Made available in DSpace on 2016-04-27T13:10:24Z (GMT). No. of bitstreams: 1 Walter Anibal Filho.pdf: 2121512 bytes, checksum: 703a7c09d1732c473fd21d82591e73c3 (MD5) Previous issue date: 2014-03-17 / Diabetes mellitus (DM) is a chronic disease characterized by impaired glucose metabolism, whose inadequate glycemic control can reduce life expectancy and impair quality of life. Due to high government investment, poor adherence by the user and little rapport of the multidisciplinary team in the program self-monitoring blood glucose (AMG), appeared motivated this study with the objectives of evaluating the performance of the team; develop and evaluate educational strategies for effective performance monitoring in type 2 diabetic patients in the AMG. We conducted a qualitative and quantitative research, the principles of action research. A total of ten professionals Basic Health Unit and Health Reference Elderly (UBS/URSI) Carandiru, SP. Eight meetings were held with educational interventions, participatory and reflexive strategies. To evaluate the performance of the team an instrument of perception and was used to assess knowledge was applied pre-and post - tests. The AMG was worse with dimension Review: little appreciation, absence of permanent education and actions that strengthen and/or value the work of professionals and systematic review. It was found best results pos test. The collective construction actions established itself as: update, add knowledge, interdisciplinary rapport, case discussion, self-assessment, focus on promotion and prevention, strengthening the program, set goals for membership, user awareness, joint consultations with multidisciplinary care and inclusion in the annual work plan. Interventions contributed to identify factors affecting the routine work, enhance the knowledge/skills, encourage participation and create a favorable environment for teamwork. Therefore efforts should be targeted to interactive strategies that are incorporated into the practice of professionals for greater integration of the team, for the benefit of the user / O diabetes mellitus (DM) é uma doença crônica, caracterizada pelo comprometimento do metabolismo da glicose, cujo controle glicêmico inadequado pode reduzir a expectativa de vida e comprometer a qualidade de vida. Devido ao alto investimento governamental, a baixa adesão por parte do usuário e o pouco entrosamento da equipe multiprofissional no programa automonitoramento glicêmico (AMG), surgiu a motivação deste estudo com os objetivos de avaliar a atuação da equipe; desenvolver e avaliar estratégias de educação para a efetiva atuação no acompanhamento de pacientes diabéticos tipo 2 no AMG. Realizou-se uma pesquisa quali-quanti, nos princípios da pesquisa-ação. Participaram dez profissionais da Unidade Básica de Saúde e de Referência Saúde do Idoso (UBS/URSI) Carandiru, SP. Foram realizados oito encontros, com intervenções educativas, com estratégias participativas e reflexivas. Para avaliar a atuação da equipe foi utilizado um instrumento de percepção e para avaliar o conhecimento foi aplicado um pré e pós-testes. O AMG foi dimensão com pior avaliação: pouca valorização, ausência de educação permanente e de ações que fortalecem e/ou valorizam a atuação dos profissionais e avaliação sistemática. Constataram-se melhores resultados no pos teste. Na construção coletiva estabeleceu-se como ações: atualização, agregar conhecimentos, entrosamento interdisciplinar, discussão de casos, auto avaliação, focar na promoção e prevenção, aprofundamento no programa, estabelecer metas de adesão, conscientização do usuário, articulação das consultas com o atendimento multiprofissional e inclusão no plano de trabalho anual. As intervenções contribuíram para identificar fatores que interferem na rotina de trabalho, aprimorar os conhecimentos/competências, estimular a participação e criar um ambiente favorável para o trabalho em equipe. Desta forma esforços devem ser direcionados para que estratégias interativas sejam incorporadas na pratica dos profissionais, para uma maior integração da equipe, em benefício do usuário

Die Blauzungenkrankheit (Bluetongue, BT) ist eine weltweit verbreitete Infektionskrankheit der Wiederkäuer. Sie wird von einem Orbivirus, dem Bluetongue virus (BTV) ausgelöst, welches durch belebte Vektoren übertragen wird. Nach ursprünglich limitierter Verbreitung zwischen dem 35. südlichen und dem 40. nördlichen Breitengrad, hat sich das BT-Virus ausgehend vom Mittelmeerraum, auch in Teilen Südeuropas manifestiert. Im Spätsommer 2006 wurde BTV erstmals auch in Zentraleuropa nachgewiesen (Belgien, Niederlande und Deutschland) und breitete sich in den folgenden Jahren in weitere angrenzende europäische Länder aus. Der nachgewiesene Serotyp 8 (BTV-8) war bis dahin nur auf Gebiete südlich der Sahara, sowie Mittel- und Südamerika beschränkt. Die Bedeutung von Wildwiederkäuern für die Epidemiologie der Blauzungenkrankheit in Deutschland und in Mitteleuropa war bis zu diesem Zeitpunkt unbekannt. Sind die einheimischen Wildwiederkäuer (Rothirsch (Cervus elaphus), Damhirsch (Dama dama), Europäischer Mufflon (Ovis aries musimon) und Reh (Capreolus capreolus)) für das BTV empfänglich, so könnten sie eine Rolle als Erregerreservoir spielen und müssen somit auch in einer wirksamen Bekämpfungsstrategie berücksichtigt werden. Von April 2008 bis März 2011 wurde ein Monitoring zum BTV-Nachweis in Thüringen durchgeführt. Es sollte untersucht werden, ob die heimischen Wildwiederkäuerarten während des BTV-8-Seuchenzuges eine Rolle in der Epidemiologie der BT gespielt haben. Im Untersuchungszeitraum wurden 2535 Blut- und 3922 Muskelfleischproben von 4204 gehaltenen und erlegten Wildwiederkäuern (Rot-, Dam-, Muffel-, Reh- und Sikawild) auf BTV untersucht. Für Rot , Dam und Muffelwild lag der Anteil der untersuchten Proben an der Jagdstrecke im Jagdjahr 2008/09 mit 3,7 %, 4,1 % und 24,3 % jeweils am höchsten und nahm in den folgenden Jagdjahren auf 0,4 %, 0,3 % und 5,3 % ab. Beim Rehwild lag der Anteil in allen Jagdjahren zwischen 0,8 % und 1,7 %. Die Seroprävalenzen waren in den Jagdjahren 2008/09 bis 2010/11 rückläufig und lagen beim Muffelwild (n=354) zwischen 4,1 % und 1,3 %, beim Damwild (n=1721) zwischen 0,7 % und 0,0 % und beim Rotwild (n=283) zwischen 3,2 % und 0,0 %. Das bestätigt die Empfänglichkeit und Exposition dieser Spezies für BTV 8 in Thüringen. Bei dem untersuchten Rehwild wurden im gesamten Betrachtungszeitraum keine Antikörper gegen BTV im Blut (n=132) gefunden. In keiner der untersuchten 2535 Blutproben wurde BT-Virusgenom mittels RT-qPCR nachgewiesen. Die rückläufigen Seroprävalenzen bei Rot-, Dam- und Muffelwild und der fehlende Virusgenomnachweis deuten darauf hin, dass es keine Neuinfektionen und keine Persistenz des BTV-8 in der Wildwiederkäuerpopulation gab. Es ist anzunehmen, dass es im Untersuchungszeitraum in Thüringen zu keiner Zirkulation des BTV-8 in der Wildwiederkäuerpopulation, vergleichbar zu dem aus Spanien berichteten „Wildzyklus“, gekommen ist. Rehwild scheint weit weniger empfänglich für eine BTV-8 Infektion zu sein als andere Wildwiederkäuerarten, weshalb die Bedeutung bei der Verbreitung des BTV-8 vernachlässigbar ist. Zur frühestmöglichen Erkennung eines erneuten Auftretens von BTV Infektionen in Deutschland oder Mitteleuropa, zur Ausbruchsverfolgung, zur Abschätzung des Infektionsdruckes im Wildwiederkäuerbestand und zur Einschätzung, ob sich ein eigener Wildwiederkäuer Zyklus etabliert hat, ist neben dem Monitoring im Nutztierbereich auch eine Untersuchung von Wildtieren (Rot-, Dam- und Muffelwild) zu empfehlen. Hierbei sollten ganz gezielt insbesondere Tiere aus Gehegen einbezogen werden. Im Rahmen dieser Studie erwies sich EDTA Blut als geeignete Probenmatrix, welche den Antikörper- und Virusgenomnachweis von BTV in Wildwiederkäuern zulässt und leicht im Rahmen der Schlachttier- und Fleischuntersuchung gewonnen werden kann. / Bluetongue disease (Bluetongue, BT) is a globally widespread infectious disease of ruminants. The causative agent is the bluetongue virus (BTV), an Orbivirus that is transmitted by living vectors. Its distribution was originally limited to regions between the 35th southern and the 40th northern latitude, however the BT virus spread from the Mediterranean and manifested in southern parts of Europe. In late summer of 2006, BTV was detected in Central Europe (Belgium, Netherlands and Germany) for the first time and spread to other European countries in the following years. Before, the detected serotype 8 (BTV 8) was limited to areas south of the Sahara, as well as Central and South America. The importance of wild ruminants in the epidemiology of BT in Germany and Central Europe was unknown up to this point. If native wild ruminants (red deer (Cervus elaphus), fallow deer (Dama dama), mouflon (Ovis aries musimon) and roe deer (Capreolus capreolus)) are susceptible to BTV, they could play a role as a virus reservoir and must be considered in an effective control strategy. From April 2008 to March 2011, a monitoring for the detection of BTV was carried out in Thuringia. The role of indigenous wild ruminants in the epidemiology of BT during the BTV-8 epidemic was to be investigated. In the course of the study period 2535 blood and 3922 muscle samples from 4204 fenced and free ranging wild ruminants (red deer, fallow deer, mouflon, roe deer and sika) were examined for BTV. For red deer, fallow deer and mouflon, the proportion of the tested samples on the hunting bag in the season 2008/09 was 3.7 %, 4.1 % and 24.3 % and decreased in the following hunting seasons to 0.4 %, 0.3 % and 5.3 %, respectively. In the case of roe deer, the proportion was between 0.8 % and 1.7 % in all hunting seasons. From the hunting seasons 2008/09 to 2010/11, the detected seroprevalences in mouflons (n=354) decreased from 4.1 % to 1.3 %, in fallow deer (n=1721) from 0.7 % to 0.0 % and in red deer (n=283) from 3.2 % to 0.0 %. These findings show the susceptibility and the exposure of these species to BTV in Thuringia. No antibodies against BTV could be detected in blood samples of roe deer (n=132) over the entire period of observation. BT virus genome was not detected in any of the 2535 investigated blood samples by RT-qPCR. The declining seroprevalences in red deer, fallow deer and mouflon and the absence of viral genome indicate that there were no new infections and no persistence of BTV-8 in the wild ruminant population. It can be assumed that there was no circulation of BTV-8 in the wild ruminant population in Thuringia during the study period, which would have been comparable to the 'wild cycle' reported from Spain. Roe deer appears to be far less susceptible to BTV-8 infection than other wild ruminants, therefore its importance for the spread of BTV-8 is negligible. To detect the reoccurrence of BTV infections in Germany or Central Europe as soon as possible, for outbreak control, to estimate the risk of infection in the wild ruminant population and to assess if a wild ruminant cycle has been established, the investigation of wild ruminant species (red deer, fallow deer and mouflon), especially the sampling of farmed wild ruminants, is recommended in addition to monitoring programs in the livestock sector. The Data of this study shows that EDTA blood is a suitable sample matrix for both, antibody and genome detection of BTV in wild ruminants, which can be easily collected during the ante and post mortem inspection.

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