CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Nos Ãltimos anos, o Programa Nacional de Controle da HansenÃase tem focado suas aÃÃes em Ãreas geogrÃficas definidas com alta detecÃÃo de casos. Este estudo teve o objetivo de caracterizar padrÃes epidemiolÃgicos, espaciais e temporais da hansenÃase em um agregado de alto risco de transmissÃo, em municÃpios dos estados do MaranhÃo, ParÃ, Tocantins e PiauÃ. Desta forma, foram aplicados diferentes mÃtodos de anÃlise espacial (Descritivo, Abordagem Bayesiana Local, EstatÃstica Scan Espacial) e quantificada a dependÃncia espacial de diversos indicadores epidemiolÃgicos e operacionais da hansenÃase. Em outro estudo, foram identificados o fluxo de pessoas afetadas e os motivos para migraÃÃo apÃs diagnÃstico. No perÃodo de 2001 a 2009, 82.463 casos novos foram detectados no agregado (coeficiente mÃdio de detecÃÃo: 95,9/100mil habitantes ao ano). No resto do Brasil o coeficiente foi 21,0 (RR=4,56, IC 95%: 4,45-4,66; p<0,0001). Houve fluxo direcionado dospacientes com hansenÃase notificados para um municÃpio diferente da sua residÃncia. AraguaÃna, Imperatriz, Marabà e Floriano receberam um nÃmero considerÃvel de casos provenientes dos municÃpios em seu entorno. As capitais SÃo LuÃs, Teresina e BelÃm absorviam tambÃm casos vindos de outros estados. GoiÃnia e BrasÃlia se localizam distante do agregado, mas tÃm destaque pela notificaÃÃo de casos provenientes do agregado. ApÃs o primeiro diagnÃstico, 53,5% dos motivos principais de migraÃÃo foram relacionados a mudanÃas de estilo de vida. AnÃlise Scan Espacial identificou 23 agregados de elevada detecÃÃo de casos novos, a maioria localizados no Parà e MaranhÃo. Estes agregados incluÃram apenas 32% da populaÃÃo, mas 55,4% dos casos novos e 101 (27,1%) municÃpios. TambÃm foram identificados 14 aglomerados significativos para o coeficiente de detecÃÃo em crianÃas e 11 de casos novos com grau 2 de incapacidade/100mil hab. O agregado mais significativo, no centro do MaranhÃo, teve um RR de 2,24 e uma detecÃÃo anual de 10,4 casos com grau 2/100mil hab. O mÃtodo de autocorrelaÃÃo local mostrou superposiÃÃo com Ãreas de alto risco identificadas pelo mÃtodo Bayesiano Local e na anÃlise Scan Espacial. O estudo mostra que a hansenÃase à hiperendÃmica na Ãrea de estudo, sem a perspectiva de exaurir estes casos nos prÃximos anos. AlÃm de diagnÃstico tardio em um nÃmero de casos considerÃvel, houve lacunas na descentralizaÃÃo do atendimento, evidenciado pelo fluxo das pessoas afetadas. A construÃÃo de mapas utilizando outros indicadores, alÃm do coeficiente de detecÃÃo geral, e a sobreposiÃÃo desses mapas pÃde identificar Ãreas desconhecidas em relaÃÃo ao risco de transmissÃo e de detecÃÃo de casos com incapacidades avanÃadas. Essa abordagem poderà ser aplicada em outras Ãreas de risco para assim identificar agregados mais especÃficos de risco elevado para a hansenÃase. / In recent years, the National Leprosy Control has focused its actions on defined geographic areas with high leprosy detection rates. This study aimed to characterize epidemiological, spatial and temporal patterns in a high risk leprosy cluster in municipalities in the states of MaranhÃo, ParÃ, Piauà and Tocantins. Different methods of spatial analysis were applied (Descriptive, Local Bayesian Approach, Spatial Scan Statistics), and the spatial dependence of various epidemiological and operational indicators was quantified. In an additional study, I identified the flow of leprosy-affected individuals, and the reasons for migration after diagnosis. In the period 2001â2009, 82,463 new cases were detected in the endemic cluster (mean detection rate: 95.9/100mil inhabitants per year). In the rest of Brazil, the mean rate was 21.0 (RR=4.56, 95% CI: 4.45 - 4.66; p<0.0001). There was a directed flow of patients who were reported by a municipality other than their residence. AraguaÃna, Imperatriz, Marabà and Floriano notified a considerable number of cases from the municipalities in the proximity. SÃo LuÃs, Teresina and BelÃm received also cases from other states. GoiÃnia and BrasÃlia are distant from the cluster, but reported cases from the cluster. After first diagnosis, in 53.5% of cases migration was related to lifestyle changes. Spatial Scan analysis identified 23 clusters of high detection rates, most of them located in Parà and MaranhÃo. These clusters included only 32% of the population but 55.4% of new cases, and 101 (27.1%) municipalities. There were also 14 significant clusters for high detection rates in children, and 11 clusters of new cases with grade 2 disabilities/100.000 population. The most significant cluster, in the centre of MaranhÃo, had a RR of 2.24 and an annual detection of grade 2 cases of 10.4/100.000 population. The local auto-correlation method showed overlapping with high-risk areas identified by Local Bayesian and Spatial Scan Statistics. The study shows that leprosy is hyperendemic in the study area, without an expected trend of reduced detection rates in the coming years. In addition to late diagnosis in a considerable number of cases, there were shortcomings in the decentralization of the health system, evidenced by the flow of affected people. The use of maps based on other indicators than detection rates and the overlap of these maps highlighted previously unknown risk areas for transmission and for cases with advanced disabilities. This approach can beapplied in other endemic areas to identify clusters of high risk for leprosy.

O controle da transmissão da doença de Chagas no Estado de São Paulo, delineado\" no presente estudo, foi equacionado e solucionado e não constitui, nos dias atuais, problema de saúde pública. O risco de ocorrência de casos agudos fica restrito a eventos isolados. Este quadro, portanto, autoriza otimismo, podendo-se supor que a atual incidência da doença no Estado seja próxima de zero e esperar que a incidência futura se mantenha nesse nível. Sob a ótica da transmissão vetorial, as ações de vigilância sobre as espécies peridomiciliares presentes atualmente no Estado têm respondido de maneira eficaz à possibilidade de infecção por Trypanosoma cruzi a partir do contato homem-vetor. A casa rural paulista não constitui hoje ecótopo adequado para a domiciliação de tais espécies de triatomíneos. O comportamento invasor, característico principalmente dos indivíduos adultos fêmeas, não tem passado despercebido à população que prontamente coleta e encaminha o inseto para análise utilizando-se, na maioria das vezes, do Centro de Saude local, numa integração da vigilância vetorial à rede de atenção à saude. O pronto atendimento a cada notificação serve de estímulo à participação. Em síntese, a vigilância vetorial está consolidada junto à comunidade e à rede de saúde local. A transmissão transfusional constitui fenômeno raro dadas as condições com que se pratica a hemoterapia no Estado de São Paulo. As ações de controle do sangue foram implementadas pela Secretaria de Saúde a partir de 1988, com índices de cobertura de seleção de doadores próximos de 100 por cento já em 1990. Mais recentemente, com a instalação da Hemo-rede estadual e a ampliação da cobertura dos Hemocentros incluindo os pequenos municípios, pode-se observar uma melhora da qualidade da hemoterapia. O descarte do candidato à doação quando procedente de área endêmica de doença de Chagas, tem contribuído para a obtenção de baixos percentuais de prevalência na triagem sorológica, situados próximos a 1 por cento . A transmissão congênita, entendida como mecanismo residual de perpetuação da infecção, ocorre em níveis discretos e pode ser perfeitamente controlada desde que se realizem provas sorológicas para doença de Chagas em gestantes com epidemiologia compatível e se pesquise a infecção na criança ao nascer e seguimento até os 6 meses. A persistência da positividade sorológica deve orientar para tratamento específico. Outros mecanismos de transmissão não apresentam qualquer importância no contexto da endemia. Resta ao sistema de saúde, portanto, olhar de frente os indivíduos infectados que merecerão atenção médica e previdenciária e cujo direito à saúde está garantido pela carta constitucional. / The present study about the contrai of Chagas\' disease transmission in the State of Sao Paulo has pointed out that nowadays the disease is no more a public health problem. The risk of occuring acute cases is restricted to isolate events. Therefore it is possible to suppose that the disease incidence is near to zero. Conceming to the vectorial transmission the surveillance of the peridomestic bugs did not detect actual Trypanosoma cruzi transmission. The rural houses nowadays do not offer conditions to triatomine bugs colonization. The presence of female adult insects indoors is noted by the population. They collect and send the bugs to the local Health Services. Each bug notification is promptly answered in order to induce local communities to participate effectively in the vector surveillance. This surveillance is now consolidated among the communities and the Local Health Services. Transfusional transmission constitutes, as far is known, a rare event because hemotheraphy in the State of Sao Paulo is sufficiently adequated. Blood control practices were improved by Govemment since 1988. Actually almost 100 per cent of blood donors are covered with serological tests. Recently a net of State Blood Services was installed witch improved the quality of hemotherapic practices. The donors coming from Chagas\' disease endemic areas are deleted. The serological prevalence is near by 1 per cent . Congenital transmission occurs in low leveis and can be controlled. Serological tests for Chagas\' disease in pregnants with compatible epidemiology and in new-bom followed up to 6 months of age children is recommended. Children with serological positivity must be treated. Other transmission routes have no importance in the disease context. So, the task of assuring medical health care to the infected people as law order is left for the health system.

O controle da transmissão da doença de Chagas no Estado de São Paulo, delineado\" no presente estudo, foi equacionado e solucionado e não constitui, nos dias atuais, problema de saúde pública. O risco de ocorrência de casos agudos fica restrito a eventos isolados. Este quadro, portanto, autoriza otimismo, podendo-se supor que a atual incidência da doença no Estado seja próxima de zero e esperar que a incidência futura se mantenha nesse nível. Sob a ótica da transmissão vetorial, as ações de vigilância sobre as espécies peridomiciliares presentes atualmente no Estado têm respondido de maneira eficaz à possibilidade de infecção por Trypanosoma cruzi a partir do contato homem-vetor. A casa rural paulista não constitui hoje ecótopo adequado para a domiciliação de tais espécies de triatomíneos. O comportamento invasor, característico principalmente dos indivíduos adultos fêmeas, não tem passado despercebido à população que prontamente coleta e encaminha o inseto para análise utilizando-se, na maioria das vezes, do Centro de Saude local, numa integração da vigilância vetorial à rede de atenção à saude. O pronto atendimento a cada notificação serve de estímulo à participação. Em síntese, a vigilância vetorial está consolidada junto à comunidade e à rede de saúde local. A transmissão transfusional constitui fenômeno raro dadas as condições com que se pratica a hemoterapia no Estado de São Paulo. As ações de controle do sangue foram implementadas pela Secretaria de Saúde a partir de 1988, com índices de cobertura de seleção de doadores próximos de 100 por cento já em 1990. Mais recentemente, com a instalação da Hemo-rede estadual e a ampliação da cobertura dos Hemocentros incluindo os pequenos municípios, pode-se observar uma melhora da qualidade da hemoterapia. O descarte do candidato à doação quando procedente de área endêmica de doença de Chagas, tem contribuído para a obtenção de baixos percentuais de prevalência na triagem sorológica, situados próximos a 1 por cento . A transmissão congênita, entendida como mecanismo residual de perpetuação da infecção, ocorre em níveis discretos e pode ser perfeitamente controlada desde que se realizem provas sorológicas para doença de Chagas em gestantes com epidemiologia compatível e se pesquise a infecção na criança ao nascer e seguimento até os 6 meses. A persistência da positividade sorológica deve orientar para tratamento específico. Outros mecanismos de transmissão não apresentam qualquer importância no contexto da endemia. Resta ao sistema de saúde, portanto, olhar de frente os indivíduos infectados que merecerão atenção médica e previdenciária e cujo direito à saúde está garantido pela carta constitucional. / The present study about the contrai of Chagas\' disease transmission in the State of Sao Paulo has pointed out that nowadays the disease is no more a public health problem. The risk of occuring acute cases is restricted to isolate events. Therefore it is possible to suppose that the disease incidence is near to zero. Conceming to the vectorial transmission the surveillance of the peridomestic bugs did not detect actual Trypanosoma cruzi transmission. The rural houses nowadays do not offer conditions to triatomine bugs colonization. The presence of female adult insects indoors is noted by the population. They collect and send the bugs to the local Health Services. Each bug notification is promptly answered in order to induce local communities to participate effectively in the vector surveillance. This surveillance is now consolidated among the communities and the Local Health Services. Transfusional transmission constitutes, as far is known, a rare event because hemotheraphy in the State of Sao Paulo is sufficiently adequated. Blood control practices were improved by Govemment since 1988. Actually almost 100 per cent of blood donors are covered with serological tests. Recently a net of State Blood Services was installed witch improved the quality of hemotherapic practices. The donors coming from Chagas\' disease endemic areas are deleted. The serological prevalence is near by 1 per cent . Congenital transmission occurs in low leveis and can be controlled. Serological tests for Chagas\' disease in pregnants with compatible epidemiology and in new-bom followed up to 6 months of age children is recommended. Children with serological positivity must be treated. Other transmission routes have no importance in the disease context. So, the task of assuring medical health care to the infected people as law order is left for the health system.

A global outbreak of a new strain of H1N1 influenza virus caused the 2009 flu pandemic. Taiwan was one of the 12 countries in the world capable of producing H1N1 vaccine domestically. The domestic vaccine manufactured by Adimmune Corporation proved to be safe and effective. However, the public opinion generally criticized negatively toward this H1N1 prevention work. This study explored the various entities and relations surrounding the prevention. The first experiment looked into people¡¦s recall toward government¡¦s promotion. This experiment used EyeLink to track subjects¡¦ eye movements on the promotional posters. The data showed the correlation between eye movement and recall, as well as the amount of information received by the subjects. The second experiment looked into people¡¦s decision toward H1N1 prevention. This experiment constructed an AHP model to study the problem. The subjects from various fields answered their view toward H1N1 prevention alternatives, and reported the actual inoculation rate of H1N1 vaccine. The goal aimed to choose a prevention method. The criteria included convenience, confidence, safety, and comfort. The alternatives included vaccination, medication, and sanitation. The experiment outcome summarized the inoculation statistics, attention distribution, involvement correlations, and decision priorities. The experiment result shows the subjects do not receive government¡¦s promotion well. The result also shows the subjects prefer sanitation for prevention. In addition, this study investigates Taiwan¡¦s vaccine and disease prevention development status. The analysis examines Adimmune Corporation and the vaccine market from different aspects. Finally, the conclusion provides recommendations for the people, the vaccine factory, and the government.

No description available.

Background: This study is located within a complex network of paradigmatical methodological, and institutional relationships, and draws concepts from a range of scholastic traditions. The hermeneutical tradition within Sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. The concept of the lifeworld/ healthworld as a description of the complex of health beliefs and behaviours of individuals in relation to the ailing body is used to describe chronic illness and healthcare access, both as lived experience and as fields for public health intervention. Aim: To understand how women living with chronic illness experience their illness and access healthcare in an urban and rural context. Methods: This study is a mixed-methods comparative case study of the healthcare access experiences of women with chronic illness in an urban and rural area in South Africa. The core of the study methodology is a comparative qualitative case study, with quantitative methods serving to contextualise the findings. The urban component of the study was conducted in Birth to Twenty (Bt20), a birth cohort study located in Johannesburg-Soweto. The rural component of the study was conducted in Agincourt, a sub-district of the Bushbuckridge district in Mpumalanga Province. The quantitative context for the Soweto case study uses secondary data collected by Bt20 to construct a historical overview of the use of formal and informal healthcare services in Soweto. It also uses the findings of a large scale cross sectional survey of the primary caregivers of the Bt20 cohort, conducted between November 2008 and June 2010. The rural case study is contextualised by a detailed review of research conducted in the Agincourt sub-district. For the qualitative case studies I employed a qualitative methodology incorporating serial narrative interviews to present an experience-based overview of concepts of disease causation, self treatment and coping. Results: The cross-sectional survey describes a low resource population with a high prevalence of chronic noncommunicable disease (NCDs). Over one third (37.3%) of the population in Soweto could be categorised as having a low socio-economic status, defined as access to only one or less of 5 socio-economic items. Slightly over half the respondents in Soweto (50.7%) reported having at least one chronic illness. Only around a third (33.3%) of the survey participants with chronic illnesses reported accessing formal healthcare services in the last 6 months. Similar trends were found in the review of research carried out in Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how the medicine from the clinic interacts with the body. The search for alternative remedies took place not as an attempt to cure disease, but to reach a deeper understanding of the diseased state of the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. In both study sites there is evidence that traditional healers were consulted for social purposes rather than health-related purposes. Discussion: Soweto and Agincourt share similar patterns of healthcare utilisation and healthcare belief. Both study sites were characterised by increasing trends in formalisation. At the same time, only a small portion of individuals in both study sites with chronic illness utilised formal healthcare services. A consideration of the findings suggests five broad themes for further research: (1) Processes of constructing body narratives; (2) Encounters with purposive-rational systems; (3) Encounters with traditional medicine; (4) Encounters with contemporary informal medicine; and (5) Religion and healthcare. These five themes constitute the beginning of a comprehensive map of the lifeworld/ healthworld schema. Such a schema has implications for healthcare policy and practice, particularly with regard to the development of integrative paradigms in South Africa as exemplified by Community Oriented Primary Care (COPC). Conclusion: The aims and objectives of the study were met through the development of an initial lifeworld/ healthworld schema, which suggests that the coexistence of diverse public healthcare concerns of high NCD prevalence and low formal healthcare utilisation is best addressed through the adoption of integrated healthcare approaches based on lifeworld/ healthworld rationalistion.

Cheng Yee Wan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 95-112). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / Table of Contents --- p.vi / List of Figures --- p.xi / List of Plates --- p.xiv / List of Tables --- p.xvi / Abbreviations --- p.xviii / Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- Legionella pneumophila --- p.1 / Chapter 1.1.1 --- Bacterial morphology and ultrastructure --- p.2 / Chapter 1.1.2 --- Microbial ecology and natural habitats --- p.4 / Chapter 1.1.2.1 --- Association with amoeba --- p.5 / Chapter 1.1.2.2 --- Association with biofilm --- p.5 / Chapter 1.2 --- Legionnaires' disease and clinical significance --- p.6 / Chapter 1.2.1 --- Epidemiology --- p.6 / Chapter 1.2.1.1 --- Worldwide distribution --- p.6 / Chapter 1.2.1.2 --- Local situation --- p.7 / Chapter 1.2.2 --- Clinical presentation --- p.7 / Chapter 1.2.3 --- Route of infection and pathogenesis --- p.8 / Chapter 1.2.4 --- Diagnosis --- p.10 / Chapter 1.2.4.1 --- Culture of Legionella --- p.10 / Chapter 1.2.4.2 --- Direct fluorescent antibody (DFA) staining --- p.13 / Chapter 1.2.4.3 --- Serologic tests --- p.13 / Chapter 1.2.4.4 --- Urine antigen testing --- p.14 / Chapter 1.2.4.5 --- Detection of Legionella nucleic acid --- p.15 / Chapter 1.2.5 --- Risk factors --- p.15 / Chapter 1.2.6 --- Treatment for Legionella infection --- p.16 / Chapter 1.3 --- Detection of Legionella in environment --- p.16 / Chapter 1.4 --- Disinfection methods --- p.17 / Chapter 1.4.1 --- Physical methods --- p.19 / Chapter 1.4.1.1 --- Filtration --- p.19 / Chapter 1.4.1.2 --- UV-C irradiation --- p.20 / Chapter 1.4.1.3 --- Thermal eradication (superheat-and-flush) --- p.21 / Chapter 1.4.2 --- Chemical methods --- p.21 / Chapter 1.4.2.1 --- Chlorination --- p.21 / Chapter 1.4.2.2 --- Copper-silver ionization --- p.22 / Chapter 1.4.3 --- Effect of biofilm and other factors on disinfection --- p.23 / Chapter 1.5 --- Photocatalytic oxidation (PCO) --- p.24 / Chapter 1.5.1 --- Generation of strong oxidants --- p.24 / Chapter 1.5.2 --- Disinfection mechanism(s) --- p.27 / Chapter 1.5.3 --- Major factors affecting the process --- p.28 / Chapter 2. --- Objectives --- p.30 / Chapter 3. --- Materials and Methods --- p.31 / Chapter 3.1 --- Chemicals --- p.31 / Chapter 3.2 --- Bacterial strains and culture --- p.31 / Chapter 3.3 --- Photocatalytic reactor --- p.33 / Chapter 3.4 --- PCO efficacy tests --- p.33 / Chapter 3.5 --- PCO sensitivity tests --- p.35 / Chapter 3.6 --- Optimisation of PCO conditions --- p.35 / Chapter 3.6.1 --- Optimization of TiO2 concentration --- p.36 / Chapter 3.6.2 --- Optimization of UV intensity --- p.36 / Chapter 3.6.3 --- Optimization of depth of reaction mixture --- p.36 / Chapter 3.6.4 --- Optimization of stirring rate --- p.37 / Chapter 3.6.5 --- Optimization of initial pH --- p.37 / Chapter 3.6.6 --- Optimization of treatment time and initial cell concentration --- p.37 / Chapter 3.6.7 --- Combinational optimization --- p.37 / Chapter 3.7 --- Transmission electron microscopy (TEM) --- p.38 / Chapter 3.8 --- Fatty acid profile analysis --- p.40 / Chapter 3.9 --- Total organic carbon (TOC) analysis --- p.42 / Chapter 3.10 --- UV-C irradiation --- p.44 / Chapter 3.11 --- Hyperchlorination --- p.44 / Chapter 3.12 --- Statistical analysis and replication --- p.45 / Chapter 3.13 --- Safety precautions --- p.45 / Chapter 4. --- Results --- p.46 / Chapter 4.1 --- Efficacy test --- p.46 / Chapter 4.2 --- PCO sensitivity --- p.47 / Chapter 4.3 --- Optimization of PCO conditions --- p.48 / Chapter 4.3.1 --- TiO2 concentration --- p.48 / Chapter 4.3.2 --- UV intensity --- p.48 / Chapter 4.3.3 --- Depth of reaction mixture --- p.51 / Chapter 4.3.4 --- Stirring rate --- p.56 / Chapter 4.3.5 --- Effect of initial pH --- p.56 / Chapter 4.3.6 --- Effect of treatment time and initial concentrations --- p.56 / Chapter 4.3.7 --- Combinational effects --- p.63 / Chapter 4.4 --- Transmission electron microscopy (TEM) --- p.66 / Chapter 4.4.1 --- Morphological changes induced by PCO --- p.66 / Chapter 4.4.2 --- Comparisons with changes caused by UV-C irradiation and chlorination --- p.67 / Chapter 4.5 --- Fatty acid profile analysis --- p.71 / Chapter 4.6 --- Total organic carbon (TOC) analysis --- p.73 / Chapter 4.7 --- UV-C irradiation --- p.74 / Chapter 4.8 --- Hyperchlorination --- p.74 / Chapter 5. --- Discussion --- p.76 / Chapter 5.1 --- Efficacy test --- p.76 / Chapter 5.2 --- PCO sensitivity --- p.76 / Chapter 5.3 --- Optimization of PCO conditions --- p.77 / Chapter 5.3.1 --- Effect of TiO2 concentration --- p.77 / Chapter 5.3.2 --- Effect of UV intensity --- p.78 / Chapter 5.3.3 --- Effect of depth of reaction mixture --- p.79 / Chapter 5.3.4 --- Effect of stirring rate --- p.79 / Chapter 5.3.5 --- Effect of initial pH --- p.80 / Chapter 5.3.6 --- Effect of treatment time and initial concentrations --- p.81 / Chapter 5.3.7 --- Combinational effect --- p.82 / Chapter 5.4 --- Transmission electron microscopy (TEM) --- p.83 / Chapter 5.4.1 --- Morphological changes induced by PCO --- p.83 / Chapter 5.4.2 --- Comparisons with changes caused by UV-C irradiation and chlorination --- p.85 / Chapter 5.5 --- Fatty acid profile analysis --- p.85 / Chapter 5.6 --- Total organic carbon (TOC) analysis --- p.86 / Chapter 5.7 --- Comparisons of the three disinfection methods --- p.88 / Chapter 6. --- Conclusion --- p.91 / Chapter 7. --- References --- p.95 / Chapter 8. --- Appendix --- p.113

The aim of this study was to explore and describe HIV and AIDS workplace programmes and policies (WPPs) in the tourism industry of Nelson Mandela Bay Municipality (NMBM) in South Africa. This study adopted a quantitative and qualitative approach, in other words, a mixed approach. The reason for using more than one method of inquiry was to obtain a deeper understanding of the tourism industry of NMBM in terms of examined behaviour, and of the meaning of occurrences in the industry. To gather qualitative data concerning HIV and AIDS programmes, key informant stakeholders in the tourism industry at global, national, provincial, and local levels were identified to conduct in-depth interviews. These respondents were selected using the non-probability sampling method of quota sampling. This is a type of stratified sampling in which the selection of the strata within the sample is not random, but rather is typically left to the discretion of the interviewer (Wienclaw, 2015). One respondent for each level of the industry was selected, resulting in four key informant stakeholders participating in the qualitative research component of this study. The initial criterion for participation in the quantitative portion for this study was that tourism businesses based in NMBM must be able to produce robust evidence of HIV and AIDS WPPs. The researcher selected the probability sampling method of stratified random sampling with proportional allocation. This technique considers the known characteristics of the population (Wienclaw, 2015). A database of tourism businesses was obtained from the local tourism organisation, who are members of the governing body for local tourism. This database was cleaned, to eliminate any data that did not meet the participation criterion for the study. Ten per cent of the total number of businesses in the cleaned database were sampled. The simplest approach to sampling is to merely randomly select from the population by, for example, having a computer choose names at random from a list, or by selecting names from a hat (Wienclaw, 2015). Therefore, every fifth business listed on the sampled database was selected to participate. Unfortunately, surveys tend to have notoriously low return rates, and people are frequently reluctant to give out information over the phone. This was also the case for most of the tourism businesses in the sample. When emailed or telephoned, they refused to participate for various reasons. Some stated that HIV does not affect their business; others reported that their businesses were too small and therefore they could not afford to implement these programmes. Some businesses were hearing about the WPP for the very first time, while several others responded with simple disinterest in participating. The findings of the study are that although tourism is viewed as an important industry that contributes to the economy, tourism businesses do not include any intervention programmes with which to respond to the threat of HIV and AIDS to their businesses. Additionally, there is neither leadership nor support from any level of the tourism industry, to create a conducive environment for the adoption of HIV and AIDS WPPs by tourism businesses. The primary reason for the lack of uptake of these programmes is ignorance across cascading levels of the tourism industry, which includes tourism businesses. Additionally, a number of perceived barriers, such as size of business, are cited as the reasons why tourism workplaces in the NMBM fail to participate in HIV and AIDS WPPs. It is anticipated that this study will create further awareness of HIV and AIDS WPPs, in an industry that seems to have limited knowledge about such programmes. This study will also provide guidance regarding the requirements to implement effective HIV and AIDS WPPs.

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.

心臟病目前仍然是最普遍的威脅人類生命安全的三大病因之一。同西藥相比, 傳統中醫藥具有多靶點，協同作用及小副作用等特性。在中藥歷史中， 丹參和葛根這兩種草藥經常出現在中藥方劑用於治療心血管相關的疾病，已有幾千年的歷史。 我們實驗室發現了一個丹參葛根湯劑具有保護動脈粥樣硬化病人心臟功能的作用，並且可以使收縮的大鼠大動脈舒張的作用。 本研究主要通過舒張豬冠狀動脈，提高大鼠對抗過氧化和離子擾動能力以及提高血管增生四個方面探討丹參葛根複方水提物 (質量比7:3) (DG配方)對血管的作用以提供其治療心血管疾病的藥理基礎。 / 在本研究的第一部， 我們主要探討了DG配方對缺血再灌注損傷的心臟及其心肌細胞的保護作用。我們發現DG配方明顯抑制了心臟損傷相關的肌酸激酶和乳酸脫氫的釋放。同時DG配方顯著促進了再灌注後冠狀動脈內血流量速度和收縮力度的恢復。這些結果說明DG配方可以保護缺血再灌注心臟並且有效促進其功能恢復。我們還觀察了長期給大鼠用DG配方14天後其心臟在缺血再灌注中的表現。類似於再灌注時給藥的結果，DG配方同樣抑制了損傷酶的釋放並且有效促進了冠狀動脈內血流量速度和收縮力度的恢復。 / 同時，在缺氧再灌注離體細胞模型中，我們發現DG配方明顯抑制了缺氧再灌注損傷帶來的細胞死亡。流式細胞儀分析結果表明，藥物處理組中的凋亡類的細胞明顯比對照組中少主要通過抑制促凋亡的caspase3表達明以及促進抗凋亡的Bcl2表達升高。DG配方減少了心肌細胞內細胞色素c從線粒體中釋放明顯以及抑制了線粒體去極化。這說明DG配方也保護了線粒體的膜的完整性，從而確保線粒體功能進而保證細胞的能量系統穩定。最有意思的是DG配方可以直接抑制缺氧再灌注相關的兩條通路, 它不僅抑制活性氧化物質的釋放, 同時也抑制了再灌注後鈣離子的累積。總之，DG配方以抗氧化和抗離子擾動的方式保護了在缺血缺氧再灌注損傷中心臟和心肌細胞的結構和功能。 / 第二部分的研究是關於DG配方對從豬心臟上分離的左冠狀動脈前室間支 (左前降支) 血管的作用及其內在的機制，我們的結果表明對由U46619引起的冠狀動脈血管收縮DG配方表現了濃度依賴的舒血管作用。而該作用並非依賴于內皮細胞及其釋放的舒張血管因數一氧化氮和前列腺素類似物環素和大部分的鉀離子通道。其中只有內向整合鉀離子通道部分參與了舒血管的過程。肌球蛋白輕鏈的磷酸化明顯被DG配方抑制，但是RhoA 的活性並沒有受其影響。鈣離子引發的血管收縮則被DG配方濃度依賴性的受到抑制。這部分的研究證明瞭DG配方主要通過類似鈣離子通道拮抗劑作用抑制鈣離子進入到血管平滑肌細胞減少肌球蛋白磷酸化達到舒張血管的作用。結果說明DG配方可以作為一種安全的藥物用於治療心血管疾病特別是高血壓和心絞痛。 / 本研究的第三部分是關於DG配方的促血管增生的作用。我們發現DG配方可以明顯促進斑馬魚的腸下動脈的出芽並且促進血管增生相關基因的表達，血管內皮細胞生長因數及其受體的mRNA表達。內皮細胞是血管增生的基礎。所以我們利用人源微血管內皮細胞檢測了DG配方在細胞的增生，遷移，分化和形成血管方面的影響以解釋它在斑馬魚中促進血管增生的作用機理。結果發現，DG配方明顯促進了該種內皮細胞的增殖，遷移和形成管狀結構。 / 綜上所述，DG配方可以通過舒張血管，抗氧化，抗離子紊亂和促進血管增生提供心血管保護功能。DG配方通過螯合活性氧化物質和抑制鈣離子的累積保護了因缺血再灌注引起的心臟損傷，說明DG配方可以作為手術的輔助藥物減少心臟病人在缺血再灌注過程中受到的損傷。它以拮抗L型鈣離子通道方式減少鈣離子進入到血管平滑肌細胞來舒張收縮的冠狀動脈血管。說明DG配方可以用於治療高血壓和心絞痛等心臟病。另外DG配方也可以促進血管增生，可用于心肌梗死病人促進其心臟血管系統重建，本研究對於未來臨床實驗具有重要的參考價值。 / Coronary heart diseases (CHD) are one of the most prevalent causes of premature death all over the world. In contrast to western medicine, traditional Chinese medicine (TCM) has shown the benefit of multi-targeting and synergism to treat CHD. Two kinds of Chinese herbs, Danshen (Radix Salviae Miltiorrhiza) (D) and Gegen (Radix Puerariae Lobatae) (G) always present on the TCM formula for treating heart disease. We found a useful formula of Danshen and Gegen decoction with weight ratio of 7:3 (DG) exerting properties of improving the heart function in patient with atheroslcerosis and providing vasodiation and antioxidant protection on the rat cardiovascular system. The present study was designed to evaluate the effects of DG on the vascular activity by its properties on antioxidant and anti-ion stunning to inhibiting the ischemia and reperfusion injury, vasodilation effect on pig coronary artery and angiogenesis effect on zebrafish model. / In the first part of the study, we explored protective effect of DG on rat hearts and cardiomyocytes after ischemia-reperfusion and hypoxia-reoxygenation injury. Comparing to control group, the release of creatine kinase (CK) and lactate dehydrogenase (LDH) significantly decreased in the DG treated groups in a dose-dependent manner. The recovery percentage of coronary flow and contractile force in the DG was higher than that in the control group. These results suggested that DG dose-dependently improved the heart function after ischemia and reperfusion injury in a dose-dependent manner. We also examined chronic effect of DG (14 days pretreatment) on rat heart with ischemia and reperfusion injury. DG induced rat heart with high potential to deal with I/R injury, less damaged enzymes release and high recovery percentage of heart function recovery. / In the cell hypoxia and reoxygenation model, DG significantly inhibited the cell death after H/R treatment with bcl2 expression increase and caspase3 expression decrease. DG also reversed the H/R-induced mitochondrial depolarization and inhibited cytochrome c diffusing out of mitochondria, which confirmed DG anti-apoptosis activity. DG also was found to significantly decrease the intracellular calcium accumulation and reactive oxygen species release within H9c2. / In the second part of present study, results revealed that DG elicited a concentration-dependent relaxation of U46619-preconstricted porcine coronary artery. DG-induced relaxation responses were not altered by the presence of endothelium-related dilator inhibitors, most potassium channel blockers, GMP and AMP pathway inhibitors and endothelium removal. Ba²⁺ (an inward rectifier K⁺ channel blocker) slightly attenuated DG-induced relaxation. The protein expression of phosphorylated myosin light chain (MLC) was inhibited by DG in a concentration-dependent manner whereas the activity of RhoA was not modified. Ca²⁺-induced contraction of coronary artery was inhibited by DG in a concentration-dependent fashion. DG acted as an antagonist of calcium channel inducing the porcine artery dilation. / The third part of the present study is about the pro-angiogenic effect of DG. We found that DG dose-dependently induced zebrafish sub-intestinal vessel sprouting and increased the mRNA expression of vascular endothelial growth factor (VEGF) and its receptors. To explore the underlying mechanism, we also examined the proangiogenic effect of DG on the angiogenesis of endothelial cells. The results showed that DG induced the HMEC-1 proliferation, migration and forming tube. / In conclusion, we found that DG could provide cardiac and cardiovascular protection by its multiple targets. It prevented heart injuries after ischemia or hypoxia and reperfusion through scavenging ROS and inhibiting calcium accumulation. Moreover, it mainly acts as an antagonist of L-type calcium channel to relax the contracted LAD vessel. It also exerted property of inducing angiogenesis in vivo and in vitro. Therefore, DG would be useful for treating coronary artery disease depending on its multiple targets. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Hu, Fan. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 170-215). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Chapter 1 --- Intorduction --- p.1 / Chapter 1.1 --- Cardiovascular system and coronary artery diseases --- p.1 / Chapter 1.1.1 --- The cardiovascular system --- p.1 / Chapter 1.1.2 --- Contraction and relaxation of the vascular myocyte in arteries --- p.4 / Chapter 1.1.2.1 --- Ultrastructure of the vascular myocyte --- p.4 / Chapter 1.1.2.2 --- Contraction mechanisms of vascular myocyte --- p.5 / Chapter 1.1.2.3 --- Relaxation mechanisms of vascular myocyte --- p.7 / Chapter 1.1.3 --- Chronic coronary heart disease --- p.9 / Chapter 1.2 --- The way to treat chronic CAD --- p.11 / Chapter 1.2.1 --- Angiogenesis --- p.11 / Chapter 1.2.2 --- Clinical surgery for treating CAD --- p.13 / Chapter 1.2.2.1 --- Three common surgeries for treating CAD --- p.13 / Chapter 1.2.2.2 --- Ischemia and reperfusion (I/R) injury in surgeries --- p.15 / Chapter 1.2.3 --- Drugs for treating CAD --- p.19 / Chapter 1.2.3.1 --- Western medicine therapy in CAD --- p.19 / Chapter 1.2.3.2 --- Traditional Chinese Medicine treatment in CAD --- p.20 / Chapter 1.3 --- Aims of studies --- p.28 / Chapter 2 --- Materials and Methods --- p.29 / Chapter 2.1 --- Solutions and Materials --- p.29 / Chapter 2.1.1 --- Solutions --- p.29 / Chapter 2.1.2 --- Chemicals and enzymes --- p.36 / Chapter 2.2 --- Methods --- p.38 / Chapter 2.2.1 --- Herbal preparation --- p.38 / Chapter 2.2.2 --- Identification and quantification of chemical markers in Danshen and Gegen decoction (DG) --- p.38 / Chapter 2.2.3 --- Assay development for the determination of the DG marker compounds in rat plasma --- p.40 / Chapter 2.2.4 --- Isolation of pig left anterior descending coronary artery --- p.44 / Chapter 2.2.5 --- Isometric tension measurement --- p.45 / Chapter 2.2.6 --- Langendorff related experiment --- p.50 / Chapter 2.2.7 --- Cell culture of H9c2 cells --- p.54 / Chapter 2.2.8 --- Cell viability assay (MTT assay) --- p.56 / Chapter 2.2.9 --- Cell proliferation measurement --- p.57 / Chapter 2.2.10 --- Hypoxia and reperfusion cell model (H9c2) --- p.58 / Chapter 2.2.11 --- Determination of cell apoptosis with Annexin VFITC and PI double staining --- p.59 / Chapter 2.2.12 --- Measurement of mitochondria depolarization --- p.61 / Chapter 2.2.13 --- Measurement of ROS release --- p.63 / Chapter 2.2.14 --- Measurement of calcium localization in H9c2 cells by fluo4 dye and confocal microscopy --- p.64 / Chapter 2.2.15 --- Extraction of proteins from tissue, cell and subcellular fractions --- p.65 / Chapter 2.2.16 --- Western blot assay --- p.67 / Chapter 2.2.17 --- Human microvascular endothelial cells (HMEC1) cell culture --- p.68 / Chapter 2.2.18 --- Cell cycle analysis by PI staining --- p.69 / Chapter 2.2.19 --- Scratch assay for HMEC1cells migration --- p.70 / Chapter 2.2.20 --- Tube formation assay --- p.71 / Chapter 2.2.21 --- Vessel sprouting of Zebrafish --- p.72 / Chapter 2.2.22 --- Real time PCR --- p.74 / Chapter 2.2.23 --- Statistical analysis --- p.76 / Chapter 3 --- Chapter 3 Cardiac protection of Danshen and Gegen decoction in hypoxia/ischemia and reperfusion induced injury --- p.77 / Chapter 3.1 --- Introduction --- p.77 / Chapter 3.2 --- Results --- p.81 / Chapter 3.2.1 --- Cytotoxicity of DG --- p.81 / Chapter 3.2.2 --- The morphology alteration of H9c2 after H/R treatment --- p.83 / Chapter 3.2.3 --- Effect on H H9c2 cell survival after H/R treatment --- p.84 / Chapter 3.2.4 --- Effect on membrane skeleton of H9c2 cells with H/R injury --- p.86 / Chapter 3.2.5 --- Effect on the apoptosis in H9c2 cells induced by H/R injury --- p.88 / Chapter 3.2.6 --- Effect on cytochrome c release from mitochondria of damaged H9c2 cells --- p.92 / Chapter 3.2.7 --- Effect on mitochondria depolarization of H9c2 after H/R treatment --- p.94 / Chapter 3.2.8 --- Effect on reactive oxidant species (ROS) release --- p.96 / Chapter 3.2.9 --- Effect on calcium accumulation within H9c2 in the reperfusion phase --- p.98 / Chapter 3.2.10 --- Effect on heart functions of rat hearts with I/R injury (acute effect) --- p.101 / Chapter 3.2.11 --- Effect on heart function in rats with I/R injury (chronic effect) --- p.107 / Chapter 3.3 --- Discussion --- p.113 / Chapter 4 --- Chapter 4 Vasodilation effects of Danshen and Gegen decoction in porcine coronary artery and its underlying mechanism --- p.118 / Chapter 4.1 --- Introduction --- p.118 / Chapter 4.2 --- Results --- p.121 / Chapter 4.2.1 --- Investigations of endothelium dependent and independent mechanisms --- p.121 / Chapter 4.2.2 --- Effects on cAMP and cGMP pathway --- p.121 / Chapter 4.2.3 --- Effects on potassium channel opening --- p.121 / Chapter 4.2.4 --- Effects on calcium induced contraction and calcium sensitization --- p.122 / Chapter 4.2.5 --- Effects on MLC phosphorylations --- p.123 / Chapter 4.3 --- Discussion --- p.132 / Chapter 5 --- Chapter 5 In vitro and in vivo angiogenic effects of DG --- p.138 / Chapter 5.1 --- Introduction --- p.138 / Chapter 5.2 --- Results --- p.140 / Chapter 5.2.1 --- Effect on subintestinal vessels sprouting in the zebrafish embryo --- p.140 / Chapter 5.2.2 --- Effect on the transcription and expression of VEGFA and VEGF receptors -- Flt1 and KDR/Flk2 --- p.143 / Chapter 5.2.3 --- Effect on HMEC1 proliferation --- p.145 / Chapter 5.2.4 --- Effect on cell cycle of HMEC1 --- p.148 / Chapter 5.2.5 --- Effect on cell migration of HMEC1 --- p.151 / Chapter 5.2.6 --- Effect on tube formation of HMEC1 --- p.154 / Chapter 5.3 --- Discussion --- p.157 / Chapter 6 --- Chapter 6 Conclusions and future work --- p.160 / Chapter 6.1 --- Cardiac protection of DG in the I/R and H/R injury --- p.160 / Chapter 6.2 --- Vasodilation effect of DG on the porcine coronary artery --- p.165 / Chapter 6.3 --- Angiogenic effect of DG in vivo and in vitro --- p.167 / Chapter 6.4 --- Overall conclusion of the study --- p.169 / Chapter 7 --- References --- p.170