Made available in DSpace on 2016-03-15T19:40:26Z (GMT). No. of bitstreams: 1 Sabrina Helena Bandini Ribeiro.pdf: 1303394 bytes, checksum: 3a8cdbfd1b0402b1d1f30c8f17251513 (MD5) Previous issue date: 2007-08-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Pervasive Developmental Disorders (PDD) are characterized by impairments in reciprocal social interaction, language, and communication and by the presence of repetitive and stereotypic patterns of behavior and interests. The prevalence of PDD has increased in recent years; currently frequencies are 30 to 60 per 10,000. There are no epidemiological studies of PDD prevalence in developing countries. The aim of this study was to verify the feasibility of our approach and of the protocol for a PDD prevalence study in Atibaia. It also describes the PDD prevalence found. Methods: To develop this pilot study, it was selected one urban neighborhood with 1470 children, ages 7 to 12. All the PDD services, all public schools in this neighborhood and the PSF team were identified and special meetings were organized with lectures and discussions about PDD. 99 children were indicated; 76 suspects cases between 07 to 12 years old children were evaluated. All suspected cases were evaluated based on PDD (ASQ) and mental health (SDQ and SRQ) screenings. Results: A PDD prevalence of 0.88% was found, with ratio of males to female 3:1. Conclusion: This is the first study reporting the prevalence of PDD in Latin American countries. The prevalence rates found was similar with others studies, although up to this moment, only the screening phase was done. It was important to use multiple informant sources. / Os Transtornos Invasivos do Desenvolvimento (TID) são caracterizados por uma tríade de comprometimentos em três áreas do desenvolvimento: interação social, comunicação e comportamentos restritos e estereotipados. Estudos epidemiológicos dos TIDs ao redor do mundo apontam um aumento do número de casos a partir da década de 90, sendo as taxas atualmente consideradas entre 30 a 60 para 10000. Não existem estudos de prevalência dos TIDs em países em desenvolvimento. O Objetivo deste trabalho foi testar a viabilidade metodológica de um estudo piloto de prevalência de TIDs e analisar a taxa de prevalência encontrada. Método: Foi eleito um bairro representativo da cidade, com 1470 crianças entre 7 e 12 anos. Todos os serviços de referência da cidade, as escolas do bairro e as equipes do PSF receberam orientações por meio de palestras e guidelines. Um total de 99 crianças foram indicadas; 76 crianças foram avaliadas com suspeita para TID. Foram aplicados questionários de rastreamento para TID (ASQ) e para saúde mental (SDQ e SRQ). Resultados: A prevalência de TID encontrada neste estudo foi de 0,88 %, com uma razão de 3:1 meninos para cada menina. Conclusão: Este é o primeiro estudo de prevalência de TID na América Latina. Apenas a fase de triagem dos casos foi realizada, os dados encontrados corroboram com os estudos de prevalência publicados. Observou-se a importância da utilização de várias fontes de informação para a busca dos casos.

Introdução: O monitoramento da qualidade da dieta tem sido utilizado para nortear e avaliar políticas públicas nos países desenvolvidos, enquanto que, no Brasil, são poucas as pesquisas epidemiológicas com esta característica. Objetivo: Monitorar a qualidade da dieta e seus fatores associados em residentes do município de São Paulo em 2003 e 2008. Métodos: Estudo transversal de base populacional de uma amostra de 2376 indivíduos coletados em 2003 e 1662 indivíduos coletados em 2008, de ambos os sexos, com idade de 12 anos ou mais, incluídos no Inquérito de Saúde de São Paulo, ISA-Capital. A amostragem é probabilística em dois estágios: setor censitário e domicílio. Características da população foram obtidas por meio de questionário e o consumo alimentar pelo Método Recordatório de 24 horas. A qualidade da dieta foi avaliada por meio do Índice de Qualidade da Dieta Revisado (IQD-R) de acordo com a realidade local segundo as diretrizes do Guia Alimentar para a População Brasileira e, posteriormente, avaliado. As médias dos escores do IQD-R foram comparadas segundo grupo etário e ano de estudo por meio do teste de Wald. A relação entre o escore do IQD-R e as variáveis socioeconômicas, demográficas, antropométricas e de estilo de vida foi verificada utilizando a análise de regressão linear múltipla, sendo realizada uma modelagem para cada ano de estudo (ISA 2003 e 2008). Resultados: A média do IQD-R em cinco anos apresentou melhora (IQD-R= 54,9 vs 56,4, p<0,005). Porém, os adolescentes apresentaram piora na qualidade da dieta, influenciada pela diminuição na pontuação dos componentes vegetais verde-escuros e alaranjados e leguminosas, cereais totais, óleos e Gord_AA. Para os adultos e idosos, a qualidade da dieta melhorou, influenciada pelo aumento na pontuação dos componentes frutas totais e frutas integrais, gordura saturada e sódio. No ano de 2008, ser adulto, em média, aumentou o escore do IQD-R em 6,1 pontos em relação aos adolescentes; já para os idosos esta diferença foi de 11,3 pontos. Conclusão: O Índice mostrou-se capaz de detectar alterações na qualidade da dieta da população ao longo do tempo, trazendo evidências da urgente necessidade do direcionamento das ações para melhoria da qualidade da dieta dos brasileiros em todas as classes de renda, priorizando os adolescentes para prevenção de futuras doenças crônicas / Introduction: The monitoring of diet quality has been used as a guide to evaluate public policies in developed countries, but in Brazil there are few epidemiological researches with such characteristics. Objective: To monitor the diet quality and the associated factors of residents from the city of São Paulo in the years of 2003 and 2008. Methods: Cross-sectional population-based survey of a sample with 2376 individuals collected in 2003, and another sample with 1662 individuals collected in 2008. The individuals were from both sexes, 12 years of age or older and were part of the Health Survey of São Paulo, ISA-Capital. Sampling is probabilistic in two stages: census tract and households. The population characteristics were obtained through a questionnaire, and the food intake was obtained using the 24 Hour Recall Method. Diet quality was assessed using the Brazilian Healthy Eating Index Revised (BHEI-R), taking into consideration the reality of the area according to the Dietary Guidelines for the Brazilian Population, and later, it was evaluated. The means of the BHEI-R scores were compared according to age group and school years by means of the Wald test. The relation between the BHEI-R scores and the socioeconomic, demographic, anthropometric and lifestyle variables was verified using the multiple linear regression analysis, with a model for each year of the study (ISA 2003 and 2008). Results: The BHEI-R mean showed improvement over the period of five years (BHEI-R =54.9 vs 56.4, p<0.005). However, the adolescent group showed worsening in diet quality, influenced by decrease in scores of dark-green and orange vegetable and legumes, total grain, oils and SoFAAS components. Diet quality of adults and elderly showed improvement, influenced by the increase in scores of total fruit and whole fruit, saturated fat and sodium. In the year of 2008, being an adult increased by 6.1 points, on average, the BHEI-R scores when compared to adolescents. For the elderly this difference was of 11.3 points. Conclusion: The index showed itself effective in detecting changes in diet quality of the population over a period of time. It brings up evidences of the urgent need in directing actions for improving Brazilian diet quality for all social classes, focusing on adolescents, in order for preventing future chronic diseases

Orientadores: Maria Isabel Pedreira de Freitas, Carlos Emílio Levy / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-25T22:17:35Z (GMT). No. of bitstreams: 1 Vilas-Boas_VanessaAparecida_D.pdf: 3742241 bytes, checksum: 6d49ce98c3aba54d7cae1f702dacd78d (MD5) Previous issue date: 2014 / Resumo: Introdução: Instrumentos cirúrgicos utilizados em cirurgias minimamente invasivas podem oferecer risco de infecção cruzada. Identificar sua fonte de contaminação contribui para prevenção de infecção e prestação do cuidado com qualidade e segurança. Contudo, a infecção de sítio cirúrgico é complexa, multifatorial e pode ser subnotificada se não houver programa de vigilância pós-alta efetivo. Objetivos: avaliar a relação entre carga microbiana de trocartes e microbiota da paciente, bem como a ocorrência de infecção de sítio cirúrgico após laparoscopia ginecológica; validar um instrumento de vigilância pós-alta por contato telefônico para cirurgias vídeo-assistidas. Método: estudo realizado em hospital público especializado em saúde da mulher. Fase I - estudo longitudinal prospectivo, 2011-2012, no qual amostras da microbiota da paciente foram coletadas no dia da internação por esfregaço com zaragatoa nas regiões da pele, ponto de McBurney esquerdo, cicatriz umbilical e fundo de saco vaginal. Após laparoscopia, trocartes foram coletados com técnica asséptica, obtendo-se o lavado microbiológico por adição de água destilada estéril e agitação, filtrados por membrana. As amostras foram incubadas para análise microbiológica. Após alta hospitalar, realizou-se vigilância por retorno ambulatorial e por contato telefônico. Realizada análise descritiva dos dados e aplicação dos testes de concordância de Kappa e Mc Nemar com nível de significância de 5%. Fase II - desenvolvida em duas etapas, a primeira 2011-2012, estudo metodológico com elaboração do instrumento de vigilância pós-alta por contato telefônico, para investigação de sinais e sintomas de infecção de sítio cirúrgico, seguida pela validação por peritos. O instrumento foi avaliado por cinco peritos quanto à pertinência, clareza e abrangência do conteúdo. A validação foi feita analisando-se a porcentagem de concordância entre peritos, sendo válidas as questões que obtiveram 80% de concordância. A segunda etapa, 2013, estudo transversal com aplicação do instrumento validado a pacientes submetidas aos procedimentos de histeroscopia e/ou laparoscopia ginecológica. Os dados foram analisados por estatística descritiva. Resultados: Fase I - a amostra foi composta por 24 pacientes, 68 esfregaços e 52 trocartes. Nos esfregaços encontrou-se predomínio de microbiota de pele Gram-positiva, mas também foram isoladas Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, dentre outros. Trocartes de 5 mm apresentaram crescimento bacteriano em 33,3% dos casos, com carga microbiana de 0-6 UFC. Trocartes de 10 mm apresentaram crescimento em 29,2%, com carga microbiana de 0-366 UFC. Observou-se grau de concordância pobre na comparação entre trocartes e microbiota da paciente (Kappa= 0,05; p= 0,08), exceto para Staphylococcus spp (p< 0,0001) e Corynebacterium spp (p= 0,0002). Não houve infecção decorrente da laparoscopia. Fase II - houve discordância entre peritos na primeira avaliação, o instrumento foi reformulado obtendo-se concordância na segunda avaliação. A amostra foi composta por 68 pacientes, sendo o contato telefônico possível em 86,36% dos casos. Queixas de dor abdominal, sangramento e edema incisional foram mais frequentes. Nenhuma apresentou infecção. Conclusão: Este estudo encontrou baixa contaminação nos trocartes, com a maioria das bactérias pertencentes à microbiota de pele da paciente sugerindo ser esta, sua principal fonte de contaminação. O questionário de vigilância pós-alta para cirurgias vídeo-assistidas foi validado, aplicado e encontra-se disponível para utilização / Abstract: Background: Surgical instruments used in minimally invasive surgery may offer risk of cross infection. Identify its source of contamination contributes to infection prevention and provision of quality and safety care. However, surgical site infection is complex, multifactorial and may be underreported if there is no post-discharge surveillance effective program. Aim: To evaluate the relationship between microbial load of trocars and patient flora as well as the occurrence of surgical site infection after gynecological laparoscopy; validate an instrument of post-discharge surveillance by telephone for video-assisted surgery. Method: study developed in public hospital specializing in women's health. Phase I - longitudinal prospective study, 2011-2012, in which the patient flora samples were collected with swabs the skin regions, left McBurney's point, umbilicus and vaginal fornix, on day of the admission. After the laparoscopy, trocars were collected using sterile technique, obtaining microbiological wash by addition of sterile distilled water and stirring, filtered through the membrane. The samples were incubated for microbiological analysis. After discharge, patients were followed up by outpatient and telephone call. Descriptive statistics, Kappa coefficient and McNemar¿s test were applied with significance level of 5%. Phase II - two stages, the first 2011-2012, methodological study with development of the post-discharge surveillance instrument for investigation of signs and symptoms of surgical site infection by telephone, addied with validation by experts. The instrument was evaluated by five experts on the relevance, clarity and completeness of contents. The validation was performed by analyzing the percentage of agreement among experts being considered valid the questions that have obtained 80% agreement. The second stage, in 2013, was a cross-sectional study with application of validated instrument to patients undergoing to hysteroscopy or gynecological laparoscopy. Data were analyzed using descriptive statistics. Results: Phase I - The sample consisted of 24 patients, 68 swabs and 52 trocars. In smears by swab there was a predominance of Gram-positive skin flora, but were also isolated Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, among others. The 5 mm trocars presented bacterial growth in 33.3% of cases with microbial load of 0-6 CFU. The 10 mm trocars presented bacterial growth in 29.2% with microbial load of 0-366 CFU. Noted poor agreement degree when comparing trocars and patient flora (Kappa= 0.05, p= 0.08), except for Staphylococcus spp (p<0.0001), and Corynebacterium spp (p= 0.0002). There was no infection resulting from laparoscopy. Phase II - there was disagreement among experts in the first evaluation, the instrument was redesigned obtaining agreement in the second evaluation. The sample consisted of 68 patients being telephone call possible in 86.36% of cases. Complaints of abdominal pain, bleeding and incisional edema were more frequent. No patient had infection. Conclusion: This study found low contamination in trocars, with most of the bacteria belonging to patient skin flora, their main source of contamination. The instrument of post-discharge surveillance for video-assisted surgery has been validated, implemented and is available for use / Doutorado / Enfermagem e Trabalho / Doutora em Ciências da Saúde

L’infection par le virus du Chikungunya est devenu en quelques années un problème de santé publique. D’abord limitée dans les régions tropicales et subtropicales, la diffusion mondiale du vecteur de l’infection couplée à la migration humaine et aux adaptations du virus contribue à la survenue de phénomènes épidémiques fréquents et touchant de nombreux territoires jusqu’aux pays tempérés. Dans les prochaines décades, la population des 65 ans ou plus sera probablement largement impactée lors des épidémies. Les conséquences de la maladie dans cette population est méconnu du fait de l’absence de données d’observation disponibles. Or, les spécificités de cette population sont connues (risque de comorbidité associée, immunosenescence, modifications physiologiques affectant le système rénal, cardiaque, pulmonaire…) et influencent fortement son mode de réponse et sa capacité à supporter un épisode infectieux. A travers l’observation et le suivi de la cohorte ChikOld constituée de 687 sujets âgés de 65 ans ou plus ayant contracté ou non la maladie en 2014, nous avons mis en évidence que les outils d’aide au diagnostic élaborés dans une population d’adultes jeunes avaient des performances médiocres dans la population âgée. Nous avons également pu mettre en évidence que les tableaux cliniques habituellement décrits de la maladie ne sont pas ceux observés le plus fréquemment dans une population de sujets de 65 ans ou plus. Ces observations ont abouti à l’élaboration un outil d’aide au diagnostic (score) spécifique à cette population. De nombreuses questions subsistent concernant cette infection, notamment sur les conséquences à moyen et long terme, sachant les conséquences en phase aiguë et l’existence de formes chroniques. Une étude préliminaire que nous avons conduit suggère l’absence de surmortalité à moyen terme (un an) et la majoration de la dépendance dans les suites d’une infection par le virus du Chikungunya. D’autres travaux seront nécessaires pour caractériser la forme habituelle de la maladie chez les sujets âgés ainsi que pour mieux appréhender les conséquences à moyen et long terme concernant la mortalité et la dépendance. / Chikungunya virus infection is an emergent arthropod-borne alpha-virus transmitted by mosquito bites, and causes fever with debilitating arthritic illness. Chikungunya virus infection is still considered as an emerging public health problem in both tropical and temperate regions. The presence of favourable conditions in temperate regions has enabled propagation of the vector, leading to the emergence of the first autochthonous cases of CHIKV in Europe and the USA. Older people may be particularly concerned about infection during an outbreak. CVhikungunya virus infection prevalence rates are not fully known, and vary from 18% to 48% The use of predictive scores would thus be very helpful in this situation. We have showed that predictive scores developed in young population have poor diagnostic performances in elderly population. In fact, the populations described in observational studies of chikungunya virus infection were predominantly young subjects. Clinical and epidemiological data in older subjects (aged 65 and over) are sparse. The mortality and morbidity related to infection in elderly people is poorly documented. We showed that the usual clinical expression of CHIKV infection is different in elderly subjects (absence of fever, arthralgia or both). We have developed and validated a new Chikungunya virus infection screening score specifically for use in the aged population.Some questions remain, in particular concerning mid- or long-term consequences of infection in elderly people. In a preliminary study, we have showed that the mid-term mortality rate of aged people infected by Chikungunya was lower than that of uninfected aged people.We need to continue our work on this thematic to explore more precisely the consequences of chikungunya virus infection in elderly people (mid- and long-term mortality, loss of autonomy, chronic form…).

La leptospirose est une zoonose bactérienne due à des Spirochètes du genre Leptospira. Elle est classée dans le groupe des maladies ré émergentes en raison du réchauffement climatique par l'OMS. Elle peut atteindre tous les mammifères et notamment l'Homme. On recense environ tous les ans 500 000 cas graves humains (c'est-à-dire ayant nécessité une hospitalisation) mais les difficultés du diagnostic laissent à penser que ce chiffre est sous évalué. La France métropolitaine est le pays d'Europe où le nombre de cas déclarés est le plus important (environ 300 / an). La contamination se produit après à un contact direct ou indirect d'une plaie ou de muqueuses saines avec les urines d'un animal infecté. Les hôtes peuvent être séparés en réservoirs, porteurs sains, et animaux malades ; les Rongeurs forment le réservoir le plus connu mais des représentants d'autres ordres de Mammifères, tels les Insectivores ou les Chiroptères, peuvent aussi jouer ce rôle. Le Ragondin (Myocastor coypus) est un grand Rongeur aquatique originaire d'Amérique du Sud qui a maintenant colonisé la quasi-totalité du territoire français. Cette espèce a été identifiée comme un porteur rénal potentiel de leptospires pathogènes en France au début des années 2000. Notre étude a été orientée suivant deux axes de travail. Tout d'abord un suivi de la contamination par les leptospires pathogènes de deux populations de Ragondin dans des zones humides de l'est de la France. Au cours de cette partie, nous nous sommes intéressés à la prévalence sérologique et à la prévalence du portage rénal dans chacune des populations. Cette étude a été complétée par une estimation de l'état général des animaux au cours d'autopsies détaillées et de l'évaluation histologique des reins afin de déterminer quel pouvait être l'impact, dans cette espèce, de l'infection par des leptospires pathogènes. Ces derniers résultats nous ont permis de clarifier, en partie, le rôle du Ragondin dans le cycle épidémiologique de la maladie. Dans un second axe, nous avons développé un outil permettant le suivi de la contamination des eaux environnementales par les leptospires pathogènes / Leptospirosis is one of the most prevalent bacterial zoonosis. It is caused by Spirochetes of the Leptospira genus and affects all mammals. The WHO considers it as a re emerging disease because of global warming. About 500 000 severe human cases are recognized worldwide but the incidence is probably under evaluated because of the diagnosis difficulties. Metropolitan France is the most affected European country with about 300 human cases declared per year. Infection results from exposure to infected urines of carrier animals, either directly or indirectly via contaminated environment. Animal hosts can be classified as reservoir hosts, healthy carriers or accidental hosts that suffer from the disease. Rodents are well known reservoir hosts but other mammals, as Insectivorous or Chiropters, can also be reservoirs for pathogenic leptospires. The nutria (Myocastor coypus) is a large aquatic rodent originating from South America. The species is now settled throughout France and it has been identified as a potential carrier of leptospirosis in 2001 in Western France. This work had two major goals. Firstly, we studied the contamination of two coypus’ populations by pathogenic leptospires. In this part we determined the serological prevalence and the prevalence of kidney carriage in both populations. Simultaneously, detailed necropsy and kidney histology were performed in order to characterize the impact of leptospirosis infection in this species and thus to clarify the role of the coypu in the epidemiological cycle of leptospirosis. Secondly, we developed a tool to detect and quantify pathogenic leptospires in environmental water that can be used in water quality surveillance program

Bien que considérées comme étant sous contrôle durant la seconde partie du 20ième siècle avec la découverte des antimicrobiens, les maladies infectieuses demeurent une menace bien réelle pour l’humanité. Quelque soit l’état de connaissance que nous avons sur ces maladies, toutes demeurent imprédictibles. Afin de lutter contre ce phénomène, de nombreuses stratégies de surveillance ont été développées amenant à la mise en place de divers outils informatiques de surveillance épidémiologique visant à détecter et identifier, le plus précocement possible, des événements anormaux. L’objectif initial de notre travail a consisté à mettre en place, au sein de l’Institut Hospitalo-Universitaire Méditerranée Infection et à partir du logiciel Microsoft Excel, deux nouveaux outils informatiques de surveillance épidémiologique visant à identifier, de façon hebdomadaire et automatisée, des événements anormaux sur la base des données de microbiologie clinique issues du laboratoire du Centre Hospitalo-Universitaire Timone à l’Assistance Publique- Hôpitaux de Marseille (AP-HM). Une fois cette étape achevée, nous avons par la suite travaillé au développement d’une structure de surveillance complète intégrant l’investigation et la validation des alarmes émises par les systèmes de surveillance créés, l’émission d’alertes à l’Agence Régionale de Santé (ARS) de la région Provence-Alpes Côte d’Azur (PACA), la valorisation des cas d’événements anormaux confirmés par des publications scientifiques, ainsi que la mise en place de rétro-informations et de bulletins épidémiologiques hebdomadaires visant à informer les acteurs locaux de la surveillance épidémiologique des maladies infectieuses. / Although considered under control in the second half of the 20th century with the discovery of antimicrobials, infectious diseases remain a serious threat to humanity. Regardless of the state of knowledge we possess on these diseases, all remained unpredictable. To fight this phenomenon, many monitoring strategies have been developed leading to the implementation of various epidemiological surveillance computer programs to detect and identify, as soon as possible, abnormal events including epidemic phenomena. The initial objective of our work was to implement, within the Hospitalo-Universitaire Méditerranée Infection and based on the Microsoft Excel software, two new automated computer-based programs for the weekly automated epidemiological surveillance of abnormal epidemic events using clinical microbiological data from the Timone teaching hospital of of Assistance Publique- Hôpitaux de Marseille (AP-HM). Once completed, we then worked to develop a comprehensive monitoring structure incorporating the investigation and the validation of alarms emitted by the established surveillance systems, the transmission of alerts to the Regional Health Agency (ARS) of the Provence-Alpes Côte d'Azur (PACA), the public dissemination of confirmed abnormal events by publishing scientific articles, and the implementation of feedback and weekly epidemiological bulletins to inform local infectious diseases epidemiological surveillance actors.

Submitted by Gabriela Lopes (gmachadolopesufpel@gmail.com) on 2018-11-20T12:22:41Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao PNPMF_EduardoRSM.pdf: 3987157 bytes, checksum: 2b0502c26f9d26a493b6a69304ae9cf2 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-11-23T18:41:40Z (GMT) No. of bitstreams: 2 Dissertacao PNPMF_EduardoRSM.pdf: 3987157 bytes, checksum: 2b0502c26f9d26a493b6a69304ae9cf2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-11-23T18:41:40Z (GMT). No. of bitstreams: 2 Dissertacao PNPMF_EduardoRSM.pdf: 3987157 bytes, checksum: 2b0502c26f9d26a493b6a69304ae9cf2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-07-25 / Sob a orientação da Política Nacional de Plantas Medicinais e Medicamentos Fitoterápicos (PNPMF), marco legal para a utilização das plantas medicinais no Sistema Único de Saúde, a academia vem desenvolvendo pesquisas sobre as plantas medicinais para dar suporte e base científica às diretrizes da PNPMF. No geral a produção acadêmica neste segmento acompanha movimentos e tendências de interesse da sociedade ao longo dos 12 anos da PNPMF. Neste período, diversas iniciativas vêm ocorrendo no sentido de efetivar a PNPMF nos municípios. O estudo destas experiências e iniciativas pode amparar e corrigir os rumos dos atores sociais que agem movidos pelas diretrizes desta política. Devido à complexidade do processo, não há fórmula que possa definir o rumo e as ações, sendo estas específicas de cada município de acordo com sua realidade. Há uma lacuna na produção científica em estudos de caso sobre os métodos e estratégias utilizados pelos atores sociais nestas experiências e no dimensionamento da produção de plantas para atender à população do município. Neste contexto, este estudo de caso acompanhou as ações e metodologias empregadas pelos atores sociais para inserção de plantas medicinais no SUS do município de Turuçu-RS, com a participação dos agricultores familiares na cadeia produtiva. Os resultados obtidos permitem concluir que a cadeia produtiva curta e descentralizada, e o perfil epidemiológico como método para seleção de plantas medicinais foram adequados para estruturar e dimensionar a produção de drogas vegetais para o município de Turuçu. / Under the guidance of the National Policy of Medicinal Plants and Phytotherapeutic Medicines (PNPMF), legal framework for the use of medicinal plants in the Unified Health System, the academy has been developing research on medicinal plants to provide support and scientific basis to PNPMF guidelines. In general, the academic production in this segment accompanies movements and tendencies of interest of society throughout the 12 years of PNPMF. During this period, several initiatives have been taking place in order to implement PNPMF in the municipalities. The study of these experiences and initiatives can support and correct the course of the social actors who act by the guidelines of this policy. Due to the complexity of the process, there is no formula that can define the direction and the actions, being these specific of each municipality according to its reality. There is a gap in scientific production in case studies on the methods and strategies used by social actors in these experiments and in the design of plant production to meet the population of the municipality. In this context, this case study followed the actions and methodologies used by social actors to insert medicinal plants into SUS in the municipality of Turuçu-RS, with the participation of family farmers in the production chain. The results obtained allow us to conclude that the short and decentralized production chain and the epidemiological profile as a method for selecting medicinal plants were adequate to structure and size the production of vegetal drugs for the municipality of Turuçu.

Les infections dues aux bactéries gram-négatif multi résistantes en particulier la résistance aux carbapénèmes, représentent un problème majeur de santé publique. La hausse des taux de résistance à ces antibiotiques a conduit à la réutilisation de la colistine, comme alternative thérapeutique de dernier recours. Notre travail de thèse s'est concentré sur l'étude épidémiologique de la résistance aux antibiotiques d’isolats cliniques au Liban. Nos travaux se sont scindés en 4 chapitres, avec trois objectifs principaux; (i) l'étude des bactéries résistantes aux carbapénèmes, (ii) l'élucidation des mécanismes moléculaires de la résistance à la colistine (iii) l'émergence de bactéries à Gram-positif résistantes à la vancomycine. Initialement, une revue de la littérature sur l'épidémiologie et les facteurs de risque associés à l'infection bactérienne au cours de conflits armés et catastrophes naturelles en Asie et au Moyen Orient a été rédigée. Dans le deuxième chapitre nous avons cherché à voir l'effet du changement de traitement de la combinaison colistine-carbapénème à la colistine en monothérapie sur la résistance d’A. baumannii, en plus de la détection du blaVIM-2 codé par plasmide. Dans le troisième chapitre, nous avons détecté la propagation de bactéries gram-négatif résistantes à la colistine en raison de la mutation des (pmrA /pmrB, phoP/phoQ), ou mgrB. Enfin, nous détectons l'émergence du gène vanA d'E. faecium. Il serait nécessaire de mettre en place des enquêtes de surveillance de l’usage des antibiotiques pour éviter la propagation de souches résistantes à ces antibiotiques au Liban. / Infections due to multidrug-resistant gram-negative bacteria especially the resistance to carbapenems, have become a major public health problem. This increase in resistance to antibiotics has led to the resuscitation of colistin, as a last-resort treatment option. Our PhD work focused on the epidemiological study of the antibiotic resistance of clinical isolates in Lebanon. This thesis is divided into 5 chapters with three main objectives; (1) the investigation of carbapenem-resistant bacteria in Lebanese hospitals. (2) the Elucidation of the molecular mechanisms of colistin-resistant bacteria in Lebanese patients, and (3) the emergence of vancomycin-resistant gram-positive bacteria in Lebanon. At the start of this thesis, we have prepared a literature review on the epidemiology and the risk factors associated with bacterial infection in conflict wounded and natural disaster in Asia and the Middle East. The second chapter aimed to see the effect of the shift of treatment from colistin-carbapenem combination to colistin monotherapy on the prevalence and resistance of A. baumannii, in addition to the detection of the plasmid-encoded blaVIM-2 gene. In the third chapter, we have detected the spread of colistin-resistant gram-negative bacteria due to mutation of the two-component systems (pmrA /pmrB, phoP/phoQ), or mgrB. We detect the emergence of vanA of Enterococcus faecium resistant to vancomycin. This observation confirms that colistin resistance in Gram-negative bacteria is indeed increasing. In conclusion, it appears necessary and urgent to set up surveys to monitor the use of antibiotics to prevent the spread of resistant strains in Lebanon.

El objetivo general del presente trabajo de investigación es proponer un modelo de gestión de la demanda de TI que permita el adecuado soporte tecnológico a los protocolos de investigación desde su concepción hasta su finalización en la empresa seleccionada, la cual es un centro militar americano de investigación de enfermedades epidemiológicas en el Perú. En el primer capítulo se presenta el marco teórico, y se analiza los estudios de investigación clínica y epidemiológica, la literatura existente de la gestión de la demanda de TI, así como los marcos de trabajo (ISO 38500, COBIT 5.0, ISO/IEC 15504) y normativas disponibles (NIST SP 800-37, NIST SP 800-53). En el segundo capítulo, se realiza el análisis del problema identificándose los puntos de dolor en: recursos de TI, capacidad actual de TI, tiempo de respuesta, cumplimiento normativo y de políticas de gobierno de TI, financiamiento, y priorización; que han puesto en riesgo el 24% de financiamiento por acuerdos para ensayos clínicos con la organización pueda perderse debido a que el área de TI no ha tenido la capacidad de gestionar la demanda de los protocolos actuales de los clientes. En el tercer capítulo, se expone la propuesta de solución al problema, para lo cual se definen cinco secciones; siendo: Objetivos, evaluación de marcos de referencia, modelo de gestión de la demanda de TI actual, modelo de gestión de la demanda de TI propuesto y viabilidad de la propuesta. Finalmente, en el capítulo 4 se detallan las conclusiones asociadas al presente trabajo y recomendaciones. / The general objective of this research work is to propose an IT demand management model that allows adequate technological support to the research protocols from its conception until its completion in the selected company, which is an American military research center of epidemiological diseases in Peru. In the first chapter, the theoretical framework is presented, and clinical and epidemiological research studies, the existing IT demand management literature, as well as the frameworks (ISO 38500, COBIT 5.0, ISO / IEC 15504) are analyzed. ) and regulations available (NIST SP 800-37, NIST SP 800-53). In the second chapter, the problem analysis is performed by identifying the pain points in: IT resources, current IT capacity, response time, regulatory compliance and IT governance policies, financing, and prioritization; that they have put at risk 24% of financing by agreements for clinical trials with the organization could be lost because the IT area has not had the capacity to manage the demand of the current protocols of the clients. In the third chapter, the proposed solution to the problem is presented, for which five sections are defined; being: Objectives, evaluation of reference frameworks, current IT demand management model, proposed IT demand management model and feasibility of the proposal. Finally, chapter 4 details the conclusions associated with this work and recommendations. / Trabajo de investigación

Introduction: Faravelli et al. [1, 2] present findings on the lifetime, point and 1-year prevalence of mental disorders from their recent Sesto Fiorentino community survey in Italy. The publication of these study findings occurs at a time where some researchers and journal editors seem to have come to the conclusion that there is currently no further need for such cross-sectional studies on the prevalence of mental disorders. In fact, there have been pleas for a pause of such studies [3]. Highlighting several noteworthy features and findings from the survey of Faravelli et al. [1, 2], this editorial will challenge this attitude. The status, past and recent progress in the field of epidemiology of mental disorders will be critically discussed, in an attempt to underline the continued core role of descriptive epidemiological studies for our field and to identify future research needs.