Dissertations / Theses on the topic 'Endemic disease'

The British cattle population hosts a diverse community of endemic pathogens that impact the sustainability of beef and dairy production. As such, there has been a tremendous amount of ongoing research to develop more cost-effective strategies for controlling disease at the industry level. Cattle movements have come under particular scrutiny over the past decade both because of their role in spreading many economically important diseases and because the movements of individual cattle in Great Britain have been explicitly recorded in a centralized electronic database since 1998. Numerous studies have shown that these cattle movements organize into complex networks with key structural and temporal features that influence transmission dynamics. Building on previous work, this thesis used a variety of epidemiological and statistical models to highlight limitations in the current approaches to controlling disease as well as opportunities for reducing endemic disease prevalence through targeted interventions. Empirical disease data from the national bovine tuberculosis (bTB) control programme and from two seroprevalence studies of bovine viral diarrhoea virus (BVDV) in Scottish cattle herds were used in conjunction with movement data from the Cattle Tracing System (CTS) database. Endemic diseases are often challenging to control due to lack of affordable and accurate diagnostic tests as well as the presence of subclinically infected carriers that can easily escape detection. There was evidence that combined issues with the sensitivity and specificity of routine surveillance methods for bTB were contributing to a low level of disease transmission within and between Scottish cattle herds from 2002 to 2009. For BVDV, herds that purchased pregnant beef dams, beef dams with a calf at foot, and open dairy heifers were significantly more likely to be seropositive even though these movements were responsible for only a small number of network contacts. In both cases, targeting the subset of high risk movements with disease specific biosecurity measures may be a more cost-effective use of limited national disease control resources. Other researchers have suggested that control strategies should target multiple diseases simultaneously to reduce trade-offs in resource allocation. Using key indicators of herd reproductive performance derived from the CTS database, it was shown that improving the reproductive management of herds operating below industry standards could reduce endemic disease prevalence by reducing the movements of replacement breeding cattle. A series of network generation algorithms were also developed to study the effects of restricting contact formation based on key demographic and network characteristics of actively trading cattle farms. Strategies that increased network fragmentation either by forcing highly connected farms to form contacts with other highly connected farms or preventing the formation of movements with a high predicted betweenness centrality were found to be particularly effective in limiting disease transmission. For these models to be useful in guiding future policy decisions, it is important to incorporate financial and behavioural drivers of dynamic network change. Following the introduction of pre- and post-movement testing requirements for cattle imported into Scotland from endemic bTB regions, there was a significant decline in cross-border movements, which has likely contributed to the decreasing risk of bTB outbreaks as much as testing itself. Many endemic cattle diseases such as BVDV also spread through local transmission mechanisms, which may undermine the success of disease control programmes that exclusively target cattle movements. There was also evidence that in the absence of national animal legislation, few farmers were likely to adopt biosecurity measures against BVDV. This may be related to the perceived inefficacy of recommendations as well as general unawareness of farm disease status due to the non-specific clinical signs of BVDV outbreaks. Although the CTS database was originally intended for use in slaughter traceback investigations, results from this thesis show how the basic records of births, deaths, and movements can be used to generate valuable insights into the epidemiology of endemic cattle diseases. The findings also emphasize that the management decisions of individual herds can have a substantial impact on industry level transmission dynamics, which offers unique opportunities to develop novel and more cost-effective disease control programmes.

The objective of this study was to compare 2 different techniques used in Peru for diagnostic and evaluate the antibody titters for B. bacilliformis in inhabitants of both post-outbreak and one established endemic area.

Bovine Parainfluenza Virus-3 (BPIV-3) is a major viral pathogen of the Bovine Respiratory Disease (BRD) complex, which is considered to be one of the most significant causes of economic loss in intensively reared cattle worldwide. Current diagnostic tests for BPIV -3 infection provide limited information on the health status of infected animals. This study was designed to address major limitations in BRD management, using Bovine Parainfleunza Virus-3 (BPIV -3) as a model virus to investigate whether screening tools based on biomarkers could be employed to successfully aid in the identification of infected animals and to understand the processes of successful immune response to vaccination. Through the application of in vitro and in vivo biomarker screening tools, this study demonstrated the potential for proteomic and metabolomics marker screening approaches to provide more accurate diagnosis of BPIV -3 infected animals and assess immune responses at the metabolite level. The application of these markers to diagnostic testing could provide numerous benefits for the management of BPIV -3 infection at the herd level. This research highlights the potential for metabolomic and proteomic biomarker approaches to be applied to the improved management and diagnosis of agricultural diseases.

Glucose-6-phosphate dehydrogenase (G6PD) is a cytoplasmic enzyme with an important function in cell oxidative damage prevention. Erythrocytes have a predisposition towards oxidized environments due to their lack of mitochondria, giving G6PD a major role in its stability. G6PD deficiency (G6PDd) is the most common enzyme deficiency in humans; it affects approximately 400 million individuals worldwide. The overall G6PDd allele frequency across malaria endemic countries is estimated to be 8%, corresponding to approximately 220 million males and 133 million females. However, there are no reports on the prevalence of G6PDd in Andean communities where bartonellosis is prevalent.

Endemic Burkitt lymphoma (eBL) is the most common pediatric cancer in malaria-endemic equatorial Africa and nearly always contains Epstein-Barr virus (EBV), unlike sporadic Burkitt Lymphoma (sBL) that occurs with a lower incidence in developed countries. Despite this increased burden the study of eBL has lagged. Additionally, while EBV was isolated from an African Burkitt lymphoma tumor 50 years ago, however, the impact of viral variation in oncogenesis is just beginning to be fully explored. In my thesis research, I focused on investigating molecular genetics of the endemic form of this lymphoma with a particular emphasis on the role of the virus and its variation in pathogenesis using novel sequencing and bioinformatic strategies. First, we sought to understand pathogenesis by investigating transcriptomes using RNA sequencing (RNAseq) from 30 primary eBL tumors and compared to sBL tumors. BL tumor samples were prospectively obtained from 2009 until 2012 in Kenya. Within eBL tumors, minimal expression differences were found based on anatomical presentation site, in-hospital survival rates, and EBV genome type; suggesting that eBL tumors are homogeneous without marked subtypes. The outstanding difference detected using surrogate variable analysis was the significantly decreased expression of key genes in the immunoproteasome complex in eBL tumors carrying type 2 EBV compared to type 1 EBV. Secondly, in comparison to previously published pediatric sBL specimens, the majority of the expression and pathway differences were related to the PTEN/PI3K/mTOR signaling pathway and was correlated most strongly with EBV status rather than the geographic designation. Moreover, the common mutations were observed significantly less frequently in eBL tumors harboring EBV type 1, with mutation frequencies similar between tumors with EBV type 2 and without EBV. In addition to the previously reported genes, we identified a set of new genes mutated in BL. Overall, these suggested that EBV, particularly EBV type 1, supports BL oncogenesis alleviating the need for particular driver mutations in the human genome. Second, we sought to comprehensively define sequence variations of EBV across the viral genome in eBL tumor cells and normal infections, and correlate variations with clinical phenotypes and disease risk. We investigated the whole genome sequence of EBV from primary tumors (N=41) and plasma from eBL patients (N=21) as well as EBV in the blood of healthy children (N=29) within the same malaria endemic region. We conducted a genome wide association analysis study with viral genomes of healthy kids and BL kids. Furthermore, we found that the frequencies of EBV types among healthy kids were at equal levels while they were skewed in favor of type 1 (70%) among eBL kids. To pinpoint the fundamental divergence between viral genome subtypes, type 1 and type 2, we constructed phylogenetic trees comparing to all public EBV genomes. The pattern of variation defined the substructures correlated with the subtypes. This investigation not only deciphers the puzzling pathogenic differences between subtypes but also helps to understand how these two EBV types persist in the population at the same time. Overall, this research provides insight into the molecular underpinning of eBL and the role of EBV. It further provides the groundwork and means to unravel the complexity of EBV population structure and provide insight into the viral variation that may influence oncogenesis and outcomes in eBL and other EBV-associated diseases. In addition, genomic and mutational analyses of Burkitt lymphoma tumors identify key differences based on viral content and clinical outcomes suggesting new avenues for the development of prognostic molecular biomarkers and therapeutic interventions.

Endemic Burkitt lymphoma (eBL) is the most common pediatric cancer in malaria-endemic equatorial Africa and nearly always contains Epstein-Barr virus (EBV), unlike sporadic Burkitt Lymphoma (sBL) that occurs with a lower incidence in developed countries. Despite this increased burden the study of eBL has lagged. Additionally, while EBV was isolated from an African Burkitt lymphoma tumor 50 years ago, however, the impact of viral variation in oncogenesis is just beginning to be fully explored. In my thesis research, I focused on investigating molecular genetics of the endemic form of this lymphoma with a particular emphasis on the role of the virus and its variation in pathogenesis using novel sequencing and bioinformatic strategies. First, we sought to understand pathogenesis by investigating transcriptomes using RNA sequencing (RNAseq) from 30 primary eBL tumors and compared to sBL tumors. BL tumor samples were prospectively obtained from 2009 until 2012 in Kenya. Within eBL tumors, minimal expression differences were found based on anatomical presentation site, in-hospital survival rates, and EBV genome type; suggesting that eBL tumors are homogeneous without marked subtypes. The outstanding difference detected using surrogate variable analysis was the significantly decreased expression of key genes in the immunoproteasome complex in eBL tumors carrying type 2 EBV compared to type 1 EBV. Secondly, in comparison to previously published pediatric sBL specimens, the majority of the expression and pathway differences were related to the PTEN/PI3K/mTOR signaling pathway and was correlated most strongly with EBV status rather than the geographic designation. Moreover, the common mutations were observed significantly less frequently in eBL tumors harboring EBV type 1, with mutation frequencies similar between tumors with EBV type 2 and without EBV. In addition to the previously reported genes, we identified a set of new genes mutated in BL. Overall, these suggested that EBV, particularly EBV type 1, supports BL oncogenesis alleviating the need for particular driver mutations in the human genome. Second, we sought to comprehensively define sequence variations of EBV across the viral genome in eBL tumor cells and normal infections, and correlate variations with clinical phenotypes and disease risk. We investigated the whole genome sequence of EBV from primary tumors (N=41) and plasma from eBL patients (N=21) as well as EBV in the blood of healthy children (N=29) within the same malaria endemic region. We conducted a genome wide association analysis study with viral genomes of healthy kids and BL kids. Furthermore, we found that the frequencies of EBV types among healthy kids were at equal levels while they were skewed in favor of type 1 (70%) among eBL kids. To pinpoint the fundamental divergence between viral genome subtypes, type 1 and type 2, we constructed phylogenetic trees comparing to all public EBV genomes. The pattern of variation defined the substructures correlated with the subtypes. This investigation not only deciphers the puzzling pathogenic differences between subtypes but also helps to understand how these two EBV types persist in the population at the same time. Overall, this research provides insight into the molecular underpinning of eBL and the role of EBV. It further provides the groundwork and means to unravel the complexity of EBV population structure and provide insight into the viral variation that may influence oncogenesis and outcomes in eBL and other EBV-associated diseases. In addition, genomic and mutational analyses of Burkitt lymphoma tumors identify key differences based on viral content and clinical outcomes suggesting new avenues for the development of prognostic molecular biomarkers and therapeutic interventions.

Analysis of immune responses in Bartonella bacilliformis carriers are needed to understand acquisition of immunity to Carrion’s disease and may allow identifying biomarkers associated with bacterial infection and disease phases. Serum samples from 144 healthy subjects from 5 villages in the North of Peru collected in 2014 were analyzed. Four villages had a Carrion’s disease outbreak in 2013, and the other is a traditionally endemic area. Thirty cytokines, chemokines and growth factors were determined in sera by fluorescent bead-based quantitative suspension array technology, and analyzed in relation to available data on bacteremia quantified by RT-PCR, and IgM and IgG levels measured by ELISA against B. bacilliformis lysates. The presence of bacteremia was associated with low concentrations of HGF (p = 0.005), IL-15 (p = 0.002), IL-6 (p = 0.05), IP-10 (p = 0.008), MIG (p = 0.03) and MIP-1α (p = 0.03). In multi-marker analysis, the same and further TH1-related and pro-inflammatory biomarkers were inversely associated with infection, whereas angiogenic chemokines and IL-10 were positively associated. Only EGF and eotaxin showed a moderate positive correlation with bacteremia. IgM seropositivity, which reflects a recent acute infection, was associated with lower levels of eotaxin (p = 0.05), IL-6 (p = 0.001), and VEGF (p = 0.03). Only GM-CSF and IL-10 concentrations were positively associated with higher levels of IgM (p = 0.01 and p = 0.007). Additionally, IgG seropositivity and levels were associated with high levels of angiogenic markers VEGF (p = 0.047) and eotaxin (p = 0.006), respectively. Our findings suggest that B. bacilliformis infection causes immunosuppression, led in part by overproduction of IL-10. This immunosuppression probably contributes to the chronicity of asymptomatic infections favoring B. bacilliformis persistence in the host, allowing the subsequent transmission to the vector. In addition, angiogenic markers associated with bacteremia and IgG levels may be related to the induction of endothelial cell proliferation in cutaneous lesions during chronic infections, being possible candidate biomarkers of asymptomatic infections.

Magister Scientiae - MSc
We review a number of compartmental models in epidemiology which leads to a nonlinear system of ordinary differential equations. We focus an SIR, SEIR and SIS epidemic models with and without vaccination. A threshold parameter R0 is identified which governs the spread of diseases, and this parameter is known as the basic reproductive number. The models have at least two equilibria, an endemic equilibrium and the disease-free equilibrium. We demonstrate that the disease will die out, if the basic reproductive number R0 < 1. This is the case of a disease-free state, with no infection in the population. Otherwise the disease may become endemic if the basic reproductive number R0 is bigger than unity. Furthermore, stability analysis for both endemic and disease-free steady states are investigated and we also give some numerical simulations. The second part of this dissertation deals with optimal vaccination strategy in epidemiology. We use optimal control technique on vaccination to minimize the impact of the disease. Hereby we mean minimizing the spread of the disease in the population, while also minimizing the effort on vaccination roll-out. We do this optimization for the cases of SIR and SEIR models, and show how optimal strategies can be obtained which minimize the damage caused by the infectious disease. Finally, we describe the numerical simulations using the fourth-order Runge-Kutta method. These are the most useful references: [G. Zaman, Y.H Kang, II. H. Jung. BioSystems 93, (2008), 240 − 249], [K. Hattaf, N. Yousfi. The Journal of Advanced Studies in Biology, Vol. 1(8), (2008), 383 − 390.], [Lenhart, J.T. Workman. Optimal Control and Applied to Biological Models. Chapman and Hall/CRC, (2007).], [P. Van den Driessche, J. Watmough. Math. Biosci., 7, (2005)], and [J. Wu, G. R¨ost. Mathematical Biosciences and Engineering, Vol 5(2), (2008), 389 − 391].
South Africa

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-10T15:54:17Z No. of bitstreams: 1 Claudia_Almeida_EPSJV_Mestrado_2012.pdf: 4597494 bytes, checksum: b79ca3aac48688166ae47f21eba2468d (MD5)
Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-10T18:48:43Z (GMT) No. of bitstreams: 1 Claudia_Almeida_EPSJV_Mestrado_2012.pdf: 4597494 bytes, checksum: b79ca3aac48688166ae47f21eba2468d (MD5)
Made available in DSpace on 2014-11-10T18:48:43Z (GMT). No. of bitstreams: 1 Claudia_Almeida_EPSJV_Mestrado_2012.pdf: 4597494 bytes, checksum: b79ca3aac48688166ae47f21eba2468d (MD5) Previous issue date: 2012
Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde.
Nesta dissertação, discute-se a Educação Profissional do trabalhador de nível médio sem formação específica em saúde - o Agente de Controle de Endemias (ACE). Além disso, numa perspectiva de complementaridade, são abordados os conceitos de qualificação e de competência profissional. A formação foi tratada do ponto de vista histórico, sendo necessária a discussão de alguns aspectos das políticas sociais, além dos modelos de gestão em saúde que embasaram a política de Educação Permanente em Saúde no Sistema Único de Saúde (SUS). Verifica-se na metodologia desta política a identificação e validação de um conjunto de competências profissionais num sistema complexo de trabalho. O estudo incidiu sobre os ACE no município de Niterói/RJ e permitiu concluir pela existência de uma dimensão bastante complexa entre a formação e a exigência prática do trabalho, enquanto elementos políticos estruturantes da Vigilância em Saúde. Apontamos que, na década de 2000, foi executada uma política de formação num padrão de excelência pelo PROFORMAR/EPSJV/FIOCRUZ.
This dissertation discusses the Professional Education of the average worker without specific training in health – Agent of Endemic Disease Control (ACE). In addition, a complementary perspective, discusses the concepts of qualification and professional competence. The training was handled in the historical point of view, it was necessary to discuss some aspects of social policies, and management models that support the health policy of Permanent Education in Health System Health Checks on the methodology of this policy identification and validation of a set of professional skills in a complex system of work. The study focused on the agents of ACE in country city Niterói/RJ, and concluded that there is a very complex dimension between training and work practice requirements, whil e structuring the political elements of Surveillance in Health points out that in 2000s, ran a training policy in a standard of excellence by PROFORMAR EPSJV/FIOCRUZ.

Made available in DSpace on 2014-06-11T19:32:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-15Bitstream added on 2014-06-13T20:07:49Z : No. of bitstreams: 1 lima_nraml_dr_fran_parcial.pdf: 266613 bytes, checksum: 5ccb285694d279c3f0e1c3bd6538513d (MD5)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Este estudo tem como tema central a história da doença pênfigo foliáceo endêmico e do Hospital do Pênfigo de Uberaba (MG), fundado no ano de 1957 e ainda em atividade. O hospital recebe pacientes portadores desta doença, popularmente conhecida como fogo selvagem, provenientes de diversas regiões do Brasil. Considerada como uma das únicas doenças autoimunes com características endêmicas, classifica-se cientificamente como sendo uma dermatose bolhosa, comumente presente em regiões geográficas de climas tropicais, cuja etiologia, a despeito do empenho em pesquisas científicas, ainda permanece desconhecida. No Brasil, seu tratamento vem sendo realizado desde o final da década de 1960, com medicamentos à base de corticosteróides, potente anti-inflamatório descoberto no final da década de 1950. O Hospital do Pênfigo, em Uberaba, é a única instituição remanescente que se dedica de modo específico, com exclusividade, ao tratamento do pênfigo foliáceo endêmico. Instituição considerada pelo Estado como de utilidade pública, o hospital é administrado e parcialmente mantido por integrantes do segmento cultural espírita e oferece, além da terapêutica tradicional, também outras, integrativas, tais como o passe magnético, a desobsessão e a fluidificação da água. Ao registrar a história deste hospital, esta pesquisa traz também subsídios para a compreensão da evolução da doença e de seu tratamento, no Brasil. Destacamos a história da fundadora Aparecida Conceição Ferreira, da peculiar maneira por ela desenvolvida de tratar a doença e da sua amizade com o médium Francisco Cândido Xavier, desde os começos da construção e edificação do hospital, cujas raízes se fundam nos preceitos morais e na filosofia da história que sustentam a teoria doutrinária espírita do francês Allan Kardec. A escrita...
The theme of this study is the history of Endemic Pemphigus Foliaceus disease, as well as of the Pemphigus Hospital of Uberaba – (MG), founded in 1957 and still active. The hospital receives patients with endemic pemphigus foliaceus disease, popularly known as “fogo selvagem”, from several regions of Brazil. Regarded as one of the few autoimmune diseases with endemic features, it is scientifically classified as a bullous dermatosis, usually found in geographical regions of tropical climates, which etiology, despite all efforts in scientific researches, still remains unknown. In Brazil, its treatment has been performed since the late 1960s, with medicines based on corticosteroids, potent anti-inflammatory discovered in the late 1950s. The Pemphigus Hospital, in Uberaba, is the only remaining institution which is engaged in a specific way, exclusively to the treatment of the endemic pemphigus foliaceus disease. The institution is considered by the state as of public utility and the hospital is run and partially maintained by members of the Spiritist cultural movement. Besides the traditional therapy, the treatment offers integrative ones, such as the magnetic healing, the disobsession and the magnetization of the water. Registering the history of this Hospital this research brings subsidies concerning the evolution comprehension of the disease and its treatment in Brazil. We highlighted the history of its founder – Aparecida Conceição Ferreira and her peculiar manner of treating the disease, moreover her friendship with the medium Francisco Cândido Xavier, since the beginnings of construction and Hospital edification, whose roots are founded on moral principles of the Spiritist Doctrine philosophy of the French Allan Kardec. The history writing on this dissertation emphasizes the theoretical contribution of Michel de Certeau and the concept of historical symmetries of Hermínio Miranda as a metho

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-17T12:31:09Z No. of bitstreams: 2 Dissertação - David Antonio Costa Barros - 2017.pdf: 4071063 bytes, checksum: ddb294c71acfa6cbe5dc316e1b8f74ec (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-17T12:31:41Z (GMT) No. of bitstreams: 2 Dissertação - David Antonio Costa Barros - 2017.pdf: 4071063 bytes, checksum: ddb294c71acfa6cbe5dc316e1b8f74ec (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2017-05-17T12:31:42Z (GMT). No. of bitstreams: 2 Dissertação - David Antonio Costa Barros - 2017.pdf: 4071063 bytes, checksum: ddb294c71acfa6cbe5dc316e1b8f74ec (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-15
This study aims at assessing the risk of Chagas disease transmission in two risk endemic Municipalities after the local implementation of Triatoma infestans Eradication Program (PETI). To that end, a epidemiological, entomological and serological assessment of PETI was carried out in loco in the Municipalities researched. In the epidemiological context of Chagas disease, according to serological investigation conducted in 1980, seroprevalence amongst the population researched was around 0,82% in São Luís dos Montes Belos (SLMB) and 2,35% in Novo Brasil (NB). At present, a serological survey is underway in the region. In the first stage of serological investigation, about to be concluded, samples from 103 children residing in Novo Brasil rural area and from 303 children residing in São Luís dos Montes Belos rural area were collected on filter paper, and the results were negative; later, 60 test-tube samples were collected in both Municipalities for performing more specific techniques. The domiciliary infestation index in SLMB (rural area) raised from 8,80% to 10,6% (2004-2005), and from 0,84% (2004) to 0,39% (January-July 2005) in NB (rural area). The population under contagion risk is around 4109 inhabitants in SLMB and 1153 inhabitants in NB, due to the presence of vectors. Endemic zones are concentrated in rural area, where potential vectors such as Triatoma sordida are found (around 90% of the species captured in SLMB and 50% in NB in 2005). Health education is jointly conducted in São Luís dos Montes Belos and Novo Brasil by the National Health Foundation (FUNASA), the Family Health Program (PSF) and both Municipal Secretariats of Education, by means of expositions, consultations and the Minimum Surveillance Unit (UMV), which is also applied in the indoor detection of traces of Triatominae. In conclusion, the control of Chagas disease transmission lies on the joint effects of seroepidemiological surveillance, continuous sprinkling of residual insecticides and the implementation of housing improvement program in endemic areas, as well as the continuance and strengthening of Health Education efforts through Family Health Program (PSF).
A doença de Chagas transmitida pelo Trypanosoma cruzi (Chagas, 1909) era uma enzootia restrita ao ambiente silvestre (mamíferos e triatomíneos em perfeito equilíbrio). No Brasil, há evidências de que a doença humana surgiu após seu descobrimento, embora tenha sido encontrada uma múmia datada de ± 1200 anos. O relato mais antigo de triatomíneos (também chamados de “vinchuca”) no Brasil foi feito pelos jesuítas (1590). Sua introdução ocorreu possivelmente através da Argentina ou Uruguai. O “engasgo” (megaesôfago) e a “hidropsia” (constipação) (Saint-Hilaire, 1819; Longgaard, 1865) já existiam endemicamente no interior de Goiás e Minas Gerais. Embora a doença de Chagas tenha sido descoberta em 1909, somente a partir de 1960 seu controle foi pensado de forma profissional. Entretanto, efetivamente, apenas a partir de 1970 foram dados os primeiros passos com essa finalidade. Portanto, as medidas de controle devem dirigir-se à eliminação desses insetos do ambiente humano. Das mais de 120 espécies conhecidas, 48 foram identificadas no Brasil, das quais 30 já foram capturadas no ambiente domiciliar. Em Goiás, com a finalidade de realizar um estudo clínico-epidemiológico da doença de Chagas, em áreas onde a espécie vetora era o Triatoma infestans, foi montado o Projeto Mambaí. Iniciado em 1974, com o estudo eco-epidemiológico da região. Posteriormente, em 1979, após o levantamento triatomínico e devido ao requerimento do Projeto, foi solicitada a colaboração da SUCAM/ Ministério da Saúde, que forneceu apoio e infra-estrutura para a implementação de um sistema de controle e vigilância da doença de Chagas (ZAPATA, 1990). Hoje, com a estratégia de monitoramento entomológico, ações de combate utilizando inseticidas específicos, assim como as melhorias habitacionais realizadas nas áreas endêmicas, a doença encontra-se sob controle de acordo com o certificado da OMS, mas o risco de transmissão continua. No contexto epidemiológico da doença, Goiás ocupava a terceira colocação pelo inquérito nacional realizado em 1980. Com a implantação do Programa de Eliminação do Triatoma infestans em 1992, que é um projeto que faz parte do Programa de Controle da Doença de Chagas no Estado de Goiás, o índice de 7,4% de prevalência da doença, caiu consideravelmente e hoje o principal vetor não é detectado ou é encontrado em índices muito baixos em alguns municípios do Estado. No contexto epidemiológico da doença de Chagas, conforme o inquérito sorológico realizado em 1980, em São Luís dos Montes Belos (SLMB) a soroprevalência estava em torno de 0,82% e em Novo Brasil (NB) em torno de 2,35% dos pesquisados. O levantamento sorológico em escolares nascidos após a fase de controle nas regiões mostrou nenhuma delas estava com sorologia positiva para a moléstia. Nas 236 Unidades Domiciliares pesquisadas (150 em São Luís dos Montes Belos e 86 em Novo Brasil), todas infestadas por triatomíneos e nenhum triatomíneo capturado positivo para Trypanosoma cruzi. O objetivo deste estudo foi avaliar o risco de transmissão da doença de Chagas em dois municípios endêmicos de risco após a implantação do Sistema Único de Saúde (SUS). Para tal, foi realizado in locus uma avaliação sorológica, entomológica e epidemiológica do Programa de Erradicação do Triatoma infestans (PETI) nos municípios pesquisados. Os objetivos deste trabalho foram determinar o nível de conhecimentos, atitudes, práticas da população sobre o controle da doença de Chagas e seus vetores em uma população de crianças em fase escolar de uma zona endêmica dos municípios de risco em Goiás, Brasil. Através deste pretende-se implantar medidas alternativas de controle e vigilância e justificar a implantação das Unidades de Vigilância Longitudinal, para um combate mais abrangente da doença de Chagas no Estado. Apesar do controle do Triatoma infestans existe o considerável aumento dos vetores secundários como o Triatoma sordida, merecendo constante estado de Vigilância epidemiológica dentro do contexto do atual Sistema Único de Saúde (SUS) e da sua potencial inserção na rotina do Programa de Saúde da Família.

Philosophiae Doctor - PhD
Tuberculosis is a bacterial infection which is a major cause of death worldwide. TB is a curable disease, however the bacterium can become resistant to the first line treatment against the disease. This leads to a disease called drug resistant TB that is difficult and expensive to treat. It is well-known that TB disease thrives in communities in overcrowded environments with poor ventilation, weak nutrition, inadequate or inaccessible medical care, etc, such as in some prisons or some refugee camps. In particular, the World Health Organization discovered that a number of prisoners come from socio-economic disadvantaged population where the burden of TB disease may be already high and access to medical care may be limited. In this dissertation we propose compartmental models of systems of differential equations to describe the population dynamics of TB disease under conditions of crowding. Such models can be used to make quantitative projections of TB prevalence and to measure the effect of interventions. Indeed we apply these models to specific regions and for specific purposes. The models are more widely applicable, however in this dissertation we calibrate and apply the models to prison populations.

>Magister Scientiae - MSc
HIV/AIDS is nowadays considered as the greatest public health disaster of modern time. Its progression has challenged the global population for decades. Through mathematical modelling, researchers have studied different interventions on the HIV pandemic, such as treatment, education, condom use, etc. Our research focuses on different compartmental models with emphasis on the effect of public health education. From the point of view of statistics, it is well known how the public health educational programs contribute towards the reduction of the spread of HIV/AIDS epidemic. Many models have been studied towards understanding the dynamics of the HIV/AIDS epidemic. The impact of ARV treatment have been observed and analysed by many researchers. Our research studies and investigates a compartmental model of HIV with treatment and education campaign. We study the existence of equilibrium points and their stability. Original contributions of this dissertation are the modifications on the model of Cai et al. [1], which enables us to use optimal control theory to identify optimal roll-out of strategies to control the HIV/AIDS. Furthermore, we introduce randomness into the model and we study the almost sure exponential stability of the disease free equilibrium. The randomness is regarded as environmental perturbations in the system. Another contribution is the global stability analysis on the model of Nyabadza et al. in [3]. The stability thresholds are compared for the HIV/AIDS in the absence of any intervention to assess the possible community benefit of public health educational campaigns. We illustrate the results by way simulation The following papers form the basis of much of the content of this dissertation, [1 ] L. Cai, Xuezhi Li, Mini Ghosh, Boazhu Guo. Stability analysis of an HIV/AIDS epidemic model with treatment, 229 (2009) 313-323. [2 ] C.P. Bhunu, S. Mushayabasa, H. Kojouharov, J.M. Tchuenche. Mathematical Analysis of an HIV/AIDS Model: Impact of Educational Programs and Abstinence in Sub-Saharan Africa. J Math Model Algor 10 (2011),31-55. [3 ] F. Nyabadza, C. Chiyaka, Z. Mukandavire, S.D. Hove-Musekwa. Analysis of an HIV/AIDS model with public-health information campaigns and individual with-drawal. Journal of Biological Systems, 18, 2 (2010) 357-375. Through this dissertation the author has contributed to two manuscripts [4] and [5], which are currently under review towards publication in journals, [4 ] G. Abiodun, S. Maku Vyambwera, N. Marcus, K. Okosun, P. Witbooi. Control and sensitivity of an HIV model with public health education (under submission). [5 ] P.Witbooi, M. Nsuami, S. Maku Vyambwera. Stability of a stochastic model of HIV population dynamics (under submission).

Viruses are known to be associated with 20% of human cancers. Epstein Barr virus (EBV) in particular is the first virus associated with human cancers. Here, we computationally detect EBV and explore the effects of this virus across cancers by taking advantage of the fact that EBV microRNAs (miRNAs) and Epstein Barr virus small RNAs (EBERs) are expressed at all viral latencies. We identify and characterize two sub-populations of EBV positive tumors: those with high levels of EBV miRNA and EBERS expression and those with medium levels of expression. Based on principal component analysis (PCA) and hierarchical clustering of viral miRNAs across all samples we observe a pattern of expression for these EBV miRNAs which is correlated with both the tumor cell type (B cell versus epithelial cell) and with the overall levels of expression of these miRNAs. We further investigated the effect of the levels of EBV miRNAs with the overall survival of patients across cancers. Through Kaplan Meier survival analysis we observe a significant correlation with levels of EBV miRNAs and lower survival in adult AML patients. We also designed a machine learning model for risk assessment of EBV in association with adult AML and other clinical factors. Our next aim was to identify targets of EBV miRNAs, hence, we used a combination of previously known methodologies for miRNA target detection in addition to a multivariable regression approach to identify targets of these viral miRNAs in stomach cancer. Finally, we investigate the variations across EBV subtype specific EBNA3C gene which interacts with the host immune system. Preliminary data suggests potential regional variations plus higher pathogenicity of subtype 1 in comparison to subtype 2 EBV. Overall, these studies further our understanding of how EBV manipulates the tumor microenvironment across cancer subtypes.

Desde que os vírus de computadores tornaram-se um grave problema para sistemas individuais e corporativos, diversos modelos de disseminação de vírus têm sido usados para explicar o comportamento dinâmico da propagação desse agente infeccioso. Como estratégias de prevenção de proliferação de vírus, o uso de antivírus e sistema de vacinação, têm contribuído para a contenção da proliferação da infecção. Outra forma de combater os vírus é estabelecer políticas de prevenção baseadas nas operações dos sistemas, que podem ser propostas com o uso de modelos populacionais, como os usados em estudos epidemiológicos. Entre os diversos trabalhos, que consideram o clássico modelo epidemiológico de Kermack e Mckendrick, SIR (suscetível - infectado - removido), aplicado ao contexto de propagação de vírus, a introdução de computadores antidotais, como programa antivírus, fornece muitos resultados operacionais satisfatórios. Neste trabalho, o modelo SIRA (suscetível - infectado - removido - antidotal) é estudado considerando a taxa de mortalidade como parâmetro e associado a isso, o parâmetro que recupera os nós infectados é variado de acordo com a alteração da taxa de mortalidade. Nessas condições, a existência dos pontos de equilíbrio livre de infecção são encontrados, mostrando que o modelo é robusto.
Since computer viruses have become a serious problem for individual and corporate systems, several models of virus dissemination have been used to explain the dynamic behavior of the spread of this infectious agent. As prevention strategies for virus proliferation, the use of antivirus and vaccination system, have contributed to contain the proliferation of the infection. Another way to combat viruses is to establish prevention policies based on the operations of the systems, which can be proposed with the use of population models, such as those used in epidemiological studies. Among the several papers, which consider the classic epidemiological model of Kermack and Mckendrick, SIR (susceptible - infected - removed), applied to the context of virus propagation, the introduction of antidotal computers, such as antivirus program, provides many satisfactory operational results. In this work, the SIRA (susceptible - infected - removed - antidotal) model is studied considering the mortality rate as a parameter and associated with this, the parameter that recovers infected nodes is varied according to the change in mortality rate. Under these conditions, the existence of infection free equilibrium points are found, showing that the model is robust.

O Cearà vem registrando nos Ãltimos anos, um aumento nas taxas de detecÃÃo de hansenÃase. Os dados do perÃodo de 1970 a 1996 revelam que as taxas de detecÃÃo aumentaram, passando de 0,23/10.000 habitantes em 1970 para 2,77/10.000 habitantes em 1996, correspondendo um crescimento com variaÃÃo de 1 104,34%. Essa ascendÃncia freqÃentemente à interpretada como evidÃncia de expansÃo da endemia, como o aumento de transmissÃo da doenÃa, ou tambÃm aos fatores operacionais, atravÃs do aumento da cobertura dos serviÃos de saÃde, principalmente no interior do Estado. Esse trabalho teve como objetivo, estudar e analisar a situaÃÃo epidemiolÃgica e operacional da hansenÃase no Estado do CearÃ, no perÃodo de 1970 a 1996, atravÃs de seus indicadores, visando avaliar a magnitude desta patologia, no CearÃ, distribuÃdos nos 14 Departamentos Regionais de SaÃde, inclusive na Capital alencarina. O mÃtodo utilizado foi um estudo retrospectivo, descritivo e analÃtico de uma sÃrie histÃrica de casos de hansenÃase dos Ãltimos 26 anos. Foi estudada a tendÃncia das taxas de detecÃÃo brutas e especÃficas por sexo e grupo etÃrio, bem como as proporÃÃes das diversas formas clÃnicas da doenÃa, comparando com outros estudos de autores brasileiros e estrangeiros, levantados na revisÃo de literatura. Como o perÃodo analisado inclui marcos importantes na evoluÃÃo da terapÃutica e do enfoque das polÃticas de controle da hansenÃase, realizou-se um breve histÃrico, correlacionado o fenÃmeno epidemiolÃgico com resultados operacionais. Observa-se, tambÃm, a queda progressiva da prevalÃncia a partir de 1990, com um descenso acumulado de 60%, devido à implantaÃÃo de um novo esquema de tratamento (poliquimioterapia-PQT/OMS) e limpeza de arquivo, com impacto de forma acentuada da endemia hansÃnica. Estudam-se tambÃm as saÃdas do registro ativo, seus motivos e graus de incapacidade no momento da cura, assim tambÃm como as coortes de multibacilares e paucibacilares. O plano de aÃÃo para a eliminaÃÃo da hansenÃase como problema de saÃde pÃblica à analisado, levando-se a uma projeÃÃo para o ano 2000, o que, baseada na ascensÃo observada no perÃodo estudado e na continuaÃÃo das polÃticas de controle e eliminaÃÃo da hansenÃase, mantendo-se a mesma velocidade e utilizando as mesmas estratÃgias, alcanÃaremos a meta da OMS, apenas no ano 2008. Portanto, se nÃo houver um maior incremento na descentralizaÃÃo das aÃÃes de diagnÃstico e controle, sensibilizando profissionais de saÃde e, principalmente, priorizaÃÃo por parte dos gestores com definiÃÃes polÃticas, necessitaremos ainda de 12 anos para a almejada meta de 1 doente por 10.000 habitantes.
In the last years we can observe, in Ceara, an increase in the detection rates of hanseniase. The dates from 1970 to 1996, show that the rates increased from 0.23/ 10 thousand inhabitant in 1970 to 2,77/ 10 thousand inhabitant in 1996, reaching an increase of 1,104.34%. The rise, is often explained, as an evidence in the expand of the endemic disease, as an increase in the transmission of the disease, and also as operational factors though the rise in the coverage of the health services, mainly in the country side of Ceara. This work has as objective to study, analyse the epidemiologic and operational situation of hanseniase, in the state of Ceara from 1970 to 1996, though their records, in order to evaluate the greatness of this patyology in Ceara, spreaded in the 14 Health Regional Departments of the state and also in Fortaleza. It is studied the tendency of these rates by sex and age as the proportions of the different clinic forms of the disease making a comparison with other studies of Brasilian and foreign authors. As the analysed period includes important signs in the evolution of the therapy and in the evolution of the therapy and in the focus politics used in the control of hanseniase, it is necessary to make a shot history, correlating the epidemiological phenomenon with the operational results. The global tendency in the rates of detection of leper in the studied period is of increase. We also observe a continuing fall of prevalence since 1990, with an expressive fall of 60%, due to a new treatment (MDT-OMS) and cleaness of file, through righ statistics making an impact of the endemic leper. We study the existence of the active record, your reasons and levels of incapacities at the moment of heal, as also the cohorts of multibacillaries and paucibacillaries. The actions plan to extringuish the leper as a health public problem is analysed, taking into consideration the projection to 2000 year. That based in the observed ascention in the study period and in the continuation of politics to the control and extinction of leper, keeping the same rapidity and using the same strategies, we will reach the OMS, goal only in 2008 year. Therefore, if there is no change in the actions of diagnostic and control, making sensible the health workers and above all the priority by the managers, with definite politics, we will need 12 years more to get the goal of 1 inhabitant to 10 thousand inhabitants.

La Enfermedad de Chagas (EC) es la enfermedad parasitaria más importante en América latina, donde es endémica. Debido a los movimientos migratorios de las últimas décadas, la EC se ha convertido en un problema de salud global. La EC presenta una fase aguda, caracterizada por una alta parasitemia, seguida de una fase crónica en la que la parasitemia es baja e intermitente. Por esta razón, la sensibilidad de la reacción en cadena de la polimerasa (PCR) en esta segunda fase es muy variable. El objetivo de esta tesis es evaluar la utilidad de la técnica de la PCR a tiempo real (qPCR) en el diagnóstico y seguimiento de pacientes en la fase crónica de la EC seguidos en dos centros de Medicina Tropical en Barcelona. La qPCR presenta baja sensibilidad en nuestra cohorte y un resultado positivo no se relaciona con la aparición de alteraciones viscerales características de la fase crónica. A pesar de ello, los resultados de parasitemia obtenidos en pacientes no tratados, pueden aportar datos sobre la dinámica del parásito y los diferentes factores que pueden influir en su presencia en sangre periférica. Sin embargo, un resultado positivo de qPCR en pacientes tratados es un maracador útil para detectar fracasos de tratamiento, tanto en la práctica clínica habitual como en el contexto de ensayos clínicos. En la cohorte seguida en nuestro centro, la tasa de fracaso a Benznidazol es muy baja. Sin embargo, el fracaso de dos pautas diferentes de Posaconazol, evaluadas en el contexto del ensayo clínico Chagasazol, fue cercana al 90%. Según la experiencia recogida en esta tesis, en la fase crónica de la EC la mayor utilidad de la qPCR es la monitorización de la respuesta al tratamiento. Este seguimiento, a falta de nuevos biomarcadores precoces de curación, debe realizarse de forma periódica y durante un largo período de tiempo. La utilización de un control de calidad externo de los resultados de qPCR confiere una mayor robustez a los resultados y permite evaluar de forma precoz los posibles errores de protocolo.
Chagas disease (CD) is the most important parasitic disease in Latin America, where it is endemic. Due to the migratory movements of the last decades, CD has become a global health problem. CD presents a sharp phase characterized by high parasitaemia followed by a chronic phase in which the parasitaemia is low and intermittent. For this reason, the polymerase’s chain reaction (PCR) sensitivity in the chronic phase is variable. The main objective of this thesis is to evaluate the usefulness of the real-time PCR technique (qPCR) in the diagnosis and monitoring of patients in the chronic phase of CD, followed in two centers of Tropical Medicine in Barcelona. The qPCR shows low sensitivity in our cohort and a positive result is not related to the appearance of the visceral involvement characteristic of the chronic phase. Despite this, the results of parasitemia obtained in untreated patients can provide data on the dynamics of the parasite and the different factors that may influence its presence in peripheral blood. However, a positive result of qPCR in treated patients is a good surrogate marker of therapeutic failure both in routine clinical practice and to evaluate new treatment patterns in clinical trials. In the cohort followed in our center, the failure rate to Benznidazole was very low, which reinforces its effectiveness as trypanocidal. However, the failure of two different treatment regimes with Posaconazole, evaluated in the context of the Chagasazol clinical trial, was close to 90%. According to the experience gathered in this thesis, the greatest utility of qPCR in the chronic phase of CD is monitoring the response to trypanocidal treatment. In the absence of new early healing biomarkers, this monitoring should be carried out periodically and over a long period of time. The use of external quality control of qPCR results makes them more robust and allows an early evaluation of possible protocol errors.

Made available in DSpace on 2016-08-10T10:53:51Z (GMT). No. of bitstreams: 1 MARTHA ARAUJO ALENCAR BRANDAO DO VALE.pdf: 4767145 bytes, checksum: c2818934083aa97cb15c854f8014194b (MD5) Previous issue date: 2013-06-07
The use of pesticides in public health to control endemic diseases in Brazil, was remarkable in the mid 50s, parallel to and deliberate misuse of these inputs, without great care about the biological and environmental risks, arising from its use. However, in view of the imbalance between risks and benefits of their effectiveness, the damage to human and environmental health, it is suggested that the space usage of pesticides in vector control, reserves the cases of outbreaks. Therefore, it is assumed that the continuous monitoring and frequent in some biological markers in individuals who are subject to occupational exposure to chemicals could ultimately lead, in advance, to medical intervention, as well as studies to better characterize these intoxications. Where this monitoring does not occur, the diagnosis of intoxication becomes insufficient, causing negative effects on human health and the environment. Therefore, this study aimed to evaluate the biochemical profile / hematology of public health officials to control vectors in occupational exposure to pesticides. The study population consists of 46 agents to combat endemic Center UBV, Goiânia, Goiás For characterization of this population, a questionnaire was applied lifestyle, based on the specs of Toxicology Research and Customer Information System Diseases Notification. In parallel, blood samples were collected to perform the biochemical and hematological (based on "Protocol for Health Care Workers Exposed to pesticides Guidelines for Comprehensive Health Care Worker Differentiated Complexity"), which were processed in the Laboratory Clinical Analysis of the Pontifical Catholic University of Goiás health workers combating endemic diseases are predominantly men, with adulthood, understood, mostly between 40 and 59 years with education level of high school. Of these, 21.7% of the ACEs have smoking habit, and 54.4% of alcohol consumption. These agents work on average more than 20 years in combating vectors, for about 8 hours daily. The pesticide currently used by over they are malathion, an organophosphate moderately toxic and ultra low volume. Despite continuous exposure and ultra low volume, some agents complained of symptoms, such as excessive salivation (19.6%), cough (28.3%), nausea (17.4%), vomiting (10, 9%), diarrhea (15.2%), tingling of feet and / or legs (39.1%), tingling of the hands and / or arms (43.5%), bradycardia (10.9%), headache (56.5%) and watery eyes (39.1%). However, no major changes were evident hematologic and biochemical, except for the values slightly increased indirect bilirubin, total cholesterol, glucose and triglycerides, which are not able to specify clinical and by the presence of slight relative lymphocytosis with atypical lymphocytes observation. Concluding that, despite symptomatic complaints, these health workers have biochemical and haematological profile within the normal range, thus requiring, in its follow-up, a greater emphasis on history.
O emprego de pesticidas nas campanhas de saúde pública para controle de endemias, no Brasil, foi marcante em meados dos anos 50, em paralelo ao uso abusivo e deliberado desses insumos, sem grandes cuidados quanto aos riscos biológicos e ambientais, provenientes do seu uso. Contudo, tendo em vista o desequilíbrio entre riscos e benefícios de sua eficácia, dos danos à saúde humana e ambiental, sugere-se que o uso espacial de pesticidas, no controle vetorial, se reserve aos casos de surtos epidêmicos. Portanto, presume-se que o acompanhamento contínuo e frequente, sob alguns marcadores biológicos em indivíduos que estejam sujeitos à exposição ocupacional a substâncias químicas, poderiam vir a conduzir, antecipadamente, à intervenção médica, bem como a estudos de melhor caracterização dessas intoxicações. Onde não ocorre este monitoramento, o diagnóstico da intoxicação torna-se falho, gerando consequências negativas à saúde humana e ambiental. Portanto, este estudo objetivou avaliar o perfil bioquímico/hematológico dos agentes de saúde pública do controle a vetores em exposição ocupacional a pesticidas. A população de estudo é constituída por 46 agentes de combate a endemias da Central de UBV, de Goiânia, Goiás. Para caraterização desta população, foi aplicado questionário de estilo de vida, baseado na Ficha de Investigação e Atendimento Toxicológico do Sistema de Informação de Agravos de Notificação. Em paralelo, foram coletados amostras de sangue para realização das análises bioquímicas e hematológicas (baseadas no Protocolo de Atenção à Saúde dos Trabalhadores Expostos a agrotóxicos das Diretrizes para Atenção Integral à Saúde do Trabalhador de Complexidade Diferenciada ), as quais foram processadas no Laboratório de Análises Clínicas da Pontifícia Universidade Católica de Goiás. Os agentes de saúde do combate a endemias são, predominantemente, homens, com idade adulta, compreendida, em sua maioria, entre 40 e 59 anos, com nível de escolaridade de ensino médio. Destes, 21,74% dos ACEs possuem hábito de fumar e, 54,35% de consumo de bebidas alcóolicas. Estes agentes trabalham, em média, há mais de 20 anos no combate a vetores, por cerca de 8 horas diárias. O pesticida, atualmente, mais usado por eles é o malathion, um organofosforado de toxicidade moderada e em ultra baixo volume. Apesar da exposição contínua e em ultra baixo volume, alguns agentes se queixaram do aparecimento de sintomas, como: salivação excessiva (19,6%), tosse (28,3%), náusea (17,4%), vômito (10,9%), diarreias (15,2%), sensação de formigamento de pés e/ou pernas (39,1%), formigamento de mãos e/ou braços (43,5%), bradicardia (10,9%), cefaléia (56,5%) e lacrimejamento (39,1%). Contudo, não ficaram evidenciados maiores alterações bioquímicas e hematológicas, exceto, pelos valores levemente aumentados de bilirrubina indireta, colesterol total, glicose e triglicérides, os quais não são capazes de especificar clínica e, pela presença de linfocitose relativa leve, com observação de linfócitos atípicos. Concluindo-se que, apesar das queixas sintomáticas, estes agentes de saúde apresentam seu perfil bioquímico e hematológico dentro dos padrões de normalidade, exigindo assim, no seu acompanhamento, uma maior ênfase a anamnese.

Thesis (MPhil (Communicable Diseases)) (Dept of Interdisciplinary Health Sciences. Community Health))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: Global control of the tuberculosis (TB) epidemic remains one of the greatest health challenges of the 21st century, despite the availability of effective treatment over the past 50 years. The rising incidence of transmitted (primary) drug resistant TB threatens the very fabric of conventional TB control efforts, which are already strained by a rampant human immunodeficiency virus (HIV) epidemic. Ongoing transmission of Mycobacterium tuberculosis is a key factor that sustains the TB epidemic in endemic areas such as the socio-economically deprived townships of Cape Town, South Africa. My research explores the disease context, or social terrain, of TB in this endemic setting. It is primarily concerned with how the social terrain of endemic TB may contribute to ongoing transmission and the potential that it holds for enhancing TB control efforts. Analyses of qualitative data from eight township research sites in and around Cape Town show that pragmatic and novel approaches are required to pierce through the enormity of TB as a political and economic problem. Broadening the current biomedical focus on treating individual patients, to include more holistic community-based interventions, can and should be developed. Data were collected as part of qualitative pre-intervention community surveys conducted in 2005 and 2006 for a public health intervention trial (ZAMSTAR) performed in Zambia and South Africa. Twenty-four communities were selected as research sites and this study draws on the survey data collected in the trial’s eight South African sites. Although the data were collected for the ZAMSTAR trial, the aims and analyses presented in this study - which seek to improve our understanding of how the social terrain is meaningful for TB control - remain independent of ZAMSTAR. Through a retrospective analysis of the South African data, I inductively present three distinctive ways in which the social terrain is meaningful for TB control. First, the interaction between social cohesion and social diversity may be an important variable that predicts community response to public health interventions aimed at reducing the prevalence of TB in these endemic areas. This is demonstrated by triangulating ZAMSTAR’S adaptation of a social systems model with further analysis of the research sites. Second, the study identifies a common discourse running through the sites that stigmatizes TB as both a dirty and HIV-related disease. It is argued that this may be significantly contributing to TB diagnostic delay and I call for more holistic approaches to TB control that can reduce perceived marginalization and TB-HIV stigma. Third, congregate settings emerge as noteworthy visible features of social terrain that clearly have the potential to facilitate TB transmission within communities. The pre-intervention surveys qualitatively described public spaces within each research site and the use thereof. Basic principles of TB transmission are applied to these descriptions, developing a novel method of mapping the relative transmission risk possibly posed. Innovative use of similar approaches could identify likely transmission “hot spots” that may serve as focal points for targeted interventions, such as adjustments that increase ventilation or encourage TB suspects to seek urgent medical diagnosis and treatment.
AFRIKAANSE OPSOMMING: Die beheer van tuberkulose (TB) bly steeds een van die grootste gesondheids uitdagings van die 21ste eeu, ten spyte van die beskikbaarheid van effektiewe behandeling vir die afgelope 50 jaar. Die stygende insidensie van oorgedraagde (primêre) middelweerstandige TB bedreig die wese van konvensionele TB kontrole programme, wat reeds gebuk gaan onder die oorweldigende impak van die menslike immuungebrek virus (MIV) epidemie. Ononderbroke oordrag van Mycobacterium tuberculosis is ‘n kardinale faktor wat die epidemie onderhou in areas soos die sosioekonomies agtergeblewe dele van Kaapstad, Suid-Afrika. My navorsing ondersoek sosiale terrein (konteks) van TB in hierdie hiperendemiese konteks. Dit is primêr gemoeid met die moontlike bydrae van die sosiale terrein tot voortgaande TB oordrag en die potensiaal wat dit mag inhou om TB kontrole te verbeter. Analise van kwalitatiewe data van agt agtergeblewe gemeenskappe in en om Kaapstad wys dat nuwe en pragmatiese benaderings benodig word om die volle omvang van TB as ‘n politieke en ekonomiese problem aan te spreek. Data is versamel as deel van kwalitatiewe pre-intervensie gemeenskapsopnames wat gedoen is gedurende 2005 en 2006 vir ‘n publieke gesondheid intervensie studie (ZAMSTAR) in Zambië en Suid-Afrika. Die studie sou poog om die TB prevalensie betekenisvol te verlaag in gemeenskappe wat erg geaffekteer word deur MIV. Vir navorsings doeleindes is vier-en-twintig gemeenskappe geselekteer, waaronder agt Suid-Afrikaanse gemeenskappe. My studie analiseer kwalitatiewe data wat versamel is in hierdie agt gemeenskappe, wat verskeie observasie en deelnemende tegnieke ingespan het. Die studie poog om algemene begrip te verbeter van hoe die sosiale terrein betekenisvol kan wees in TB kontrole; dit is my eie werk en is totaal onafhanklik van die groter ZAMSTAR studie. Induktiewe retrospektiewe analise van data identifiseer drie voorbeelde wat illustreer hoe die sosiale terrein betekenisvol mag wees vir TB kontrole. Eerstens, die interaksie tusses sosiale kohesie en sosiale diversiteit mag ‘n belangrike verandelike wees wat gemeenskapsrespons tot publieke gesondheidsintervensies voorspel. Dit word geïllustreer deur die toepassing van ‘n sosiale sisteme model (soos aangepas deur ZAMSTAR) en analise van ander aanvullende data. Tweedens, identifiseer die studie ‘n gemeenskaplike diskoers in alle navorsings gemeenskappe wat TB stigmatiseer as beide ‘n vuil en MIV-verwante siekte. Dit word geargumenteer dat hierdie verskynsel moontlik betekenisvol bydra tot vertraging van TB diagnose en die nodigheid vir meer holistiese benaderings wat marginalisasie en TB-HIV stigma kan verminder word uitgewys. Derdens blyk dit dat openbare vergaderplekke ‘n belangrike deel van die sosiale terrein vorm en duidelik die potensiaal het om TB oordrag binne gemeenskappe te fasiliteer. Die pre-intervensie opnames het alle openbare vergaderplekke sorgvuldig beskryf en basiese beginsels van TB oordrag is gebruik om vergaderplekke geografies te kaart volgens die moontlike transmissie risiko wat dit mag inhou. Innoverende gebruik van GIS-gebasseerde benaderings, soortgelyk aan die metode wat gebruik is om potensiële “transmission hot spots” te kaart, mag bydra om intervensies beter te fokus, deur bv. verbeterde ventilasie te verskaf of mense met simptome van TB aan te moedig om dringend mediese hulp te soek.

La esquistosomiasis es una enfermedad parasitaria dentro del grupo de las denominadas “enfermedades desatendidas”. Se estima que unos 240 millones de personas están infectadas en todo el mundo. En el Hospital Nossa Senhora da Paz, situado en el municipio de Cubal, Angola, donde se realizó la presente tesis doctoral, la esquistosomiasis urinaria es una patología frecuente. Sin embargo, la epidemiología concreta, los factores de riesgo para su adquisición o la carga de enfermedad eran desconocidas. En esta tesis se incluyen dos estudios ecográficos que analizan el nivel de morbilidad secundaria a esquistosomiasis presente en el municipio. Estudian además el papel del análisis de orina mediante tiras reactivas como posibles marcadores de gravedad y los cambios evolutivos de todos estos parámetros tras la realización de tratamiento. Los hallazgos principales indican que se trata de una zona con una de las cargas de enfermedad en relación a esquistosomiasis urinaria de las más elevadas descritas en África Subsahariana, que la tira reactiva de orina, y principalmente los niveles de proteinuria mayores de 300 mg/dL permiten predecir la presencia de lesiones de gravedad, y que a los seis meses del tratamiento las lesiones revierten de forma muy significativa, pero no desaparecen por completo. Cabe destacar que ambos trabajos se basan en el artículo incluido en el anexo, realizado por parte del mismo equipo y publicado anteriormente a la inscripción en el programa de doctorado. Se trata del estudio epidemiológico inicial, que tiene como hallazgo principal la detección de una prevalencia de esquistosomiasis urinaria muy elevada (del 61%) en escolares, que califica al municipio como de alto riesgo para el desarrollo de complicaciones, según la Organización Mundial de la Salud, y por tanto es tributario del inicio de forma inmediata de medidas preventivas.
Human schistosomiasis is a parasitic disease within the group of so-called "neglected diseases". It is estimated that roughly 240 million people are infected worldwide. In the Hospital Nossa Senhora da Paz, located in the municipality of Cubal, Angola, where the present document was carried out, urinary schistosomiasis is a frequent diagnosis. However, the epidemiology in the area, the risk factors for its acquisition or the burden of disease in the area were unknown. This thesis includes two sonographic studies that analyze the level of morbidity secondary to schistosomiasis present in the city. They also study the role of urine analysis using reactive strips as possible markers of severity and the evolution of all these parameters after the completion of treatment. The main findings indicate that it is an area with one of the highest burden of disease in relation to urinary schistosomiasis in sub-Saharan Africa; it shows also that urine dipsticks, and mainly proteinuria levels greater than 300 mg / dL, are useful to predict the presence of severe lesions; after six months of treatment the lesions revert in a very significant way, but they do not disappear completely. It is noteworthy that both works are based on the article included in the annex, made by the same team and published previously to the inscription in the doctoral program. This is the initial epidemiological study, which has as its main finding the detection of a very high prevalence of urinary schistosomiasis (61%) in schoolchildren, which qualifies the municipality as high risk for the development of complications, according to the World Health Organization, and therefore is tributary of the immediate start of preventive measures.

Malaria remains an important cause of morbidity and mortality among children in sub-Saharan Africa despite recent reductions in malaria incidence in some parts of Africa. Current control tools face threats such as the emergence of drug resistant parasites and insecticide resistant mosquitoes. A malaria vaccine is needed to complement and/or replace existing tools in order to achieve better malaria control and eventually eliminate the disease. RTS,S/AS01E is the most clinically advanced pre-erythrocytic malaria vaccine candidate and is currently being tested in a phase III trial. The short-term efficacy of RTS,S/AS01E is known but the duration of protection is unknown. Furthermore, although RTS,S is protective, it is unclear which immunological assays predict efficacy: hence there are no known correlates of vaccine-induced protection against clinical malaria. In a randomized controlled trial, I assessed the efficacy of RTS,S/AS01E in children (5-17 months old) residing in Kilifi, Kenya, over 4 years of follow-up and determined the correlates of protection against clinical malaria. In order to examine the effect of variations in malaria exposure on vaccine efficacy, I developed an individual marker of malaria exposure calculated as distance-weighted prevalence of malaria infection within 1 km radius of every child. Over 4 years of follow-up, RTS,S/AS01E had an efficacy of 29.9% (95%CI: 10.3% to 45.3%, p=0.005) and 16.8% (95%CI: -8.6% to 36.3% p=0.18) against first and all malaria episodes, respectively (by intention to treat analysis). Vaccine efficacy waned over time and with increasing malaria exposure. RTS,S/AS01E efficacy was 43.6% (95% CI, 15.5 to 62.3) in the first year but was -0.4% (95% CI, -32.1 to 45.3) in the fourth year. Vaccine efficacy was 45.1% (95%CI 11.3% to 66.0%) among children with lower than average malaria exposure index, but 15.9% (95%CI -11.0 to 36.4%) among children with higher than average malaria exposure index. Despite waning in efficacy, RTS,S/AS01E averted 65 cases of malaria per 100 vaccinated children, with more cases averted among the children in the higher malaria-exposure cohort (78 cases per 100 vaccinated children) than those the low exposure cohort (62 cases per 100 vaccinated children). RTS,S/AS01E induced high titres of anti-CS protein antibodies and CD4+ T cell but not CD8+ T cell responses. Anti-CS antibody titres and the frequency of TNF-α producing CD4+ T cell responses were independently associated with protection from clinical malaria, and the combination of both anti-CS titers and TNF-α producing CD4+ T cell response satisfied the Prentice criteria for surrogate markers of protection. There was no association between avidity of RTS,S-induced anti-CS protein antibodies and protection from clinical malaria. Conclusions: RTS,S/AS01E efficacy against all episodes is 16.8% over the 4 years of follow-up. The vaccine efficacy wanes over time and with increasing malaria exposure. RTS,S/AS01E-induced TNF-α producing CD4 T cell and anti-CS protein antibody responses were independently associated with protection from clinical malaria. Anti-CS avidity did not predict protection from clinical malaria. Long-term follow-ups of malaria vaccine trials are essential in the evaluation of the longevity of vaccine efficacy.

A total of 60% of the area of Alagoas / Brazil is considered endemic to the occurrence of schistosomiasis and is not known the classification of clinical forms of the disease. This work has the objective of evaluating an endemic Schistosomiasis population in Alagoas, taking into account the prevalence, classification of the clinical forms and the results of laboratorial analysis. The sample was made of people from endemic areas of Rio Largo/Alagoas. The participants were submitted to a stool examination by Kato-Katz technique and the diagnostic was made after the reading of two microscopic slides for each sample. The patients positive for schistosomiasis mansoni were submitted to a clinical examination and blood collection. The positivity for Schistosomiasis observed in the population under study was of 8.11%. The medium parasite load was of 79,1+174,3 eggs. The clinical forms found were intestinal (90.57%) and hepatointestinal (9.43%), statistically significant at p<0.001. There were not found serious clinical forms. The present study shows results which update information on Schistosomiasis in the city of Rio Largo, data that, although referring to only three locations of this place, suggest the decrease of the parasite load and the clinical forms as well.
Em torno de 60% do território do estado de Alagoas é considerado área endêmica para esquistossomose mansoni, sendo observadas áreas de moderada a alta prevalência com mais de dois milhões de indivíduos expostos à infecção, não sendo conhecido o atual estadiamento das formas clínicas da parasitose. Este trabalho tem o objetivo de avaliar a população de uma área endêmica de esquistossomose no Estado de Alagoas em relação à prevalência, estadiamento das formas clínicas e dados de exames laboratoriais. A amostra foi constituída de moradores de três áreas endêmicas (Ilha Angelita, Lourenço de Albuquerque e Fazenda Riachão) do município de Rio Largo, Estado de Alagoas. Foram realizados 3.082 exames parasitológico de fezes através da técnica Kato-Katz, sendo o diagnóstico firmado após a leitura de duas lâminas para cada amostra. Do total das amostras, 249 foram positivos para Schistosoma mansoni , correspondendo a uma prevalência de 8,11%. Estes pacientes foram submetidos a exame clínico e coleta de sangue para realização de exames laboratoriais. A média da carga parasitária encontrada foi de 79,1+174,3 ovos. As formas clínicas encontradas foram a intestinal (90,57%) e hepatointestinal (9,43%) sendo uma diferença estatisticamente significativa (p<0,001). Não foram encontradas formas clínicas graves. O presente estudo apresenta resultados que atualizam dados sobre a esquistossomose mansônica no município de Rio Largo e embora sejam referentes a três localidades, sugerem haver uma diminuição da carga parasitária e das formas clínicas graves.

Bakgrund: Vi äter allt mer kött. Tidigare forskning har visat på samband mellan högt köttintag och bland annat hjärt- och kärlsjukdomar och cancer. Information om skyddsfaktorer som minskar risken för folksjukdom är begränsad. Forskning om hälsa och sjukdom hos kvinnor är begränsad och därför behövs kvinnors hälsa lyftas fram. Syfte: Litteraturstudiens syfte var att undersöka huruvida ett högt köttintag kan påverka risken för folksjukdomar hos kvinnor. Resultat: Resultatet tyder på en koppling mellan ett högt intag av rött och bearbetat kött och folksjukdomar hos kvinnor. Samband har funnits mellan högt köttintag och bröstcancer, diabetes och hjärt- och kärlsjukdomar. Riskerna har visat sig kunna minska vid ett utbyte från det röda och bearbetade köttet till andra animaliska proteinkällor eller vegetabilier. Diskussion: Kosten bör vara en viktig förebyggande insats när det gäller folksjukdomar. Kostråd för kvinnor bör innefatta ett lågt intag av rött och bearbetat kött och en kost rik på frukt, grönsaker och protein från andra källor än rött och bearbetat kött. Slutsats: Tydliga och enhetliga kostråd bör tas fram för att minska folksjukdomarna hos den kvinnliga befolkningen.
Background:Our meat intake increases. Previous research has shown the connection between high meat intake, including cardiovascular disease and cancer. Information on appropriate diet to reduce the risk of endemic disease is limited. Research on health and disease in women is limited and, therefore, women's health must be taken seriously. Objective: The aim of the literature study was to investigate whether a high meat intake may influence risk of endemic diseases in women. Results: The results suggest a link between a high intake of red and processed meat and endemic diseases in women. Correlations have been found between high meat intake and breast cancer, diabetes and cardiovascular disease. Exchanges from the red and processed meat to other sources of animal protein and vegetables have been shown to reduce the risk of endemic diseases. Discussion: Advice on diet should be an important prevention strategy on endemic diseases. Advice on diet for women should include a low intake of red and processed meat and a diet rich in fruits, vegetables and protein from sources other than red and processed meat. Conclusion: Clear and consistent dietary guidelines should be developed to help reduce the endemic diseases of the female population.

A presente pesquisa consiste na análise do processo de trabalho do Notorium Magnificus 132mg – Droga de Artista - uma embalagem de medicamento, uma bula prescritiva e uma série de materiais publicitários. A idéia de que poderia haver distúrbios sistêmicos e doenças fictícias ocasionadas no sistema da arte atual, configura-se por meio de um entrecruzamento de discursos artísticos e farmacêuticos. Neste sentido, a bula do Notorium Magnificus 132mg – Droga de Artista se apresenta como uma prática de inserção, porém abre uma outra via que não é tão somente a da citação da arte, nem a da inserção da arte nos circuitos industriais, mas que opera difusa entre realidade e ficção, como leitura.
The present research consists on the analysis of the work process of the Notorium Magnificus 132mg – Drug of Artist, composed of a packing-case, printed directions for its use and a series of advertisement material. The idea that it could occur systemic disturbances and fictitious diseases inside the contemporary Art system is configured by an intersection between artistic discourse and pharmaceutical ones. In this sense, the Notorium Magnificus 132mg – Drug of Artist - presents itself as an insertion practice; however, it opens another path that is not only the Art quotation nor the Art insertion in the industrial circuit, but one that operates diffused between the reality and the fiction, as a reading.

South Africa has the highest species diversity of ericaceous plants belonging to the Erica genus. There are over 850 identified species in the Cape Floral Region. The Albany Centre of Endemism (ACOE) is located within this region and is a hotspot of diversity consisting of various plant genera. The success of Erica plants is ubiquitously attributed to mycorrhizal relationships they engage in with a diverse group of fungi. This symbiosis is known as the ericoid mycorrhizal (ERM) association. The overall aim of this study was to establish the diversity of root fungi associated with Erica plants using morphological, molecular and 454 pyrosequencing techniques. Six Erica species were identified using leaf and flower morphology according to taxonomic keys. The identified plants were Erica cerinthoides, Erica demissa, Erica chamissonis, Erica glumiflora, Erica caffra and Erica nemorosa. Roots from sampled plants were stained and examined microscopically to determine their mycorrhizal status. Ericoid mycorrhizal associations together with dark septate endophyte (DSE) structures and hyphae that did not form any specific structure were observed in all the roots. In addition arbuscular mycorrhizal (AM) structures in the form of vesicles were detected in E. glumiflora and E. cerinthoides. In order to identify the culturable fungi associated with the respective hosts, sterilised roots were placed on various culture media for cultivation. Thereafter isolated fungi were morphologically classified into 67 morphotypes. These were mostly sterile and darkly pigmented. Non-sporulating mycelia of variable colouration such as white, cream-yellowish, beige, green and brown were also observed. Further identification was carried out using molecular techniques. DNA was extracted separately from pure cultures and amplified using ITS1 and ITS4 primers in a polymerase chain reaction (PCR). Thereafter sequencing and Basic Local Alignment Search Tool (BLAST) were used to identify the isolates to generic level. The fungi were taxonomically classified into 54 operational taxonomic units and 94 percent were Ascomycetes and Helotiales was the dominant order. Unclassified Helotiales with affinities to fungi currently identified as Epacrid root fungus was common in all hosts. Other isolates that were identified included Oidiodendron, Meliniomyces, Phialocephala, Cadophora, Lachnum, Leohumicola Cryptosporiopsis, Chaetomium, Acremonium and Epicoccum species. Basidiomycetes were represented by two OTUs belonging to the genus Mycena. Four OTUs comprised fungi that had no significant alignments in the reference databases. Direct root DNA extraction together with 454 pyrosequencing was used to detect the diversity of culturable and unculturable fungi associated with the identified hosts. The ITS2 region was targeted for sequencing. Although Ascomycetes remained the dominant phyla, Basidiomycetes were also detected in all host plants. Glomeromycota was present in E. caffra and E. cerinthoides. Helotiales was dominant in all Erica plants with the exception of E. cerinthoides and E. chamissonis which were dominated by the order Chaetothyriales. The OTUs identified to genus level included Epacris pulchella root fungus, Oidiodendron cf. maius, Acremonium implicatum, Leohumicola, Lachnum, Capronia and Mycena species. Culture-based techniques and pyrosequencing detected similar fungal composition comprising Ascomycetes, while, pyrosequencing was able to detect Glomeromycetes and Basidiomycetes.

Orientador: Mariangela Ribeiro Resende
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-09T21:35:03Z (GMT). No. of bitstreams: 1 Barao_SandraCristina_D.pdf: 3775784 bytes, checksum: ffb11ed337f2da69883370a4bf0d4b32 (MD5) Previous issue date: 2007
Resumo: As informações que existem acerca da leishmaniose visceral humana, provêm em sua maioria das notificações realizadas nas áreas de alta endemicidade. Por isso, ainda há muitos aspectos a respeito da transmissão urbana e dos quadros de infecção assintomática que precisam ser elucidados. O dimensionamento real da prevalência da infecção por Leishmania chagasi pode contribuir para a definição e avaliação do impacto das medidas de controle. Com o objetivo de determinar a prevalência da infecção por L. chagasi em área de autoctonia recente, município de Araçatuba e, avaliar os fatores associados em relação aos casos humanos de leishmaniose visceral notificados, foi realizado um estudo transversal, com amostra estratificada de fase única, realizada em duas áreas urbanas de níveis sócio-econômicos distintos, designadas A1 (periférica, menor nível sócio-econômico) e A2 (central, melhor nível sócio-econômico). A soroprevalência foi avaliada com a utilização do teste imunocromatográfico com antígeno recombinante K39 (Ag-RK39). A prevalência observada foi de 18,4% (23/125) em A1 e 4,8% (6/125) em A2. A proporção entre indivíduos assintomáticos e casos de doença ativa nas áreas 1 e 2 foram respectivamente 1,35:1 e 2:1. Não houve diferença significativa da soropositividade na distribuição por idade, nem por sexo, entre as áreas. Contudo, foi observada diferença na proporção de casos assintomáticos entre as áreas, possivelmente associada aos níveis sócio-econômicos e intensidade de transmissão. Também houve relação com a presença canina nos últimos dois anos e a soropositividade para o Ag-rK39. As informações obtidas sugerem a associação da soroprevalência à presença canina nos dois últimos anos e reforça a estratégia de controle adotada
Abstract: Many information exist about human visceral leishmaniasis are origin to thepontificated cases, moreover, almost all data substantiating derive high levels transmission. So, there are many aspects about the urban transmission and asymptomatic infection to need to elucidated. The real comprehensive measurements about the Leishmania chagasi infection to be able to contribute to improve the assessment impact about the measures control. The objective to this study was determining the prevalence of asymptomatic visceral leishmaniasis infection in Araçatuba city, a recent autoctone area. This was a cross-sectional survey on a random sample of the population in two urban different areas, called A1 (outskirts, low social-economic condition) and A2 (central, good social-economic condition). The seroprevalence was assessing by the Immunochromatographic test with recombinant antibody K39 dipstick. The prevalence was 18.4% (23/125) in A1 and 4.8% (6/125) in A2. And the proportion between the asymptomatic and active disease in areas 1 and 2 was 1.35:1 and 2:1, respectively. There was no significant difference in age, nor gender, distribution of seropositivity between the areas. But we observed a difference in asymptomatic infection rates between the two areas, possibly associated with socioeconomic levels and transmission intensity. The data from this study suggest an associate between the human symptomatic seroprevalence and the presence of dogs in last two years old
Doutorado
Ciencias Basicas
Doutor em Clínica Médica

>Magister Scientiae - MSc
In this thesis, we investigate the HIV/AIDS epidemic in a population which experiences a significant flow of immigrants. We derive and analyse a math- ematical model that describes the dynamics of HIV infection among the im- migrant youths and intervention that can minimize or prevent the spread of the disease in the population. In particular, we are interested in the effects of public-health education and of parental care.We consider existing models of public-health education in HIV/AIDS epidemi-ology, and provide some new insights on these. In this regard we focus atten-tion on the papers [b] and [c], expanding those researches by adding sensitivity analysis and optimal control problems with their solutions.Our main emphasis will be on the effect of parental care on HIV/AIDS epidemi-ology. In this regard we introduce a new model. Firstly, we analyse the model without parental care and investigate its stability and sensitivity behaviour.We conduct both qualitative and quantitative analyses. It is observed that in the absence of infected youths, disease-free equilibrium is achievable and is asymptotically stable. Further, we use optimal control methods to determine the necessary conditions for the optimality of intervention, and for disease eradication or control. Using Pontryagin’s Maximum Principle to check the effects of screening control and parental care on the spread of HIV/AIDS, we observe that parental care is more effective than screening control. However, the most efficient control strategy is in fact a combination of parental care and screening control. The results form the central theme of this thesis, and are included in the manuscript [a] which is now being reviewed for publication. Finally, numerical simulations are performed to illustrate the analytical results.

Made available in DSpace on 2016-01-26T12:51:52Z (GMT). No. of bitstreams: 1 adriano mondini_dissert.pdf: 3033302 bytes, checksum: 9710dd822dc859570da326193bf341f4 (MD5) Previous issue date: 2005-12-03
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
The use of spatial analysis tools is an important instrument to understanding dengue incidences in different areas of the municipality and providing important information for the risk stratification and the optimization of control and vigilance tools. This study aimed at performing a spatial and a temporal analysis on dengue transmission in a medium-sized city in the interior of the State of Sao Paulo, Brazil, covering the period from September 1994 to August 2002. Autochthonous cases with confirmation by laboratory tests were utilized. Population data on the city of Sao Jose do Rio Preto were obtained from the Brazilian Institute for Geography and Statistics and the municipal authorities. The cases were georeferenced according to street addresses and clustered according to the 432 census tracts in the municipality, thus resulting in thematic maps. The analysis of main components generated a factor which was used to divide the municipality in four distinct groups, according to socioeconomic level. Moran Index was calculated through multiple regressions of socioeconomic variables. Georeferencing, spatial analysis and the confection of maps were performed through ArcGis tools. A rising trend in annual incidence was noted, with a peak in 2000/2001. From 1990 to 1994 the length of the transmission period reached a maximum of five months per year. This period increased in length over subsequent years. In the final year investigated, transmission occurred in all twelve months, without interruptions. In the period of study 94-95, the socioeconomic component was relevant in dengue incidences. The risk of getting infected in class-4 sites was 2,7 times bigger than in class-1 areas in this period. Not only socioeconomic variables were responsible for dengue incidences in the municipality, but also demographic and environmental characteristics. The endemic pattern of the transmission and the differentiated occurrence according to areas need to be taken into account when developing strategies for dengue control. It is important to stand out that spatial patterns are very important in the risk of dengue transmission. However, several variables are intimately linked with the modulation of disease dynamics, such as circulating serotypes in the municipality and the immunity level of resident population, socioeconomic factors, mosquito infestation, among others, demonstrating that dengue incidences cannot be interpreted in an unilateral form, but contemplated in an holistic way.
O uso de ferramentas de análise espacial é um importante instrumento para o entendimento do comportamento das incidências de dengue em diferentes áreas que compõem o município, além de fornecer subsídios importantes para a estratificação do risco e otimização das medidas de vigilância e controle. O principal objetivo do estudo é a análise espacial e temporal da transmissão de dengue em São José do Rio Preto, SP, entre setembro de 1994 e agosto de 2002. Foram agrupados em um banco de dados 14.431 casos autóctones da área urbana confirmados laboratorialmente, juntamente com dados populacionais e vetoriais da Fundação Instituto Brasileiro de Geografia e Estatística e da Prefeitura Municipal. Os coeficientes de incidências foram calculados considerando-se períodos entre setembro de um ano a agosto do ano seguinte. Os meses de setembro e agosto foram escolhidos por apresentarem menores valores de incidência em relação aos demais meses do ano e possibilitarem uma boa representação da sazonalidade da doença. Os casos foram geocodificados a partir do eixo de logradouros e agrupados segundo os 432 setores censitários do município o que permitiu a produção de mapas temáticos. A análise de componentes principais gerou um fator utilizado para dividir o município em quatro agrupamentos distintos segundo nível socioeconômico. O índice de Moran foi calculado utilizando-se regressões múltiplas de variáveis socioeconômicas. O georreferenciamento, a análise espacial e a confecção de mapas foram realizados através de ferramentas do programa ArcGis. Com a análise das séries históricas notou-se um aumento progressivo das incidências anuais com pico em 2000/2001. Entre 1990 e 1994 a duração da transmissão atingiu, no máximo, 5 meses em cada período, com aumento nos anos seguintes. No último período, ocorreu nos doze meses, sem interrupção. No período de 94/95, a componente sócio-econômica foi relevante nas incidências de dengue em diversos setores censitários do município. Neste período, o risco de adoecer nos locais de classe 4 foi aproximadamente 2,7 vezes maior do que naqueles de classe 1. Não apenas variáveis socioeconômicas foram responsáveis pelas incidências de dengue no município, mas também características demográficas e ambientais. A característica endêmica da transmissão e a ocorrência diferenciada segundo áreas devem ser levadas em conta na estruturação de estratégias para o controle de dengue e na otimização de recursos. É importante ressaltar que padrões espaciais são muito importantes no risco de transmissão de dengue. No entanto, diversas outras variáveis estão intimamente relacionadas com a modulação da dinâmica da doença, dentre elas, os sorotipos circulantes no município e o grau de imunidade da população em relação a eles, os fatores socioeconômicos, a infestação pelo vetor, dentre outros, demonstrando que as incidências de dengue não podem ser interpretadas de forma unilateral e, sim, contempladas de maneira holística.

Recomendações para rastreamento de Tuberculoses Latente (TBL) em pacientes que receberão tratamento com antagonistas do TNF-alfa (anti- TNF) permanecem controversas para regiões endêmicas Objetivo: Esse estudo buscou demonstrar a eficácia em longo prazo do rastreamento e tratamento da TBL em pacientes portadores de Artrite Reumatoide (AR) recebendo anti-TNF. Métodos: 202 pacientes com AR, antes do início do anti-TNF, foram rastreados para TBL por meio do teste tuberculínico (TT), Radiografia de tórax (RX) e história de prévia de exposição à tuberculose (EXP). Todos os pacientes foram seguidos com intervalos de um a três meses. Resultados: 85 pacientes (42%) foram tratados com um único agente anti-TNF e 117 pacientes (58%) mudaram de anti-TNF uma ou duas vezes. O rastreamento para TBL foi positivo em 66 pacientes, 44 apresentaram TT positivo, 23 apresentavam história de exposição (EXP), e 14, alterações radiográficas (RX). EXP isoladamente foi responsável por 14 diagnósticos em pacientes TT negativos. Pacientes portadores de TBL receberam tratamento com Isoniazida (300 mg/dia por seis meses) e nenhum deles desenvolveu TB. Durante os seguimentos, o TT foi repetido em 51 pacientes. A conversão foi observada em cinco: três foram diagnosticados com TBL e dois com TB ativa (14 e 36 meses após receber terapia anti-TNF), sugerindo nova exposição a TB. Conclusão: O rastreamento e tratamento da TBL antes do início da terapia com anti-TNF é efetiva em regiões endêmicas, e reforça a relevância da história de contato com TB para o diagnóstico da TBL em pacientes com AR
Recommendations for screening of latent tuberculosis infection (LTBI) in patients eligible for anti-TNF agents remain unclear in endemic regions. Objective: This study aimed to evaluate the long-term efficacy of LTBI screening/treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers. Design: 202 RA patients were screened for LTBI prior to receiving anti-TNF treatment, by means of tuberculin skin test (TST), chest radiography (X-Ray), and history of tuberculosis exposure (EXP). All subjects were regularly followed at 1- to 3-month intervals. Results: Eighty-five patients (42%) were treated with a single anti-TNF agent, and 117 patients (58%) switched anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 presented positive TST, 23 had a history of EXP, and 14, abnormal X-Ray. Exposure alone accounted for LTBI diagnosis in 14 patients with negative TSTs. LTBI patients were treated with Isoniazid (300 mg/day during six months) and none developed TB. During follow up, TST was repeated in 51 patients. Conversion was observed in five: three were diagnosed with LTBI and two with active TB (14 and 36 months after receiving anti-TNF therapy, suggesting new TB exposure). Conclusion: LTBI screening and treatment prior to anti-TNF treatment is effective in endemic areas and reinforces the relevance of contact history for diagnosing LTBI in RA patients

Submitted by Socorro Pontes (socorrop@ufersa.edu.br) on 2017-02-08T15:08:05Z No. of bitstreams: 1 ThaísAK_DISSERT.pdf: 1952872 bytes, checksum: d756cff8a38a02ad11767b390ea5ce27 (MD5)
Made available in DSpace on 2017-02-08T15:08:05Z (GMT). No. of bitstreams: 1 ThaísAK_DISSERT.pdf: 1952872 bytes, checksum: d756cff8a38a02ad11767b390ea5ce27 (MD5) Previous issue date: 2016-02-23
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Visceral leishmaniasis (VL) is a potentially fatal chronic disease when left untreated. In Brazil, is caused by the protozoan Leishmania infantum is transmitted primarily by sandfly Lutzomyia longipalpis, the dog as the main reservoir. The control of this disease has been in a challenge to public health, and as a proposal for a measure of control of canine VL using dog collars impregnated with deltamethrin to 4% in dogs. Thus, the research aims to assess the effectiveness of these collars on the prevalence of canine VL and infection rate of sandfly to L. infantum in endemic areas for VL. The survey was conducted in two areas equidistant from the city of Mossoró/RN, with similar environmental characteristics. In both of these areas were carried out two surveys every six months and to serologic canines are search for a year, and in a were performed only the procedures mentioned above, being named Control Area (AC) and the other, in addition to the steps mentioned earlier were also carried out two collaring dogs with collars impregnated with deltamethrin the 4% that occurred every six months This area was named “Encoleiramento” Area (AE). For diagnosis of canine VL was made DPP and ELISA. The analysis of the prevalence of canine VL was carried out through the Chi-square test and the incidence rate of the disease through the Odds ratio. For the collection of sandflies were selected three houses in each of the areas, the insects were collected monthly using CDC light traps and separated by species, sex, stage of investigation and research. The morphological identification of sandflies and the females were subjected to real-time PCR for the detection of DNA of L. infantum. With regard to prevalence and incidence rates of VL, evaluating the areas in isolation, one could observe that the use of dog collars was able to reduce the prevalence of the disease in AE and 53 to 59% reduction in the risk of illness. As the sandfly, collected the species L. longipalpis, L. evandroi, L. cortelezzii and L. migonei, with 81,8% % L. longipalpis. Positive pools were obtained from L. longipalpis of AE only during the first investigation while in AC could observe the presence of DNA of the parasite in vector in both investigations. Based on the results, the use of impregnated with deltamethrin collars to 4% has the potential to reduce the prevalence of canine VL as well as allows a reduction in at least 53% the risk of illness. It is also possible to suggest that the continued use of these dog collars can have the potential to reduce the rate of infected sandflies. Thus, impregnated with deltamethrin collars to 4% can be indicated as a control measure for the disease, together with other measures currently recommended
A leishmaniose visceral (LV) é uma doença crônica potencialmente fatal quando não tratada. No Brasil, é causada pelo protozoário Leishmania infantum é transmitida principalmente pelo flebotomíneo Lutzomyia longipalpis, tendo o cão como principal reservatório urbano. O controle desta afecção tem consistido em um desafio para a Saúde Pública, e como proposta de medida de controle da LV canina tem-se a utilização de coleiras impregnadas com deltametrina a 4% em cães. Assim, a pesquisa tem como objetivo avaliar a efetividade dessas coleiras sobre a prevalência da LV canina e taxa de infecção de flebotomíneos para L. infantum em áreas endêmicas para LV. A pesquisa foi realizada em duas áreas equidistantes do município de Mossoró/RN com características ambientais semelhantes. Em ambas as áreas foram realizados dois inquéritos sorológicos caninos semestrais e a pesquisa de flebotomíneos. Na Área Controle (AC) foram realizados os procedimentos anteriormente citados e na Área Encoleiramento (AE) foram também realizados dois encoleiramentos caninos com coleiras impregnadas com deltametrina a 4% que ocorreram a cada seis meses. Para diagnóstico da LV canina foram realizados o teste rápido DPP e ELISA. A análise da prevalência da LV canina foi realizada através do teste de Qui-quadrado e da taxa de incidência através do Odds ratio. A pesquisa de flebotomíneos teve duração de um ano em três residências de cada uma das áreas. Os insetos foram coletados mensalmente utilizando armadilhas luminosas tipo CDC e separados por espécie, sexo, primeiro ou segundo inquérito e área da pesquisa. Foi realizada a identificação morfológica dos flebotomíneos e as fêmeas foram submetidas à técnica de PCR em tempo real para a detecção de DNA de L. infantum. Com relação às taxas de prevalência e incidência da LV canina, avaliando-se as áreas isoladamente, pôde-se observar que o uso das coleiras foi capaz de reduzir a prevalência da doença na AE e reduzir em 53 a 59% o risco de adoecimento. Quanto aos flebotomíneos, foram coletadas as espécies L. longipalpis, Lutzomyia evandroi, Lutzomyia cortelezzii e Lutzomyia migonei, sendo que 81,8% destes insetos eram L. longipalpis. Foram obtidos pools positivos de L. longipalpis da AE somente durante o primeiro inquérito ao passo que na AC pôde-se observar a presença do DNA do parasita no vetor em ambos os inquéritos. Com base nos resultados, pode-se afirmar que a utilização de coleiras impregnadas com deltametrina a 4% reduziu a prevalência da LV canina, e permite reduzir em pelo menos 53% o risco de adoecimento. Também é possível sugerir que o uso contínuo destas coleiras pode ter o potencial de reduzir a taxa de flebotomíneos infectados. Dessa forma, coleiras impregnadas com deltametrina a 4% podem ser indicadas como medida de controle para a LV canina, aliada as demais medidas atualmente preconizadas
2017-02-08

Note des Bibliothèques :la thèse du Dr Vanderpas a été défendue en 1991 mais il n'est techniquement pas possible d'indiquer cette date dans le logiciel Bictel/e.

Première partie :Fonction thyroïdienne de la naissance à 7 ans chez les enfants d’un essai clinique de supplémentation d’huile iodée versus placebo à la femme enceinte.

L’endémie goitreuse du Nord-Congo (République démocratique, ex-Zaïre) a fait l’objet d’un programme de santé publique de prévention du goitre et du crétinisme dans le cadre du Centre d’Etudes Médicales de l’Université Libre de Bruxelles pour les actions de coopération de 1974 à 1995. Le partenaire congolais était l’Institut de Recherche Scientifique et le Bureau National des Troubles dus à la Carence Iodée.

Le présente travail s’inscrit dans ce contexte et analyse plus particulièrement la fonction thyroïdienne chez l’enfant de zéro à sept ans, dans la continuité d’un suivi d’un essai clinique pharmacologique randomisé et contrôlé (RCT, Randomised Clinical Trial) de phase 2 consistant à administrer une huile iodée (Lipiodol®) à des femmes enceintes se présentant à la maternité de Karawa. Cette cohorte de femmes enceintes a été précédemment étudiée par le Professeur Claude-Hector Thilly*.

Chez les enfants nés de mères non supplémentées en iode, l’histoire fonction thyroïdienne se caractérise comme suit :

Une fonction thyroïdienne relativement stable au ours de la première année de vie par rapport aux valeurs de TSH et de T4 sériques du sang de cordon ;les moyennes de ces marqueurs biologiques sont clairement indicateurs d’un niveau de carence iodée par rapport aux normes d’une population d’enfants belges d’âge comparable (T4 sérique abaissée et TSH sérique élevée) ;

Une aggravation des altérations de la TSH et de la T4 sériques au cours de la deuxième année de vie, aggravation qui se poursuit jusqu’à la quatrième année ;

Un maintien de marqueurs biologiques de TSH et T4 sérique fortement altérés au moins jusqu’à l’âge de 7 ans (étendue d’âge étudiée).

Dans cette région, le manioc est connu pour son rôle goitrogène, au travers de son contenu en glucosides cyanogènes, et il avait été précédemment démontré que le thiocyanate élevé des mères passait librement la barrière placentaire. Au cours de la première année de vie, lorsque les nourrissons sont essentiellement alimentés au sein, le thiocyanate sérique diminue fortement et se rapproche de valeurs observées chez des enfants d’autres régions non exposés au manioc. La dégradation de la fonction thyroïdienne au cours de la deuxième année de vie coïncide avec l’introduction du manioc dans l’alimentation. Pour une valeur de concentration urinaire en iode stable au cours des 7 premières années de vie, la prévalence de goitre et les variations de T4 et TSH sériques suivent celles du thiocyanate sérique. Cela est confirmé au travers d’une analyse multi-variée qui met en évidence l’association entre les valeurs moyennes de TSH et T4 et les concentrations urinaires en iode et en thiocyanate.

L’administration intra-musculaire d’huile iodée prévient les altérations de la fonction thyroïdienne chez la mère (Thilly 1978), et cette protection s’étend chez l’enfant jusqu’à 24 mois, c’est-à-dire jusqu’à ce que l’allaitement maternel reste le principal apport nutritionnel. Au-delà de 24 mois, des altérations de la fonction thyroïdienne apparaissent chez certains de ces enfants (Elévation de la TSH et abaissement de la T4), et au-delà de 4 ans, la fréquence des altérations de la fonction thyroïdienne est aussi fréquente chez les enfants de mères traitées que chez les enfants de mères non traitées.

Au vu de la fréquence fort élevée d’altérations de la fonction thyroïdienne entre 4 et 7 ans (2/3 ont une TSH anormalement élevée > 10 mU/L), seuls certains enfants présentent les stigmates d’une hypothyroïdie prolongée depuis le début de l’existence. Il apparaît qu’il y a lieu de distinguer des hypothyroïdies juvéniles de durée, de sévérité, et de timing différents. Si l’hypothyroïdie juvénile est aussi fréquente au-delà de 4 ans dans les deux groupes de l’étude, les stigmates cliniques d’hypothyroïdie persistante sont plus fréquemment observés chez les enfants nés de mères non supplémentées en iode que chez les autres. De plus, la sévérité des stigmates cliniques (degré d’arriération mentale ;importance du retard de développement statural) démontre que l’hypothyroïdie persistante s’est installée plus précocement chez ertains enfants nés de mères non supplémentées en iode que chez les autres. Dans les formes les plus sévères, l’évolution staturale et le niveau d’intelligence de ces enfants avec hypothyroïdie persistante sont compatibles avec le tableau clinique de crétinisme myxédémateux endémique décrits chez le sujet adulte par les Professeurs François Delange et Jacques Dumont.

Deuxième partie: étude du métabolisme iodé chez les enfants hypothyroïdiens et mise en évidence de la carence combinée en iode et en sélénium.

Certains enfants hypothyroïdiens le sont depuis longtemps (depuis la naissance, éventuellement), d’autres le sont transitoirement, sans que leur hypothyroïdie passagère ne laisse de séquelles évidentes en termes de retard statural ou d’arriération mentale.

Ceux qui sont en hypothyroïdie persistante au-delà de 4 ans ont une fonction thyroïdienne altérée :lorsqu’on leur administre de l’iode, leur glande ne répond pas à cette correction de carence iodée, et ils demeurent profondément hypothyroïdiens. Ce phénomène de non réponse à la correction de la carence iodée n’estpas observé chez les enfants hypothyroïdiens plus jeunes :cela démontre qu’il y a, chez certains enfants, une perte progressive de la capacité fonctionnelle de la thyroïde à répondre à la supplémentation iodée. Ces sujets développent le tableau clinique de crétin myxédémateux endémique.

On constate que l’hypothyroïdie juvénile recouvre un vaste spectre depuis les cas d’hypothyroïdie transitoire jusqu’aux cas d’hypothyroïdie irréversible, même après correction de la carence iodée.

Sur base d’hypothèse physiopathologique de cette perte de capacité fonctionnelle de la thyroïde chez certains jeunes enfants, il a été proposé qu’une carence combinée en iode et en sélénium pourrait expliquer ce processus. Une telle carence combinée a été décrite dans notre travail dans la région goitreuse du Nord-Congo, et pas dans d’autres régions non goitreuses du même pays ou dans d’autres endémies goitreuses avec peu de crétinisme myxédémateux endémique (Soudan, Sénégal).

*Thilly Claude-Hector, Delange François, Lagasse Raphael, Bourdoux Pierre, Ramioul L, Berquist Helen, Ermans André-Marie. Fetal hypothyroidism and maternal thyroid status in severe endemic goiter. Journal of Clinical Endocrinology and Metabolism.

Agrégation de l'enseignement supérieur, Orientation médecine
info:eu-repo/semantics/nonPublished

Made available in DSpace on 2016-01-26T12:51:53Z (GMT). No. of bitstreams: 1 margarethdibo_tese.pdf: 1810718 bytes, checksum: 4df01c13c55a541f2c4aff4668fbacd7 (MD5) Previous issue date: 2004-03-17
Fundação de Amparo a Pesquisa do Estado de São Paulo
The strategy to contain the vector of Dengue fever in the state of São Paulo is centered around a reduction in breeding places and by chemical controls. To obtain better results in the reduction of the vectorial density it is important to incorporate other measures in the routine approach. Egg traps are considered to be preventative and control measures of Aedes aegypti, however, there are no studies that define the favorite egg-laying locations in residences. The utilization of an infusion of Panicum maximum in traps increases its attractiveness to vector females and increases the number of eggs collected. This study aims to contribute to techniques by using traps to evaluate the number of weeks this infusion remains attractive to females. More importantly, it aims to assess the egg-laying behavior of the Aedes aegypti and Aedes albopictus populations in Mirassol, a town situated in the region of São José do Rio Preto, Brazil. Traps with egg-collecting paddle were installed in 200 houses in 20 blocks giving a total of 10 houses to each block. Half of the blocks were chosen at random for the installation of traps baited with the infusion and in the other half, traps with ordinary water were installed. Two egg-traps were placed inside the house (bedroom and living room) and two outside (one under cover and the other in the open). Weekly visits were made from September to December 2002, to analyze all the traps, collecting the existing sticks and leaving new ones. In the laboratory the viable and nonviable eggs on the sticks were counted. Positive sticks were considered to be those on which eggs were found and these were correlated with the type of trap, infusion or water, the location of the trap within the house and the number of weeks after the start of the trial. A sample of these sticks was placed in water, to hatch the larvae with the aim of identifying the species. The mean numbers of eggs and larvae of the Aedes aegypti and Aedes albopictus were calculated and associated with the location within the house, the type of trap used, infusion or water, and the week number. Analyzing the number of positive sticks, and the mean number of eggs on the traps, it was evidenced that the traps with infusion were more attractive/stimulating for egg-laying for females of the genera Aedes than those with water in the first three weeks of exposition. The uncovered outdoor traps were the most favored location for egg-laying during the entire study period; in second place were the outdoor ones under cover. High values of the Spearman correlation coefficients and p-values less than 0.004 demonstrated a strong correlation between the positivity and the mean number of eggs, indicating that one variable predicts the other. From the analysis of the hatched larvae, Aedes aegypti were identified on 99.6% (CI 95%: 99.04 99.84) of the sticks and Aedes albopictus on 1.8% (CI 95%: 1.19 2.70) of them. In Mirassol the probability of finding eggs of Aedes aegypti on any one stick under these circumstances is greater than 99%.
A estratégia para controle do vetor do dengue no estado de São Paulo está centrada na redução de criadouros e ações de controle químico. Para a obtenção de melhores resultados na redução da densidade vetorial é importante que se incorpore outras medidas de uso rotineiro. Armadilhas de oviposição são consideradas medidas de vigilância e controle de Aedes aegypti, entretanto não existem estudos sobre locais do domicílio preferidos para oviposição. A utilização de infusão de Panicum maximum em armadilhas propicia maior atração às fêmeas do vetor e coleta de maior quantidade de ovos. Através deste estudo, procurou-se subsidiar as técnicas para o uso de armadilhas, avaliar durante quantas semanas a referida infusão manteve sua atração sobre as fêmeas e, principalmente, avaliar o comportamento de oviposição de populações de Aedes aegypti em Mírassol, cidade situada na região de São José do Rio Preto. Instalaram-se armadilhas de oviposição em 200 casas, divididas em 20 quadras, distribuindo-as em 10 casas por quadra. Foram sorteadas 50% das quadras para instalação de armadilhas iscadas com infusão, e nas demais se instalou armadilhas com água. Duas armadilhas foram colocadas no intradomicílio (quarto e sala) e duas no peridomicílio (uma sob cobertura e outra ao relento). Foram feitas visitas semanais entre setembro e dezembro de 2002, para a análise de todas as armadilhas, e substituição das palhetas. Em laboratório, contaram-se ovos viáveis e inviáveis existentes nas palhetas. A presença de ovos na palheta significou a sua positividade, a qual foi verificada quanto à presença ou não de infusão, local de instalação na casa e número de semanas. Uma amostra destas palhetas foi colocada em água, para eclosão de larvas, visando à identificação específica. Os números médios de ovos e de larvas Aedes aegypti e Aedes albopictus foram quantificados segundo o posicionamento no domicílio, presença de armadilha iscada com infusão ou água e o número de semanas. Analisando-se Nota de Resumo as positividades e os números médios de ovos das armadilhas, obteve-se que as armadilhas iscadas com infusão mostraram-se mais atraentes/estimulantes para oviposição pelas fêmeas do gênero Aedes que as com água, nas três primeiras semanas de exposição. O relento foi o local com maior preferência para oviposição durante todo o estudo; em segundo lugar encontrou-se o coberto. Elevados valores dos coeficientes de correlação de Spearman e valores de p inferiores a 0,004 mostraram forte correlação entre positividade e média de ovos, indicando que uma variável prediz a outra. A partir das análises das larvas eclodidas, identificou-se a presença de Aedes aegypti em 99,6% (IC 95%: 99,04 -99,84) das palhetas e de Aedes albopictus em 1,8% (1C95%: 1,19 - 2,70) delas. Em Mirassol, a probabilidade de se encontrar ovos de Aedes aegypti em uma palheta sob estes condições é superior a 99%.

A medicina de viagem (MV) surgiu em resposta ao crescente deslocamento populacional, com o objetivo de prevenir os agravos à saúde relacionados às viagens. No Brasil teve inicio no final da década de 90, momento em que reformas socioeconômicas levaram a melhorias das condições de vida dos brasileiros. O Núcleo de Medicina do Viajante (NMV), do Instituto de Infectologia Emilio Ribas (IIER), foi o primeiro serviço de atenção à saúde do viajante criado na cidade de São Paulo, em maio de 2000. O presente estudo visa: descrever a população de viajantes que procuraram orientação pré-viagem no Núcleo de Medicina do Viajante (NMV) do Instituto de Infectologia Emilio Ribas (IIER) no período de janeiro de 2006 a dezembro de 2010; descrever as medidas de prevenção recomendadas em relação às doenças infecciosas; descrever as atividades de ensino realizadas e a participação do serviço na discussão de diretrizes em políticas públicas em medicina de viagem. No período estudado, 2744 viajantes procuraram orientação pré-viagem no NMV do IIER. Foram realizados 2836 atendimentos de orientação pré-viagem, 92 viajantes procuraram o serviço mais de uma vez. A faixa etária entre 18 e 34 anos (54,2%), o sexo feminino (51,1%) e grau de educação superior (75,5%) foram as principais características demográficas desses viajantes. Os destinos mais procurados foram: África (24,5%), Europa (21,2%), Ásia (16,6%) e Brasil (19,2%). O turismo (35,7%) e o trabalho (35,7%) foram os motivos de viagem mais referidos. O tempo de permanência menor ou igual a 30 dias foi referido pelos viajantes em que o objetivo de viagem foi o turismo, enquanto os viajantes que referiram o trabalho ou estudo apresentaram maior tempo de permanência (p < 0,001). O meio de transporte mais referido foi o aéreo (62,8%). Os viajantes relataram durante a consulta pré-viagem dificuldade de acesso ao serviço. As fontes de informação mais referidas foram: informação a partir de amigos, indicação por profissional da saúde e mídia eletrônica. As medidas de prevenção recomendadas variaram conforme o destino. O tratamento autoadministrado para diarreia foi mais recomendado aos viajantes com destino à Ásia. As vacinas de febre amarela, poliomielite e antimeningocócica A e C foram mais recomendadas aos viajantes com destino à África, assim como a quimioprofilaxia para malária, que foi recomendada para 26,4% dos viajantes para esse destino. A quimioprofilaxia (QPX) para malária foi recomendada em 10,3% de todas as orientações. Houve diferença com significância estatística na recomendação segundo a finalidade (p < 0,30), o destino (p < 0,001) e a duração da viagem (p < 0,001). Das 422 orientações realizadas aos viajantes com destino ao Brasil, a QPX foi recomendada somente para 30 (7,1%). Dos 2744 viajantes atendidos, 664 (24,2%) relataram pelo menos uma morbidade prévia; 66 (2,4%) eram menores de 10 anos de idade; e 157 (5,7%) tinham 60 anos ou mais. Em relação às atividades de ensino, no período do estudo, 83 médicos residentes estagiaram no NMV e foram orientadas onze monografias de conclusão de residência médica. O NMV participou de 12 reuniões para discussão de diretrizes sobre a saúde do viajante e de iniciativas como a Carta de São Paulo (documento em defesa da saúde do viajante elaborado por acadêmicos e profissionais de saúde participantes do SUS). Da criação da Sociedade Brasileira de Medicina de Viagem e da criação do Comitê Estadual de Saúde do Viajante, pela Secretaria de Estado da Saúde de São Paulo. Essas atividades foram passos decisivos para corroborar a implementação de políticas públicas em saúde do viajante no Brasil
Travel medicine (TM) arose in response to the growing population displacement and its objective is the prevention of health problems related to travel. Began in Brazil in the in the late 1990s, at which socioeconomic reforms have led to improvements in of life of Brazilians. Travel Medicine Center (TMC) at \"Instituto de Infectologia Emilio Ribas\" (IIER) was the first health of traveler service created in São Paulo city in May 2000. The present study aims: to describe the traveler population who sought pre-travel guidance in TMC at IIER from January 2006 to December 2010; to describe the recommended preventive measures to travelers concerned with infectious diseases; to describe the teaching activities performed and the service involvement in debating guidelines about public policies in travel medicine. In the time period studied, a total of 2744 travelers sought pre-travel guidance in TMC of IIER, but 2836 assistances were provided for pre-trip orientation since 92 travelers sought the service more than once. The age group between 18-34 years (54.2%), female (51.1%), and university level degree (75.5%) were the main demographic characteristics. The more popular destinations were: Africa (24.5%), Europe (21.2%), Asia (16.6%) and Brazil (19.2%). Tourism (35.7%) and work (35.7%) were the main purposes of trip for travelers. For tourism purpose travelers would stay 30 or less days, while for work or study they stayed for a longer time (p <0,001). Commercial air travel was the preferred alternative (62.8%). The main sources of information were friends, health professionals, and electronic media. The recommended preventive measures varied according to the destination. The self-treatment for diarrhea was more recommended for travelers to Asia. Vaccination against yellow fever, polio, and anti-meningococcal (A and C) was more recommended for travelers to Africa, as well as chemoprophylaxis (CP) of malaria was recommended for 26.4% of travelers to the same country. The CP of malaria was indicated for 10.3% of all assistances. There was statistically significant difference in the recommendation according to purpose (p < 030), destination (p < 0.001) and trip duration (p < 0.001). From 422 assistances to travelers to Brazil, CP was only recommended for 30 (7.1%) travelers. From the 2744 travelers assisted, 664 (24.2%) reported at least one previous morbidity; 66 (2.4%) were under age 10; and 157 (5.7%) were 60 years or older. During the research period and relating to study activities, 83 residents were interns in TMC, and eleven monographs for completion of the Medical Residency were supervised. TMC participated in 12 meetings to discuss guidelines in travel medicine, and participated in initiatives such as \"Carta de São Paulo\" (a document in defense of traveler health prepared by academics and health professionals participating in the Unified Health System); in the institution of the Brazilian Society of Travel Medicine, and of the São Paulo State Travel Medicine Committee by the Secretariat for Health of São Paulo State. These were decisive steps to support implementation of public policies in traveler health in Brazil

INTRODUÇÃO: A hanseníase é uma doença infecciosa crônica granulomatosa, cujo agente etiológico é uma bactéria de vida intracelular obrigatória, o Mycobacterium leprae, que tem no homem seu principal reservatório. A doença possui distribuição universal, predominando atualmente, em latitudes tropicais e tem sido enquadrada entre as enfermidades negligenciadas, atingindo desproporcionalmente populações pobres e marginalizadas. O bacilo é altamente contagioso, de baixa patogenicidade e acomete primordialmente pele e nervos, com grande potencial incapacitante. A doença grassou no Velho Mundo durante a Idade Média e praticamente desapareceu da Europa ainda no início do século XX, antes que qualquer recurso terapêutico eficaz estivesse disponível. Introduzida com os primeiros colonizadores europeus, a hanseníase é doença endêmica no Brasil e um problema de saúde pública. A hanseníase é hiperendêmica em muitos municípios, notadamente nos estados das regiões Norte e Centro-Oeste, que abrangem biomas de cerrado, pântano e floresta amazônica, em vastas áreas de baixa densidade demográfica; estas áreas vêm sofrendo enorme pressão antrópica relacionada ao incremento de atividades agropecuárias e extrativistas, gerando preocupações em relação ao impacto ambiental sobre a saúde humana, decorrente de transformações na dinâmica territorial. OBJETIVO: O propósito desta pesquisa foi conhecer o efeito ecológico de fatores sociodemográficos na delimitação de espaços endêmicos de hanseníase e gerar hipóteses sobre a relação entre a constituição do território e a exposição ambiental ao agente biológico da doença. MATERIAL E MÉTODOS: Supondo que a variação dos fatores de risco para contrair hanseníase pudesse ser maior entre grupos populacionais do que entre indivíduos, foi empreendido um estudo epidemiológico de delineamento ecológico do tipo grupo múltiplo, envolvendo 203 municípios dos estados do Mato Grosso e Mato Grosso do Sul, que estão localizados na região Centro-Oeste do Brasil. Foram constituídas variáveis sociodemográficas de exposição e a variável de efeito foi representada pela taxa de detecção média anual de hanseníase entre os anos de 2000 e 2006. Foram aproveitados dados secundários provenientes do Instituto Brasileiro de Geografia e Estatística e do Ministério da Saúde. Para compor um modelo multivariado, 14 variáveis foram analisadas por regressão linear simples e selecionadas sete variáveis com probabilidade de p < 0,2 para o coeficiente de inclinação da reta de regressão. As variáveis independentes selecionadas foram passo a passo testadas, simultaneamente e analisada a associação da variável dependente, visando o ajuste de um modelo singular da variabilidade da taxa de detecção de hanseníase. RESULTADOS: As variáveis que restaram no modelo após o processo de ajuste foram: Proporção da população moradora em domicílios com seis ou mais pessoas; Proporção da população não natural do estado; e, Cobertura populacional da estratégia de Atenção Saúde da Família. Estas variáveis juntas explicam 24,1% da variação nas taxas de detecção de hanseníase. CONCLUSÕES: Fatores sociodemográficos representam um importante domínio na epidemiologia da doença. A associação positiva do desfecho com a cobertura da estratégia de Atenção Saúde da Família indica que deve haver melhora no acesso ao diagnóstico mediante a implantação de modelos de Atenção Primária à Saúde baseados em racionalidades preventivas. Doentes poderiam ter sua contagiosidade interrompida mais precocemente, uma vez melhorada a capacidade diagnóstica dos serviços de saúde. Como recomendação para melhorar o acesso ao diagnóstico nas áreas endêmicas, a adoção da estratégia de Atenção Saúde da Família deve ser encorajada. Aglomeração domiciliar como variável ecológica foi interpretada como sendo um indicador socioeconômico indireto, mais do que propriamente relacionada às condições de contato. A qualidade da moradia, talvez seja mais importante para controle da endemia, tanto quanto possa vir acompanhada de melhorias gerais no padrão de vida. Reservatórios do M. leprae constituídos por indivíduos que eliminam bacilos cronicamente são os que perpetuam a endemia, embora possam, em tese, serem suplementados por fontes secundárias representadas por portadores transitórios. Fatores ligados à formação da fronteira agrícola e à urbanização brasileira podem ter fomentado a endemia de hanseníase, ao predisporem a renovação de susceptíveis pelas migrações, que modificam a composição populacional quanto à experiência de contato com o bacilo. Migrações poderiam romper os focos de hanseníase que estivessem saturados de indivíduos resistentes ao redistribuir espacialmente a população susceptível, levar infectantes para áreas indenes ou instalar as premissas biológicas e territoriais para tornar o contágio recorrente na população, mesmo que o contingente demográfico proveniente de imigrações não seja predominantemente mais vulnerável à doença. Tecnicização rural e constrições na esfera do trabalho têm movimentado populações que procuram refúgio nas periferias das cidades, caracterizadas por escassa infraestrutura urbana e rápido crescimento demográfico, supostamente continentes de grupos humanos dotados de diferentes perfis de resistência ao M. leprae. O circuito inferior da economia, uma resposta social à escassez de meios de vida e um traço da territorialização brasileira, tem oferecido os predicados espaciais para a persistência da endemia de hanseníase nos bolsões de pobreza urbana, ao gerar uma multiplicidade de contatos em proximidade e alimentar suas relações sociais de uma massa de recém-chegados do campo e da cidade, sua principal e mais abundante variável. Se a geografia estuda as condições de vida sobre a terra, estes resultados sugerem que a topografia médica, para além da descrição dos aspectos demográficos e socioeconômicos dos lugares de surgimento de doenças, pode contribuir em muito ao conhecimento em saúde, ao considerar analisar tais fatores enquanto potenciais condicionantes de endemias
BACKGROUND: Leprosy is a chronic granulomatous infectious disease whose causative agent is an obligate intracellular bacterium of life, Mycobacterium leprae, which has its main reservoir in man. The disease has a worldwide distribution, currently prevailing in tropical latitudes and has been framed between neglected diseases, disproportionately affecting poor and marginalized populations. The bacillus is highly contagious, and low pathogenic primarily affects the skin and nerves, with great potential crippling. The disease raged in the Old World during the Middle Ages and still practically disappeared from Europe in the early twentieth century, before any effective therapeutic resource was available. Introduced with the first European settlers, leprosy is endemic in Brazil and a public health problem. Leprosy is hyperendemic in many cities, especially in the states of North and Midwest, covering biomes savannah, swamp and rainforest, in vast areas of low population density; these areas have suffered huge human pressure related to increased activity agricultural and extractive, generating concerns about the environmental impact on human health, due to dynamic changes in territorial. OBJECTIVE: The purpose of this research was to understand the ecological effect of sociodemographic factors in the delimitation of leprosy-endemic areas and generating concerns about the relationship between the constitution of the territory and environmental exposure to the biological agent of the disease. MATERIAL AND METHODS: Assuming that the variation of the risk factors for contracting leprosy could be higher among population groups than between individuals, an epidemiological study was undertaken to design ecological type group multiple, involving 203 municipalities in the states of Mato Grosso and Mato Grosso do Sul, which are located in the Midwest region of Brazil. Sociodemographic variables were recorded for exposure and effect was variable represented by annual average detection rate of leprosy between 2000 and 2006. We utilized secondary data from the Brazilian Institute of Geography and Statistics and the Ministry of Health to compose a multivariate model, 14 variables were analyzed by linear regression and seven variables selected with probability p<0.2 for the slope coefficient of regression line. The independent variables were tested step by step, and simultaneously analyzed the association of the dependent variable in order to fit a model of the variability of the detection rate of leprosy. The variables that remained in the model after adjustment process were: \"Proportion of population living in households with six or more people,\" \"Proportion of population unnatural state,\" and \"Coverage of Population Health Care Strategy Family \". These variables together explain 24.1% of the variation in detection rates of leprosy. CONCLUSIONS: Sociodemographic factors represent an important area in the epidemiology of the disease. The positive association with the outcome of the strategic coverage of Family Health Care indicates that there must be improved access to diagnosis by implementing models of primary care-based preventive rationales. Patients could have their contagiousness interrupted earlier, once improved the diagnostic capacity of health services. As a recommendation to improve access to diagnosis in endemic areas, the adoption of the strategy of the Family Health Care should be encouraged. Household crowding as ecological variable was interpreted as an indirect socioeconomic indicator, rather than strictly related to contact conditions. The quality of housing, perhaps most important for disease control, as far as can be accompanied by general improvements in living standards. Reservoirs of M. leprae consist of individuals who are chronically eliminate bacilli that perpetuate endemic, although, in theory, be supplemented by secondary sources represented by transient carriers. Factors related to the formation of the agricultural frontier and the Brazilian urbanization may have fostered endemic leprosy, predispose to the renewal of the likely migration, which modify the composition of the population as to the experience of contact with the bacillus. Migration could break outbreaks of leprosy that were saturated with individuals resistant to spatially redistribute the population likely lead to infective areas unaffected or install the territorial and biological assumptions to make the recurring infection in the population, even though the population from immigration quota is not predominantly more vulnerable to disease. Technicisation rural and constrictions in the sphere of labor are busy people seeking refuge on the outskirts of cities, characterized by poor urban infrastructure and rapid population growth, supposedly continents groups of humans with different resistance profiles to M. leprae. The lower circuit of the economy, a social response to the scarcity of livelihood and a dash of Brazilian territorialization, has offered the spatial predicates for the persistence of endemic leprosy in pockets of urban poverty, to generate a plurality of contacts in proximity and feed their social relationships from a mass of newcomers from the countryside and the city, its main and most abundant variable. If geography studies the conditions of life on earth, these results suggest that medical topography, beyond the description of the demographic and socioeconomic aspects of the places outbreaks of diseases, can contribute greatly to health knowledge, to consider examining such factors as potential determinants of diseases