Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

The diploma thesis Infectious diseases of drug users is focused on monitoring the trend in the incidence of selected infectious diseases associated with the drug usage for a certain period of time. I have chosen viral hepatitis B and C for this monitoring because they belong to the most common infections typical for drug addicts at all. The issue of infectious diseases associated with intravenous drug usage is quite extensive therefore I tried to mention the most important information. Transmission of infectious diseases through intravenous drug usage is particularly insidious due to irrelevant length depending on time. The risk on non-compliance of basic hygiene measures is possible after a single application (using a sterile needle and syringe, a separate drug solution etc.). Another serious risk is that the viral hepatitis B and C can pass into the chronic stage, which significantly affects the quality of life and can also significantly reduce it. HIV infection is still incurable so it ends with the early death of the patient. If the syphilis is not treated and passes into the third stage it can ends up fatally. Infectious endocarditis is a serious life-threatening illness if not recognized and treated early. The diploma thesis has theoretical and practical part. In the theoretical part of this thesis I deal with various infectious diseases related to drug usage. I chose the most common disease according to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA): viral hepatitis A, B, C, infections transmitted by sexual contact (syphilis, gonorrhea), HIV / AIDS, tuberculosis, infectious endocarditis and infections of the skin and soft tissues. Individual infections are divided into several chapters where the causative agent is described, mode of transmission, clinical picture, disease diagnosis, treatment and epidemiological measures. In the theoretical part I drew inspiration from the literature, internet sources and valid legal legislation. In the practical part I paid attention to the issue of occurrence of viral hepatitis B and C in the Pilsen Region for a certain period of time typical for intravenous drug users and the rest of the population. I compare these figures to the incidence of viral hepatitis in other regions of the Czech Republic for the same years. Data are analysed using quantitative research technique of secondary data analysis. Data are obtained from the information reporting system and records of transmissible diseases EPIDAT and from annual reports of the Czech Republic. The diploma thesis has one objective: to characterize and compare the trends of selected infectious diseases among drug users and the general population of the Pilsen Region in 2003-2011. Four hypotheses were defined: H1: The incidence of infectious diseases among drug users has been growing. H2: The frequency of infectious diseases among drug users in the Pilsen Region in the period 2003-2011 is comparable to the incidence of infectious diseases among drug users in the Czech Republic in the same time period. H3: The sickness rate of viral hepatitis B among drug users in the Pilsen Region in the period 2003-2011 is statistically more significant than among the general population of the Pilsen Region in the same time period. H4: The sickness rate of viral hepatitis C among drug users in the Pilsen Region in the period 2003-2011 is statistically more significant than among the general population of the Pilsen Region in the same time period. Due to lack of information in 2002, the objective of this diploma thesis and individual hypotheses had to be modified. Therefore the period relates to the year 2003-2011. Individual hypotheses were statistically tested to determine the statistical significance. The first and second hypothesis was refuted. A third hypothesis and fourth hypothesis was confirmed.

Orientador: Carlos Antonio Caramori / Banca: Beatriz Matsubara / Banca: Deilson Elgui de Oliveira / Banca: Monica Parente Ramos / Banca: Daniela Melare Vieira Barros / Resumo: Os profissionais da saúde necessitam de métodos efetivos de educação continuada, com estratégias de capacitação objetivas, flexíveis e dinâmicas. Desse modo, proposta de ensino/aprendizado baseadas na Web podem ser bem sucedidas na sua atualização. Levantamos a hipótese de que o emprego da plataforma Moodle de educação on-line pode viabilizar a criação de portal eletrônico para educação médica continuada e pode ser uma ferramenta viável e simples para a formulação de segunda opinião em saúde nas hepatites virais. Assim, este trabalho descreve a criação de plataforma voltada ao aprendizado em hepatites virais, empregando o sistema Moodle de gerenciamento de cursos. O portal foi desenvolvido de acordo com proposta de Cook & Dupras, que descreve 10 recomendações na elaboração de sites educacionais: análise das necessidades, metas e objetivos; determinação de recursos técnicos e necessidades; avaliação de sistemas similares pré-existentes; assegurar compromisso de todos os participantes e identificar potenciais barreiras à implantação do projeto; desenvolvimento de conteúdo em íntima coordenação com o design do site; criação de materiais que estimulem o aprendizado ativo; encorajamento no uso do site pelo usuário; avaliação dos usuários e do curso; promoção de estudo piloto; monitoração da comunicação on-line e atualização periódica. O conteúdo incluiu consensos científicos nacionais e internacionais, aulas, animações, tutoriais, suporte para segunda opinião médica e links de interesse na Web. Acredita-se que esta ferramenta ofereça uma alternativa interativa de educação e ratifique a necessidade de se promover estudos adicionais para validar estratégias efetivas de educação continuada. / Abstract: Health workers need effective methods of continuing education, with objective, flexible and dynamic strategies. Thus, teaching and learning based on Web can be successful in upgrading those professionals. We hypothesized that the use of Moodle for online education can facilitate the creation of an electronic portal for continuing medical education and it is a viable tool to formulate queries for viral hepatitis second opinion. This paper describes the creation of a learning platform focused on viral hepatitis, using the Moodle system of course management. The portal was developed according to Cook & Dupras proposal, following ten recommendations: perform a needs analysis and specify goals and objectives; determine technical resources and needs; evaluate preexisting software; secure commitment from all participants and identify potential barriers to implementation; develop content in close coordination with website design; encourage active learning; facilitate use by the learner; evaluate learners and course; pilot the website, and plan to monitor online communication periodically. The contents include national and international guidelines, presentations, support for second medical opinion and links of interest on the Web. It is expected that this tool offers an interactive alternative for education and encourage further studies to validate effective strategies for continuing education. / Doutor

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-19T20:56:33Z No. of bitstreams: 1 JaquelineCalçaAssis_dissert.pdf: 1656909 bytes, checksum: 0f9e5425c7d3ffa51b86c71d5b4b9687 (MD5) / Made available in DSpace on 2018-10-19T20:56:33Z (GMT). No. of bitstreams: 1 JaquelineCalçaAssis_dissert.pdf: 1656909 bytes, checksum: 0f9e5425c7d3ffa51b86c71d5b4b9687 (MD5) Previous issue date: 2016-11-07 / The presence of anti-HBc alone can have several meanings: false positive, healing immune window, delayed immunity or occult hepatitis B virus infection (OBI). In clinical practice, it is important and necessary to clarify the diagnosis to prevent transmission to the risk population such as hemodialysis patients, blood donors, transplant recipients and co-infected individuals with HIV and/or HCV. Objectives: The aim of the study was to determine the prevalence of anti-HBc alone and occult hepatitis B, respectively, in blood samples from Adolfo Lutz Institute - Regional Laboratory Center X - São José do Rio Preto (IAL - CLR X - SJRP) and patients from Municipal Ambulatory of Viral Hepatitis (AMHV) both from São José do Rio Preto city in the period from January 1st, 2009 to December 31st, 2014. Methods: The study population of IAL - CLR X - SJRP is from the region served by the 15th Health Regional Division (DRS), and the AMHV is a population screened for clarification, monitoring and treatment of viral hepatitis in the city. In this population with anti-HBc alone, patients were immunized against hepatitis B and the individuals without vaccine response were selected for the performance of HBV-DNA research for the diagnosis of occult hepatitis B. Results: During the study period, 6805 samples were evaluated without duplication in IAL - CLR X - SJRP, of these 624 samples had anti-HBc positive, and the prevalence of anti-HBc alone was 17.63% (110/624). In the AMHV, 940 patients anti-HBc isolated were evaluated, from these 816 (86.81%) were vaccinated and after the criterion of disregarding the vaccinated patients who did not have anti-HBs evaluated after vaccination (85 - 10.42%), 731 (89.58%) patients were considered for analysis of the vaccine response, and 568 (77.70%) presented seroconversion with anti-HBs positive and 163 (22.30%) non-seroconverted patients. The research of HBV-DNA was performed in 25.77% (42/163) patients without a vaccine response, finding a prevalence of occult hepatitis B (OBI) of 47.62% (20/42).The presence of antibodies to HIV and HCV was 25.40% and 13.25% in the blood samples IAL - CLR X - SJRP and in AMHV was 1.80% and 0.33%, respectively. Conclusion: The results show the occurrence of antiHBc alone in IAL - CLR X - SJRP and the need of monitoring this population. In AMHV, the vaccination was effective for most cases, which demonstrates the need of vaccine introduction as a routine in anti- HBc alone patients in the overall population. The occult hepatitis B was found in almost half of patients assessed without vaccine response. / A presença do anti-HBc isolado pode ter vários significados: falso positivo, janela imunológica de cura, imunidade tardia ou infecção oculta pelo vírus da hepatite B (IOB). Na prática clínica é importante e necessário o esclarecimento diagnóstico para evitar transmissão em populações de risco como pacientes hemodialisados, doadores de sangue, transplantados e indivíduos coinfectados com HIV e/ou HCV. Objetivo: O objetivo do estudo foi determinar a prevalência de anti-HBc isolado e hepatite B oculta, respectivamente, em amostras de sangue do Instituto Adolfo Lutz - Centro de Laboratório Regional X - São José do Rio Preto (IAL - CLR X - SJRP) e pacientes do Ambulatório Municipal de Hepatites Virais (AMHV) ambos da cidade de São José do Rio Preto, no período de 01 de janeiro de 2009 a 31 de dezembro de 2014. Casuística e Métodos: A população estudada do IAL - CLR X - SJRP é proveniente da região atendida pela Divisão Regional de Saúde (DRS) XV e a do AMHV é uma população triada para esclarecimento, acompanhamento e tratamento das hepatites virais do município. Nesta população com anti-HBc isolado os pacientes foram imunizados contra hepatite B e os indivíduos sem resposta vacinal foram selecionados para realização da pesquisa de HBV-DNA para diagnóstico da hepatite B oculta. Resultados: Durante o período de estudo, foram avaliadas 6805 amostras, sem duplicação, no IAL - CLR X - SJRP, destas, 624 amostras apresentavam anti-HBc reagente, sendo a prevalência de anti-HBc isolado 17,63% (110/624). No AMHV foram analisados 940 pacientes com anti-HBc total isolado destes 816 (86,81%) foram vacinados e depois de aplicado o critério de desconsiderar os pacientes vacinados que não tiveram o anti-HBs avaliado após a vacinação (85 - 10,42%), 731 (89,58%) pacientes foram considerados para análise da resposta vacinal, sendo que 568 (77,70%) apresentaram soroconversão com anti-HBs positivo e 163 (22,30%) pacientes não soroconverteram. A pesquisa do HBV-DNA foi realizada em 25,77% (42/163) dos pacientes sem resposta vacinal, encontrando uma prevalência de hepatite B oculta (IOB) de 47,62% (20/42). A presença de anticorpos contra HIV e HCV foi de 25,40%, 13,25% nas amostras do IAL - CLR X - SJRP e no AMHV foi de 1,80%, 0,33%, respectivamente. Conclusão: Os resultados obtidos demonstram a ocorrência de anti-HBc isolado nas amostras do IAL - CLRX - SJRP e a necessidade de acompanhamento dessa população. No AMHV a vacinação esclareceu a maioria dos casos, o que demonstra a necessidade da introdução da vacina como rotina em pacientes anti-HBc isolado na população geral. A hepatite B oculta foi encontrada em quase metade dos pacientes não respondedores vacinais avaliados.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

BACKGROUND: Hepatitis C (HCV) is the most common chronic blood-borne infection in the US5,6 and has life-threatening complications.10,11,18,27,44 HCV rates in Cambodian Americans are as high as national rates,5,11,22,37,41 but the transmission risks for Cambodians in the US are unclear. Rates of drug use, the most common national transmission risk,3,6,21 are not as high in this population.14,21 With the second largest population of Cambodians nationally, Lowell, Massachusetts12,19 provides a unique opportunity to study the risk factors associated with HCV transmission. OBJECTIVE: The objective of this study is to examine the risk factors associated with HCV in Cambodian Americans. The hypothesis is that HCV infected Cambodian Americans will have different rates of the United States Preventive Services Task Force (USPSTF) recognized risk factors compared to HCV infected non-Cambodian Americans.28 METHODS: This is a cross sectional study of HCV infected Cambodian and non-Cambodian Americans. Medical record data were abstracted for adults with reactive HCV antibody or RNA virus testing at Lowell Community Health Center (LCHC) between 2009 and 2012. Information regarding USPSTF-designated HCV risk factors was collected, and a comparison was made of HCV risk factors between infected Cambodian and non-Cambodian Americans. RESULTS: Cambodian Americans with HCV (n=128) were older (mean age 53 vs. 43 years old) and less likely to be male (41%) than the non-Cambodian group (67% male, n=541). Cambodians had far lower rates of overall recreational drug use (2.3% vs. 82.1%) and intravenous drug use (1.6% vs. 33.6%). The predominant HCV risk factor in Cambodians was birth between 1945 and 1965, while that for non-Cambodians was drug use. CONCLUSION: Most HCV infected Cambodian Americans treated at LCHC between 2009 and 2012 lacked any history of drug use. In contrast, the major risk factor for HCV infected non-Cambodian Americans treated at LCHC was drug use, consistent with the major risk factor for HCV transmission nationwide.3,6,21 This suggests that the current major HCV risk factors fail to describe how this virus was transmitted to Cambodian Americans who seek care at LCHC.

The thesis contains basic information regarding Viral hepatitis E, particularly the causative agents, human and animal strains, the clinical picture and occurrence in the Czech Republic as well as abroad. The practical part is focused on analysis of trends of occurrence of the viral hepatitis E in the Czech Republic from the very earliest, up until the present time. The research further looks at morbidity in the different regions of the Czech Republic, which is compared to the morbidity in Plzen region. The practical part further focuses on the specific source, route of transmission and possible preventive measures against viral hepatitis E. In this work, both quantitative and qualitative types of research were used. In quantitative research, secondary analysis of data was used from various sources like EPIDAT. In the qualitative research, semi standardised interviews with doc. MUDr. Petr Pazdiora CSc, and with MVDR. Vaclav Polacek. Based on the interviews, an educational material in form of a leaflet was created. From the year 1996 to the year 2012, a total of 894 cases of HEV where recorded. In 1996, there was only one case of Viral hepatitis E which was recorded. From 1997 to 2005, the occurrence was sporadic and negligible. From 2006, there was a linear increase in viral hepatitis E. The incidence significantly increased in the year 2009 and 2011. In the Czech Republic, Viral Hepatitis E has an upward trend of occurrence. Viral hepatitis E cannot be prevented by active immunization, possibility of a vaccine is still being investigated. Basic preventive measures include maintaining principles of hygiene like avoiding drinking water from unknown sources, food should be prepared using drinking water and fruit should be properly washed and then peeled before consumption. It is important to find out about the occurrence of viral hepatitis E, before travelling to any foreign country. During meat processing, it is important to avoid cross contamination between clean and unclean operations. Before consuming foods like black pudding, sausages, steaks and pies, it is important to ensure that this food is properly cooked using adequate heat and for a period of time. From the research, it can be concluded that, there is need to devote adequate attention to viral hepatitis E. It may seem that the incidence in the Czech Republic is not serious, but it is important to focus on public awareness of this disease, especially the preventive measures so as to stop it from spreading.

Made available in DSpace on 2014-06-11T19:28:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T19:15:50Z : No. of bitstreams: 1 gabriel_gfcp_me_botfm.pdf: 271018 bytes, checksum: fda89419fe6178194c119a6733ea76fd (MD5) / A hepatite aguda pelo vírus da hepatite tipo A (VHA) é uma causa comum de doença hepática em crianças em nosso meio, sendo o tipo mais freqüente entre as de causa viral. Usualmente, diante de um paciente com quadro clínico e dados epidemiológicos sugestivos de hepatite aguda, a presença de doença hepática é confirmada e a evolução é acompanhada utilizando-se as chamadas “provas de função hepática” (PFH), cujos resultados habitualmente são conhecidos antes do resultado do exame sorológico, que define a etiologia. Diante do número relativamente grande de PFH que podem ser utilizadas, das implicações fisiopatológicas diferentes que podem ter e do custo de sua execução, procuramos verificar quais delas poderiam ser substituídas por outra(s) e quais as possíveis relações entre os mecanismos de suas alterações. Para isso estudamos as correlações entre os níveis das seguintes PFH – concentração sérica bilirrubina total (BT), concentração sérica de bilirrubina de reação direta (BD), atividades séricas de aspartato aminotransferase (AST), de alanina aminotransferase (ALT), de fosfatase alcalina (FA) e de γ-glutamiltransferase (γGT) em crianças com hepatite do tipo A (HA), que evoluíram para cura, em diferentes fases de sua evolução – do 1o ao 7o dia (G 0-7), do 8o ao 14o dia (G 8-14), do 15o ao 30o dia (G 15-30), do 31o ao 60o dia (G 31-60) e após os 60 dias (G > 60). Foi aplicada análise de correlação múltipla efetuando-se as seguintes análises: 1) correlação entre BD (variável dependente - VD) e BT, AST, ALT, FA e γGT (variáveis independentes - VI) nos grupos G 0-7 e G 8-14; 2) correlação entre BT (VD) e AST, ALT, FA e γGT (VI), nos demais grupos; 3) correlação entre AST (VD) e BT, ALT, FA e γGT (VI) em todos os grupos e 4) correlação entre... / Acute type A hepatitis (HA) is a common disease in children in Brazil. And is the most frequent cause of viral hepatitis. Usually when the clinical picture and epidemiological data are suggestive of acute hepatitis the diagnosis of hepatic damage and the follow-up is made using the so called “liver function tests” (LFT), besides the serological confirmation of a recent infection by the hepatitis type A virus (HAV). Considering that: 1) the number of available LFT is relatively large: 2) the ordering of many tests repeatedly over the course or disease would be expensive, and 3) the physiopathological mechanisms of their alterations may be different one from the other we aimed at determining which test(s) could be substituted by other(s) and which are the possible relations among the physiopathological mechanisms of their alterations. To fulfil these objectives, we studied, in children with type A hepatitis, which eventually cured, the multiple correlations among combinations from the following group of tests: total serum bilirubin concentration (TB), direct reactant bilirubin concentration (DB), serum aspartate aminotransferase activity (AST), serum alanine aminotransferase activity (ALT), serum alkaline phosphatase activity (AP) and serum γglutamiltranspeptidase activity (γGT). The correlations were calculated from data taken during different periods after jaundice was noticed – from 0 to 7 days (G 0-7), from 8 to 14 days (G 8-14), from 15 to 30 days (G 15-30), from 31 to 60 days (G 31-60) and after 60 days. A multiple correlation test was applied to carry out the following analyses: 1) correlation between DB ( dependent variable – DV) and TB, AST, ALT, AP and γGT (independent variable – IV) for the groups G 0-7 and... (Complete abstract, click electronic access below)

3456 ABSTRACT: Background: VHC is a widespread serious chronic infectious disease. Most of the patients affected by the disease consist of IDUs. Treatment of VHC is now perceived as an important preventive element for the spread of the disease in IDUs population. Adherence to treatment is absolutely crucial for the successful completion of treatment. Adherence to treatment is often questioned by clinicians who treat VHC in patients using addictive substances. Objectives: To compare the efficacy of treatment of VHC in patients with a history of drug in patients without a history of drug, to compare treatment adherence among patients without a drug history and patients with drug history, to map out the factors affecting adherence to treatment and to find a place in the therapeutic team for expertise of addictologist. Material and Methods: Data from documentation of 258 patients that were treated in 2006- 2015 for viral hepatitis C at the Department of Infectious Diseases at the University Hospital Brno have been processed with using the statistical and analytical methods and in compliance with ethical rules retrospectively. Adherence to treatment (defined as the completion or early termination of treatment due to non-compliance with the treatment regime by the patient) and the effectiveness of treatment, as...