This dissertation aims at analyzing complex problems arising in the context of dynamical networks, proteomics, and disease prevention. First, a new graph-based method for proving global stability of synchronization in directed dynamical networks is developed. This method utilizes stability and graph theories to clarify the interplay between individual oscillator dynamics and network topology. Secondly, a graph-theoretical algorithm is proposed to predict Ca2+-binding site in proteins. The new algorithm enables us to identify previously-unknown Ca2+-binding sites, and deepens our understanding towards disease-related Ca2+-binding proteins at a molecular level. Finally, an optimization model and algorithm to solve a disease prevention problem are described at the population level. The new resource allocation model is designed to assist clinical managers to make decisions on identifying at-risk population groups, as well as selecting a screening and treatment strategy for chlamydia and gonorrhea patients under a fixed budget. The resource allocation model and algorithm can have a significant impact on real treatment strategy issues.

Chlamydia trachomatis is a human pathogen of the genital tract and ocular epithelium. It is an obligate intracellular parasite with a unique biphasic development cycle. C.trachomatis infection is the most common bacterial sexually transmitted disease in industrialized nations. Its ability to cause chronic disease makes it a serious economic burden and health threat to developed and developing countries. Although treatable, approximately 70% of C.trachomatis infections are asymptomatic, potentially leading to the development of chronic sequelae. Furthermore, chlamydial genital tract infection has been associated with an increased risk of cervical cancer and human immunodeficiency virus infection. Consequently, the development of an efficacious vaccine is the most convenient, potentially reliable and cost effective option to control chlamydial infection and disease complications. Anti-chlamydial protective immunity is essentially mediated by a T helper, type 1 (Th1), response that is dependent upon the presentation of antigen via major histocompatibility (MHC) class II molecules. While antibody secreting cells are not critical components of the primary effector response, they have been shown to be important for clearance of re-infection. Thus an ideal vaccine would be one capable of inducing both a strong Th1 T cell response and a strong mucosal antibody response. Currently there are very few efficacious vaccine candidates that have been identified and characterized. More specifically, there is only a limited number of known T cell antigens processed and presented by the human leukocyte antigen (HLA) class II molecules. This type of antigen is going to be essential to the development of an efficacious chlamydial vaccine. In this study we have identified a number of unique vaccine candidates using a novel in silico approach. In an attempt to overcome HLA polymorphism the whole chlamydial genome was screened for proteins containing epitopes predicted to bind multiple HLA class II molecules (i.e. predicted ‘promiscuous’ T cell epitopes). A wide range of HLA class II molecules were used in this screen to identify vaccine antigens that could potentially offer broad and ethnically balanced population coverage. This analysis identified a number of novel targets and was validated by the identification of a known chlamydial T cell epitope. A selection of these target proteins was cloned, expressed and purified. Recombinant protein was screened against serum samples from patients with both acute and chronic chlamydial infections. Two novel targets, hypothetical protein CT425 and ribonucleotide reductase small chain protein (NrdB) were identified as being immunoreactive. The in vivo protective efficacy of NrdB was analyzed using a mouse model. CD4+ T cells were harvested from NrdB immunized mice and adoptively transferred to naïve mice, which were subsequently infected at the genital site. NrdB immunization was found to confer a CD4+ T cell driven degree of protection similar to that seen with CD4+ T cells primed from a live challenge. The adjuvants and route of immunization used ensured immunological responses were initiated at both the systemic and local sites of infection. Immunization elicited a predominant Th1 response with primed T cells producing high levels of interferon gamma, an essential requirement for the development of an efficacious chlamydial vaccine. Furthermore, high titres of antigen specific IgG and IgA were produced following immunization, with sera derived antibodies demonstrating neutralization properties. NrdB is a highly conserved chlamydial protein with an essential role in the replication of chlamydiae and could play a central role in a multi-subunit vaccine against chlamydial genital tract infections.

Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen worldwide. Chlamydia spp. infect epithelial cells of the respiratory, intestinal, and reproductive tracts. Chlamydial infections in women may lead to pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and infertility. In addition to infecting infection the female reproductive tract (FRT), Chlamydia also infects the gastrointestinal tract (GIT) of animals and humans. In mice Chlamydia muridarum disseminates from the FRT to the GIT via internal routes and in a stepwise manner. Initially Chlamydia spreads from the FRT to infect the FRT-draining iliac lymph nodes (ILNs), then the spleen, and then the GIT. The first step of this dissemination (FRT to ILN) is mediated by tissue CD11c+ DCs. Chlamydia transport from ILN to the spleen is dependent on cell transport and is mediated by sphingosine 1-phosphate (S1P) signaling. The third step of Chlamydia transport from the spleen to the GIT is significantly hindered in splenectomized mice. However, which cells mediate this transportation of the second and the third step remain unknown. Using mouse-specific C. muridarum as a model pathogen we show that following depletion of CD8+ T cells or monocytes, Chlamydia dissemination to the spleen and the GIT is significantly hindered. Furthermore, this study reveals that Chlamydia may infect various cell types which then mediate its dissemination internally. It remains to be determined what role systemic dissemination may have in Chlamydia pathogenesis.

Master of Public Health - MPH / In the Maseru district, the high prevalence of unintended pregnancies among adolescents aged between 15 to 19 years may be due to non-use of modern contraceptive methods. It is therefore important to investigate possible barriers adolescents in Maseru in Lesotho face in accessing contraceptive methods and services. This research has therefore focused on the factors that affect the accessibility and usage of contraceptive services among in-school adolescent girls in Maseru City, Lesotho.The study was an observational, analytical, cross-sectional study. A sample of 10 high schools in Maseru city was selected as study sites, using computer-generated random numbers. A stratified random sampling method was used to enrol a total of 368 sexually active respondents, aged 15-19 years into the study. Data was collected using a structured one-on-one interviewer administered questionnaire and analysis was conducted using the STATA 14 statistical software programme. Ethical approval was obtained from the Biomedical Research and Ethics Committee (University of the Western Cape) and the Lesotho Ministry of Health and Social Welfare. Written parental/caregiver informed consent and written participant consent and assent, as per the Lesotho law were obtained.

No description available.

This thesis and study is sponsored by Minor Field Study scholarship through University of Borås and is funded by SIDA (Swedish International Development Cooperation Agency). There are around half a million people living with HIV/AIDS in Thailand and it is one of Thailand’s most increasing public health diseases since 1984. There are several organizations working jointly with prevention and lifting the level of knowledge among the public and decreasing new infections.The aim of this study is to describe experiences of persons living with HIV or AIDS in Thailand. In-depth interviews was carried out and analysed with a qualitative content analysis. Six persons, three female and three male, aged between 18 to 67 years living with either HIV or AIDS participated. The informants expressed that they were enjoying life and had plans for the future despite of the infection as they felt a sense of wellbeing, had an acceptance of the infection and themselves. It was important to have support from friends and family to cope with life and that support made them feel blessed and grateful. However the informants also expressed a feeling of no self worth and that they had giving up living because of feeling isolated, stigmatized, depressed, ashamed of themselves and being a burden with a sense of guilt that made them repress themselves. The conclusion is that these aspects were interlinked but the negative dominated among these with AIDs and the positive aspects were more common among the informants living with HIV. / Program: Sjuksköterskeutbildning

Millions of dollars are spent each year on preventing sexually transmitted diseases (STDs), yet the rates of chlamydia trachomatis (chlamydia) and neisseria gonorrhoeae (gonorrhea) infection continue to be high. Health literacy and its impact have been recognized in diabetes maintenance, control of hypertension, medical adherence, and reproductive health outcomes, yet no research has been conducted regarding the relationship between health literacy and chlamydia and gonorrhea prevalence. This study examined the relationship between health literacy scores and chlamydia and gonorrhea prevalence health literacy scores and reproductive health/STD knowledge, and reproductive health/STD knowledge and chlamydia and gonorrhea prevalence. Participants included 114 women over 18 years of age, who attended community health clinics in the northeastern United States. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine instrument, and reproductive health/STD knowledge was assessed using a self-administered questionnaire. Data analysis revealed an inverse correlation between lower health literacy scores and an increase in gonorrhea and combined chlamydia/gonorrhea prevalence. Findings also revealed a positive correlation between health literacy scores and reproductive health/STD knowledge scores. The results of this study suggest that service providers should consider the use of health literacy level with targeted reproductive health and STD messages as a tool to empower clients, decrease the prevalence of chlamydia and gonorrhea, and increase positive reproductive health outcomes.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-05-06T14:45:58Z No. of bitstreams: 1 arquivototal.pdf: 1684430 bytes, checksum: f3e04a7ef2e88b3a595dd56ea0694457 (MD5) / Made available in DSpace on 2016-05-06T14:45:58Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1684430 bytes, checksum: f3e04a7ef2e88b3a595dd56ea0694457 (MD5) Previous issue date: 2016-03-02 / Introduction: The present study had as general objective to analyze the vulnerability and preventive practices against sexually transmitted diseases (STDs) affective-sexual relations. Methods: this was an exploratory study and descriptive, transversal and qualitative character. The sample was composed of 18 participants defined lesbian women, with ages ranging from 19 to 42 years (M = 26; DP = 6.1). For the collection of data was used a demographic questionnaire and semi-structured interviews. The collection came from a participant matrix and followed the selection of new participants by the method of "snowball". The data from the demographic questionnaire were analyzed through descriptive statistics in PASW Statistics Software (SPSS) for Mac-23 version, the data obtained in the interviews were analyzed by analyzing thematic category MAXQDA software 11-Data Analysis Qualitative Software (qualitative data analysis Software). Results: Were applicants in the accounts the idea of greater vulnerability associated with the male presence in the relationship, getting behind in speeches that the only relationship between women could be a protective factor. Reports emerged about the absence of further clarification about the existence, use and effectiveness of preventive inputs to STD's that can be used in relations between women. Were highlighted in the speeches that the alleged methods available would not own, or designed to prevent the STDs among women, considering that most of these means of prevention would be adaptations of existing methods, as the male condom or unlubricated adaptations of items which originally would be used for other purposes (plastic film, PVC gloves, latex barrier use in dentistry). Confidence in the partnership and in the existence of a presumed fidelity were cited as elements of prevention strategies. The bias was related to lack of campaigns that drive the lesbians on the need to prevent sexual relations, and stigma to the myth that lesbians would be marginalized women. The presence of the element constraint was highlighted as a factor preventing the search for Gynecological medical care. The lack of preparation of health professionals emerged as an element that can influence on increasing the vulnerability of this population health. More than half of the participants stated that often reveal their sexual orientation to doctors gynecologists, which may indicate a breakthrough for Lesbian visibility. It is concluded that the factors of programmatic can influence more evident to the worsening in the situations of vulnerability to health of lesbians, although elements of individual and social dimension also are associated and these misdeeds. These findings may serve as a framework that highlights elements of individual, social order, as well as deficiencies in programmatic, that relate and can influence for the most vulnerable situation in health of lesbians. / Introdução: O presente estudo teve como objetivo geral analisar a vulnerabilidade e as práticas preventivas frente às Doenças Sexualmente Transmissíveis (DST`s) nas relações afetivo-sexuais de lésbicas. Método: Tratou-se de um estudo exploratório e descritivo, de caráter transversal e qualitativo. A amostra foi composta por 18 participantes mulheres que se autodefinem lésbicas, com idades variando de 19 a 42 anos (M=26; DP=6,1). Para a coleta dos dados foram utilizados um questionário sociodemográfico e entrevistas semiestruturadas. A coleta partiu de uma participante matriz e seguiu a seleção de novas participantes pelo método de “bola de neve”. Os dados oriundos do questionário sociodemográfico foram analisados por meio de estatísticas descritivas no Software PASW Statistics (SPSS) for Mac - versão 23, os dados obtidos nas entrevistas foram analisados por meio da análise categorial temática através do software MAXQDA 11 - Qualitative Data Analysis Software (Software de Análise de Dados Qualitativos). Resultados: Foram recorrentes nos relatos a ideia de maior vulnerabilidade associada a presença masculina na relação, ficando subjacente nos discursos que o relacionamento apenas entre mulheres poderia ser um fator de proteção. Emergiram relatos sobre a ausência de maiores esclarecimentos acerca da existência, formas de uso e eficácia de insumos preventivos às DST’s que possam ser utilizados nas relações entre mulheres. Foram evidenciados nos discursos que os supostos métodos existentes não seriam próprios, específicos ou pensados para na prevenção às DST’s entre mulheres, tendo em vista que a maioria destes meios de prevenção seriam adaptações de métodos já existentes, como o preservativo masculino sem lubrificação ou adaptações de itens que originalmente seriam utilizados com outras finalidades (plástico filme de PVC, luvas, barreira de látex de uso odontológico). A confiança na parceria e na existência de uma fidelidade presumida foram elementos citados como estratégias de prevenção. O preconceito foi relacionado à ausência de campanhas que orientem às lésbicas sobre a necessidade de prevenção nas relações sexuais, e o estigma ao mito de que lésbicas seriam mulheres marginalizadas. A presença do elemento constrangimento foi destacado como um fator impeditivo para a busca por atendimento médico ginecológico. A falta de preparo dos profissionais de saúde emergiu como um elemento que pode influenciar no aumento da vulnerabilidade em saúde desta população. Mais da metade das participantes afirmaram que costumam revelar sua orientação sexual aos médicos ginecologistas, o que pode indicar um avanço para à visibilidade lésbica. Conclui-se que fatores de ordem programática podem influenciar de maneira mais evidente para o agravo nas situações de vulnerabilidade a saúde de lésbicas, embora elementos de dimensão individual e social também estejam associados e estes agravos. Estes achados podem servir como um quadro que evidencia elementos de ordem individual, social, bem como deficiências programáticas, que se relacionam e podem influenciar para a situação de maior vulnerabilidade em saúde das lésbicas.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-11-19T12:09:09Z No. of bitstreams: 2 Dissertação - Roberta Ribeiro Rios - 2012.pdf: 1382110 bytes, checksum: bf39296c44d43bcbbb2ab974af3fb6b4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-11-20T14:20:46Z (GMT) No. of bitstreams: 2 Dissertação - Roberta Ribeiro Rios - 2012.pdf: 1382110 bytes, checksum: bf39296c44d43bcbbb2ab974af3fb6b4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-11-20T14:20:46Z (GMT). No. of bitstreams: 2 Dissertação - Roberta Ribeiro Rios - 2012.pdf: 1382110 bytes, checksum: bf39296c44d43bcbbb2ab974af3fb6b4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-09-08 / Syndromic management approach to sexually transmitted diseases consists of classifying the disease within predetermined syndromes, using flowcharts which are based on signs and symptoms establishing treatment immediately without waiting serological laboratory results for confirmation, providing at the first appointment the diagnosis, treatment and appropriate counseling, interrupting the transmission chain and avoiding the complications of sexually transmitted diseases, thus allowing immediate reversal of symptoms. But its success requires constant evaluation of the protocols, and training of professionals. OBJECTIVE: to assess the impact of in-service education on knowledge of nurses from Family Health Strategy regarding the use of the syndromic approach to sexually transmitted diseases before and after a training course. METHOD: This research was performed through the interventional study approach. The samples consisted of Brazilian Primary Care and Family Health Strategy Nurses. A survey to evaluate the knowledge about the syndromic management approach was applied before and after the education. RESULTS: 71 nurses participated in this study, and there was a significant improvement in knowledge concerning the syndromic approach (p <0.05); in relation to the identification of clinical signs, such as genital ulcers, urethral discharges and vaginal and pelvic pain, there was a significant improvement among the professionals after the training, with an increase in the percentage of 27%, 28%, 23% and 31% respectively. Regarding the prescription of drugs proposed for each syndrome, 40.84% of nurses reported performing the prescription for patients with genital ulcers, 49.30% prescribed to patients with urethral discharge, 84.5% to those with with vaginal discharge and cervicitis and only 22.53% with pelvic pain. CONCLUSION: The training of nurses has provided increased knowledge on the syndromic approach to sexually transmitted diseases. It is believed that these actions indirectly favor the reduction of the chain of transmission and spread of sexually transmitted diseases if they are being carried out with quality and effective intervention. It is therefore urgent that continuing education is effectively established at primary health care, ensuring an effective improvement of quality of care provided to patients with STDs. / A abordagem sindrômica das doenças sexualmente transmissíveis consiste em classificar a doença dentro de síndromes pré-estabelecidas, utilizando fluxogramas que se baseiam em sinais e sintomas, instituindo o tratamento imediato sem aguardar resultados de exames laboratoriais sorológicos para sua confirmação, provendo na primeira consulta o diagnóstico, o tratamento e o aconselhamento adequados, interrompendo a cadeia de transmissão e evitando as complicações advindas das doenças sexualmente transmissíveis permitindo dessa forma a regressão imediata dos sintomas, entretanto seu sucesso exige avaliação constante dos protocolos, e treinamento dos profissionais envolvidos. OBJETIVO: Avaliar o impacto das ações educativas no conhecimento de enfermeiros da Estratégia de Saúde da Família quanto à utilização da abordagem sindrômica das doenças sexualmente transmissíveis antes e após um curso de capacitação. MÉTODO: Estudo analítico e de intervenção com enfermeiros que atuam nas Unidades de Atenção Básica de Saúde da Família. Um questionário de avaliação do conhecimento sobre a abordagem sindrômica foi aplicado antes e após a educação permanente. RESULTADOS: Participaram desse estudo 71 enfermeiros, verificou-se uma melhora significativa no domínio dos conteúdos referentes à abordagem sindrômica (p<0,05 e na identificação dos sinais clínicos de úlceras genitais, corrimentos uretral e vaginal e dor pélvicacom acréscimos percentuais de 27%, 28%, 23% e 31%, respectivamente. Em relação à prescrição dos medicamentos propostos para cada síndrome 40,84% relataram realizar a prescrição para pacientes com úlceras genitais; 49,30% com corrimento uretral; 84,5% com corrimento vaginal e cervicite e apenas 22,53% com dor pélvica. CONCLUSÃO: A capacitação dos enfermeiros proporcionou uma melhora significativa do conhecimento em abordagem sindrômica de doenças sexualmente transmissíveis. Acredita- se essas ações sendo exercidas com qualidade e de forma resolutiva favorecem de maneira indireta a redução da cadeia de transmissão e a propagação de doenças sexualmente transmissíveis. Assim, torna-se relevante que a educação permanente seja efetivamente instituída na atençãol primária de saúde, garantindo uma melhora efetiva da qualidade da assistência prestada ao portador de doença sexualmente transmissível.

Abstract 1: A multi-level assessment of disproportionate population sex ratios and high-risk sexual behaviors among STD clinic patients Low male-to-female sex ratios in a population may influence high-risk sexual behaviors, such as multiple sex partners and inconsistent condom use, which facilitate the transmission of STDs. This study used multi-level modeling to assess whether population sex ratios were associated with these two individual-level behaviors. All analyses were stratified by gender. Interview data were collected from patients (N = 9,203, 48% male) attending participating STD clinics. Interviews included information on socio-demographics and sexual behavior, including number of sex partners in the previous 3 months and condom use at last sex. The sex ratio per census tract was obtained from the U.S. Census Bureau. There was no association between sex ratio and multiple sex partners or condom use for either men or women. That is, we found no evidence that a shortage of men in census tracts was associated with increased engagement in high-risk sexual behavior.   Abstract 2: A multi-level assessment of neighborhood vacancy rates and high-risk sexual behaviors among STD clinic patients The “broken windows” theory posits that physical neighborhood deterioration, and its association with reduced social cohesion, can lead to changes in individual behaviors. Thus individuals living in neighborhoods with high levels of deterioration may be more likely to engage in high-risk sexual behaviors. This study used multi-level modeling to evaluate the extent to which high residential vacancy rates increased the likelihood of individuals having multiple sex partners. Interview data, including data on patient demographics and sexual behaviors, were collected from patients (N = 6,347, 52% male) attending participating STD clinics in the Richmond, Virginia area from 2008-2010. Neighborhood vacancy rates were obtained from the U.S. Census Bureau. Fifty-one percent of men and 36% of women reported having 2 or more sex partners in the previous 3 months. Men who lived in census tracts with high vacancy rates were slightly more likely to report multiple sex partners (53.9%) compared to men who lived in low vacancy tracts (49.7%). In multi-level models, there was no association between high vacancy rates and having multiple sex partners among either women (OR = 0.98; 95% CI: 0.79, 1.20) or men (1.18; 95% CI: 0.99, 1.42). That is, we found no evidence that increased neighborhood deterioration, as measured by high residential vacancy rates, was associated with increased risk of having multiple sex partners among STD clinic patients.   Abstract 3: Residential segregation and gonorrhea rates in U.S. metropolitan statistical areas The residential segregation of black populations, often in areas of high economic disadvantage and low social status, may play a crucial role in the observed racial inequities in STD rates. An ecological analysis of 2005-2009 average gonorrhea rates was performed across 277 U.S. metropolitan statistical areas (MSAs). The black isolation index and Gini index of income inequality were used as proxy measures for racial and economic residential segregation respectively, derived from 2005-2009 U.S. Census estimates. We used logistic regression modeling to produce estimates of odds ratios (OR) and 95% confidence intervals (CI) for the association between a high black isolation index and Gini index, both independently and in combination, on gonorrhea rates in MSAs. Effect measure modification was assessed by calculating the relative excess risk due to interaction (RERI) between the two indices. Compared to MSAs with low levels of racial segregation, MSAs with high levels of racial segregation had increased odds of high gonorrhea rates (adjusted OR 5.54; 95% CI: 2.29-13.44). Adjustment for potential confounders did not noticeably impact the relationship between the Gini index and gonorrhea, with higher levels of income inequality predicting higher gonorrhea rates (adjusted OR = 2.47; 95% CI: 1.21-5.03). In combined models, the influence of racial residential segregation on gonorrhea rates was stronger than that of income inequality-based segregation; there was no evidence of additivity or a multiplicative interaction. Residential segregation by race or income equality may be a key component in the perpetuation of high rates of gonorrhea and other STDs among black populations in the U.S.