Endophytes are organisms that live inside plants without causing disease and include microbes that benefit their hosts by aiding in nutrient acquisition and pathogen control. This thesis concerns the endophytes of the genus Zea which includes modern maize (Zea mays L.). Beginning 9,000 years ago, maize was domesticated from wild grasses in Mexico (teosintes), bred into diverse varieties and moved to new soils throughout the Americas. The impact of these long-term changes on the associated endophytic communities has not been examined. Furthermore, today, maize is routinely transplanted around the world to facilitate breeding, but the short-term impact of switching soils on endophyte composition is not known. I attempted to answer the first question by surveying the bacterial endophytes that inhabit 14 diverse ancestral, ancient and modern Zea genotypes. To answer the second question, three extreme Zea genotypes, ancestral, intermediate and modern, were grown side by side on two extreme soils that span the tropical-to-temperate migration route of maize. Endophyte populations from seeds, roots and shoots were DNA fingerprinted using terminal restriction length polymorphism (TRFLP) of 16S rDNA. To understand microbial functions, bacteria were cultured and tested for >13 in vitro traits including nitrogen fixation, phosphate solubilization, plant hormone production and antibiosis. Relationships between endophyte communities were analyzed using principle component analysis (PCA) and Sᴓrensen’s similarity index. The results show that different Zea tissues and genotypes have diverse endophytic communities. The community composition of seed endophytes correlates with host phylogeny suggesting that as humans bred maize, they inadvertently impacted its microbial inhabitants, though the change was gradual. Soil swapping and growth on sterile sand confirm that shoot and root endophyte communities in juvenile plants are primarily inherited. However, a given maize genotype can also select and take up the same microbes (based on TRFLP) from geographically diverse soils. These latter results show that the endophyte communities of Zea plants are significantly buffered from the short-term effects of migration. A few microbes and microbial traits are conserved across all Zea genotypes and soil treatments, suggestive of a core taxonomic and functional microbiota for this agriculturally important genus. / OMAFRA New Directions, Ontario Research Fund, Canadian Foundation for Innovation

An emergency reaction is required in Africa because HIVIAIDS is a reality which may be regarded as a developing crisis and a catastrophe. Approximately a third of all women in the North-West Province are HIV positive. Because of their vulnerability against HIVIAIDS there arose a need for health service provision to the HIV positive woman to focus specifically on the reduction of the transmission of HIVIAIDS from mother to child. Mother to child transmission is the biggest cause of HIV infection among children. Almost all HIV positive children are infected during pregnancy, labour, childbirth or breastfeeding. Without the necessary preventative measures as many as 25-35% of the children of HIV positive mothers may be infected. The biggest percentage of infections, however, takes place during labour and the birth process. In first world countries the mother has access to choices and facilities to make an informed decision about antiretroviral therapy, as well as the method of birth. In the North-West Province not all these options and facilities are available, and therefore the knowledge and skills of midwives must be deployed to reduce vertical transmission of HIV during the intrapartum practice. It is important that midwives have the necessary knowledge about intrapartum practices and vertical transmission of HIV, in order to distinguish between risky and safe intrapartum practices. The purpose of this research was to determine whether midwives in the Southern region of the North-West Province have sufficient knowledge of intrapartum practices to reduce vertical transmission of HIV, as well as to determine the intrapartum practices in the Southern region of the North-West Province. The ultimate goals, then, were to determine how the national policy should be adapted and implemented in the Southern region of the North-West Province to reduce HIV transmission during intrapartum practices. A quantitive survey design was used. For the data collection a questionnaire and a control list were used. The questionnaire and the control list, which are adapted and based on literature, were submitted to research and subject specialists, after which they were adapted. Permission was obtained for this research from the Department of Health in the North-West Province, the ethics committee of the PU for CHE as well as each provincial hospital in the Southern region in the North-West Province to conduct the research. A purposeful availability sample of midwives working in the Southern region of the North-West Province was used and a random sample was used for auditing the obstetric records. A total of 31 midwives participated as respondents, and 401 obstetrical records were audited. Data analysis was performed by means of a frequency analysis, effect sizes and cross reference. Based on these findings it was concluded that the midwives do have basic knowledge regarding vertical transmission of HIV, but that this knowledge is not reflected in the intrapartum practice. There is uncertainty about certain aspects where the latest research about intrapartum practices are not implemented in practice. Recommendations were accordingly formulated for nursing education, research and practice. This research particularly focused on improving midwives' knowledge about intrapartum practices to reduce the vertical transmission of HIV, so that this knowledge may result in improved intrapartum practice. Recommendations are also made as to how the national policy may be adapted and implemented in the Southern region of the North-West Province. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2004.

No description available.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / From the HIV infection pregnant women and puerperas need specialized clinical follow-up, besides paying attention to their demands in the social dimension. The latter can be evaluated by the set of socio-environmental elements that act in a protective way, enabling individuals to deal adequately with everyday situations, such as care for the maintenance of prophylaxis of vertical HIV transmission. The objective was to evaluate if the social support perceived by pregnant women is different from that perceived by puerperal women living with HIV. This is a cross-sectional quantitative approach. The data collection site was Hospital Universitário de Santa Maria / RS, from April to November 2014, based on an instrument composed of a socio-demographic, clinical and obstetric characterization of pregnant women and puerperal women living with HIV; Social Support Scale for People Living with HIV / AIDS. The eligible population totaled 78 participants. The normality of the variables was evaluated through the Shapiro-wilk test; Descriptive statistics were used to present the baseline characteristics and the T test of independent samples. The Fischer's exact test, the linear logistic regression, was used to obtain estimates of OR and their respective confidence intervals (95% CI) for the intervening factors using the backward method. In all analyzes, significance level was set at p <0.05 and the statistical package SPSS version 21.0 was used. The population of pregnant women was 33.3% (n = 28) and 66.7% (n = 50) were puerperal. When the distribution between the pregnant and postpartum groups was evaluated, it was possible to verify that gestation is a protective factor when compared to the puerperium, since the puerperal women present a 8.8-fold chance of having low social support (OR: 8.80 ; CI: 1.01 - 16.76) and 6.0 times (OR: 6.00; CI: 1.53 - 10.48) for instrumental social support. Participants who are in the gestational period have a greater chance of presenting higher values of total and instrumental social support. In order to verify the reasons for the difference in total and instrumental social support, the characteristics of the groups were evaluated, a significant difference was observed in relation to the ingestion of alcoholic beverages (p = 0.007), use of ART before pregnancy was discovered (p = 0.044) (P = 0.050), support received from friends in emotional social support (p = 0.009), support received from friends in instrumental social support (p = 0.004). It is concluded that it is fundamental that the health professional knows and interacts with the social support network of these women, with the intention of implementing actions that allow them to overcome obstacles in maternal and child health care, especially during this period of family reorganization. / A partir da infecção pelo HIV gestantes e puérperas necessitam de acompanhamento clínico especializado, além de atenção as suas demandas na dimensão social. Esta ultima poderá ser avaliada pelo conjunto de elementos socioambientais que atuam de forma protetora, habilitando os indivíduos a lidarem de forma adequada com situações cotidianas, como os cuidados para a manutenção da profilaxia da transmissão vertical do HIV. Objetivou avaliar se o suporte social percebido por gestantes é diferente daquele percebido por puérperas vivendo com HIV. Trata-se de uma pesquisa de abordagem quantitativa do tipo transversal. O local de coleta de dados foi Hospital Universitário de Santa Maria/RS, no período de abril à novembro de 2014, a partir de um instrumento composto por questionário de caracterização sócio demográfica, clínica e obstétrica das gestantes e puérperas vivendo com HIV; Escala de Suporte Social para Pessoas Vivendo com HIV/aids. A população elegível totalizou 78 participantes. Foi avaliada a normalidade das variáveis por meio do teste Shapiro-wilk; foi utilizada estatística descritiva para apresentação das características basais e o teste T de amostras independentes. Realizou-se o teste exato de Fischer, a regressão logística linear para obter estimativas de OR e seus respectivos intervalos de confiança (IC 95%) para os fatores intervenientes, utilizando método backward. Em todas as análises, adotou-se nível de significância p < 0,05 e utilizou-se o pacote estatístico SPSS versão 21.0. A população de gestantes foi de 33,3% (n = 28) e 66,7% (n = 50) eram puérperas. Ao ser avaliado a distribuição entre os grupos de gestante e puérperas foi possível verificar que gestação é fator de proteção quando comparado ao puerpério, visto que as puérperas apresentam uma chance de 8,8 vezes de ter baixo suporte social geral (OR: 8,80; IC: 1,01 – 16,76) e 6,0 vezes (OR: 6,00; IC: 1,53 – 10,48) para suporte social instrumental. As participantes que estão no período gestacional possuem chance maior que apresentarem valores superior de suporte social total e instrumental. Para verificar os motivos de diferença no suporte social total e instrumental foi avaliado as características dos grupos, foi verificado diferença significativa com relação de ingestão de bebidas alcoólicas (p = 0,007), utilização de TARV antes da descoberta da gestação (p = 0,044), o grau de satisfação com apoio nas atividades para o dia a dia (p = 0,050), apoio recebido de amigos no suporte social emocional (p = 0,009), apoio recebido de amigos no suporte social instrumental (p = 0,004). Conclui-se que é fundamental que o profissional de saúde conheça e interaja com a rede de suporte social dessas mulheres, com o intuito de implementar ações que as permitam superar os obstáculos nos cuidados em saúde tanto materno e infantil, principalmente nesse período de reorganização familiar.

Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-03-29T19:03:03Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Doutorado_POSCA_VilmaMacedo_2015.pdf: 2539315 bytes, checksum: f902199f34f31cb9dbedb12dc56463ff (MD5) / Made available in DSpace on 2016-03-29T19:03:03Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Doutorado_POSCA_VilmaMacedo_2015.pdf: 2539315 bytes, checksum: f902199f34f31cb9dbedb12dc56463ff (MD5) Previous issue date: 2015-08-18 / CNPq / FACEPE / A sífilis gestacional é uma doença infecciosa, transmitida verticalmente, e está associada a diversos desfechos negativos na gravidez que são evitáveis quando detectada e tratada de forma precoce. As recomendações atuais para o controle da sífilis reforçam a necessidade de priorizar intervenções globais em prevenção, diagnóstico e tratamento oportuno com atenção a grupos populacionais mais expostos. O objetivo desta tese foi estudar os fatores que influenciam a ocorrência e o tratamento para sífilis em mulheres atendidas em sete maternidades públicas do Recife – PE. O documento foi estruturado nos seguintes capítulos: revisão da literatura, método, resultados apresentado sob a forma de dois artigos originais, considerações finais e recomendações. O estudo foi desenvolvido a partir de uma pesquisa mais abrangente, do tipo caso-controle, que recrutou 1.206 mulheres a partir da admissão nas maternidades, conforme local de residência e resultado do exame de VDRL (Venereal Disease Research Laboratory). Para cada resultado de VDRL reagente sob qualquer titulação, buscavam-se, na sequência posterior de ordem de admissão, duas com resultados de VDRL não reagentes, durante os anos de 2013/2014. O primeiro artigo analisou os fatores de risco sociodemográficos, comportamentais e de assistência à saúde relacionados à ocorrência de sífilis em mulheres residentes e atendidas em maternidades públicas da cidade do Recife – PE. Utilizou-se um delineamento do tipo caso-controle que considerou o resultado da sorologia ELISA (Enzyme-Linked Immunosorbent Assay). A amostra foi constituída de 561 mulheres, das quais 239 eram reagentes (casos) e 322 eram não reagentes (controles) ao ELISA. Os resultados mostraram que os fatores de risco à sífilis gestacional estavam relacionados a menor escolaridade, ausência de acesso ao telefone, religião católica, ocorrência de quatro ou mais gestações, maior número de parceiros sexuais nos últimos doze meses, início do uso de drogas antes dos dezoito anos, assim como à utilização de drogas ilícitas pelo companheiro. Além destes, ao número insuficiente de consultas ao pré-natal e ao relato de história anterior de infecção sexualmente transmissível. O segundo artigo teve como objetivo caracterizar o perfil sociodemográfico, reprodutivo e assistencial segundo a situação do pré-natal, o registro do VDRL e o tratamento para sífilis em mulheres admitidas em maternidades públicas de uma capital do Nordeste do Brasil, entre 2013 e 2014. Trata-se de um estudo transversal, com uma amostra de 1.206 mulheres residentes em Pernambuco nos anos de 2013/2014. Os resultados evidenciaram entraves para o controle da transmissão vertical da sífilis. Do total, 91,3% das mulheres realizaram o pré-natal. O registro do VDRL no cartão de pré-natal estava ausente em 23,9% e destas, a maior parte iniciou o acompanhamento no último trimestre da gestação. O pré-natal não se mostrou efetivo na prevenção e rastreio da sífilis, uma vez que 34,1% apresentaram-se reagentes ao VDRL na admissão à maternidade. Entre as mulheres não tratadas para sífilis no pré-natal, apenas 57,7% e 46,2% cumpriram as recomendações de iniciar o acompanhamento no primeiro trimestre gestacional e realizar seis ou mais consultas, em contraste com as que receberam tratamento com valores de 70% para as duas situações, respectivamente. A ocorrência da sífilis na gestação está associada ao baixo nível de escolaridade, a piores condições socioeconômicas, a comportamentos de maior vulnerabilidade e acompanhamento pré-natal insatisfatório. Notou-se, também, obstáculos no diagnóstico e tratamento da sífilis durante o pré-natal, tornando ainda mais complexo o controle nessa população. / Gestational syphilis is an infectious disease transmitted vertically. It is associated with many negative outcomes during pregnancy, which can be avoided when the disease is detected and treated early. The current recommendations for controlling syphilis reinforce the need of prioritizing global preventive interventions, diagnosis, and timely treatment, paying special attention to more exposed groups. The objective of this thesis was to study the factors that influence the occurrence of syphilis and its treatment in women attending seven public maternity hospitals in Recife – PE. The document was structured into the following chapters: literature review, method, results presented in the form of two original articles, final considerations, and recommendations. The study was developed from a more comprehensive case-control study, which recruited 1,206 women during hospital admission according to their address and Venereal Disease Research Laboratory (VDRL) test. For every woman recruited with a positive VDRL test result regardless of titer, two consecutive women with negative VDRL test results were recruited by order of admission during 2013 and 2014. The first article analyzed the sociodemographic, behavioral, and health care risk factors related to the presence of syphilis in women from Recife/PE attending the city’s maternity hospitals. A case-control design took into account the result of the Enzyme-Linked Immunosorbent Assay test. The sample consisted of 561 women, of which 239 were ELISA positive (cases) and 322 were ELISA negative (controls). The results showed that the risk factors for gestational syphilis were related to lower education level, no access to a telephone, being Catholic, occurrence of four or more pregnancies, higher number of sexual partners in the last twelve months, illicit drug use before age 18 years, illicit drug use by partner, inadequate number of prenatal care visits, and a reported history of sexually transmitted diseases. The second article aimed to characterize the sociodemographic, reproductive, and health care profile according to prenatal care adequacy, VDRL records, and treatment for syphilis of women attending public maternity hospitals in a state capital in the Brazilian Northeast between 2013 and 2014. The cross-sectional study included 1,206 women from Pernambuco recruited between 2013 and 2014. The results evidenced obstacles for controlling vertical syphilis transmission. In total, 91.3% of the women received prenatal care. The VDRL test result was not recorded in 23.9% of the prenatal care cards and most of these women began prenatal care during the last trimester of pregnancy. Prenatal care did not effectively prevent and screen syphilis since 34.1% of the women had positive VDRL test result on hospital admission. Among women who did not receive treatment for syphilis during prenatal care, only 57.7% and 46.2% followed the recommendations to begin follow-up during the first trimester of pregnancy and to attend six or more visits. On the other hand, 70% of the women who received treatment began follow-up during the first trimester of pregnancy and attended six or more prenatal care visits. The occurrence of gestational syphilis is associated with low education level, low socioeconomic level, more vulnerable behaviors, and unsatisfactory prenatal care. Obstacles for controlling syphilis in this population were also present.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-03-24T17:25:34Z No. of bitstreams: 2 Tese - Joseneide Teixeira Câmara - 2014.pdf: 2654661 bytes, checksum: 45d6b37146cb1b9be595aa54c97b9a6a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-03-24T17:27:34Z (GMT) No. of bitstreams: 2 Tese - Joseneide Teixeira Câmara - 2014.pdf: 2654661 bytes, checksum: 45d6b37146cb1b9be595aa54c97b9a6a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-24T17:27:34Z (GMT). No. of bitstreams: 2 Tese - Joseneide Teixeira Câmara - 2014.pdf: 2654661 bytes, checksum: 45d6b37146cb1b9be595aa54c97b9a6a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-05-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The vertical transmission of infection from mother to child, and may increase morbidity and mortality of both mother and child, when not diagnosed and by suitably dealest, causing a serious public health problem. This study aimed to estimate the prevalence of antibodies to toxoplasmosis, rubella, cytomegalovirus, hepatitis B, syphilis and HIV among pregnant women in Caxias, Maranhão, Brazil and identify the main factors associated with seropositivity for Toxoplasma gondii infection in pregnant women attending two referral centers Caxias, MA. Descriptive, observational, cross-sectional study of 561 pregnant women who received prenatal care at two clinics reference to prenatal high risk in the period July 2011 to December 2012, the outpatient clinics of Maternity Carmosina Coutinho (MCC) and the Specialized Center for Maternal and Child Care (CEAMI). Serological tests for toxoplasmosis, rubella, cytomegalovirus, hepatitis B were performed by a laboratory conveniado to the municipality by the same trained technician, and for syphilis and HIV were performed in the Counseling and Testing Center (ATC) in the city laboratory. And a small sample of whole blood from five pregnant IGM reagent for Toxoplasma gondii and their respective newborns was processed at the Institute of Tropical Pathology and Public Health in the Department of Parasitology UFG for performing Polymerase Chain Reaction (PCR). Statistical analysis was performed using SPSS version 20.0 Windows, using the chi-square tests of association and Odds Ratio (95%CI), considering a significance level of 5%. It was found to be positive for HIV was 0.4%, 2.0% syphilis, rubella and cytomegalovirus IgG reactivity were 93.6% and 87.8% respectively without reactive IgM, HBsAg was negative for all pregnant women in the sample tested. Regarding toxoplasmosis in 437 (77%), 124 susceptibility (22.1%) and 5 (0.9%) women with active infection. Found no significant association between toxoplasmosis susceptibility and age, location, income, education, sewerage, number of pregnancies and gestational age. Variables with significant association (p≤0.05) were seropositive pregnant women who are multiparous (p=0.036), living with dogs stuck at home (p=0.001), and consumption of raw kibbeh (p=0.036). The frequency of seropositivity of these infectious diseases of vertical transmission in pregnant women seen at antenatal care in the city of Caxias-MA is considered high, but are similar to those described in other regions of Brazil. Pregnant women who are multiparous who perform consumption of raw kibbeh and live with dogs that do not wobble on the street, had more chance of becoming infected with Toxoplasma gondii, thus guidance on primary prevention measures and quarterly serological monitoring should be strengthened these infections of pregnant women, since it is important to identify and/or prevent congenital infection measured. / A transmissão vertical das infecções da mãe para o filho e pode aumentar a morbimortalidade do binômio mãe-filho. Quando não diagnosticadas e tratadas adequamente, e ocasionam um sério problema de saúde pública. Este estudo objetivou estimar a soroprevalência de anticorpos para toxoplasmose, rubéola, citomegalovírus, hepatite B, sífilis e HIV entre gestantes em Caxias, Maranhão, Brasil e identificar os principais fatores associados à soropositividade para o Toxoplasma gondii (T. gondii) em gestantes atendidas em dois centros de referência em Caxias–MA. Estudo descritivo, observacional, transversal, com 561 gestantes que realizaram a assistência pré-natal em dois ambulatórios de referência para pré-natal de alto risco, no período de julho de 2011 a dezembro de 2012, nos ambulatórios da Maternidade Carmosina Coutinho (MCC) e no Centro Especializado de Assistência Materno-Infantil (CEAMI). Os testes sorológicos de toxoplasmose, rubéola, citomegalovírus, hepatite B foram realizados por um laboratório conveniado ao município, e para sífilis e HIV foram realizadas no laboratório do Centro de Testagem e Aconselhamento (CTA) do município. Uma amostra de sangue total das cinco gestantes IGM reagente para o T. gondii e de seus respectivos recém-nascidos foi processada no Instituto de Patologia Tropical e Saúde Publica da UFG no Setor de Parasitologia para a realização de Reação em Cadeia da Polimerase (PCR). A análise estatística foi realizada com o programa SPSS versão 20.0 Windows, usando os testes de associação qui-quadrado e Odds Ratio (IC95%), considerando-se o nível de significância de 5%. Constatou-se que a soropositividade para HIV foi de 0,4%, sífilis 2,0%, rubéola e citomegalovírus a reatividade de IgG foram de 93,6% e 87,8% respectivamente sem IgM reativa, HBsAg foi não reagente para todas as gestantes da amostra. Em relação ao T. gondii 437 (77,9%) foram soropositivas, a susceptibilidade em 124 (22,1%) e 5 (0,9%) gestantes com infecção ativa. Não foi observada associação significativa entre soropositividade para toxoplasmose e idade, procedência, renda, escolaridade, rede de esgotos, número de gestações e idade gestacional. As variáveis com associação significativa (p≤0,05) para soropositividade foram gestantes que são multigestas (p=0,036), convívio com cães presos em casa (p=0,001), e consumo de quibe cru (p=0,036). A frequência de soropositividade dessas doenças infecciosas de transmissão vertical em gestantes atendidas no pré-natal, no município de Caxias-MA é considerada alta, mas encontram-se semelhantes aos descritos em outras regiões do Brasil. As gestantes que são multigestas que realizam consumo de quibe cru e convivem com cães presos em casa, apresentaram mais chance de se infectar com o Toxoplasma gondii, assim, deve ser reforçada orientações sobre medidas de prevenção primária e o monitoramento sorológico trimestral dessas infecções às gestantes, uma vez que são medidas importantes para identificar e/ou prevenir as infecções congênitas.

O objetivo do estudo foi avaliar a influência da implantação do projeto Pré-natal do parceiro (PNP) no município de Ribeirão Preto sobre: 1) as taxas das infecções pelo vírus da imunodeficiência humana (HIV), vírus das hepatites B e C (VHB, VHC) e pelo Treponema pallidum (TP) entre gestantes; 2) as taxas de transmissão vertical (TV) dos VHB, VHC, do HIV e do TP; 3) os indicadores de qualidade do pré-natal (número de consultas; idade gestacional (IG) na primeira consulta; desfecho gestacional); 4) os indicadores perinatais (peso ao nascer; prematuridade; índice de Apgar no 1º e 5º minutos) e 5) as taxas das infecções pelos VHB, VHC, do HIV e do TP nos parceiros que aderiram ao projeto. Estudo transversal do grupo de gestantes (G) e nascidos vivos (NV) que tiveram seus parceiros participantes do projeto PNP (denominados G1 e NV1) e do grupo de gestantes e NV que não tiveram seus parceiros participantes do projeto PNP (denominados G2 e NV2). Os grupos de gestantes e parceiros foram incluídos no estudo no período de 1º de Julho de 2013 a 30 de Junho de 2014 e os grupos de NV, entre 1º de Julho de 2013 a 31 de Dezembro de 2014. Foram selecionadas 5391 gestantes (1781 do G1 e 3610 do G2), 1781 parceiros e 4044 NV (1376 do NV1 e 2668 do NV2). Utilizado o teste Quiquadrado de Pearson com um nível de significância de 5%. Os resultados demonstraram prognósticos estatisticamente mais favoráveis no grupo onde houve a participação do parceiro no pré-natal (G1 e NV1). Encontraram-se menores taxas de TV (0,7% no NV1 e 1,5% no NV2 com p= 0,04); início mais precoce do PN (com até 120 dias de gestação 88,3% no G1 e 84,5% no G2 com p< 0,01); mais de sete consultas no PN (80,8% no G1 e 74,3% no G2 com p< 0,01); desfecho gestacional favorável (95,9% no G1 e 94,2% no G2 com p= 0,01); menores taxas de prematuridade (10,3% no NV1 e 12,9% no NV2 com p= 0,01), menor ocorrência de baixo peso ao nascer (8,7% no NV1 e 11,4% no NV2 com p< 0,01) e melhores índices de Apgar no 5º minuto (2,5% de Apgar <= 7 no NV1 e 3,8% no NV2 com p= 0,03). Frente a estes dados foi possível concluir que a estratégia de inclusão do parceiro no PN foi importante na identificação e tratamento da sífilis reduzindo significativamente a taxa de TV do TP. A adesão do parceiro ao PNP foi fundamental para a adesão da gestante ao PN associando-se também à melhora significativa dos indicadores de saúde perinatal / The goal of these study was to evaluate of the influence of the implementation of the project \"Male Partner in the Prenatal Care (MPPC)\" in Ribeirao Preto city on: 1) the rates of infection by the human immunodeficiency virus (HIV), hepatitis virus B and C (HBV, HCV), and Treponema pallidum (TP) among pregnant women; 2) the vertical transmission (VT) rates of HBV, HCV, HIV and TP; 3) the prenatal care quality indicators (number of visits, gestational age (GA) at the first visit, gestational outcome); 4) the perinatal indicators (birth weight, prematurity, Apgar score at 1 and 5 minutes) and 5) the rates of infection with HIV, HBV, HCV and TP in partners that have joined the project. It is a cross-sectional study of group of the pregnant women (G) and born alive (BA) who had their partners participating MPPC project (called G1 and NV1) and the group of pregnant women and BA who have not had their partners participants (called G2 and NV2). The pregnant women groups and the male partners group were surveyed in the period from July 1, 2013 to June 30, 2014 and the BA groups, between July 1, 2013 to December 31, 2014. Were selected 5391 pregnant women (1781 of the G1 and 3610 of the G2), 1781 partners and 4044 BA (1376 of the NV1 and 2668 of the NV2). Used the Chi-square test of Pearson with a 5% significance level. The results showed statistically more favorable prognosis in the group where there was the partner\'s participation in prenatal care (G1 and NV1). The lower VT rate was found (0.7% in NV 1 and 1.5% in NV2 p= 0.04); earlier initiation of PN (up to 120 days of gestation 88.3% in G1 and 74.3% in G2 with p< 0.01); more than seven consultations in PNC (80.8% in G1 and 74.3% in G2 with p< 0.01); favorable pregnancy outcome (95.9% in G1 and 94.2% in G2 with p= 0.01); lower prematurity rates (10.3% in the NV1 and 12.9% in the NV2 with p= 0.01); lower incidence of low birth weight (8.7% in NV1 and 11.4% in NV2 with p< 0.01) and better Apgar scores at five minutes (2.5% Apgar <= 7 in NV1 and 3.8% in NV2 with p= 0.03). Considering these data it was concluded that the male partner\'s inclusion strategy in prenatal care was important in the identification and treatment of syphilis reducing significantly the VT rate of the TP. The partner\'s adherence to MPPC project was essential to the mother\'s adherence to PNC and it was also associated with significant improvement in perinatal health indicators.

ObjeEste estudo teve como objetivo primário avaliar a estratégia de incluir o parceiro na assistência pré-natal no município de Franca-Brasil. Constituíram os objetivos secundários: 1) Detectar a prevalência de parceiros com dosagens alteradas de colesterol total, HDL-colesterol, LDL-colesterol e triglicérides; 2) Detectar a prevalência de parceiros com dosagens alteradas de glicemia de jejum; 3) Detectar a prevalência de parceiros com HAS; 4) Detectar a prevalência da sífilis, HIV, hepatites B e C entre gestantes; 5) Verificar a taxa de DMG e de DM entre as gestantes; 6) Detectar a prevalência da sífilis, HIV, hepatites B e C entre os parceiros das gestantes; 7) Avaliar a motivação da equipe de saúde em acolher a Estratégia Pré-natal do Parceiro; 8) Avaliar a aceitação materna e do parceiro sobre a estratégia de inclusão do parceiro na assistência PN. Estudo quantitativo, utilizado o teste \"t\" de Student para comparações das variáveis paramétricas e o teste Qui-quadrado para as variáveis não paramétricas, considerando significativo o valor de p< 0,05 em quaisquer dos testes. Os resultados identificaram quatro parceiros com hipertensão arterial (3,4%) e 51 (43,2%) com intolerância à glicose, verificando-se que em quatro casos, a glicemia possibilitou diagnosticar diabetes mellitus. Constatou-se que a prevalência de dislipidemias dos parceiros foi de 84,4%. No tocante às sorologias identificou-se um casal (1,5%) com sorologia discordante para sífilis (gestante com sífilis) e outro casal, no qual o parceiro foi diagnosticado como portador da infecção pelo vírus da imunodeficiência humana (HIV), cujo diagnóstico só foi possível por sua participação no PNP. Foi possível identificar que 57 parceiros (48,3%) qualificaram as equipes de saúde com não motivadoras para a adoção da estratégia PNP. No entanto, 58 (49,1%) participaram por motivação própria. A percepção paterna sobre o PNP foi referida como positiva por 77,9% dos parceiros e 93 gestantes/mães (78,8%) consideraram importante e positiva a inclusão do parceiro no PN. Foi identificado que a inclusão do parceiro no PN foi importante no diagnóstico e tratamento precoces de doenças de transmissão vertical e crônicas e que é necessário incentivar a equipe de saúde a difundir os benefícios dessa participação no PN, contribuindo com a saúde da tríade mãe, filho e parceiro. / This study\'s primary objective was to analyze the strategy of including the male partner in prenatal care in the city of Franca, Brazil. The secondary objectives were: 1) To detect the prevalence of male partners with abnormal levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides; 2) To detect the prevalence of male partners with abnormal levels of fasting blood glucose; 3) To detect the prevalence of systemic hypertension among male partners; 4) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among pregnant women; 5) To find out the frequency of Gestational diabetes mellitus (GDM) and of Diabetes mellitus (DM) among pregnant women; 6) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among the pregnant women\'s male partners; 7) To gauge the health team\'s motivation to implement the strategy of male involvement in prenatal care; 8) To assess maternal acceptance and male partner acceptance of the strategy of including the male partner in prenatal care. This was a quantitative study, which used the Student\'s t-test to compare parametric variables and the Chi-squared test for the nonparametric variables and which considered a p-value < 0.05 as significant in both tests. The results identified 4 male partners with hypertension (3.4%) and 51 male partners (43.2%) with glucose intolerance, of which four had a diagnosis of Diabetes mellitus as a result of the blood glucose test. We found that the Anexos 100 prevalence of dyslipidemia among the male partners was 84.4%. Regarding serology tests, we identified a couple (1.5%) with discordant syphilis serology (pregnant woman with syphilis) and another couple in which the male partner was diagnosed with Human Immunodeficiency Virus (HIV) infection with such diagnosis only having been possible because of his participation in prenatal care. We could identify that 57 male partners (48.3%) classified the health teams as not encouraging of the male involvement in prenatal care. However, 58 male partners (49.1%) participated by selfmotivation. The fathers\' perception of their involvement in prenatal care was referred to as positive by 77.9% of the male partners and 93 pregnant women / mothers (78.8%) considered the inclusion of the male partner in prenatal care important and positive. We identified that the inclusion of the male partner in prenatal care was important in the early diagnosis and early treatment of vertical transmission diseases and chronic diseases as well as that it is crucial to encourage health teams to communicate the benefits of the inclusion of the male partner in prenatal care, thus contributing to the health of the father- mother-child triad.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-07-15T00:58:46Z No. of bitstreams: 1 Disserta??o vers?o final p?s defesa.pdf: 1222902 bytes, checksum: 40007ee76422c5102a64eba0abe995f4 (MD5) / Made available in DSpace on 2016-07-15T00:58:46Z (GMT). No. of bitstreams: 1 Disserta??o vers?o final p?s defesa.pdf: 1222902 bytes, checksum: 40007ee76422c5102a64eba0abe995f4 (MD5) Previous issue date: 2015-03-25 / Objective: To analyze the survival and factors associated with death in children, adolescents and young adults infected with HIV through vertical transmission, enrolled in the Municipal Reference Center (CRM) STD / HIV / AIDS Feira de Santana. Methods: An observational, longitudinal study, developed from a cohort of HIV-positive to HIV, infected by vertical transmission from secondary data obtained from the review of clinical records of 37 children, 21 adolescents and five (5) young adults, ranging age between 0 and 24 years enrolled in the Specialized Care Service (SAE) of CRM, from 2003 to 2014. In the analyzes we used Pearson X2 test, exact Fisher test and its value p, to investigate factors associated with death. In addition, it used survival analysis with construction of Kaplan-Meier curves and log-rank test to verify statistically significant association between groups of variables listed. Finally, we used regression Cox proportional hazards to estimate adjusted risk factors for death. Results: There was a predominance of groups of 0-12 years (58.7%) and 13-19 years (33.3%), female (52.4%) and black / mulatto (71.8%). Most of the study population made use of ART (71.4%), 82.5% had no comorbidities and 65.1% were not affected by non-oral opportunistic infections, though, 85.7% had at least one episode oral candidiasis. . Of the subjects studied, 71.4% were alive at the end of the follow-up period; 23.8% had AIDS as a cause death and three 4.8% patients died from other causes. Risk factors associated with death highlighted the variables "age" (p = 0.02), "non-oral opportunistic infection" (p = 0.00), " oral candidiasis "(p = 0.00)," CD4 "(p = 0.03). Survival analysis showed reduction in the probability of survival time only for individuals who came to the service with CD4 cell counts less than 350 cells / mm 3 (p = 0.00). The median overall survival time was 8.8 years, and the individuals using HAART had a higher survival (10.6 years) compared to those who have not used antiretroviral (6.0 years). In the multivariate analysis, statistically significant variables were age (<13 years), behaving as a protective factor (HR: 0.88; 95% CI: 0.78 to 0.98) and non-oral opportunistic infection as a factor of risk of death (HR: 4.3; 95% CI 1.51 to 12.1). Conclusion: This study points to the increased survival among infected by vertical route, evidenced by the significant number of individuals who have reached adolescence and possibly this is due to the use of antiretroviral with longer survival time among those who used the therapy, which shows that good results can be achieved, even in countries with limited resources. Causes of death resembled the national standard, although this is in transition, considering the causes unrelated to AIDS. The opportunistic infection remained a risk factor for death, according to the literature. The results show continuing need for adjustments and developments, in order to deal with the challenge of a chronic infection among individuals in a vulnerable stage, own youth. / Objetivo: analisar a sobrevida e fatores associados ao ?bito em crian?as, adolescentes e adultos jovens infectados pelo HIV , por transmiss?o vertical, matriculados no Centro de Refer?ncia Municipal (CRM) DST/HIV/AIDS de Feira de Santana. M?todos: estudo observacional, longitudinal, desenvolvido a partir de uma coorte de soropositivos para HIV, infectados por transmiss?o vertical, a partir de dados secund?rios obtidos da revis?o de prontu?rios cl?nicos de 37 crian?as, 21 adolescentes e cinco (5) adultos jovens, na faixa et?ria compreendida entre 0 e 24 anos , matriculados no Servi?o de Aten??o Especializada (SAE) do CRM, no per?odo de 2003 a 2014. Nas an?lises foi utilizado teste ?2 de Pearson, teste exato de Fisher e respectivo valor p, para investigar fatores associados ao ?bito. Al?m disso, foi utilizada an?lise de sobrevida com constru??o das curvas de Kaplan-Meier e teste log-rank a fim de verificar associa??o estatisticamente significante entre os grupos das vari?veis elencadas. Finalmente, utilizou-se regress?o de riscos proporcionais de cox para estimativa ajustada dos fatores de risco para ?bito. Resultados: Houve predom?nio das faixas de 0-12 anos (58,7%) e 13 a 19 anos (33,3%), sexo feminino (52,4%) e cor negra/parda (71,8%).. A maioria da popula??o estudada fazia uso de TARV (71,4%), 82,5% n?o apresentavam comorbidades e 65,1% n?o foram acometidos por infec??es oportunistas n?o orais, embora, 85,7% apresentaram, pelo menos, um epis?dio de candid?ase oral. . Dos indiv?duos estudados, 71,4% estavam vivos at? o fim do per?odo de seguimento; 23,8% tiveram Aids como causa morte e tr?s 4,8% ?bitos ocorreram por outras causas. Como fatores de risco associados ao ?bito destacaram-se as vari?veis ?faixa et?ria? (p=0,02), ?infec??o oportunista n?o oral? ( p=0,00), ?candid?ase oral? (p=0,00), ?contagem de c?lulas CD4? (p=0,03). A an?lise de sobreviv?ncia demonstrou probabilidade na redu??o do tempo de sobrevida apenas para indiv?duos que chegaram ao servi?o com contagem de c?lulas CD4 menor que 350 c?lulas/mm3 ( p=0,00). A mediana do tempo de sobrevida geral foi de 8,8 anos, sendo que os indiv?duos em uso de TARV apresentaram sobrevida maior (10,6 anos) quando comparados aos que n?o usaram antirretroviral (6,0 anos). Na an?lise multivariada, as vari?veis estatisticamente significativas foram idade (< 13 anos), comportando-se como fator de prote??o (HR:0,88; IC 95%: 0,78-0,98) e infec??o oportunista n?o oral como fator de risco para ?bito (HR:4,3; IC 95%: 1,51-12,1). Conclus?o: Este estudo aponta para o aumento da sobrevida entre infectados por via vertical, evidenciado atrav?s do n?mero significativo de indiv?duos que chegaram ? adolesc?ncia e, possivelmente, isto deve-se ? utiliza??o de antirretroviral com tempo de sobrevida maior entre aqueles que faziam uso da terapia, o que demonstra que bons resultados podem ser alcan?ados, mesmo em pa?ses com recursos limitados. As causas de ?bito assemelharam-se ao padr?o nacional, embora esse esteja em processo de transi??o, considerando as causas n?o relacionadas ? Aids. A infec??o oportunista permaneceu como fator de risco para ?bito, concordando com a literatura. Os resultados apontam necessidade cont?nua de adequa??es e empreendimentos, a fim de lidar com o desafio de uma infec??o cr?nica entre indiv?duos em fase de vulnerabilidade, pr?prias da juventude.

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