YELLOW FEVER PREVENTION STRATEGIES AWARENESS AMONG HIV-INFECTED PATIENTS IN S��O PAULO, BRAZIL

Introduction: Vaccination is the main preventive strategy against Yellow Fever (YF), which is a public health concern in Brazil. However, HIV-infected patients might have insufficient knowledge regarding YF, YF prevention, and vaccines in general. Methods: In this questionnaire-based study, data from 158 HIV-infected individuals were addressed in three distinct outpatient clinics in São Paulo. Information was collected on demographic and clinical characteristics, as well as patients' knowledge of vaccines, YF and YF preventive strategies. In addition, individual YF vaccine recommendations and vaccine status were investigated. Results: Although most participants adequately ascertain the vaccine as the main prevention strategy against YF, few participants were aware of the severity and lack of specific treatment for YF. Discrepancy in YF vaccine (patients who should have taken the vaccine, but did not) was observed in 18.8% of participants. Conclusion: YF is an important and preventable public health concern, and these results demonstrate that more information is necessary for the HIV-infected population.

Economic Evaluation of Ticagrelor for Secondary Prevention Following Acute Coronary Syndromes

INTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS: A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS: Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of ���610. Thus the incremental cost per life year saved is ���4780 and the incremental cost per QALY is ���5517. CONCLUSIONS: The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.

Adhesion Prevention in Laparoscopic Surgery

Adhesions have important consequences for patients, surgeons, and health services. Peritonealtissue injury can be prevented by using careful surgical techniques. A large number of antiadhesion products have been used experimentally and clinically to prevent postoperative adhesions. Methods: The current author reviewed the surgical literature published about epidemiology, pathogenesis, and various prevention strategies of adhesion formation. Results: Meticulous surgery is essential to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. Several preventive agents against postoperative peritoneal adhesions have been investigated. Bioresorbable membranes are site-specific antiadhesion products but may be more difficult to use laparoscopically. Liquids and gels have the advantage of more-widespread areas of action and increased ease of use, particularly during laparoscopic operations. Effective pharmacologic agents that can reduce release of proinflammatory cytokines or activate peritoneal fibrinolysis are under development. Their results are encouraging but most of them are contradictory. Conclusions: Many modalities are being studied to reduce this risk; despite initial promising results of different measures in postoperative adhesion prevention, none of them have become standard applications. With the current state of knowledge, preclinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies for avoiding postoperative peritoneal adhesions.

Exploring motor neuron degeneration in ALS - prevention by glycoursodeoxycholic acid and signaling to microglia

Disserta����o para obten����o do Grau de Mestre em Gen��tica Molecular e Biomedicina

Analysis of molecular biology techniques for the diagnosis of human papillomavirus infection and cervical cancer prevention

The objective of the present study was to evaluate the usefulness of molecular methodologies to access human papillomavirus genome in the genital tract. Samples from 136 women aged 17 to 52 years old obtained from the Dr. S��rgio Franco Laboratories between 2000 and 2001, were analyzed by the hybrid capture assay and amplified by PCR with generic primers MY09/MY11 and specific primers for types 16, 18, 31, 33, 35, 58. Viral genome was detected in 71.3% of the samples by hybrid capture and 75% by amplification. When cytopathology was used as a reference method for screening lesions, hybrid capture (p=0) and amplification (p=0.002) presented positive association. The 3 methods showed absolute agreement when cytopathology confirmed papillomavirus infection and high grade intraepithelial lesion. Disagreements occurred for 10 cases: seven inflammatory cases positive by PCR and negative for hybrid capture and 3 low squamous intraepithelial lesions positive for hybrid capture but negative for amplification. In conclusion, hybrid capture was shown to be sensitive and specific enough for use in clinical routines. Moreover, the evaluation of viral load values obtained by this method were shown to be related to the severity of the lesion and merit further studies to analyze the possible association with risk of progression to malignancy.

Implementation of a pilot project for the treatment and prevention of substance abuse in children and adolescents : strengthening families for parents and youths 12-16

RESUMO: Antecendentes: Uma avalia����o dos servi��os de abuso de subst��ncias em Barbados identificou a necessidade de programas e servi��os que s��o projetados especificamente para crian��as e adolescentes. Objetivo: Realizar programa com base em evid��ncias para reduzir a incid��ncia de abuso de drogas entre crian��as e adolescentes por meio do fortalecimento da unidade familiar atrav��s de parentalidade positiva, de maior funcionamento familiar e de resist��ncia dos jovens. M��todo: Dois projetos-piloto foram realizadas com base no programa "Fortalecer as Fam��lias para Pais e Jovens de 12 a 16 anos (SFPY). O programa de nove semanas foi empregado como uma interven����o para criar la��os familiares mais fortes, aumentar a resist��ncia dos jovens e reduzir o abuso de drogas entre crian��as e adolescentes de idades de 11 a 16 anos. A decis��o foi tomada para incluir participantes de 11 anos desde que as crian��as possam estar no primeiro ano da escola secund��ria nessa idade. IMPLEMENTATION OF SUBSTANCE ABUSE PILOT PROJECT FOR CHILDREN AND ADOLESCENTS 5 Resultados: Quinze fam��lias participaram em dois projetos-piloto e a avalia����o final mostrou que os jovens ap��s o programa, geralmente tornaram-se mais positivos sobre o seu lugar na unidade familiar e sentiram que sua participa����o no programa foi ben��fica. Os pais, da mesma forma, relataram que eles conquistaram, com o programa uma rela����o mais positiva, uma melhor compreens��o das necessidades, e consci��ncia das mudan��as de desenvolvimento de seus jovens. Desta forma, considera-se que o programa atingiu o resultado desejado de criar unidades familiares mais fortes. Conclus��o: O Projeto Piloto ���SFPY��� foi bem sucedido em fazer pais e jovens mais conscientes de suas necessidades individuais e de responsabilidades dentro da unidade familiar. Como resultado, o relacionamentos das respectivas fam��lias melhorou. Estudos baseados em evid��ncias t��m demonstrado que um rela����o familiar mais forte diminui a incid��ncia de uso e abuso de drogas na popula����o adolescente, aumentando os fatores de prote����o e diminuindo os fatores de risco. A implementa����o do programa, que foi desenvolvido e testado no ambiente norte-americano, demonstrou que era transfer��vel para a sociedade de Barbados. No entanto, seu impacto total s�� pode ser determinado atrav��s de um estudo comparativo envolvendo um grupo de controle e / ou uma interven����o alternativa ao abuso de subst��ncias. Portanto, �� recomend��vel que um estudo comparativo da interven����o SFPY deve envolver uma amostra representativa de adolescentes que est��o em est��gio de desenvolvimento anterior mais cedo. Evid��ncias j�� demonstram que o programa �� mais eficaz, com impacto mais longo sobre os jovens que participam em uma idade maisABSTRACT:Background: An evaluation of substance abuse services in Barbados has identified the need for programmes and services that are specifically designed for children and adolescents. Aim: To conduct an evidence-based programme to reduce the incidence of substance abuse among children and adolescents by strengthening the family unit through positive parenting, enhanced family functioning and youth resilience. Method: Two pilot projects were conducted based on the ���Strengthening Families for Parents and Youths 12��� 16��� (SFPY) programme. The nine-week programme was employed as an intervention to create stronger family connections, increase youth resiliency and reduce drug abuse among children and adolescents between the ages of 11 to 16. The decision was made to include participants from age 11 since children may be in the first year of secondary school at this age. IMPLEMENTATION OF SUBSTANCE ABUSE PILOT PROJECT FOR CHILDREN AND ADOLESCENTS 3 Results: Fifteen families participated in two pilot projects and an evaluation conducted at the conclusion showed that the youth were generally more positive about their perceived place in the family unit and felt that the being in the programme was generally beneficial. The parents similarly reported they had a more positive relationship with their youths and also had a better understanding of their needs, and an awareness of their developmental changes. This affirmed that the programme had achieved its desired outcome to create stronger family units. Conclusion: The SFPY Pilot Project was successful in making parents and youths more aware of their individual needs and responsibilities within the family unit. As a result relationships within their respective families were strengthened. Evidence-based studies have shown that enhanced family functioning decreases the incidence of substance use and abuse in the adolescent population by increasing protective factors and decreasing risk factors. The implementation of the programme, which was developed and tested in the North American environment, demonstrated that it was transferable to the Barbadian society. However, its full impact can only be determined through a comparative study involving a control group and/or an alternative substance abuse intervention. It is therefore recommended that a comparative study of the SFPY intervention should be delivered to a representative sample of adolescents who are at an earlier developmental stage. Evidence has shown that the programme is more effective, with longer impact on youths who participate at a younger age.

Etiological treatment of young women infected with Trypanosoma cruzi, and prevention of congenital transmission

The objective was to detect Trypanosoma cruzi infection in 32 children in Salta, Argentina, born to 16 chronically infected young women who were treated with benznidazole. Tests were performed to assess the efficacy of treatment after 14 years. At the end of the follow up, 87.5% of the women were non-reactive to EIA tests, 62.5% to IHA and 43.8% to IFA. 62.5% of the women were non-reactive according to two or three serological tests. No infected children were detected among the newborns of mothers treated before their pregnancy.

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.

Prevention of respiratory syncytial virus infections

Respiratory syncytial virus is the most important cause of viral lower respiratory illness in infants and children worldwide. By the age of 2 years, nearly every child has become infected with respiratory syncytial virus and re-infections are common throughout life. Most infections are mild and can be managed at home, but this virus causes serious diseases in preterm children, especially those with bronchopulmonary dysplasia. Respiratory syncytial virus has also been recognized as an important pathogen in people with immunossupressive and other underlying medical problems and institutionalizated elderly, causing thousands of hospitalizations and deaths every year. The burden of these infections makes the development of vaccines for respiratory syncytial virus highly desirable, but the insuccess of a respiratory syncytial virus formalin-inactivated vaccine hampered the progress in this field. To date, there is no vaccine available for preventing respiratory syncytial virus infections, however, in the last years, there has been much progress in the understanding of immunology and immunopathologic mechanisms of respiratory syncytial virus diseases, which has allowed the development of new strategies for passive and active prophylaxis. In this article, the author presents a review about novel approaches to the prevention of respiratory syncytial virus infections, such as: passive immunization with human polyclonal intravenous immune globulin and humanized monoclonal antibodies (both already licensed for use in premature infants and children with bronchopulmonary dysplasia), and many different vaccines that are potential candidates for active immunization against respiratory syncytial virus.

National suicide prevention strategy for Afghanistan (NSPS)

RESUMO: Do suic��dio no Afeganist��o �� uma prioridade de sa��de p��blica. O Afeganist��o �� um pa��s de baixo rendimento, emergindo de tr��s d��cadas de conflitos. H�� uma alta preval��ncia de sofrimento psicol��gico, perturba����es mentais e abuso de subst��ncias. Existem v��rias quest��es sociais, tais como, desequil��brio/viol��ncia de g��nero, pobreza, atitudes e costumes obsoletos, r��pidas mudan��as s��cio-culturais, viola����o dos direitos humanos e especialmente dos direitos das mulheres e das crian��as. Estes fatores de risco contribuem para o aumento da vulnerabilidade da popula����o em rela����o ao suic��dio. A relativa alta taxa de suic��dio no Afeganist��o �� especialmente significativa comparada com as taxas baixas em todos os pa��ses isl��micos. Os estudos mostraram predomin��ncia de suic��dio nas mulheres (95%) e em pessoas jovens. Existe, por isso, uma necessidade urgente do pa��s ter uma estrat��gia de preven����o do suic��dio. A estrat��gia foi desenvolvida pela cria����o de um grupo t��cnico/ de assessoria multi-sectorial de diferentes intervenientes tais como governo, ONGs, ag��ncias doadoras, as fam��lias das v��timas e outraas partes interessadas. A estrat��gia baseia-se os seguintes valores chave:, respeito pelas diversidades; sensibilidade para as quest��es s��cio-cultura-religiosa e de g��nero; promo����o da dignidade da sociedade; respeito pelos direitos humanoss.. Os 'seis pontos estrat��gicos' s��o: envolvimento das principais partes interessadas e cria����o de colabora����o intersectorial coordenada; fornecimento de cuidados ��s pessoas que fazem tentativas de suic��dio e ��s suas fam��lias; melhoria dos servi��os para pessoas com doen��a mental e problemas psicossociais; promover uma comunica����o e imagem adequada dos comportamentos suicidas, pelos meios de comunica����o; reduzir o acesso aos meios de suic��dio e coligir informa����o sobre as taxas de suic��dio, os fatores de risco, os fatores protetores e as interven����es eficazes. A estrat��gia nacional de preven����o do suic��dio ser�� inicialmente implementada por 5 anos, com uma avalia����o anual do plano de ac����o para entender os seus pontos fortes e limita����es. Recomenda����es e sugest��es ser��o incorporadas nos pr��xima planos anuais para uma interven����o eficaz. Um sistema de monitoriza����o ir�� medir o progresso na implementa����o da estrat��gia.-----------------------------ABSTRACT: Suicide in Afghanistan is a public health priority. Afghanistan is a low-income country, emerging from three decades of conflicts. There is high prevalence of mental distress, mental disorders and substance abuse. There are multiple social issues, such as gender imbalance/violence, poverty, obsolete attitudes and customs, rapid social-cultural changes, human right violations, and especially women and children rights. These risk factors contribute to increase the vulnerability of the population for suicide. The relative high rate of suicide in Afghanistan is especially significant as the rates are low in all Islamic countries. Research studies have shown predominance of suicide in women (95%) and in young age people. There is an urgent need for the country to have a suicide prevention strategy. The strategy has been developed by establishing a multi-sectoral technical/advisory group of different stakeholders from government, NGOs, donor agencies, victim���s families, and interested parties. The strategy is based on the following key values, namely, respect for diversities; sensitiveness to socio-culture-religious and gender issues; promotion of the society dignity and respect for the human rights of people. The six ���Strategic directions��� are: involving key stakeholders and creating coordinated inter-sectoral collaboration; providing after care for people making a suicide attempt and their families; improving services for people with mental disorders and psycho-social problems; promoting the safe reporting and image of suicidal behaviour by media; reducing access to the means of suicide and gathering information about suicide rates, risk factor, protective factors and effective interventions. The National Suicide Prevention Strategy will be initially implemented for 5 years, with an annual evaluation of the action plan to understand the strengths and limitations. Recommendations and suggestions will be incorporated into the next annual plans for effective intervention. A monitoring framework will measure progress in implementing the strategy.

Prevention in underground construction with sequential excavation method

This paper aims to describe the Sequential Excavation Method, used for excava-tion in underground works, as well as the related risks and preventive measures. This method has characteristics that differentiate it from other tunnelling techniques: it uses a larger number of workers and equipment; it has a high concurrency of tasks with various workers and equip-ment quite exposed to hazards; and it uses many potentially aggressive chemicals. Firstly, it is given a broad overview of this issue. Afterwards, it will be presented the results of a survey to a sample of experienced technicians, aimed at gauging the relevance of a set of guidelines relat-ing to the design and work phases, applicable to the domestic market and prepared following technical visits to works abroad.

Aplicaci��n potencial de probi��ticos para la prevenci��n y control de la matitis bovina. Potential aplication of probiotics for prevention and control of bovine mastitis.

Ubicada en el centro del pa��s, R��o Cuarto pertenece a las cuencas lecheras m��s importantes del pa��s, localizadas en las provincias de C��rdoba, Santa Fe, Entre R��os y Buenos Aires. C��rdoba, con una producci��n promedio anual de 2,4 mil millones de litros, contribuye con un 25 por ciento a la producci��n nacional que seg��n informe de la Secretar��a de Agricultura Ganader��a y Pesca de la Naci��n (2006) ha alcanzado los 9.000 millones de litros al a��o, ubic��ndose en segundo lugar despu��s de Santa Fe. La mastitis bovina es responsable de las mayores p��rdidas econ��micas dentro del rodeo lechero, debido a los elevados costos de la terapia antibi��tica, al retiro del animal del circuito productivo, y a las consecuencias negativas ocasionadas en la reproducci��n. Diferentes estrategias se han desarrollado en el pa��s y el mundo, tendientes a minimizar los problemas ocasionados por la enfermedad. De ellos, la desinfecci��n pre y post-orde��e y la terapia con antibi��ticos al secado, son los m��todos de control m��s ampliamente utilizados. Las terapias con antibi��ticos, formuladas para uso intramamario, frecuentemente resultan ineficientes para prevenir o eliminar las infecciones cr��nicas producidas por <i>S. aureus</i>, principal agente causal de la enfermedad. A ello se suma el aumento en la frecuencia de cepas resistentes a los antibi��ticos, por lo que existen presiones cada vez mayores por parte de los entes reguladores para limitar el uso de los mismos en el ganado. La ineficacia de estos procedimientos para reducir la tasa de nuevas infecciones ha orientado la investigaci��n hacia la b��squeda de m��todos de control alternativos basados en el desarrollo de vacunas, inmunomoduladores o sustancias naturales, como un enfoque racional para controlar infecciones en animales utilizados en la producci��n de alimentos, o bien a la aplicaci��n de medidas preventivas. El presente proyecto aborda el tema de la prevenci��n de la mastitis bovina a trav��s del estudio de una cepa de BL con propiedades probi��ticas en ensayos de inoculaci��n in vivo en gl��ndulas mamarias de bovinos para su futura aplicaci��n en la prevenci��n de la mastitis bovina. En particular se propone a) Determinar la capacidad de las BL seleccionada como potencial probi��tico, a partir del aislamiento realizado por nuestro grupo de investigaci��n y de otras previamente caracterizadas en el CERELA, para adherirse y colonizar el canal del pez��n de la ubre, b) Profundizar en el estudio de los mecanismos involucrados en el efecto (ben��fico o adverso) de la administraci��n local de BL en el canal del pez��n de la gl��ndula mamaria y c) Estudiar las condiciones f��sico-qu��micas para la obtenci��n de biomasa de BL y sustancias antag��nicas. El proyecto sentar�� las bases para, en un futuro cercano, realizar el dise��o de un producto a base de probi��ticos lo cual ser�� un importante aporte socio-comunitario a la prevenci��n de la mastitis bovina de alt��sima incidencia. El desarrollo de un producto con estas caracter��sticas permitir�� la articulaci��n con el sector productivo.

Estudio de la micobiota y sus micotoxinas en ingredientes y raciones de animales dom��sticos. Estrategias orientadas a la prevenci��n de las micotoxicosis. Studies on mycobiota and incidence of mycotoxins in raw material and feedstuff for domestic animals. Different strategies for mycotoxicosis prevention.

Numerosas investigaciones han desarrollado estrategias para la remoci��n de micotoxinas en alimentos por diferentes m��todos, aunque muchos de ellos no han llegado a ser utilizados debido a los elevados costos o a las dificultades pr��cticas involucradas en el proceso de detoxificaci��n. Estos argumentos estimulan a los investigadores a desarrollar nuevas estrategias de decontaminaci��n que eviten el uso de agentes qu��micos y que reduzcan las p��rdidas en el valor nutritivo y la palatabilidad de los alimentos decontaminados. Una de las alternativas promisorias es la detoxificaci��n biol��gica. Las levaduras capaces de adsorber micotoxinas y con habilidades probi��ticas o prebi��ticas son promisorias para reducir la exposici��n humana a las micotoxinas. En el tracto gastrointestinal se encuentra normalmente un gran n��mero de especies de bacterias comensales y pat��genas; sin embargo, cuando se incrementa la cantidad de microorganismos pat��genos se pueden producir alteraciones de la salud y muerte. La industria argentina de alimentos destinados a animales necesita reducir los niveles de micotoxinas presentes en ingredientes o en insumos terminados. Si bien los resultados obtenidos en el mundo en la tem��tica son preliminares y promisorios, en nuestro pa��s a��n no se han desarrollado estrategias biol��gicas de decontaminaci��n de micotoxinas aplicadas a estos alimentos. Estudios de incidencia de micoflora y detecci��n de micotoxinas en alimentos balanceados para aves, llevados a cabo por nuestro grupo de investigaci��n en la regi��n del sur de C��rdoba demostraron la presencia de los principales g��neros toxicog��nicos (Aspergillus, Penicillium y Fusarium) y sus micotoxinas asociadas (aflatoxinas, zearalenona y fumonisinas). En relaci��n a porcinotecnia, la zona sur de la provincia de C��rdoba es considerada una de las tres zonas de mayor densidad porcina en Argentina. Sin embargo, la contaminaci��n de los granos con micotoxinas representa un serio problema debido a que producen rechazo del alimento, disminuci��n de la tasa de crecimiento y reducci��n inmunol��gica. Si consideramos la evoluci��n en la producci��n lechera en los ��ltimos a��os ha seguido una l��nea de intensificaci��n que ha conllevado un cambio en la utilizaci��n de los alimentos, evolucionando del simple pastoreo a los sistemas de alimentaci��n ��nica, basados en la formulaci��n de alimentos balanceados que constituyen la clave de la alimentaci��n de los animales. Diferentes estudios epidemiol��gicos usando t��cnicas moleculares han demostrado que con frecuencia la infecci��n por A. fumigatus ocurre como consecuencia de la adquisici��n ex��gena del hongo. La magnitud del problema se manifiesta en la continua b��squeda de medidas de prevenci��n y control de estas micotoxicosis. Debido a este impacto negativo que ejercen las toxinas f��ngicas lo cual, afecta los par��metros productivos como ganancia de peso y conversi��n alimenticia con graves p��rdidas a la industria animal tanto en el mercado interno como externo.