京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18516号 / 社医博第57号 / 新制||社医||8(附属図書館) / 31402 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 横出 正之, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DGAM

Made available in DSpace on 2015-12-06T23:46:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2013 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: O resfriado comum a uma das sindromes infecciosas mais frequentes na infancia, sendo causado por um grupo numeroso de virus, podendo vir acompanhado de complicacoes e uma significativa morbidade. Constitui uma das principais causas de consultas em servicos de atendimento primario a Saúde e um dos principais motivos para o uso indevido de antibioticos.! OBJETIVOS. Descrever a ocorrencia, etiologia, evolucao clinica, uso de antibioticos e absenteismo no trabalho dos responsaveis dos casos de resfriados comuns dentre as criancas atendidas em um servico de atencao primaria a Saúde na cidade de São Paulo. METODOS. No periodo de mar/2008 a fev/2009, foi selecionada uma amostra de casos de criancas menores de 12 anos com diagnostico de resfriado comun com inicio ate cinco dias, as quais foram acompanhadas ate a resolucao completa do quadro. Foram excluidos casos com suspeita de infeccoes bacterianas secundarias, cardiopatias congenitas, doencas pulmonares cronicas, imunodefiCiências e historico de prematuridade. Os dados clinicos foram anotados em formularios padronizados e as amostras de lavado de nasofaringe (uma por caso) foram submetidas a uma ou mais tecnicas laboratoriais (imunofluorescencia direta, reacao da polimerase em cadeia e reacao da polimerase em cadeia em tempo real) para a deteccao de rinovirus (HRV), virus sincicial respiratorio (RSV), parainfluenza 1, 2 e 3 (PIV1-3), adenovirus (AdV), metapneumovirus (hMPV), bocavirus (HBoV), influenza A e B (IFVA e IFVB), coronavirus (HCoV) e enterovirus (HEV). RESULTADOS. Os resfriados representaram 29,0% de todas as consultas medicas (955/3282). Foi obtida uma amostra de 134 casos, com media de idade de 3,6 anos (med 2,6 a). Em 73,8% (99/134) dos casos foi detectado pelo menos um virus, tendo sido o HRV (41,0%) e o IFVA (17,2%) os mais frequentes. O tempo medio de duracao dos sintomas foi de 8,8 dias, nao tendo havido diferencas nas medias de duracao dos sintomas associados aos diferentes virus. A coriza (91,8%) e a tosse (90,3%) foram as manifestacoes mais frequentes, sendo que o quadro associado aos diferentes virus foi semelhante, exceto pelos casos com HRV que apresentaram menos febre (p=0,025) e com IFVB que apresentaram menos tosse (p=0,001). As coinfeccoes ocorreram em 30,3% dos casos (30/99) e nao apresentaram diferencas com relacao as manifestacoes clinicas, ocorrencia de complicacoes e media de duracao dos sintomas quando comparadas aos casos com monoinfeccoes, O indice de complicacoes foi de 11,9%, porem, os antibioticos foram prescritos em 39,6% dos casos, tendo sido a maior parte das prescricoes consideradas indevidas. Foi verificada uma media de 1,5 consultas e 1,0 dia de absenteismo por caso de resfriado. CONCLUSAO. Apesar de considerados patologias benignas, os resfriados foram responsaveis por um alto indice de uso indevido de antibioticos, consultas medicas e dias de absenteismo no trabalho. A ampliacao das faixas etarias para as vacinas disponiveis no sistema publico de Saúde, a disponibilizacao de testes diagnosticos rapidos para os virus respiratorios e o estimulo a educacao medica continuada poderiam contribuir para melhorar o cenario atual possibilitando uma profilaxia mais ampla, o diagnostico rapido e o uso racional de antibioticos / INTRODUCTION. The common cold are caused by a large group of viruses and is one of the most frequent infectious syndromes in childhood which can be followed by complications and a significant morbidity. They are a major cause of consultations in primary care services and a major reason for the misuse of antibiotics. OBJECTIVES. To describe the occurence, etiology, clinical course, complications, use of antibiotics, number of consultations and days of work absenteeism of parents in cases of common colds in children attending an outpatient primary health care service in São Paulo city. METHODS. From mar/2008 to Feb/2009, we selected a sample of cases of children under 12 years diagnosed with common colds starting up to five days, which were followed until resolution of symptoms. We excluded cases with suspected secondary bacterial infections, congenital heart disease, chronic lung diseases, immunodeficiencies and history of prematurity. Clinical data were recorded on a standardized form and samples of nasopharyngeal wash (one for each case) were subjected to one or more laboratory techniques (direct immunofluorescence, polymerase chain reaction and real time polymerase chain reaction) for detection of rhinovirus (HRV), respiratory syncytial virus (RSV), parainfluenza virus 1, 2 and 3 (PIV1-3), adenovirus (AdV), metapneumovirus (hMPV) Bocavirus (HBoV), influenza A and B (IFVA and IFVB ), coronavirus (HCoV) and enterovirus (HEV). RESULTS. Colds accounted for 29.0% of all medical consultations (955/3282). We obtained a sample of 134 cases of common cold cases, with a mean age of 3.6 years (med 2.6). At least one virus was detected in 73.8% (99/134) of cases and HRV (41.0%) and IFVA (17.2%) were the most frequent viral agents. The mean time of symptoms was 8.8 days, with no differences among different types of viruses. Coriza (91.8%) and cough (90.3%) were the most frequent symptoms, and the clinical characteristics among different types of viruses were similar, except for the fact that cases with HRV had less fever (p = 0.025) and with IFVB had less cough (p = 0.001). The coinfections occurred in 30.3% of cases (30/99) and were not different with respect to clinical manifestations, rate of complications and duration of symptoms when compared to cases with monoinfections. The complication rate was 11.9%, however, antibiotics were prescribed in 39,6% of cases, with most prescriptions considered improper. The average of doctos visits and lost work days was 1.5 visits and 1.0 days of absenteeism per case of common cold. CONCLUSION. Although considered benign diseases, common colds were responsible for a high rate of antibiotics misuse, doctor visits and days of work absenteeism. A wider coverage for all ages with vaccines available in the Brazilian public health system, the availability of rapid diagnostic tests for respiratory viruses and the continuous medical education could improve the current scenario and promote a broader prevention, rapid diagnosis and rational use of antibiotics. / BV UNIFESP: Teses e dissertações

Einleitung: Atemwegsinfekte gehören zu den häufigsten Krankheitsbildern in der Allgemeinarztpraxis. Ziel der Erhebung war es, Daten zur Diagnostik und Therapie von Atemwegsinfekten in der hausärztlichen Praxis zu erheben. Methoden: Während einer jeweils eintägigen Hospitation bei 30 Fachärzten für Allgemeinmedizin wurde deren Vorgehensweise bei allen Patienten mit einem akuten Atemwegsinfekt dokumentiert, die im Zeitraum der Beobachtung den Arzt konsultierten. Es erfolgte eine Unterscheidung zwischen Erst- und Folgekontakten. Ergebnisse: Diagnostisch wurden am häufigsten die Auskultation der Lunge und die Inspektion des Mund-Rachen-Raumes durchgeführt. 98,4% der Patienten mit Erstkonsultationen und 62,5% der Patienten mit Folgekonsultationen erhielten eine medikamentöse Verordnung. Im Durchschnitt erhielten erstkonsultierende Patienten 2,1 (+-1,0), Patienten im Folgekontakt 1,3 (+-1,1) Medikamente. Am häufigsten wurden Medikamente aus der Gruppe der Husten- und Erkältungspräparate verordnet (87,1% der Erstkontakte und 52,9% der Folgekontakte). 43,5% der Erstkontakte und 29,9% der Folgekontakte erhielten ein Antibiotikum (37,5% Makrolide, 21,5% Penicilline, 20,8% Doxycyclin als Monosubstanz oder in Kombination mit Expektorantien). Schlussfolgerung: Nahezu alle Patienten erhielten ein Rezept über mindestens ein Medikament. Die erhobenen Daten lassen vermuten, dass sich bei einer höheren Gewichtung der so genannten "Hausmittel" ein deutliches Einsparungspotential böte. Angesichts des hohen Anteils der Antibiotikaverordnungen sollte die entsprechende Indikationsstellung kritisch überdacht werden.

This study investigated the relationship between specific psychosocial factors and susceptibility to the common cold in a sample of 124 distance runners. A cross-sectional survey design was used to assess the role of life events, coping, hardiness, training workload and competition frequency in the athlete's risk of infection. Using correlational statistical techniques, it was found that the magnitude of recent life changes and the avoidance coping strategy of denial were positively related to self-reported symptoms of the common cold. Furthermore, a significant inverse correlation was observed between hardiness and symptom duration scores. However, approach coping, training workload and competition frequency were not significantly related to the dependent measures. The results of this study suggest that certain stress-related psychosocial factors are associated with susceptibility to the common cold in distance runners. Several strategies for the prevention and treatment of upper respiratory tract infections in this group are implied by these findings. / Psychology / M.A. (Psychology)

This study investigated the relationship between specific psychosocial factors and susceptibility to the common cold in a sample of 124 distance runners. A cross-sectional survey design was used to assess the role of life events, coping, hardiness, training workload and competition frequency in the athlete's risk of infection. Using correlational statistical techniques, it was found that the magnitude of recent life changes and the avoidance coping strategy of denial were positively related to self-reported symptoms of the common cold. Furthermore, a significant inverse correlation was observed between hardiness and symptom duration scores. However, approach coping, training workload and competition frequency were not significantly related to the dependent measures. The results of this study suggest that certain stress-related psychosocial factors are associated with susceptibility to the common cold in distance runners. Several strategies for the prevention and treatment of upper respiratory tract infections in this group are implied by these findings. / Psychology / M.A. (Psychology)

The diagnosis and treatment of respiratory tract infections in ambulatory adults is challenging. The prevalence of these conditions outstrips the medical profession's efficiency and effectiveness in dealing with them. However, selecting diagnostic techniques that identify causative organisms and therapeutic agents targeted to those organisms should lead to a reduction in the morbidity and mortality associated with these illnesses.