Introdução. O Ambulatório de Viajantes (DMIP/HC/FMUSP) foi criado em São Paulo em fevereiro de 2001. Atualmente, os viajantes comparecem à clínica para consulta pré-viagem e em caso de doença, quando voltam à cidade. Avaliação pós- viagem não é feita rotineiramente. Esta pesquisa tem como objetivo ampliar as informações sobre as viagens realizadas e avaliar a adequação e a adesão às orientações pré-viagem. Métodos. No período de 03/02/2011 a 31/12/2011 foram convidados a participar do estudo os viajantes que procuraram o ambulatório para consulta pré-viagem. Os viajantes que concordaram em participar assinaram o Termo de Consentimento Livre e Esclarecido. O estudo foi realizado em duas etapas. Orientação pré-viagem: coleta de dados sobre as medidas de prevenção gerais recomendadas em relação a doenças transmitidas por vetores, água e alimentos, exposição acidental a animais; e dados individuais sobre as condições da viagem, vacinação prévia e histórico de saúde. Avaliação Pósviagem: Um questionário foi enviado aos participantes 15 dias após a data prevista de retorno. As respostas foram armazenadas na base de dados Excel. Foi utilizada estatística descritiva para apresentar todas as variáveis relevantes, utilizando Epi Info (CDC) e SPSS. Regressão logística multivariada foi usada para detectar fatores de risco independentes associados com o desenvolvimento de diarréia. Resultados. Foram obtidas 150 respostas (taxa de resposta de 52,8%), sendo 94 % dos participantes brasileiros, 89% com nível universitário, 55,1% do sexo feminino, a maioria entre 25 e 44 anos (54,5%). O tempo desde a consulta até a viagem foi menor de 28 dias em 60,1 %. Os destinos mais frequentes foram África em 58 viajantes (38,7%), seguida pela Ásia em 43 (28,7%). Demanda por serviços de saúde: 10,9% durante a viagem, e 6% no retorno. Causa da procura de atenção médica, diarréia (31,2%), seguido de acidentes em 18,7% e suspeita de malária em 12,5%. Entre os pacientes com diarréia ficar em casa de nativos (RR = 2,38; P = 0,004) e ter várias acomodações (RR 1,93; P = 0,02) foram fatores de risco na análise univariada. Viagem à Ásia foi também fator de risco (P= 0,024). Na análise multivariada a associação não se manteve. Em relação à adesão às medidas profiláticas recomendadas, a utilização de água mineral foi elevada entre todos os viajantes (94,1%), uso de hipoclorito, água fervida e limpeza dos alimentos antes do consumo foi maior no grupo de viajantes com diarréia. Hipoclorito para o consumo de água foi fator de risco (P = 0,003), independentemente do país visitado. Adesão à quimioprofilaxia da malária foi baixa, no entanto, apenas 9,6 % dos viajantes em risco apresentou malária. Exposição acidental a outros animais ocorreu em 4,7% dos viajantes. Relação sexual com conhecidos durante a viagem foi relatada por 20 % dos viajantes; 43,3 % não usaram preservativos; 46,1 % dos viajantes fizeram comentários favoráveis ao atendimento recebido e a utilidade durante a viagem. Conclusões. A principal causa de doença e procura por assistência médica foi diarreia. Adesão à quimioprofilaxia da malária e outras medidas recomendadas foi baixa. A procura por atendimento médico durante e após a viagem foi alta nessa série. Propõe-se aumentar a divulgação do serviço de forma a atingir outros setores da população / Background. The Travelers Outpatient Clinic (DMIP/HC /FMUSP) was established in São Paulo in February 2001. Currently, patients attend the clinic for pre-travel consultation and in case of illness when return to the city. Post-travel evaluation is not done routinely. This research aims to expand the information about the trips; profile occurrences; assess pre-trip orientations; adherence and adequacy, impact on disease prevention, and may be used to improve the pre-travel orientation and quality of care. Methods. In the period from 03/02/2011 to 31/12/2011 were invited to participate in the study travelers seeking outpatient care for pre-travel consultation. Travelers who agreed to participate signed the informed consent form. The study was conducted in two stages. Pre-travel orientation: collecting data on general prevention measures recommended in relation to vector-borne diseases, food and water, accidental exposure to animals, and individual data on the conditions of travel, prior vaccination and health. Post-travel evaluation: A questionnaire was sent to participants 15 days after the expected travel return date. The responses were stored in Excel database. Descriptive statistics were used to present all relevant variables using Epi Info (CDC) and SPSS. Multivariate logistic regression was used to detect independent risk factors associated with the development of diarrhea. Results. Were obtained 150 responses (52.81% response rate); 94% of participants were Brazilians, (89%) had college education, 54.5% of the participants were between 25 and 44 years and 55.1% were female. The time from consultation until the trip was less than 28 days in 60.1%. Travel destination: Africa in 58 travelers (38.7%), followed by Asia in 43 (28.7%). Demand for medical services: 10.9% during the trip, and 6% in return. Cause of seeking medical care: diarrhea (31.2 %) followed by accidents in 18.7% and suspected malaria in 12.5%. Among the patients with diarrhea the accommodation in native houses (RR=2.38 P = 0.004) and multiple accommodations (RR=2.006 P = 0.020) were risk factors. Travel to Asia was also a risk (RR 1.93 P = 0.024). In multivariate analysis the association was not maintained. Regarding adherence to prophylactic measures recommended; the use of mineral water was high among all travelers (94.1%); use of hypochlorite, boiled water and cleaning food before consumption were higher in the group of travelers with diarrhea; finding hypochlorite for water consumption as a risk factor (P = 0.003) regardless of the country visited. Adherence to chemoprophylaxis for malaria was low, however only 9.6% of travelers at risk had malaria. Reporting of accidental exposure to other animals occurred in 4.7% of our travelers. The sexual relationship with acquaintances during the trip was reported by 20% of travelers; of these 43.3% did not use condoms. 46.1% of travelers made favorable comments to the care received and the utility during the trip. Conclusions. The leading cause of illness and demand for medical care was diarrhea. Adherence to chemoprophylaxis for malaria and other recommended measures was low. Looking for medical service during and after the trip was high in this series.Proposes to increase the disclosure of the service in order to reach other sectors of the population .

As mulheres infectadas por aids, ao engravidarem, enfrentam múltiplas dificuldades, entre elas o receio da transmissão vertical. Objetivou-se com este estudo identificar as características sócio-demográficas e as condições de vida e trabalho de mulheres com aids; identificar os significados atribuídos por elas à maternidade e conhecer as implicações de ser mãe no processo saúde-doença. Trata-se de um estudo exploratório, qualitativo, com 16 mulheres com AIDS, matriculadas num serviço especializado em DST/AIDS do município de São Paulo. Os dados foram obtidos meio de consulta aos prontuários clínicos e de entrevista com roteiro semi-estruturado e submetidos posteriormente à análise de conteúdo, sendo interpretados à luz do conceito de Vulnerabilidade. As características do grupo de mulheres estudadas são: solteiras, idade reprodutiva, baixa escolaridade e condições de vida precárias, infectadas por via sexual, souberam do diagnóstico tardiamente. Dos significados da maternidade, emergiram três categorias: a primeira “a vivência da gravidez" abrangendo os determinantes, os sentimentos e as repercussões da gravidez; a segunda categoria, “expressão da maternidade" reuniu os significados atribuídos à maternidade e as dificuldades enfrentadas. A terceira “implicações da maternidade no cotidiano" referem-se ao enfrentamento do processo saúde-doença e ao relacionamento familiar. Na análise das categorias foram identificados elementos potencializadores e protetores da vulnerabilidade à infecção, adoecimento e morte pelo HIV no contexto de transmissão vertical do HIV. Concluiu-se que a maternidade, na ótica das mulheres, constituiu-se em um evento protetor da vulnerabilidade ao adoecimento e morte por HIV, sendo assim necessária uma abordagem dessas mulheres sobre o desejo de ter filhos, pois a maternidade possibilita re-significar suas vidas. / When women who are infected by AIDS get pregnant, they face several difficulties such as the fear of vertical transmission. The objective of this study is to identify the socio-demographic and living and work conditions in the life of women who have AIDS; identify the meaning attributed by them to maternity and identify the implications of being a mother in the health-disease process. It consists of an exploratory and quantitative study with 16 AIDS infected women, enrolled in a specialized service in STD/AIDS in the city of Sao Paulo. The data collected from clinical records and interviews from semi-structured guidelines, were later submitted to the content analysis, and interpreted according to the Vulnerability concept. The characteristics of the women studied are: single, reproductive age group, low education and precarious life condition, sexually infected, with late diagnostic. From de meaning of maternity three categories stood out: the first, “the pregnancy experience", including the determinants, the feelings and the pregnancy consequences: the second category, “maternity significance", combined the meanings attributed to maternity and the difficulties encountered. The third “daily implications of maternity" is related to the confront of the health-disease process and family relationship. While analyzing the categories, potential elements, protectors against the vulnerability to infection, falling ill and death caused by HIV in vertical HIV transmission, were identified. We concluded that maternity, from the women’s point of view, was a protective event against the vulnerability to illness and death caused by the HIV. Therefore, it is necessary to approach these women to discuss the willingness of having children, because maternity makes it possible for them to redirect their lives.

Apesar de caracterizar-se como uma das enfermidades mais antigas e conhecidas no mundo, a tuberculose ainda permanece como um dos principais agravos à saúde. A busca de sintomáticos respiratórios representa um importante pilar dentre as estratégias implementadas para controlar a doença, visto que pretende antecipar os efeitos adversos do processo de adoecimento por tuberculose pulmonar. Imersos nesse contexto, encontram-se os gerentes locais dos serviços de saúde, dos quais é esperado, entre outras coisas, a assunção de responsabilidades junto às atividades realizadas para o desenvolvimento e implantação de uma política de organização dos serviços, cujo objetivo final é a oferta de cuidados. O objetivo desta pesquisa foi analisar discursivamente como os efeitos de sentido têm influenciado na operacionalização da busca de sintomáticos respiratórios da tuberculose no município de São José do Rio Preto/SP, Brasil. Trata-se de uma pesquisa qualitativa, cuja fundamentação teórico-metodológica deu-se a partir dos postulados da Análise de Discurso de matriz francesa (pêcheuxtiana). Constituíram como sujeitos do estudo, 14 gerentes locais, atuantes no contexto da Atenção Primária à Saúde. Adotou-se como critério de inclusão os sujeitos que estivessem no cargo há um ano ou mais, excluindo-se os que no momento da coleta de dados estivessem em licença médica ou que não agendassem a entrevista após três tentativas. A geração de dados fez-se através de entrevistas semidirigidas, gravadas em áudio e realizadas em locais e horários pré-acordados com os sujeitos. O material empírico foi transcrito na íntegra e gerenciado pelo software Atlas ti, o qual antecedeu às analises discursivas. O projeto de pesquisa foi submetido e aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Os resultados evidenciam que os sujeitos estão envoltos em formações ideológicas de assujeitamento às normas e metas pré-estabelecidas, ao mesmo tempo que, a partir dessas condições resistem às imposições, o que reflete em descontinuidades na operacionalização da busca de sintomáticos respiratórios. A partir disso concluímos que a demanda, por vezes desconexas das reais necessidades apresentadas pelos usuários/população dos serviços de saúde, geram ambientes pouco motivadores, sobretudo no que concerne ao controle da tuberculose por meio da busca de sintomáticos respiratórios. Portanto, faz-se necessária a (re)construção de uma gestão mais participativa, envolvendo os diversos níveis hierárquicos, a fim de que haja um ambiente mais proativo e favorável à efetivação de metas e normas que visem a prevenção de doenças e a promoção da saúde da população. / Although characterized as one of the oldest and best-known diseases in the world tuberculosis continues as one of the major health problems. The respiratory symptoms search is an important pillar among the strategies to control the disease because it aims to anticipate the adverse effects of the pulmonary tuberculosis disease process. The local health service managers are immersed in this process, of which is expected, among other things, the assumption of the responsibility for the development and implementation of a services organization policy whose ultimate goal is to provide care. The purpose of this study was to analyze discursively how the effects of meaning have influenced the search for tuberculosis respiratory symptoms in the city of São Jose de Rio Preto/SP, Brazil. The theoretical and methodological foundation of this qualitative study lies on the French Discourse Analysis Matrix (Pêcheuxtian). The study subjects consisted of 14 local managers operating in the Primary Health Care context. The criterion adopted for inclusion chose subjects that had been in office for a year or more, excluding those that at the time of data collection were on sick leave or that had not schedule an interview after three attempts. The data generation was done through semi-structured interviews, audio- recorded and performed in places and times pre-agreed with the subjects. The empirical material was transcribed verbatim and managed by Atlas TI software prior to the discursive analysis. The research project was presented to and approved by the Research Ethics Committee of Nursing School of Ribeirão Preto, University of São Paulo. Results show that the subjects are shrouded in ideological formations of subjection to rules and pre-set targets, whilst from this conditions resist impositions, resulting in discontinuities in the respiratory symptoms search operations. From this, we conclude that the demand, sometimes disconnected from the real needs presented by the health services users/population, generates unproductive environments, especially with regard to tuberculosis control through the pursuit of respiratory symptoms. Therefore, the (re) rebuilding of a more participatory administration is necessary, involving the various hierarchical levels, so that an environment more proactive and conducive to the realization of goals and standards for the prevention of disease and promotion of the health of the population.

Vivenciando no dia-dia que o número de casos das infecções sexualmente transmitidas (IST) e da aids vem aumentando em todo mundo e na África, principalmente na população jovem, é imprescindível a tomada de medidas preventivas para seu controle. Assim, desenvolvemos este estudo do tipo descritivo transversal com o objetivo de identificar os conhecimentos e risco para IST e aids entre estudantes de nível médio. O referencial teórico foi o “o Modelo de Crenças em Saúde” que compõe as dimensões de susceptibilidade percebida, severidade percebida, benefícios percebidos e barreiras percebidas. A população estudada constituiu-se de 385 estudantes, pertencente a três escolas de ensino médio. A coleta dos dados ocorreu no período de maio a junho de 2004 e os dados analisados quali-quantitativamente. Para análise quantitativa, os dados foram codificados e registrados numa base de dados e tratados em estatística descritiva. Quanto aos dados qualitativos foram tratados com base no Método de BARDIN (1977), sendo analisados e interpretados utilizando o referencial teórico do Modelo de Crenças em saúde de Rosenstock (1974a). Quanto às características demográficas, 59,9% dos estudantes eram do sexo feminino, 49,1% do sexo masculino, a idade variou entre 13 e 45 anos, 83,9% referiram ser solteiros. Com relação às práticas sexuais, 77,4% dos alunos investigados eram sexualmente ativos, sendo que 51,6% mencionaram nunca terem usado ou usado algumas vezes o preservativo; 66,7% referiram nunca terem usado e ou usado algumas vezes o preservativo com o parceiro fixo; 55,3% perceberam o risco de adquirir as IST/ aids. Quanto as informações acerca das IST /aids 95,8% dos respondentes já ouviram falar da aids, 95,3% de sífilis, 92,9% de gonorréia, 58,1% de hepatite B, sendo que 90,1% dos informantes tiveram como fonte de informação a televisão, 85,4% o radio, 78,4% os amigos, 74,5% os livros, 65,9% o jornal. Quanto à susceptibilidade, através dos enunciados dos participantes referiram perceber a sua vulnerabilidade e risco em adquirir IST/ aids. No tocante à severidade percebida, os estudantes associaram a aids a doença sem cura e à morte. Os informantes demonstram terem tido conhecimentos sobre os modos de transmissão e medidas preventivas das principais IST, porém bastante limitados. Sobre benefícios percebidos, foram mencionados pelos investigados alguns fatores facilitadores do uso do preservativo, como meio de prevenção e método contraceptivo, para além da citação de algumas barreiras percebidas como, a dificuldade no uso do preservativo. Diante destas situações, é imprescindível a implementação de programas educativos de prevenção com vistas à promoção da saúde. / Experiencing in everyday life that the number of cases with sexually transmissible infections (STI) and aids is increasing all over the world and in Africa, mainly in the juvenile population, preventive measures are essential for their control. Thus, this escriptive and cross-sectional study aimed to identify knowledge and risk of STI and aids among secondary students. The theoretical reference framework was the “Health Belief Model”, which covers the dimensions of perceived susceptibility, perceived severity, perceived benefits and perceived barriers. The study population consisted of 385 students from three secondary schools. Data were collected in May and June and subject to qualitative and quantitative analysis. With a view to quantitative analysis, data were coded, registered in a database and treated by means of descriptive statistics. In qualitative analysis, data were treated on the basis of BARDIN’s method (1977) and analyzed and interpreted through the theoretical reference framework of ROSENSTOCK’s (1974 a) Health Belief Model. With respect to demographic characteristics, 59.9% of the students were women and 49.1% men, ages ranged from 13 to 45 years and 83.9% mentioned they were single. What sexual practices is concerned, 77.4% of the investigated students were sexually active; 51.6% indicated they had used the condom never or a few times; 66.7% mentioned they had used the condom never or a few times with their fixed partner; 55.3% perceived the risk of acquiring STI/aids. As to information about STI/aids, 95.8% of the respondents had already heard about aids, 95.3% about syphilis, 92.9% about gonorrhea and 58.1% about hepatitis B. 90.1% of the informants obtained their information from television, 85.4% from radio, 78.4% from friends, 74.5% from books and 65.9% from newspapers. With respect to susceptibility, the participants’ discourse indicated they perceived their vulnerability and risk of acquiring STI/aids. What perceived severity is concerned, students associated aids to an incurable disease and to death. The informants demonstrated their knowledge about transmission modes and measures to prevent the main STI, although quite limited. As to perceived benefits, the participants mentioned some facilitating factors of condom use as a means of prevention and contraceptive method. Furthermore, they indicated some perceived barriers as difficulties for condom use. In light of these situations, educational prevention programs have to be implemented with a view to health promotion.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / PapilomavÃrus Humano (HPV) à um agente viral que causa doenÃa infecciosa, de transmissÃo freqÃentemente sexual, conhecida usualmente como condiloma acuminado, verruga genital ou crista de galo, à o principal agente causal do cÃncer de colo do Ãtero, podendo repercutir na vida do indivÃduo infectado e na saÃde da famÃlia. Os objetivos foram avaliar a estrutura, o desenvolvimento e o funcionamento da famÃlia composta por mulher acometida pelo PapilomavÃrus Humano, com base no Modelo Calgary; identificar possÃveis influÃncias causadas na estrutura familiar, em decorrÃncia da doenÃa; reconhecer influÃncias no desenvolvimento e funcionamento da famÃlia, em decorrÃncia da doenÃa; identificar fatores os quais a mulher relaciona com a causa da doenÃa. A pesquisa foi do tipo descritiva com abordagem qualitativa, tendo sido realizado um estudo de caso, no domicÃlio da participante, utilizando como referencial o Modelo Calgary de AvaliaÃÃo de FamÃlia. A coleta de dados foi realizada em janeiro e fevereiro de 2007 atravÃs de entrevista semi-estruturada com o casal, genograma e ecomapa da famÃlia. A famÃlia era composta por quatro membros, o casal: Josuà e Rosa; e seus dois filhos: Gabriel e Bela. Em exame ginecolÃgico de rotina foi diagnosticado em Rosa uma verruga externa e uma pequena lesÃo na junÃÃo escamo-colunar do colo uterino. Todos os membros da famÃlia mantÃm relacionamento saudÃvel entre si, hà um pouco de negatividade no vÃnculo entre Rosa e Gabriel, em decorrÃncia das cobranÃas com relaÃÃo aos estudos. O casal nÃo se distanciou da sua rede social em decorrÃncia do acometimento com o vÃrus. A esposa compartilhou o caso com o marido, culpando-o, mas posteriormente conseguiu conscientizÃ-lo da importÃncia dos hÃbitos sexuais seguros. O casal conseguiu superar a fase crÃtica vivenciada, deixando como melhor repercussÃo a mudanÃa de hÃbitos e maior afeiÃÃo entre a famÃlia. Com relaÃÃo ao tema HPV, verifica-se que muitas pessoas ainda o desconhecem, ficando a cargo dos profissionais difundirem o assunto com maior Ãnfase tanto entre as mulheres como os homens. Assim como tambÃm promover a educaÃÃo em saÃde, para que as pessoas reflitam a respeito da importÃncia de utilizar o preservativo. / Human Papillomavirus (HPV) is one viral agent that causes infective disease, of transmission frequently sexual, known usually as acuminated conduloma, genital wart or cockscomb, it is the main agent that causes the cancer of the uterus colon as sure as can be with repercussion in the life of the infected individual and in the health of the family. The aims were to evaluate the structure, the development and the function of the family composed by attacked woman by Human Papillomavirus, based in the Calgary Model; to identify possible influences caused within structural family due to disease; to identify factors that the woman relates with the cause of the disease. The search was the descriptive type with qualitative boarding, having been realized one case study, at the home of the informer making use of the Calgary Model as one touched topic of family valuation. Datum collection was realized in January and February from 2007, through interview semi-structured with the couple, genogram and echomap from family. The family was composed of four members such as: the couple Josuà and Rosa and their two children: Gabriel and Bela. By gynecological routine exam it was diagnosed in Rosa, one external wart and one small lesion in the scale-columnar junction of the uterus colon. All the members of the family maintain healthy relationship among them; there is a little bit of negativity in the entail between Rosa and Gabriel, due to charges with relation to studies. The couple didnât keep away from their social net, due to undertaking with the virus. The housewife shared the case with her husband, accusing him, but lately she got acquired him of the importance from safe sexual habits. The couple got over comes the grasped critical phases, overlooking as better repercussion, the changing of their habits and bigger affection among the family. With regard to the theme HPV, it had seen that many people unknown still, staying to the load from professional spread the subject with more emphasis as among women well as men. As well as to promote the education within health, in order to the people reflect to respect of the great importance in utilizing the prophylactic.

Apesar de caracterizar-se como uma das enfermidades mais antigas e conhecidas no mundo, a tuberculose ainda permanece como um dos principais agravos à saúde. A busca de sintomáticos respiratórios representa um importante pilar dentre as estratégias implementadas para controlar a doença, visto que pretende antecipar os efeitos adversos do processo de adoecimento por tuberculose pulmonar. Imersos nesse contexto, encontram-se os gerentes locais dos serviços de saúde, dos quais é esperado, entre outras coisas, a assunção de responsabilidades junto às atividades realizadas para o desenvolvimento e implantação de uma política de organização dos serviços, cujo objetivo final é a oferta de cuidados. O objetivo desta pesquisa foi analisar discursivamente como os efeitos de sentido têm influenciado na operacionalização da busca de sintomáticos respiratórios da tuberculose no município de São José do Rio Preto/SP, Brasil. Trata-se de uma pesquisa qualitativa, cuja fundamentação teórico-metodológica deu-se a partir dos postulados da Análise de Discurso de matriz francesa (pêcheuxtiana). Constituíram como sujeitos do estudo, 14 gerentes locais, atuantes no contexto da Atenção Primária à Saúde. Adotou-se como critério de inclusão os sujeitos que estivessem no cargo há um ano ou mais, excluindo-se os que no momento da coleta de dados estivessem em licença médica ou que não agendassem a entrevista após três tentativas. A geração de dados fez-se através de entrevistas semidirigidas, gravadas em áudio e realizadas em locais e horários pré-acordados com os sujeitos. O material empírico foi transcrito na íntegra e gerenciado pelo software Atlas ti, o qual antecedeu às analises discursivas. O projeto de pesquisa foi submetido e aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Os resultados evidenciam que os sujeitos estão envoltos em formações ideológicas de assujeitamento às normas e metas pré-estabelecidas, ao mesmo tempo que, a partir dessas condições resistem às imposições, o que reflete em descontinuidades na operacionalização da busca de sintomáticos respiratórios. A partir disso concluímos que a demanda, por vezes desconexas das reais necessidades apresentadas pelos usuários/população dos serviços de saúde, geram ambientes pouco motivadores, sobretudo no que concerne ao controle da tuberculose por meio da busca de sintomáticos respiratórios. Portanto, faz-se necessária a (re)construção de uma gestão mais participativa, envolvendo os diversos níveis hierárquicos, a fim de que haja um ambiente mais proativo e favorável à efetivação de metas e normas que visem a prevenção de doenças e a promoção da saúde da população. / Although characterized as one of the oldest and best-known diseases in the world tuberculosis continues as one of the major health problems. The respiratory symptoms search is an important pillar among the strategies to control the disease because it aims to anticipate the adverse effects of the pulmonary tuberculosis disease process. The local health service managers are immersed in this process, of which is expected, among other things, the assumption of the responsibility for the development and implementation of a services organization policy whose ultimate goal is to provide care. The purpose of this study was to analyze discursively how the effects of meaning have influenced the search for tuberculosis respiratory symptoms in the city of São Jose de Rio Preto/SP, Brazil. The theoretical and methodological foundation of this qualitative study lies on the French Discourse Analysis Matrix (Pêcheuxtian). The study subjects consisted of 14 local managers operating in the Primary Health Care context. The criterion adopted for inclusion chose subjects that had been in office for a year or more, excluding those that at the time of data collection were on sick leave or that had not schedule an interview after three attempts. The data generation was done through semi-structured interviews, audio- recorded and performed in places and times pre-agreed with the subjects. The empirical material was transcribed verbatim and managed by Atlas TI software prior to the discursive analysis. The research project was presented to and approved by the Research Ethics Committee of Nursing School of Ribeirão Preto, University of São Paulo. Results show that the subjects are shrouded in ideological formations of subjection to rules and pre-set targets, whilst from this conditions resist impositions, resulting in discontinuities in the respiratory symptoms search operations. From this, we conclude that the demand, sometimes disconnected from the real needs presented by the health services users/population, generates unproductive environments, especially with regard to tuberculosis control through the pursuit of respiratory symptoms. Therefore, the (re) rebuilding of a more participatory administration is necessary, involving the various hierarchical levels, so that an environment more proactive and conducive to the realization of goals and standards for the prevention of disease and promotion of the health of the population.

Scrapie is a transmissible spongiform encephalopathy (TSE) of sheep and goats, for which there is currently no ante-mortem diagnostic test. A rapid, ante-mortem diagnostic test for scrapie would also potentially be important for other TSEs such as bovine spongiform encephalopathy (BSE) and variant Creutzfeldt Jakob's disease (vCJD). The hypothesis of this study was that there is differential gene expression in the blood and peripheral tissues of scrapie infected animals, and that a panel of differentially expressed genes could be identified and used as surrogate markers of infection. An expression screening approach, using real-time PCR and an EST microarray, was used to identify genes that were differentially expressed between SSBP/1 infected and mock-infected control sheep. The animals used in this study were New Zealand Cheviot sheep of three genotypes, the highly susceptible VRQ/VRQ (incubation time 193 ± 12 days), the intermediately susceptible VRQ/ARR (incubation time 325 ± 36 days) and the disease resistant ARR/ARR (no clinical signs of disease), experimentally infected with scrapie strain SSBP/1 and sacrificed at various time points post infection. No differentially expressed candidates were identified in blood. Other microarray experiments in our group had demonstrated evidence of differential expression in spleen fractions enriched for follicular dendritic cells (FDCs). These data were analysed and candidates were selected for quantitative real-time PCR validation, with a view to assessing the expression of validated candidates in blood as a more targeted approach to identifying markers of infection. The gene Early Growth Response 1 (EGR1) emerged as an interesting candidate as its expression was found to be significantly up-regulated in FDC-enriched spleen samples of VRQ/VRQ and ARR/ARR animals over a number of time points post infection. EGR1 expression was steady among all mock-infected controls. There was, however, no evidence of differential expression of EGR1 in blood. This is the first report of differential expression of EGR1 in preclinical spleen samples in sheep. EGR1 is an attractive candidate for a surrogate marker of preclinical infection, as its levels rise very early after infection and remain elevated for a sustained amount of time in the VRQ/VRQ sheep. Elevated expression is also detectable in VRQ/ARR and in ARR/ARR sheep. Further studies with larger sample numbers would be necessary to more accurately estimate the extent of differential expression and to assess its true worth as a diagnostic marker. Expression studies in samples from other TSEs and non-TSE neuropathological disease would also be necessary to establish whether differential expression of EGR1 is specific to TSE disease.

Transmissible spongiform encephalopathies (TSEs) or prion diseases, are subacute neurodegenerative diseases that infect humans and animals. Many of these diseases are acquired by peripheral exposure (e.g. orally). After oral exposure prion replication within the Peyer's patches (PP) in the small intestine is necessary for the efficient spread of the disease to the brain. Within the intestine, bacteria and pathogenic microorganisms can affect the status of the gut associated lymphoid tissue (GALT). GALT consists of PP and isolated lymphoid follicles (ILF) that maintain homeostasis and protect from infections. Therefore, factors which modify GALT status, might dramatically affect oral prion disease pathogenesis by influencing the uptake of prions from the gut lumen or expanding their distribution within the host. Chronic intestinal helminth infections are common in animals and in man, and can cause significant pathology within the intestine. Little is known of the effects that intestinal helminth infections may have on oral prion diseases susceptibility. Therefore, in this study the influence that co-infection with Heligmosomoides polygyrus (a natural pathogen of the mouse small intestine) may have on oral prion disease pathogenesis and susceptibility was determined. The studies consisted of groups of 4 (for H. polygyrus characterization and for early prion detection) and 8 (for H. polygyrus-prion co-infection to terminal stage) mice infected with H. polygyrus (orally) alone or subsequently infected with ME7 scrapie prions (orally) at different time-points after parasitic infection. The effects of the H. polygyrus infection alone, and on oral prion disease pathogenesis and susceptibility were then determined. Initially the characterization of H. polygyrus infection on the host intestine revealed that this parasite caused significant pathology in the small intestine and affected the GALT microarchitecture. In the PP follicles, H. polygyrus infection increased the area of follicular dendritic cell expression, altered the positioning of mononuclear phagocytes and increased M cell density. H. polygyrus infection also reduced the number of ILF in both the small and large intestines. Additional studies in mice co-infected with a low dose of prions, revealed that these pathological changes affected the survival time and disease susceptibility. Data also show that the extent of the effects on prion disease pathogenesis and susceptibility were dependent on the stage of the helminth infection at which the mice were orally-exposed to prions. Data demonstrate that co-infection with the gastrointestinal helminth H. polygyrus can influence oral prion disease pathogenesis and susceptibility. Helminth infections can significantly modify the microarchitecture of the gut and the GALT. Data presented suggest the pathological changes that pathogens such as small intestinal helminths cause, may also influence the uptake of prions from the gut lumen after oral exposure.

In nanopore analysis, peptides and proteins can be detected by the change in current when single molecules interact with an α-hemolysin pore embedded in a lipid membrane. Studies into the effects of fluorenylmethoxycarbonyl (Fmoc), acetylation or proline modification to negatively charged α-helical peptides showed that Fmoc peptides give more translocations than acetylated peptides. The addition of a proline in the middle of an acetylated peptide further reduces the number of translocations compared to Fmoc. The effect of peptide conformation on translocation or intercalation was studied with small α-helical and β-sheet hairpins. The capped β-hairpin increased translocations compared to the uncapped. The Fmoc-α-helical hairpin, containing a disulfide link, displayed both bumping and translocations whereas in the unlinked peptide the proportion of translocations was greater. Prion diseases arise from the misfolding and aggregation of the normal cellular prion protein. Nanopore analysis of prion peptides with α-helical and β-strand sequences show changes to the event parameters that help distinguish them. The interaction of bovine prion protein (bPrP), with α-hemolysin showed both bumping (type-I) and intercalation/translocation (type-II) events. There are several lines of evidence that indicate these type-II events with a blockade current of -65 pA for bPrP, represent translocations. Nanopore analysis showed that about 37% events were translocations. The interaction of metal ions with bPrP showed that Cu(II) or Zn(II) reduced translocations. Surprisingly, Mn(II) caused an increase in translocation events to about 64%. Complex formation between antibodies and prion peptides and proteins can be detected by nanopore analysis. The PrP/antibody complex is too large to translocate whereas the event parameters for unbound molecules are unchanged. In principle, a nanopore can detect a single molecule; thus, this work represents the first step towards the development of a prion detector. The nanopore will provide the sensitivity and the antibodies will provide the specificity to distinguish between PrPC and PrPSc. Also, the prion N- and C-terminal signal peptides interact with bPrP changing the event parameters, relating to a new mechanism. Finally, the folding intermediates of bPrP at 0.86 M Gdn-HCl suggests that the protein unfolds and then refolds into a different conformation with event parameters similar to those of bPrP.

In nanopore analysis, peptides and proteins can be detected by the change in current when single molecules interact with an α-hemolysin pore embedded in a lipid membrane. Studies into the effects of fluorenylmethoxycarbonyl (Fmoc), acetylation or proline modification to negatively charged α-helical peptides showed that Fmoc peptides give more translocations than acetylated peptides. The addition of a proline in the middle of an acetylated peptide further reduces the number of translocations compared to Fmoc. The effect of peptide conformation on translocation or intercalation was studied with small α-helical and β-sheet hairpins. The capped β-hairpin increased translocations compared to the uncapped. The Fmoc-α-helical hairpin, containing a disulfide link, displayed both bumping and translocations whereas in the unlinked peptide the proportion of translocations was greater. Prion diseases arise from the misfolding and aggregation of the normal cellular prion protein. Nanopore analysis of prion peptides with α-helical and β-strand sequences show changes to the event parameters that help distinguish them. The interaction of bovine prion protein (bPrP), with α-hemolysin showed both bumping (type-I) and intercalation/translocation (type-II) events. There are several lines of evidence that indicate these type-II events with a blockade current of -65 pA for bPrP, represent translocations. Nanopore analysis showed that about 37% events were translocations. The interaction of metal ions with bPrP showed that Cu(II) or Zn(II) reduced translocations. Surprisingly, Mn(II) caused an increase in translocation events to about 64%. Complex formation between antibodies and prion peptides and proteins can be detected by nanopore analysis. The PrP/antibody complex is too large to translocate whereas the event parameters for unbound molecules are unchanged. In principle, a nanopore can detect a single molecule; thus, this work represents the first step towards the development of a prion detector. The nanopore will provide the sensitivity and the antibodies will provide the specificity to distinguish between PrPC and PrPSc. Also, the prion N- and C-terminal signal peptides interact with bPrP changing the event parameters, relating to a new mechanism. Finally, the folding intermediates of bPrP at 0.86 M Gdn-HCl suggests that the protein unfolds and then refolds into a different conformation with event parameters similar to those of bPrP.