A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health: Occupational Hygiene, Johannesburg, 2012 / The aim of the study was to determine if the gold mine under study achieved the 2008 elimination of silicosis occupational hygiene milestones as set out by the South African mining industry in 2003. To identify high risk quartz exposed occupations within the conventional stope and TM³ stope employees of an underground gold mine between July 2008 and June 2010; to describe the personal quartz exposure of conventional stope and TM³ stope employees in an underground gold mine between July 2008 and June 2010; and to compare the time weighted average (TWA) quartz exposures between the conventional stope and TM³ stope to the Department of Mineral Resources-Occupational Exposure Limit (DMR-OEL) of 0.1 mg/m3, the National Institute of Occupational Safety and Health-Recommended Exposure Limit (NIOSH-REL) of 0.05 mg/m3 and the American Conference of Government Industrial Hygienists-Threshold Limit Value (ACGIHTLV) of 0.025 mg/m3.

A research report submitted in partial fulfilment of the requirements for the degree of Master of Science in Epidemiology in the field of Infectious Diseases School of Public Health, University of the Witwatersrand May 2014 / South Africa continues to grapple with the HIV/AIDS epidemic almost 30 years since the disease was first described. South Africa has 6.4 million people living with HIV thereby contributing 17% to the global burden of HIV/AIDs even though it makes up 0.7% of the world population translating to an HIV prevalence of 10.6% in the general population. . Multiple concurrent sexual partnerships (MCP) and inconsistent condom use are notably the major contributors to the spread or transmission of HIV in South Africa. The South African government has allocated massive financial resources to support HIV/AIDS interventions, however, the epidemic continues to amplify in South Africa and there is a growing need for targeted HIV prevention interventions which will address behaviour change. Objectives The objectives of the study were to determine the differences in sexual risk behaviour between self-identified HIV positive and HIV negative men and identify factors associated with sexual risk behaviour. Methodology This was secondary data analysis of a cross sectional design study called "Risk Perceptions of HIV Positive Men" and it was conducted in clinics from Soweto, Cape Town and the Cape Winelands from October 2010 to July 2011. The sample size was 451 and the study population comprised self-identified HIV positive and negative men between ages 18 - 60 years. Proportion of consistent condom use (CCU) and multiple concurrent partnerships (MCP) were calculated and difference between those self-identified HIV positive and negative were determined using Chi-square tests. Factors associated with MCP and CCU between the two groups was determined using univariable and multivariable logistic regression Results We analysed data for 451 men with a mean age of 39 years (std. dev. 11.30). Out of the 451 men 311 (69%) identified themselves as HIV positive and there was a statistical significant difference in baseline characteristics between HIV positive and HIV negative men (age, race, relationship status, employment status, education level, religion, area of residence, age at sexual debut, condom use at first sex, sexual orientation and circumcision status). HIV positive men were four times more likely to have used condoms consistently in the last six months compared to HIV negative men (AOR=3.72, CI: 1.95-7.11), however, HIV positive men were also four times more likely to have had Multiple Concurrent Partnerships in the last 12 months compared to HIV negative men (AOR=4.60, CI: 2.09- 10.12) . Other factors associated with sexual risk behaviour were; relationship status, age group, race, age at sexual debut, alcohol frequency, sexual orientation and perceptions about undetectable viral load reducing HIV transmission risk. Conclusion and recommendation There is a difference in sexual risk behaviour between men who identified themselves as HIV positive and those who identified themselves as HIV negative. Men who identified themselves as HIV negative were less likely to have used condoms consistently in the last six months. Though the HIV positive men are using condoms consistently they have multiple concurrent partners. There is need to strengthen post HIV test counselling coupled with targeted messages for both HIV positive and HIV negative men.

A research report submitted to the School of Public Health, University of the Witwatersrand (Johannesburg, South Africa) in partial fulfilment of the requirements for the degree of Master of Public Health for the year 2014 / Introduction: After 12 years of implementing the national Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme in South Africa, interventions to prevent MTCT of HIV are now offered in more than 95% of public antenatal and maternity facilities country-wide free of charge (MRC, 2010), even though HIV/AIDS-related diseases are said to be a major cause of death in young children (UNICEF, 2011). The context within which women make decisions about PMTCT participation depends on, amongst other things, the level of their knowledge about HIV/AIDS (Leonard et al, 2001; Sematimba et al, 2004). The concept of behavior-based programming is central to a behavior change approach to reducing Mother-to-Child Transmission of HIV. This places behaviours at the centre of the program design process (Moore, 2003). Understanding the providers and users of the PMTCT interventions’ knowledge and experience on HIV and PMTCT is therefore important to ensure appropriate interventions to address beliefs, attitudes, myths and misunderstandings. Methodology: Semi-structured interviews were conducted with users of the PMTCT programme, while structured survey questionnaires were collected with the providers of the PMTCT programme in early 2012. Users of the PMTCT programme were asked questions regarding HIV knowledge, experience of HIV testing in pregnancy, PMTCT knowledge and experience of the PMTCT programme. We also asked questions on infant feeding choices and practices. Forty six interviews were carried out with participants at three ANC Clinics with PMTCT services in Soweto - Gauteng. Thirty were users of PMTCT programme and sixteen were providers of PMTCT service. Results: All participants understood that HIV was a virus that affected the immune system. Results show that there is generally a good understanding of HIV and how it is transmitted. In addition there was a good understanding on methods to prevent acquiring HIV. There was a general feeling that a lot of people were afraid of being tested. Interestingly, most participants believed that people who were pregnant or sick had no choice but to get tested. Most of the participants believed that education should be a tool used to motivate more people to get tested for HIV. Most users in this study disclosed their HIV status and PMTCT programme use. Overwhelmingly the decision to participate was based on the desire not to infect their infants. Women had been informed that mixed feeding increased the risk of transmission by breast feeding. There were a few participants who believed that HIV infected women should not breastfed. It was found that almost two-thirds of the women in this study were formula feeding their infants. Reason cited for formula feeding was that they did not want to infect their infants. As far as PMTCT knowledge was concerned, it was found that almost all health care providers knew that the most common route of HIV acquisition was through heterosexual sexual practices. All the HCWs knew that prolonged breastfeeding increased the risk of transmission. Reassuringly all HCWs knew not to use invasive delivery procedures and that risk of transmission was decreased with low maternal viral load. Only 50% of the HCWs indicated that the first choice of WHO- recommended mother-to-child regimen for antiretroviral prophylaxis in PMTCT was Zidovudine (ZDV) and Nevirapine (NVP) (WHO, 2012). The HCWs understood that infant formula did not provide superior nutritional support or antibody protection. They also knew that formula feeding carried increased risk of diahorrea or bacterial infections. There was confusion regarding the duration of exclusive breast feeding. Only half of the HCWs stated that post-natal infant-feeding counselling and follow-up are required whenever a mother decides to change her feeding practice. HCW participants felt that most patients fail to adhere to their medication requirements. This was cited to be mainly due to the fact that patients may not have disclosed their HIV status to the household members. Baby feeding choices are cited as the strongest barriers to the success of the PMTCT programmes. Mothers who have not disclosed their HIV status to their household members find it difficult to comply with the chosen feeding choices especially bottle feeding; they therefore opt for exclusive breastfeeding –which family members attempt to interrupt with mixed feeding practices for a number of reasons. Conclusion: Contrary to studies cited in the literature review, health systems failure was not a major problem in Soweto and therefore was not a factor that could impact on either the knowledge or the experience of users and providers. Even though disclosure rates were high amongst the users interviewed in this study, participants believed that the biggest barrier to people participating in the PMTCT programme was because of stigma, ignorance, and fear that they may be recognised while accessing services by people they may know. Although women had been provided with information on exclusively breastfeed, most users of the PMTCT programme interviewed were bottlefeeding – not due to stigma, but due to fear of transmission. In terms of barriers – adherence was noted as a major problem by providers. This linked to issues of feeding practices - if mothers bottle-feed they are stigmatised and opt for exclusive feeding, but are then forced by family to supplement with the bottle for various reasons. Mothers do not reveal their status, which jeopardises their success on the programme

Thesis (Ph.D. (Virology))--University of the Witwatersrand, Faculty of Health Sciences, 2012 / The majority of HIV-1 infections around the world occur via sexual intercourse and women, especially in developing countries, are disproportionately affected. Recently a number of strategies have been proposed to control the spread of HIV, among these the use of microbicides to prevent the sexual transmission of the virus. A clinical trial of 1% tenofovir gel that conferred up to 39% protection provided a proof-of-concept that an anti-HIV microbicide is feasible. Various other compounds, acting at different stages of HIV-1 life cycle, are also being investigated as potential microbicides. These include the lectins Griffithsin (GRFT), cyanovirin-N (CV-N) and scytovirin (SVN). GRFT was isolated from the red algae griffithsia sp. while CV-N and SVN were isolated from the blue green alga Nostoc ellipsosporum and the cyanobacterium Scytonema varium, respectively. These lectins bind mannose-rich glycans found on the surface of HIV-1 envelope and act as entry inhibitors. Although HIV-1 subtype C is the main cause of infections around the world, almost all studies conducted with GRFT, CV-N and SVN are based on subtype B viruses. The Chapter Two sought to establish the neutralization sensitivity of HIV-1 subtype C viruses to the three lectins, using both a cell line and primary cells, and compared this sensitivity to subtype B. This Chapter also examined mannose-rich glycans on HIV-1 that are involved in GRFT, CV-N and SVN binding. The conclusion from this study was that the neutralization of subtype C viruses by these lectins is similar to subtype B and that the 234 and 295 mannose-rich glycans were involved in their interaction with the virus. In general these data supported further studies on the use of GRFT, CV-N and SVN for prevention of HIV-1 subtype C sexual transmission. In Chapter Three, the ability of GRFT to expose the CD4 binding site (CD4bs) on HIV-1 gp120 is explored. I found that this exposure resulted in the enhancement of HIV-1 binding to plates coated with anti-CD4bs antibodies b12 and b6 or the CD4 receptor mimetic CD4-IgG2. This lectin also synergized with b12 and HIVpositive plasma containing antibodies to the CD4bs to neutralize the virus. Furthermore, the glycan at position 386, which shields the CD4bs, was shown to be involved in both GRFT enhancement of HIV-1 binding to b12 and b6 and in the synergistic interaction between the lectin and these antibodies. The importance of this study is that it investigated in details the effect of GRFT binding on HIV-1 envelope and also suggests this lectin can be used in combination with anti-HIV-1 antibodies to synergistically enhance the anti-viral activity. In Chapter Four I investigated GRFT, CV-N and SVN inhibition of the virus binding to the DC-SIGN receptor and their inhibition of the DCSIGN transfer of HIV-1 to target cells. These lectins only moderately inhibited the virus binding to the receptor while they potently inhibited its transfer to target cells. However, the inhibition of transfer was stronger when the virus bound the lectins after binding the DC-SIGN receptor compared to when it bound the lectins prior to binding the receptor. These three lectins can, therefore, inhibit the sexual transmission of HIV-1 since the DCSIGN- mediated transfer of the virus to susceptible cells is pivotal to this mode of transmission. Chapter Five is an investigation of the ability of HIV-1 subtype C to escape GRFT, CV-N and SVN, which involved growing the virus under escalating concentrations of these compounds. This was to know how this virus behaves under conditions of continuous exposure to the lectins. I found that HIV-1 subtype C became increasingly resistant to the lectins and viral envelope sequence analysis showed that this was associated with the deletion of mannose-rich glycans on gp120. Furthermore, of the 11 potential mannose-rich glycosylation sites on gp120 seven (230, 234, 241, 289, 339, 392 and 448) were involved in GRFT, CV-N and SVN resistance. Thus, the conclusion was that although these three lectins are potent inhibitors of HIV-1 infection, the virus is also able to escape their neutralization by deleting mannose-rich glycans on its envelope. However, the fact that escape to these lectins involved multiple deglycosylation and was only partial suggests that HIV-1 subtype C escape from GRFT, CV-N and SVN in a microbicide formulation may not be an easy process. We discuss the implications of these findings in Chapter Six and suggest future studies that could complement data presented in this thesis. Overall our data show that GRFT, CV-N and SVN can prevent the sexual transmission of both free and DC-SIGN associated HIV-1 particles and supports further development of these lectins as microbicides against HIV-1.

O controle da transmissão da doença de Chagas no Estado de São Paulo, delineado\" no presente estudo, foi equacionado e solucionado e não constitui, nos dias atuais, problema de saúde pública. O risco de ocorrência de casos agudos fica restrito a eventos isolados. Este quadro, portanto, autoriza otimismo, podendo-se supor que a atual incidência da doença no Estado seja próxima de zero e esperar que a incidência futura se mantenha nesse nível. Sob a ótica da transmissão vetorial, as ações de vigilância sobre as espécies peridomiciliares presentes atualmente no Estado têm respondido de maneira eficaz à possibilidade de infecção por Trypanosoma cruzi a partir do contato homem-vetor. A casa rural paulista não constitui hoje ecótopo adequado para a domiciliação de tais espécies de triatomíneos. O comportamento invasor, característico principalmente dos indivíduos adultos fêmeas, não tem passado despercebido à população que prontamente coleta e encaminha o inseto para análise utilizando-se, na maioria das vezes, do Centro de Saude local, numa integração da vigilância vetorial à rede de atenção à saude. O pronto atendimento a cada notificação serve de estímulo à participação. Em síntese, a vigilância vetorial está consolidada junto à comunidade e à rede de saúde local. A transmissão transfusional constitui fenômeno raro dadas as condições com que se pratica a hemoterapia no Estado de São Paulo. As ações de controle do sangue foram implementadas pela Secretaria de Saúde a partir de 1988, com índices de cobertura de seleção de doadores próximos de 100 por cento já em 1990. Mais recentemente, com a instalação da Hemo-rede estadual e a ampliação da cobertura dos Hemocentros incluindo os pequenos municípios, pode-se observar uma melhora da qualidade da hemoterapia. O descarte do candidato à doação quando procedente de área endêmica de doença de Chagas, tem contribuído para a obtenção de baixos percentuais de prevalência na triagem sorológica, situados próximos a 1 por cento . A transmissão congênita, entendida como mecanismo residual de perpetuação da infecção, ocorre em níveis discretos e pode ser perfeitamente controlada desde que se realizem provas sorológicas para doença de Chagas em gestantes com epidemiologia compatível e se pesquise a infecção na criança ao nascer e seguimento até os 6 meses. A persistência da positividade sorológica deve orientar para tratamento específico. Outros mecanismos de transmissão não apresentam qualquer importância no contexto da endemia. Resta ao sistema de saúde, portanto, olhar de frente os indivíduos infectados que merecerão atenção médica e previdenciária e cujo direito à saúde está garantido pela carta constitucional. / The present study about the contrai of Chagas\' disease transmission in the State of Sao Paulo has pointed out that nowadays the disease is no more a public health problem. The risk of occuring acute cases is restricted to isolate events. Therefore it is possible to suppose that the disease incidence is near to zero. Conceming to the vectorial transmission the surveillance of the peridomestic bugs did not detect actual Trypanosoma cruzi transmission. The rural houses nowadays do not offer conditions to triatomine bugs colonization. The presence of female adult insects indoors is noted by the population. They collect and send the bugs to the local Health Services. Each bug notification is promptly answered in order to induce local communities to participate effectively in the vector surveillance. This surveillance is now consolidated among the communities and the Local Health Services. Transfusional transmission constitutes, as far is known, a rare event because hemotheraphy in the State of Sao Paulo is sufficiently adequated. Blood control practices were improved by Govemment since 1988. Actually almost 100 per cent of blood donors are covered with serological tests. Recently a net of State Blood Services was installed witch improved the quality of hemotherapic practices. The donors coming from Chagas\' disease endemic areas are deleted. The serological prevalence is near by 1 per cent . Congenital transmission occurs in low leveis and can be controlled. Serological tests for Chagas\' disease in pregnants with compatible epidemiology and in new-bom followed up to 6 months of age children is recommended. Children with serological positivity must be treated. Other transmission routes have no importance in the disease context. So, the task of assuring medical health care to the infected people as law order is left for the health system.

As instituições prisionais são tidas como um reservatório para doenças transmissíveis, entre estas a tuberculose. O estudo objetivou analisar na produção cientifica as estratégias para o controle da tuberculose no sistema prisional. Assim, elegeu-se a revisão integrativa da literatura a qual se deu com a busca de artigos científicos originais nas bases de dados PubMed, Literatura Latino-Americana em Ciências de Saúde, Cumulative Index to Nursing and Alied Health Literature, Web of Science e Scopus, lançando mão de diferentes estratégias de buscas com a utilização de descritores controlados e não controlados, cuja seleção dos artigos foi pautada em critérios de inclusão e exclusão. Após as buscas nas bases de dados com a leitura de título e resumo das publicações, foi possível pré-selecionar para esta revisão 33 artigos científicos originais e, conseqüente à leitura na íntegra dos mesmos chegou-se à amostra final de 22 artigos, que compõem este estudo. Pela leitura dos artigos foi possível identificar 11 estratégias, todas direcionadas à detecção da doença, e agrupá-las em três categorias \"Busca Ativa como estratégia para o controle da tuberculose\", \"Busca Ativa como estratégia para identificação de tuberculose latente\" e \"Utilização de imagem para diagnóstico da tuberculose\". A partir dos estudos incluídos nesta revisão pode-se evidenciar que quando as estratégias são desenvolvidas como complementares e realizadas periodicamente proporciona maiores chances do controle efetivo da tuberculose no sistema prisional / Prison institutions are known as reservoirs for transmittable diseases, such as tuberculosis. The study aimed to analyze the strategies for the control of tuberculosis in the prison system, trough scientific work. Thus, integrative review was chosen, happening through the search of original scientific articles in the PubMed, Literatura Latino-Americana em Ciências de Saúde, Cumulative Index to Nursing and Alied Health Literature, Web of Science and Scopus databases, including different search strategies using controlled and non-controlled descriptors, selecting articles based on inclusion and exclusion criteria. After the database search using titles and summaries, it was possible to pre-select 33 original scientific articles for this review and, consequent to full reading of those articles, come to a final of 22, which compose the study. Through the reading of such articles it was possible to identify 11 strategies, all aimed to the detection of the disease, and group them into three categories \"Active Case-finding as a strategy for control of tuberculosis\", \"Active Case-finding as a strategy for identifying latent tuberculosis\" and \"Use of image to diagnose tuberculosis\". Through the studies included in this review it\'s possible to make clear that when all strategies are developed as complementary and performed periodically they can provide higher chances of effective control of tuberculosis in the prison system

Liu, Qilin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 97-110). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese; appendixes includes Chinese.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Nos Ãltimos anos, o Programa Nacional de Controle da HansenÃase tem focado suas aÃÃes em Ãreas geogrÃficas definidas com alta detecÃÃo de casos. Este estudo teve o objetivo de caracterizar padrÃes epidemiolÃgicos, espaciais e temporais da hansenÃase em um agregado de alto risco de transmissÃo, em municÃpios dos estados do MaranhÃo, ParÃ, Tocantins e PiauÃ. Desta forma, foram aplicados diferentes mÃtodos de anÃlise espacial (Descritivo, Abordagem Bayesiana Local, EstatÃstica Scan Espacial) e quantificada a dependÃncia espacial de diversos indicadores epidemiolÃgicos e operacionais da hansenÃase. Em outro estudo, foram identificados o fluxo de pessoas afetadas e os motivos para migraÃÃo apÃs diagnÃstico. No perÃodo de 2001 a 2009, 82.463 casos novos foram detectados no agregado (coeficiente mÃdio de detecÃÃo: 95,9/100mil habitantes ao ano). No resto do Brasil o coeficiente foi 21,0 (RR=4,56, IC 95%: 4,45-4,66; p<0,0001). Houve fluxo direcionado dos pacientes com hansenÃase notificados para um municÃpio diferente da sua residÃncia. AraguaÃna, Imperatriz, Marabà e Floriano receberam um nÃmero considerÃvel de casos provenientes dos municÃpios em seu entorno. As capitais SÃo LuÃs, Teresina e BelÃm absorviam tambÃm casos vindos de outros estados. GoiÃnia e BrasÃlia se localizam distante do agregado, mas tÃm destaque pela notificaÃÃo de casos provenientes do agregado. ApÃs o primeiro diagnÃstico, 53,5% dos motivos principais de migraÃÃo foram relacionados a mudanÃas de estilo de vida. AnÃlise Scan Espacial identificou 23 agregados de elevada detecÃÃo de casos novos, a maioria localizados no Parà e MaranhÃo. Estes agregados incluÃram apenas 32% da populaÃÃo, mas 55,4% dos casos novos e 101 (27,1%) municÃpios. TambÃm foram identificados 14 aglomerados significativos para o coeficiente de detecÃÃo em crianÃas e 11 de casos novos com grau 2 de incapacidade/100mil hab. O agregado mais significativo, no centro do MaranhÃo, teve um RR de 2,24 e uma detecÃÃo anual de 10,4 casos com grau 2/100mil hab. O mÃtodo de autocorrelaÃÃo local mostrou superposiÃÃo com Ãreas de alto risco identificadas pelo mÃtodo Bayesiano Local e na anÃlise Scan Espacial. O estudo mostra que a hansenÃase à hiperendÃmica na Ãrea de estudo, sem a perspectiva de exaurir estes casos nos prÃximos anos. AlÃm de diagnÃstico tardio em um nÃmero de casos considerÃvel, houve lacunas na descentralizaÃÃo do atendimento, evidenciado pelo fluxo das pessoas afetadas. A construÃÃo de mapas utilizando outros indicadores, alÃm do coeficiente de detecÃÃo geral, e a sobreposiÃÃo desses mapas pÃde identificar Ãreas desconhecidas em relaÃÃo ao risco de transmissÃo e de detecÃÃo de casos com incapacidades avanÃadas. Essa abordagem poderà ser aplicada em outras Ãreas de risco para assim identificar agregados mais especÃficos de risco elevado para a hansenÃase. / In recent years, the National Leprosy Control has focused its actions on defined geographic areas with high leprosy detection rates. This study aimed to characterize epidemiological, spatial and temporal patterns in a high risk leprosy cluster in municipalities in the states of MaranhÃo, ParÃ, Piauà and Tocantins. Different methods of spatial analysis were applied (Descriptive, Local Bayesian Approach, Spatial Scan Statistics), and the spatial dependence of various epidemiological and operational indicators was quantified. In an additional study, I identified the flow of leprosy-affected individuals, and the reasons for migration after diagnosis. In the period 2001â2009, 82,463 new cases were detected in the endemic cluster (mean detection rate: 95.9/100mil inhabitants per year). In the rest of Brazil, the mean rate was 21.0 (RR=4.56, 95% CI: 4.45 - 4.66; p<0.0001). There was a directed flow of patients who were reported by a municipality other than their residence. AraguaÃna, Imperatriz, Marabà and Floriano notified a considerable number of cases from the municipalities in the proximity. SÃo LuÃs, Teresina and BelÃm received also cases from other states. GoiÃnia and BrasÃlia are distant from the cluster, but reported cases from the cluster. After first diagnosis, in 53.5% of cases migration was related to lifestyle changes. Spatial Scan analysis identified 23 clusters of high detection rates, most of them located in Parà and MaranhÃo. These clusters included only 32% of the population but 55.4% of new cases, and 101 (27.1%) municipalities. There were also 14 significant clusters for high detection rates in children, and 11 clusters of new cases with grade 2 disabilities/100.000 population. The most significant cluster, in the centre of MaranhÃo, had a RR of 2.24 and an annual detection of grade 2 cases of 10.4/100.000 population. The local auto-correlation method showed overlapping with high-risk areas identified by Local Bayesian and Spatial Scan Statistics. The study shows that leprosy is hyperendemic in the study area, without an expected trend of reduced detection rates in the coming years. In addition to late diagnosis in a considerable number of cases, there were shortcomings in the decentralization of the health system, evidenced by the flow of affected people. The use of maps based on other indicators than detection rates and the overlap of these maps highlighted previously unknown risk areas for transmission and for cases with advanced disabilities. This approach can be applied in other endemic areas to identify clusters of high risk for leprosy.

O controle da transmissão da doença de Chagas no Estado de São Paulo, delineado\" no presente estudo, foi equacionado e solucionado e não constitui, nos dias atuais, problema de saúde pública. O risco de ocorrência de casos agudos fica restrito a eventos isolados. Este quadro, portanto, autoriza otimismo, podendo-se supor que a atual incidência da doença no Estado seja próxima de zero e esperar que a incidência futura se mantenha nesse nível. Sob a ótica da transmissão vetorial, as ações de vigilância sobre as espécies peridomiciliares presentes atualmente no Estado têm respondido de maneira eficaz à possibilidade de infecção por Trypanosoma cruzi a partir do contato homem-vetor. A casa rural paulista não constitui hoje ecótopo adequado para a domiciliação de tais espécies de triatomíneos. O comportamento invasor, característico principalmente dos indivíduos adultos fêmeas, não tem passado despercebido à população que prontamente coleta e encaminha o inseto para análise utilizando-se, na maioria das vezes, do Centro de Saude local, numa integração da vigilância vetorial à rede de atenção à saude. O pronto atendimento a cada notificação serve de estímulo à participação. Em síntese, a vigilância vetorial está consolidada junto à comunidade e à rede de saúde local. A transmissão transfusional constitui fenômeno raro dadas as condições com que se pratica a hemoterapia no Estado de São Paulo. As ações de controle do sangue foram implementadas pela Secretaria de Saúde a partir de 1988, com índices de cobertura de seleção de doadores próximos de 100 por cento já em 1990. Mais recentemente, com a instalação da Hemo-rede estadual e a ampliação da cobertura dos Hemocentros incluindo os pequenos municípios, pode-se observar uma melhora da qualidade da hemoterapia. O descarte do candidato à doação quando procedente de área endêmica de doença de Chagas, tem contribuído para a obtenção de baixos percentuais de prevalência na triagem sorológica, situados próximos a 1 por cento . A transmissão congênita, entendida como mecanismo residual de perpetuação da infecção, ocorre em níveis discretos e pode ser perfeitamente controlada desde que se realizem provas sorológicas para doença de Chagas em gestantes com epidemiologia compatível e se pesquise a infecção na criança ao nascer e seguimento até os 6 meses. A persistência da positividade sorológica deve orientar para tratamento específico. Outros mecanismos de transmissão não apresentam qualquer importância no contexto da endemia. Resta ao sistema de saúde, portanto, olhar de frente os indivíduos infectados que merecerão atenção médica e previdenciária e cujo direito à saúde está garantido pela carta constitucional. / The present study about the contrai of Chagas\' disease transmission in the State of Sao Paulo has pointed out that nowadays the disease is no more a public health problem. The risk of occuring acute cases is restricted to isolate events. Therefore it is possible to suppose that the disease incidence is near to zero. Conceming to the vectorial transmission the surveillance of the peridomestic bugs did not detect actual Trypanosoma cruzi transmission. The rural houses nowadays do not offer conditions to triatomine bugs colonization. The presence of female adult insects indoors is noted by the population. They collect and send the bugs to the local Health Services. Each bug notification is promptly answered in order to induce local communities to participate effectively in the vector surveillance. This surveillance is now consolidated among the communities and the Local Health Services. Transfusional transmission constitutes, as far is known, a rare event because hemotheraphy in the State of Sao Paulo is sufficiently adequated. Blood control practices were improved by Govemment since 1988. Actually almost 100 per cent of blood donors are covered with serological tests. Recently a net of State Blood Services was installed witch improved the quality of hemotherapic practices. The donors coming from Chagas\' disease endemic areas are deleted. The serological prevalence is near by 1 per cent . Congenital transmission occurs in low leveis and can be controlled. Serological tests for Chagas\' disease in pregnants with compatible epidemiology and in new-bom followed up to 6 months of age children is recommended. Children with serological positivity must be treated. Other transmission routes have no importance in the disease context. So, the task of assuring medical health care to the infected people as law order is left for the health system.

Stroke continues to plague the United States, affecting 795,000 people annually. Although stroke mortality has decreased, the overall incidence of stroke appears essentially unchanged. With a population that is projected to increase in age and stroke risk over the next 10-15 years, this is concerning. Current stroke prevention education may not be adequately tailored to community learning needs. Analyzing existing demographic data within electronic medical records may allow healthcare systems to identify high-risk neighborhoods by geocoding stroke diagnoses and then completing a qualitative analysis within the target community of specific stroke knowledge deficits. That information may then inform stroke prevention education for that neighborhood. A descriptive, exploratory approach was used to identify a community with a high incidence of stroke using geocoded demographic data from patients coding out with a stroke diagnosis. Qualitative interviews conducted within the community yielded the following themes: fragmented knowledge of stroke causes and risk factors, unawareness of hypertension and diabetes as significant risk factors for stroke, knowing but experiencing challenges to engaging in healthy practices—specifically, diet and exercise, and financial barriers to healthcare resources. While most of the participants had adequate healthcare coverage and reported regular interactions with a primary healthcare provider, this community continued to experience a higher incidence of stroke than surrounding neighborhoods. The findings of this study highlighted specific challenges to stroke prevention that may inform future stroke prevention initiatives. Future research in other communities using this approach may provide additional insights into the specific knowledge deficits unique to communities, as well as revealing patterns and trends in stroke prevention knowledge. Approaching stroke prevention education using only data obtained from large registries may provide a broad overview of knowledge deficits, but lack the specificity necessary to effectively address stroke knowledge needs at the community level. Recognizing the challenges inherent with behavior modification for implementing lifestyle changes should also be considered when designing future stroke education. Harnessing technology in the form of web applications, text messaging, and email for maintaining communication with patients may improve effectiveness of stroke prevention interventions. Implementing a comprehensive health promotion program that addresses specific community needs with tailored health education and behavioral support may lead to decreased incidence of cerebrovascular disease in this community and provide a model for managing other preventable diseases. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection