Orientadores: Fernanda Aparecida Cintra, Maria Cecília Bueno Jayme Gallani / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T19:22:34Z (GMT). No. of bitstreams: 1 Saccomann_IzabelCristinaRibeirodaSilva_D.pdf: 1907143 bytes, checksum: 3a2fea4d1cf5b3293c60f3e8257afc43 (MD5) Previous issue date: 2012 / Resumo: A Insuficiência Cardíaca (IC) representa uma das principais causas de hospitalização no cenário mundial. Vários fatores como o tratamento prolongado, o conhecimento sobre a doença e o comportamento do paciente frente à tomada de medicamentos exercem influência na adesão à terapêutica. Os programas de gerenciamento da doença revelam que a educação em saúde em portadores de IC configura-se como componente chave na adesão ao tratamento, pois contribuem para a redução das admissões hospitalares e da morbi-mortalidade, bem como para melhora da qualidade de vida relacionada à saúde (QVRS). Este estudo teve como objetivo avaliar o efeito de um Programa de Educação em Saúde na adesão medicamentosa e não medicamentosa, e na QVRS em portadores de IC, em seguimento ambulatorial. Estudo experimental, controlado e randomizado envolvendo dois grupos: intervenção e controle. A amostra constitui-se de 99 sujeitos, de ambos os sexos, com idade igual ou superior a 50 anos, com diagnóstico médico de IC. Fizeram parte do grupo controle (GC) 50 pacientes e do grupo de intervenção (GI) 49 pacientes. Foram aplicados sequencialmente os instrumentos de medida: Caracterização sociodemográfica e clínica, Escala de Adesão de Morisky, Medida da Adesão Medicamentosa, Beliefs about Medication Compliance Scale (BMCS), Beliefs about Self-monitoring Compliance (BSMCS), e Minnesota Living With Heart Failure Questionaire (LHFQ). A análise revelou que os fatores que influenciaram a adesão ao tratamento diurético foram: esquecimento, sintomas e sexo. O fator que influenciou as barreiras percebidas para adesão a auto-monitorização do peso/edema foi o controle do peso. O Programa de Educação em Saúde apresentou efeito positivo na mudança da avaliação global de adesão e nas barreiras para auto-monitorização de peso/edema que explicou 50% e 53% da variabilidade, respectivamente. Mostrou ainda efeito positivo na dimensão física e no escore total do LHFQ, que explicaram 11% e 6% da variabilidade, respectivamente. Os Programas de Educação em Saúde, com a adoção de estratégias voltadas à mudança no comportamento de autocuidado, devem ser incentivados para a compreensão do seu efeito na QVRS. Além disso, o envolvimento do paciente pode ter sido decisivo para a mudança do comportamento de adesão e para o sucesso do Programa / Abstract: Heart failure (HF) represents a major cause of hospitalization all over the world. Several factors such as prolonged treatment, knowledge about the disease and the patient's behavior about taking medication influence on adherence to therapy. Disease management programs have shown that health education in patients with HF is configured as a key component in treatment adherence, since they contribute to reducing hospital admissions and mortality and morbidity as well as to improving the health-related quality of life (HRQL). This study aimed to evaluate the effect of a program of health education in medication and non-medication adherence and in HRQL in outpatients with HF. Experimental study, controlled and randomized, involving two groups: intervention and control. The sample consisted of 99 subjects, both male and female, aged 50 years old or more with a diagnosis of HF. Fifty patients (50) took part in the control group (CG) and 49 patients in the intervention group (IG). The following measuring instruments were sequentially applied: socio demographic and clinical characterization, Morisky Adherence Scale, Measure of Medication Adherence, Beliefs about Medication Compliance Scale (BMCs), Beliefs about Self-Monitoring Compliance (BSMCS) and Minnesota Living with Heart Failure Questionnaire (LHFQ). The analysis showed that the factors which influenced adherence to diuretic treatment were: forgetfulness, symptoms and sex. The factor that influenced the perceived barriers to adherence to self-monitoring of weight/edema was weight control. The Health Education Program had a positive effect in changing the overall assessment of adherence and barriers to self-monitoring of weight/edema which explained 50% and 53% of the variability, respectively. The program also showed positive effect in the physical dimension and in the total score in the HRQL, which explained 11% and 6% of the variability, respectively. Health Education Programs, with the adoption of strategies to change the behavior in self-care, should be encouraged in order to understand their effect in the HRQL. Moreover, the involvement of the patients may have been decisive in changing their behavior and adherence to the success of the Program / Doutorado / Enfermagem / Doutor em Enfermagem

Les Accidents Vasculaires Cérébraux (AVC) sont un groupe de maladies à morbi-mortalité élevée, classés parmi les causes les plus communes de décès et de handicap acquis dans le monde. Ainsi, leur épidémiologie jouerait un rôle crucial dans la diminution de leur impact sur la population. Les pays en voie de développement sont aujourd'hui les plus responsables de l'augmentation de la fréquence de la maladie, vu que la sensibilisation des gens et l'amélioration de la prise en charge dans les pays développés a permis de contrôler à un certain degré l'incidence et la mortalité de la maladie dans ces pays. Au Liban, un pays en voie de développement du Moyen Orient, les études épidémiologiques concernant les AVC sont relativement rares, malgré que nécessaires. En effet, le pays confronte le problème de vieillissement de sa population et des taux très élevés de tabagisme, et à un moindre degré d'obésité, hypertension et diabète, comparés aux autres pays. Dans ce contexte, il fallait initier ce travail qui surligne les grands titres de l'épidémiologie des AVC au Liban. Deux études ont été conduites, l'une communautaire transversale pour estimer la prévalence des AVC et la deuxième hospitalière rétrospective pour évaluer d'une part la prévalence des sous-types et leur association aux facteurs de risque et, d'une autre part, la prise en charge précoce de la maladie. Malgré que les résultats obtenus soient peu généralisables, on pourrait dire que la prévalence estimée (5‰ [95% CI= 3.3-6.6‰]) serait liée à l'incidence élevée de la maladie (notamment des athéroscléroses des gros vaisseaux) plutôt qu'à une meilleure prise en charge des AVC en phase aiguë. Des campagnes de sensibilisation des gens au risque et symptômes des AVC surtout parmi les fumeurs aideraient à limiter l'incidence et la sévérité de la maladie. De plus, l'implantation d'unités neurovasculaires diminuerait le taux de mortalité à court terme et les handicaps à long terme. / Stroke is a group of cerebrovascular diseases with high morbidity and mortality rates, classified among the most common causes of death and acquired disability worldwide. Thus, assessing its epidemiology may play a crucial role in reducing its impact on the population. Stroke late burden is attributable to developing countries mainly, as people in developed countries have a better access to optimal care and an increased awareness of stroke symtpoms and risk factors. However, in less developed countries, where population confronts the huge impact of urbanization and globalization with a great increase in the prevalence of cardiovascular risk factors, the incidence of stroke remains high. Lebanon, a developing country of the Middle East region, lacks epidemiological data on stroke burden. Moreover, he confronts the aging problem and very high rates of smoking, and to a lesser degree of obesity, hypertension and diabetes, compared to other countries. In this context, it was necessary to initiate this work to highlight some features of the disease epidemiology in the country. Two studies were conducted, the first one was a community-based cross-sectional study to assess stroke prevalence in the country, whereas the second one was a retrospective hospital-based study to assess stroke prevalence by subtypes and associations with risk factors, and to evaluate stroke acute management in hospitals. Despite that the obtained results were not generalizable, we could state the following: The estimated prevalence of stroke (5 ‰ [95% CI= 3.3-6.6‰]) may be linked to a high incidence of the disease (especially large artery atherosclerosis) rather than a better acute stroke care. Awareness campaigns on stroke risk and symptoms especially among smokers would help limit the incidence and severity of the disease, while the establishment of stroke units may reduce short-term mortality and long term disabilities.

The first confirmation of the presence of Colletotrichum gloeosporioides Penz. on cashew in Mozambique was based on a combination of observed symptoms, isolation and identification using basic morphological and molecular techniques. Anthracnose is now the second most important in the country, after powdery mildew caused by Oidium anacardii Noack. The present thesis represents a broad overview of the disease in Mozambique. The main focus of this study was thus to gather scientific information on the relevance of this disease in the country and through experimentation, generate recommendations that help farmers and decision makers to mitigate the disease pressure. The specific objectives of this study were as follows: - Provide a distinctive description of anthracnose symptoms on leaves through hostpathogen interaction studies in the laboratory. - Enhance current knowledge on the identity of Mozambican pathogen isolates, using DNA tools. - Assess the current anthracnose management practices, both at nursery and field level with a view to formulate timely, local and adequate management strategies. - Conduct experimental trials to select economically effective fungicides spraying programs for anthracnose disease management. ii - Search for variability and germplasm tolerance among dwarf and common cashew plant populations in Mozambique. By analyzing and integrating existing published literature on the subject, we successfully separated issues that concerned previously inaccessible information from those that reflect insufficient scientific knowledge. A survey was initiated to determine, the status of cashew anthracnose disease management practices in Mozambique. Subsequently, the information obtained was used to develop a national strategic framework for research and extension in the country. Areas identified as gaps were aligned with the main goals of this thesis and include: - Areas where scientific information lacked were identified. - The symptoms of the disease on leaves were successfully and distinctively distinguished from other common leaf diseases that simultaneously occur in orchards. - The pathogen isolates were identified using PCR techniques. The presence of Colletotrichum acutatum Simmonds was not confirmed at least not among the suspected and tested isolates. - Knowledge on the epidemiology of the disease was generated and its application for more effective disease management was successfully applied. - Effective fungicide applications and disease control programmes were developed for Colletotrichum gloeosporioides Penz.. - Appropriate nursery management strategies that reduce anthracnose disease development were developed. - Variability in germplasm reaction to the disease was demonstrated and therefore tolerant and susceptible genotypes were identified. - A technique for rapid and accurate evaluation of leaf anthracnose symptom grades was developed. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Microbiology and Plant Pathology / Unrestricted

Introduction: Guinea worm disease (GWD) is a painful, disabling disease caused by the parasite dracunculus medinensis. The implementation of the global GWD eradication campaign resulted in a decrease of global burden of disease and several countries have been proclaimed free of the disease. Though, Ethiopia has implemented the GWD eradication programme since 1992 the disease remains endemic in the Gambella region. Purpose of the study: The purpose of this study was to explore the perceptions and experiences of the community of Gambella region on Guinea worm disease (GWD) eradication interventions. Methodology: A qualitative study paradigm with a phenomenological research design was employed to collect data using focus group discussions, in-depth individual interviews, document reviews, and observations. The study participants were determined by purposive sampling. Qualitative data analysis involved transcription, data entry, and management of verbal information followed by coding, categorizing into themes. Interpretation of the data was done using triangulation methodology with appropriate mechanisms for validity and trustworthiness. Result: The study found that there are gaps in the perceptions and understanding of the community and programme implementers about the achievement and application of the various interventions on the eradication of Guinea worm disease. Health education programme was not fine-tuned to the eradication of GWD by community participation. Community perception was not at the required level for the eradication of GWD due to the low success of the educational intervention. Conclusion: continuous health education targeting the community with clear objectives of helping to eradicate GWD was found to be limited in its coverage. In addition, provision of water filters necessary for GWD eradication was inadequate. Moreover, the community did not have clear understanding of the causes of GWD and its eradication strategy. It is hoped that the findings of this study would contribute significantly to the GWEP in Gambella region, as well as elsewhere where GWD may be endemic / Health Studies / M.A. (Public Health)

Purpose: To describe the experience of managing relapsing-remitting multiple sclerosis among adult women users of injectable disease modifying drugs, including day-to-day management, medication beliefs, and health care provider influence. Rationale/Significance of the study:Approximately 85% of the 400,000 Americans with multiple sclerosis have relapsing-remitting multiple sclerosis (RRMS), characterized by unpredictable relapses and partial or full remissions of neurological symptoms. Untreated, RRMS may progress to permanent, irreversible disability and decreased quality of life. Current guidelines recommend immediate and sustained treatment with injectable disease modifying drugs (DMDs). However, despite pronounced modest benefits, approximately 30%-62% of patients are not undergoing DMD therapy. A small number of quantitative studies have identified factors that predict adherence to injectable DMDs. However, little is known about injectable DMDs from patients’ perspectives. It is important to develop an understanding of the experience of managing RRMS among adult users of injectable DMDs in order for health care providers to provide ongoing education, counseling, and support. Organizing Framework:The framework, Beliefs About Medicines, was used to guide the study. Design: Qualitative descriptive design. Setting: Data were collected from adult women with RRMS who received care from an MS clinic, a neurology practice, and through snowball sampling. Sample: Purposive and theoretical sampling was used to recruit 32 women with RRMS. Maximum variation sampling ensured the appropriate breadth and depth of experiences. Women currently undergoing injectable DMD therapy (n = 25), as well as women who either discontinued (n = 6), or never used (n = 1) injectable DMDs were interviewed. Methods: A qualitative descriptive design was utilized. Verification occurred through trustworthiness of data, including rich, thick description from qualitative interviews; field notes and memoing; and member checks. Simultaneous data collection, analysis, and interpretation facilitated interview revision in order to elicit or expand emerging themes. Content analysis inductively derived themes and patterns within and across categories. Participant quotes substantiated particular themes. Confirmability of the data analysis process was undertaken in consultation with the research advisor. Implications: Findings elucidated adult women’s subjective experiences concerning management of RRMS among users of DMDs, including day-to-day management, medication beliefs, and health care provider influence. Results from this study can be used to educate, counsel, and support women in the management of RRMS.

Chronic conditions are public health threats. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based disease management program that addresses personal self-management of chronic conditions. The CDSMP involves peer trainers who instruct and assist with chronic disease preventive measures. Although disease management demonstrates promise to improving patient self-maintenance, previous researchers have not evaluated how the program affects program leaders. The purpose of this study was to discover how self-help leaders feel about the CDSM program. The overarching research question asked about perspectives that self-help leaders had toward the program. Through a narrative qualitative approach, the perceptions of peer leaders were examined to determine if the program was personally beneficial. Guided by the social cognitive theory, a purposeful convenience sample of 20 participants completed the study. The participants were practicing peer trainers in the CDSMP program. Data analysis included hand coding using open and axial coding and content analysis. Study findings included themes surrounding how the CDSMP program benefits health in general as well as the management of facilitators' own chronic diseases, health behaviors, and increased quality of life. The ability for chronic disease management leaders to experience positive effects of the program they administer may result in positive social change. This awareness can positively affect social change by enhancing an already established evidence-based community health program with stronger and better-equipped leaders.

Federal support and funding for human embryonic stem cell (hESC) research in the United States lags behind stem cell programs in many countries because of the divisive debate over hESC research and the continually evolving federal policies that have hindered research efforts. The purpose of this phenomenological study was to explore the perceptions of stem cell researchers, stakeholders, and investors in the United States about the effects of the current federal stem cell policy on stem cell research in the United States, the moral disagreement with stem cell research, and their recommendations to improve stem cell research policy in the United States. Rogers's diffusion of innovation theory and Kingdon's agenda-setting theory served as the theoretical frameworks for this study. Data were collected through telephonic semistructured interviews with a snowball sample of 21 participants. Data were analyzed using Attride-Stirling's 6 steps of thematic coding. Findings indicated the need to educate laypersons and legislators, involve the public in the stem cell research policy debate, increase federal funding, and exclude religious considerations from political discussions. The implications for positive social change are directed at stem cell policymakers to focus attention and resources on creating a cohesive federal hESC funding policy to ensure that stem cell research improves in the United States with the goal of developing treatments for conditions that are currently untreatable.

Macrophomina phaseolina (Mp) and Fusarium oxysporum f. sp. fragariae (Fof) are emerging soilborne pathogens causing crown rot and Fusarium wilt, respectively, in commercial strawberry production in California. Fungicides representing eight active ingredients from four different mode of action groups (FRAC groups 1, 3, 7 and 12) were evaluated for their efficacy against each pathogen in vitro and each disease in planta. Fungicide active ingredients were evaluated for their ability to inhibit mycelial growth of both pathogens in vitro. Half-strength potato dextrose agar was amended with six different concentrations (0.01, 0.1, 1.0, 5.0, 10, 50 µg a.i./ml) of seven fungicides in FRAC groups 3, 7 and 12. Concentrations that inhibited fungal growth by 75% (EC75) compared to unamended media were determined for two different isolates each of Mp and Fof and were used to determine fungicide rates for subsequent in planta studies. Tebuconazole strongly inhibited the mycelial growth of both pathogens (average EC75 for Mp was 2.4 ppm; average EC75 for Fof was 7.48 ppm), as did metconazole (average EC75 for Mp was2.53 ppm; average EC75 for Fof was 1.28 ppm). Fludioxonil strongly inhibited mycelial growth of Mp, but had no impact on the growth of Fof. Penthiopyrad, fluopyram, flutriafol, and flutolanil were less effective at inhibiting fungal growth of either fungus. Greenhouse in planta studies evaluated twenty-four fungicide treatments (eight fungicides at low, med and high rates) that were drench applied to infested potting media two days prior to planting of pathogen susceptible strawberry cultivars (San Andreas for Mp and Monterey for Fof) and again at day 21. Controls were a non-inoculated and an inoculated water-drench treatment. Buried inoculum was recovered at days 2 and 23 and plated on selective media for colony forming unit (CFU) quantification. Plant disease assessments were made each week for 11 weeks. An analysis of variance (ANOVA) of CFUs revealed no significant differences (p > 0.05) among treatments and when compared to the non-treated control for both Mp and Fof, but showed significant decreases (p < 0.05) in CFUs between weeks 1 and 3 for both Mp and Fof. An ANOVA for disease assessments in the form of area under the disease progress curve (AUDPC) showed significant decreases of disease severity in treatments with penthiopyrad only (low, medium and high rates) (p < 0.05). There were no significant differences (p > 0.05) in AUDPC among treatments and when compared to the non-inoculated and no-fungicide controls for Fof. The data indicates that these fungicides used alone are not effective against these pathogens in planta. A strawberry plant extract (germination stimulant) was assessed for its ability to stimulate germination of Mp microsclerotia in vitro and in planta. The germination stimulant was applied as a drench at six different concentrations (0, 10, 100, 1,000, 10,000 and 30,000 ppm) to soil containing filter disk packets of microsclerotia of Mp at day 0 and 14. Filter disk packets were retrieved three days after the drench and microsclerotia were observed microscopically for germination. Results showed that the number of germinating microsclerotia was significantly higher after the application of the germination stimulant compared to non-drench and 0 ppm controls (p < 0.001). An integrated container trial was also conducted using the germination stimulant at 10,000 ppm applied three days prior to a fungicide drench with tebuconazole or thiophanate-methyl to determine the effect of fungicides on the germinated microscleotia. The use of the germination stimulant with label rates of the fungicides lowered the number of germinated intact microsclerotia significantly (p < 0.001) especially after two drench applications. The use of the germination stimulant with fungicides could be investigated further as one method for controlling soilborne diseases of strawberry.

Bakgrund  Över 50 miljoner människor världen över lever med epilepsi vilket gör det till en av världens vanligaste neurologiska sjukdomar. I Sverige lever cirka 81 000 personer med sjukdomen, däribland lika delar män som kvinnor. Varje år diagnostiseras ungefär 4 500 vuxna och 1 500 barn. Att ha epilepsi innebär ofta fysiska, men också psykologiska och sociala konsekvenser. Det finns fördomar och socialt stigma mot personer med epilepsi vilket kan påverka deras välmående. Hälsa och samspel mellan kvinnligt könshormon och epilepsin gör att kvinnor kan tänkas uppleva särskilt unika utmaningar. Syfte Syftet var att undersöka ungdomar och vuxnas upplevelser av att leva med epilepsi i vardagen. Metod  Studien är en icke-systematisk litteraturöversikt som baserades på 13 vetenskapliga kvalitativa originalartiklar. Databaserna Pubmed och Cinahl användes för datainsamling och datan bearbetades med integrerad analys av båda författare. Resultat  Bredden av resultatet visar på hur sjukdomen påverkar livets olika aspekter för personer med epilepsi, där anfallsoförutsägbarhet och de konsekvenser som den får, det ansvar som det innebär att själv hantera sin sjukdom, hur personen blir bemött i samhället och vilka möjligheter personen har i arbetslivet är centralt för den generella upplevelsen av hur det är att leva med epilepsi. Personer med epilepsi i låginkomstländer är särskilt utsatta för stigmatisering och utanförskap vilket får en multifaktoriell påverkan på deras välmående och förutsättningar i livet. Slutsats  Personer med epilepsi möter utmaningar vilket drabbar såväl den fysiska som mentala hälsan. Därtill förstärker okunskap och stigma i samhället svårigheterna för personer med epilepsi att ta sig fram i det dagliga livet. Det verkar också finnas skillnader i förutsättningar till hälsa för personer med epilepsi i låg- och höginkomstländer. Resultatet ger en ökad förståelse för hur det är att leva med epilepsi och hur personer med epilepsi behöver bli bemötta och stöttas från vården. / Background Over 50 million people worldwide live with epilepsy, making it one of the world's most common neurological diseases. In Sweden, approximately 81,000 people live with the disease, including an equal number of men and women. Each year approximately 4,500 adults and 1,500 children are diagnosed. Having epilepsy often involves physical, but also psychological and social consequences. There is prejudice and social stigma against people with epilepsy which can affect their well-being. Health and the interplay between female sex hormones and epilepsy means that women may experience particularly unique challenges. Aim The aim of this study was to examine the experience of adolescents and adults of living with epilepsy in everyday life. Method This study is a non-systematic literature review that was based on 13 original, qualitative scientific articles. The databases Pubmed and CINAHL were used for data collection and the data were processed with integrative analysis by both authors. Results The width of the results show how the disease affects the different aspects of life for people with epilepsy, where the unpredictability of seizures and the consequences it has, the responsibility it entails to manage one's own disease, how the person is treated in society and what opportunities the person has in working life are central to the general experience of what it is like to live with epilepsy. People with epilepsy in low-income countries are particularly exposed to stigmatization and social exclusion, which has a multifactorial impact on their well-being and conditions in life. Conclusions People with epilepsy face challenges which affect both physical and mental health. In addition, ignorance and stigma in society increase the difficulties for people with epilepsy to get by in daily life. There also seem to be differences in the health conditions for people with epilepsy in low- and high-income countries. The result provides an increased understanding of what it is like to live with epilepsy and how people with epilepsy need to be treated and supported by healthcare.

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