Orientador: Ione Corrêa / Resumo: O Sistema de Vigilância Sanitária da Itália detectou 445 casos de hepatite B e 69 de hepatite C, relacionados aos tratamentos de beleza. Fato esse alarmante, pois, os cuidados com a aparência, têm levado a população a buscar os padrões de beleza estabelecidos pela mídia. Destacando-se que os salões de beleza no Brasil estão cada vez mais comuns com a atuação dos profissionais de manicure e pedicure. Entretanto, os produtos cosméticos necessitam de uma avaliação da qualidade sanitária, ou seja, testes que indicam a quantidade de micro-organismos viáveis em cada amostra. Pois, evidências mostram a sobrevivência dos Trichophytonrubrum, Trichopyton mentagrophytes, Candida albicans, Candida parapsilosis no esmalte de unha. Todavia, a composição e a fabricação do esmalte são pouco conhecidas, devido várias etapas estarem envolvidas na produção dos esmaltes de unhas comuns. Objetivo: Avaliar a ação dos solventes presentes no esmalte de unha, o acetato de etila e o acetato de butila, sobre o herpes vírus bovino tipo 5. Método: Realizou ensaios da atividade antiviral nas diferentes fases do ciclo replicativo com os solventes, acetato de etila e o acetato de butila. Resultados: No pré-tratamento, não houve replicação viral no acetato de etila a partir da diluição 10-6 e no acetato de butila 10-5 . No póstratamento não houve replicação viral no acetato de etila a partir da diluição 10-7 e no acetato de butila 10-5 e na inativação viral, tanto o acetato de etila como o butila, após 48 e ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Health Surveillance System in Italy detected 445 cases of hepatitis B and 69 hepatitis C related to beauty treatments. These alarming facts, for care of the appearance have led people to look for the beauty standards set by the media. If highlighting the beauty salons in Brazil is becoming more common with the activities of manicure and pedicure professionals. However, cosmetic products require a quality assessment of the health, is tests which indicate the amount of viable microorganisms in each sample. For evidence shows the survival of Trichophyton rubrum, Trichophyton mentagrophytes, Candida albicans, Candida parapsilosis in nail polish. However, the enamel composition and manufacturing are little known due several steps are involved in the production of common nail enamels. Objective: To evaluate the action of solvents present in nail enamel, ethyl acetate and butyl acetate, about herpesvirus bovine type 5. Method: The antiviral activity test performed at different stages of the replicative cycle of the solvents, ethyl acetate and butyl acetate. Results: In the pre-treatment, there was no viral replication in the ethyl acetate dilution from 10-6 to 10-5 in butyl acetate. In the post-treatment there was no viral replication in ethyl acetate from the dilution 10-7 and 10-5 butyl acetate and viral inactivation, both the ethyl acetate and the butyl after 48 and 72 hours, all dilutions they showed viral replication, 10-1 to 10-10 . Discussion: Although not identify the sp... (Complete abstract click electronic access below) / Mestre

Orientadores: Ana Maria Segall Correa, Antonieta Keiko Kakuda Shimo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T02:09:05Z (GMT). No. of bitstreams: 1 Feracin_JussaraCunhaFleury_D.pdf: 1330727 bytes, checksum: 070897d55253d8c3248839454c7f0a06 (MD5) Previous issue date: 2009 / Resumo: Constitui prioridade de pesquisa e intervenção no Brasil a transmissão vertical do vírus HIV, infecção que tem aumentado entre as mulheres em idade fértil, resultando em progressiva redução na relação homem/mulher. O objetivo deste trabalho é analisar as ações de prevenção da transmissão vertical do vírus da AIDS durante o pré-natal, parto e puerpério, bem como as ações de vigilância epidemiológica, entre as mulheres grávidas soropositivas ao vírus HIV, residentes em um município do interior do estado de São Paulo. Trata-se de estudo realizado em duas fases, com abordagem quantitativa na primeira e qualitativa na segunda. Na primeira, descreve-se a situação epidemiológica dos 11 municípios pertencentes àquele Departamento, no período de janeiro de 2000 a dezembro de 2005, partindo-se das notificações e das fichas epidemiológicas de 112 gestantes portadoras do vírus HIV e das crianças nascidas destas gestações. As informações referem-se à idade das mulheres, local de sua moradia, momento de identificação da infecção, local e data do parto, além daquelas relativas aos procedimentos assistenciais terapêuticos e profiláticos. Na abordagem qualitativa, ou seja, na segunda fase foram realizadas entrevistas nas quais foi utilizado um roteiro padronizado e pré-testado com enfermeiros e médicos que prestam atendimento às gestantes e parturientes nas Unidades Básicas de Saúde e Hospital do município sede do Departamento Regional. Os resultados mostram, entre outras coisas, que todas as gestantes residiam em zona urbana, a maioria era branca (67,9%), de baixa escolaridade, sendo que mais de dois terços não haviam completado o primeiro grau e 42,9% tinham idade abaixo de 25 anos. Mais da metade conhecia seu status de soro-positividade antes da gravidez (53,6%) e para 10,7%, essa era a 2ª gravidez após o diagnóstico. Foram observadas falhas na profilaxia da transmissão vertical na gestação, parto e pós-parto. Nessa última intervenção, 17 mulheres não receberam AZT intravenoso e três recém-nascidos não fizeram profilaxia com AZT oral e outros três iniciaram a profilaxia 24 horas depois do parto. A estimativa de transmissão vertical do HIV foi de 4,5%. Na etapa qualitativa, foi observado que as solicitações de exames anti-HIV eram rotina estabelecida no pré-natal, não havendo, no entanto, aconselhamento pré e pósteste. No momento que antecede o parto, é sempre solicitado teste rápido. A necessidade da profilaxia, a indicação do parto cesariano e a inibição da lactação são de conhecimento dos profissionais, porém, esses profissionais não referem à forma como manejam essas intervenções. Conforme dados epidemiológicos resultantes desta pesquisa, algumas atitudes relacionadas à assistência às gestantes HIV positivas e a seus filhos não atendem as recomendações do Ministério da Saúde para a redução da transmissão vertical e as falas dos profissionais reforçam a necessidade de programas de capacitação e treinamentos na forma de educação continuada sobre o assunto para alcançar o objetivo proposto nas diretrizes nacionais de saúde / Abstract: A priority for public health research and intervention in Brazil is the vertical transmission of the AIDS virus, which has increased among women of reproductive age, resulting in a decreasing male/female ratio. The objective of this study is to analyze actions to prevent the vertical transmission of the AIDS virus during pregnancy, childbirth, and postpartum period, as well as the actions of epidemiological monitoring, of HIV-positive pregnant women residing in a city in the interior of the state of São Paulo. The study has two phases, one quantitative and the other qualitative. The first phase consisted of a descriptive study of the epidemiological situation in 11 municipalities pertaining to the Department of Health in the period from January, 2000, to December, 2005, based on epidemiological notifications and case records of HIV-positive pregnant women and the children resulting from those pregnancies. Information collected included the women's age, residence; time the HIV infection was identified, locale and date of delivery, as well as data on therapeutic and prophylactic care procedures. In the qualitative phase of the study, semi-structured interviews were conducted with nurses and physicians working in Primary Health Care Units and hospitals in the city where the Regional Health Department is located and, who provide care to the pregnant women and newborns. All the pregnant women reside in the urban area, most are White, with low educational levels, and 42.9% were less than 25 years old. More than half were aware of their HIV-positive status before becoming pregnant, and 10.7% of these were in their second pregnancy after having been diagnosed. Errors were observed in prophylactic procedures to prevent vertical transmission during pregnancy, during childbirth, and post-partum. With reference to the latter, 17 women were not given intravenous AZT, three newborns were not given AZT orally, and an additional three initiated prophylaxis 24 hours postpartum. The estimated vertical transmission of HIV was 4.46%. In the qualitative phase, it was observed that requests for anti-HIV tests were routine in pre-natal care, but with no counseling provided before or after the test. A rapid test is routinely requested at the moment just before childbirth, but there are no institutional standardized procedures that obligate staff to follow the recommendations that come with the test. The need for prophylaxis, cesarean birth, and inhibition of lactation are known by the professionals, however they do not refer to the way they normally deal with those procedures with the women. It was also observed that pediatricians deal better than other professionals with patients diagnosed as HIV-positive. The observed failures in health care and epidemiological surveillance for HIV-positive pregnant women and for their children confirm that the Ministry of Health HIV/AIDS protocols were not always followed by the health professionals, which shows the needs for continuing education, as they themselves pointed out / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

Introdução: Um pequeno grupo de fatores de risco modificáveis é responsável por grande parte da mortalidade e morbidade devidas a doenças crônicas não transmissíveis (DCNT). Esses comportamentos de risco, frequentemente, se originam na adolescência e se mantêm na vida adulta, com consequências a curto, médio e longo prazo. Atualmente, além de determinar a prevalência de cada um dos fatores de risco, destaca-se a importância de avaliar como eles se agrupam na população, pois alguns desses comportamentos podem interagir entre si, produzindo um risco ainda maior do que a soma de riscos individuais. Objetivos: Identificar padrões de comportamentos de risco e proteção relacionados a doenças crônicas entre adolescentes brasileiros e verificar sua associação com características socioeconômicas e demográficas; avaliar a coocorrência de múltiplos fatores de risco entre os adolescentes, identificar agrupamentos e verificar a associação do acúmulo de riscos com características da população. Método: A fonte de dados utilizada foi a Pesquisa Nacional de Saúde do Escolar 2012, que coletou informações sobre saúde de adolescentes por meio de questionário autoaplicável em amostra representativa de alunos matriculados no 9º ano do ensino fundamental de escolas públicas e privadas brasileiras. Foram utilizadas informações sobre alimentação, atividade física, tabagismo, consumo de álcool e características socioeconômicas e demográficas. A análise fatorial foi usada para identificar padrões de comportamento a partir de uma lista de fatores de risco e proteção para DCNT. A associação entre os padrões encontrados e as características dos estudantes foi avaliada com modelos de regressão linear. A coocorrência de múltiplos fatores de risco foi avaliada com um escore correspondente à soma de cinco comportamentos: 1) Consumo infrequente de frutas e hortaliças, 2) Consumo frequente de alimentos ultraprocessados; 3) Atividade física insuficiente; 4) Fumo; e 5) Consumo abusivo de álcool. Os agrupamentos foram identificados utilizando a razão entre a prevalência observada e a prevalência esperada (O/E) para cada uma das 32 combinações de fatores de risco possíveis. As razões de prevalência O/E maiores que um foram indicativas de um agrupamento (ou cluster). A associação entre o acúmulo de quatro ou cinco dos fatores de risco e as variáveis socioeconômicas e demográficas foi avaliada com a utilização de modelo de regressão logística. Resultados: Foram encontrados quatro padrões de comportamentos: \"alimentação não saudável\", \"alimentação saudável\", \"atividade física\" e \"álcool e cigarro\". De forma geral, os grupos que apresentaram pior perfil de adesão aos padrões comportamentais encontrados foram: meninas, adolescentes mais velhos, e aqueles que não viviam com a mãe e o pai. Em relação à ocorrência simultânea dos fatores de risco definidos, apenas 2,5% dos adolescentes não apresentou nenhum dos comportamentos, enquanto 38,1% acumulou dois, 34,2%, três, 8,9%, quatro e 1,5%, os cinco fatores de risco estudados. As combinações de comportamentos mais comuns nos adolescentes foram aquelas em que estavam presentes os fatores de risco relacionados a alimentação e atividade física, ainda que as razões O/E fossem próximas a um. As maiores razões O/E foram encontradas para as combinações em que estavam presentes o cigarro e o álcool, indicando a forte correlação entre o uso das duas substâncias, ainda que a prevalência seja baixa nessa faixa etária. As características associadas ao acúmulo de quatro ou cinco fatores de risco foram: sexo feminino, ter mais de 16 anos, não viver com a mãe e o pai, menor escolaridade da mãe, ser aluno de escola pública, viver em municípios que sejam capitais de estado e nas regiões mais desenvolvidas do país. Conclusão: Os comportamentos de risco relacionados a alimentação e atividade física são os mais frequentes e se distribuem de forma independente nessa faixa etária. Por outro lado, o uso de cigarro e álcool é bastante correlacionado, apesar da baixa prevalência. A presença de múltiplos fatores de risco é comum nessa população e a identificação de grupos mais vulneráveis pode auxiliar no direcionamento de estratégias de promoção à saúde e prevenção de agravos relacionadas ao controle de DCNT ainda durante a adolescência / Introduction: A small group of modifiable risk factors accounts for most of the disease burden and mortality due to non-communicable diseases (NCD). These risk behaviors frequently originate in adolescence and remain in adulthood with short-, medium- and long-term consequences. Currently, in addition to determining the prevalence of each of the risk factors, it is important to evaluate how they cluster among the population, since some of these behaviors might interact with each other, producing an even greater risk than the sheer sum of individual risks. Objectives: To identify patterns of risk and protection behaviors related to chronic diseases among Brazilian adolescents and to verify their association with socioeconomic and demographic characteristics; And to assess the co-occurrence of multiple risk factors among adolescents, to investigate the clustering of risk factors, and to verify the association of presence of multiple risk factors with population characteristics. Methods: Our data source was the Brazilian National Survey of School Health (Pesquisa Nacional de Saúde do Escolar - PeNSE) 2012, which collected data on adolescent health through a self-administered questionnaire in a representative sample of students enrolled in the 9th grade of elementary education in public and private Brazilian schools. We used data about diet, physical activity, smoking, alcohol consumption, socioeconomic and demographic characteristics. Factor analysis was used to identify patterns of behavior from a list of risk and protective factors for NCD. The association between the identified patterns and students\' characteristics was evaluated using linear regression models. The co-occurrence of multiple risk factors was evaluated with a score corresponding to the sum of five behaviors: 1) Infrequent consumption of fruits and vegetables, 2) Frequent consumption of ultraprocessed foods; 3) Insufficient physical activity; 4) Smoke; and 5) Abuse of alcohol. The clustering was identified using the ratio between the observed and expected prevalence (O/E) for each of the 32 combinations of risk factors. Observed/expected ratios (O/E) higher than 1 were considered an indicative of clustering. The association between the prevalence of four or five risk factors and the socioeconomic and demographic variables was evaluated using a logistic regression model. Results: Four patterns of behavior were found: \"unhealthy diet\", \"healthy diet\", \"physical activity\" and \"alcohol and cigarette use\". In general, the groups that presented the worst profile of adherence to the behavioral patterns found were: girls, older adolescents, and those who did not live with the mother and the father. Regarding the simultaneous occurrence of defined risk factors, only 2.5% of adolescents did not present any of the behaviors, while 38.1% accumulated two, 34.2%, three, 8.9%, four and 1.5% all of risk factors analyzed. The most common combinations of behaviors in adolescents were those in which risk factors related to diet and physical activity were present, even though O/E ratios were close to one. The highest O/E ratios were found for the combination of cigarette and alcohol, suggesting a strong correlation between the use of both substances, although the prevalence is low in this age group. The characteristics associated with the presence of four or five risk factors were: female, being over 16 years old, not living with the mother and father, lower education of the mother, being a public school student, living in capitals, and living in the more developed regions of the country. Conclusion: The risk behaviors related to diet and physical activity are the most frequent and occur independently in this age group. On the other hand, cigarette and alcohol use is highly correlated, despite the low prevalence. The presence of multiple risk factors is common in this population and the identification of more vulnerable groups can support strategies for health promotion and prevention of diseases related to the control of CNCD even during adolescence

Objetivo. Adaptar e testar um sistema de vigilância de fatores de risco relacionados à prática de atividade física e sedentarismo para doenças crônicas não transmissíveis (DCNT) em uma área de atuação do Programa de Saúde da Família (PSF) no município de São Paulo. Material e métodos. Foi realizado um inquérito domiciliar em 1.805 adultos residentes em domicílios cadastrados no PSF da área de abrangência da unidade básica de saúde (UBS) Jardim Jaraguá no Município de São Paulo. O questionário utilizado foi adaptado do instrumento empregado nas entrevistas do sistema VIGITEL. Os indicadores desse sistema sobre prática de atividade física e sedentarismo foram analisados segundo gênero, faixa etária e escolaridade dos indivíduos. A reprodutibilidade dos indicadores foi avaliada comparando-se resultados obtidos na entrevista original e de outra entrevista repetida após período de 7 a 15 dias, em uma subamostra de 101 indivíduos (pelo cálculo de coeficientes kappa). Resultados. Atividades físicas no lazer, no deslocamento e na ocupação foram mais freqüentes em homens enquanto a atividade física em tarefas domésticas foi mais freqüente em mulheres. A condição de completa inatividade física foi mais freqüente em homens. Associação positiva entre escolaridade e atividade física foi encontrada, no sexo masculino, apenas para atividade no lazer e, no sexo feminino, para inatividade física. Associação inversa entre escolaridade e inatividade física foi observada no sexo masculino enquanto para o sexo feminino, houve associação inversa entre escolaridade e atividade física no ambiente doméstico. O sistema proposto reuniu características potenciais de simplicidade, rapidez, baixo custo e boa fidedignidade, revelando boa reprodutibilidade dos indicadores estudados uma vez que os mesmos apresentaram valores de coeficiente kappa com concordância moderada a substancial. Conclusões. Os resultados desse estudo demonstraram a viabilidade de práticas de vigilância relacionadas ao PSF. Ainda, os dados gerados pelo estudo apontaram alto nível de inadequação da prática de atividade física na população estudada destacando a necessidade de práticas de vigilância voltadas grupos populacionais específicos / Objective. To adapt and test a surveillance system of risk factors related to physical activity and inactivity to chronic non-communicable diseases (NCDs) in an area of operation of the Family Health Program (FHP) in the municipality of São Paulo. Material and methods. We conducted a household survey in 1,805 adults living in households enrolled in the PSF area covered by the basic health unit (BHU) Jardim Jaraguá in São Paulo. The questionnaire used was adapted from the instrument employed in the interviews of VIGITEL system. The indicators of this system on physical activity and inactivity were analyzed according to gender, age and education of individuals. The reproducibility of the indicators was assessed by comparing the results obtained in the original interview and in another interview repeated after a period of 7 to 15 days in a subsample of 101 individuals (by calculating kappa coefficients). Results: Physical activity during leisure, transportation and occupation were more frequent in men as physical activity in housework was more frequent in women. The condition of complete physical inactivity was more common in men. Positive association between education and physical activity was found in males for activity at leisure and in females for physical inactivity. Inverse association between education and physical inactivity was observed among males. There was an inverse association between education and physical activity at home among females. The proposed system met a potentially simple, rapid, low cost and good reliability, with good reproducibility of the indicators studied since they had values of kappa coefficient with moderate to substantial agreement. Conclusions. The results of this study demonstrate the feasibility of surveillance practices related to the FHP. Still, the data generated by the study showed high level of inadequate physical activity in this population highlights the need for surveillance practices aimed at specific population groups

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The inclusion of topics related to health and non communicable diseases (DANTs) should be prioritized in the school context, as these diseases are the first cause of death in our country. However, so that these issues can be worked in school, it is important that educators are properly trained to take on such a task. Thus, the process of continuous training of teachers to work with an interdisciplinary education and health, and significantly, should be encouraged, and may be based on the use of active methods such as problematization methodology (MP). In this context, the main objective of this thesis was to evaluate the effectiveness of the MP as interdisciplinary teaching tool, and promote the training of teachers and elementary school students about health and risk factors for DANTs. Initially we investigated the knowledge of the students and faculty of Sciences and Physical Education 7th grade of primary education on health and risk factors for DANTs where it was established a good base of knowledge to certain risk factors, such as the sedentary lifestyle and poor diet. But, stands out that further is needed clarification and activities aimed at prevention and health promotion at school, because it is an audience of teenagers in formation of habits and lifestyle. Subsequently, were provided to teachers, training courses on health in the school context, in partnership with those responsible for public schools and state agencies of Alegrete/RS. These courses, in addition to providing updates on issues related to health and DANTs prevention, aimed at the proposal of interdisciplinary work between the areas involved, having the MP with the bow Maguerez as a teaching tool. It found small share of the contingent of teachers from both school systems, but great interest and motivation among participants. Finally, the educational intervention activities were conducted in health with students of the 7th grade of elementary school, based on the problematization methodology. The activities were proposed in an interdisciplinary way, and can be seen that the students considered the proposal of MP attractive, were motivated in performing their steps because the issues addressed have become significant and related to the same reality, as recommended the MP. Still, with respect to the use of the MP, the teachers showed interest and good acceptance for using it as a teaching proposal, as well as availability to start work on education and health in school. Thus, we highlight the urgency of further encouraging continuing education of teachers of basic education, through projects, training courses and workshops, so that they feel prepared to approach the relevant issues, and belonging the everyday student. / A inserção de temáticas relacionadas à saúde e aos fatores de risco para doenças e agravos não transmissíveis (DANTs) deve ser priorizada no contexto escolar, uma vez que estas doenças representam a primeira causa de morte em nosso país. No entanto, para que estas temáticas sejam abordadas na escola, é preciso que os educadores estejam devidamente capacitados para assumir tal tarefa. Assim, o processo de formação continuada de professores para o trabalho com educação e saúde de forma interdisciplinar e significativa, deve ser estimulado e, pode ter como base a utilização de metodologias ativas, como a Metodologia da Problematização (MP). Nesse contexto, o objetivo principal desta tese foi avaliar a efetividade da metodologia da problematização como ferramenta de ensino interdisciplinar e, promover a capacitação de professores e alunos do ensino fundamental sobre saúde e fatores de risco para DANTs. Inicialmente investigou-se o conhecimento dos escolares e professores de Ciências e Educação Física da 7ª série do ensino fundamental sobre saúde e fatores de risco para DANTs, onde foi possível constatar uma boa base de conhecimento para determinados fatores de risco, como por exemplo, o sedentarismo e a má alimentação. Mas, vale ressaltar que, por se tratar de um público de adolescentes em período de formação de hábitos e estilo de vida é necessário maior esclarecimento sobre estes temas e atividades que visem o estímulo à prevenção e promoção da saúde na escola. Posteriormente, foram proporcionados, aos professores, cursos de capacitação em saúde no contexto escolar, realizados em parceria com os órgãos públicos responsáveis pelas escolas municipais e estaduais de Alegrete/RS. Estes cursos, além de proporcionarem atualizações sobre temáticas relacionadas à saúde e prevenção de DANTs, visavam à proposta de um trabalho interdisciplinar entre as áreas envolvidas, tendo a MP com o arco de Maguerez como ferramenta de ensino. Constatou-se pequena participação do contingente de professores de ambas as redes de ensino, mas grande interesse e motivação entre os participantes. Por fim, foram realizadas atividades de intervenção educativa em saúde com os alunos da 7ª série do ensino fundamental, tendo como base a metodologia da problematização. As atividades foram propostas de forma interdisciplinar e, pode-se constatar que os alunos consideraram a proposta da MP atraente e, motivaram-se na realização de suas etapas, pois os temas abordados tornaram-se significativos e relacionados à realidade dos mesmos, como preconiza a MP. Ainda, com relação à utilização da MP, os professores demonstraram interesse e boa aceitação para utilização da mesma como proposta de ensino, assim como disponibilidade para iniciar o trabalho com educação e saúde na escola. Logo, salienta-se a premência de um maior incentivo à educação continuada dos professores da Educação Básica, por meio de projetos, cursos e oficinas de capacitação, a fim de que os mesmos se sintam preparados para abordagem de temas relevantes, e que façam parte do cotidiano do aluno.

The following treatise first frames the role of CBOs in responding to the HIV/Aids crisis in relation to their position in the global health governance system through a literature survey that moves from an analysis of the global structures down to the local. The survey covers the role of international organisations, international NGOs (INGOs), national governments, local NGOs and CBOs and outlines the context in which Masizakhe is working within the global health governance structure. Secondly the research design and methodology are outlined focusing on the longitudinal, case study and participant--‐observation approaches. Hypotheses, conceptualisation, definitions, key variables are described and data collection methods and fieldwork practice extrapolated upon. Following that data capturing, editing and analysis are discussed in conjunction with shortcomings and sources of error. In the fourth chapter the research discusses the history, structure and outlines the research findings by comparing what has changed within the organisation over time, presenting and discussing the results. The outcomes of this research have shown that existing problems in this particular CBO are very difficult to overcome without committed, sustained support from donors, government, community and the organisation’s members. CBOs are often hamstrung by a series of intersecting factors which hamper their ability to problem--‐solve, even when the route to overcoming the problem is clear, particularly when the capacity and will to do so is not always present from both within the organisation and from outside support systems. These challenges then impact on the overall quality of and ability to deliver the services the organisation is structured to deliver. The major challenge for the organisation remains the inconsistent donor cycle and resultant instability thus created within an organisation already working in a highly volatile, unstable situation marked by poverty and disease. Thus the title, The Aids of Aid?, captures the essence of Masizakhe’s struggle with its own syndrome of problems. It summarises a comment made by the project secretary said that: “Sometimes it feels like we are not only fighting for the health of our people – We are fighting for the health of our organisation. We are a sick organisation trying to help sick people. All we need is donors and funding –we can’t live without them, and when they don't give, we get sick” (Stamper, Pers Comm, 2011). The other emergent challenges were a battle internally with ‘founder syndrome’, lack of management transparency and a dysfunctional board.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-26T13:25:46Z No. of bitstreams: 1 chislenepereiravanelli.pdf: 1181150 bytes, checksum: 7977ccd5a6660800b22cf060d5f86b37 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-27T11:03:00Z (GMT) No. of bitstreams: 1 chislenepereiravanelli.pdf: 1181150 bytes, checksum: 7977ccd5a6660800b22cf060d5f86b37 (MD5) / Made available in DSpace on 2016-01-27T11:03:00Z (GMT). No. of bitstreams: 1 chislenepereiravanelli.pdf: 1181150 bytes, checksum: 7977ccd5a6660800b22cf060d5f86b37 (MD5) Previous issue date: 2014-12-10 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Introdução: As doenças crônicas não transmissíveis estão associadas a grande morbimortalidade e a elevados custos financeiros para o sistema público de saúde. Dentre estas doenças, destaca-se a hipertensão arterial sistêmica (HAS), uma doença de alta prevalência e que se associa frequentemente com complicações metabólicas, renais e, sobretudo cardiovasculares. Diante dessa realidade, foi implantado o Programa Hiperdia Minas no Estado de Minas Gerais, visando garantir o acesso à assistência especializada aos indivíduos com hipertensão arterial sistêmica, diabetes mellitus e doença renal crônica. O presente estudo foi dividido em duas etapas, as quais tiveram por objetivo descrever o perfil sociodemográfico e clínico dos usuários, além da caracterização das equipes das unidades de saúde avaliadas. Metodologia: O estudo descreveu e analisou a base de dados do Centro HIPERDIA Minas de Juiz de Fora e também as unidades de atenção primária a saúde (UAPS) que encaminharam usuários a este Centro. Foram incluídos no estudo 943 usuários encaminhados e atendidos para controle da HAS. Foram entrevistados os profissionais de saúde de 14 UAPS da cidade de Juiz de Fora, selecionadas pelo número de encaminhamentos ao Centro HIPERDIA. Resultados: A média de idade dos indivíduos foi 58,8±13,1 anos, sendo 61,3% do gênero feminino. Apenas 20,7% dos usuários chegaram ao Centro HIPERDIA com HAS em estágio 3. Do total de usuários avaliados, 78,6% apresentava excesso de peso. Hipertrigliceridemia, hipercolesterolemia e elevação do colesterol LDL estiveram presentes em 45,0, 49,6 e 66,5%, respectivamente. Além disso, 49,9% apresentaram taxa de filtração glomerular estimada < 60 mL/min, 15,3% dos usuários apresentavam coronariopatia, 76,1% disfunção diastólica de ventrículo esquerdo e 34,8% alto risco cardiovascular. A pressão arterial esteve elevada em 72,5% dos hipertensos por ocasião da admissão no Centro HIPERDIA Minas de Juiz de Fora. UAPS com equipes incompletas foram relatadas por 53,8% dos supervisores. Não foram realizadas “Referência” e “Contra referência” de atendimento de usuários entre a atenção básica e os outros níveis de complexidade em 61,5% das unidades. Em 84,6% das UAPS, a coordenação não analisou os relatórios emitidos pelo sistema de informações do Hiperdia. Conclusões: Observou-se elevada prevalência de dislipidemia, doença cardiovascular e redução na taxa de filtração glomerular. Encaminhamentos inadequados, mau controle da hipertensão arterial e a elevada prevalência de lesões de órgãos alvo sugerem a fragmentação no sistema de atenção à saúde e a ineficiência de interlocução entre os diferentes níveis da rede de atenção à saúde. / Introduction: The chronic non-communicable diseases are associated to large morbimortality and to elevated financial costs for the public health system. Amongst these diseases, highlights the systemic arterial hypertension (SAH), a disease of high prevalence which is frequently associated to metabolic, renal and, mostly, cardiovascular complications. Facing this reality, the Hiperdia Minas Program was implemented in the state of Minas Gerais, aiming at guaranteeing the access to specialized care for the individuals with systemic arterial hypertension, diabetes mellitus and chronic kidney disease. This study was divided into two stages, which aimed to describe the sociodemographic and clinical profile of users, and the characterization of teams of health units evaluated. Methodology: This study described and analyzed the database of the HIPERDIA Minas center of Juiz de Fora and also the primary healthcare unities (UAPS) which forwarded users to this Center. 943 users who were forwarded and attended for the control of SAH were included. The health professionals of 14 UAPS in the city of Juiz de Fora, selected by the number of forwarding to the HIPERDIA Center, were interviewed. Results: the individual age average was 58.8±13.1 years old, being 61.3% females. Only 20.7% of the users arrived to the HIPERDIA Center presenting stage 3 HAS. Out of all the evaluated users, 78.6% were overweight. Hypertriglyceridemia, hypercholesterolemia and elevated LDL cholesterol were present in 45.0, 49.6 and 66.5%, respectively. In addition, 49.9% had estimated glomerular filtration rate <60 mL/min, 15.3% of users had coronary artery disease, 76.1% diastolic dysfunction of the left ventricle and 34.8% high cardiovascular risk. Blood pressure was elevated in 72.5% of hypertensive on admission in HIPERDIA Minas center of Juiz de Fora. UAPS with incomplete teams were reported by 53.8% of supervisors. User attendance “Reference” and “Counter reference” between basic care and other attendance complexity levels were not performed in 61.5% of the units. In 84.6% of the UAPS, the coordination didn’t analyze the reports emitted by the Hiperdia information system. Conclusions: A high prevalence of dyslipidemia, cardiovascular disease and reduced in the glomerular filtration rate were observed. Inadequate forwarding, poor control of arterial hypertension and high prevalence of lesions of targeted organs suggest the fragmentation of the health care system and the inefficiency of dialog between the different levels of the health care network.

MENVSC (Geography) / Department of Geography and Geo-Information Sciences / Semi-arid regions of Africa are prone to epidemics of malaria. Epidemic malaria occurs along the geographical margins of endemic regions, when the equilibrium between the human, parasite and mosquito vector populations are occasionally disturbed by changes in one or more meteorological factors and a sharp but temporary increase in disease incidence results. Monthly rainfall and temperature data from the South African Weather Service and malaria incidence data from Department of Health were used to determine the influence of meteorological variables on malaria transmission in Limpopo from 1998-2014. Meteorological influences on malaria transmission were analyzed using time series analysis techniques. Climate suitability for malaria transmission was determined using MARA distribution model. There are three distinct modes of rainfall variability over Limpopo which can be associated with land falling tropical cyclones, cloud bands and intensity of the Botswana upper high. ENSO and ENSO-Modoki explains about 58% of this variability. Malaria epidemics were identified using a standardized index, where cases greater than two standard deviations from the mean are identified as epidemics. Significant positive correlations between meteorological variables and monthly malaria incidence is observed at least one month lag time, except for rainfall which shows positive correlation at three months lag time. Malaria transmission appears to be strongly influenced by minimum temperature and relative humidity (R = 0.52, p<0.001). A SARIMA (2, 1, 2) (1, 0, 0)12 model fitted with only malaria cases has prediction performance of about 53%. Warm SSTs of the SWIO and Benguela Niño region west of Angola are the dominant predictors of malaria epidemics in Limpopo in the absence of La Niña. Warm SSTs over the equatorial Atlantic and Benguela Niño region results in the relaxation of the St. Helena high thus shifting the rainy weather to south-east Africa. La Niña have been linked with increased malaria cases in south-east Africa. During El Niño when rain bearing systems have migrated east of Madagascar ridging of the St. Helena high may produce conducive conditions for malaria transmission. Anomalously warmer and moist winters preceding the malaria transmission season are likely to allow for high mosquito survival and the availability of the breeding sites thus high population in the beginning of the transmission season hence resulting in increased epidemics. / NRF

In infected patients, the rapid identification of pathogens is critical. After a long period of slow technological improvement, the microbiology laboratory is now undergoing significant evolution. This work evaluated the contribution of recent MALDI-TOF MS technology in terms of the diagnosis and clinical management of patients and its implementation in the laboratory of tomorrow. The studies were conducted over a 3.5-year period, mostly in the iris public hospital network of Brussels. <p>First, we confirmed the accurate performance of MALDI-TOF MS in the identification of routine isolates, regardless of whether the Biotyper (92.7% correct species identification) or VITEK MS (93.2%) (n=986) commercial system was used, and demonstrated the supremacy of this technology over conventional identification techniques for fastidious bacteria, including Campylobacter and related organisms (98.3%, 72.2% and 79.9% correct species identification by Biotyper, Vitek NH Card and API Campy, respectively; n=234). <p>Second, we showed that the direct MALDI-TOF MS identification of bacteria from positive blood cultures was not only feasible but also led to an 24-h reduction in the time-to-identification. In an adult population, more than 13% of the direct identifications from positive blood cultures resulted in the faster adaptation of the antimicrobial treatment. <p>Third, we demonstrated that MALDI-TOF MS could easily be implemented in a network, which was associated with significant cost savings and reduction in the time-to-identification. Finally, our promising Blastocystis subtyping results suggest that the number of MALDI-TOF MS applications may be increased.<p>In the future, automation of the technique will make its use in clinical laboratories even easier, eliminating the use of conventional identification techniques. Improvement of the preanalytical procedures is also important to make MALDI-TOF MS a suitable instrument for resistance and toxicity mechanism detection and subtyping. <p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2019 / Objectives To determine the prevalence and survival rate; and to assess the maternal risk factors as well as complications of prematurity, associated with the mortality of very low and extremely low birth weight infants in the Neonatal Intensive Care Unit (NICU) of Mankweng Hospital. Materials and Methods A retrospective descriptive study was conducted at the NICU of Mankweng Hospital for a 7-month period from 1st January to 31st July 2015. The patient medical records and the Perinatal Problem Identification Programme (PPIP) data were used for the study. Results Prevalence of prematurity was 23%, Infants weighing between 500g-1499g represented 6.3% of the total live births and 25% of the admissions to the NICU; of which 4.9% were classified as extremely low birth weight (ELBW). Overall 77% of the study population survived until discharge. From the medical records, the survival to discharge of infants with weight 500g - 999g was 52%; and 84% for those with weight 1000g-1499g. Multivariable analysis found that improved survival was associated with an increase in gestational age (p <0.001), as well as birth weight (p <0.001) and prolonged length of stay. Variables associated with poor survival were spontaneous preterm labour (p = 0.031), low Apgar score at 1 and 5 minutes (p <0.001), sepsis (p = 0.001), respiratory distress syndrome (p <0.001), pulmonary hemorrhage (p <0.001), hypothermia (P = 0.005), resuscitation at birth (p = 0.002) and necrotising enterocolitis (p =0.044). Antenatal steroids were not associated with survival (p =0.111), however this was not documented in 53%(134/252) of the records, so the non-significance to outcome in this study may not be a true reflection. The use of NCPAP or SiPAP only was associated with improved survival of up to 69% and high mortality rates were recorded in babies who required invasive ventilator support. Multi-organ immaturity was found to be the most common cause of death, followed by sepsis. Conclusion: The prevalence and survival rates of very low and extremely low birth weight, found in this study are comparable to those found in other tertiary hospitals in South Africa. The survival rate of ELBW babies is low and must be improved. Reliable data and further research should address effective steps to prevent preterm labour, extreme prematurity and hypothermia. The documentation and provision of antenatal steroids is encouraged. KEY CONCEPTS: Prematurity, Extremely low and Very low birth weight, Risk factors, Prevalence, Survival, Neonatal mortality rate.