Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

A importância dos serviços de assistência odontológica prestada pela Faculdade de Odontologia da Universidade de São Paulo reflete nos dados obtidos do Anuário Estatístico da Universidade de São Paulo. Somente na disciplina de Cirurgia, foram realizados 1075 atendimentos cirúrgicos, no ano de 2000 saltando para 5686 em 2007. A cada paciente gera-se um prontuário que contém informações de cunho pessoal, da história médica, odontológicas, e de imagens que lhe atribui alto valor legal e de pesquisa. Com a alta procura pelos serviços oferecidos pela faculdade, o número de documentos gerados por paciente cresce proporcionalmente e constata-se que o arquivamento dos prontuários de toda a faculdade é frágil e sujeito à ocorrência de eventos que poderiam danificar o material. A morosidade na busca por dados dos pacientes, a perda de informações, e a dificuldade em realizar estudos epidemiológicos levaram à motivação para o desenvolvimento e avaliação de um prontuário virtual e seu respectivo Banco de Dados da disciplina de Cirurgia da Faculdade de Odontologia da Universidade de São Paulo. Um modelo de ficha para transcrição eletrônica, com os mesmos itens da ficha clínico-cirúrgica, foi elaborado e utilizado para a transcrição das informações dos pacientes atendidos no ambulatório de Cirurgia, no curso noturno, no ano de 2008. Um protótipo de prontuário virtual foi desenvolvido e os dados coletados de 417 pacientes foram inseridos e armazenados localmente num Banco de Dados desenvolvido para WEB, visando uma nova forma de acesso à informação. A partir dos testes de uso retrospectivo e prospectivo, concluímos que o protótipo do prontuário virtual representa uma importante ferramenta baseada em tecnologias de informação, de uso epidemiológico, de pesquisa e de avaliação dos requisitos necessários para o desenvolvimento de um prontuário virtual com mais robustez e flexibilidade. / The importance of the dental aid services offered by the School of Dentistry of the University of São Paulo reflects on the data from the Statistical Yearbook of the University of São Paulo. In the discipline of Oral Surgery by itself, 1075 surgical appointments were done in 2000, which has increased greatly to 5686 in 2007. To every new patient admitted by the service, a record file is created and contains personal information, health and dental history, and images, thus setting a high legal and research value on the patient record file for the institution. With the high demand for these dental services, the number of documents by patient proportionally augments and it can be seen in the entire institution fragility of the files archiving and risk of events occurrence that could damage the material. The slowness of retrieving patient data, lack of information, and difficulties motivate the development and evaluation of an electronic health record and its respective database in the discipline of Oral Surgery of the School of Dentistry of the University of São Paulo. A sheet form for electronic transcription, with the same content of the surgical-clinical questionnaire form, was elaborated to transcript the health information of the patients admitted at the Oral Surgery Service, in the nocturnal graduation course during 2008. A prototype of an electronic health record was created and the collected data were processed and stored in a web-based local database, aiming to an innovative access mode to information. By the tests of retrospective and prospective use of the electronic health record, we concluded the prototype of the electronic health record represents an important tool based in technologies of information, useful to epidemiology, research and evaluation of required features to development of an electronic health record more robust and flexible.

M.Cur.(Medical & Surgical Nursing: Critical Care General) / The majority of Africans use traditional medicine, but do not divulge this information to the nurses and doctors when admitted to critical care units. For this reason, patients develop complications, and these makes it difficult for nurses and medical doctors in critical care units to assess and to provide comprehensive quality care, as they treat only the visible clinical manifestations. The purpose of this study was to explore and describe the factors leading to non- divulgence by patients who used traditional medicines in critical care units of a Westrand mine hospital, in order to describe strategies to facilitate divulgence. The researcher used a qualitative, exploratory, descriptive and contextual research design. The population was composed of the patients who were envisaged to have used traditional medicines in the critical care unit of a Westrand mine hospital. Twelve participants were purposively selected from the critical care unit register because these patients displayed the symptoms of having used traditional medicine. Semi-structured individual interviews were conducted. Ethical principles were adhered to. Trustworthiness was ensured by using namely; credibility, transferability, dependability and confirmability. A qualitative open coding method of data analysis was used according to Tesch’s protocol. The following theme and subthemes emerged from the data analysis: Fear and anxiety as the main theme. Subthemes were 1. Fear to divulge secrets. 2. Fear of negative attitudes from nurses and 3. Fear to lose rights, norms and values. It is recommended that the strategies described be used in clinical practice, nursing education and for further research regarding divulgence of the use of traditional medicine to the nurses and doctors, in order to provide a comprehensive assessment and treatment of the patients in critical care units.

Un requisito primordial para las organizaciones de salud es la protección y distribución de Historiales Médicos, porque almacenan toda la información médica sensible de los pacientes. Sin embargo, las organizaciones de salud privadas peruanas tienen problemas de seguridad e interoperabilidad del Historial Médico Electrónico, porque la mayoría de ellas tienen sistemas centralizados tercerizados. Las nuevas arquitecturas tecnológicas se desarrollan utilizando Blockchain, ofreciendo un completo control y disponibilidad del Historial Médico para el paciente. No obstante, las arquitecturas encontradas en la literatura no están diseñadas para las necesidades de las organizaciones de salud privadas peruanas. En esta investigación se utiliza Blockchain para el diseño de una arquitectura tecnológica de gestión de Historiales Médicos en organizaciones de salud privadas peruanas. Se consideran las regulaciones peruanas e internacionales para la gestión de la información, proporcionando registros de transacciones y tecnología off-chain para almacenar imágenes médicas de manera eficiente. Los resultados obtenidos en una clínica a través de una prueba de concepto muestran que las organizaciones de salud privadas tienen baja seguridad y eficiencia en sus procesos de gestión de Historiales Médicos; sugiriendo una oportunidad para desarrollar una solución tecnológica de gestión del Historial Médico. / A prime requirement for health organizations is the protection and distribution of Medical Records because they store all the sensitive health information of the patients. However, Peruvian private health organizations have problems in security and interoperability of the Electronic Medical Record because most of them have centralized outsourced systems. New Technology Architectures are developed using Blockchain, offering complete control and availability of their medical record to the patient. However, the architectures found in the literature are not designed for Peruvian private health organization needs. In this research, Blockchain is used to design a technological architecture for the management of Medical Records in Peruvian private health organizations. Peruvian and international regulations for information management are considered, providing transaction logs and off-chain technology to store medical images efficiently. The results obtained in a clinic through a proof of concept show that private health organizations have low security and efficiency in their Medical Record management processes, suggesting an opportunity to develop a technology solution for Electronic Medical Record management. / Tesis

No description available.

This thesis offers a detailed account of early polio epidemics (between 1918 and 1945) in Johannesburg, where the disease was particularly severe. At this time, little was known about the poliovirus, and such limited understanding affected the public health and medical initiatives taken during this period. These actions are highlighted in the thesis, along with the responses of the media and lay public to the disease. The effect of war on the management of the disease is also examined, as it siphoned off vital medical personnel and jeopardised disease control. It also lent an emotional overlay to the way the disease was perceived, as `battle' rhetoric became the parlance used against polio, which was personified as the `enemy' of innocent children who were disabled at the whim of the virus. The epidemic of 1944-1945 was the first to be systematically investigated, by Dr James Gear as part of his groundbreaking polio research; he later became part of an international team of researchers who contributed to the development of a prophylactic vaccine within a decade of this epidemic. / History / M.A. (History)

Le but de cette thèse était d’analyser les associations entre plusieurs facteurs environnementaux (consommations maternelles de tabac, d’alcool et de boissons caféinées pendant la grossesse) et médicaux (antécédents d’asthme ou d’eczéma) et les leucémies aiguës de l’enfant, et d’étudier des polymorphismes génétiques susceptibles de modifier ces associations. Les analyses ont été réalisées à partir de l’étude cas-témoins nationale ESCALE réalisée en population générale en 2003 et 2004. Les données sur les antécédents médicaux et les consommations maternelles pendant la grossesse ont été recueillies au cours d’un entretien téléphonique standardisé des mères. Les polymorphismes génétiques d’intérêt ont été sélectionnés suivant une approche candidate sur leur fonctionnalité, dans des gènes impliqués dans le métabolisme du tabac (CYP1A1*2, CYP2E1*5, NQO1*2, EPHX1 et NAT2*5), de l’alcool (CYP2E1*5, ADH1C*2) et de la caféine (NAT2*5), et dans l’allergie (IL4, IL4R, IL10 et IL13). Les données génétiques ont été obtenues à partir de prélèvements de sang chez les cas et de salive chez les témoins, par génotypage de 370 000 SNPs chez les cas et sur puce à façon de 4 500 SNPs chez les témoins, complété par des imputations génotypiques lorsque les polymorphismes candidats n’étaient pas disponibles au génotypage. Au total, les données étaient disponibles pour 493 cas de leucémie aiguë et 442 témoins d’origine européenne.La consommation maternelle de café pendant la grossesse était positivement associée aux leucémies aiguës de l’enfant dans cette étude. Aucune association significative n’était observée avec le tabagisme maternel ou la consommation d’alcool pendant la grossesse. La présence de deux allèles NAT2*5 était associée aux leucémies aiguës lymphoblastiques (Odds Ratio OR=1.9 [1.3-2.7]), mais les analyses ne montraient pas d’association avec les autres polymorphismes des enzymes du métabolisme. Aucune interaction significative n’a été observée entre les polymorphismes candidats et le tabagisme maternel ou les consommations d’alcool ou de boissons caféinées pendant la grossesse. Cependant, les allèles candidats de CYP2E1, NQO1 et EPHX1, trois enzymes impliquées dans le métabolisme du benzène, semblaient interagir entre eux.Les allèles variants dans les gènes IL13, IL4, IL10 et IL4R n’étaient pas associés au risque de leucémie de l’enfant. Les antécédents d’asthme ou d’eczéma étaient plus fréquemment retrouvés chez les témoins que chez les cas (OR=0.7 [0.6-0.9]). Cette association inverse était essentiellement retrouvée chez les enfants porteurs d’un haplotype variant régulant l’expression de l’IL10 (p interaction=0.08) et porteurs de deux allèles de référence pour IL13-rs20541 (p interaction=0.06).En conclusion, ces résultats suggèrent un rôle de la consommation de café dans le risque de leucémie, déjà observé dans la précédente étude de l’équipe, qui devra être répliqué et approfondi. En revanche, aucune association n’a été observée avec la consommation maternelle de tabac ou d’alcool, même en tenant compte des polymorphismes génétiques candidats. L’interaction gène-gène des trois enzymes impliquées dans le métabolisme du benzène est intéressante et devra être explorée dans d’autres études. Enfin, l’association inverse entre le risque de leucémie aiguë et les antécédents d’asthme ou d’eczéma semble limitée aux enfants porteurs de certains polymorphismes des interleukines IL10 et IL13, ce qui pourrait refléter des mécanismes biologiques sous-jacents. Ces hypothèses pourront être testées d’autres études, et en particulier dans l’étude ESTELLE, récemment réalisée par l’équipe. / The aim of this thesis was to analyze the associations between several environmental (maternal consumption of tobacco, alcohol or caffeinated drinks during pregnancy) and medical (history of asthma or eczema) factors and childhood acute leukemia, and to study genetic polymorphisms suspected to modify those associations.The analyses were performed using data from the national population-based case-control ESCALE study conducted in 2003 and 2004. Information about medical history and maternal consumptions during pregnancy was obtained through a standardized telephone interview with the mothers. The genetic polymorphisms were selected using a candidate approach based on their functionality, in genes involved in the metabolism of tobacco (CYP1A1*2, CYP2E1*5, NQO1*2, EPHX1 and NAT2*5), alcohol (CYP2E1*5, ADH1C*2) or caffeine (NAT2*5), and in allergy (IL4, IL4R, IL10 and IL13). Biological samples consisting of blood for cases and saliva for controls allowed for the genotyping of 370,000 SNPs in the cases and 4,500 SNPs in the controls. Where the candidate polymorphisms were not available from the genotyping, genotypic imputation was used to infer those. In total, data was available for 493 acute leukemia cases and 442 controls of European origin. Maternal coffee drinking during pregnancy and, to a lesser extent, cola soda drinking, was positively associated with childhood leukemia in the ESCALE study. No significant association was observed with maternal smoking or alcohol consumption during pregnancy. Carrying two NAT2*5 alleles was associated with acute lymphoblastic leukemia (Odds Ratio OR=1.9 [1.3-2.7]), although the analyses showed no association with the other candidate alleles involved in metabolism. There was no significant interaction between the candidate genetic polymorphisms and maternal consumptions of tobacco, alcohol or caffeinated drinks during pregnancy. However, the candidate alleles of CYP2E1, NQO1 and EPHX1, three enzymes involved in benzene metabolism, seemed to interact together.The variant alleles in IL13, IL4, IL10 and IL4R genes were not associated with childhood leukemia. A history of asthma or eczema was more frequently reported in controls than in cases (OR=0.7 [0.6-0.9]). This inverse association was mostly observed in children carrying a variant haplotype regulating the expression of IL10 (p for interaction=0.08), and carrying two reference alleles for IL13-rs20541 (p for interaction=0.06).As a conclusion, these results suggest a role of maternal coffee drinking during pregnancy in childhood leukemia that had already been reported in a previous French study of the same research team, and needing in-depth study and replication. However, no association was observed with maternal smoking or alcohol drinking, even after taking into account the candidate genetic polymorphisms. The gene-gene interaction of the three enzymes involved in benzene metabolism is interesting and needs to be investigated in other studies. Finally, the inverse association between childhood acute leukemia risk and medical history of asthma or eczema seems to be limited to the children with specific polymorphisms of interleukins IL10 and IL13, which could reflect underlying biological mechanisms. Those hypotheses should be further tested in other studies, such as the ESTELLE study, that has been recently conducted by the team.

This thesis offers a detailed account of early polio epidemics (between 1918 and 1945) in Johannesburg, where the disease was particularly severe. At this time, little was known about the poliovirus, and such limited understanding affected the public health and medical initiatives taken during this period. These actions are highlighted in the thesis, along with the responses of the media and lay public to the disease. The effect of war on the management of the disease is also examined, as it siphoned off vital medical personnel and jeopardised disease control. It also lent an emotional overlay to the way the disease was perceived, as `battle' rhetoric became the parlance used against polio, which was personified as the `enemy' of innocent children who were disabled at the whim of the virus. The epidemic of 1944-1945 was the first to be systematically investigated, by Dr James Gear as part of his groundbreaking polio research; he later became part of an international team of researchers who contributed to the development of a prophylactic vaccine within a decade of this epidemic. / History / M.A. (History)

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Parents have increasingly participated in their children’s bedside care. Parental participation has led to more provider-parent interactions and communication during such stressful events. Helping parents through such stressful events requires nurses to be skilled communicators. Brief methods of training emotion-focused communication with newly licensed nurses are needed, but as yet are rare. The purpose of this study was to evaluate the impact of a validated brief communication (Four Habits Model) training program for newly licensed pediatric nurses. The intervention focused on ways to improve nurses’ emotion-focused conversations with parents. Information processing and Benner’s novice to expert informed this study. The intervention is based on the four habits model, with “habits” providing a structure for nurses to organize their thinking and behavior during emotion-focused conversations with parents. Thirty-five pediatric nurses with 0–24 months of nursing experience at a large mid-western children’s hospital participated in the study. Mixed methods provided data for this experimental study, using a group-by-trials repeated measures ANOVA design. Participants randomized to the intervention group participated in a one-hour three-part training: adapted four habits model content, simulated nurse-parent communication activity, and debrief. Participants randomized to the control group observed a one-hour travel video. Key outcome variables were Preparation, Communication Skills, Relationships, Confidence, Anxiety, and Total Preparation. Compared with the controls, the intervention group improved significantly in the following areas: Preparation, F(1,33) = 28.833, p < .001; Communication Skills, F(1,33) = 9.726, p = .004; Relationships, F(1,33) = 8.337, p = .007; Confidence, F(1,33) = 36.097, p < .001; and Total Preparation, F(1,33) = 47.610, p < .001. Nurses’ experience level had no effect, with the exception of Anxiety. Nurses with more experience (≥ 12 m) showed a greater reduction in Anxiety, when compared to nurses with less experience (< 12 m), F(1,31) = 5.733, p = .023. Fifty-two percent of the nurses involved in the intervention later reported specific examples of implementing the four habits when working with parents in clinical settings. A one-hour four habits communication-training program is effective in improving newly licensed nurses’ preparation for emotion-focused conversations with parents.