Thesis (Ph. D.)--University of Arizona, 1993.

Thesis (M.S.)--University of Wisconsin-Madison, 1993. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 41-44).

Thesis (Ph. D.)--Ohio State University, 2005. / Title from first page of PDF file. Document formatted into pages; contains xxv, 449 p.; also includes graphics (some col.). Includes bibliographical references (p. 376-449). Available online via OhioLINK's ETD Center

Few authors report comprehensive psychometric data for their acquired brain injury (ABI) outcome indices (e.g., items analyses, test-retest reliability, survivor-proxy agreement, internal consistency, convergent validity). Even fewer authors submit their indices to modern psychometric analyses, like Rasch analysis. The purpose of this dissertation was to evaluate the traditional and modern psychometric properties of a new index of brain injury outcome: the Functional Outcome Profile (FOP). One hundred and thirteen mixed (estimated mild, moderate, and severe injury) ABI survivors and 22 significant others participated in the study. Items analyses (n = 113) revealed that all items were endorsed by at least one ABI survivor, suggesting that the FOP assessed areas relevant to ABI survivors. However most items, composite scores, and the total score had distributions that were negatively skewed. One-week test-retest reliability correlations for the total score, composites, and items (n = 25) were generally in the moderate to strong range (r > 0.7), while survivor-proxy agreement correlations for the items (n = 22) were generally in the moderate range (r = 0.5 to 0.7). The internal consistency scores (n = 113) for 5 of the 8 composite scales and for the full FOP were good (Cronbach α > 0.7). Concurrent-convergent validity analyses revealed that the FOP correlated moderately well with the Mayo-Portland Adaptability Index (MPAI-4) (r = -0.75), but that it did not correlate with injury-related information (e.g., age at injury, time since injury, estimated severity). Rasch calibration of the FOP resulted in a 62-item index that fit the Rasch model well and that demonstrated good reliability and separation. Overall, the results suggest that the FOP has good traditional and modern psychometric properties when used with community-based outpatient ABI survivors. Future studies with the FOP should focus on improving the FOP’s clinical utility and further verifying its convergent and divergent validity.

Acquired Brain Injury (ABI) can cause balance and mobility deficits with activity and participation limitations. Repetitive Functional Task Practice (RFTP), currently best practice to promote recovery, is often not delivered at an adequate volume due to limited resources. This case series looked at the feasibility of treating community-dwelling people with ABI, in a group format, thus allowing economical, intense rehabilitation. Four participants attended for four weeks, three days/week, 4.25 hours/day. One-to-one and semi-supervised therapy was delivered with one therapist and one assistant. 89.51 minutes of RFTP and 134.82 minutes of total physical therapeutic activity was delivered per day. Participant satisfaction was good. All participants improved on some clinical measures. Three participants improved single and dual-task balance measures. This project established feasibility, allowed the formation of guiding principles for and supported the value of future research and development of this ABI Boot Camp model. / February 2016

Methicillin-resistant Staphylococcus aureus (MRSA) is a successful pathogen which was historically found in hospital settings but now is a common cause of infection in communities. The rapid emergence of community-acquired MRSA (CA-MRSA) at the turn of the 21st century has established this bacterium’s presence throughout the globe and MRSA continues to be endemic in certain countries. Asia is the most populous continent in the world and also holds a high burden of MRSA infection. This presents a concern for both public health and the acquisition of antibiotic resistance in this region. This literature review describes how MRSA became a successful pathogen. It provides a systematic review of the recent literature on MRSA in East Asia to identify major MRSA clones by country as determined by their molecular characteristics. Also to identify notable genetic and epidemiological factors associated with these MRSA clones. The results of this survey provided evidence of the importance of using molecular categorization techniques to accurately distinguish MRSA strains that require specific antibiotic treatment methods. It also provided evidence of CA-MRSA clones invading hospital settings and traditional hospital-acquired MRSA (HA-MRSA) clones continuing to develop multi-drug resistance throughout East Asian countries. The results also detected novel MRSA strains across hospitals and reported the spread of major MRSA clones within and between countries. Strengthening existing surveillance systems and collaborative efforts between countries within Asia should be a priority to monitor the evolution and movement MRSA especially in the age of globalization and accessible travel.

Orientador: Maria de Lourdes Ribeiro de Souza da Cunha / Banca: Carlos Magno Castelo Branco Fortaleza / Banca: Maria Clara Padoveze / Resumo: O gênero Staphylococcus está envolvido em infecções adquiridas tanto na comunidade como em hospitais, sobressaindo-se atualmente como um dos maiores problemas clínicos e epidemiológicos em infecções nosocomiais. Diante da importância do S.aureus como um dos microrganismos mais freqüentemente isolados de infecções de pele e tecidos moles e a crescente disseminação dos S. aureus resistentes a oxacilina (MRSA), este estudo objetiva identificar a presença de MRSA em feridas de pacientes atendidos em unidades básicas de saúde da cidade de Botucatu, caracterizar o cassete cromossômico mec e identificar fatores de risco para aquisição de S aureus e MRSA. Foram incluídas no estudo 126 amostras isoladas de 107 pacientes atendidos no período de março de 2010 à fevereiro de 2011. As amostras foram submetidas à identificação e detecção de resistência a oxacilina pelo método de difusão com disco de oxacilina e cefoxitina, penicilina, levofloxacina, clindamicina, eritromicina, gentamicina, sulfametazol/Trimetropim, tigeciclina, ácido fusídico, quinupristina/dalfopristina, linezolida e vancomicina. Foi realizada a caracterização do SCCmec por PCR multiplex nas amostras de S. aureus com gene mecA. Foi investigada a presença dos genes codificadores da Leucocidina Panton-Valentine (PVL). As amostras de Staphylococcus spp. também foram submetidas detecção de produção de -lactamase. Das 126 amostras estudadas, 73(58%) foram identificadas como genero Staphylococcus spp., sendo 49/73(67,1%) isolados S. aureus e 24/73(32,9%) estafilococos coagulase-negativa (ECN). A produção de -lactamase foi positiva em 65/73(89%) das amostras de Staphylococcus spp. Foi encontrado 7/49(14,2%) isolados de S. aureus e 13/24(54,1%) isolados de ECN com presença do gene mec A... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The genus Staphylococcus is involved in both community and hospital-acquired infections, currently standing out as major clinical and epidemiological problems in nosocomial infections. Given the importance of S. aureus as one of the most frequently microorganism isolated from skin and soft tissue infections and the increasing spread of methicillin-resistant S. aureus (MRSA), the aims of this study were to identify the presence of MRSA in wounds of patients treated at basic health units in Botucatu, characterize the cassette chromosome mec (SCCmec) and identify risk factors for acquisition of S aureus and MRSA. The study included 126 isolates from 107 patients treated from March 2010 to February 2011. The samples were identified and the disk diffusion method with cefoxitin and oxacillin disks was carried out in order to detect the resistance to oxacillin. The disk diffusion method was also carried out to set the susceptibility profile for the following antibiotics: penicillin, levofloxacin, clindamycin, erythromycin, gentamicin, sulfamethoxazole/trimethoprim, tigecycline, fusidic acid, quinupristin/dalfopristin, linezolid and vancomycin. mecA positive samples were submitted to SCCmec characterization using multiplex PCR. We also investigated the presence of genes encoding Panton-Valentine Leukocidin (PVL) as far as the - lactamase production. From the 126 samples studied, 73 (58%) were identified as genus Staphylococcus spp., and 49/73 (67.1%) isolates were identified as S.aureus and 24/73 (32.9%) as coagulase-negative Staphylococcus (CoNS). The -lactamase production was positive in 65/73 (89%) samples of Staphylococcus spp. The mecA gene was detected in 7/49 (14.2%) isolates of S. aureus and 13/24 (54.1%) isolates of CoNS. Among MRSA, 4/7 (57.2%) isolates were SCCmec type... (Complete abstract click electronic access below) / Mestre

Introdução: A adolescência é um dos períodos mais intensos da vida, pelos desafios, descobertas e oportunidades de exploração nela presentes e, por isso, se constitui um determinante da vulnerabilidade ao HIV/AIDS. Objetivo: identificar as evidências científicas da literatura sobre os elementos da vulnerabilidade de adolescentes ao HIV/AIDS. Metodologia: Revisão sistemática da literatura, na modalidade de denominada revisão integrativa. A busca de dados foi realizada nas seguintes bases e bancos de dados: CINAHL, PUBMED, SCOPUS, LILACS, ADOLEC, DEDALUS, Biblioteca Digital de Teses e Dissertações -BDTD, portal de teses da USP, no período de 1996 a 2006. Após avaliação do rigor metodológico dos estudos previamente selecionados, foram incluídos como amostra para análise 41 estudos realizados em diferentes países. Resultados: foram apresentados em duas etapas: a caracterização dos estudos e as evidências científicas dos elementos de vulnerabilidade. Os elementos identificados são iguais ou muito semelhantes nos diferentes países em que foram realizados os estudos, sendo diferente a forma como a vulnerabilidade se expressa, bem como a associação entre os elementos que a compõem. Foram identificados 33 elementos de vulnerabilidade, agrupados segundo três temas centrais: \"comportamentos e conhecimentos sobre o HIV/AIDS\", \"normas sociais\", \"condições socioeconômicas\" e \"gestão de serviços de saúde\". Os elementos da dimensão individual foram identificados com maior freqüência, seguidos pelos da dimensão social e programática. Os elementos da dimensão individual foram: grau e qualidade das informações que o adolescente possui sobre HIV, capacidade de assimilar e incorporar essas informações a sua vida, desconhecimento de sua vulnerabilidade, confiança na monogamia do parceiro, não adoção de práticas de proteção, uso de drogas, recusa ou incômodo em utilizar o preservativo, dificuldade de negociação de adolescentes femininas sobre uso do preservativo, gravidez como maior preocupação da conseqüência do ato sexual desprotegido, relações de gênero, representações da aids (doença do outro). Na dimensão social identificou-se: pobreza, violação dos direitos humanos, relações de gênero (aspectos culturais, exploração sexual, prostituição como meio sobrevivência), esgarçamento de laços familiares, acesso aos meios de escolarização e informação, desemprego, violência e falta de expectativas quanto ao futuro. Os elementos da dimensão programática envolveram: relação entre o usuário adolescente e o profissional (discriminação), qualidade do aconselhamento, teste para HIV, acessibilidade aos serviços de saúde, (descontinuidade das ações preventivas e falta de integração com outros serviços no planejamento e desenvolvimento das ações). Conclusões: a revisão integrativa permitiu identificar evidências científicas dos elementos constantes das três dimensões da vulnerabilidade, descritas no conceito de vulnerabilidade, assim como outros elementos, como a falta de percepção do adolescente sobre sua vulnerabilidade ao HIV/AIDS e a falta de perspectiva quanto ao futuro. A contribuição deste estudo para as práticas de saúde é relevante, uma vez que explicitou por meio das evidências científicas, os elementos da vulnerabilidade do adolescente ao HIV/AIDS, que devem ser considerados no planejamento das ações de prevenção para esse segmento social. Além disso, permitiu identificar lacunas de conhecimento sobre a temática, bem como a qualidade do conhecimento produzido, que também devem ser levados em conta em pesquisas futuras / Introduction: Adolescence is one of the most intense periods of life, because of the challenges, discoveries and chances that are present, and it is also a period of vulnerability infection to HIV. Objective: This study\'s goal is to identify the scientific evidences of literature on the elements of vulnerability of adolescents to the HIV/AIDS. Method: Systematic literature review called integrative review. The search of data was carried through in the following bases and data bases: CINAHL, PubMed, SCOPUS, LILACS, ADOLEC, DEDALUS, Capes- BDTD, portal of thesis of USP, in the period of 1996 to 2006. 661 studies, carried out in different countries, were previously selected to be evaluated for its methodology rigor. After evaluation the methodological rigor of the studies previously selected 41 of those studies were chosen as sample. Results: Where presented in two stages: the characterization of the studies and the scientific evidences of the vulnerability elements. The identified elements were equal or very similar, in the different countries where the studies had been carried through, being different the way that vulnerability was expressed as well as the association between such elements. Thirty- three elements of the vulnerability had been identified and grouped according to the central subject of each element: \"social behaviors and knowledge about HIV/AIDS\", \"social rules\", \" socioeconomical conditions \"and \"management of health services\". The elements of the subjective dimension were identified more frequently, followed by the ones of the social and programmatical dimension. The elements of the individual dimension were: the how much adolescent learns about aids ; the ability to assimilate and incorporate this knowledge to his/her your life; not knowing that he/she is vulnerable; trusting in his partner\'s monogamy; not adopting protection practices; use of drugs, uncomfortable or refusal to use condoms; difficulty in negotiating with her partner on the use of condom; pregnancy as the most undesirable consequence of the unprotected sexual act; gender relations; aids like a disease of other. The following social elements were identified: poverty; human rights violation; gender relations (cultural aspects), sexual exploitation (prostitution as a way of living) weakening of family bonds; access to school and information; unemployment, violence and hopelessness in the future. The following programmatical elements, are pointed out: relation between the adolescent patient and the health professional (discrimination); quality of counseling, testing for HIV, accessibility to health services, lack of preventive actions and lack of integration with other services in planning and development prevention actions for this social segment. Conclusions: This integrative review allowed identifying scientific evidences of vulnerability elements in the three dimensions, described in the vulnerability concept, as well as other elements, like the lack of perception of the adolescent on their own vulnerability to HIV/AIDS infection and the lack of perspective about their future. The contribution of this study for the health practices is relevant, once had proved by means of the scientific evidences, the elements of the vulnerability of the adolescent to the HIV/AIDS, that must be considered in the planning of the actions prevention for this social segment. Moreover, it allowed to identify knowledge gaps on the thematic one, as well as the quality of the produced knowledge, that also must been considered in future research

Metodologia: Na primeira parte desse trabalho realizou-se um estudo descritivo sobre aspectos relacionados a aids e sexualidade com a populaÃÃo dos profissionais mÃdicos, enfermeiros e agentes de saÃde das equipes do PSF (programa saÃde da famÃlia) do municÃpio de Fortaleza.O instrumento utilizado para a coleta de dados foi uma adaptaÃÃo do questionÃrio da pesquisa nacional acerca do Comportamento Sexual da PopulaÃÃo Brasileira, elaborado pelo MinistÃrio da SaÃde, no ano de 2000. Na segunda fase da pesquisa foi feito um estudo qualitativo com a formaÃÃo de grupos focais, com esta mesma populaÃÃo, abordando temas relacionados à aids e a sexualidade humana. A partir de um conjunto de referÃncias para os estudos sobre AIDS (os estudos da Antropologia) e levantamentos feitos por estudiosos na Ãrea, chegou-se aos seguintes eixos norteadores: I) as prÃticas sexuais como prÃticas sociais; II) A construÃÃo social das prÃticas sexuais acompanha o dinamismo das culturas e III) as prÃticas sexuais que sÃo prÃticas sociais, sÃo vividas por sujeitos multidimensionais. Resultados da primeira etapa: a pesquisa apontou que a prÃtica sexual entre pessoas do mesmo sexo e a existÃncia de relaÃÃes extraconjugais foi amplamente rejeitada pelos participantes da pesquisa. Apesar de quase todos haverem realizado treinamentos em aids, alguns revelaram que a doenÃa se pode pegar usando banheiros pÃblicos, fazendo-se uso da camisinha masculina ou feminina ou usando o mesmo talher de pessoas contaminadas. A maioria apontou que os preservativos sÃo desagradÃveis mas mesmo assim deve-se usÃ-los para se evitar a aids. Resultados da segunda etapa: O estudo nos revelou uma concepÃÃo mÃtica que envolve aspectos relacionados à doenÃa colocando-a ,quase sempre, como uma coisa do outro; o preservativo por sua vez, adquiriu um status de instrumento de intermediaÃÃo na relaÃÃo de poder; vislumbrando-se, tambÃm, uma concepÃÃo de naturalizaÃÃo nas relaÃÃes interpessoais mediadas por essas relaÃÃes de poder. ConclusÃes: Vimos que as opiniÃes desses profissionais, apesar de todo o arsenal de conhecimentos especÃficos e treinamentos impetrados, sÃo atravessadas por uma forte influÃncia biomÃdica de assepsia dos corpos e por um conjunto de vivÃncias e valores que nÃo se diferenciam muito da populaÃÃo com a qual atuam, levando-se a refletir de que modo se està dando suporte a essa dialogicidade entre o profissional e a comunidade. / Methodology: In the first part of this work a research was carried through became fullfilled a descriptive study on the population of the medical professionals, nurses and health agents who compose the teams of the PSF of the city of Fortaleza. The instrument of collection of data were an adaptation of the questionnaire used in the national research concerning the Sexual Behavior of the Brazilian Population, carried through for the Health department, in the year of 2000. At as a moment a qualitative study with the accomplishment of focal groups was made, with this same population, that approached subjects related to the AIDS and sexuality. After bibliographical survey of the authors who present works of relevance related to the subject we arrive at the following axles that had guided our look had been: I) practical sexual as practical the social ones; Practical II) the social construction of the sexual ones follow the dynamism of the cultures and practical III) the sexual ones are lived by multidimensionais.Resultados citizens of the first stage: the research pointed that practical sexual between people of the same sex and existence of extramarital relations widely it was rejected by the participants of the research. Although almost all to have carried through training in AIDS, some had disclosed that the illness if can catch using public bathrooms, becoming use of the masculine or feminine condom in the sexual relation or using the same place setting of contaminated people. The majority pointed that the condoms are ackward but exactly thus it must be used to prevent aid. Results of the second stage: The study in it disclosed a conception to them mythical that involves aspects related to the illness placing it, almost always, as a thing of the other; the condom in turn, acquired a status of instrument of intermediation in the relation of being able; glimpsing also a naturalization in the interpersonal relations mediated by these relations of being able. Conclusions: It was observed that it has a economic difference partner enters the professionals of the team of the PSF thus characterizing a difference of classrooms and sort permeado for intrinsic relations of being able. We saw that the opinions of these professionals, although all the armory of specific knowledge and petitioned training, are crossed by one strong biomedical influence of asepsis of the bodies, characterized for a set of experiences and values that are not differentiated very of the population in general.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Apesar de avanÃos cientÃficos no tratamento ao HIV e de polÃtica pÃblica especÃfica à populaÃÃo infectada, a aids se constitui em sÃrio problema de saÃde, que acomete grupos mais vulnerÃveis. Desta forma, ao tratar de pessoas vivendo com HIV à necessÃrio levar em conta os determinantes sociais relacionados ao processo de saÃde-doenÃa. Objetiva-se analisar a distribuiÃÃo espacial de pacientes com aids no Estado do CearÃ, Brasil, e sua associaÃÃo com determinantes sociais de saÃde. Estudo ecolÃgico transversal, considerou-se indivÃduos com aids, de idade igual ou superior a 13 anos, residentes no CearÃ, notificados entre 2001 e 2011 pelo Sistema de InformaÃÃo de Agravos de NotificaÃÃo. Trabalhou-se com variÃveis sociodemogrÃficas obtidas na Secretaria da SaÃde do Estado, dados socioeconÃmicos, ambientais e de saÃde do Instituto Brasileiro de Geografia e EstatÃstica, do Departamento de InformÃtica do Sistema Ãnico de SaÃde do Brasil e do Departamento de AtenÃÃo BÃsica. ConstruÃram-se indicadores epidemiolÃgicos e sociais baseados no Modelo TeÃrico de DeterminaÃÃo Social sugerido por Whitehead e Dahlgren. Para anÃlise dos dados individuais empregou-se o software SPSS 20.0. Testes foram aplicados para comparaÃÃo das proporÃÃes (exato de Fisher ou qui-quadrado de Pearson), comparaÃÃo de mÃdias (t de Student), correlaÃÃo entre variÃvel dependente e suas regressoras (teste de Pearson) e teste para aferir a normalidade da variÃvel dependente (Shapiro-Wilk). Foram consideradas estatisticamente significantes anÃlises inferenciais de ρ inferior a 0,05. Para dados socioambientais e de saÃde foram utilizados mÃtodos de geoprocessamento e de geoanÃlise. Para identificaÃÃo de aglomerados espaciais, calculou-se taxa mÃdia de aids do perÃodo e relacionada com o mapa vetorial do CearÃ, atravÃs do programa ArcGis10.1. AutocorrelaÃÃo espacial foi verificada pelo Ãndice de Moran. O Modelo de RegressÃo Linear Global foi Ãtil para anÃlise multivariada. Foram construÃdos mapas do risco relativo à formaÃÃo de aglomerados de aids ao longo da sÃrie temporal. Obteve-se aprovaÃÃo do Comità de Ãtica da Secretaria da SaÃde do Estado, sob protocolo n 203.911. A aids à crescente no CearÃ, com maioria masculina, adulta, residente na Capital. Foi observado processo de feminizaÃÃo, juvenizaÃÃo e interiorizaÃÃo da epidemia. O uso de drogas à prevalente entre jovens e pessoas de baixa escolaridade. Ocorre tendÃncia crescente da doenÃa entre pessoas com sete a onze anos de estudo, e diferenÃa estatÃstica significativa entre os sexos. A Rede Social de Apoio e de SaÃde Especializada para aids concentra-se na RegiÃo Metropolitana do Estado. Clusters de aids com altas taxas foi verificada na RegiÃo LitorÃnea e em Ãreas prÃximas à fronteira do PiauÃ, provavelmente vinculados ao turismo e aos processos migratÃrios. As taxas de aids foram associadas com a maioria dos indicadores socioeconÃmicos estudados. Observou-se relaÃÃo positiva entre aids e desigualdades econÃmicas. Foi verificada associaÃÃo inversa entre o agravo e a atenÃÃo primÃria. Constatou-se risco para clusters de aids primeiramente nos SertÃes do Estado e maior risco relativo em municÃpios do Noroeste Cearense ao longo da sÃrie temporal. Segundo se conclui, a aids no Cearà possui Ãreas de dependÃncia espacial e as disparidades socioeconÃmicas e de acesso à saÃde geram determinaÃÃes preponderantes ao adoecimento pelo HIV. / Despite scientific advances in HIV treatment and the specific public policy for the infected population, aids represents a severe health problem that affects more vulnerable groups. Therefore, when treating HIV-positive people, the social determinants of the health-disease process need to be taken into account. The goal is to analyze the spatial distribution of aids patients in the State of CearÃ, Brazil, and its association with social determinants of health. In this cross-sectional ecological study, individuals with aids aged 13 years or older were considered, who lived in Cearà and had been notified between 2001 and 2011 in the Brazilian Case Registry Database. Sociodemographic variables were used that were collected from the State Health Secretary; socioeconomic, environmental and health data from the Brazilian Institute of Geography and Statistics, from the Informatics Department of the Brazilian Unified Health System and from the Primary Healthcare Department. Epidemiological and social indicators were constructed based on the Theoretical Model of Social Determination suggested by Whitehead and Dahlgren. For individual data analysis, SPSS 20.0 software was employed. Tests were applied for comparison of proportions (Fisherâs exact or Pearsonâs chi-square), comparison of means (Studentâs t), correlation between dependent variable and its regressor variables (Pearson) and a test to verify the normality of the dependent variable (Shapiro-Wilk). Inferential analyses with ρ inferior to 0.05 were considered statistically significant. For socio-environmental and health data, geoprocessing and geo-analysis methods were used. To identify spatial clusters, the mean aids rate for the period was calculated and related to the vector map of CearÃ, using the software ArcGis10.1. Spatial self-correlation was verified through Moranâs index. The Global Linear Regression Model was useful for multivariate analysis. Risk maps were constructed for the formation of aids clusters throughout the time series. Approval was obtained from the Ethics Committee of the State Health Secretary under protocol 203.911. Aids is increasing in CearÃ, with a mostly male, adult population living in the state capital. It was observed that the epidemic is expanding among women, young people and in the interior of the state. Drugs use prevails among young people and people with low education levels. A growing trend of the disease is observed among people with seven to 11 years of education, with a statistically significant difference between the sexes. The Social Support and Specialized Health Network for aids is concentrated in the Metropolitan Region of the State. Aids clusters with high rates were verified in the Coastal Region and in areas close to the border with the State of PiauÃ, probably linked to tourism and migration processes. The aids rates were associated with most of the socioeconomic indicators studies. A positive relation was observed between aids and economic inequalities. An inverse association was verified between the problem and primary care. The risk of clusters was verified primarily in the hinterland of the State and a greater relative risk in cities in the Northeast of Cearà throughout the time series. As concluded, aids in Cearà is marked by areas of spatial dependence and the disparities in socioeconomic and health access conditions produce preponderant determinations for illness caused by HIV.