Introdução: As infecções relacionadas à assistência a saúde (IRAS) são adquiridas durante o atendimento ao paciente para tratamento clínico ou cirúrgico e são o evento adverso mais frequente em serviços de saúde. Pacientes internados em unidades de terapia intensiva (UTI) apresentam maior risco de infecção e as infecções de corrente sanguínea ICS associadas a cateter venoso central (CVC) podem ser consideradas uma importante complicação em pacientes críticos e estão relacionadas com aumento na mortalidade, morbidade, tempo de internação e custos. A implantação de medidas de prevenção é capaz de prevenir mais de 50% das ICS associadas a CVC, resultando não apenas em redução de custos diretos, mas, também, em melhora da qualidade da assistência. Objetivos: Implantação de medidas de intervenção e avaliação do impacto destas medidas na redução das taxas de infecção de ICS laboratorialmente confirmadas associadas a CVC em hospitais com UTI adulto do estado de São Paulo de abril a dezembro de 2011 e até 6 meses após este período. Métodos: Uma amostra de 56 hospitais do Estado de São Paulo participou do estudo. Os hospitais foram orientados a formar grupos de trabalho e a aplicar um questionário de conhecimento aos seus profissionais de saúde. Além disso, os hospitais realizaram observação de práticas de inserção e cuidados com CVC. Os dados foram compilados e divulgados às equipes durante uma reunião na qual foram definidas quatro estratégias de intervenção. Após a implantação das medidas de intervenção, os hospitais realizaram um segundo período de observação e as equipes se reuniram em mais duas ocasiões para discutir as dificuldades e os resultados. As taxas de ICS associada a CVC foram acompanhadas durante todo o período. Os modelos lognormal de efeitos mistos e modelos baseados em equações de estimação generalizada foram utilizados para selecionar variáveis associadas à redução de ICS associada a CVC. Resultados: Houve melhora nas práticas de cuidados com CVC dos profissionais de saúde após a implantação das medidas de intervenção. A redução das taxas de ICS associada a CVC foi mais significativa em hospitais com taxas iniciais maiores que 7,4 / 1000 cateteres-dias (p < 0,001) e naqueles que introduziram o uso de cateter central de inserção periférica (PICC) (p = 0,01). No modelo final de análise de dados a variação nas taxas pós / pré-intervenção foi estimada. Para os hospitais com taxas iniciais altas, mesmo sem a implantação do PICC ou de novos dispensadores de produto alcoólico para higiene das mãos, espera-se que as taxas diminuam em 36% (95% IC: 9- 63%) ao longo do tempo. Conclusões: A redução das taxas de ICS associada a CVC foi mais significativa em hospitais com taxas inicialmente altas e naquelas que implantaram PICC. O processo de avaliar práticas e discutir problemas, no entanto, pode ter tido um efeito adicional na redução de taxas / Background: Healthcare-associated infections (HAI) are the most frequent adverse event in health services. Intensive Care Unit (ICU) patients are at increased risk of infection and catheter-related bloodstream infections (BSIs) may be considered an important complication and are related to increased mortality, morbidity, time hospitalization, and costs. Several studies on the impact of interventions to reduce BSI have been published and show the feasibility and cost-effectiveness of these measures. Objectives: Implantation of intervention measures and evaluation of the impact of these measures in reducing the rates of BSI rates in adult ICUs in the state of São Paulo, Brazil, from April to December 2011 and up to 6 months after this period. Methods: 56 hospitals were requested to form work teams. Each hospital applied a questionnaire to their health care workers (HCW) and performed observation of practices. Data were compiled then fed back to the teams during a meeting in which 4 intervention strategies were defined. A 2nd observation period followed and teams met on 2 further occasions to discuss difficulties and results. BSI rates were registered. Log-normal mixed effects models and generalized estimating equation based models (GEE based models) were used to select variables significantly associated with the variation in BSI. Results: Interventions improved HCWs practices. Reduction of BSI rates was more significant in hospitals with initial BSI rates > 7.4/1000 catheter-days (p < 0.001) and those that introduced the use of peripherally-inserted central catheters (PICC) (p=0.01). A final model incorporing such findings was fitted and post/preintervention variation in rates were estimated. For hospitals with high BSI initial rates, without implementation of PICC or new alcohol hand rub dispensers, the rates are expected to decrease by 36% (95%CI: 9-63%) over time. Conclusions: Reduction of BSI rates was more significant in hospitals with initially high rates and in those implementing PICCs. The process of evaluating practices and discussing problems, however, may have had an additional effect

A proposição inicial do uso de camisinha como prevenção de HIV/aids está vinculada à noção de sexo seguro, desenvolvida pela comunidade gay estadunidense no início da década de 1980. No Brasil, o sexo seguro foi incorporado nas primeiras respostas à epidemia e, com o desenvolvimento das ações preventivas, a camisinha foi adotada como a principal estratégia de proteção contra a transmissão do HIV por via sexual. Atualmente, o segmento populacional composto por gays e outros homens que fazem sexo com homens (HSH) configura um dos focos de concentração da epidemia e, portanto, um dos públicos-chave para o direcionamento da prevenção. Este trabalho tem como objetivo recuperar os discursos acerca da camisinha como estratégia de prevenção de HIV/aids entre gays/HSH, construídos pela política pública de saúde e pelos movimentos sociais no Brasil, buscando compreender seus significados no contexto dos impasses enfrentados pela prevenção ao longo de sua história. O estudo é fundamentado nas abordagens construcionistas da sexualidade e utiliza como referências a perspectiva da vulnerabilidade e a teoria dos scripts sexuais. Trata-se de investigação qualitativa, realizada com base em entrevistas em profundidade com 13 pessoas que mantêm/mantiveram envolvimento significativo com o enfrentamento da epidemia de HIV/aids no país e/ou com a reflexão acerca das questões relativas à prevenção, especialmente no âmbito dos cenários sexuais gays/HSH. Foram selecionados atores de destaque no trabalho relacionado à promoção do uso da camisinha: condução de políticas públicas, produção de pesquisa e atuação em movimentos sociais LGBT e de aids. A partir das narrativas colhidas e de referências associadas, é apresentada uma recuperação histórica da trajetória da camisinha como prevenção de HIV/aids. A análise ressalta que a convergência dos discursos preventivos na recomendação da camisinha resvalou no tecnicismo, característico do processo de medicalização do social. O uso tecnicista da prevenção consistiu em (a) uma abordagem prescritiva, expressa na progressiva reprodução da mensagem \"use camisinha\"; (b) na descontextualização dos discursos preventivos em relação ao conteúdo sexual inerente ao uso da camisinha, contestada especialmente nas propostas de erotização desse insumo; (c) na postura impositiva de profissionais e campanhas de prevenção. Adicionalmente, a prevenção tem esbarrado nas dificuldades de abordagem do homoerotismo em função do fortalecimento de resistências moralistas e conservadoras na política brasileira. Esse cenário, que compromete os direitos de gays/HSH à saúde, é agravado por uma crise na estrutura dos programas de aids e das organizações dos movimentos sociais. Desse modo, o avanço no enfrentamento da epidemia e, mais especificamente, a redução das taxas de infecção em gays/HSH dependem da superação dessas barreiras, que tendem a se reproduzir na abordagem das novas tecnologias de prevenção em HIV/aids / The initial proposal for the use of condoms to prevent HIV/AIDS is linked to the concept of safe sex, developed by the gay community in the United States in the early 1980s. In Brazil, safe sex was incorporated in the early responses to the epidemic and, with the development of preventive actions, condom promotion was adopted as the main strategy to protect against HIV sexual transmission. Nowadays, the population segment composed of gay men and other men who have sex with men (MSM) represents one of the focuses of the epidemic concentration and therefore one of the key populations for targeting prevention. This work aims to recover the discourses on the use of condoms as an HIV/AIDS prevention strategy directed to gay/MSM population, built by both Brazilian public health policy and social movements, seeking to understand their meaning in the context of the impasses faced by prevention throughout his history. This study is based on constructionist frameworks of sexuality and uses as references the vulnerability perspective and the theory of sexual scripts. This is a qualitative research, carried out based on in-depth interviews with 13 people who keep/kept significant roles in fighting the HIV/AIDS epidemic in the country and/or in the reflecting on issues related to prevention, especially in the scope of gay/MSM sexual scenarios. The selected participants are prominent actors in the work related to the promotion of condom use: driving public policy, producing research and acting in LGBT and AIDS social movements. From the collected narratives and associated references, a historical recovery of the trajectory of the condom as an HIV/AIDS prevention is presented. The analysis points out that the convergence of preventive discourses on recommendation of the condom slipped on the technicism, characteristic of the process of social medicalization. The technicist use of the prevention consisted of (a) a prescriptive approach, expressed in the forward playback of the message \"use condom\"; (b) the decontextualization of preventive discourses in relation to sexual content inherent in the use of condoms, especially contested in proposals of eroticizing this device; (c) the impositive posture of professionals and prevention campaigns. Additionally, prevention has bogged down in difficulties on the approach of homoeroticism due to the strengthening of moralist and conservative resistances in Brazilian policy. This scenario, which undermines the rights of gay/MSM to health, is exacerbated by a crisis in the structure of AIDS programs and organizations of social movements. Thus, the progress in confronting the epidemic and, more specifically, in the reduction of infection rates in gay/MSM depend on overcoming these barriers which tend to be reproduced in the approach to the new HIV/AIDS prevention technologies

I ntrodução: A incidência de lesões venosas pós-implante transvenoso de dispositivos cardíacos eletrônicos implantáveis (DCEI) é elevada, sendo a disfunção ventricular e o uso prévio de marcapasso temporário (MPT) ipsilateral ao implante definitivo fatores de risco independentes para sua ocorrência. A utilidade de estratégias terapêuticas profiláticas para a prevenção dessa complicação ainda permanece controversa. O objetivo desse estudo clínico, randomizado e controlado foi avaliar o papel da anticoagulação oral na prevenção das lesões venosas pós-implante transvenoso de DCEI em pacientes de alto risco, analisando a influência na incidência das obstruções venosas, a segurança, a eficácia e as complicações do tratamento. Método: No período de Fevereiro/2004 a Setembro/2007 foram estudados 101 pacientes adultos submetidos ao primeiro implante transvenoso de DCEI, apresentando fração de ejeção do ventrículo esquerdo (FEVE) <=0,40 e/ou presença de MPT ipsilateral ao implante definitivo. Após o procedimento, os pacientes foram randomizados para o uso diário de placebo ou varfarina. Avaliações clínicas e laboratoriais foram realizadas periodicamente. A pesquisa de lesões venosas foi feita pela venografia por subtração digital, seis meses após o implante. A análise dos dados foi realizada segundo o princípio de \"intenção-de-tratar\". Na análise da associação das variáveis demográficas, clínicas e operatórias com a presença de lesões venosas empregou-se os testes Qui-quadrado, Exato de Fisher ou \"t\" de Student e o modelo de regressão logística foi utilizado para a identificação de fatores de risco. Resultados: As características basais foram similares nos dois grupos, não sendo encontradas diferenças significativas entre as variáveis demográficas, clínicas e operatórias. Durante o período de seguimento clínico, ocorreram seis óbitos, quatro relacionados com a progressão da insuficiência cardíaca e duas mortes súbitas. Do total de óbitos, quatro pacientes estavam alocados no Grupo Varfarina e dois no Placebo. Somente um paciente, do Grupo Varfarina, apresentou sangramento gastrintestinal, com necessidade de hospitalização e transfusão de hemoderivados. O valor médio do INR dos pacientes do Grupo Varfarina foi 2,3±0,7 enquanto que no Grupo Placebo foi 1,1±0,3, sendo que esta diferença manteve-se ao longo de todo o período de seguimento. O valor médio da hemoglobina e do hematócrito foi similar em ambos os grupos, sendo 13,9±1,6g/dL e 41,2±4,6%, no Grupo Placebo e 14,0±1,4g/dL e 41,9±3,7%, no Grupo Varfarina. Dos pacientes alocados no Grupo Varfarina, 17 (38,6%) apresentaram obstruções venosas, em comparação a 29 (60,4%) casos do Grupo Placebo, com redução absoluta do risco de 22% (RR= 0,63; IC 95%= 0,013 a 0,42). A comparação das características clínicas dos pacientes que apresentaram lesões venosas com as dos pacientes que não apresentaram mostrou que o uso de varfarina (P=0,037) esteve associado a uma menor incidência de lesões venosas e a presença da doença de Chagas (P= 0,051) esteve associada a uma maior incidência. Somente a ausência de anticoagulação oral foi identificada como fator de risco independente para a ocorrência das lesões venosas (OR= 2,424; IC 95% 1,048 - 5,606; P= 0,038). Conclusão: O uso profilático da anticoagulação mostrou-se seguro e reduziu significativamente a incidência de obstruções venosas pós-implante de DCEI nos pacientes de alto risco. / Introduction: The incidence of venous thrombosis after cardiac devices implantation is high. Ventricular dysfunction and previous transvenous temporary leads ipsilaterally to the permanent implantation are independent risk factors. The effect of prophylactic strategies to prevent these complications remains controversial. The aim of this clinical, randomized and controlled study was to evaluate the role of oral anticoagulant therapy in the prevention of these complications in high risk patients, analyzing the effect on the venous obstructions incidence, the safety, effectiveness and complications of this treatment. Method: Between February 2004 and September 2007, 101 adult patients submitted to first transvenous cardiac devices implantation, with left ventricular ejection fraction <=0.40 and/or previous transvenous temporary leads were evaluated. After device implantation, patients were randomly assigned to receive either placebo or warfarin. Periodical clinical and laboratorial evaluations were performed to anticoagulant management. Following the six-month period, every patient was submitted to a digital subtraction venography. Data analysis was performed according to the \"intention-to-treat\" principle. The association of demographic, clinical and procedure variables with the presence of venous lesions was analyzed by the Chi-square, Fisher\'s exact, or \"t\" Student tests, and logistic regression model was used to identify risk factors. Results: Baseline characteristics were similar in both groups and no significant difference was observed in demographic, clinical and procedure variables. During the follow-up period, six patients died, four related to heart failure progression and two of sudden death. Four of the patients dead were allocated in Warfarin group and two in Placebo group. Only one patient of the Warfarin group presented with gastrointestinal bleeding, requiring hospitalization and blood transfusion. The median INR of patients in the Warfarin group was 2.3 ± 0.7, whereas the median INR in the Placebo group was 1.1 ± 0.3. This difference was maintained throughout the study period. The median hemoglobin and hematocrit values were similar in both groups, with 13.9 ± 1.6g / dL and 41.2 ± 4.6% in the Placebo group and 14.0 ± 1.4g / dL and 41.9 ± 3.7% in the Warfarin group. The frequency of venous obstructions in the Warfarin group was 38.6% compared with 60.4% in the Placebo group (P=0.018), corresponding to an absolute risk reduction of 22% (RR= 0.63, 95% CI= 0.013-0.42). The comparison between obstructed and non-obstructed patients showed that warfarin use was associated with a lower incidence of venous lesions (P= 0.037) and that Chagas\' disease presence was associated with a higher incidence (P= 0.051). Logistic regression analysis showed that only absence of anticoagulant therapy (P=0.038; OR=2.424, 95% CI= 1.048 - 5.606) was a predictor of venous obstruction. Conclusion: The prophylactic use of the anticoagulation therapy has been safe and reduced the frequency of venous thrombosis after transvenous cardiac devices implantation in high risk patients.

Nível elevado de homocisteína (Hcy) no plasma é considerado fator de risco de doença cardiovascular. Consumo reduzido de vitaminas B6, B12 e ácido fólico tem sido relacionado com hiperhomocisteinemia. O objetivo desse estudo foi verificar o consumo de vitaminas B6, B12 e ácido fólico nas populações urbana e rural, bem como a correlação dos níveis plasmáticos dessas vitaminas com os níveis plasmáticos de Hcy. Também determinamos os níveis séricos de lipídeos e avaliamos o risco cardiovascular das populações frente a hiperlipemia. O consumo de B6 e ácido fólico é maior na população urbana, com p=0,00 e p=0,04 respectivamente, sendo o consumo de B12 maior na população rural, com p=0,47. As correlações são significativamente negativa entre Hcy e as vitaminas B12 e ácido fólico . A população rural apresenta Hcy com valor médio de 16,5±9,2&#181;mol/L, classificada como hiperhomocisteinemia moderada, e a população urbana 12,8±5,5 &#181;mol/L, o qual está dentro da faixa de referência. O valor médio de LDL sérica é maior na população urbana (3,4±0,8mmoI/L) do que na população rural (2,8±0,9mmoI/L), com valor de p=0,00. Como fator de risco cardiovascular, consideramos Hcy plasmática >14&#181;mol/L e LDL sérica >3,38mmol/L. Neste caso, 41,4% da população rural e 7,4% população urbana apresentam Hcy maior que 14&#181;mol/L. O inverso ocorre em relação a LDL, onde 43,2% da população urbana e 11% na população rural apresentam níveis acima de 3,38mmol/L. Concluímos que o risco cardiovascular decorrente de hiperhomocisteinemia é maior na população rural que na urbana e este risco poderia reduzir mediante o consumo de vitaminas. / Elevated levels of plasma homocysteine (Hey) are considered a risk factor for cardiovascular diseases. Low intake of vitamins 86, 812 and folic acid have been related to hyperhomocysteinemia. The purpose of the present study is to determine the consumption of the vitamins B6, B12 and folic acid in two Brazilian urban and rural populations, along with the plasmatic levels of these vitamins and plasmatic homocysteine. In addition, the serum levels of lipids have been determined to evaluate the cardiovascular risk in the two populations regarding their hyperlipidemie comdition. The consumption of B6 and folic acid is higher in the urban population (p=0.00 and p=0.04 respective/y), while the consumption of B12 is not significantly different (p=0.47). There is a negative correlation between B12 and folic acid with Hcy. The rural population shows mean Hcy value of 16.5±9.2&#181;mol/L and is classified as having moderate hyperhomocysteinemia, while for the urban population, the mean value is 12.8±5.5&#181;mol/L and is well within the normal range. The mean value of the serum LDL is higher in the urban population (3.4±0.8mmol/L) compared to the rural population (2.8±0.9mmol/lL) with a significance of p=0.00. Plasma Hcy values >14&#181;mol/L and serum LDL >3.38mmol/L were considered as the risk factors for cardiovascular disease. With in the reference values, 41.4% of the rural population and 7.4% of the urban population showa Hcy as a risk factor. For LDL, the inverse is true, i.e 43.2% of urban and 11% of the rural population are at risk. We conclude that the cardiovascular risk arising from hyperhomocysteinemia is higher in the rural population and that this can be reduced by increased consumption of vitamins.

Introdução: As infecções relacionadas à assistência a saúde (IRAS) são adquiridas durante o atendimento ao paciente para tratamento clínico ou cirúrgico e são o evento adverso mais frequente em serviços de saúde. Pacientes internados em unidades de terapia intensiva (UTI) apresentam maior risco de infecção e as infecções de corrente sanguínea ICS associadas a cateter venoso central (CVC) podem ser consideradas uma importante complicação em pacientes críticos e estão relacionadas com aumento na mortalidade, morbidade, tempo de internação e custos. A implantação de medidas de prevenção é capaz de prevenir mais de 50% das ICS associadas a CVC, resultando não apenas em redução de custos diretos, mas, também, em melhora da qualidade da assistência. Objetivos: Implantação de medidas de intervenção e avaliação do impacto destas medidas na redução das taxas de infecção de ICS laboratorialmente confirmadas associadas a CVC em hospitais com UTI adulto do estado de São Paulo de abril a dezembro de 2011 e até 6 meses após este período. Métodos: Uma amostra de 56 hospitais do Estado de São Paulo participou do estudo. Os hospitais foram orientados a formar grupos de trabalho e a aplicar um questionário de conhecimento aos seus profissionais de saúde. Além disso, os hospitais realizaram observação de práticas de inserção e cuidados com CVC. Os dados foram compilados e divulgados às equipes durante uma reunião na qual foram definidas quatro estratégias de intervenção. Após a implantação das medidas de intervenção, os hospitais realizaram um segundo período de observação e as equipes se reuniram em mais duas ocasiões para discutir as dificuldades e os resultados. As taxas de ICS associada a CVC foram acompanhadas durante todo o período. Os modelos lognormal de efeitos mistos e modelos baseados em equações de estimação generalizada foram utilizados para selecionar variáveis associadas à redução de ICS associada a CVC. Resultados: Houve melhora nas práticas de cuidados com CVC dos profissionais de saúde após a implantação das medidas de intervenção. A redução das taxas de ICS associada a CVC foi mais significativa em hospitais com taxas iniciais maiores que 7,4 / 1000 cateteres-dias (p < 0,001) e naqueles que introduziram o uso de cateter central de inserção periférica (PICC) (p = 0,01). No modelo final de análise de dados a variação nas taxas pós / pré-intervenção foi estimada. Para os hospitais com taxas iniciais altas, mesmo sem a implantação do PICC ou de novos dispensadores de produto alcoólico para higiene das mãos, espera-se que as taxas diminuam em 36% (95% IC: 9- 63%) ao longo do tempo. Conclusões: A redução das taxas de ICS associada a CVC foi mais significativa em hospitais com taxas inicialmente altas e naquelas que implantaram PICC. O processo de avaliar práticas e discutir problemas, no entanto, pode ter tido um efeito adicional na redução de taxas / Background: Healthcare-associated infections (HAI) are the most frequent adverse event in health services. Intensive Care Unit (ICU) patients are at increased risk of infection and catheter-related bloodstream infections (BSIs) may be considered an important complication and are related to increased mortality, morbidity, time hospitalization, and costs. Several studies on the impact of interventions to reduce BSI have been published and show the feasibility and cost-effectiveness of these measures. Objectives: Implantation of intervention measures and evaluation of the impact of these measures in reducing the rates of BSI rates in adult ICUs in the state of São Paulo, Brazil, from April to December 2011 and up to 6 months after this period. Methods: 56 hospitals were requested to form work teams. Each hospital applied a questionnaire to their health care workers (HCW) and performed observation of practices. Data were compiled then fed back to the teams during a meeting in which 4 intervention strategies were defined. A 2nd observation period followed and teams met on 2 further occasions to discuss difficulties and results. BSI rates were registered. Log-normal mixed effects models and generalized estimating equation based models (GEE based models) were used to select variables significantly associated with the variation in BSI. Results: Interventions improved HCWs practices. Reduction of BSI rates was more significant in hospitals with initial BSI rates > 7.4/1000 catheter-days (p < 0.001) and those that introduced the use of peripherally-inserted central catheters (PICC) (p=0.01). A final model incorporing such findings was fitted and post/preintervention variation in rates were estimated. For hospitals with high BSI initial rates, without implementation of PICC or new alcohol hand rub dispensers, the rates are expected to decrease by 36% (95%CI: 9-63%) over time. Conclusions: Reduction of BSI rates was more significant in hospitals with initially high rates and in those implementing PICCs. The process of evaluating practices and discussing problems, however, may have had an additional effect

The purpose of this research was to examine potential sustainable delivery methods for Oral Health Promotion (OHP) in developing populations in India, utilising non-dental rural community development groups, specifically those led by Non-Governmental Organizations (NGO) involved in community development. The focus of this research was based on a longitudinal cohort study experimental design for exploratory purposes conducted over a period of one year, using a randomised cluster sampling of community developmental projects within the rural-tribal villages of Ambernath, Maharashtra, India. The study was measured in 4 phases: oral health knowledge of village parents through a questionnaire, dental screenings of children, and integration of a ‘train-the-trainer’ type of Oral Health Awareness Programme (OHAP) for three test groups, followed by one-year comparison follow-up data. Findings show evidence of comprehension and dissemination of the information in the OHAP course. Screening data also showed a reduction in decay in primary and permanent teeth in the children, after one year, and a positive change in oral hygiene behaviours. The collaboration and utilisation of non-dental NGO teams and local participatory groups from a ‘grass-roots’ level was proven to be effective for disseminating information and activities for oral health awareness and promotional programmes within these populations. Evidence supports a collaboration of these groups can be recommended for introducing a structured and understandable oral health programme utilising non-dental NGO and local participatory groups.

Cardiovascular diseases (CVD) are the leading cause of death, and the underlying atherosclerotic process has its origin in youth. Physical activity lowers future CVD risk, however few adolescents achieve the recommended minimum amount of daily activity and interventions fail to meaningfully increase activity levels in this group. It is therefore essential to identify how small volumes of exercise can be optimised for the primary prevention of CVD. The purpose of this thesis is to identify the influence of exercise intensity on vascular health outcomes in adolescents, and to assess the efficacy of 2 weeks of low volume, high-intensity interval training on CVD risk factors in this population. Chapter 4 demonstrates that a single bout of high-intensity interval exercise (HIIE) performed one hour before a high fat meal elicits comparable reductions in postprandial lipaemia as a work-matched bout of moderate-intensity exercise (MIE) in girls. However, neither exercise attenuated postprandial lipaemia in the boys. Additionally, HIIE elicited a superior increase in postprandial fat oxidation and decrease in blood pressure, and this was sex independent. These findings are furthered in Chapter 5, which identified that accumulating HIIE, but not MIE, favourably modulates glycaemic control, postprandial blood pressure and fat oxidation in adolescents irrespective of sex. A high fat meal was included in Chapter 6 in order to impair vascular function via oxidative stress. Postprandial vascular function was preserved following MIE, but improved after HIIE, and these changes were not related to changes in postprandial lipaemia or total antioxidant status. Chapter 7 addressed the time course of the changes in vascular function post exercise, and identified that HIIE promotes superior changes in vascular function than MIE. Finally, Chapter 8 identified that 2 weeks of high-intensity interval training improved novel (endothelial function and heart rate variability), but not traditional CVD factors in adolescent boys and girls. However, most of these favourable changes were lost 3 days after training cessation. Thus, this thesis demonstrates that vascular health outcomes are positively associated with exercise intensity. Given that HIIE was perceived to be more enjoyable than MIE in Chapters 4, 6 and 7, performing HIIE appears to be an effectual and feasible alternative to MIE for the primary prevention of CVD.

Physician assistants play a pivotal role in expanding access to care, yet research on their preventive medicine practices is limited. Guided by Lewis's conceptual model for predicting counseling practices, this cross-sectional study examined the relationship between physician assistants' preventive medicine practices, personal health habits, prevention and counseling attitudes, and perceived barriers to the delivery of clinical preventive services. A 104-item self-administered survey was used to collect data from 314 physician assistants attending the American Academy of Physician Assistants' 42nd Annual Conference. Data were analyzed using descriptive statistics, Pearson's correlation, and stepwise multiple regression. Results indicated that physician assistants engaged in preventive medicine activities about half the time, believed it was very important to counsel patients on prevention topics, felt they were somewhat effective in changing patient behaviors, and reported that barriers were somewhat important in hindering preventive care delivery. Significant and predictive relationships between physician assistants' health habits, attitudes, perceived barriers, and practices were found. These findings may guide researchers, providers, policymakers, and the public in making informed and comprehensive health care decisions. This study contributes to social change by serving as a baseline for the creation of effective strategies for physician assistant practice and self-assessment. Additionally, data from this study can be used to advocate changes in the education, training, and certification of physician assistants, as well as foster medicine and public health collaborations.

This paper focuses on boys and young men's attitudes, knowledge and practices with regard to pregnancy and HIV infection. The objective of the study is to ascertain how boys and young men perceive the risks of pregnancy and HIV infection. The study further investigates the strategies which the sexually active respondents considered as appropriate, practical and effective in coping with these risks. The study was based on the secondary data which was extracted from the transitions to adulthood survey conducted in KwaZulu Natal during 2001. The analysis was restricted to young men aged 14 to 24 years. The major findings from the study revealed that young men did not perceive themselves at risk of HIV infection. Overall, respondents were fairly knowledgeable about HIV/AIDS and knew where to access condoms, how HIV is contracted or transmitted etc. Findings also indicated that many respondents regarded pregnancy as a matter of great concern. Many respondents perceived pregnancy as highly problematic and were concerned to protect themselves against this risk. The major finding for this study revealed that the majority of sexually active young men used condoms for preventing both pregnancy and HIV/AIDS; while some also used various contraceptive methods to prevent pregnancy. A major factor promoting consistent condom use was the perception of pregnancy as highly problematic. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2006.

Introduction: The public health system is of central importance in efforts to reduce the burden of chronic disease, yet there are no national data on organizational capacity (OC) or dissemination practices pertaining to chronic disease prevention (CDP) programming in the public health system. The aim of this thesis is to investigate OC and dissemination practices within the Canadian public health system. Two new conceptual models pertaining to these constructs were developed, and a survey of all public health organizations across Canada engaged in CDP was conducted in 2004-5. / Method: Data were collected in telephone interviews with persons most knowledgeable about CDP programming in 77 "resource" organizations that develop and transfer CDP innovations to other organizations, and 216 "user" organizations that adopt and deliver CDP programs in specific populations. Reliable measures of the constructs of interest were developed using principal components analyses. Levels of OC, its potential determinants, and involvement in CDP programming were compared across three types of organizations and across Canada. In addition, levels of 13 dissemination-related practices were compared across organizations and independent correlates of dissemination were identified in multiple linear regression. / Results: Levels of skill and involvement were highest for tobacco control and healthy eating programming; lowest for stress management, social determinants of health, and program evaluation. Any notable differences in skill levels favoured central Canada. Resource adequacy was low overall; lowest in eastern Canada and within formal public health organizations. Supports for OC were highest in central Canada and in grouped organizations. Dissemination practices most heavily engaged in included: Identification of barriers to adoption/implementation of the innovation, tailoring dissemination strategies and design of dissemination plan. There was little coherence across organizations in the number or types of dissemination practices engaged in. Skill at planning/implementing dissemination, external sources of funding, type of resource organization, attitude toward the process of collaboration, and user-centeredness were all positively associated with dissemination (R2=0,42; F value 8.20, p&lt;0.0001). / Conclusions: These results provide a backbone for organizational research in public health systems. Strengths and gaps identified in OC and dissemination practices will guide strategic investment in the public health system.