Inledning: Sjukvården är beroende av frivilliga bloddonatorer. Det behövs alltid fler bloddonatorer då vi med dagens sjukvård kan utföra alltmer avancerad kirurgi samt rädda och hjälpa allt fler sjuka samt skadade, med hjälp av blod från frivilliga donatorer. Syfte: Syftet var att undersöka vilka skäl som anges till att inte donera blod, samt undersöka om viljan att ge blod skiljer sig beroende på kön, ålder och om man har yrkes- eller studieanknytning till sjukvård. Syftet var också att undersöka vilka faktorer potentiella blodgivare anger som motiverande till att donera blod. Metod: Denna uppsats baseras på en kvantitativ tvärsnittsstudie, bestående av en webbenkät som delats av författarnas på det sociala mediet Facebook. Enkäten vände sig till personer som enligt blodcentralens kriterier får donera blod, totalt inkom 90 svar, med ett bortfall på totalt 11 personer. Enkäter analyserades sedan kvantitativt med hjälp av statistikprogrammet SPSS. Resultat: Studien visar att den vanligaste orsaken till att respondenten inte gått och donerat blod är att de tillfrågade har tänkt på det men att det inte blivit av. Det finns ingen skillnad i motivationen att donera blod gällande kön, ålder och om man har yrkes-/studieanknytning till sjukvården. Det som respondenterna uppgett som mest motiverande till att gå och donera blod är att få svar på olika provsvar som till exempel kolesterol och infektionsparametrar. Slutsats: Att försöka göra blodgivningen mer tillgänglig skulle förhoppningsvis kunna öka antalet blodgivare, eftersom en tredjedel av de tillfrågade har tänkt på det, men att det inte blivit av. Att erbjuda bloddonatorerna svar på olika blodprover skulle troligtvis också öka chanserna för att flera personer ska bli återkommande bloddonatorer. / Introduction: Hospitals and general healthcare are dependent on volunteers to donate blood. Due to today’s advanced surgery there is an everlasting need for new and more blood donors. With the aid of donated blood more people in need could receive the appropriate treatment. Aim: The aim was to investigate what reasons would be given for not donating blood, and to investigate whether the will to donate blood may depend on gender, age and whether the subject has a work- or study relation to healthcare. The aim was also to determine the motivating factors to blood donation of future donors. Method: This essay is based on a quantitative cross-sectional study consisting of a web based survey shared by the authors on the social networking service Facebook. The target group of the survey was people who are suitable to donate blood according to the criteria of the blood donation centre. A total of 90 individuals responded to the survey, with a loss of 11 people. The surveys were analyzed quantitatively using the statistical program SPSS. Results: The study indicates that the most common reason to why the respondent has not donated blood is that he or she has thought of donating blood, but that it has simply not yet happened. The motivation of donating blood is not dependent on the person’s gender, age or whether or not the person has a work- or study relation to healthcare. The most motivating factor to donating blood is the opportunity to be informed of test results such as cholesterol levels and infection parameters. Conclusion: Since one third of the respondents have considered donating blood, but that they still have not done so, there would probably be an increase in the numbers of blood donors if blood donating centres were more accessible. To offer the donors the results of various kinds of blood tests would probably motivate more persons to become regular blood donors.

This thesis explored the impact on whole blood donors of a six month deferral from giving blood due to a low haemoglobin (Hb) concentration. The aims were two-fold: first, to quantify the effect of a temporary deferral on donation patterns once eligible to return, and second, to identify the processes contributing to the effect. The mixed methods design utilised four distinct research phases: statistical analysis of donation patterns over a three year period, surveys of whole blood donors three and twelve months after deferral, and semi-structured interviews with 25 blood donors in the weeks immediately following deferral. Deferral for a low Hb increased the likelihood of non-return in both new and repeat donors, and, amongst those who did return, delayed first return, reduced donation frequency and increased the likelihood of drop-out in later years. Qualitative interviews suggested that, predominantly, individuals give blood because it represents an easy and convenient way to help others, and provides additional rewards, such as enhancing positive self-concepts and a free health check. Returning promptly after deferral appears to be related to three aspects of a person and his/her context: an individual’s other obligations, especially parenting; the extent to which donation is considered personally rewarding; and whether donation arrangements were facilitated by a range of supports prior to deferral. Over three quarters of surveyed deferred donors seek further advice and investigations from their medical practitioner and nearly half of those are encouraged to change their donation patterns. With the exception of having a low haemoglobin level confirmed at follow-up testing, experiences seeking further investigations were not associated with either intentions or return. Triangulation of findings suggests that deferral disrupts the habit of regular donation, and that this disruption makes donors more vulnerable to changes to their personal circumstances or collection practices. Deferral may also increase the perceived inconvenience of the activity, decrease self-perceptions of competence and good health, and diminish the “blood donor” identity. Practical implications of these findings are recommendations that may increase retention of deferred donors, including encouraging donors to return promptly once eligible, enhancing the convenience of blood donation, and improving aspects of the deferral event. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1381077 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2010

This thesis explored the impact on whole blood donors of a six month deferral from giving blood due to a low haemoglobin (Hb) concentration. The aims were two-fold: first, to quantify the effect of a temporary deferral on donation patterns once eligible to return, and second, to identify the processes contributing to the effect. The mixed methods design utilised four distinct research phases: statistical analysis of donation patterns over a three year period, surveys of whole blood donors three and twelve months after deferral, and semi-structured interviews with 25 blood donors in the weeks immediately following deferral. Deferral for a low Hb increased the likelihood of non-return in both new and repeat donors, and, amongst those who did return, delayed first return, reduced donation frequency and increased the likelihood of drop-out in later years. Qualitative interviews suggested that, predominantly, individuals give blood because it represents an easy and convenient way to help others, and provides additional rewards, such as enhancing positive self-concepts and a free health check. Returning promptly after deferral appears to be related to three aspects of a person and his/her context: an individual’s other obligations, especially parenting; the extent to which donation is considered personally rewarding; and whether donation arrangements were facilitated by a range of supports prior to deferral. Over three quarters of surveyed deferred donors seek further advice and investigations from their medical practitioner and nearly half of those are encouraged to change their donation patterns. With the exception of having a low haemoglobin level confirmed at follow-up testing, experiences seeking further investigations were not associated with either intentions or return. Triangulation of findings suggests that deferral disrupts the habit of regular donation, and that this disruption makes donors more vulnerable to changes to their personal circumstances or collection practices. Deferral may also increase the perceived inconvenience of the activity, decrease self-perceptions of competence and good health, and diminish the “blood donor” identity. Practical implications of these findings are recommendations that may increase retention of deferred donors, including encouraging donors to return promptly once eligible, enhancing the convenience of blood donation, and improving aspects of the deferral event. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1381077 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2010

O vírus do Oeste do Nilo (VON) é um Flavivírus capaz de infectar muitas espécies de vertebrados, incluindo o homem. Embora reconhecida desde 1940, esta virose nunca havia sido descrita nas Américas, onde emergiu nos Estados Unidos ao final da década de 1990, com numerosos casos de meningoencefalite em humanos. Posteriormente, sua transmissão por transfusão de sangue e órgãos foi comprovada, levando à implantação de testes moleculares (NAT) para a triagem de doadores nos EUA e Canadá a partir de 2003. Nos anos seguintes, o VON foi sendo progressivamente detectado em países como México, Panamá e áreas do Caribe, sugerindo sua iminente introdução na América do Sul. De fato, evidências sorológicas foram reveladas em cavalos e aves na Colômbia, Venezuela, Argentina e muito recentemente no pantanal mato-grossense (em cavalos). A vigilância epidemiológica para este agente é de grande importância para a saúde pública, visto o potencial de morbimortalidade deste vírus para humanos. Sendo assim este trabalho tem o objetivo de investigar a presença do RNA do VON em amostras de doadores de sangue, pacientes com meningoencefalite ou febre de origem indeterminada e soros e amostras cerebrais de equinos. Foram analisadas 2.202 doações de sangue do Amazonas (HEMOAM), 3.144 do Mato Grosso do Sul (HEMOSUL); líquido cefalorraquidiano de 51 pacientes com suspeita de meningoencefalite viral (Hospital das Clínicas/FMUSP, São Paulo) e soro de 198 pacientes com síndrome febril aguda, negativos para Dengue e Malária (Fundação de Medicina Tropical de Manaus). Além disto, 293 amostras de soros de equinos da região do Pantanal e 63 biópsias de tecido cerebral de cavalos que foram a óbito por encefalite de etiologia desconhecida. Estas amostras foram submetidas ao teste automatizado cobas TaqScreen WNV (Roche) na plataforma cobas s201 em sistema de pool de 6 unidades (doações de sangue) ou individualmente (pacientes). Todas as amostras apresentaram amplificação satisfatória do controle da reação, porém nenhuma apresentou resultado positivo para a presença do RNA do VON. Embora já exista evidência da exposição de equinos no Brasil ao VON, não parece haver até o momento, disseminação importante deste agente entre humanos e equinos, uma vez que o RNA viral não foi detectado nem em doadores de sangue e nem em equinos, incluindo os de cidades próximas aos locais onde cavalos soropositivos foram encontrados (Corumbá MS). / The West Nile Virus (WNV) is a Flavivirus able to infect many species of vertebrates, including man. Recognized since 1940, this virus had never been described in the Americas, which emerged in the United States at the end of the 1990s, with numerous cases of meningoencephalitis in humans. Later, transmission by transfusion of blood and organs was confirmed, leading to the deployment of molecular testing (NAT) for screening of donors in the U.S. and Canada since 2003. In the following years, WNV has been progressively detected in countries like Mexico, Panama and the Caribbean areas, suggesting their imminent introduction in South America In fact, serological evidence was revealed in horses and birds in Colombia, Venezuela and Argentina and most recently in Pantanal, Mato Grosso (horses). Epidemiological surveillance for this agent is of great importance to public health, given the potential morbidity and mortality of this virus to humans. Therefore this study aims to investigate the presence of WNV RNA in samples of blood donors, patients with meningoencephalitis or fever of unknown origin and serum and brain samples from horses. We analyzed 2202 blood donations from Amazon (HEMOAM), 3144 from Mato Grosso do Sul (HEMOSUL); cerebrospinal fluid of 51 patients with suspected viral encephalitis (Hospital das Clínicas / FMUSP, São Paulo) and serum samples from 198 patients with acute febrile syndrome, negative for Dengue and malaria (Foundation for Tropical Medicine in Manaus). In addition, more 293 serum samples from horses of the Pantanal and 63 biopsies of brain tissue from horses that died of encephalitis of unknown etiology. These samples were subjected to automated cobas TaqScreen WNV test (Roche) on the platform in cobas S201with a system of 6 units pool (blood donations) or individually (patients). All samples showed satisfactory control amplification, but none showed as positive for the presence of RNA VON. Although there is already evidence in horses in Brazil of exposure to WNV, there seems to be far that an important spread of this agent between humans and horses, since the viral RNA was not detected either in blood donors or in horses, including cities near the locations where seropositive horses were found (Corumbá - MS).

O vírus do Oeste do Nilo (VON) é um Flavivírus capaz de infectar muitas espécies de vertebrados, incluindo o homem. Embora reconhecida desde 1940, esta virose nunca havia sido descrita nas Américas, onde emergiu nos Estados Unidos ao final da década de 1990, com numerosos casos de meningoencefalite em humanos. Posteriormente, sua transmissão por transfusão de sangue e órgãos foi comprovada, levando à implantação de testes moleculares (NAT) para a triagem de doadores nos EUA e Canadá a partir de 2003. Nos anos seguintes, o VON foi sendo progressivamente detectado em países como México, Panamá e áreas do Caribe, sugerindo sua iminente introdução na América do Sul. De fato, evidências sorológicas foram reveladas em cavalos e aves na Colômbia, Venezuela, Argentina e muito recentemente no pantanal mato-grossense (em cavalos). A vigilância epidemiológica para este agente é de grande importância para a saúde pública, visto o potencial de morbimortalidade deste vírus para humanos. Sendo assim este trabalho tem o objetivo de investigar a presença do RNA do VON em amostras de doadores de sangue, pacientes com meningoencefalite ou febre de origem indeterminada e soros e amostras cerebrais de equinos. Foram analisadas 2.202 doações de sangue do Amazonas (HEMOAM), 3.144 do Mato Grosso do Sul (HEMOSUL); líquido cefalorraquidiano de 51 pacientes com suspeita de meningoencefalite viral (Hospital das Clínicas/FMUSP, São Paulo) e soro de 198 pacientes com síndrome febril aguda, negativos para Dengue e Malária (Fundação de Medicina Tropical de Manaus). Além disto, 293 amostras de soros de equinos da região do Pantanal e 63 biópsias de tecido cerebral de cavalos que foram a óbito por encefalite de etiologia desconhecida. Estas amostras foram submetidas ao teste automatizado cobas TaqScreen WNV (Roche) na plataforma cobas s201 em sistema de pool de 6 unidades (doações de sangue) ou individualmente (pacientes). Todas as amostras apresentaram amplificação satisfatória do controle da reação, porém nenhuma apresentou resultado positivo para a presença do RNA do VON. Embora já exista evidência da exposição de equinos no Brasil ao VON, não parece haver até o momento, disseminação importante deste agente entre humanos e equinos, uma vez que o RNA viral não foi detectado nem em doadores de sangue e nem em equinos, incluindo os de cidades próximas aos locais onde cavalos soropositivos foram encontrados (Corumbá MS). / The West Nile Virus (WNV) is a Flavivirus able to infect many species of vertebrates, including man. Recognized since 1940, this virus had never been described in the Americas, which emerged in the United States at the end of the 1990s, with numerous cases of meningoencephalitis in humans. Later, transmission by transfusion of blood and organs was confirmed, leading to the deployment of molecular testing (NAT) for screening of donors in the U.S. and Canada since 2003. In the following years, WNV has been progressively detected in countries like Mexico, Panama and the Caribbean areas, suggesting their imminent introduction in South America In fact, serological evidence was revealed in horses and birds in Colombia, Venezuela and Argentina and most recently in Pantanal, Mato Grosso (horses). Epidemiological surveillance for this agent is of great importance to public health, given the potential morbidity and mortality of this virus to humans. Therefore this study aims to investigate the presence of WNV RNA in samples of blood donors, patients with meningoencephalitis or fever of unknown origin and serum and brain samples from horses. We analyzed 2202 blood donations from Amazon (HEMOAM), 3144 from Mato Grosso do Sul (HEMOSUL); cerebrospinal fluid of 51 patients with suspected viral encephalitis (Hospital das Clínicas / FMUSP, São Paulo) and serum samples from 198 patients with acute febrile syndrome, negative for Dengue and malaria (Foundation for Tropical Medicine in Manaus). In addition, more 293 serum samples from horses of the Pantanal and 63 biopsies of brain tissue from horses that died of encephalitis of unknown etiology. These samples were subjected to automated cobas TaqScreen WNV test (Roche) on the platform in cobas S201with a system of 6 units pool (blood donations) or individually (patients). All samples showed satisfactory control amplification, but none showed as positive for the presence of RNA VON. Although there is already evidence in horses in Brazil of exposure to WNV, there seems to be far that an important spread of this agent between humans and horses, since the viral RNA was not detected either in blood donors or in horses, including cities near the locations where seropositive horses were found (Corumbá - MS).