Published also as thesis (Ph. D.) Columbia university. / Bibliography: p. 102-103.

Includes bibliographical references and index.

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Background: The development of contemporary isolation measures has emerged through centuries from the time of ships under quarantine to modern personal protective equipment and knowledge about disease control. The underlying need for care in isolation could be multidrug resistant organisms or immunosuppression. Aim: The aim of this review was to explore patient´s experience of care in isolation due to somatic disease. Method: The study was conducted as a literature review with an inductive content analysis. During the literature search 11 qualitative studies corresponding to the aim of this study was chosen. Analysis of the quality of the studies were conducted. The results were analysed and compiled in themes and subthemes. Results: Patients described isolation policies as a form of imprisonment and in terms of negative experiences. Discrepancies in practice of isolation measures amongst health care workers contributed to patients’ apprehension and worry. The isolation room could both be seen as a prison and a safe haven. It represented a feeling of safety and disengagement from demands from the outside. The relationship between the patient and the health care worker was important for the experience of care in isolation. Patients described feelings of loneliness and contact with friends and family had major impact both through visits but also by phone or computer. To find acceptance or meaning made it easier to cope with the period of loneliness. Conclusion: To be cared for in isolation is a global phenomenon and it has major impact on the daily life of the affected persons. Attitudes, work procedures amongst the health care workers and their personal treatment towards the patients may have a positive or negative impact on the patients experience of isolation. Friends and family carry out an important role in alleviating loneliness and new technology for example videocalls may offer whole new opportunities to be able to interact socially with others during time spent in isolation. / Bakgrund: Nutida isoleringsvård har utvecklats och växt fram under århundraden alltsedan tiden då fartyg låg i karantän fram till dagens kunskap om smittskydd och tillgång till skyddsutrustning. Den bakomliggande orsaken till isoleringsvård kan bland annat vara antibiotikaresistenta bakterier eller immunsuppression. Syfte: Syftet med denna litteraturstudie var att beskriva hur patienter med somatisk sjukdom upplever isoleringsvård. Metod: Studiedesign var litteraturstudie där analysen genomfördes med induktiv ansats. I artikelsökningar påträffades 11 kvalitativa originalartiklar som svarade till studiens syfte. Kvalitets- och resultatanalys av inkluderade studier gjordes och ett sammanställt resultat med teman och subteman utarbetades. Resultat: Isoleringsrutiner upplevdes som en form av fångenskap och beskrevs i negativa ordalag. Oro och ängslan upplevdes bland patienter när sjukvårdpersonal gjorde avsteg från isoleringsrutinerna. Rummet kunde upplevas som ett fängelse och begränsande men även som en fristad där eget rum, en upplevd trygghet och befrielsen från omgivningens krav sågs som positivt. Relationen mellan patient och personal var av betydelse för hur tiden i isoleringsvård upplevdes. Patienter uttryckte känslor av ensamhet och kontakten med anhöriga spelade en stor roll både genom direktkontakt men även via telefon och dator. Meningsskapande eller att finna acceptans inför situationen gjorde det lättare att hantera tiden i ensamhet. Slutsats: Isoleringsvård förekommer världen över och det har stor påverkan på individens dagliga liv. Bemötande, attityder och arbetssätt hos sjukvårdspersonal kan ha både positiv och negativ inverkan på patientens upplevelse av vårdformen. Närstående har en viktig roll i att lindra ensamheten och teknik såsom videosamtal öppnar helt nya möjligheter till social interaktion under tiden i isoleringsvård.

The world is changing. India is changing. Food is changing. Bodies are changing. What does this mean for the women of Maharashtra, India? Globalization and modernity manifest in new and interesting ways the world over. As people establish networks of global commodity, capital, and human circulation, anthropologists raise pertinent concerns. While some are apprehensive about cultural loss and western cultural imperialism, others make a case for the rise of glocalization. While some espouse the positives of a free market economy, others are critical of the nutrition transition in developing countries and what this means for the health of the people undergoing this transition. The site of this study is the region of Konkan in Maharashtra, India. India is undergoing fast paced culture change since liberalizing its economy in the year 1991. I focus on the experiences of present day rural and urban Deorukhe Brahmin women (mothers and their daughters), who belong to an endogamous upper caste group that claims to be indigenous to Konkan. Generally, rural Indian regions are modernizing more slowly than urban areas. This study looks at how women are active agents in the changes that are taking place in their bodies, diet, and gender identities. A biocultural study, this dissertation takes into consideration anthropometric data and ethnographic data to comprehend the manner in which women, who are the gastronomic decision makers at the household level, are responding to the increasing influx of non-traditional foods. My study focuses on the moral implications of changing dietary practices and the appearance of chronic non-communicable diseases on the notions of the self. By discussing the manner in which Indian women practice their agency, using traditional gender roles, I aim to demonstrate how these women adjoin that which is thought to index the global and the local to shape a new India.

Made available in DSpace on 2012-05-07T14:47:59Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 000038.pdf: 9427487 bytes, checksum: 33328dce5f228d33dac16e8f06112fe9 (MD5) Previous issue date: 2009 / Desde o final do século XIX até a década de 1940, o óleo de chaulmoogra foi um importante elemento na prática terapêutica da lepra. Esse óleo era extraído das sementes encontradas nos frutos das árvores indianas chamadas de Chaulmoogras e foi apropriado pela medicina ocidental no final do século XIX, a partir da observação de seu uso pela população indiana para o tratamento de doenças de pele. Essa pesquisa tem como objetivo discutir a apropriação do óleo de chaulmoogra pelos médicos brasileiros e o processo de nacionalização desse tratamento, entre as décadas de 1920 e 1950. A análise será feita, principalmente, observando em que medida a aceitação dessa terapêutica se deu no contexto nacional pela comunidade médica e científica, na tentativa de controlar uma doença tropical que estava sendo definida como uma endemia nacional. Dessa forma, procuro refletir sobre o papel ativo dos cientistas brasileiros nos processos de adoção e adaptação de conhecimentos, vendo-os não como receptores passivos de ciência e tecnologia, mas como criadores de novos saberes e práticas em relação à lepra .

Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2007 / Reinfection is an important mechanism leading to recurrent tuberculosis. Recently, molecular epidemiological studies have shown that in high incidence settings, recurrent tuberculosis may occur through reinfection. Animal model experiments have shown that a reinfecting mycobacterial strain is specifically targeted to existing granulomas and that these structures are more dynamic than was previously thought. In this study we hypothesised that primary infection with M. tuberculosis may reprogramme human macrophages thereby preventing or facilitating reinfection with a secondary mycobacterial strain. Two antibiotic-resistant M. tuberculosis H37Rv variants were generated by electrotransformation of marked plasmids, designated KanRand HygR . A THP1 human macrophage cell line was infected and reinfected with different combinations of these marked strains as well as a hypervirulent M. tuberculosis Beijing strain. Mycobacterial growth has been assessed by colony forming unit enumeration and confirmed with polymerase chain reaction (PCR) analysis. In vitro growth curves of wild-type and differentially marked M. tuberculosis H37Rv Kan Rand HygR strains were compared in the BACTECTM mycobacterial growth indicator tube (MGITTM) system in parallel with conventional liquid culturing. In vitro liquid culture growth curves of hypervirulent clinical Beijing strain isolates were also compared to M. tuberculosis H37Rv growth curves. Through this it was established that there was no fitness cost as result of plasmid integration and that these strains of varying virulence had similar growth curves. Competitive dynamics within THP1 human macrophage cells were then assessed and have shown that there were no significant differences in growth patterns between primary and secondary infecting strains during THP1 cell reinfection. The findings of this study answered fundamental questions regarding reinfection of mycobacterial strains. It was established here that human macrophages can indeed be reinfected with a second virulent mycobacterial strain.

Orientador: Maria Luiza Moretti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T19:58:22Z (GMT). No. of bitstreams: 1 Oliveira_AlexandreMacedode_D.pdf: 7363190 bytes, checksum: 9dd09c9023ccfce04ae0c4df21fadd3c (MD5) Previous issue date: 2007 / Resumo: A epidemiologia de campo corresponde ao ramo da ciência que usa estratégias de epidemiologia clássica com o objetivo de controlar um problema de saúde pública e assim melhorar a condição de vida de uma população. Além da epidemiologia clássica, o epidemiologista de campo precisa usar conhecimentos de outras áreas como economia, antropologia, ciências sociais e comunicação para planejar e implementar medidas de controle, alcançando assim seus objetivos. As limitações nos estudos de epidemiologia de campo são muitas, mas é dever do profissional dessa área manter o rigor científico e ser criativo a fim de garantir a qualidade do seu trabalho. Mesmo sem o propósito inicial de avançar o conhecimento científico, investigações de campo oferecem oportunidades únicas para tal. Apresentamos três trabalhos de epidemiologia de campo no âmbito das doenças infecciosas, seus processos de investigação e suas implicações para saúde pública. O primeiro deles é a investigação de um surto de hepatite C numa clínica de hemato/oncologia. A investigação foi capaz de identificar 99 casos de hepatite C relacionados à referida clínica. A transmissão ocorreu através da contaminação de bolsas de solução salina pelo desrespeito às práticas de controle de infecção em serviços de saúde. Esse fato ressalta os desafios em implementar medidas de controle de infecção em serviços de saúde ambulatoriais e aprimorar a vigilância epidemiológica da hepatite C com fins à detecção precoce de surtos. O segundo trabalho é também fruto da investigação do surto de hepatite C. Fomos capazes de avaliar a sensibilidade dos testes sorológicos para hepatite C em pacientes oncológicos. Encontramos sensibilidade de 83% dos referidos testes, o que compromete sua capacidade diagnóstica neste grupo de pacientes. Como recomendação, sugerimos a realização concomitante de provas sorológicas e aquelas baseadas em amplificação de ácido nucleico para diagnóstico de hepatite C em pacientes oncológicos. O terceiro exemplo de aplicação da epidemiologia de campo é a investigação da suspeita de um caso de transmissão do vírus do Oeste do Nilo através de transfusão de sangue apesar de triagem laboratorial. A rápida resposta das autoridades de saúde pública permitiu confirmar o evento e evitar que novos casos ocorressem pelo uso de co-produtos contaminados. Além disso, permitiu avaliar a efetividade da implementação de testes de triagem laboratorial baseados na amplificação de ácido nucleico nos serviços de doação de sangue. A epidemiologia de campo provou ser útil na investigação desses eventos e seus achados serviram de base para a tomada de decisões com fins de melhorar a condição de saúde das populações em risco. Essas investigações permitiram também o avanço do conhecimento científico nas respectivas áreas / Abstract: Field epidemiology is an area of science that uses principles of classic epidemiology to respond to public health threats and improve the quality of life of a given population. In addition to classic epidemiology, the field epidemiologist uses knowledge from other areas such as economics, anthropology, social sciences, and communications to develop and implement control measures to reach his objectives. Limitations in this field are common, but it is the epidemiologist¿s responsibility to be creative and to maintain scientific rigor to guarantee the accuracy of his work. Although field investigations may not aim to advance scientific knowledge, they offer unique opportunities to achieve this end. We present three field investigations and their implications for public health. The first one is the investigation of an outbreak of hepatitis C virus infections at a hematology/oncology clinic. We identified 99 cases of infection associated with the clinic. Transmission was related to the contamination of saline bags due to lack of adherence to proper infection control practices. This investigation highlights the challenges in implementing infection control programs in outpatient care facilities and the need for better hepatitis C surveillance to allow for early detection of outbreaks. The second investigation is also related to this hepatitis C outbreak. We evaluated the sensitivity of hepatitis C serologic tests in oncology patients and found that these tests are only 83% sensitive in this population, which limits their diagnostic utility if used alone. As a result, we recommend that serologic tests be combined with assays based on nucleic acid amplification in oncology patients. The third example describes the use of field epidemiology to investigate a possible case of West Nile virus transmission associated with blood transfusion despite laboratory screening. The rapid response by public health authorities confirmed this suspicion and prevented the occurrence of additional cases associated with the use of co-components from the original donation. In addition, the investigation provided evidence on the effectiveness of West Nile virus nucleic acid amplification tests for blood screening. These three examples demonstrate the utility of field epidemiology in public health investigations and how investigative findings support the implementation of measures to improve the quality of health of populations at risk. These investigations also allowed for the advancement of scientific knowledge in the respective areas / Doutorado / Clinica Medica / Doutor em Clínica Médica

Introdução - Considerada um grave problema de saúde pública mundial em regiões de clima tropical e subtropical, a dengue foi a única dentre as doenças tropicais negligenciadas a apresentar tendência de aumento na mortalidade nos últimos anos. Fatores relacionados ao ciclo de vida do principal vetor, fêmeas do mosquito Aedes aegypti, influenciam a distribuição espacial e o caráter sazonal da doença. A incidência de casos de dengue é dependente de uma complexa rede de relações entre vetor, vírus e hospedeiro, assim como a ocorrência de casos graves e de óbito. Desde a introdução do vírus, o estado de São Paulo vem apresentado epidemias envolvendo número cada vez maior de municípios, de incidência de casos e de óbitos por dengue. Objetivo - Avaliar a distribuição espacial, temporal e espaço-temporal dos óbitos por dengue no estado de São Paulo. Métodos - Trata-se de estudo ecológico, com componentes espacial e temporal, a partir da notificação de óbitos por dengue no SINAN, tendo como unidades de análise os municípios e as microrregiões do estado de São Paulo, no período de 1998 a 2017. Os óbitos por dengue no estado de São Paulo foram descritos segundo sexo e idade. As taxas de mortalidade bruta, padronizada por sexo e idade e suavizada pelo método bayesiano empírico local foram estimadas e mapeadas segundo município de residência. Os sorotipos detectados pelo Instituto Adolfo Lutz foram mapeados segundo microrregião. Estimou-se as tendências temporais da mortalidade. Aglomerados de alto risco espacial e espaço-temporal e de variação espacial na tendência temporal foram detectados e mapeados. O risco relativo espacial da mortalidade por dengue ajustado pelo tempo e covariáveis consideradas foi estimado por modelos Bayesianos Gaussianos Latentes com abordagem INLA (2007 - 2016). Foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Saúde Pública da Universidade de São Paulo sob parecer de número 1.687.650. Resultados - Foram identificados 1.121 óbitos por dengue com confirmação laboratorial e residentes no estado de São Paulo entre 1998 e 2017. A mediana de idade foi de 57 anos. A média anual da mortalidade bruta por dengue no estado de São Paulo na série histórica foi de 0,14 óbitos por 100.000 habitantes. Houve tendência de elevação da mortalidade para todos os sexos e idades no período, sendo o crescimento mais proeminente nos adultos com >= 50 anos, e de aumento do percentual de municípios com casos e óbitos ao longo dos anos estudados. Houve associação positiva entre as regiões com maior quantidade de sorotipos e taxas de mortalidade mais elevadas. Aglomerados de alto risco foram identificados nas áreas com alta taxa de mortalidade. O grau de urbanização, número de anos com casos e a introdução de novo sorotipo associaram-se a um maior risco relativo para a mortalidade por dengue. Tanto as taxas de mortalidade mais elevadas, quanto os maiores riscos relativos para o óbito foram observados nas regiões norte, noroeste, oeste, sudeste e litoral do estado de São Paulo. Conclusão - a mortalidade por dengue no estado de São Paulo apresentou padrão cíclico e sazonal, com tendência de elevação principalmente nas faixas etárias mais avançadas. Houve identificação de agregados de área de alto risco, com associação do grau de urbanização, do número de anos com casos e da introdução de novo sorotipo a maior risco de mortalidade por dengue. / Introduction - Considered a major global public health problem in tropical and subtropical regions, dengue was the only one among neglected tropical diseases to show an increase in mortality in recent years. Factors related to the life cycle of the main vector, females of Aedes aegypti mosquito, influence the spatial distribution and the seasonal nature of the disease. The incidence of dengue cases is dependent on a complex network of relationships between vector, virus and host, as well as the occurrence of severe cases and death. Since the introduction of the virus, the state of São Paulo has been presenting epidemics involving an increasing number of municipalities, incidence of cases and deaths due to dengue. Objective - To evaluate the spatial, temporal and spatial-temporal distribution of dengue deaths in the state of São Paulo. Methods - This is an ecological study, with spatial and temporal components, based on the notification of dengue deaths at SINAN, with the municipalities and microregions of the state of São Paulo as analysis units from 1998 to 2017. Deaths from dengue in the State of São Paulo were described according to sex and age. The crude mortality rates standardized by sex and age and smoothed by the local empirical Bayesian method were estimated and mapped according to the municipality of residence. The serotypes detected by the Adolfo Lutz Institute were mapped according to microregion. The temporal trends of mortality were estimated. High-risk space and space-time clusters and spatial variation in time trend were detected and mapped. The spatial relative risk of dengue mortality adjusted by time and covariables considered was estimated by Latent Gaussian Bayesian models with INLA approach (2007 - 2016). It was approved by the Research Ethics Committee of the School of Public Health of the University of São Paulo under opinion number 1,687,650. Results - A total of 1,121 dengue deaths with laboratory confirmation were identified and residents of the State of São Paulo between 1998 and 2017. The median age was 57 years. The annual average of the gross mortality from dengue in State of São Paulo in the historical series was 0.14 deaths per 100,000 inhabitants. There was a trend of increased mortality for all sexes and ages in the period, with the most prominent growth in adults aged >= 50 years, and an increase in the percentage of municipalities with cases and deaths over the years studied. There was positive association between the regions with the highest number of serotypes and the highest mortality rates. High-risk clusters were identified in areas with high mortality rates. The degree of urbanization, number of years with cases and the introduction of a new serotype were associated with a higher relative risk for dengue mortality. Both the highest mortality rates and the highest relative risks for death were observed in the north, northwest, west, southeast and coastal regions of the State of São Paulo. Conclusion - dengue mortality in the state of São Paulo presented a cyclical and seasonal pattern, with a tendency to increase mainly in the more advanced age groups. There was identification of high risk area clusters, with association of the degree of urbanization, number of years with cases and the introduction of a new serotype at greater risk of dengue mortality.