Philosophiae Doctor - PhD / Sexually transmitted infections (STIs) are a problem for both developed and developing countries. Sub-Saharan Africa has the highest rates in the 15-49 years old group. The discovery that these infections playa vital role in the transmission of HIV raised their profile and made their control one of the central strategies of stopping the HIV/AIDS epidemic. In response to the challenge of improving the quality of care for people infected with STIs in the public health sector, the South African Ministry of Health adopted the syndromic management approach, recommended by the World Health Organisation as suitable for resource-poor settings, for use in primary health care clinics. In addition to providing guidelines on clinical management of STIs, the syndromic approach requires health providers to counsel and educate patients about STIs, encourage patients to complete treatment even if symptoms abate, promote condom use and the treatment of all sexual partners. While the management guidelines are clear and detailed around the diagnostic and medication issues, the processes of education and counseling are not as clearly outlined. Furthermore, although the syndromic approach is a viable way of providing good quality care to larger sections of the population than could be serviced through dedicated STI clinics, it requires health providers working in primary health care clinics, most of whom are professional nurses, to perform some tasks for which they may not be adequately trained. This study evaluated the quality of care for persons infected with ST!s by examining the extent to which the syndromic approach was being implemented in primary health care clinics. Interviews, using semi-structured interview schedules, were conducted with ST! patients and health providers in twenty-four clinics located in four provinces. In depth qualitative interviews were also conducted with a sub-sample of the patients. For further triangulation the methods of participant observation, through the use of simulated patients, and focus group discussions with various community groups were used. The findings of the study indicate that although primary health care clinics in South Africa are well-resourced, the management of patients with ST!s is inadequate. Adherence to the various aspects of syndromic management was poor. Similar to other studies in South Africa, the attitudes of health providers towards patients with ST!s were found to be problematic, a finding that has implications for health-seeking behaviours. The thesis argues that a large part of the problem is related to the multiple roles that nurses have to play in primary health care settings, as well as the content and methodology of the training of nurses who manage ST! patients. It further argues for the constitution of the basic health team at primary health clinics to be multi-disciplinary, and for a multi-disciplinary input in the training of health providers.

Unwanted pregnancies and sexually transmitted infections (STIs) are major health concerns of women worldwide. These concerns have prompted efforts to develop Multipurpose Prevention Technologies (MPTs), which simultaneously provide contraception and prevent STIs, including HIV. LL-37, the only human cathelicidin and an effective spermicide on human sperm, has broad antimicrobial activity including in vitro activity against HIV. 17BIPHE2 is a truncated LL-37 peptide, engineered to contain 5 unnatural residues, thus limiting its protease degradation within vaginal fluid. Hence, this antimicrobial peptide (AMP) represents a promising MPT agent. It was therefore hypothesized that these peptides would be inhibitors of HIV infection in cell lines, PBMC, and CD4+ T cells. In the chronically infected ACH-2 cell line, there was significant reduction in p24 production when cells were treated with 17BIPHE2, but not LL-37. When 17BIPHE2 was pre-incubated with HIV prior to infection and present during infection, viral replication decreased in the TZM-bl reporter cell line, but this result was not recapitulated in the primary activated cells, PBMCs nor isolated CD4+ T cells. Conversely, pre-incubation of 17BIPHE2 with target cells prior to infection significantly inhibited HIV infection in a dose-dependent manner. Therefore, 17BIPHE2 may act on the cell or on the virus/cell interaction rather than on the virus itself to inhibit HIV infection.

No description available.

Background: Selected factors place Dominican female adolescent and adults at risk for sexually transmitted infections (STIs) such as Chlamydia, causative organism Chlamydia trachomatis, and Gonorrhea, causative organism Neisseria gonorrhoeae. The purpose of this study was to determine the prevalence of Chlamydia and Gonorrhea among adolescent and adult females that utilize the clinic in Veron, Dominican Republic. Clinical standards of care for these STIs and educational programs for prevention were developed from the data gathered from this study. Significance at 0.05 ά of the relationship of educational level, management of risk factors and other selected independent variables on prevalence rate of Chlamydia and Gonorrhea in the clinic population of Veron, Dominican Republic were determined. The objectives of the study were to 1) determine the prevalence of adolescent and young adult females diagnosed with Gonorrhea and Chlamydia who visit the clinic for prenatal visits, annual pap smear exams and gynecological complaints; 2) determine the extent to which educational level is a predictor of positive diagnosis or risk for infection of Chlamydia and Gonorrhea and; 3) determine which selected demographic and risk factors are associated with positive test results for Gonorrhea and Chlamydia. Methods: All adolescent and adult females ages 15 years and older visiting the clinic in Veron for prenatal exams, pap smear exams and gynecological complaints between January 28, 2008 – March 3, 2008 were invited to participate in this prevalence study. Of the 90 invited, the accepting sample was 90 who signed an informed consent form. Prior to STI testing each patient completed a verbal interview and questionnaire on sociodemographic characteristics as well as knowledge, attitudes, and beliefs related to Chlamydia and gonorrhea, sexual experiences and behaviors and illicit drugs use. Specimens collected from the endocervical canal of each female were tested and results provided within two hours, followed by immediate treatment by a licensed Dominican physician and follow-up care based on the guidelines and standards of care. The data were analyzed using descriptive statistics, chi square, t-test and logistic regression. Results: A total of ninety women participated in the study. Chlamydia was detected in 6.7% of the patient population and Gonorrhea was detected in 22.2% of the patient population. Co-infection of both Chlamydia and Gonorrhea was present in 2 cases. Among the positive Chlamydia tests results, 50% had less than a six-year education and 50% had more then six years of education. In addition, 83.3% of the patients with positive Chlamydia results answered "yes", they could read and 16.6% stated they could not read, while 83.3% of the patients with positive Chlamydia results stated they could write and 16.6% stated they could not write (P>0.05). Among the patients that tested positive for Gonorrhea, 55% stated they had less than six years of formal education and 45% had more than six years of formal education (P>0.05). There were 75% of the patients that tested positive for Gonorrhea that stated they could read and 25% who stated they could not read (P>0.05); while 85% of the patients with positive Gonorrhea results stated they could write and 15% stated they could not write (P> 0.05). Conclusion: Educational level and other selected demographic characteristics and risk factors in this study are not a significant predictor of positive diagnosis or risk of infection for Chlamydia or Gonorrhea. We cannot conclude that specific risk factors are associated with positive test results for Gonorrhea and Chlamydia. For the physicians involved in the clinical decision-making regarding the female patients at the Veron clinic, more data are needed to determine appropriate populations for screening of Gonorrhea and Chlamydia as well as appropriate educational tools on sexually transmitted infections. / Ph. D.

Thesis advisor: Christopher S. Lee / Background: Genital hair removal is a popular practice in Westernized cultures and has been associated with the belief that removal is necessary for hygiene. A body of literature exists that has found that genital hair removal is associated with adverse health outcomes, including sexually transmitted infections (STIs). This dissertation aims to detail the history of the practice, why the hygiene belief exists, and to systematically review the existing literature that assesses genital hair removal and STIs. Methods: Historical, socio-cultural analysis from the feminist perspective was performed on the literature to outline why genital hair removal was adopted at a population level. The STI/genital hair removal literature was systematically reviewed and analyzed utilizing PRISMA guidelines. The data generated did not support meta-analysis. Results: Genital hygiene removal has been normalized in Westernized culture as a compulsory component of genital hygiene, particularly for women. Genital hair removal decreases pubic lice infestations. Genital hair removal increases the incidence of gonorrhea and chlamydia infections in women. The data does not support that genital hair removal is necessary for genital hygiene and may be harmful to genital health. Conclusions: Healthcare providers should ask about genital hair and genital hygiene practices when taking a sexual health or preventative care history. Health care providers can educate patients that genital hair removal is not necessary for genital health. New research inquiries on this topic must account for the normalization of the genital hygiene belief. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Sexually transmitted infections (STIs) are a common health problem in all populations; however, female adolescents are at increased risk for acquiring STIs and their complications. Their increased risk of acquiring STIs is due to their behavior, anatomy. and lack of knowledge about STIs. STIs have many complications in women. Some complications include: pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and infertility. The purpose of this integrative review is to identify current sexual behaviors of female adolescents, and to find strategies at preventing or reducing STIs within this population. Nurses and other health care providers need to know the current statistics of STIs in adolescent females, and need to understand their current sexual behaviors in order to implement effective preventative strategies.

Com esta pesquisa buscou-se identificar os fatores presentes na integração pós-fusão dos Sistemas e Tecnologias de Informação (STIs) que influenciaram a integração e os seus resultados, em fusões e aquisições entre instituições bancárias nacionais. Como estratégia de pesquisa foi adotada a triangulação de métodos qualitativos e quantitativos. Foram realizadas entrevistas com executivos ligados às áreas dos STIs e aplicados questionários às equipes dos bancos pesquisados que estiveram formalmente envolvidos com as atividades de integração. Para o tratamento e análise dos dados qualitativos utilizou-se a técnica da Análise de Conteúdo e para os dados quantitativos a técnica estatística multivariada Modelagem de Equações Estruturais. Os fatores considerados mais influentes para a integração pós-fusão dos STIs foram a qualidade e a expertise das equipes de integração dos STIs, que envolveu o conhecimento das características técnicas dos Sistemas de Informação (SIs) e das regras de negócios dos bancos; a gestão da integração, que coordenou os esforços de gerenciamento das atividades de integração dos STIs, valorizando o trabalho em equipe e otimizando o uso dos recursos computacionais; as configurações dos STIs, cuja similaridade entre elas ajudou a acelerar a integração e a redução de problemas técnicos; os conhecimentos oriundos das experiências prévias em que o conhecimento tácito se revelou importante, até mesmo como um fator de empregabilidade, não obstante a ausência de processos internos formais para transformar o conhecimento tácito das equipes técnicas em conhecimento explicito; o alinhamento estratégico dos STIs que apresentou menor relevância para a integração mesmo refletindo as funcionalidades dos SIs dos bancos adquiridos e que foram inseridas nos SIs dos bancos adquirentes, pois o uso dos recursos tecnológicos pode ter impacto limitado; a infraestrutura e arquitetura dos STIs, o fator menos relevante, dadas as facilidades de comunicação entre elas, e a sua desativação nos bancos adquiridos. Entre os resultados positivos, o aumento da eficiência dos STIs e o incremento das respectivas capacidades, associados à melhoria na qualidade dos SIs, constituíram-se nos principais legados da integração, seguidos pelo aumento da satisfação dos usuários desses STIs e pelo impacto positivo nas equipes técnicas dos STIs. A redução de custos da Tecnologia de Informação não apareceu como resultado relevante da integração. O resultado negativo deveu-se à deficiência em explorar as oportunidades de aprendizado com o processo. Outro aspecto significativo revelado pelo estudo, refere-se às sinergias técnicas conseguidas, que poderão alavancar a rentabilização dos bancos adquirentes, dado o potencial das elevadas economias de escala que elas podem proporcionar. / With this research we tried to identify present factors in the post-merger integration of Systems and Information Technology (STIs) that influenced the integration and their results in mergers and acquisitions among national banking institutions. As a research strategy it was adopted triangulating between qualitative and quantitative methods. Interviews were conducted with executives linked to the areas of STIs and completed questionnaires with the teams of the banks surveyed who were formally involved with integration activities. For treatment and analysis of qualitative data it was used the technique of Content Analysis and quantitative data with multivariate statistics called Structural Equation Modeling (SEM). The most influential factors for the post-merger integration of STIs were the quality and expertise of the teams for the integration of STIs, which involved knowledge of the technical characteristics of the Information Systems (ISs) and the rules of business of banks; management of integration, which coordinated efforts to manage the integration activities of STIs, valuing teamwork and optimizing the use of computational resources; the configuration of STIs, whose similarity between them helped to accelerate integration and reduction of technical problems; the knowledge from the previous experiences in that tacit knowledge was an important, even as a factor of employability, despite the absence of formal internal process to transform the tacit knowledge of the technical teams in explicit knowledge; the strategic alignment of STIs, which was less relevance to integration even reflecting the features of ISs of banks that were acquired and incorporated in the ISs of the acquiring banks, because the use of technological resources may have limited impact; the infrastructure and architecture of STIs, the factor less relevant, given the communication facilities between them, and their deactivation in the acquired banks. Among the positive results, the increased efficiency of STIs and increasing their capacities, associated with improving the quality of the ISs were the main legacies of integration, followed by increased user satisfaction of STIs and the positive impact on technical teams of STIs. Reduction of Information Technology costs did not appear as a relevant result of integration. The negative result was due to deficiency in exploring the opportunities for learning through the process. Another significant aspect revealed by the study refers to the technical synergies achieved, since these synergies could increase the profitability of the acquiring banks, given the high potential of economies of scale that they can provide.

A Chlamydia trachomatis é um patógeno causador de doenças sexualmente transmissíveis (DST). Esse agente afeta significativamente a saúde sexual e reprodutiva de mulheres, estando relacionado à esterilidade em número bastante significativo,sendo também responsável por desfechos em gestantes acometidaspor DSTs no Brasil e no mundo. Apesar da sua alta prevalência, muito pouco se sabe sobre a distribuição de genótipos de Chlamydiatrachomatis. Este estudo teve como objetivo estimar a prevalência e os fatores associados à infecção causada por esse patógeno em gestantes admitidas na Maternidade da Fundação Santa Casa de Misericórdia do Pará. O estudo constou de uma amostra mínima de 363 gestantes atendidas por demanda espontânea, sendo incluídas na amostra o excedente de 32 gestantes totalizando 395 gestantes,em um período da coleta de 3 meses. Foram aplicados testes Qui-quadrado para verificação de associações entre as variáveis selecionadas para ump<0,05 como estatisticamente significativo. A prevalência de infecção porChlamydiafoi de 9,11%. A infecção porChlamydianão se associou à idade(p = 0,826),à realização de consulta pré-natal (p = 0,451),à presença de HIV (p = 0,379)ao exame VDRL(p = 0,344) ou à prematuridade (p = 0,229). O estudo mostra alta prevalência de infecção por Chlamydiatrachomatis em gestantes. A infecção urogenital por Chlamydia trachomatis representa uma importante causa de morbidade perinatal, que pode ser adequadamente tratada por antibioticoterapia durante a gestação. A prevalência da infecção mostrou-se também superior às obtidas em outras populações de gestantes, sendo o Estado do Pará considerado de alta prevalência para a infecção. Fatores de risco para DSTs, como baixa idade, ausência de parceiro fixo e concomitância com outras DSTs apresentam-se importantes também dentro do quadro da infecção por Chlamydia trachomatis. / Chlamydia trachomatis is a pathogen that causes sexually transmitted infections (STIs). This agent significantly affects the sexual and reproductive health of women, and is related to sterility in a rather significant number of cases. It is also responsible for outcomes in pregnant women who have STIs in Brazil and worldwide. Despite its high prevalence, very little is known about the distribution of Chlamydia trachomatis genotypes. The objective of this study was to estimate the prevalence and factors associated with infection caused by this pathogen in pregnant women admitted to the Maternity Department at Fundação Santa Casa de Misericórdia do Pará, in the state of Pará. Sample of 363 pregnant women seen due to spontaneous demand, and the sample included the surplus of 32 pregnant women, to a total of 395 pregnant women in a 3-month collection period. Chi-Square tests were applied to verify the associations between the variables selected for a p < 0.05 as statistically significant. The prevalence of Chlamydia infection was 9.11%. The result of Chlamydiawas not associated with age (p = 0.826), antenatal visit (p = 0.451), presence of HIV (p = 0.379) VDRL test (p = 0.344) and with prematurity (p = 0.229). The study shows a high prevalence of infection due to Chlamydiatrachomatis in pregnant women. Urogenital infection due to Chlamydia trachomatis is a major cause of perinatal morbidity, which can be treated by antibiotics during pregnancy. The prevalence of infection also proved superior to those obtained in other populations of pregnant women, and the state of Pará is considered a place with a high prevalence of the infection. Risk factors for STIs, such as young age, absence of a fixed partner and concomitance with other STIs are also important in the picture of infection by Chlamydia trachomatis.

A Chlamydia trachomatis é um patógeno causador de doenças sexualmente transmissíveis (DST). Esse agente afeta significativamente a saúde sexual e reprodutiva de mulheres, estando relacionado à esterilidade em número bastante significativo,sendo também responsável por desfechos em gestantes acometidaspor DSTs no Brasil e no mundo. Apesar da sua alta prevalência, muito pouco se sabe sobre a distribuição de genótipos de Chlamydiatrachomatis. Este estudo teve como objetivo estimar a prevalência e os fatores associados à infecção causada por esse patógeno em gestantes admitidas na Maternidade da Fundação Santa Casa de Misericórdia do Pará. O estudo constou de uma amostra mínima de 363 gestantes atendidas por demanda espontânea, sendo incluídas na amostra o excedente de 32 gestantes totalizando 395 gestantes,em um período da coleta de 3 meses. Foram aplicados testes Qui-quadrado para verificação de associações entre as variáveis selecionadas para ump<0,05 como estatisticamente significativo. A prevalência de infecção porChlamydiafoi de 9,11%. A infecção porChlamydianão se associou à idade(p = 0,826),à realização de consulta pré-natal (p = 0,451),à presença de HIV (p = 0,379)ao exame VDRL(p = 0,344) ou à prematuridade (p = 0,229). O estudo mostra alta prevalência de infecção por Chlamydiatrachomatis em gestantes. A infecção urogenital por Chlamydia trachomatis representa uma importante causa de morbidade perinatal, que pode ser adequadamente tratada por antibioticoterapia durante a gestação. A prevalência da infecção mostrou-se também superior às obtidas em outras populações de gestantes, sendo o Estado do Pará considerado de alta prevalência para a infecção. Fatores de risco para DSTs, como baixa idade, ausência de parceiro fixo e concomitância com outras DSTs apresentam-se importantes também dentro do quadro da infecção por Chlamydia trachomatis. / Chlamydia trachomatis is a pathogen that causes sexually transmitted infections (STIs). This agent significantly affects the sexual and reproductive health of women, and is related to sterility in a rather significant number of cases. It is also responsible for outcomes in pregnant women who have STIs in Brazil and worldwide. Despite its high prevalence, very little is known about the distribution of Chlamydia trachomatis genotypes. The objective of this study was to estimate the prevalence and factors associated with infection caused by this pathogen in pregnant women admitted to the Maternity Department at Fundação Santa Casa de Misericórdia do Pará, in the state of Pará. Sample of 363 pregnant women seen due to spontaneous demand, and the sample included the surplus of 32 pregnant women, to a total of 395 pregnant women in a 3-month collection period. Chi-Square tests were applied to verify the associations between the variables selected for a p < 0.05 as statistically significant. The prevalence of Chlamydia infection was 9.11%. The result of Chlamydiawas not associated with age (p = 0.826), antenatal visit (p = 0.451), presence of HIV (p = 0.379) VDRL test (p = 0.344) and with prematurity (p = 0.229). The study shows a high prevalence of infection due to Chlamydiatrachomatis in pregnant women. Urogenital infection due to Chlamydia trachomatis is a major cause of perinatal morbidity, which can be treated by antibiotics during pregnancy. The prevalence of infection also proved superior to those obtained in other populations of pregnant women, and the state of Pará is considered a place with a high prevalence of the infection. Risk factors for STIs, such as young age, absence of a fixed partner and concomitance with other STIs are also important in the picture of infection by Chlamydia trachomatis.

Com esta pesquisa buscou-se identificar os fatores presentes na integração pós-fusão dos Sistemas e Tecnologias de Informação (STIs) que influenciaram a integração e os seus resultados, em fusões e aquisições entre instituições bancárias nacionais. Como estratégia de pesquisa foi adotada a triangulação de métodos qualitativos e quantitativos. Foram realizadas entrevistas com executivos ligados às áreas dos STIs e aplicados questionários às equipes dos bancos pesquisados que estiveram formalmente envolvidos com as atividades de integração. Para o tratamento e análise dos dados qualitativos utilizou-se a técnica da Análise de Conteúdo e para os dados quantitativos a técnica estatística multivariada Modelagem de Equações Estruturais. Os fatores considerados mais influentes para a integração pós-fusão dos STIs foram a qualidade e a expertise das equipes de integração dos STIs, que envolveu o conhecimento das características técnicas dos Sistemas de Informação (SIs) e das regras de negócios dos bancos; a gestão da integração, que coordenou os esforços de gerenciamento das atividades de integração dos STIs, valorizando o trabalho em equipe e otimizando o uso dos recursos computacionais; as configurações dos STIs, cuja similaridade entre elas ajudou a acelerar a integração e a redução de problemas técnicos; os conhecimentos oriundos das experiências prévias em que o conhecimento tácito se revelou importante, até mesmo como um fator de empregabilidade, não obstante a ausência de processos internos formais para transformar o conhecimento tácito das equipes técnicas em conhecimento explicito; o alinhamento estratégico dos STIs que apresentou menor relevância para a integração mesmo refletindo as funcionalidades dos SIs dos bancos adquiridos e que foram inseridas nos SIs dos bancos adquirentes, pois o uso dos recursos tecnológicos pode ter impacto limitado; a infraestrutura e arquitetura dos STIs, o fator menos relevante, dadas as facilidades de comunicação entre elas, e a sua desativação nos bancos adquiridos. Entre os resultados positivos, o aumento da eficiência dos STIs e o incremento das respectivas capacidades, associados à melhoria na qualidade dos SIs, constituíram-se nos principais legados da integração, seguidos pelo aumento da satisfação dos usuários desses STIs e pelo impacto positivo nas equipes técnicas dos STIs. A redução de custos da Tecnologia de Informação não apareceu como resultado relevante da integração. O resultado negativo deveu-se à deficiência em explorar as oportunidades de aprendizado com o processo. Outro aspecto significativo revelado pelo estudo, refere-se às sinergias técnicas conseguidas, que poderão alavancar a rentabilização dos bancos adquirentes, dado o potencial das elevadas economias de escala que elas podem proporcionar. / With this research we tried to identify present factors in the post-merger integration of Systems and Information Technology (STIs) that influenced the integration and their results in mergers and acquisitions among national banking institutions. As a research strategy it was adopted triangulating between qualitative and quantitative methods. Interviews were conducted with executives linked to the areas of STIs and completed questionnaires with the teams of the banks surveyed who were formally involved with integration activities. For treatment and analysis of qualitative data it was used the technique of Content Analysis and quantitative data with multivariate statistics called Structural Equation Modeling (SEM). The most influential factors for the post-merger integration of STIs were the quality and expertise of the teams for the integration of STIs, which involved knowledge of the technical characteristics of the Information Systems (ISs) and the rules of business of banks; management of integration, which coordinated efforts to manage the integration activities of STIs, valuing teamwork and optimizing the use of computational resources; the configuration of STIs, whose similarity between them helped to accelerate integration and reduction of technical problems; the knowledge from the previous experiences in that tacit knowledge was an important, even as a factor of employability, despite the absence of formal internal process to transform the tacit knowledge of the technical teams in explicit knowledge; the strategic alignment of STIs, which was less relevance to integration even reflecting the features of ISs of banks that were acquired and incorporated in the ISs of the acquiring banks, because the use of technological resources may have limited impact; the infrastructure and architecture of STIs, the factor less relevant, given the communication facilities between them, and their deactivation in the acquired banks. Among the positive results, the increased efficiency of STIs and increasing their capacities, associated with improving the quality of the ISs were the main legacies of integration, followed by increased user satisfaction of STIs and the positive impact on technical teams of STIs. Reduction of Information Technology costs did not appear as a relevant result of integration. The negative result was due to deficiency in exploring the opportunities for learning through the process. Another significant aspect revealed by the study refers to the technical synergies achieved, since these synergies could increase the profitability of the acquiring banks, given the high potential of economies of scale that they can provide.