Introdução: A transmissão ocupacional de patógenos veiculados pelo sangue é uma realidade na área de saúde, expondo os profissionais ao risco de aquisição do HIV, VHC e VHB dentre outros micro-organismos. Objetivo: Avaliar as condutas de profissionais da área da saúde vítimas de acidentes ocupacionais com material biológico que atuam no Serviço de Atenção Domiciliar de Ribeirão Preto. Materiais e Métodos: Trata-se de um estudo de corte transversal aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. A população elegível do estudo era de 72 profissionais da área da saúde e foi composta por 58 profissionais que preencheram os critérios de inclusão. Os dados foram coletados por meio de entrevistas individuais, no período de maio de 2014 a junho de 2015 e analisados por meio de estatística descritiva utilizando-se o programa Statistical Package for the Social Sciences, version 17.0. para Windows. Resultados: Dos 58 entrevistados, 19 referiram ter sofrido acidentes com material biológico ao longo de sua experiência profissional na instituição. Ressalta-se que 31,6% dos profissionais acidentados realizaram a conduta correta, ou seja, notificaram o acidente por meio da Comunicação de Acidente de Trabalho e procuraram atendimento clínico especializado, porém 52,6% não realizaram nenhuma conduta após o acidente e 15,8% realizaram conduta incompleta. Os motivos mais frequentemente alegados pelos profissionais para não notificarem o acidente e não procurarem por atendimento clínico especializado foi conhecer o paciente fonte e considerar a lesão superficial. Dos 18 profissionais que relataram conhecer as condutas preconizadas para acidentes com material biológico apenas 33,3% realizaram a conduta completa. Conclusões: O presente estudo permitiu identificar as condutas adotadas pelos profissionais que atuavam no Serviço de Atenção Domiciliar, após a ocorrência de acidente com material biológico / Introduction: The occupational transmission of blood borne pathogens is a reality in the health area, exposing professionals to the risk of acquiring HIV, HCV and HBV among other microorganisms. Objective: To evaluate the conducts of health professionals who are victims of occupational accidents with biological material at the Home Care Service in Ribeirao Preto. Materials and Methods: This is a cross- sectional study approved by the Research Ethics Committee in of the University of São Paulo at Ribeirão Preto College of Nursing. The eligible population of the study was 72 professionals of the health area and was composed by 58 professionals who met the inclusion. The data were collected through individual interviews, in the period from May, 2014 to June, 2015 and analyzed through descriptive statistics using the Statistical Package for the Social Sciences, version 17.0.for windows. Results: From the 58 interviewed, 19 reported that already had an accident with biological material throughout its professional experience at the institution. It is noteworthy that 31.6% of the accidented professionals made the correct conduct, that consists in notify the accident through the Work Accident Report, and also looked for specialized clinical care, however 52.6% did not perform any conduct after the accident and 15,8% performed an incomplete conduct. The reasons most frequently alleged by professionals for not notifying the accident and not look for specialized clinical care were to know the source patient and considered that they had a superficial injury. From the 18 professionals who reported knowing the recommended procedures for accidents with biological material, only 33.3% had the complete conduct. Conclusions: This study identified the conduct adopted by professionals working at the Home Care Service, after the occurrence of accidents with biological material

Made available in DSpace on 2014-12-17T15:38:41Z (GMT). No. of bitstreams: 1 VanessaABMG.pdf: 453215 bytes, checksum: 24ae84f6ac14ea21a38c45ddaeeb8fed (MD5) Previous issue date: 2008-06-11 / Violence is a complex and multifarious phenomenon that has convoked the government to think about strategies to face the question. This work is about one of these strategies proposed by brazilian Health Minister: the Individual notification/investigation Card - Domestic Violence, Sexual and/or others Interpersonal Violences . This instrument is a notification protocol which is been implanted in all of the country. This process is in course in Natal/RN. This work is a report of one research realized in five units of basic health care network of Natal/RN concerning this process about the implementation of the violence notification card. The study aims to cartography all the process of card implantation, discussing the used strategies, the drawn course, difficulties and possibilities as well as how the researcher intended to map subjective process involved at health professional acting at violence case and the propose to use the card. Meetings were held at each unit and a daily fieldwork report was used as research instrument. In this investigation it was observed that notifying violence involves a complexity that is not present in other kinds of notification as consequence of the phenomenon characteristic and health workers are invited to act in different perspective that knowledge and instruments of traditional health fieldwork available does not work. It was observed that the notification card, as a possible instrument of intervention, are considered important detectors from process of work at health basic care and health policies. Depending the way the instrument is used, it may incentive different discussions and manners to offer health care or in other way it can reproduce control and vigilance logics. Consequently it is necessary to consider some factors pointed out at this experience, implanting instruments like this, thinking about these limits and possibilities / A viol?ncia ? um fen?meno complexo e multicausal que tem convocado o poder p?blico a desenvolver estrat?gias para o seu enfrentamento. O presente estudo versa sobre uma dessas estrat?gias propostas pelo Minist?rio da Sa?de: a Ficha de Notifica??o/Investiga??o Individual Viol?ncia Dom?stica, Sexual e/ou outras Viol?ncias Interpessoais . Tal instrumento se trata de um protocolo de notifica??o que vem sendo implantado em todo o pa?s. Este processo encontra-se em andamento no munic?pio de Natal/RN. Este trabalho ? o relato de uma pesquisa realizada em cinco unidades da rede b?sica de sa?de do munic?pio acerca do processo de implanta??o da ficha de notifica??o da viol?ncia. Teve como objetivos realizar uma cartografia de todo o processo envolvido na implanta??o da ficha, problematizando as estrat?gias utilizadas, o percurso tra?ado, as dificuldades e possibilidades, bem como pretendeu mapear os processos subjetivos que atravessam a atua??o dos profissionais de sa?de frente ?s demandas da viol?ncia e ? proposta de uso deste instrumento. Metodologicamente, foram realizados encontros com cada um dos servi?os e se fez uso de um di?rio de campo. Nessa investiga??o percebeu-se que notificar a viol?ncia envolve complexidades n?o presentes em outros tipos de notifica??es pelas pr?prias caracter?sticas do fen?meno viol?ncia, pois os profissionais s?o convocados a assumirem posturas para as quais os conhecimentos e instrumentos tradicionais em sa?de n?o respondem satisfatoriamente. Percebeu-se que a ficha de notifica??o, enquanto instrumento poss?vel de interven??o, configura-se como um analisador importante dos processos de trabalho da aten??o b?sica e das pol?ticas da ?rea. Dependendo de como for manejado, esse instrumento pode ter a pot?ncia de suscitar novas discuss?es e modos de ofertar sa?de, mas tamb?m de reproduzir uma l?gica de controle e vigil?ncia. Faz-se necess?rio, ent?o, considerar alguns fatores apontados nessa experi?ncia quando da implanta??o de instrumentos como esse, problematizando seus limites e suas potencialidades

INTRODUÇÃO: este trabalho apresenta a arquitetura de um sistema de emissão de alertas para surtos e epidemias em tempo real, baseado em notificações eletrônicas da meningite, e discute os resultados dos testes e simulações realizados. MÉTODOS: esse sistema foi desenvolvido em quatro etapas: Concepção, Análise, Construção e Teste/Simulações. A Concepção contemplou a elicitação de requisitos, a qual definiu o que o sistema deve fazer. A Análise se preocupou com a modelagem e especificação das regras que definem como o sistema deve trabalhar. A Construção abrangeu a transformação das regras definidas e modeladas em linguagem de programação. A última etapa, Teste/Simulação, foi responsável por garantir que o sistema construído estava em conformidade com os requisitos elicitados na etapa de Concepção. RESULTADOS: vários artefatos foram criados e algumas constatações foram verificadas nesta etapa. Sobre os artefatos podemos citar os requisitos, casos de uso, diagrama de classes, modelo físico de dados, casos de teste e programas. Sobre as constatações podemos citar o disparo de alertas nas simulações realizadas pelo sistema dois dias antes que o alerta feito pelas autoridades de saúde do Estado de São Paulo usando os procedimentos habituais. DISCUSSÃO e CONCLUSÃO: O sistema desenvolvido pode ser classificado como um Early Warning System. Nas simulações, observamos que em duas oportunidades ele conseguiu evidenciar ocorrência de surto antecipadamente ao método tradicional utilizado pelo Centro de Vigilância Epidemiológico de São Paulo. Comparando-o com sistemas semelhantes em produção, verificamos que esse sistema se diferencia ao emitir ativamente alertas de surtos em tempo real. / INTRODUCTION: this essay presents the architecture of an alert system for epidemics based on real-time electronic notification of meningococcal meningitis, and discusses the results of tests and simulations made. METHODS: this system was developed in four stages: Conception, Analysis, Construction and Test/Simulation. The Conception covered the requirements elicitation, which defined what the system should do. The Analysis involved the modeling and specification rules that defined how the system should work. The Construction covered the transformation of defined and modeled rules in programming language. The last stage, Test/Simulation, checked the system under known scenarios, comparing the timing of outputs with the Brazilian notification surveillance framework. RESULTS: many artifacts were made and some evidences were verified. About the artifacts we can mention the requirements, use cases, class diagram, physical data model, test cases, and algorithms. About the evidences we can mention the fast alert production in simulations of this system as compared with the current procedure in use by health authorities. DISCUSSION AND CONCLUSION: this system can be classified as an Early Warning System. In simulations we observed that in two opportunities, it managed to put in evidence outbreak occurrence in advance to the traditional used method by Epidemiological Surveillance Center of São Paulo. In comparison with the similar systems under operation, we note this system is distinguished from them in issuing real-time outbreak alerts.

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-10-18T18:47:46Z No. of bitstreams: 1 SONIA LÚCIA DE CARVALHO.pdf: 840198 bytes, checksum: 5b1144c6abe0bc36ef9a1f3f30853f91 (MD5) / Made available in DSpace on 2017-10-18T18:47:46Z (GMT). No. of bitstreams: 1 SONIA LÚCIA DE CARVALHO.pdf: 840198 bytes, checksum: 5b1144c6abe0bc36ef9a1f3f30853f91 (MD5) Previous issue date: 2016-09-29 / Introduction: Health workers are exposed to occupational hazards. Among these are the biological risks that could lead to illness. This study seeks to clarify the factors that predispose the accident to biological material, not only for those who act in the attention to the user, but also for future professionals to know how severe a biological infection becomes. Objective: to identify and analyze the evidence available in the literature on accidents with biological material among health workers working in hospitals. Methodology: This is an Integrative Bibliographic Review on the factors that predispose work accidents with biological material among health professionals working in hospitals, held in the Virtual Health Library, in June 2016, The following descriptors were used Occupational OR occupational exposure OR exposure to biological agents OR work injury notification AND health personnel OR worker health. Results and Discussion: After applying the inclusion and exclusion criteria, nine articles were included in the study. All articles identified the needle as the main device causing the occupational accident, and blood was the main fluid involved. When analyzing the professional categories that were injured, the articles pointed to the nursing category, being the nursing assistant the most affected. In 60% of the articles, the accident record was addressed, but it is not clear in which system the accident was recorded, whether SINAN or CAT. Conclusions: It is of fundamental importance that the professionals are offered permanent education programs on biosafety, which emphasize the prevention of accidents with biological material, attention in performing procedures with the patient, care in the disposal of contaminated materials and compliance with biosafety standards. / Introdução: Os Trabalhadores da área de saúde ficam expostos aos riscos ocupacionais. Dentre esses estão os riscos biológicos que poderão ocasionar doenças. Este estudo busca esclarecer os fatores que predispõem o acidente com material biológico, não somente para aqueles que atuam na atenção ao usuário, mas para que futuros profissionais tenham conhecimento do quão grave se torna uma infecção biológica. Objetivo: identificar e analisar as evidências disponíveis na literatura sobre os acidentes com material biológico entre trabalhadores da área de saúde que atuam em hospitais. Metodologia: Trata-se de uma Revisão Bibliográfica Integrativa sobre os fatores que predispõem acidentes de trabalho com material biológico entre profissionais de saúde que atuam em hospitais, realizada na Biblioteca Virtual em Saúde, no mês de junho de 2016, Foram utilizados os seguintes descritores riscos ocupacionais OR exposição ocupacional OR exposição a agentes biológicos OR notificação de acidentes de trabalho AND pessoal de saúde OR saúde do trabalhador. Resultados e Discussão: Após a aplicação dos critérios de inclusão e exclusão, foram incluídos no estudo nove artigos. Todos os artigos identificaram a agulha como principal dispositivo causador do acidente ocupacional, e o sangue, foi o principal fluido envolvido. Ao analisar as categorias profissionais que se acidentaram, os artigos apontaram para a categoria de enfermagem, sendo o auxiliar de enfermagem o mais acometido. Em 60% dos artigos, o registro dos acidentes foi abordado, porém não é claro em qual sistema o acidente foi registrado, se SINAN ou CAT. Conclusões: É de fundamental importância que sejam oferecidos aos profissionais programas de educação permanente sobre biossegurança, que enfatizam a prevenção dos acidentes com material biológico, atenção na realização dos procedimentos com o paciente, cuidados no descarte de materiais contaminados e cumprimento das normas de biossegurança.

Após a criação do Acordo Geral Sobre Pautas Aduaneiras e Comércio (GATT) em 1947, as barreiras não tarifárias passaram a ser o principal instrumento utilizado pelos países para a proteção do mercado nacional. Os países que buscavam a liberalização do comércio internacional passaram, então, a buscar soluções a fim de conter tais barreiras. Havia uma dificuldade em identificar quando uma medida que restringia o comércio internacional era uma proteção disfarçada ao comércio de quando ela perseguia fins legítimos como a proteção da saúde humana e animal. Com o advento da Organização Mundial do Comércio (OMC), alguns acordos anexos foram assinados que visavam diferenciar essas medidas e proteger a liberdade comercial alcançada nas rodadas do GATT. Entre esses acordos, entrou em vigor o Acordo sobre Barreiras Sanitárias e Fitossanitárias (SPS) que trata de medidas que visam proteger a vida e a saúde humana, animal e vegetal. Esse acordo, apesar de essencial para um país exportador de commodities como o Brasil, recebeu pouca atenção da academia jurídica brasileira. Buscando amenizar essa lacuna, o presente trabalho se propôs a aprofundar o estudo do acordo sob uma perspectiva jurídica. Assim, sua origem, seu escopo de aplicação, seus princípios e características, e sua aplicação no Sistema de Solução de Controvérsias (SSC) da OMC são explanados no primeiro capítulo dessa dissertação O Acordo SPS também estabeleceu a criação do Comitê sobre Barreiras Sanitárias e Fitossanitárias (Comitê SPS) que administra a aplicação e o debate dos temas relacionados ao acordo. E é sobre esse comitê que o segundo capítulo dessa pesquisa se debruça. O objetivo da dissertação é demonstrar e melhor compreender que, apesar do comitê possuir diversas funções, duas são de extrema relevância, a saber, seu papel como harmonizador internacional e como solucionador de conflitos. Na persecução desses objetivos, o comitê conta com diversos instrumentos como as notificações e as preocupações comerciais específicas (PCEs) que são estudadas e detalhadas no presente trabalho. Para desenvolver essa pesquisa, foram realizados levantamentos bibliográficos, documentais e jurisprudenciais junto à OMC e a outras instituições e, a partir dos dados coletados, foi aplicado o método hipotético-dedutivo. Os resultados vieram a comprovar e a limitar o escopo da natureza harmonizadora e solucionadora de conflitos do Comitê SPS, esclarecendo os meandros do trabalho diplomático no seio do comitê. Resta claro que o comitê é um ator essencial e ativo no comércio internacional. / After the creation of the General Agreement on Tariffs and Trade (GATT) in 1947, the non-tariff barriers have become the main instrument used by countries to protect their national markets. Countries seeking liberalization of international trade began, then, to seek solutions in order to restrain such barriers. There was a difficulty in identifying when a measure that restricting the international trade was a disguised trade protection from when it pursued legitimate purposes such as the protection of the human and animal health and lives. With the advent of the World Trade Organization (WTO), some attachments agreements were signed in order to differentiate between these measures and to protect the free trade achieved in the GATT rounds. Among these agreements, entered into force the Agreement on Sanitary and Phytosanitary Barriers (SPS) that deals with measures to protect human, animal and plant health and lives. This agreement, although essential to a commodities exporter such as Brazil, received little attention from the Brazilian legal academia. Seeking to mitigate this gap, this study aimed to further study the agreement in a legal perspective. Thus, its origin, its scope of application, its principles and features, and its application in the WTO Dispute Settlement System (SSC) are explained in the first chapter of this dissertation. The SPS Agreement also established the creation of the Committee on Sanitary and Phytosanitary Barriers (SPS Committee) that manages the application and discussion of issues related to the agreement. Moreover, it is on this committee that the second chapter of this research focuses The purpose of this research is to demonstrate and to understand that, although the committee has several functions, two are of utmost importance, namely its role as international harmonizer and as conflict solver. In pursuing these objectives, the committee uses several instruments such as the notifications and the specific trade concerns (STCs) that are studied and detailed in this paper. To develop this research, bibliographical, documentary and jurisprudential surveys within the data of WTO and other institutions were conducted, and based on the data collected, it was applied the hypothetical-deductive method. The results came to prove and to define the scope of the SPS Committee as an international harmonizer and as a conflict solver, explaining the intricacies of diplomatic work within the committee. Therefore, it is clear that the committee is an essential and active player in international trade.

L'évaluation des données de sécurité du médicament reste encore limitée dans les pays en voie de développement. La création du Centre National de Pharmacovigilance du Vietnam en 2009 a permis l'enregistrement des notifications spontanées d'effets indésirables (EIs) permettant une analyse quantitative et qualitative et de générer des éventuels signaux de pharmacovigilance. Les objectifs principaux de la thèse étaient : (i) décrire le système de pharmacovigilance vietnamien, et comparer les données à travers quelques exemples, au système de pharmacovigilance français, (ii) appliquer un ensemble d'approches pharmaco-épidémiologiques pour identifier les risques médicamenteux au Vietnam et (iii) améliorer la sous-notification des EIs. Nous introduisons pour la première fois, un bilan complet du système de pharmacovigilance vietnamien avec une série de suggestions pour les pays partageant le même contexte de ressources limitées. Quelques résultats et défis pour le développement durable du système ont également été discutés. Secondairement, nous avons utilisé les bases de données de pharmacovigilance vietnamienne et française pour comparer le profil de notification pour 2 types d'EIs : anaphylaxie et syndrome de Steven-Johnson et nécrolyse épidermique toxique (SSJ/NET) d'origine médicamenteuse. Nous avons généré les premiers signaux de pharmacovigilance vietnamienne : l'allopurinol, la carbamazépine, les médicaments traditionnels, la colchicine, l'acide valproïque et le méloxicam ont généré des signaux pour le SSJ/NET - déjà connus dans littérature. Par ailleurs, nous avons retrouvé des signaux significatifs pour le cefixime et le paracétamol. Pour l'anaphylaxie, nous avons identifié 4873 (13.2%) cas dans la base vietnamienne pendant la période 2010-2016 avec une tendance à l'augmentation au cours du temps. Les antibiotiques (notamment céphalosporines de 3ème génération) sont les causes principales de l'anaphylaxie médicamenteuse au Vietnam. De plus, des signaux pour certains médicaments comme l'alpha-chymotrypsine, l'amoxicilline/sulbactame et les solutions de glucose ou électrolytes peuvent être typiques pour les pays en voie de développement. Enfin, l'identification des EIs à partir des données de laboratoire de biologie de l'hôpital pourrait améliorer le taux de notification d'EI au Vietnam. [...] / The understanding and quantitative analysis in drug safety domain among developing countries remain still limited. The creation of the National Drug Information and Adverse Drug Reaction Monitoring Centre (NDIADRMC) of Vietnam in 2009 was a landmark for the pharmacovigilance activities in this country and allowed the registration of spontaneous adverse drug reaction (ADR) reports. The accumulation of National Pharmacovigilance Database of Vietnam (NPDV) requires a quantitative and qualitative analysis and generation of pharmacovigilance signals to better protect Vietnamese people's health. The main objectives of the thesis are: (i) describe the Vietnamese pharmacovigilance system, with the comparison to another developed pharmacovigilance system as a reference (France), (ii) apply a set of pharmacoepidemiological approaches to identify the specific drug-related risks, and (iii) improve the under-reporting issue in Vietnam. Firstly, we introduce a full-detailed overview of Vietnamese pharmacovigilance system with a series of lessons learned for the other countries sharing the similar limited-resource context. Some achievements and challenges for the sustainable development of the system were also equitably discussed. Secondly, we used the Vietnamese and French pharmacovigilance databases to compare the differences in characteristics of two types of ADR: anaphylaxis and Steven-Johnson's syndrome and toxic epidermal necrolysis (SJS/TEN) induced by medications. Next, we generated the first Vietnamese pharmacovigilance signals. The signals of drug-induced SJS/TEN were generated with allopurinol, carbamazepine, traditional or herbal drugs, colchicine, valproic acid and meloxicam which were similar to the other previously studies in literature. Furthermore, we also found the significant signals of cefixime and paracetamol. For drug-induced anaphylaxis, we identified 4873 (13.2%) cases in the Vietnamese database during the period 2010-2016 with an increasing trend over time. The antibiotics (especially the third-generation cephalosporins) were the main causes of drug-induced anaphylaxis in Vietnam. In addition, the signals were generated with several drugs such as alpha-chymotrypsin, amoxicillin/sulbactam and glucose or electrolyte solutions which were typical for the resource-restricted countries. On the other hand, the identification of ADR through the screening the laboratory test results could help to increase the ADR reporting rate in Vietnam. [...]

Accounts of sexual abuse appear daily in the media. Rightfully, this issue demands attention. Juveniles may be victims; they may also be offenders who are subject to sex offender registration and notification (SORN) policies. Growing research finds that SORN policies fail to achieve intended public policy outcomes. Little is known, however, about the unintended consequences of SORN for juvenile offenders. This study contributed to a more comprehensive understanding of the effects of these policies on this population. Merton's concept of manifest and latent functions of purposive social action and an alternate non-criminogenic form of Lemert's secondary deviance proposition provided the theoretical framework. Research questions focused on whether a relationship exists between sex offender registration for a juvenile offense and severity of depression in current and former registrants after maturation into adulthood, and whether the relationship persists. A quantitative causal-comparative study was conducted using self-reported survey data from a non-probability sample of 59 registrants. Multiple regression analysis found SORN had a significant positive predictive relationship to severity of depression in adults currently registering for a juvenile offense as compared to former registrants, and the control group of those never registered, as measured by the Public Health Questionaire-9. A significant persistent depressive effect was not found in former registrants. Findings validate concerns that SORN may have iatrogenic effects for juvenile offenders; these findings also suggest that alternate, non-criminogenic forms of secondary deviancy appear to be associated with this policy. This understanding of the net effects of SORN informs policy decision makers and has social change implications for future sexual abuse prevention policies that may have greater likelihood of efficacy.

Lesões autoprovocadas por autointoxicação intencional por medicamento (AIM) e óbitos por suicídio são passíveis de prevenção e representam grave problema de saúde pública mundial. Este estudo investigou lesões autoprovocadas e suas recorrências por AIM e fatores sociodemográficos, clínicos e farmacológicos associados, bem como óbitos por suicídio por AIM e fatores sociodemográficos, clínicos e farmacológicos associados. Trata-se de estudo quantitativo, transversal, analítico e documental. Foi realizado a partir de dados secundários de bancos de dados do Sistema de Informação de Agravos de Notificação e do Sistema de Informação sobre Mortalidade da Secretaria de Estado de Saúde de Mato Grosso, Brasil. Foram incluídos no estudo todos os casos registrados de lesões autoprovocadas e os óbitos por suicídio de pessoas acima de nove anos de idade, no período de 1º de julho de 2015 a 31 de dezembro de 2017, em todos os municípios do estado de Mato Grosso. Para análise dos dados foram elaborados modelos de regressão logística com efeitos aleatórios, pertencentes à classe dos modelos Generalized Estimating Equations, utilizando-se o software Statistical Analysis System 9.2. O estudo foi aprovado por Comitê de Ética em Pesquisa. Constatou-se que, no período em estudo, foram notificadas 1.507 lesões autoprovocadas, sendo 27,34% delas por AIM, com destaque para utilização de medicamentos que atuam no Sistema Nervoso. O modelo de regressão logística constatou maior chance de lesão autoprovocada por AIM entre pessoas com idade de 10 a 19 anos e de 20 a 59 anos, quando comparadas àquelas com mais de 60 anos, mulheres comparadas aos homens, de raça branca em relação às de outras raças, ocorrência em zona urbana comparada a não urbana e ocorrência em residência comparada a outros locais. Observou-se menor chance de lesão autoprovocada por AIM entre pessoas com suspeita de uso de álcool quando comparadas àquelas sem tal suspeita. Das 381 pessoas com lesões autoprovocadas por AIM na primeira notificação, nove pessoas tiveram mais de uma lesão autoprovocada por esse método, com destaque para utilização de medicamentos que atuam no Sistema Nervoso. No modelo de regressão logística para analisar os fatores associados às recorrências de lesões autoprovocadas por AIM, nenhuma das variáveis contribuiu significativamente. Dos 412 casos de lesões autoprovocadas por AIM, 13 pessoas foram a óbito por suicídio por AIM. Em 11 desses casos não havia informações sobre o medicamento e em dois casos foram utilizados medicamentos que atuam no Sistema Nervoso. No modelo de regressão logística, para analisar os fatores associados aos óbitos por suicídio por AIM, houve menor chance de óbito por suicídio por AIM entre pessoas com idade de 10 a 19 anos e de 20 a 59 anos, quando comparadas àquelas com mais de 60 anos. Os achados deste estudo fornecem importantes subsídios para estratégias direcionadas à prevenção do suicídio e de lesões autoprovocadas por AIM, bem como para a qualificação da assistência de enfermagem / Self-injuries by intentional drug self-poisoning and suicide deaths are preventable and represent a serious public health problem worldwide. This study investigated selfinjuries and their recurrences by intentional drug self-poisoning and associated sociodemographic, clinical and pharmacological factors, as well as suicide deaths by intentional drug self-poisoning and associated sociodemographic, clinical and pharmacological factors. It is a quantitative, cross-sectional, analytical and documentary study. It was carried out from secondary databases of the Notification of Injury Information System and Mortality Information System of the Health Secretariat of the state of Mato Grosso, Brazil. This study included all registered cases of selfinjuries and suicide deaths of people aged above nine years, from July 1, 2015 to December 31, 2017, in all municipalities of the state of Mato Grosso. For data analysis, logistic regression models with random effects, based on Generalized Estimating Equations models, were developed using the software Statistical Analysis System 9.2. The study was approved by the Research Ethics Committee. It was found that, during the study period, 1,507 self-injuries were reported, of which 27.34% were by intentional drug self-poisoning, with emphasis on the use of drugs that act on the Nervous System. The logistic regression model found a greater chance of self-injuries by intentional drug self-poisoning among people aged from 10 to 19 years and from 20 to 59 years, when compared to those over 60 years, women compared to men, white category compared to all other race categories, occurrence in urban areas compared to non-urban areas and occurrence at home compared to other places. It was observed a lower chance of self-injury by intentional drug self-poisoning among people suspected of using alcohol when compared to those without such suspicion. Of the 381 people with self-injuries by intentional drug self-poisoning in the first notification, nine of them had more than one self-injury by this method, with emphasis on the use of drugs that act on the Nervous System. In the logistic regression model to analyze the factors associated with recurrences of self-injury by intentional drug self-poisoning, none of the variables contributed significantly. Of the 412 cases of self-injury by intentional drug selfpoisoning, 13 people died by suicide by intentional drug self-poisoning. In 11 of these cases, there was no information about the drug and, in two cases were used drugs that act on the Nervous System. In the logistic regression model, to analyze the factors associated with death by suicide by intentional drug self-poisoning, there was a lower chance of death by suicide by intentional drug self-poisoning among people aged from 10 to 19 years and from 20 to 59 years, when compared to those over 60 years old. These findings provide important subsidies for strategies aimed at suicide prevention and self-injuries by intentional drug self-poisoning, as well as for the qualification of nursing care

L'objectif de ce travail est d'étudier l'exploitation des réseaux haute performance des grappes dans le cadre du stockage distribué. Les applications parallèles s'exécutant sur les grappes nécessitent à la fois des communications performantes entre les différents noeuds et des accès efficaces au système de stockage. Les travaux menés sur les technologies réseau ont abouti à la conception d'architectures dédiées aux grappes qui permettent des communications très rapides entre les noeuds. Les travaux visant à obtenir un stockage distribué efficace dans les grappes se sont pour leur part principalement focalisés sur des mécanismes de parallélisation pour augmenter la charge de travail supportée par le (ou les) serveur. Nous proposons dans ce travail d'améliorer les performances du stockage distribué dans les grappes en utilisant au mieux le réseau haute performance sous-jacent pour accéder au stockage distant. La question générale que nous soulevons est : est-ce que les réseaux rapides des grappes sont adaptés à un accès transparent, efficace et performant au stockage distant ? Nous montrons que les besoins du stockage sont très différents de ceux du calcul parallèle. Les réseaux des grappes ont été conçus pour optimiser les communications entre les différents noeuds d'une application parallèle. Nous étudions leur utilisation dans le cadre, très différent, du stockage dans les grappes, qui s'appuie généralement sur un modèle client/serveur d'accès aux fichiers distants (par exemple NFS, PVFS ou Lustre). Une étude expérimentale reposant sur l'utilisation de GM, l'interface de programmation du réseau rapide Myrinet, dans le contexte du stockage distribué révèle différents freins. Tout d'abord, l'utilisation mémoire particulière dans les couches système d'accès au stockage s'intègre difficilement dans l'habituelle gestion mémoire des réseaux rapides. Ensuite, les modèles client-serveur utilisés dans le stockage distribué présentent des besoins spécifiques pour la gestion des messages et des événements réseau, besoins non couverts par les interfaces actuelles. Nous proposons différentes solutions pour résoudre, au niveau du système de fichiers les problèmes liés au contrôle du réseau mais montrons qu'il est nécessaire de modifier l'interface de programmation réseau et le système d'explotation pour venir à bout des difficultés liées au transfert de données. Nous détaillons des propositions à mettre en oeuvre dans les interfaces de programmation du réseau pour faciliter leur utilisation dans le cadre du stockage. L'intégration dans une nouvelle interface de programmation, Myrinet/MX, d'une gestion souple des transferts de données est présentée. Les premiers résultats montrent que son utilisation dans le cadre du stockage distribué, mais aussi dans d'autres applications, se révèle aisée et efficace.

Chlamydia trachomatis (CT) can cause infertility and is the most common sexually transmitted infection (STI) of bacterial origin in Europe. Surveys in seven countries estimated a population prevalence of 1.4-3.0 % in people 18 to 44 years. Approximately 87% of those diagnosed in Sweden are 15-29 years. Since 1997, with the exception of 2009-2010, despite all efforts, CT has increased steadily in many European countries including Sweden. That made us investigate risk factors associated with catching STIs, especially CT. In Sweden partner notification is mandatory by law when a patient is diagnosed with CT. Centralised partner notification, performed by a few experienced counsellors, and evaluation of the sexual history for at least 12 months back in time, shows superior results compared to other studies. Phone-interviews are a good option in remote areas. “The Västerbotten model” for partner notification fulfils these criteria and our evaluation has functioned as a model for changing recommendations of partner notification in Sweden. Preventing CT by primary prevention such as information and counselling is, however, still of great importance. We investigated whether it was necessary to test for CT in the throat. We found that patients testing positive for pharyngeal CT neither had more symptoms or signs nor a sexual history that differed from others. We therefore believe that we will find most or all of these patients by conventional testing of urine and cervical/vaginal samples. We wanted to further identify risk factors among patients attending a clinic for sexually transmitted infections to enable individualized care depending on risk. None or inconsistent use of condoms with new/temporary partners in combination with having at least one new/temporary partner within the past 6 months could identify persons with risk behaviour and at increased risk of CT (re)infection. Additional information about whether the condom was used during the whole intercourse did not add any risk of infection. A drop-in reception is a good contribution to an opportunistic screening approach. The rate of CT infected is high and the clinic attracts men and individuals ≥25 years old at risk of infection, groups which usually have a reduced test rate. The mean age was 28 years and 58% of the patients were men. The figure of correct condom usage is very low indicating the need for risk reducing counselling also in this grown-population. Among adult STI patients anxiety was common and depression uncommon. Neither was linked to high risk sexual behaviour nor ongoing CT infection. Hazardous alcohol consumption, however, was common and linked to anxiety and high risk sex. We conclude that preventive work can not only focus on STI prevention, but must consider the high frequency of hazardous alcohol consumption, which probably is contributing to sexual risk behaviour.