Delivering health care services in an efficient and effective way has become a great challenge for many countries due to the aging population worldwide, rising health expenses, and increasingly complex healthcare delivery systems. It is widely recognized that models and analytical tools can aid decision-making at various levels of the healthcare delivery process, especially when decisions have to be made under uncertainty. This thesis employs stochastic models to improve decision-making under uncertainty in two specific healthcare settings: inpatient flow management and infectious disease modeling. In Part I of this thesis, we study patient flow from the emergency department (ED) to hospital inpatient wards. This line of research aims to develop insights into effective inpatient flow management to reduce the waiting time for admission to inpatient wards from the ED. Delayed admission to inpatient wards, also known as ED boarding, has been identified as a key contributor to ED overcrowding and is a big challenge for many hospitals. Part I consists of three main chapters. In Chapter 2 we present an extensive empirical study of the inpatient department at our collaborating hospital. Motivated by this empirical study, in Chapter 3 we develop a high fidelity stochastic processing network model to capture inpatient flow with a focus on the transfer process from the ED to the wards. In Chapter 4 we devise a new analytical framework, two-time-scale analysis, to predict time-dependent performance measures for some simplified versions of our proposed model. We explore both exact Markov chain analysis and diffusion approximations. Part I of the thesis makes contributions in three dimensions. First, we identify several novel features that need to be built into our proposed stochastic network model. With these features, our model is able to capture inpatient flow dynamics at hourly resolution and reproduce the empirical time-dependent performance measures, whereas traditional time-varying queueing models fail to do so. These features include unconventional non-i.i.d. (independently and identically distributed) service times, an overflow mechanism, and allocation delays. Second, our two-time-scale framework overcomes a number of challenges faced by existing analytical methods in analyzing models with these novel features. These challenges include time-varying arrivals and extremely long service times. Third, analyzing the developed stochastic network model generates a set of useful managerial insights, which allow hospital managers to (i) identify strategies to reduce the waiting time and (ii) evaluate the trade-off between the benefit of reducing ED congestion and the cost from implementing certain policies. In particular, we identify early discharge policies that can eliminate the excessively long waiting times for patients requesting beds in the morning. In Part II of the thesis, we model the spread of influenza pandemics with a focus on identifying factors that may lead to multiple waves of outbreak. This line of research aims to provide insights and guidelines to public health officials in pandemic preparedness and response. In Chapter 6 we evaluate the impact of seasonality and viral mutation on the course of an influenza pandemic. In Chapter 7 we evaluate the impact of changes in social mixing patterns, particularly mass gatherings and holiday traveling, on the disease spread. In Chapters 6 and 7 we develop agent-based simulation models to capture disease spread across both time and space, where each agent represents an individual with certain socio-demographic characteristics and mixing patterns. The important contribution of our models is that the viral transmission characteristics and social contact patterns, which determine the scale and velocity of the disease spread, are no longer static. Simulating the developed models, we study the effect of the starting season of a pandemic, timing and degree of viral mutation, and duration and scale of mass gatherings and holiday traveling on the disease spread. We identify possible scenarios under which multiple outbreaks can occur during an influenza pandemic. Our study can help public health officials and other decision-makers predict the entire course of an influenza pandemic based on emerging viral characteristics at the initial stage, determine what data to collect, foresee potential multiple waves of attack, and better prepare response plans and intervention strategies, such as postponing or cancelling public gathering events.

Aphanomyces invadans is the pathogen that causes epizootic ulcerative syndrome (EUS), an economically devastating fish disease in southern Asia. The present thesis considered possible improvements to current methods of monitoring EUS, and examined the mechanisms of the host immune response to A. invadans in order to establish whether they could be enhanced to reduce the impact of EUS on aquaculture. Monoclonal antibody (MAb) technology was considered as a possible improvement to the histopathological methods currently used in diagnosis of EUS. Five MAbs were raised to day-old A. invadans germlings. Four gave weak reactions to A. invadans and cross-reacted with other Aphanomyces spp, though they may be useful for future studies on A. invadans. The other, designated MAb 3gJC9, only cross-reacted with the crayfish plague pathogen, A. astaci, and was used for the development of an immunohistochemistry protocol that may be of use in diagnosis. Immunohistochemistry with MAb 3gJC9, which recognised an extracellular product (ECP) of A. invadans, was specific to A. invadans in fish tissue, although it also recognised A. astaci in plague-infected crayfish. It also recognised the mycelium in fish infected with ulcerative mycosis, indicating that ulcerative mycosis is synonymous with EUS. Preliminary observations indicated that both ECPs and what appeared to be a hitherto unreported early stage of the mycelium are important in the pathology of EUS. Studies in vitro on the macrophages of EUS-susceptible giant gourami Osphronemus gouramy and silver barb Barbodes gonionotus, and EUS-resistant Nile tilapia Oreochromis niloticus, found that their macrophages were able to inhibit the growth of A. invadans. The macrophages of striped snakehead Channa striata did not inhibit A. invadans, which may account for their high EUS-susceptibility, especially as A. invadans strongly inhibited the respiratory burst of snakehead macrophages. Studies on humoral immune responses revealed that complement inhibited A. invadans in the case of snakeheads, gourami and barbs but not tilapia or swamp eels Monopterus albus. The humoral responses of the latter were very different to the four other species, and not elucidated. Low levels of anti A. invadans antibodies were found in tilapia and gourami from an EUS-endemic region, and high levels in snakehead. Snakehead antibodies appeared to be able to inhibit A. invadans even when complement was removed, but lower levels were produced at the low temperatures typically associated with EUS. A range of potential immunostimulants were screened for the ability to enhance resistance to EUS. The two successful products were administered as feed supplements to snakeheads and barbs that were subsequently injected intramuscularly with A. invadans. One, the algal extract Ergosan, showed some beneficial effects on snakeheads although the challenge was inconclusive. The other, the vitamin supplement Salar-bec, accelerated the cellular immune response and reduced mortality in snakeheads and barbs, and enhanced antibody production in snakeheads. The antibody response of snakeheads was further studied by comparing the anti- A. invadans antibody level, inhibitory activity of sera in vitro and protective capacity of sera from EUS-naïve snakeheads to that of snakeheads recently exposed to EUS and those subject to long term EUS-exposure. Sera of populations recently exposed to EUS showed an increased level of antibodies, but little improvement in inhibitory or protective activity. Sera from snakeheads that had endured long term exposure showed a wide range of antibody levels, but marked increases in inhibitory and protective activity. Antibodies cross-reacted with non-pathogenic Aphanomyces spp. in all cases.

Revised and extended version of the author's doctoral thesis. / Includes bibliographical references and index.

Thesis (Ph.D)--Industrial and Systems Engineering, Georgia Institute of Technology, 2010. / Committee Chair: Keskinocak, Pinar; Committee Member: Ergun, Ozlem; Committee Member: Goldsman, David; Committee Member: Hupert, Nathaniel; Committee Member: Swann, Julie. Part of the SMARTech Electronic Thesis and Dissertation Collection.

Brucellosis is one of the neglected diseases in Nigeria. In Lagos, the commercial capital of Nigeria with about twenty one million people, a descriptive cross-sectional study was carried out in order to determine the sero-prevalence of brucellosis among people at risk in some selected abattoirs and secondary health care facilities (hospitals) in the state. Mixed sampling method was employed at the abattoir while convenient sampling method was used in sampling the respondents at the hospitals. Sera samples from three hundred and one (n=301) abattoir-based workers and traders; and one hundred and twenty one (n=121) hospital-based individuals which include people with febrile illnesses and blood donors were tested for brucellosis using Rose Bengal Plate test (RBPT), with indirect ELISA being used as a confirmatory test. Of the 301 abattoir-based workers and traders, 27 (8.97%) were sero-positive to the infection when Rose Bengal Plate test antigen was used. The twenty seven individuals consists of fifteen (15) butchers; four (4) veterinarians; two (2) meat transporters and bone/cow horn dealers each as well as one each of blood meal producer, abattoir engineer, water seller and meat supplier. When blood samples from the sero-positive individuals were subjected to ELISA, 3 (11.1%) were sero-positive to the brucellosis, while one is equivocal. These results confirm that agglutination observed on RBPT might be related to unknown cross-reactions and confirmation with a different test was necessary. None of the hospital-based respondents is sero-positive to the infection. The clinical signs significant for the infection in this study were fever, joint pain, lower backache, regular headache and miscarriage. Brucellosis awareness level among the respondents was very low. Data was analysed using (SPSS) version 20.0 at α0.05 significant level. The significant risk factors for human brucellosis according to this research are consumption of fura (unpasteurized milk) and wara (fresh cheese). The study revealed that brucellosis is not only an occupational disease but can also affect people who trade or live in proximity with infected animals. / Agriculture, Animal Health and Human Ecology / M. Sc. (Agriculture)

Submitted by Priscila Nascimento (pnascimento@icict.fiocruz.br) on 2012-11-12T12:44:48Z No. of bitstreams: 1 dulce-lemos-lopes.pdf: 771261 bytes, checksum: c267c2bc34c9977f6022766515a8dd61 (MD5) / Made available in DSpace on 2012-11-12T12:44:48Z (GMT). No. of bitstreams: 1 dulce-lemos-lopes.pdf: 771261 bytes, checksum: c267c2bc34c9977f6022766515a8dd61 (MD5) Previous issue date: 2005-03 / Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / Como rege a constituição brasileira, “a saúde é direito de todos e dever do Estado”. No âmbito da política de sangue atualmente vigente no Brasil, é dever do Estado prover acesso universal e de boa qualidade aos serviços de hemoterapia em funcionamento no país. Instaurar, sustentar e expandir a qualidade dos serviços de hemoterapia implica em garantir a segurança das transfusões sanguíneas, o que somente pode ser alcançado através da prevenção da disseminação dos agentes causadores dedoenças infecto-contagiosas. Visando o fornecimento de “sangue com garantia de qualidade em todo o seu processo” – meta mobilizadora nacional para o setor saúde até 2003 – o Ministério da Saúde lançou, através da GerênciaGeral de Sangue e Outros Tecidos e Órgãos da Agência Nacional de Vigilância Sanitária (GGSTO/ANVISA) a implantação de um sistema de controle e avaliação externa da qualidade. Tal projeto – objeto desta dissertação – teve como objetivo garantir a exatidão dos resultados dos testes sorológicos assegurando a confiabilidade dos resultados obtidos por 130 Serviços de Hemoterapia do Brasil denominados laboratórios participantes do programa de avaliação externa da qualidade. A confiabilidade dos testes realizados por estes laboratórios participantes - testes anti-HIV-1/2; testes anti-HTLV-I/II; testes anti-HBV; testes anti-HCV; testes para detecção do HBsAg; e testes de triagem para Doença de Chagas e Sífilis - foram aferidas através do índice estatístico Kappa (K). Os resultados dos testes obtidos pelos laboratórios participantes foram analisados através índice do Kappa, aos resultados dos testes já conhecidos pelo Laboratório Organizador (LAPPS/Bio-Manguinhos/FIOCRUZ). Os testes de triagem realizados pelos laboratórios participantes foram, então, classificados segundo o grau de concordância, como sofríveis, ruins, regulares, moderados, bons ou excelentes. Além de fornecer informações a respeito da confiabilidade dos Serviços de Hemoterapia no país,é descrita a implantação e operacionalização do programa de controle externo da qualidade do sangue no Brasil, os quais poderão contribuir para a auto-avaliação e, se necessário, re-estruturação destes serviços para melhor servir e proteger a saúde do cidadão brasileiro. / As stated in the Brazilian Constitution “health is the right of all citizens and a State duty”. According to the current blood policy established in Brazil, it is the State´s duty to provide universal access to good quality blood banking services operating in the country. To install, maintain and expand the quality of blood banking services, one must assure the safety of blood transfusions. This, in turn, can only be accomplished through the prevention of the dissemination of pathologens responsible for causing infectious diseases. Seeking the provision of “blood with quality assurance throughout its process” – a national mobilization goal for the health sector until 2003 – the Ministriy of Health has launched, through the General Management for blood and Other Tissues and Organs of the National Agengy of Health Surveillance (GGSTO/ANVISA) the implantation of an external quality control and assurance system. This project had as its goal to assure the reability of the serological test results obtained in 130 blood banking services, participating in the external quality evaluation program in Brazil. The reliability of the tests carried out by these blood banking services – tests anti-HIV-1/2; tests anti-HTLV-I/II; tests anti-HBV; tests anti-HCV; tests for the detection of HBsAg; and screening tests for Chagas disease and Syphilis – were measured by means of a statistical index Kappa (K). The test results obtained by the participating laboratories were compared to the already known test results of the Organizing Laboratory (LAPPS/Bio-Manguinhos/FIOCRUZ) by using Kappa values. The serological tests carried out by the participating laboratories were thus classified according to their degree of proximity to the true test results, as bad, regular, moderate, good or excellent. Besides describing information as to thereliability and quality level of the blood banking services in the country, this dissertation also offers the implementation and operationalization of the external quality evaluation program/system for blood in Brazil. This dissertation also constitutes an essential tool for self-evaluation and, if necessary, re-structuring on the part of such services so that they may better serve and protect the health status of the Brazilian citizen.

Submitted by NATÁLIA AUGUSTO BENEDETTI null (benedetti@fmb.unesp.br) on 2016-04-06T23:09:36Z No. of bitstreams: 1 dissertação final abril 2016.docx: 4301870 bytes, checksum: 5ef2edd34f4c9f2caef591ab8900f625 (MD5) / Rejected by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: A versão final da dissertação/tese deve ser submetida no formato PDF (Portable Document Format). O arquivo PDF não deve estar protegido e a dissertação/tese deve estar em um único arquivo, inclusive os apêndices e anexos, se houver. Por favor, corrija o formato do arquivo e realize uma nova submissão. Agradecemos a compreensão. on 2016-04-07T18:21:01Z (GMT) / Submitted by NATÁLIA AUGUSTO BENEDETTI null (benedetti@fmb.unesp.br) on 2016-04-12T15:26:01Z No. of bitstreams: 1 dissertação final abril 2016.pdf: 1048311 bytes, checksum: 20ef19de54a6fc1bc779302643956cce (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-04-13T13:10:19Z (GMT) No. of bitstreams: 1 benedeti_na_me_bot.pdf: 1048311 bytes, checksum: 20ef19de54a6fc1bc779302643956cce (MD5) / Made available in DSpace on 2016-04-13T13:10:19Z (GMT). No. of bitstreams: 1 benedeti_na_me_bot.pdf: 1048311 bytes, checksum: 20ef19de54a6fc1bc779302643956cce (MD5) Previous issue date: 2016-02-26 / O Sistema de Vigilância Sanitária da Itália detectou 445 casos de hepatite B e 69 de hepatite C, relacionados aos tratamentos de beleza. Fato esse alarmante, pois, os cuidados com a aparência, têm levado a população a buscar os padrões de beleza estabelecidos pela mídia. Destacando-se que os salões de beleza no Brasil estão cada vez mais comuns com a atuação dos profissionais de manicure e pedicure. Entretanto, os produtos cosméticos necessitam de uma avaliação da qualidade sanitária, ou seja, testes que indicam a quantidade de micro-organismos viáveis em cada amostra. Pois, evidências mostram a sobrevivência dos Trichophytonrubrum, Trichopyton mentagrophytes, Candida albicans, Candida parapsilosis no esmalte de unha. Todavia, a composição e a fabricação do esmalte são pouco conhecidas, devido várias etapas estarem envolvidas na produção dos esmaltes de unhas comuns. Objetivo: Avaliar a ação dos solventes presentes no esmalte de unha, o acetato de etila e o acetato de butila, sobre o herpes vírus bovino tipo 5. Método: Realizou ensaios da atividade antiviral nas diferentes fases do ciclo replicativo com os solventes, acetato de etila e o acetato de butila. Resultados: No pré-tratamento, não houve replicação viral no acetato de etila a partir da diluição 10-6 e no acetato de butila 10-5 . No póstratamento não houve replicação viral no acetato de etila a partir da diluição 10-7 e no acetato de butila 10-5 e na inativação viral, tanto o acetato de etila como o butila, após 48 e 72 horas, todas as diluições apresentaram replicação viral, 10-1 a 10-10 . Discussão: Apesar de não identificar na literatura relatos específicos sobre solventes acetato de etila e acetato de butila na atividade antiviral, o presente estudo evidenciou que apesar de pouca diferença entre as diluições sequenciais desses solventes, houve replicação viral em diluições mais concentradas de vírus e de solventes. A limitação do estudo, com o uso do esmalte de unha, se deu pelo fato deste produto não ser diluído em meio de cultura para células em sua totalidade, além de conter substâncias muito voláteis que secam o produto rapidamente. Conclusão: Concluiu-se que houve replicação viral nas diferentes diluições, em maior concentração de solvente e maior número de vírus. Para diminuir o risco de contaminação cruzada da população pela disseminação de micro-organismos, mostra a necessidade dos órgãos fiscalizadores atuarem mais nesses estabelecimentos, educando e verificando a rotina do trabalho desses profissionais. / The Health Surveillance System in Italy detected 445 cases of hepatitis B and 69 hepatitis C related to beauty treatments. These alarming facts, for care of the appearance have led people to look for the beauty standards set by the media. If highlighting the beauty salons in Brazil is becoming more common with the activities of manicure and pedicure professionals. However, cosmetic products require a quality assessment of the health, is tests which indicate the amount of viable microorganisms in each sample. For evidence shows the survival of Trichophyton rubrum, Trichophyton mentagrophytes, Candida albicans, Candida parapsilosis in nail polish. However, the enamel composition and manufacturing are little known due several steps are involved in the production of common nail enamels. Objective: To evaluate the action of solvents present in nail enamel, ethyl acetate and butyl acetate, about herpesvirus bovine type 5. Method: The antiviral activity test performed at different stages of the replicative cycle of the solvents, ethyl acetate and butyl acetate. Results: In the pre-treatment, there was no viral replication in the ethyl acetate dilution from 10-6 to 10-5 in butyl acetate. In the post-treatment there was no viral replication in ethyl acetate from the dilution 10-7 and 10-5 butyl acetate and viral inactivation, both the ethyl acetate and the butyl after 48 and 72 hours, all dilutions they showed viral replication, 10-1 to 10-10 . Discussion: Although not identify the specific reports literature solvents ethyl acetate and butyl acetate in antiviral activity, this study showed that despite little difference between serial dilutions of these solvents, there viral replication in more concentrated dilutions of virus and solvents. A limitation of the study, using the nail polish, was due to the fact that this product is not be diluted in culture medium to cells in its entirety, and contain highly volatile substances that dry the product quickly. Conclusion: We conclude that there was viral replication in the different dilutions, higher solvent concentration and a higher number of viruses. To reduce the risk of cross-contamination of the population by the spread of micro-organisms, it shows the need for regulatory agencies act more in these establishments, educating and checking the routine work of these professionals.

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-12-12T14:18:13Z No. of bitstreams: 1 arquivo total.pdf: 2343289 bytes, checksum: c12ef1be247d5c0b7f1ee07493ef20c3 (MD5) / Made available in DSpace on 2016-12-12T14:18:13Z (GMT). No. of bitstreams: 1 arquivo total.pdf: 2343289 bytes, checksum: c12ef1be247d5c0b7f1ee07493ef20c3 (MD5) Previous issue date: 2016-07-29 / The empiric indicators of the nursing record for hospitalized individuals with infectious contagious diseases must adequately represent the interest focus. Aim: Analyse the validity of the empiric indicators of the basic human necessities presented in a nursing report for hospitalized individuals with infectious contagious diseases. Method: Methodological research, developed into two phases: analysis of content and clinical validation. Thirty-seven specialist nurses, participated of the first phase, where they evaluated the relevance, the clarity and the precision of the empiric indicators studied; sixty-five individuals who were interned in the clinics of infectious contagious diseases of two university hospitals, were evaluated aiming to check the presence or absence of the empiric indicators analysed by the specialists. The data collection happened between August 2015 and April 2016. The data analysis was performed using the quantitative approach. This study was analysed by the Ethics Committee in Research of the University Hospital Lauro Wanderley and was approved according to the report Number 1.015.985 and CAAE: 43249115.7.0000.5183. Results: In the analysis of the content, fourteen empiric indicators were eliminated, considering the relevance criterion. On the clarity and precision criteria, 33 empiric indicators had their operational definitions redesigned. On the reliability, it was observed the internal consistency of the empiric indicators above 0,9. On the clinical validation, it was found association between the psychobiological, psychosocial, and psycho-spiritual needs and from them the medical diagnosis. The presence and absence of the empiric indicators were also evaluated, which subsided the adjusts and final presentation of the nursing record. Conclusion: The findings of this study will strength the clinic practice, the teaching and the scientific community of nursing on the approach of the individual with infectious contagious diseases. / Los indicadores empíricos del registro de enfermería para personas hospitalizadas con enfermedades infecciosas deben representar adecuadamente el foco de interés. Objetivo: Analizar la validez de los indicadores empíricos de las necesidades humanas básicas presentadas en un registro de enfermería para personas hospitalizadas con enfermedades infecciosas. Método: investigación metodológica, desarrollada en dos etapas: análisis de contenido y validación clínica. De la primera etapa, participaron 37 enfermeros especializados, que evaluaron pertinencia, claridad y precisión de los indicadores empíricos en el estudio; y de la segunda, 65 individuos estuvieron hospitalizados en clínicas de enfermedades infecciosas de dos hospitales universitarios, las cuales fueron evaluadas con el fin de verificar la presencia o ausencia de indicadores empíricos analizados por los expertos. Datos recolectados de agosto de 2015 a abril de 2016. Análisis de datos llevada a cabo utilizándose el enfoque cuantitativo. Estudio aprobado por el Comité de Ética de Investigación del Hospital Universitario Lauro Wanderley, según parecer Nº 1.015.985 y CAAE: 43249115.7.0000.5183. Resultados: En el análisis de contenido, catorce indicadores empíricos fueron eliminados, teniendo en cuenta el criterio de pertinencia. En cuanto a los criterios de claridad y precisión, 33 indicadores empíricos tuvieron sus definiciones operativas reformulados. La fiabilidad no había consistencia interna de los indicadores empíricos mayor que 0,9. En la validación clínica, hubo asociación entre las necesidades psicobiológicas, psicosociales y psicoespirituales y con los diagnósticos médicos. Fueron evaluadas presencia y ausencia de indicadores empíricos, lo que apoyó la configuración y presentación final del registro de enfermería. Conclusión: Los resultados de este estudio refuerzan la práctica clínica, la enseñanza y la comunidad científica de enfermería en el enfoque al paciente con enfermedades infecciosas. / Os indicadores empíricos do histórico de enfermagem para indivíduos hospitalizados com doenças infectocontagiosas devem representar adequadamente o foco de interesse. Objetivo: Analisar a validade dos indicadores empíricos das necessidades humanas básicas apresentadas em um histórico de enfermagem para indivíduos hospitalizados com doenças infectocontagiosas. Método: Pesquisa metodológica, desenvolvida em duas etapas: análise de conteúdo e validação clínica. Da primeira etapa participaram 37 enfermeiros especialistas, que avaliaram a relevância, a clareza e a precisão dos indicadores empíricos em estudo; e da segunda, 65 indivíduos que estavam internados nas clínicas de doenças infectocontagiosas de dois hospitais universitários, que foram avaliados com o intuito de verificar a presença ou ausência dos indicadores empíricos analisados pelos especialistas. A coleta dos dados ocorreu no período de agosto de 2015 a abril de 2016. A análise dos dados foi realizada por meio da abordagem quantitativa. Este estudo foi apreciado pelo Comitê de Ética em Pesquisa do Hospital Universitário Lauro Wanderley e obteve aprovação segundo parecer nº 1.015.985 e CAAE: 43249115.7.0000.5183. Resultados: Na análise de conteúdo, foram eliminados quatorze indicadores empíricos, considerando o critério de relevância. Quanto aos critérios de clareza e precisão, 33 indicadores empíricos tiveram suas definições operacionais reformuladas. Sobre a fidedignidade, observou-se consistência interna dos indicadores empíricos acima de 0,9. Na validação clínica, constatou-se associação entre as necessidades psicobiológicas, as psicossociais e as psicoespirituais e delas com os diagnósticos médicos. Também foram avaliadas a presença e a ausência dos indicadores empíricos, o que subsidiou os ajustes e a apresentação final do histórico de enfermagem. Conclusão: Os achados deste estudo fortalecerão a prática clínica, o ensino e a comunidade científica de enfermagem na abordagem do indivíduo com doenças infectocontagiosas.

Submitted by RAFAEL ORBOLATO null (doriva_tt@hotmail.com) on 2018-03-22T03:25:48Z No. of bitstreams: 1 ORBOLATO, R. - 2018 - Dissertação Mestrado.pdf: 1151946 bytes, checksum: 0af1b8e7055676e2bcc2c2c3a1ef6813 (MD5) / Approved for entry into archive by Claudia Adriana Spindola null (claudia@fct.unesp.br) on 2018-03-22T14:01:51Z (GMT) No. of bitstreams: 1 orbolato_r_me_prud.pdf: 1151946 bytes, checksum: 0af1b8e7055676e2bcc2c2c3a1ef6813 (MD5) / Made available in DSpace on 2018-03-22T14:01:51Z (GMT). No. of bitstreams: 1 orbolato_r_me_prud.pdf: 1151946 bytes, checksum: 0af1b8e7055676e2bcc2c2c3a1ef6813 (MD5) Previous issue date: 2018-02-23 / O Sistema Único de Saúde (SUS) é a principal fonte de serviços de saúde da população brasileira, onde aproximadamente 71,1% da população utilizam seus serviços. As Doenças Crônicas Não Transmissíveis (DCNTs) exercem um impacto expressivo na morbidade e mortalidade da população. A Atividade Física (AF) é um importante recurso para promoção da saúde, controle da obesidade e principalmente para a prevenção de DCNTs. Objetivo: Investigar as mudanças na prática de AF e tempo de televisão em usuários do SUS durante um período de 18 meses e o impacto do gênero e tempo nessas variáveis, assim como relacionar se a prática de AF, ou a falta dela, influência nos gastos com saúde no SUS. Métodos: Foram avaliados 198 participantes (58 homens e 140 mulheres) durante um segmento de 18 meses, as avaliações ocorreram a cada seis meses. O Nível de AF foi mensurado através do questionário de Baecke, foram realizadas medidas antropométricas e hemodinâmicas (peso, estatura, IMC, circunferência de cintura, pressão arterial), a composição corporal foi analisada pela impedância bioelétrica, foram questionados também a respeito da condição econômica e gastos com saúde. Resultados: Foi verificado que homens apresentaram maiores escores em todas as variáveis de AF de deslocamentos (caminhada [p-valor 0,013], ciclismo [p-valor 0,001] e locomoção [p-valor 0,007]) quando comparados às mulheres, mas para comportamento sedentário não houve diferença significativa. Esses resultados ratificam as consistentes diferenças na prática de AF entre homens e mulheres, as quais são suportadas por fatores socioculturais. Pessoas que acumularam maior prática de ciclismo apresentaram menores valores para IMC (p-valor= 0,03), gordura corporal (p-valor= 0,001), onde o ciclismo explicou 2,4% e 8,6% dessas mudanças, respectivamente. Custos com saúde e maior prática de ciclismo foram negativamente relacionados, onde o ciclismo foi responsável por reduzir 2% de todos custos acumulados durante o período. Conclusão: Homens são usualmente mais ativos que mulheres em diferentes comportamentos relacionados à prática de atividade física e a prática de ciclismo impactou positivamente na redução dos custos com saúde na atenção primária e indicadores de adiposidade. / The Unified Health System (SUS) is the main source of health services for the Brazilian population, where approximately 71.1% of the population use their services. The Chronic Non-communicable Diseases (DCNTs) have a significant impact on the morbidity and mortality of the population. The Physical Activity (AF) is an important resource for health promotion, control of obesity and especially for the prevention of DCNTs. Objective: To investigate changes in physical activity and sedentary behavior in users of the Brazilian National Health System during 18 months and the impact of gender and time on such variables, as well to relate whether the practice of AF, or the lack of it, influence health expenditures in the SUS. Methods: 198 participants (58 men and 140 women) were assessed. Physical activity level was assessed using the Baecke questionnaire, anthropometrical and hemodynamic measures (weight, stature, BMI, waist circumference, blood pressure) were performed, body composition was analyzed by bioelectrical impedance, were also questioned about the economic condition and health expenditures. Results: It was verified that men presented higher scores in all physical activity variables (walking [p-value 0.013], cycling [p-value 0.001] and locomotion [p-value 0.007]) when compared to women, but for sedentary behavior there was no significant difference between genders, which are supported by sociocultural factors. People who accumulated more cycling had lower values for BMI (p-value = 0.03), body fat (p-value = 0.001) where cycling explained for 2.4% and 8.6% of these changes, respectively. Costs with health and greater cycling were negatively related, where cycling was responsible for reducing 2% of all costs accumulated during the period. Conclusion: Men are usually more active than women in different domains of physical activity and changes through the time are similar between genders and cycling practice had a positive impact on the reduction of health care costs in primary care and adiposity indicators.

Thesis (MTech (Biomedical Sciences))--Cape Peninsula University of Technology, 2015. / BACKGROUND AND OBJECTIVES: Group B Streptococci (GBS) can asymptomatically colonise the vagina and rectum of women. Studies have shown that this bacterium is the leading cause of septicemia, meningitis and pneumonia in neonates. In Namibia no known studies have investigated GBS colonisation and the antibiotic resistance profile of GBS isolates in pregnant women. This study accessed the GBS colonisation rate amongst the pregnant women who attended the Windhoek Central Hospital Antenatal Clinic (Khomas region), in Namibia for a period of 13 months. Furthermore, using the VITEK 2 system, the GBS isolates were tested against the following antimicrobial substances; benzylpenicillin, ampicillin, clindamycin, erythromycin, tetracycline, vancomycin, cefotaxime, ceftriaxone, linezolid and trimethoprim/sulfamethoxazole. Penicillin G is the drug of choice in the majority of studies, and seems to be the most effective drug for intrapartum antibiotic prophylaxis (IAP). All the GBS isolates found in this study were also analysed for the presence of selected genes known to be associated with resistance to key antibiotics using specific primers within a polymerase chain reaction (PCR).