The Hygiene Hypothesis and Old Friends Hypothesis focus attention on the coevolutionary relationship between humans and pathogens, positing that reduced pathogen exposure in economically developed nations is responsible for immune dysregulation and associated increases in chronic inflammation, allergy, and autoimmunity. Despite progress in testing these ideas, few studies have examined these relationships among populations undergoing the transition from traditional to more market-based lifestyles. The present study tests relationships between economic development and social change, altered infectious disease exposure, and immune function among the Shuar forager-horticulturalists of Amazonian Ecuador, a population undergoing rapid economic change associated with increased market participation. Using stool samples to assess soil-transmitted helminth (STHs; parasitic intestinal worms) burden, dried blood spot measurement of the inflammatory marker C-reactive protein (CRP), and interviews to evaluate level of market integration (MI; the suite of social and cultural changes associated with rapid economic development) and disgust sensitivity, this dissertation tests the Hygiene and Old Friends Hypotheses. The first study tests relationships between STH exposure and MI, using geographic location in relation to the regional market center as a proxy for MI. This study documents lower rates of STHs in people living in more market integrated regions. The second study tests the coevolutionary role that STHs and other pathogens have played in shaping human psychology and behavior. Findings suggest that pathogen exposure has acted as a selective pressure, resulting in evolved disgust sensitivity toward pathogen related stimuli. This study provides evidence that disgust sensitivity is calibrated to local environments, acting to decrease STH exposure. The third study tests the role of STHs in immune function. CRP was positively related to age in uninfected individuals. No relationships existed for more traditionally living or infected individuals. These findings suggest that STH exposure may decrease the risk of developing chronic inflammation and associated diseases with advancing age. These studies provide support for the idea that STHs provide stimuli that decrease chronic inflammation, suggesting that altered intestinal microflora in developed nations may be partially responsible for the development of chronic inflammatory disorders like allergy and autoimmunity. This dissertation includes previously published and unpublished coauthored material.

sami.alcedo@gmail.com / Background Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers. Methods Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR). Results Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity. Conclusion An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience. / Revisión por pares

Typescript (photocopy). / Digitized by Kansas Correctional Industries

A adolescÃncia à uma fase da vida caracterizada por diversos acontecimentos, dentre os quais se destaca o inÃcio da atividade sexual. PorÃm, devido Ãs modificaÃÃes advindas do processo de adolescer, as prÃticas sexuais, em muitos casos, sÃo realizadas de forma desprotegidas, com isso tornando o adolescente vulnerÃvel Ãs DST/Aids. Diante deste panorama, surge o enfermeiro para tentar intervir junto a este grupo com o intuito de prevenir Ãs DST/Aids. Uma das formas de se alcanÃar isto à por meio da educaÃÃo em saÃde que pode fazer uso de tecnologias educativas na sua prÃtica. Dentre os diversos tipos de tecnologias educativas destaque-se o jogo educativo que devido Ãs suas caracterÃsticas dinÃmicas e lÃdicas favorecem o processo ensino-aprendizagem dos adolescentes, sendo uma ferramenta importante na prevenÃÃo das DST/Aids na adolescÃncia. Com isto, este estudo teve o intuito de validar um jogo educativo, no auxÃlio da prevenÃÃo de adolescentes Ãs DST/Aids, em escolas pÃblicas de Fortaleza-CE e comparar a aquisiÃÃo do conhecimento dos adolescentes em relaÃÃo prevenÃÃo de DST/Aids usando o jogo educativo, a palestra expositiva e aula ministrada tradicionalmente. Trata-se de um estudo quase-experimental com abordagem quantitativa que foi dividido em duas fases, sendo que a primeira foi composta de 120 adolescentes e a segunda de 198 inicialmente. A primeira fase compreendeu a construÃÃo dos instrumentos de prà e pÃs-teste que foi utilizado na fase seguinte. Na segunda etapa ocorreu a aplicaÃÃo da intervenÃÃo propriamente dita, sendo que um grupo participou do jogo educativo que abordava a prevenÃÃo das DST/Aids, o segundo grupo participou de uma palestra ilustrada tambÃm sobre a mesma temÃtica e o terceiro grupo da aula ministrada em sala de aula pelo professor responsÃvel. O trÃs grupos responderam ao prÃ-teste antes da intervenÃÃo educativa e ao pÃs-teste vinte dias depois da intervenÃÃo realizada. A anÃlise dos dados ocorreu por meio de testes estatÃsticos do Software Statistical Package for Social Sciences (SPSS), versÃo 17.0 for Windows. Considerou significantes as anÃlises estatÃsticas inferenciais quando p < 0,05. Salienta-se que a anÃlise tambÃm ocorreu baseada na literatura da referente ao tema. Esta pesquisa atendeu os aspectos Ãticos, sendo aprovada com o protocolo nÃmero 229.369. A primeira etapa da pesquisa originou o prÃ-teste e o pÃs-teste com dez questÃes de mÃltipla-escolha, menciona-se que estes instrumentos foram oriundos de um questionÃrio com trinta questÃes. No que se refere à segunda etapa, foi verificado que nÃo houve diferenÃa estatisticamente significante entre as variÃveis sexo (p valor 0,168), sÃrie (p valor 0,509), moradia (p valor 0,905) e inÃcio da atividade sexual ( p valor 0,695). No que se refere Ãs diferenÃas estatisticamente significantes entre a aplicaÃÃo do jogo educativo, palestra expositiva e aula ministrada tradicionalmente, notou-se que nÃo houve diferenÃa entre a palestra e o jogo, mÃdia dos postos foram 2,1 e 2,45 respectivamente. No entanto quando comparado o jogo ao grupo que nÃo recebeu uma intervenÃÃo especÃfica, percebeu-se que houve diferenÃa (p valor < 0,001). Por meio deste estudo concluiu-se que o jogo educativo auxilia no processo educativo do adolescente assim como a palestra expositiva, no entanto melhor que nenhuma atividade especÃfica na prevenÃÃo de DST/Aids. / Adolescence is a stage of life characterized by several events. One of the most important is the sexual activity. But due to the resulting changes at the adolescent process, sexual practices, in many cases, are made of unprotected form, as a result of it, teenagers are becoming more vulnerable to sexual diseases like STD / AIDS. In order to prevent this, the nurse comes up to try to intervene with this group in order to prevent and inform them about STD / AIDS. One way to achieve this is through health education that can make use of educational technologies in their practice. Among the various types of educational technologies highlighted, the educational game, due to its dynamic and entertaining features, favors the teaching-learning process of adolescents, being an important tool in the prevention of STD / AIDS in adolescence. This study aimed to validate an educational game built to help with the prevention of adolescent STD / AIDS in public schools of Fortaleza city, and also to compare the acquisition of knowledge of adolescents regarding STD / AIDS educational game using the expository lecture and regular class. It was a quasi-experimental study with a quantitative approach that was divided into two phases, the first of which was composed of 120 adolescents and the second of, initially, 198 adolescents. The first phase included the construction of a pre- and a post-test that were used in the next step. However, the second step was the application of the intervention itself, and one group received the educational game that addressed to the prevention of STD / AIDS, the second group also attended an illustrated lecture on the same topic and the third group class taught in the classroom by the teacher responsible for the group . The three groups responded to the pretest before the educational intervention and the posttest twentieth day following the intervention performed. Data analysis was based on statistical tests of the Software Statistical Package for Social Sciences (SPSS) version 17.0 for Windows. Considered significant inferential statistical analysis at p < 0.05 . It is noted that the analysis was also based on the literature on the topic. This research meets the ethical aspects, being approved with the number 229 369 protocol. The first stage of this research contained the pre- and post-tests, each one composed by ten multiple-choice questions, which were derived from a previous thirty question questionnaire. Regarding the second step, no statistically significant differences in the results were found among the variables âgenderâ (p value 0.168), âgradeâ (p value 0.509), âdwellingâ (p value 0.905) and âearly sexual activityâ (p value 0.695). In regard to statistically significant differences between the application of the educational game, the expository lecture and the regular class, no relevant distinction was noticed through the results of the educational game and the expository lecture, for their average score were 2.1 and 2.45 respectively. However, when compared the results of the game to those of the group that did not receive a specific intervention, a difference was noticed in the outcome (p value <0.001). Through this study it was concluded that the educational game assists in the educational process of the adolescent as well as the illustrated lecture, however rather than any specific activity in the prevention of STD / AIDS.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A violÃncia sexual caracteriza-se como um grave problema de saÃde pÃblica que acarreta distÃrbios no desenvolvimento biopsicossocial e sexual de suas vÃtimas, principalmente quando essa agressÃo ocorre na fase da adolescÃncia, pois esses sujeitos se encontram numa etapa da vida marcada por mudanÃas e adaptaÃÃes, especialmente no Ãmbito da sexualidade. Portanto, as crenÃas e valores das vitimas de violÃncia sexual precisam ser compreendidas para promover a adoÃÃo de comportamentos sexuais saudÃveis. Objetivou-se compreender como as crenÃas e valores das adolescentes vitimas de violÃncia sexual influenciam no comportamento de prevenÃÃo das DST e da AIDS com base no Modelo de CrenÃas em SaÃde (MCS) . Trata-se de uma pesquisa qualitativa, descritiva, realizada numa InstituiÃÃo de Acolhimento no Municipal de Fortaleza, no perÃodo de maio a julho de 2011, com oito adolescentes vitimas de violÃncia sexual. Foram utilizados como instrumentos e procedimentos para a coleta de informaÃÃes: a observaÃÃo participante de todos os encontros, que foram registrados no diÃrio de campo; todo o material produzido durante os grupos focais, como cartazes, desenhos, entre outros; e a transcriÃÃo da gravaÃÃo dos diÃlogos durante as estratÃgias de grupo e do roteiro de entrevista semiestruturada. As informaÃÃes foram organizadas conforme as dimensÃes do MCS. Todos os aspectos legais e Ãticos da pesquisa envolvendo os seres humanos foram respeitados. Inicialmente, foi necessÃrio caracterizar as participantes do estudo e observou-se que as histÃrias de vida dessas adolescentes estavam condizentes com a literatura. Em relaÃÃo Ãs categorias criadas conforme o MCS: as adolescentes tem um dÃfice de conhecimento em relaÃÃo a essas doenÃas e nÃo se consideraram susceptÃveis as DST/AIDS por acreditarem que nÃo irÃo se relacionar sexualmente com homens, mesmo identificando a maior vulnerabilidade da mulher a essas patologias; em relaÃÃo à percepÃÃo da gravidade, elas classificaram essas doenÃas como graves, incurÃveis e que alteram o convÃvio social, demonstrando medo de contrair uma dessas patologias; identificaram como benefÃcios e barreiras do mÃtodo preventivo ser de fÃcil acesso e utilizaÃÃo e prevenir tanto doenÃas como gravidez, mas interferem no prazer sexual; e seu uso està relacionado com questÃes culturais e sociais, ressalta-se tambÃm, que o abuso de Ãlcool e drogas intervÃm na adoÃÃo de comportamentos saudÃveis. Conclui-se que as crenÃas e valores dessas adolescentes as tornam vulnerÃveis a DST/AIDS, sendo necessÃrio refletir sobre as consequÃncias da violÃncia sexual na vida dessas adolescentes para a elaboraÃÃo de estratÃgias e aÃÃes preventivas voltadas para esse publico-alvo no que concerne ao desenvolvimento da sexualidade de forma segura, minimizando traumas e sofrimentos advindos dessa experiÃncia na vida dessas adolescentes, tornando-as conscientes dos seus direitos sexuais e reprodutivos. / Sexual assault is characterized as a serious public health problem that leads to disorders in the bio-psychosocial and sexual development of the victims, especially when the aggression happens in adolescence, because these subjects are in a stage of life marked by changes and adaptations, especially concerning sexuality. Therefore, the values and beliefs of the victims of sexual assault must be understood to promote the adoption of a healthy sexual behavior. It was aimed to understand how beliefs and values of adolescent victims of sexual assault influence the behavior of prevention of STD/AIDS based on the Health Belief Model. It is a qualitative descriptive research carried out at a Host Institution in the City of Fortaleza from May to July 2011 with eight adolescent victims of sexual assault. Using as tools and procedures for data collection: participant observation of all meetings, which were registered in a field diary; all the material produced during the focus groups, such as posters, drawings, among others; and the transcription of the dialogue recording during the group strategies and semi-structured interviews. The information was organized according to the Health Belief Model dimensions. All legal and ethical aspects of researches involving human beings were respected. Initially, it was necessary to characterize the study participants and it was found that the life stories of these adolescents were consistent with the literature. Regarding the categories created according to the Health Belief Model: the adolescents lack knowledge about these diseases and don't considered them susceptible to STD/AIDS because they believe that they will not relate sexually with men, in spite identifying the greater vulnerability of women to such pathologies; concerning the perception of gravity, they classified these diseases as serious, incurable, and that changes social life, demonstrating fear of contracting these diseases; they identified as benefits and barriers of preventive method: it is easy to access and use, and prevents both diseases as pregnancy, but interferes with sexual pleasure; and its use is related to cultural and social issues, we also emphasize that the abuse of alcohol and drugs interferes in the adoption of healthy behaviors. We conclude that the beliefs and values of these adolescents make them vulnerable to STD/AIDS, being necessary to reflect on the consequences of sexual violence in their lives to build strategies and preventive actions aimed at this target audience in terms of a safe development of sexuality, minimizing trauma and suffering resulting from this experience in their lives, making them aware of their sexual and reproductive rights.

Magister Psychologiae - MPsych / An epidemiological study was conducted with the main goal of describing the occurrences of the various STIs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STIs prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the STI cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpful for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all STIs including HIV I AIDS.

Background: Antiretroviral drug resistance is steadily growing in populations of HIV treatment-naive individuals due to person-to-person transmission. However, Iowa-specific data for transmitted antiretroviral drug resistance-associated mutations prevalence has not been previously reported. We postulate that the prevalence of drug resistance in Iowa does not differ significantly between HIV risk groups. Methods: Data were collected from electronic medical records and an HIV Program database between 2006 and 2011. Information included age, gender, risk exposure group, viral load, CD4 count, CD4%, and other HIV risk factors and behaviors. Results: Transmitted drug resistance mutations (TDRM) were not associated with many risk factors, but rapid plasma reagin (RPR) screening for syphilis was significant (p=0.02) and used as a proxy for highest level of sexual risk behavior. RPR was used with minor NRTI and NNRTI along with intravenous drug use in logistic regression to model the likelihood of acquiring TDRM. Conclusion: Some question the practicality of implementing genotypic ARV resistance testing guidelines because of uncertainty about the prevalence of ARV drug resistance among treatment-naïve patients but harboring resistance mutations puts patients at high risk of failing effective, first-line therapies. Hence, genotypic resistance testing at HIV diagnoses can not only improve disease management but also assist in surveillance.

Bibliography: leaves 103-113. Uses GIS to map the pattern of widespread transmission, commercial sex workers, poverty prevalence, illiteracy rate, population displacement and other social indicators to show the vulnerability of the region's population; and to demonstrate that there is no single point of radiation of HIV/AIDS in the sub region. Discusses mitigation and prevention strategies and proposes the use of GIS be incorporated in the fight against HIV/AIDS in sub Saharan Africa.

Sexually transmissible infections (STIs), one of the major preventable health problems affecting the Australian population, are often asymptomatic and, if undetected, can cause sub-fertility, infertility and chronic morbidity. In addition to these significant and costly consequences, STIs increase the risk of transmission of HIV. Given that 80% of Australian patients attend their General Practitioner (GP) each year, GPs are well placed to have a significant impact on STI transmission by diagnosing and treating both asymptomatic and symptomatic disease. Good professional practice would suggest that all GPs will undertake certain actions when they are consulted by a patient who either has symptoms of an STI or who appears to be at risk of acquiring an STI. This expectation is based on the premise that all GPs share the same detailed knowledge of STI risk factors and symptoms. It assumes that they will have no difficulty in eliciting such information from the patient, that the patient will comply with STI testing and treatment and that the patient will return for follow-up, to ensure that they and their sexual partners have been adequately treated. Given the constraints of the real world in which general practice exists, the sensitive nature of sexual health, and the stigma associated with STIs, there are many barriers to achieving such an outcome. My own previous research has highlighted some of the difficulties experienced by GPs in the area of STI control. This study has used data from four different sources (policy and stakeholder documents, literature, key informant interviews and my own past research) to examine ideal practice and actual practice in the prevention and treatment of STIs. A number of discrepancies were identified, and from these arose a series of recommendations for ways of making STI control in general practice less complex. To ensure that the results of the study were firmly embedded in the reality of general practice, comments on the recommendations were sought from GPs employed in a variety of practice settings, including those with low STI caseloads. These comments were used to modify the recommendations to ensure they would offer a practical and effective contribution to STI control in Victoria.

Sexually transmitted infections (STIs) and unplanned pregnancy are significant public health concerns. Abstinence-only until marriage (AOUM) and abstinence pledge programs have received a significant amount of government funding in an attempt to address these problems. Despite receiving over two billion dollars in funding, the programs have not been shown to be effective in achieving their stated goals. In addition, there are significant concerns about the content of AOUM curriculums, including medical inaccuracy and use of outdated gender stereotypes.