Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2006. / Includes bibliographical references.

Thesis (M.A.)--Duquesne University, 2009. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 56-62) and index.

Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / IMPORTANCE: With greater access to health care through health care reform it is important to know if quality of care for similar complaints differs across clinical settings. OBJECTIVE: Develop and pilot a chart review instrument to measure quality of care for patients presenting with urethritis and vaginitis. METHODS: List of sexually transmitted infection (STI) quality of care measures was reviewed by a panel of five STI experts representing Emergency Department (ED), Obstetrics/Gynecology (Ob/Gyn), Family Medicine (FM), Primary Care (PC) and Infectious Disease. Panel members grouped each measure into “standard” or “exceeds standard of care” in evaluation and management of male patients with penile discharge/dysuria or female patients with vaginal discharge. The chart review instrument was piloted on 50 charts per gender from the STI Clinic and matched charts, by patient presenting complaint, age, gender, and visit date, from PC, FM, ED, and Ob/Gyn (for vaginal discharge) in the same large safety-net hospital in Massachusetts. RESULTS: Twenty-four and 34 final measures in male and female patients, respectively, were selected on plurality of expert panel member’s categorization into “standard of care”. Measures were grouped into 7 clinical domains: history, examination, laboratory testing, additional screening, assessment, treatment, and counseling. Performance on the 7 domains ranged from 3.16-4.36 on male patients and 3.17-4.40 on female patients, with the highest scores in the STI Clinic. However, each clinical setting had particular documentation strengths and weaknesses: STI Clinic scored higher on laboratory testing, additional screening, and counseling, but scored lower on examination and assessment; ED scored higher on examination and treatment; PC and FM scored higher on laboratory testing for male patients and on examination and treatment for female patients; Ob/Gyn scored higher on treatment. All sites other than the STI Clinic scored poorly on additional screening and counseling. CONCLUSIONS: An instrument to discern standard of care and identify strengths and weaknesses in specific domains of clinical documentation for patients presenting with STI complaints can be rapidly developed and implemented to evaluate quality of care across care settings. Further research is needed on whether these findings can be integrated into site-specific quality improvement processes and linked to cost analyses. / 2031-01-01

As doenÃas sexualmente transmissÃveis (DST), o vÃrus da imunodeficiÃncia humana (HIV) e a sÃndrome da imunodeficiÃncia adquirida (Aids) constituem significativos problemas de saÃde pÃblica no Brasil e no mundo. Qualquer pessoa sexualmente ativa pode adquirir DST/HIV/Aids. Entretanto, o adolescente à considerado sujeito bastante vulnerÃvel. O estudo apresenta como objetivo geral avaliar a atuaÃÃo de enfermeiros na prevenÃÃo de DST/Aids com adolescentes no Programa SaÃde na Escola. Pesquisa de avaliaÃÃo com abordagem quanti-qualitativa, realizada de janeiro a novembro de 2013. Os sujeitos do estudo foram setenta e oito enfermeiros que atuavam no Programa SaÃde na Escola (PSE) de Fortaleza, CearÃ, Brasil. Para coleta de dados, foi adotada a entrevista semiestruturada e o checklist. Para organizaÃÃo e anÃlise dos dados, foi tomado por referÃncia o MÃtodo de InterpretaÃÃo dos Sentidos e a anÃlise estatÃstica descritiva por meio do software Excel. A pesquisa foi aprovada pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, conforme parecer de n 209.337 de 28/02/2013. Os resultados apresentam que a grande maioria dos sujeitos da pesquisa nÃo realizou satisfatoriamente as aÃÃes preconizadas pelo MinistÃrio da SaÃde para o PSE e, por conseguinte, nÃo alcanÃaram os resultados esperados na linha de aÃÃo EducaÃÃo para SaÃde Sexual, SaÃde Reprodutiva e PrevenÃÃo das DST/Aids e de Hepatites Virais. Assim, por meio do checklist, a maioria afirma que nÃo foram realizados e alcanÃados as seguintes aÃÃes e resultados: nÃo houve, de forma contÃnua, encontros de mobilizaÃÃo e sensibilizaÃÃo na Ãrea; atividades que utilizassem metodologias participativas; formaÃÃo de estudantes nos temas; envolvimento dos educandos no planejamento, execuÃÃo e avaliaÃÃo das atividades; debates com a comunidade escolar sobre a importÃncia da participaÃÃo juvenil; inclusÃo das temÃticas nos projetos polÃtico-pedagÃgicos das escolas; aÃÃes educativas e participativas sobre os temas; adesÃo dos educandos e da comunidade escolar Ãs atividades desenvolvidas e disponibilizaÃÃo de preservativos nas escolas. Contudo, à oportuno destacar que alguns sujeitos do estudo afirmaram por meio de depoimentos que tais aÃÃes foram desenvolvidas com a periodicidade devida, utilizando-se de estratÃgias apropriadas. Todavia, importantes obstÃculos foram encontrados para a nÃo efetivaÃÃo dessas aÃÃes pela maioria dos profissionais, que perpassam por aspectos profissionais (habilidades e competÃncias), administrativos e gerenciais (papel das instÃncias gestoras envolvidas no programa) e do pÃblico envolvido (adolescentes e famÃlias). Neste sentido, o estudo obteve informaÃÃes fundamentais que sugerem a necessidade de modificaÃÃes urgentes no programa, a fim de que a atuaÃÃo do enfermeiro venha ser capaz de colaborar, de fato, na promoÃÃo da saÃde sexual e reprodutiva de adolescentes assistidos pelo PSE. E, nÃo somente isso, mas para que estes e os demais atores envolvidos consigam cumprir o objetivo central do programa de promover formaÃÃo e atenÃÃo integral a estudantes, levando a uma melhoria da qualidade de vida e saÃde destes sujeitos. / Sexually transmitted diseases (STDs), human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (Aids) represent significant public health problems in Brazil and the whole world. Any sexually active person is susceptible to contract STD/HIV/AIDS. Nonetheless, adolescents are considered very vulnerable subjects. The main objective of this study is to assess the performance of nurses in the prevention of STD/AIDS with adolescents in the School Health Program. This is an evaluation research with quantitative and qualitative approach, conducted from January to November 2013. The subjects in study were 78 nurses working in the School Health Program (SHP) in Fortaleza, CearÃ, Brazil. For data collection, we applied the semi-structured interview and the checklist. For data organization and analysis, we used the Method of Meanings Interpretation as reference and the descriptive statistical analysis through the Excel software. The Research Ethics Committee of the Universidade Federal do CearÃ, under protocol No. 209.337 of February 28, 2013, approved the study. The results show that the vast majority of the subjects in study did not satisfactorily perform the actions recommended by the Ministry of Health for the SHP and therefore did not achieve the expected results in the course of action on Education for Sexual Health, Reproductive Health, and Prevention of STD/AIDS and Viral Hepatitis. Thus, through the checklist, most people reported they did not perform nor achieve the following actions and results: continuous mobilization and sensitization meetings in the area; activities that used participatory methodologies; students training on the themes; students involvement in planning, implementation and evaluation of activities; discussions with the school community about the importance of adolescents participation; inclusion of themes in the political-educational school projects; educational and participatory activities on the themes; adherence of students and school community to the activities developed; and the provision of condoms in schools. However, it is worth mentioning that some subjects in study, through the interviews, reported that such actions happened with the proper periodicity, using appropriate strategies. Nevertheless, we identified several barriers for the non-implementation of these actions by most professionals, involving professional aspects (skills and competencies), administrative and managerial aspects (role of management levels involved in the program), and aspects of the public in question (adolescents and families). In this sense, the study obtained essential information that point to the need for urgent modifications in the program, so that the nursesâ performance collaborates effectively to the promotion of sexual and reproductive health of adolescents assisted by the SHP. Also, for these and the other actors involved fulfill the main objective of the program, which is promoting education and comprehensive care for students, thus leading to an improved quality of life and health of these subjects.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / No panorama das DST/HIV/AIDS entre os adolescentes, a estratÃgia para controlar a transmissÃo à a prevenÃÃo, a fim de promover a sua saÃde. Na perspectiva de implementar novas estratÃgias, considerando as caracterÃsticas da adolescÃncia, sua vulnerabilidade, e da carÃncia de aÃÃes educativas a longo prazo, utilizou-se neste estudo, uma nova proposta adotada na escola: o plantÃo educativo individual do adolescente. Assim, o objetivo geral desta pesquisa foi avaliar a aplicaÃÃo de um plantÃo educativo sobre DST/HIV/AIDS com adolescentes de uma escola pÃblica em Imperatriz â MA. Pesquisa de intervenÃÃo, quase-experimental, quantiqualitativa, com delineamento longitudinal. Foram avaliados 250 adolescentes escolares entre janeiro e junho de 2013 em trÃs etapas. Na primeira, os adolescentes responderam um instrumento sobre o conhecimento, os comportamentos e as atitudes frente Ãs DST/HIV/AIDS antes de participar da intervenÃÃo educativa. Na segunda etapa, os estudantes participaram do plantÃo educativo. Na terceira etapa, os adolescentes responderam novamente um instrumento para avaliar se houve mudanÃa nos conhecimentos, comportamentos e nas atitudes em relaÃÃo Ãs DST/HIV/AIDS, 30 dias apÃs a intervenÃÃo educativa. Analisaram-se na amostra estratificada as caracterÃsticas sociodemogrÃficas, o conhecimento dos adolescentes quanto ao acesso e uso de serviÃos de saÃde, as fontes de informaÃÃo utilizadas sobre DST/HIV/AIDS, e, os conhecimentos, comportamentos e as atitudes quanto Ãs prÃticas sexuais seguras frente Ãs DST/HIV/AIDS antes e depois da intervenÃÃo educativa. Os dados foram analisados no software estatÃstico STATA versÃo 8.0. Os adolescentes possuem mÃdia de 15,5 anos de idade, sÃo solteiros (as) sem parceiro (a) fixo (75,6%), com predomÃnio do sexo feminino (52,4%) e renda familiar entre um e trÃs salÃrios mÃnimos (46%). Verificaram-se tendÃncias de aumento proporcional estatisticamente significante por sexo (p-valor=0,00), evidenciando maior nÃvel de instruÃÃo dos pais dos meninos. Houve tendÃncia de aumento estatisticamente significante com relaÃÃo ao sexo dos entrevistados (p-valor=0,02), sinalizando menor rendimento familiar entre as meninas. A maioria dos estudantes nÃo tem indicaÃÃo de serviÃos de saÃde pela escola (79,6%). As principais fontes de informaÃÃo fora da escola sobre DST/HIV/AIDS sÃo rÃdio/televisÃo/jornal (54%). Os adolescentes aumentaram o conhecimento sobre os sintomas (99,2%), as formas de transmissÃo da AIDS (100%) e o uso do preservativo para prevenir DST/HIV/AIDS (100%). Parcela substancial dos adolescentes (98,4%) acredita nÃo ter nenhuma possibilidade de adquirir o HIV. Os que tÃm atividade sexual possuem um parceiro (56,3%) e usaram preservativo na Ãltima relaÃÃo sexual (65,7%). Os adolescentes avaliaram o plantÃo educativo como muito bom (77,6%), referiram ter mudado os conhecimentos e os comportamentos em relaÃÃo Ãs DST/AIDS para melhor (79,6%) e manter o uso do preservativo nas relaÃÃes sexuais. Portanto, o plantÃo educativo na escola pode ser considerado uma nova estratÃgia de educaÃÃo em saÃde, jà que aumentou nos adolescentes o conhecimento e a adesÃo a comportamentos saudÃveis para a prevenÃÃo de DST/HIV/AIDS. / In the panorama of STD / HIV / AIDS among adolescents, the strategy is to control the transmission prevention in order to promote their health. From the perspective of implementing new strategies, considering the characteristics of adolescence, their vulnerability, and lack of educational long term was used in this study, a new proposal adopted in school: the duty of the individual educational teenager. The objective of this research was to evaluate the application of a duty education on STD / HIV / AIDS with adolescents from a public school in Imperatriz - MA. Intervention research, quasi-experimental, quantiqualitative, with a longitudinal design. Were evaluated 250 adolescent students between January and June 2013 in three stages. At first, the adolescents completed an instrument of knowledge, behaviors and attitudes of STD / HIV / AIDS before attending the educational intervention. In the second stage, students participated in educational duty. In the third stage, adolescents responded again an instrument to assess whether there was a change in knowledge, attitudes and behaviors related to STD / HIV / AIDS, 30 days after the educational intervention. Analyzed in stratified sample sociodemographic characteristics, knowledge of adolescents regarding the access and use of health services, the sources of information used on STD / HIV / AIDS, and the knowledge, behaviors and attitudes regarding safe sex practices forward to STD / HIV / AIDS before and after the educational intervention. The data were analyzed with statistical software STATA version 8.0. Adolescents have an average of 15.5 years of age, are unmarried (as) without a partner (a) fixed (75.6 %), predominantly female (52.4 %) and family income between one and three minimum wages (46 %). There were trends proportional increase was statistically significant by gender (p - value = 0.00), indicating higher levels of parental education of boys. There was a statistically significant increasing trend with respect to sex of respondents (p - value = 0.02), indicating lower household income among girls. Most students have no indication of health services by the school (79.6 %). The main sources of information outside of school on STD / HIV / AIDS are radio / TV / newspaper (54 %). Adolescents increased knowledge about the symptoms (99.2 %), the modes of transmission of AIDS (100 %) and the use of condoms to prevent STD / HIV / AIDS (100 %). Substantial portion of adolescents (98.4 %) believe have no chance of acquiring HIV. Those who have sexual activity have a partner (56.3 %) and condom use at last intercourse (65.7 %). Adolescents evaluated the educational duty as very good (77.6 %) reported having changed the knowledge and behaviors related to STD / AIDS to better (79.6 %) and maintain the use of condoms during sexual intercourse. Therefore, the shift in school education can be considered a new strategy of health education; it increased in adolescentâs knowledge and adherence to healthy behaviors for the prevention of STD / HIV / AIDS.

FundaÃÃo de Amparo a CiÃncia e Tecnologia de Pernambuco / O ensino e as pesquisas na Ãrea de enfermagem tÃm procurado adequar-se aos avanÃos das tecnologias de informaÃÃo e comunicaÃÃo. Percebeu-se entÃo a importÃncia de investigar a utilizaÃÃo de uma tecnologia digital na aprendizagem dos futuros profissionais de saÃde, em face da repercussÃo das infecÃÃes sexuais no sistema de saÃde e a relevÃncia da temÃtica para a formaÃÃo do enfermeiro. O foco desta investigaÃÃo foi avaliar o resultado da utilizaÃÃo de hipermÃdia educativa para aprendizagem de acadÃmicos de enfermagem sobre doenÃas sexualmente transmissÃveis. Trata-se de um estudo quase-experimental, aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. Estrutura-se em quatro etapas: 1) construÃÃo da hipermÃdia; 2) validaÃÃo por especialistas; 3) avaliaÃÃo da aprendizagem; e 4) avaliaÃÃo pelos alunos. Na primeira etapa, fez-se um amplo resgate da literatura de modo a disponibilizar as principais referÃncias e consensos existentes sobre a temÃtica. Selecionaram-se as mÃdias e elaboraram-se o guia do aluno, os objetivos acadÃmicos e o conteÃdo dos mÃdulos. A hipermÃdia foi hospedada no ambiente virtual de aprendizagem SOLAR. Na segunda etapa, a hipermÃdia foi validada por nove especialistas de conteÃdo e trÃs especialistas tÃcnicos, definidos a partir de parÃmetros adaptados da literatura. Obteve-se Ãndice de validade do conteÃdo geral de 0,97 nos itens avaliados (objetivo, conteÃdo, relevÃncia, ambiente, funcionalidade, usabilidade e eficiÃncia). Na terceira etapa, participaram 58 acadÃmicos de enfermagem divididos em dois grupos semelhantes (controle e intervenÃÃo). O grupo controle participou da aula tradicional e o grupo intervenÃÃo utilizou a hipermÃdia no ambiente virtual de aprendizagem. Ambos responderam a um questionÃrio validado sobre o tema (prà e pÃs-teste). No pÃs-teste, a mÃdia de acertos obteve ganho de 4,20 (30,95%) questÃes no grupo controle e 6,65 (54,46%) questÃes no grupo intervenÃÃo. Hà evidÃncia de aumento da mÃdia no pÃs-teste (p=0,00) do grupo intervenÃÃo apontando a aprendizagem online como estratÃgia tÃo eficaz quanto a presencial e que pode ser utilizada como recurso de ensino complementar na formaÃÃo de enfermeiros. Na quarta etapa, a maioria dos acadÃmicos de enfermagem avaliou a hipermÃdia como adequada, tendo como base os antecedentes do conceito aprendizagem online (interaÃÃo e estÃmulo, ferramentas de comunicaÃÃo, material didÃtico, interesse e motivaÃÃo para aprender, dedicaÃÃo, disciplina e gerenciamento de tempo, papel do aluno). A atitude do aluno referente à motivaÃÃo (p=0,001) e ao fato dele acreditar ser responsÃvel por sua aprendizagem (p=0,004) tiveram relaÃÃo estatisticamente significativa no aumento do nÃmero de acertos do pÃs-teste. Conclui-se que a hipermÃdia sobre doenÃas sexualmente transmissÃveis està apta a facilitar o processo de ensino/aprendizagem dos acadÃmicos de enfermagem. Constitui-se em uma ferramenta de apoio ao ensino presencial que colabora com o processo de formaÃÃo profissional, tornando a aprendizagem ativa e significativa.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivou-se comparar os achados de infecÃÃes vaginais em gestantes obtidos por meio do fluxograma de corrimento vaginal com exames presentes na prÃtica clÃnica. O estudo foi do tipo avaliativo, com delineamento transversal e abordagem quantitativa, desenvolvido no Centro de Parto Natural LÃgia Barros Costa em Fortaleza - CE, com amostra composta por 104 gestantes. Os dados foram coletados por meio de entrevista e exame ginecolÃgico de Janeiro a Julho de 2011. Foi realizada anÃlise estatÃstica, utilizando frequÃncia absoluta, mÃdia e Desvio PadrÃo. Realizou-se, tambÃm, testes de sensibilidade, especificidade, valores preditivos positivo e negativo, acurÃcia e as razÃes de verossimilhanÃa positiva e negativa, em que se estabeleceu significÃncia para valor de p<0,1. O projeto de pesquisa foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, conforme protocolo n 298/10. As gestantes apresentaram mÃdia de idade de 23,7 anos, parceria fixa (78; 75%), mÃdia de 12,3 anos de estudo e renda familiar entre um e dois salÃrios mÃnimos (59; 56,7%). A menarca ocorreu em mÃdia com 12,8 anos e a sexarca com 16 anos. NÃo apresentavam histÃria pregressa de IST (90; 86,5%) e nÃo realizavam exame citolÃgico periodicamente (58; 55,8%). Houve predomÃnio de mulheres multÃparas (58; 55,8%), com uma mÃdia de 20,24 semanas gestacionais. As queixas ginecolÃgicas mais predominantes foram: corrimento vaginal (87; 83,7%), odor de secreÃÃo vaginal (45; 43,3%), dispareunia (36; 34,6%), prurido (27; 26%), disÃria (12; 11,5%), sinusorragia (6; 5,8%) e febre (4; 3,9%). Encontrou-se uma prevalÃncia de 13,5% de positividade para pelo menos uma das trÃs infecÃÃes vaginais investigadas de acordo com o exame a fresco. Observou-se predominantemente o pH de valor 5 (50; 48,1%) e o teste de aminas negativo (66; 63,5%). O fluxograma nÃo se mostrou eficaz na identificaÃÃo de candidÃase, apresentando uma baixa sensibilidade (0,0%) e Valor Preditivo Positivo (0,0%), uma alta especificidade (97,9%), Valor Preditivo Negativo (90,2%) e acurÃcia (88,5%), alÃm de RazÃo de VerossimilhanÃa Positiva nula e RazÃo de VerossimilhanÃa Negativa igual a 1. Para tricomonÃase, apresentou baixa sensibilidade (50%), especificidade (46%), Valor Preditivo Positivo (3,6%) e acurÃcia (46,2%), um alto Valor Preditivo Negativo (95,8%), RazÃo de VerossimilhanÃa Positiva igual a 0,9 e RazÃo de VerossimilhanÃa Negativa de 1,08. Para vaginose bacteriana, mostrou-se satisfatÃrio, com uma alta sensibilidade (100%), Valor Preditivo Negativo (100%) e acurÃcia (74%), uma baixa sensibilidade (64%) e Valor Preditivo Positivo (51,8%), alÃm de RazÃo de VerossimilhanÃa Positiva igual a 2,7 e RazÃo de VerossimilhanÃa Negativa nula. Conclui-se que o emprego da abordagem sindrÃmica das infecÃÃes vaginais em gestantes precisa ser reavaliada, visto que o fluxograma nÃo foi eficaz em identificar infecÃÃes como candidÃase e tricomonÃase. Os esforÃos para o desenvolvimento de testes simples e mais acessÃveis devem ser contÃnuos. Entretanto, devem-se empregar tÃcnicas mais avanÃadas, como o exame a fresco, na prÃtica clÃnica, com intuito de aprimorar as prÃticas em saÃde sexual e reprodutiva, evitando a disseminaÃÃo de infecÃÃes, reduzindo tratamentos desnecessÃrios e melhorando a qualidade de vida das gestantes. / The aim was to compare the findings of vaginal infections in pregnant women obtained from the vaginal discharge flowchart with tests present in the clinical practice. This was an evaluation study, with a transversal delineation and quantitative boarding, developed in the Center of Natural Birth LÃgia Barros Costa in Fortaleza â CE, with a sample of 104 pregnant women. The data was collected through interviews and gynecological examination from January to July of 2011. Statistical analysis was carried through, using absolute and average frequency and Standard Deviation. It was also conducted tests of sensitivity, specificity, predictive positive and negative values, accuracy and reasons of positive and negative probability, where it was established a significance value of p< 0,1. The research project was approved by the Research Ethics Committee of the Federal University of the CearÃ, under the protocol n 298/10. The pregnant women presented an average age of 23,7 years, fixed partnership (78; 75%), average of 12,3 years of study and family income between one and two minimum wages (59; 56,7%). The menarche occurred with an average age of 12,8 years and the first sexual intercourse with 16 years. They did not present history of STDs (90; 86.5%) and did not take cytological examinations regularly (58; 55,8%). The majority of the women are multiparous (58; 55.8%), with an average of 20,24 weeks of gestation. The predominant gynecological complaints were: vaginal discharge (87; 83.7%), vaginal secretion odor (45; 43.3%), dyspareunia (36; 34.6%), itch (27; 26%), dysuria (12; 11.5%), sinusorragia (6; 5.8%) and fever (4; 3,9%). It was observed a prevalence of 13,5% of positivity for at least one of three vaginal infections investigated according to the fresh examination. It was observed predominantly a pH value of 5 (50; 48.1%) and whiff test negative (66; 63,5%). The flowchart did not reveal efficient in the identification of candidiasis, presenting a low sensitivity (0.0%) and positive predictive value (0.0%), a high specificity (97.9%), negative predictive value (90.2%) and accuracy (88.5%), as well as null positive likelihood ratio and negative likelihood ratio equal to 1. For trichomoniasis, it presented low sensitivity (50%), specificity (46%), positive predictive value (3.6%) and accuracy (46.2%), a high negative predictive value (95.8%), positive likelihood ratio equal to 0,9 and negativo likelihood ratio 1,08. For bacterial vaginosis, it revealed satisfactory, with a high sensitivity (100%), negative predictive value (100%) and accuracy (74%), a low sensitivity (64%) and positive predictive value (51.8%), as well as positive likelihood ratio equal to 2,7 and null negative likelihood ratio. In conclusion, the use of a syndromic boarding for vaginal infections in pregnant women needs to be reevaluated, since the flowchart was not efficient in identifying infections such as candidiasis and trichomoniasis. The efforts for the development of simple and accessible tests must be continuous. However, more advance and techniques, like the fresh examination, in the practical clinic, aiming to contribute to the improvement of the sexual health and reproductive practices, preventing the dissemination of infections, reducing unnecessary treatments and improving the quality of life of these women.

As doenÃas sexualmente transmissÃveis (DST) sÃo importante causa de morbidade em todo o mundo, com considerÃveis repercussÃes mÃdicas, sociais e econÃmicas. Para traÃar o perfil epidemiolÃgico das DST em mulheres em idade fÃrtil de um pequeno municÃpio do interior do CearÃ, foi realizado um estudo de base populacional em Pacoti em janeiro e fevereiro de 2001. O estudo consistiu em questionÃrios estruturados, exame ginecolÃgico e diagnÃstico laboratorial para detecÃÃo de HPV, clamÃdia, tricomonas, gonorrÃia, sÃfilis e HIV. Participaram do estudo 734 mulheres entre 12 e 49 anos da zona urbana e rural do municÃpio (75% da populaÃÃo-alvo). Dentre essas, 592 haviam iniciado vida sexual e foram incluÃdas na anÃlise. As taxas de prevalÃncia foram: HPV 11,7% (IC 95%: 9,3-14,7), clamÃdia 4,5% (IC 95%: 3,0-6,6), tricomonas 4,1% (IC 95%: 2,7-6,1), gonorrÃia 1,2% (IC 95%: 0,5-2,6) e sÃfilis 0,2% (IC 95%: 0,0-1,1). Nenhum exame para HIV foi positivo. Apresentaram pelo menos uma DST 19,6% (IC 95%: 16,5-23,2) das mulheres. As DST foram mais prevalentes entre as adolescentes. A prevenÃÃo do cÃncer ginecolÃgico anterior mostrou forte efeito protetor contra ter DST (OR=0,4; IC 95%: 0,2-0,6). Foram identificados os seguintes fatores de risco: >2 parceiros na vida (OR=2,8; IC 95%: 1,8-4,4), idade da primeira gestaÃÃo <16 anos (OR=2,1; IC 95%: 1,1-4,1), nÃo saber se o parceiro tem outra parceira (OR=1,7; IC 95%: 1,0- 2,8), idade <20 anos (OR=1,9; IC 95%: 1,1-3,4), >1 parceiro nos Ãltimos 12 meses (OR=3,0, IC 95%: 1,4-6,7), inÃcio precoce da vida sexual (OR=2,0; IC 95%: 1,3-3,1) e nÃo habitar com o parceiro (OR=1,7; IC 95%: 1,1-2,7). Nenhum fator sÃcio-econÃmico mostrou associaÃÃo significativa a ter uma DST. O fator protetor e os primeiros trÃs fatores de risco acima mencionados foram independentemente associados a ter DST no modelo multivariado. As DST representam um importante problema na populaÃÃo estudada, e a identificaÃÃo dos fatores protetores e de risco pode orientar a implementaÃÃo de medidas de controle especÃficas que respeitem particularidades de gÃnero e faixa etÃria. O presente estudo permite inferir sobre a epidemiologia das DST em outros municÃpios de perfil semelhante. / Sexually transmitted diseases (STD) are an important cause of morbidity throughout the world with considerable medical and socio-economic repercussions. To assess the epidemiological situation of STD among women of reproductive age in a small municipality in the hinterland of CearÃ, a population-based study was conducted in January and February 2001. The study consisted of application of structured questionnaires, gynecological examination and laboratory diagnosis to detect HPV, chlamydia, trichomonas, gonorrhea, syphilis and HIV. A total of 734 women aged 12 to 49 years participated in the study (75% of the target population). Among these, 592 had initiated sexual life and were included in the present analysis. The following prevalences were found: HPV 11,7% (IC 95%: 9,3-14,7), chlamydia 4,5% (IC 95%: 3,0-6,6), trichomonas 4,1% (IC 95%: 2,7-6,1), gonorrhea 1,2% (IC 95%: 0,5-2,6) and syphilis 0,2% (IC 95%: 0,0-1,1). There was no case of HIV infection. At least one STD was detected in 19,6% (IC 95%: 16,5-23,2). STD were more prevalent among adolescents. A previous pap smear collection showed an important protective effect against STD (OR=0,4; IC 95%: 0,2-0,6). The following risk factors were identified: >2 partners in life (OR=2,8; IC 95%: 1,8-4,4), first pregnancy <16 years of age (OR=2,1; IC 95%: 1,1-4,1), not knowing if the partner has another partner (OR=1,7; IC 95%: 1,0-2,8), being <20 years of age (OR=1,9; IC 95%: 1,1-3,4), >1 partner in the last 12 months (OR=3,0; IC 95%: 1,4-6,7), early sexual debut (OR=2,0; IC 95%: 1,3-3,1) and not living with a partner (OR=1,7; IC 95%: 1,1-2,7). There was no significant association between STD and socio-economic variables. The above mentioned protective factor and the first three risk factors were independently associated with STD in the multivariate analysis. STD represent an important problem in the population studied, and the identification of protective and risk factors can guide the implementation of gender and age specific control measures. The present study allows to conclude about the STD epidemiology in other municipalities with similar characteristics.

Magister Public Health - MPH / Background: The HIV / AIDS pandemic have been characterized as the greatest natural challenge ever to confront humanity and one of the great moral causes of our time (World Bank, 2007). Although, the HIV and AIDS pandemic is a global problem, some regions of the world, notably sub-Saharan Africa are hardly hit by the pandemic. Namibia is one of the sub-Saharan African countries which are badly affected by the HIV and AIDS pandemic. It is estimated that about 360 000 Namibians were infected with HIV by 2010. This translates to a national HIV prevalence of (18.8%). The National HIV and AIDS Response Department has designed various interventions and strategies to curb the spread of the HIV. Promotion of male condoms promotion is one of the key strategies being advocated. If used consistently and correctly, male condoms are regarded as an effective preventive tool of HIV transmission. However, changing individual’s sexual behaviors and lifestyle to make condom use part of their sexual life seems to be the challenge. In Namibia most of the research in the area of HIV and AIDS were done among the youth and population aged between 15 – 49 years. Hence, this study looks at older men as a neglected population. Aim: The aim of the current study was to assess knowledge, attitudes and practices of condom use among male employees age 50 (fifty) years and older at a mining company in Southern Namibia. Methodology: A descriptive, cross-sectional survey utilizing quantitative research approach was applied. Data was collected through face-to-face interviewing male employees, age fifty years and older, while at work at the Mine Area 1 (MA1). Data was captured in excel and imported into SPSS version 16.0. Chi-square test was used to determine the association between KAP variables and the socio-demographic characteristics of the respondents. The level of statistical significance was set at 0.05. Results: Among 105 respondents (males, mean age 54.5 years), more than half lived in the singe sex male hostels. Knowledge about condom use was good but there remained a significant number of the respondents whose knowledge was insufficient. A high percentage of the respondents suggested that HIV positive individuals should always use condom every time they have sexual intercourse. Conclusion: This study showed that respondents are not at a high risk of contracting HIV infection due to lack of knowledge on condom use though some of them possessed insufficient knowledge. Thus, to minimize the likelihood of HIV infection targeted interventions including peer education programmes were suggested, and working with the community in the area. Moreover, a more comprehensive knowledge attitude and practice study among mine employees from various sections of the mine would be beneficial to identify the level of risk within the total employee population.

Master of Public Health - MPH / The notification and treatment of sexual partner(s) is a key element in the prevention and control of sexually transmitted infections (STIs). Partner notification interrupts the chain of STI transmission, prevents STI complications and long-term sequelae in the sexual partner(s), and also prevents re-infection of the treated index patient. Partner notification is a recognized component of the syndromic management of STIs in Namibia and yet the partner notification rates in the country remain low - as low as 7% in the district of Windhoek currently. In this district, which has the highest number of STIs cases in Namibia, the specific factors that hinder partner notification have not yet been documented. This study sought to investigate the perceived and experienced barriers to partner notification amongst STI patients attending an urban primary health center in the district. An explorative, qualitative study with eight patients (four males and four females), aged 16 years and over, who presented with a new/recurrent episode or a STI follow up was conducted. The participants were purposively selected with the aid of the deputy nurse in charge of the health center after agreeing to take part in the study. The patients were asked about what they felt were personal, partner-relationship and health services related factors that hindered partner notification. Three health workers working at the health center served as key informants and were asked about barriers to partner notification based on their experience of delivering preventative and curative STI - related services over the past three or more years. Interviews with both patients and key informants were conducted in the health facility, recorded and later transcribed. Content analysis of the transcribed data was conducted to identify recurring themes across the different interviews. The results of the study suggest that the partner notification strategy was not functioning optimally as a result of a number of inter-twined factors. The factors can be categorized into personal barriers, partner-relationship dynamics and health services related barriers. The study found that participants considered there were barriers to partner notification across all these three categories. Commonly reported barriers included the stigma associated with STIs and the cultural and religious norms that do not promote discussion of topics related to sex and sexuality in general. Other barriers such as gender inequality, the fear of a partner's reaction to the notification, feelings of guilt associated with infidelity, the lack of communication between partners and the inability to locate partner(s) were highlighted by participants. Barriers associated with the health services included the lack of health education about the importance of partner notification, the absence of thorough risk reduction counseling, the current method of partner notification that is being utilized and the negative attitudes of health workers. It is suggested that having a greater understanding of these barriers and how to work with them in a health education or counseling sessions will allow health workers to address them more directly with their patients and in turn, hopefully improve the management and outcomes of partner notification strategies in the STI prevention and control program in the Windhoek district and potentially other districts in Namibia.