A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Arts (Clinical Psychology) in the Department of Psychology University of Zululand, 2004. / The present research investigated the attitudes and perceptions on condom-use among male and female students of the University of Zululand (main campus). The sample (N=100) consisted of male (N=68) and female (N=32) students, whose ages ranged from 17 to 44 years. The sample consisted of English, Sothor Tsonga, Swazi, Ndebele, and mainly Zulu speaking students (74%). Although a significant difference was found in perceptions of male and. female students on condom use on some items on sexual satisfaction, no significant differences were found in their perceptions on condom use in relation to health hazards and sexual interest.

No description available.

No abstract available. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.

University of Macau / Institute of Chinese Medical Sciences

This study examines the experiences of HIV/AIDS prevention workers whose clients include injection drug users (IDUs). Via a mixed methods approach (survey questionnaire and interview) the specifics of workers' practices were documented, along with their perspectives on a variety of IDU, addiction and HIV/AIDS-related issues. Foucault's writings on knowledge and power were used as the theoretical framework for this analysis. Thirty-six workers completed a self-administered questionnaire, from which preliminary analyses were conducted to identify emergent themes for exploration during qualitative interviews. Sixteen participants subsequently discussed themes such as treatment options, social marginalization, and the workers' approaches to working with IDUs. The findings reveal that the workers share some common beliefs. They are convinced their IDU clients would be able to practice better self care if they had access to safe and affordable housing. In terms of addictions services, the continued broadening of needle exchange programs (NEPs) is good, but that NEP itself should not be the only harm reduction strategy in place. With regards to abstinence-based services, none of the participants found satisfactory the existing meagre services accesible to their clients who want to stop using drugs. They were ambivalent towards methadone maintenance therapy (MMT), once used as an initial stage towards total abstinence, now more commonly used as a harm reduction instrument, by eliminating opiate use (and injection), or reducing the frequency of opiate injection. Workers emphasized the substanial gaps between the services available and what is needed, in terms of harm reduction or (particularly) abstinence. These workers use their own, local knowledge about IDUs and addiction, and navigate their clients through the limited services available. As hundreds of IDUs continue to become infected with HIV each year in Vancouver, a dramatic increase in access to abstinence-based services, and a more explicit gradiation between "pure" abstinence-based programs and NEPs, could be put in place. Most workers support a more nuanced spectrum of treatment options for IDUs.

O objetivo do trabalho foi descrever, em uma perspectiva histÃrica, o perfil epidemiolÃgico da peste no Estado do Cearà a partir de 1900 e a evoluÃÃo das aÃÃes de controle desse agravo no perÃodo de 1980 a 2008. Realizou-se um estudo descritivo, de natureza histÃrica, com associaÃÃo da abordagem da histÃria oral, para construÃÃo dos cenÃrios epidemiolÃgicos e operacionais e uma revisÃo de informaÃÃes histÃrico-epidemiolÃgicas do programa de controle. Para consubstanciar as informaÃÃes obtidas, foram realizadas entrevistas abertas com especialistas na Ãrea. Os registros histÃricos dos casos humanos foram recuperados somente a partir de 1935 e perÃodos de intensa atividade e outros de quiescÃncia foram identificados. Destaca-se que na dÃcada de 1980 a peste persistiu, atà 1986, de forma endÃmica na Serra da Ibiapaba. No perÃodo de 1982 a 1985 ocorreu um surto na Serra de Baturità tendo sido confirmados 89 casos humanos, registrada elevada densidade populacional de roedores e verificado considerÃvel incremento das aÃÃes do programa. Na dÃcada de 1990 apenas trÃs casos humanos foram confirmados na Serra da Ibiapaba e em 2005 mais um caso foi confirmado na Serra da Pedra Branca. O declÃnio dos casos humanos a partir de 1986 levou à reduÃÃo de todas as aÃÃes. Por vÃrias dÃcadas as aÃÃes do Programa de Controle da Peste (PCP) incluÃam educaÃÃo em saÃde, busca ativa de atividade pestosa e coleta de espÃcimes para anÃlises bacteriolÃgicas e sorolÃgicas. InquÃritos sorolÃgicos em carnÃvoros domÃsticos (cÃes e gatos) predadores de roedores foram introduzidos na rotina do PCP em 1989 visando o monitoramento da circulaÃÃo da Y. pestis e se revelou a ferramenta mais eficaz para detecÃÃo da atividade da zoonose. Foram detectados picos de positivaÃÃo em 1997, 2001 e 2005, e mesmo assim essa atividade vem sendo enfraquecida no estado e a recomendaÃÃo atual à restringir os inquÃritos sorolÃgicos apenas a amostras caninas. Os focos do Cearà estÃo localizados nos complexos ecolÃgicos das Serras de BaturitÃ, do Machado, das Matas, da Pedra Branca, de Uruburetama, da Ibiapaba e Chapada do Araripe. As aÃÃes inicialmente desenvolvidas nos focos como unidade ecolÃgica, apÃs a divisÃo polÃtico/administrativa das Ãreas, com a descentralizaÃÃo, passaram a ser organizadas em nÃvel de Regionais. Os focos do Cearà destacam-se como os mais importantes no Brasil, tanto pela ocorrÃncia de casos humanos quanto pela evidÃncia de circulaÃÃo permanente da bactÃria. A persistÃncia da peste no estado deve, pois, ser considerada uma ameaÃa real e permanente de acometimento humano nessas regiÃes, que pode estender-se para outros lugares, inclusive centros urbanos, tornando-se imperativo que os profissionais de saÃde estejam preparados. Por isso, para garantir o monitoramento dos focos na totalidade, torna-se imprescindÃvel a manutenÃÃo da vigilÃncia na perspectiva de foco, para permitir a adoÃÃo de medidas de controle adequadas para proteÃÃo das populaÃÃes humanas nas Ãreas focais. / Our objective was to describe, in a historical perspective, the epidemiological profile of plague in the State of Cearà since 1900 and the evolution of the activities of the disease control from 1980 to 2008. We carried out a descriptive study using an historical approach based on the oral history for the construction of epidemiological and operational scenarios and a review of the historical and epidemiological information about the plague control program. To strengthen the information obtained, we conducted interviews with experts in the area. Historical records of human cases have been recovered only from 1935, and periods of intense activity and others of quiescence were identified. It is noteworthy that in the years 1980 plague persisted as endemic in Serra da Ibiapaba until 1986. In the period from 1982 to 1985 there was an outbreak in Serra de Baturità with 89 confirmed human cases; a rise of the rodentsâ population and significant increasing in the activities of the program were observed. In the 1990s, only three human cases were confirmed in Serra da Ibiapaba and in 2005 another case was confirmed in Serra da Pedra Branca. The decline of human cases after 1986 led to the reduction of the program activities. For several decades the activities of the Plague Control Program (PCP) included health education, active search for plague activity and collection of specimens for bacteriological and serological analysis. Serological surveys in domestic carnivores (dogs and cats) predators of rodents were introduced into the routine of PCP in 1989 to monitor Y. pestis activities in the foci proving the most effective tool to detect the zoonosis activities in the foci. In spite of the occurrence of positivity peaks detected in 1997, 2001 and 2005, this activity has been diminished in the state and the present recommendation is to restrict the serological surveys to canine samples only. The Cearà foci are located in the ecological complexes of the âserrasâ BaturitÃ, Machado, Matas, Pedra Branca, Uruburetama, Ibiapaba and Araripe. The foci area were formerly dealt as ecological units; however after the political/administrative division of the areas, in view of the âdecentralization processâ, they are now scattered among the âRegionaisâ. The Cearà foci are among the most important in Brazil, both by the number of human cases and by evidence of the permanent circulation of the bacterium. The persistence of plague in the state should therefore be considered a real and permanent risk in these regions, which may extend to other places, including urban centers, making it imperative that health professionals are prepared. Therefore, to ensure the monitoring of the foci, it is essential to maintain surveillance under the ecological approach, to enable the adoption of appropriate control measures for protection of human populations in focal areas.

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.

Class of 2006 Abstract / Objectives: To further define the health promotion and disease prevention domain of the Outcomes Expected (OE) document at the University of Arizona, College of Pharmacy to make it consistent with the other domains. Also, it was aimed to make Domain 3 meet standards consistent with other health sciences curricula. Methods: This was a systematic review of all publications pertaining to health promotion or disease prevention curricula using Medline and IPA between the years 1995 and 2005. The data extraction form was developed based on a compilation of articles published in the December, 2004 issue of American Journal of Preventive Medicine which presented a framework of competencies. These consisted of four competencies: Evidence Base of Practice, Clinical Preventive Services-Health Promotion, Health Systems and Health Policy, and Community Aspects of Practice. Results: The initial search yielded a total of 197 results. Of those results, 63 articles fit within the framework of the data extraction form. Key concepts were identified after reviewing the articles and provided the basis for creating components within the competencies. Conclusion: After reviewing the literature, it is evident that the OE document needs to be changed to further define health promotion and disease prevention. The updated Domain 3 is proposed in Appendix 1 and provides components that were substantially addressed in the articles reviewed.

This study examines the experiences of HIV/AIDS prevention workers whose clients include injection drug users (IDUs). Via a mixed methods approach (survey questionnaire and interview) the specifics of workers' practices were documented, along with their perspectives on a variety of IDU, addiction and HIV/AIDS-related issues. Foucault's writings on knowledge and power were used as the theoretical framework for this analysis. Thirty-six workers completed a self-administered questionnaire, from which preliminary analyses were conducted to identify emergent themes for exploration during qualitative interviews. Sixteen participants subsequently discussed themes such as treatment options, social marginalization, and the workers' approaches to working with IDUs. The findings reveal that the workers share some common beliefs. They are convinced their IDU clients would be able to practice better self care if they had access to safe and affordable housing. In terms of addictions services, the continued broadening of needle exchange programs (NEPs) is good, but that NEP itself should not be the only harm reduction strategy in place. With regards to abstinence-based services, none of the participants found satisfactory the existing meagre services accesible to their clients who want to stop using drugs. They were ambivalent towards methadone maintenance therapy (MMT), once used as an initial stage towards total abstinence, now more commonly used as a harm reduction instrument, by eliminating opiate use (and injection), or reducing the frequency of opiate injection. Workers emphasized the substanial gaps between the services available and what is needed, in terms of harm reduction or (particularly) abstinence. These workers use their own, local knowledge about IDUs and addiction, and navigate their clients through the limited services available. As hundreds of IDUs continue to become infected with HIV each year in Vancouver, a dramatic increase in access to abstinence-based services, and a more explicit gradiation between "pure" abstinence-based programs and NEPs, could be put in place. Most workers support a more nuanced spectrum of treatment options for IDUs. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

M.Phil. / AIDS is regarded as the most disastrous health threat in the world. The impact of HIV/AIDS goes beyond the physical well being of the individual: it affects the world's economic, social and political functioning. The greatest number of people living in sub-Saharan Africa, are infected or affected by HIV/AIDS.HIV/AIDS related issues amongst adolescents were neglected due to the visible impact of this pandemic on babies and adults. Adolescents' behaviour is regarded as high-risk because of their involvement in sexual activities at a young age. Presently there is no cure or vaccine for AIDS. The only effective way to prevent or reduce HIV transmission is through changing the behaviour that leads to HIV infection. The National and Provincial Departments of Health, Education and Welfare implemented various AIDS prevention programmes, focussing on promoting the practice of safer sex amongst adolescents. Unfortunately, these AIDS prevention programmes did not result in the behavioural changes of adolescents. The dissatisfying outcome questions the efficacy of the development and implementation of these programmes, although they have adequate knowledge about HIV/AIDS. Most AIDS prevention programmes do not ·focus, nor accommodate the specific needs of adolescents, especially adolescent boys. The purpose of this study was to explore and describe adolescent boys' views about sexual activities and their specific needs in terms of an AIDS prevention programme. Guidelines would then be presented to developers of AIDS prevention programmes, based on the identified views and needs. The research design was based on qualitative research because of its exploratory, descriptive and contextual nature. The collection of the data was done by means of focus group interviews and field notes reflecting the observation done during the interviews. The analysis of the data was done according to Tesch's approach of data reduction. Literature was used to compare and complement the results. Applying Guba' s model on trustworthiness ensured the trustworthiness ofthe research. The results of the fieldwork indicated the following themes: • Most adolescents are sexually active. • Different roles and motives exist for adolescent boys and girls in terms of sex. • Adolescents externalise the risks HIV presents. • Three categories of views exist toward the acceptability of involvement in sexual activity, ranging from unacceptable to acceptable. • Adolescents' experience underlying feelings of fear in terms of issues related to sex. • Adolescents' needs in terms of AIDS prevention programmes mainly focus on the functionality of the information that is provided as well as the presentation of these programmes. • The importance of ongoing sex education, including HIV/ AIDS related 1ssues, were stressed by adolescents and confirmed by literature. Based on these findings, guidelines were presented to inform developers of HIV/AIDS programmes, of the specific needs adolescent boys need to be addressed.