Stigmatisering - Personers upplevelser av att leva med HIV/AIDS

Bakgrund: HIV är en infektionssjukdom som kan överföras vid bland annat oskyddade samlag, via blod och transplanterad vävnad. Då det idag finns antivirala läkemedel ses HIV inte längre som en dödlig utan en kronisk sjukdom. Personer med HIV/AIDS upplever att sjukdomen påverkar den fysiska och psykiska hälsan negativt. Sjuksköterskor har bristande kunskaper om sjukdomen samt är ovilliga att ge omvårdnad till dessa personer. Syfte: Syftet med litteraturöversikten var att beskriva personers upplevelser av att leva med HIV/AIDS. Metod: Litteraturöversikten baserades på 13 artiklar med kvalitativ design som analyserades enligt Fribergs femstegsmodell. En induktiv ansats användes. Resultat: Huvudtemat stigmatisering identifierades tillsammans med temat transition med tillhörande fem underteman samt temat rädsla med tillhörande tre underteman. Slutsats: Personerna med HIV/AIDS upplevde sig stigmatiserade av närstående, i samhället och i kontakt med hälso- och sjukvården. För att stigmatiseringen ska upphöra behöver sjuksköterskor mer kunskap om HIV/AIDS. För att nå ett personcentrerat förhållningssätt behöver sjuksköterskor se personerna bakom sjukdomen samt medvetandegöra sina attityder och förutfattade meningar mot personerna som lever med HIV/AIDS.

Knowledge of the patients regarding leprosy and adherence to treatment

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It is known for its great disfiguring capacity and is considered an extremely serious disease to public health worldwide. The state of Ceará ranks 13th in number of cases of leprosy in Brazil, and fourth in Northeastern region, with an average of 2,149 new cases diagnosed every year. This study aimed to evaluate the knowledge of leprosy patients regarding treatment, and to assess the level of treatment adherence and its possible barriers. The study was conducted in the reference center for dermatology, from September 2010 to October 2010, in Fortaleza, Ceará. The study data were collected by means of a structured interview, along with the Morisky-Green test, in order to assess treatment adherence and barriers to adherence. A total of 70 patients were interviewed, out of whom 66 were new cases. The majority of patients were between 42 and 50 years old, and 37 (52.9%) were male. Most patients were clinically classified as presentingmultibacillary leprosy (80%), and 78.6% of them were from Fortaleza, Brazil. The Morisky-Green test indicated that 62.9% of patients presented a low level of adherence (p < 0.005), despite claiming to aware of the disease risks. However, it was observed that 57.1% of the patients had no difficulty adhering to treatment, while 38.6% reported little difficulty. This study shows that despite the patients claiming to be familiar with leprosy and its treatment, the Morisky-Green test clearly demonstrated that they actually were not aware of the principles of therapy, which is evidenced by the low degree of treatment adherence

Methods matter: computational modelling in public health policy and planning

This work is aimed at understanding and unifying information on epidemiological modelling methods and how those methods relate to public policy addressing human health, specifically in the context of infectious disease prevention, pandemic planning, and health behaviour change. This thesis employs multiple qualitative and quantitative methods, and presents as a manuscript of several individual, data-driven projects that are combined in a narrative arc. The first chapter introduces the scope and complexity of this interdisciplinary undertaking, describing several topical intersections of importance. The second chapter begins the presentation of original data, and describes in detail two exercises in computational epidemiological modelling pertinent to pandemic influenza planning and policy, and progresses in the next chapter to present additional original data on how the confidence of the public in modelling methodology may have an effect on their planned health behaviour change as recommended in public health policy. The thesis narrative continues in the final data-driven chapter to describe how health policymakers use modelling methods and scientific evidence to inform and construct health policies for the prevention of infectious diseases, and concludes with a narrative chapter that evaluates the breadth of this data and recommends strategies for the optimal use of modelling methodologies when informing public health policy in applied public health scenarios.

Comunicação de risco em saúde : a importância do eWOM

Os surtos de doenças infeciosas estão atualmente no topo das preocupações relacionadas com riscos de saúde, devido à grande capacidade de disseminação e difusão que as caracteriza e, não menos importante, por causa da eventual possibilidade de evolução dos surtos para o nível de pandemia. A nível global, os Governos e as organizações oficiais de saúde estão empenhados em criar planos para lidar com os riscos de saúde, de forma a mitigar e controlar os efeitos nefastos provocados pelas doenças infeciosas na população. O mundo mudou, devido às novas tecnologias, tornou-se globalmente digital. As pessoas, hoje, têm um novo estatuto, são atores sociais, unidos por laços sociais no seio das redes digitais, dentro das quais, têm acesso a uma vasta panóplia de informação - acerca de assuntos de saúde por exemplo, que flui livremente através da rede e diminui os limites entre o cidadão comum e os profissionais e os peritos acerca dos mais diversos temas. O utilizador atual de internet, é um "prosumer". A tecnologia permite-lhe pesquisar a informação que procura e, adicionalmente, compartilhar e comentar o resultado das suas pesquisas e da sua própria experiência pessoal. No contexto dos riscos de saúde, a comunicação é um elemento preponderante em qualquer estratégia de planeamento de risco. Por sua vez, a internet, os novos media digitais e as redes sociais online, são ferramentas postas à disposição dos consumidores, que lhes possibilitam a procura a partilha e o armazenamento de informação. Em virtude da importância que assume a comunicação nos cenários de crise, no âmbito deste trabalho, centraremos o foco da nossa atenção, nos fenómenos de comunicação, conhecidos por “passa-palavra” e “passa-palavra eletrónico” (WOM e WOM), revelando a sua influência na participação dos consumidores na dinâmica comportamental de partilha de eWOM, dentro do grupo restrito de cada indivíduo (eWOM dentro do grupo). Para produzir o nosso modelo concetual, usaram-se medidas adaptadas de outros construtos retirados da literatura, nomeadamente, “Credibilidade da fonte”; “Credibilidade de informação” e “eWOM Dentro do Grupo”.

Investigating novel approaches to the detection of virus neutralising antibodies to rabies and Rift Valley fever virus

Serosurveillance is a powerful tool fundamental to understanding infectious disease dynamics. The presence of virus neutralising antibody (VNAb) in sera is considered the best evidence of infection, or indeed vaccination, and the gold standard serological assay for their detection is the virus neutralisation test (VNT). However, VNTs are labour intensive, costly and time consuming. In addition, VNTs for the detection of antibodies to highly pathogenic viruses require the use of high containment facilities, restricting the application of these assays to the few laboratories with adequate facilities. As a result, robust serological data on such viruses are limited. In this thesis I develop novel VNTs for the detection of VNAb to two important, highly pathogenic, zoonotic viruses; rabies and Rift Valley fever virus (RVFV). The pseudotype-based neutralisation test developed in this study allows for the detection of rabies VNAb without the requirement for high containment facilities. This assay was utilised to investigate the presence of rabies VNAb in animals from a variety of ecological settings. In this thesis I present evidence of natural rabies infection in both domestic dogs and lions from rabies endemic settings. The assay was further used to investigate the kinetics of VNAb response to rabies vaccination in a cohort of free-roaming dogs. The RVFV neutralisation assay developed herein utilises a recombinant luciferase expressing RVFV, which allows for rapid, high-throughput serosurveillance of this important neglected pathogen. In this thesis I present evidence of RVFV infection in a variety of domestic and wildlife species from Northern Tanzania, in addition to the detection of low-level transmission of RVFV during interepidemic periods. Additionally, the investigation of a longitudinal cohort of domestic livestock also provided evidence of rapid waning of RVF VNAb following natural infection. Collectively, the serological data presented in this thesis are consistent with existing data in the literature generated using the gold standard VNTs. Increasing the availability of serological assays will allow the generation of robust serological data, which are imperative to enhancing our understanding of the complex, multi-host ecology of these two viruses.

Análise do efeito de polimorfismos não-sinônimos em genes de reparo de DNA da via BER na resposta inflamatória da meningite

In vitro and in animal models, APE1, OGG1, and PARP-1 have been proposed as being involved with inflammatory response. In this work, we have investigated if the SNPs APE1 Asn148Glu, OGG1 Ser326Cys, and PARP-1 Val762Ala are associated to meningitis and also developed a system to enable the functional analysis of polymorphic proteins. Patients with bacterial meningitis (BM), aseptic meningitis (AM) and controls (non-infected) genotypes were investigated by PIRA-PCR or PCR-RFLP. DNA damages were detected in genomic DNA by Fpg treatment. IgG and IgA were measured from plasma and the cytokines and chemokines were measured from cerebrospinal fluid samples using Bio-Plex assays. The levels of NF-κB and c-Jun were measured in CSF by dot blot assays. A significant (P<0.05) increase in the frequency of APE1 148Glu allele in BM and AM patients was observed. A significant increase in the genotypes Asn/Asn in control group and Asn/Glu in BM group was also found. For the SNP OGG1 Ser326Cys, the genotype Cys/Cys was more frequent (P<0.05) in BM group. The frequency of PARP-1 Val/Val genotype was higher in control group (P<0.05). The occurrence of combined SNPs increased significantly in BM patients, indicating that these SNPs may be associated to the disease. Increasing in sensitive sites to Fpg was observed in carriers of APE1 148Glu allele or OGG1 326Cys allele, suggesting that SNPs affect DNA repair activity. Alterations in IgG production were observed in the presence of SNPs APE1Asn148Glu, OGG1Ser326Cys or PARP-1Val762Ala. Reductions in the levels ofIL-6, IL-1Ra, MCP-1/CCL2and IL-8/CXCL8 were observed in the presence of APE1148Glu allele in BM patients, however no differences were observed in the levels of NF-κB and c-Jun considering genotypes and analyzed groups. Using APE1 as model, a system to enable the analysis of cellular effects and functional characterization of polymorphic proteins was developed using strategies of cloning APE1 cDNA in pIRES2-EGFP vector, cellular transfection of the construction obtained, siRNA for endogenous APE1 and cellular cultures genotyping. In conclusion, we obtained evidences of an effect of SNPs in DNA repair genes on the regulation of immune response. This is a pioneering work in the field that shows association of BER variant enzymes with an infectious disease in human patients, suggesting that the SNPs analyzed may affect immune response and damage by oxidative stress level during brain infection. Considering these data, new approaches of functional characterization must be developed to better analysis and interactions of polymorphic proteins in response to this context

Transient hyperglycemia in patients with tuberculosis in Tanzania: implications for diabetes screening algorithms.

BACKGROUND: Diabetes mellitus (DM) increases tuberculosis risk while tuberculosis, as an infectious disease, leads to hyperglycemia. We compared hyperglycemia screening strategies in controls and patients with tuberculosis in Dar es Salaam, Tanzania. METHODS: Consecutive adults with tuberculosis and sex- and age-matched volunteers were included in a case-control study between July 2012 and June 2014. All underwent DM screening tests (fasting capillary glucose [FCG] level, 2-hour CG [2-hCG] level, and glycated hemoglobin A1c [HbA1c] level) at enrollment, and cases were tested again after receipt of tuberculosis treatment. Association of tuberculosis and its outcome with hyperglycemia was assessed using logistic regression analysis adjusted for sex, age, body mass index, human immunodeficiency virus infection status, and socioeconomic status. Patients with tuberculosis and newly diagnosed DM were not treated for hyperglycemia. RESULTS: At enrollment, DM prevalence was significantly higher among patients with tuberculosis (n = 539; FCG level > 7 mmol/L, 4.5% of patients, 2-hCG level > 11 mmol/L, 6.8%; and HbA1c level > 6.5%, 9.3%), compared with controls (n = 496; 1.2%, 3.1%, and 2.2%, respectively). The association between hyperglycemia and tuberculosis disappeared after tuberculosis treatment (adjusted odds ratio [aOR] for the FCG level: 9.6 [95% confidence interval {CI}, 3.7-24.7] at enrollment vs 2.4 [95% CI, .7-8.7] at follow-up; aOR for the 2-hCG level: 6.6 [95% CI, 4.0-11.1] vs 1.6 [95% CI, .8-2.9]; and aOR for the HbA1c level, 4.2 [95% CI, 2.9-6.0] vs 1.4 [95% CI, .9-2.0]). Hyperglycemia, based on the FCG level, at enrollment was associated with tuberculosis treatment failure or death (aOR, 3.3; 95% CI, 1.2-9.3). CONCLUSIONS: Transient hyperglycemia is frequent during tuberculosis, and DM needs confirmation after tuberculosis treatment. Performance of DM screening at tuberculosis diagnosis gives the opportunity to detect patients at risk of adverse outcome.

Clínica e cirurgia de animais de companhia

Este relatório foi realizado no âmbito da conclusão do mestrado integrado em medicina veterinária da Universidade de Évora, encontrando-se dividido em duas partes. A primeira é referente à casuística acompanhada ao longo do estágio curricular, decorrido no Hospital Veterinário do Restelo (HVR), com a duração de quatro meses, desde 03 de Agosto de 2015 a 06 de Dezembro de 2016, sob orientação da Doutora Sandra Branco e coorientação do Dr. Diogo Magno, subdiretor clínico do HVR. A segunda parte é constituída por uma monografia subordinada ao tema “Erliquiose Monocítica Canina”, seguida de um caso clínico acompanhado pelo autor no âmbito do referido tema. A erliquiose monocítica canina (EMC) é uma doença infeciosa transmitida por um vetor, o ixodídeo Riphicephalus sanguineus, cujos controlos químicos e ambientais são essenciais para reduzir a prevalência da doença. É causada por uma bactéria intracelular, Ehrlichia canis, que afeta o sistema imunitário dos cães, manifestando diferentes fases de evolução e podendo apresentar formas aguda e crónica da doença. O tratamento de primeira escolha é o uso da antibioterapia com tetraciclinas, dentre as quais a doxiciclina, para além do tratamento de suporte, como a fluidoterapia. O prognóstico é variável, dependendo da precocidade e eficiência da terapêutica instituída; ABSTRACT: The present report, wrote to get the master degree in veterinary medicine area, on Universidade de Évora, is divided up into two distinct parts. On one hand it describes the clinical situations’ roll, assisted through the experimental trainee, that took place on Hospital Veterinário do Restelo (HVR), for a period of four months, specifically since 3 august 2015 until 6 december 2015, and this trainee was led by Doctor Sandra Branco, and also the HVR’s clinical subdirector Dr. Diogo Magno. On other hand the second parts reveals a monograph titled “ehrlichiosis monocytic canine” (EMC), specifying a particular clinical case followed by the author. The EMC an infectious disease transmitted by a tick - Riphicephalus sanguineus – whose chemical controls and even the environmental ones are crucial to reduce the disease’s prevalence. The disease has an intracellular bacteria origin - Ehrlichia canis – responsability for the dog’s immune system infection, and it reveals different evolution phases and present acute or in some cases chronic forms. The treatment’s first step is to use an antibiotic with tetracycline that include doxycycline, and as a fluid’s therapy addition is use to do the supportive treatment. The diagnosis is variable so it depends on precocity evaluation and even on the therapeutics efficiencies.

Trèlat's beads as oral manifestations in patients with HIV/TB

Tuberculosis (TB) is a contagious infectious disease caused by Mycobacterium tuberculosis (Koch's bacillus). Co-infection with human immunodeficiency virus (HIV) and TB has reached a significant importance as a public health problem and this association has been recognized as the most significant event that changed "the balance between man and Koch's bacillus" in the last century, and has a large contribution to the risk for disease spreading. Tuberculosis has two main standard categories of clinical manifestations: primary and secondary. Primary TB is responsible for the initial infection with lungs being the involved organ. Oral lesions are observed as a secondary TB clinical manifestation with most frequent sites being hard and soft palate, tongue, lips, gums, tonsils, and salivary glands. A case of classical TB lesions in the oral cavity is reported, and the importance of a correct diagnosis through careful history taking is emphasized. Treatment selection needs to be done assertively, with great determination and building a link between patient and treatment protocol, in order to promote patient's adherence.

Avian flu: the creation of expectations in the interplay between science and the media

This paper examines the emerging cultural patterns and interpretative repertoires in reports of an impending pandemic of avian flu in the UK mass media and scientific journals at the beginning of 2005, paying particular attention to metaphors, pragmatic markers ('risk signals'), symbolic dates and scare statistics used by scientists and the media to create expectations and elicit actions. This study complements other work on the metaphorical framing of infectious disease, such as foot and mouth disease and SARS, tries to link it to developments in the sociology of expectations and applies insights from pragmatics both to the sociology of metaphor and the sociology of expectations.

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.

Remarkable gains have been made in global health in the past 25 years, but progress has not been uniform. Mortality and morbidity from common conditions needing surgery have grown in the world’s poorest regions, both in real terms and relative to other health gains. At the same time, development of safe, essential, life-saving surgical and anaesthesia care in low-income and middle-income countries (LMICs) has stagnated or regressed. In the absence of surgical care, case-fatality rates are high for common, easily treatable conditions including appendicitis, hernia, fractures, obstructed labour, congenital anomalies, and breast and cervical cancer. In 2015, many LMICs are facing a multifaceted burden of infectious disease, maternal disease, neonatal disease, non-communicable diseases, and injuries. Surgical and anaesthesia care are essential for the treatment of many of these conditions and represent an integral component of a functional, responsive, and resilient health system. In view of the large projected increase in the incidence of cancer, road traffic injuries, and cardiovascular and metabolic diseases in LMICs, the need for surgical services in these regions will continue to rise substantially from now until 2030. Reduction of death and disability hinges on access to surgical and anaesthesia care, which should be available, affordable, timely, and safe to ensure good coverage, uptake, and outcomes. Despite growing need, the development and delivery of surgical and anaesthesia care in LMICs has been nearly absent from the global health discourse. Little has been written about the human and economic effect of surgical conditions, the state of surgical care, or the potential strategies for scale-up of surgical services in LMICs. To begin to address these crucial gaps in knowledge, policy, and action, the Lancet Commission on Global Surgery was launched in January, 2014. The Commission brought together an international, multi- disciplinary team of 25 commissioners, supported by advisors and collaborators in more than 110 countries and six continents. We formed four working groups that focused on thedomains of health-care delivery and management; work-force, training, and education; economics and finance; and information management. Our Commission has five key messages, a set of indicators and recommendations to improve access to safe, affordable surgical and anaesthesia care in LMICs, and a template for a national surgical plan.

Interventions for reducing extinction risk in chytridiomycosis-threatened amphibians

Wildlife diseases pose an increasing threat to biodiversity and are a major management challenge. A striking example of this threat is the emergence of chytridiomycosis. Despite diagnosis of chytridiomycosis as an important driver of global amphibian declines 15 years ago, researchers have yet to devise effective large-scale management responses other than biosecurity measures to mitigate disease spread and the establishment of disease-free captive assurance colonies prior to or during disease outbreaks. We examined the development of management actions that can be implemented after an epidemic in surviving populations. We developed a conceptual framework with clear interventions to guide experimental management and applied research so that further extinctions of amphibian species threatened by chytridiomycosis might be prevented. Within our framework, there are 2 management approaches: reducing Batrachochytrium dendrobatidis (the fungus that causes chytridiomycosis) in the environment or on amphibians and increasing the capacity of populations to persist despite increased mortality from disease. The latter approach emphasizes that mitigation does not necessarily need to focus on reducing disease-associated mortality. We propose promising management actions that can be implemented and tested based on current knowledge and that include habitat manipulation, antifungal treatments, animal translocation, bioaugmentation, head starting, and selection for resistance. Case studies where these strategies are being implemented will demonstrate their potential to save critically endangered species.

A Bayesian approach to study the risk variables for tuberculosis occurrence in domestic and wild ungulates in South Central Spain

BACKGROUND Bovine tuberculosis (bTB) is a chronic infectious disease mainly caused by Mycobacterium bovis. Although eradication is a priority for the European authorities, bTB remains active or even increasing in many countries, causing significant economic losses. The integral consideration of epidemiological factors is crucial to more cost-effectively allocate control measures. The aim of this study was to identify the nature and extent of the association between TB distribution and a list of potential risk factors regarding cattle, wild ungulates and environmental aspects in Ciudad Real, a Spanish province with one of the highest TB herd prevalences. RESULTS We used a Bayesian mixed effects multivariable logistic regression model to predict TB occurrence in either domestic or wild mammals per municipality in 2007 by using information from the previous year. The municipal TB distribution and endemicity was clustered in the western part of the region and clearly overlapped with the explanatory variables identified in the final model: (1) incident cattle farms, (2) number of years of veterinary inspection of big game hunting events, (3) prevalence in wild boar, (4) number of sampled cattle, (5) persistent bTB-infected cattle farms, (6) prevalence in red deer, (7) proportion of beef farms, and (8) farms devoted to bullfighting cattle. CONCLUSIONS The combination of these eight variables in the final model highlights the importance of the persistence of the infection in the hosts, surveillance efforts and some cattle management choices in the circulation of M. bovis in the region. The spatial distribution of these variables, together with particular Mediterranean features that favour the wildlife-livestock interface may explain the M. bovis persistence in this region. Sanitary authorities should allocate efforts towards specific areas and epidemiological situations where the wildlife-livestock interface seems to critically hamper the definitive bTB eradication success.

Novel insights into the dynamics of green turtle fibropapillomatosis

Outbreaks of fibropapillomatosis (FP), a neoplastic infectious disease of marine turtles, have occurred worldwide since the 1980s. Its most likely aetiological agent is a virus, but disease expression depends on external factors, typically associated with altered environments. The scarcity of robust long-term data on disease prevalence has limited interpretations on the impacts of FP on turtle populations. Here we model the dynamics of FP at 2 green turtle foraging aggregations in Puerto Rico, through 18 yr of capture-mark-recapture data (1997−2014). We observed spatiotemporal variation in FP prevalence, potentially modulated via individual site-fidelity. FP ex pression was residency dependent, and FP-free individuals developed tumours after 1.8 ± 0.8 yr (mean ± SD) in the infected area. Recovery from the disease was likely, with complete tumour regression occurring in 2.7 ± 0.7 yr (mean ± SD). FP does not currently seem to be a major threat to marine turtle populations; however, disease prevalence is yet unknown in many areas. Systematic monitoring is highly advisable as human-induced stressors can lead to deviations in host− pathogen relationships and disease virulence. Finally, data collection should be standardized for a global assessment of FP dynamics and impacts.

Complications of pneumococcal bacteremia after 13-valent conjugate vaccine withdrawal

In the Region of Madrid, universal immunization with the 13-serotypes pneumococcal conjugate vaccine (PCV13) started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. Our aim was to investigate the impact of PCV13 withdrawal from Madrid Region's universal immunization program on the incidence of complicated pneumococcal bacteremia. We performed a multi-center retrospective cohort study, from 2009 to 2014. Participants were children aged <14 years with Streptococcus pneumoniae bacteremia. Complications were defined as any condition requiring intensive care or surgery. Sequelae were conditions lasting ≥90 days. A total of 168 patients were recruited. One-fourth of both immunized and non-immunized patients had complications. Global complications increased after PCV13 withdrawal. A total of 28% of PCV13 serotypes presented complications. Complications due to PCV13 serotypes did not increase after July 2012. No-PCV13 serotypes increased progressively from 2009 on, and 23% presented complications. A significant risk of complications was found for patients with meningitis, empyema, C-reactive protein >100 mg/L, and serotype 1. A multivariate analysis indicated that complications were associated with meningitis and hospital admission after July 2012. Sequelae were significantly associated with children <2 years of age, meningitis and no-PCV13 serotypes. The incidence of complications due to PCV13 serotypes did not increase two years after PCV13 withdrawal. Nevertheless, all-serotypes complications increased. The likely cause was that no-PCV13 serotypes (associated with meningitis) are on the rise.