevention, as well as for therapeutic purposes, the need for effective, affordable ARVs with few adverse effects will continue to rise. It is important to note that the dramatic growth in treatment coverage of PLHIV seen during the past decade has been primarily due to the increased use of generic ARVs. Thus, there will be a need to scale-up the research and development, production, distribution and access to generic ARVs and ART regimens. However, these processes must occur within national and international regulated free-market economic systems and must deal with increasingly multifaceted patent issues affecting the price while ensuring the quality of the ARVs. National and international regulatory mechanisms will have to evolve, which will affect broader national and international economic and trade issues. Because of the complexity of these issues, the Editors of this Supplement conceived of asking experts in their fields to describe the various steps from relevant research and development, to production of generic ARVs, their delivery to countries and subsequently to PLHIV in low- and middle-income countries. A main objective was to highlight how these steps are interrelated, how the production and delivery of these drugs to PLHIV in resource-limited countries can be made more effective and efficient, and what the lessons are for the production and delivery of a broader set of drugs to people in low- and middle-income countries.

Objective: Little has been published about the length and determinants of survival for persons with AIDS in developing countries. This study examined the survival experience of Brazilian AIDS patients from 1982 to 1989., Design: A retrospective cohort study involving record review of reported AIDS cases., Methods: We obtained information about 2135 adult AIDS patients in Brazil. Local health officials supplied data regarding demographic and clinical characteristics and length of survival. Statistical techniques of survival analysis were applied., Results: Median survival was 5.1 months, much shorter than in developed countries, and there was no improvement in survival for cases diagnosed more recently. Younger patients and those in the intravenous drug use exposure category lived longer than other AIDS patients. Those presenting with Kaposi's sarcoma, esophageal candidiasis, and tuberculosis fared relatively well, while those presenting with multiple diagnoses or toxoplasmosis did more poorly., Conclusions: These results tend to confirm the predictors of AIDS survival previously reported from developed countries and to document the poor survival of AIDS patients in the developing world.