Made available in DSpace on 2014-07-29T15:30:38Z (GMT). No. of bitstreams: 1 Dissertacao Jose Laerte Rodrigues da Silva Junior.pdf: 1539460 bytes, checksum: 734766715ffd43b1be965ce4c8870c7a (MD5) Previous issue date: 2011-11-17 / Objectives: To evaluate the effect of the climate seasonality on the occurrence of respiratory symptoms in patients attending a primary health unit in a tropical city. Methods: We conducted a cross-sectional study on subjects attending an out-patient primary health unit in relation with meteorological data collected daily. During one year, forty-four cross-sectional observations categorized by season were made. The observations were chosen randomly, in twelve-hour intervals (7am to 7pm). Analysis of variance was used to compare means across seasons. Pairwise correlation was conducted to verify the association between the number of patients and each meteorological variable. A model of autoregressive moving average with exogenous variables was conducted to evaluate the ability of the meteorological variables to predict the proportions of subjects with respiratory symptoms on each season. Results: Among the 3,354 subjects enrolled, 14.6% had respiratory symptoms. The temperature variation was not enough to change the number of individuals with respiratory symptoms, however there was an increase of subjects with respiratory symptoms coinciding with low levels of humidity during winter, with a statistically significant difference between seasons (p=0,01). Correlation showed that the mean of previous three days minimum air humidity correlates negatively with the number of respiratory subjects (p < 0.04). An ARMAX model that included the same variable showed a statistically significant coefficient (p < 0.0001). Conclusion: In a Brazilian city with tropical weather, the number of subjects with respiratory symptoms attending a primary health unit is increased with the reduction of air humidity and it is possible that this increase could be predicted by meteorological data. / Objetivo: Avaliar o efeito da sazonalidade climática na ocorrência de sintomas respiratórios nos indivíduos que procuraram uma Unidade Básica de Saúde em uma cidade de clima tropical. Métodos: Foi realizado um estudo de corte transversal relacionando os indivíduos que procuraram assistência médica em uma Unidade Básica de Saúde com dados meteorológicos coletados diariamente. Durante um ano, quarenta e quatro observações foram realizadas, onze em cada estação. O dia de cada corte transversal foi escolhido de forma aleatória e ocorreu em intervalos de 12 horas. Análise de variância (ANOVA) foi usada para comparação das médias das variáveis dependentes em cada estação. Correlação pareada foi conduzida entre as variáveis dependentes e cada variável meteorológica. Um modelo auto-regressivo, de média móvel com variável exógena (ARMAX) foi empregado para avaliar a capacidade das variáveis meteorológicas em prever a proporção de indivíduos com sintomas respiratórios em cada estação do ano. Resultados: Entre os 3.354 indivíduos incluídos, 14,6% possuíam sintomas respiratórios. A variação de temperatura não foi suficiente para provocar mudanças no número de indivíduos com sintomas respiratórios, porém houve aumento destes indivíduos coincidindo com baixos níveis de umidade no inverno, com diferença estatisticamente significativa entre as estações (p=0,01). Foi observado que a média da umidade relativa mínima dos três dias que antecederam as observações correlacionou-se negativamente com o número de indivíduos com sintomas respiratórios (p<0,04) e um modelo ARMAX que incluiu a mesma variável apresentou um coeficiente estatisticamente significativo (p<0,0001). Conclusão: Em uma Unidade Básica de Saúde de uma cidade de clima tropical, o número de indivíduos com sintomas respiratórios aumenta com a redução da umidade relativa do ar e existe possibilidade de esse aumento ser previsto a partir de dados meteorológicos.

No / To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.

Yes / This study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.