In the absence of an effective vaccine, vector control and surveillance of dengue fever (DF) and dengue hemorrhagic fever (DHF) are the most important strategies currently used to reduce the impact of these diseases in affected population. The objectives of this study were to estimate the incidence of symptomatic and asymptomatic dengue cases, the prevalence of antidengue antibodies, and to evaluate the laboratory and clinical aspects related to an active surveillance of dengue cases. In this study, active surveillance was incorporated as a part of the study design. At total of 3,255 people from four high risk neighborhoods were followed in a two years prospective study whereby the participants' houses were visited three times a week. During these visits, dengue cases were characterized by identifying patients with fever as well as other symptoms that were compatible with dengue disease. In addition, a biannual blood sample was taken for each study participants, to establish the prevalence and six month incidence of dengue infection. We found a crude incidence density (ID) of 3.24 by 100,000 person/days (p/d) which changed from 5.69 by 100,000 p/d for the first year of the study to 1.45 by 100.000 p/d in the second year. In both years, the months from July through September had the highest ID of 8.81 by 100,000 p/d. Children displayed higher ID when compared to adults, RR: 3.92 (2.38 - 6.48). The Plaque Reduction Neutralization Test was used to assay for the presence of antidengue antibody in 2,125 study participants (65.3% of total). The prevalence of anti dengue antibodies was found to be 86.6% (1,840 positives). The prevalence of anti DENV-1 was 74%, while 65.2 % of the participants had anti- DENV-1 and anti- DENV-2 simultaneously. The cumulative incidence of anti IgG dengue antibody in the negative participants (283 at the start of the study) was 30% in the first 6 months period, 29.6% in the second 6 months, and 23.8 in the third one. The difference between the numbers of participants detected in the active surveillance, (270 confirmed and non confirmed dengue cases) with the numbers of people who showed sero-conversion to anti-IgG dengue antibody within a relatively short period of time suggested that there was a high number of asymptomatic dengue infections present in the population. Transmissibility of the virus, the surveillance of dengue, and vaccine implementation in the near future would all be affected by the large number of asymptomatic people in hyperendemic countries.

Les mycoplasmes sont des bactéries à petit génome dérivées d’ancêtres à Gram positif par une succession de pertes de matériel génétique. Il a longtemps été considéré que la réduction génétique était la seule force régissant l’évolution de ces bactéries, cependant, des transferts horizontaux de grandes régions chromosomiques au sein et entre les espèces de mycoplasmes ont été récemment mis en évidence. Des éléments conjugatifs et intégratifs (ICE) découverts chez certaines espèces de mycoplasme pourraient être à l’origine de ces transferts. Ces ICEs codent les systèmes nécessaires pour leur excision, leur transfert conjugatif et leur intégration dans la cellule receveuse.Mycoplasma hominis est un mycoplasme commensal des voies génitales qui peut être responsable d’infections gynécologiques, d’infections néonatales et d’infections extragénitales. L’analyse préliminaire de génomes de M. hominis avait montré la présence de régions codantes caractéristiques des ICEs. Les objectifs de cette thèse étaient de rechercher et caractériser les ICEs chez 12 isolats cliniques de M. hominis entièrement séquencés et de déterminer la prévalence de ces ICEs au sein de l’espèce M. hominis. Pour cela, une étude rétrospective sur une période de 6 ans a été menée sur des isolats cliniques obtenus au CHU de Bordeaux. Les concentrations minimales inhibitrices des tétracyclines et des fluoroquinolones ainsi que les mécanismes de résistance ont été déterminés, permettant de disposer d’une collection d’isolats cliniques caractérisés pour l’étude des ICEs.Des ICEs de près de 30 kpb ont été trouvés en une ou plusieurs copies dans sept des 12 souches de M. hominis séquencées. Seulement cinq de ces ICEs semblaient fonctionnels puisqu’une forme circulaire a pu être détectée. Tous les ICEs de M. hominis présentaient une structure similaire avec un module spécifique de M. hominis d’environ 4-kpb, codant des protéines ayant des caractéristiques structurelles similaires à des effecteurs TAL (transcription activator-like), impliqués dans la reconnaissance de nucléotides et dans la transduction de signaux chez les bactéries symbiotiques. La caractérisation des mécanismes de résistance aux antibiotiques des isolats cliniques de M. hominis collectés au CHU de Bordeaux nous a permis de disposer d’une collection de 183 isolats isolés entre 2010 et 2015, parmi lesquels 14,8% étaient porteur du gène tet(M) responsable de la résistance aux tétracyclines, 2,7% étaient résistant à la lévofloxacine et 1,6% étaient résistants à la moxifloxacine par mutation des gènes de la topoisomérase IV et de l’ADN gyrase. Le screening de 120 de ces isolats cliniques a révélé une prévalence élevée des ICEs dans l’espèce M. hominis, mesurée à 45%. Il n’y avait pas de prédominance des ICEs dans les isolats portant le gène tet(M), suggérant que les ICEs n’étaient pas responsables de la dissémination de la résistance à la tétracycline.Des expériences complémentaires de conjugaison seront nécessaires pour confirmer la fonctionnalité des ICEs retrouvés dans l’espèce M. hominis. Cependant, la forte prévalence et le caractère très conservé des ICEs chez M. hominis suggèrent que ces ICEs pourraient conférer un avantage sélectif pour la physiologie ou la physiopathologie de la bactérie. Ce travail ouvre ainsi la voie à de futures études qui permettront une meilleure compréhension des transferts horizontaux de gènes et des facteurs de virulence chez M. hominis. / Mycoplasmas are small-genome bacteria derived from Gram-positive ancestors by a succession of genetic material losses. It has long been considered that genetic reduction was the only force governing the evolution of these bacteria, however, horizontal transfers of large chromosomal regions within and between mycoplasma species have recently been reported. Conjugative and integrative elements (ICE) found in some species of mycoplasma may be responsible for these transfers. These ICEs encode the systems necessary for excision, conjugative transfer and integration into a recipient cell.Mycoplasma hominis is a commensal genital mycoplasma that can be responsible for gynecological infections, neonatal infections and extragenital infections. Preliminary analysis of M. hominis genomes had showed the presence of coding regions characteristic of ICEs. The objectives of this thesis were to search for and characterize ICEs in one reference strain and 11 fully sequenced M. hominis clinical isolates and to determine the prevalence of these ICEs in the M. hominis species. To do so, a retrospective study over a period of 6 years was conducted on clinical isolates collected at the Bordeaux University Hospital. The minimum inhibitory concentrations of tetracyclines and fluoroquinolones as well as resistance mechanisms were determined, providing a collection of clinical isolates characterized for the study of ICEs.ICEs of 27-30 kpb were found in one or two copies in seven of the 12 M. hominis sequenced strains. Only five of these ICEs seemed functional since circular forms of extrachromosomal ICE were detected. All M. hominis ICEs exhibited a similar structure consisting of a 4.0-5.1 kb module composed of five to six juxtaposed CDSs, encoding proteins that share common structural features with transcription activator-like (TAL) effectors, involved in polynucleotide recognition and signal transduction in symbiotic bacteria. The characterization of antibiotic resistance mechanisms in M. hominis clinical isolates collected at Bordeaux University Hospital enabled us to obtain a collection of 183 isolates isolated between 2010 and 2015, of which 14.8% harbored the tet(M) gene responsible for tetracycline resistance, 2.7% were resistant to levofloxacin and 1.6% were resistant to moxifloxacin by mutation in topoisomerase IV and DNA gyrase genes. Screening of 120 of these clinical isolates revealed a high prevalence of ICEs in M. hominis, measured to be 45%. The proportion of ICEs was not higher in isolates carrying the tet (M) gene, suggesting that ICEs were not responsible for the spread of tetracycline resistance.Additional mating experiments will be necessary to confirm the functionality of the ICEs found in the M. hominis species. However, the conserved and specific structure of M. hominis ICEs and the high prevalence in clinical strains suggest that these ICEs may confer a selective advantage for the physiology or pathogenicity of the bacteria. This work opens the way for future studies that will provide a better understanding of horizontal gene transfers and virulence factors in M. hominis.

In the rural areas of Kwa Zulu Natal small scale farming is the main agricultural activity, which is often carried out in addition to other employment taken on in another location by at least one member of the household. Although Veterinary services (VS) was aware of several diseases occurring in this area and has implemented a dipping strategy for tick borne diseases as well as a regional annual vaccination campaign for Rabies, Anthrax and Black quarter, uncertainty remained about the relative importance of other diseases such as brucellosis, leptospirosis and enzootic bovine leucosis. Further it was of interest to investigate the serological resistance of cattle against the tick borne diseases babesiosis and anaplasmosis. In addition to this veterinary services wanted to increase their understanding of the perceptions and practices of local cattle owners that were relevant for the context of disease control. A serological survey of cattle was carried out between March 2001 and December 2003 to determine the prevalence of the above-mentioned diseases. The survey was designed as a two-stage survey, considering the diptank as the primary sampling unit. The conduction of the questionnaire survey was based on a convenience sample and took place during the dipping procedure. The apparent prevalence at district level was adjusted for clustering, and diagnostic test sensitivity and specificity and displayed in maps. The mean true prevalence of brucellosis varied from zero to 15.8 percent in the north eastern region with the large majority of the districts being disease free. Enzootic Bovine Leukosis (EBL) was widely present in the province at generally low prevalences, except in the central region where the highest prevalence at district level was recorded to be 70 percent. Leptospirosis also occurred frequently with the highest prevalence noted being 62 percent at district level. The southern regions showed a higher leptospirosis prevalence than other areas of the province, while in some of the northern and western districts a lower prevalence is noted. The encountered servovars were pomona, which occurred most frequently, tarrasovi, bratislava, hardjo, canicola and icterohaemorrhagica. While Babesia bovis and anaplasmosis occurred at a high prevalence throughout the province, B. bigemina was found to be much less established and is absent from many of the northern districts. Most prevalences calculated at district level do show large confidence intervals due to uncertainty that arose from the sampling frame and should be interpreted with care. / Dissertation (MSc (Production Animal Studies))--University of Pretoria, 2007. / Production Animal Studies / MSc / unrestricted

Background: Worldwide efforts have been made by some countries to offer HPV vaccination since its introduction in 2006. Population effectiveness of HPV vaccines is presently an active area of research. We review available evidence on the effectiveness of HPV vaccine uptake among female adolescents to prevent HPV infection. Methods: A comprehensive search of published and grey literature was conducted in several electronic databases using a pre-defined search strategy related to HPV prevalence following vaccination. The database searches were complemented by hand-searches of reference lists of eligible studies. Data were extracted onto a purpose-designed data extraction form, pooled in a meta-analysis and stratified by continent considering vaccine type, cross protective and (high/low) risk HPV types as subgroups. Results: Our search yielded 1680 studies, of which thirteen met with our inclusion criteria (8332 vaccinated women aged 12 to 34 years from across the world). The pooled HPV (comprising types 6, 11, 16 and 18) prevalence among vaccinated female adolescents was 7% (95% Confidence Interval (CI): 5% to 9%, 13 studies, n=8,332). The 13 studies were conducted across 3 continents: HPV prevalence for North America was 5% (95% CI: 3% to 7%, 9 studies, n=5781, age range =13 to 34); Europe, 14% (95% CI: 9% to 18%, 3 studies, n=2213, age range =13 to 29) and Australia 5% (95% CI: 3% to 8%, 1 study, n=5781, age range=13 to 34). Of the studies which reported the effect of vaccination on other non-vaccine HPV type prevalence (known as cross protective types) HPV (31, 33, 45, 51 & 58), the overall pooled cross protective HPV prevalence was 9% (95% CI: 6% to 12%, 4 studies, n=3081 age range=13 to 29), by continent North America had 14% (95% CI: 12 to 17%, 1 study, n=753 age range=14 to 24), Europe 7% (95% CI: 6 to 8%, 2 studies, n=1990, age range=13 to 29) and Australia with 8% (95% CI: 5% to 11%, 1 study, n=338 age range=18 to 26). Conclusion: This study showed an HPV prevalence of 7% in women vaccinated against HPV types 6,11,16 and 18, which represents a substantial difference to the 22% HPV prevalence in non-vaccinated women. There was no statistically significant difference between HPV prevalence across the continents. There is however, still a dearth of information on vaccinated women and HPV prevalence, highlighting the need for further studies in this area. Strengths and limitation of this review • The review comprehensively searched multiple databases and bibliographies. We had no language restrictions. • We were stringent in the selection of studies as far as vaccination status was concerned. Studies considering HPV prevalence in unvaccinated women were excluded. • A variety of methods was utilised in collecting data across the studies. However, some of the study participants were not representative of the general population. Caution therefore, needs to be considered when using these results to make inferences or conclusions about prevalence of certain populations.

Background: There is a dearth of information regarding prevalence of extensively drugresistant tuberculosis (XDR-TB) in Africa. Although countries in Africa conduct national tuberculosis surveys on a regular basis, this information has not been systematically reviewed to ascertain the overall prevalence of XDR-TB in Africa. Methods: The study aimed to perform a systematic review and meta-analysis of the prevalence and factors associated with prevalence of pulmonary XDR-TB among adults in Africa. Eligible studies, published between 2006 and 2018, were sourced from various electronic databases including PubMed, Scopus, and Web of Science. Meta-analysis was performed using STATA (version 14.2) statistical software. The protocol of this review was registered with PROSPERO, reg No CRD42018117037. Result: A total of 6242 records were retrieved. Forty-eight studies were screened for eligibility and seven, which varied in terms of country setting and study design, were included. The prevalence of XDR-TB is 4% (95%CI 2-7) among participants tested for second-line anti-TB drug resistance, and 3% (95%1-6) among participants with drug resistant TB. The prevalence of XDR-TB was 7% (95%CI 1-18) among participants with MDR-TB. A few studies reported on the factors associated with the prevalence of XDR-TB. Discussion: The reported prevalence of XDR-TB among participants tested for second-line anti-TB drug resistance is low compared to WHO estimates. The systematic review underscores a dearth of studies depicting the reality regarding the prevalence of XDR-TB in Africa. Policymakers and stakeholders interested in drug-resistant TB should apply prudence when considering XDR-TB prevalence reported for Africa.

Thesis (MPH.) -- University of Limpopo, 2020 / The purpose of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and the associated risk factors in the Greater Giyani Area, Mopani District. Quantitative cross-sectional descriptive study was conducted to determine the prevalence rate and risk factors of GDM. Data was collected using questionnaire and data entry form. One hundred and one (101) pregnant women who were attending antenatal clinic visits at Nkhensani Hospital, Nkhensani Gateway Clinic and Giyani Healthcare Centre participated in the study. The SPSS programme was used and p-value of <0.05 was considered significant. The study found that the prevalence of GDM in the area was 1.9%. Pregnant women above 30 years with secondary education, employed, obese and at gestational age of 31-35 weeks were more likely to present with GDM. A family history of diabetes was significantly associated with development of GDM. In conclusion, the universal screening approach for GDM needs to be adopted by all health institutions.

Background: Previous studies provided inconsistent associations of smoking, stroke, and serious psychological distress (SPD) with epilepsy while urban-rural differences in the associations of risk factors with epilepsy are not well documented. Objectives: This study aimed to evaluate the associations of lifestyle, health conditions, and SPD with epilepsy and to examine whether the associations differ between urban and rural areas. Patients and Methods: A total of 604 adults with epilepsy and 42416 controls were selected from the 2005 California Health Interview Survey. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors (behavioral factors, SPD, social factors and health conditions) with epilepsy. The odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Results: The overall prevalence of epilepsy was 1.3% and the prevalence was higher in urban area than rural area (1.4 vs. 1.1%). The prevalence of SPD was 11% in cases and 4% in controls, respectively. The percentage of stroke was higher in cases than in controls (9% vs. 2%). After adjusting for other factors using multiple logistic regression, current smoking, stroke, cancer, SPD and living in urban were positively significantly associated with epilepsy (OR = 1.74, 95% CI = 1.28 - 2.38; OR = 4.81, 95% CI = 3.13 - 7.41; OR = 1.52, 95% CI = 1.12 - 2.06; OR = 2.02, 95% CI = 1.39 - 2.92, and OR = 1.4, 95% CI = 1.08 - 1.81, respectively); while binge drinking was negatively associated with epilepsy (OR = 0.65, 95% CI = 0.43 - 0.99). Stratified by residence, in the urban area, current smoking and race were only associated with epilepsy. Stroke and SPD showed stronger association with epilepsy in the rural area (OR = 7.63, 95% CI = 3.68 - 15.8, and OR = 3.14, 95% CI = 1.52 - 6.47, respectively) comparing with urban region (OR = 4.51, 95% CI = 2.79 - 7.28 and OR = 1.9, 95% CI = 1.27 - 2.86, respectively). Conclusions: Smoking, stroke, and SPD were associated with epilepsy; while the associations differed between urban and rural areas.

Thesis advisor: Britt F. Pados / Background. Ankyloglossia, commonly known as tongue-tie, reduces tongue mobility through restriction of the lingual frenulum. A recent professional consensus notes that tongue-tie is one possible reason for breastfeeding challenges. Prevalence reporting of tongue-tie has been variable, and an understanding of which infants benefit most from treatment is unknown.Screening and treatment guidelines have not been developed, mainly due to low-level evidence in published research. Despite this, there has been a substantial increase in tongue-tie treatment via frenotomy in the last 15 years. Purpose. The purpose of this program of research was to improve our understanding of tongue- tie and its impact on infant feeding. Eight specific aims were developed to achieve this purpose: 1) identify the prevalence rate of anyloglossia in infants age birth through 12 months; 2) review and evaluate the diagnostic criteria used to diagnose ankyloglossia; 3) identify and summarize original research addressing the impact of ankyloglossia on infant feeding, comparing symptoms of problematic feeding before and after frenotomy; 4) review the quality of the feeding-related outcome measures and psychometric properties of the assessment tools used; 5) describe changes in problematic feeding symptoms, as measured by the NeoEAT, pre- and post-frenotomy; 6) explore the contribution of infant age to the magnitude of change in problematic feeding pre- and post-frenotomy; 7) describe changes in maternal symptoms pre- and post-frenotomy; and 8) evaluate the relationships between maternal symptoms and symptoms of problematic feedingpre- and post-frenotomy. Methods. First, we performed a systematic review and meta-analysis of the literature on tongue- tie to determine the prevalence of the anomaly in the infant population and critiqued the methods used to achieve tongue-tie diagnosis. Second, we identified and summarized original research addressing the impact of tongue-tie on infant feeding, comparing symptoms of problematic feeding before and after frenotomy. In this same study, we evaluated the psychometric properties of the assessment tools used in the published research. Next, we assessed maternal and infant symptoms of problematic feeding pre- and post-frenotomy. In this same study, we utilized a comprehensive evaluation of infant feeding symptoms using a validated measure. Results. Cumulatively, this dissertation research has identified symptoms in both mothers and their infants in the setting of tongue-tie. Each of the eight specific aims proposed for this dissertation were addressed. Specifically, through the meta-analysis and systematic review, we determined 1) prevalence of tongue-tie is higher than previously thought, affecting 8% of the infant population, 2) current screening tools for tongue-tie require psychometric evaluation, 3) LATCH scores and maternal self-efficacy improve following frenotomy but little is known about the effect of frenotomy on infant feeding, and 4) infant feeding has not been evaluated comprehensively or with a validated measure for babies with tongue-tie. The research study conducted in Chapter IV found that 5) infants with severe tongue-tie experienced significant improvements in problematic feeding symptoms following tongue-tie correction as measured by the NeoEAT, 6) regardless of infant age, improvements in symptoms of problematic feeding were seen post-frenotomy in babies with severe tongue-tie, 7) maternal symptoms previously thought to occur in the setting of tongue-tie improved following frenotomy (e.g., painful or difficult latch), and 8) symptoms that have not been assessed in earlier research also improved after tongue-tie correction (e.g., chewing on nipple, incomplete breast drainage, and over supply of breastmilk). Conclusions. The program of research in this dissertation has made meaningful contributions to the literature on tongue-tie. Through the production of the first meta-analysis of prevalence data, a thorough evaluation of the available research, and the determination of maternal and infant symptoms associated with tongue-tie, we have crafted recommendations for future research and recommendations for improvements in the clinical management of infants with this oral anomaly. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The presence of a significant number of people who do not intend to be vaccinated could negatively impact efforts to control the COVID-19 pandemic. Therefore, this study sought to determine the prevalence of intention to be vaccinated against COVID-19 and associated sociodemographic and psychosocial factors in thirteen countries in Latin America and the Caribbean (LAC). A total of 5510 people from 13 LAC countries participated. Frequencies, percentages, bivariate analyses using chi-square tests, and Poisson regression analysis with robust variance were used. The countries with the highest prevalence of intention to be vaccinated were Brazil (96.94%), Cuba (89.59%), Chile (84.59%), and Mexico (78.33%). On the other hand, the countries with the lowest prevalence were El Salvador (54.01%), Paraguay (55.87%), and Uruguay (56.40%). Prevalence is also reported according to some sociodemographic and health variables. It was found that country, male sex, hours exposed to information about COVID-19, university education, living in an urban area, belief in the animal origin of the virus, perceived likelihood of contracting COVID-19, perceived severity of COVID-19, and concern about infecting others significantly predicted intention to be vaccinated in the 13 LAC countries. While most countries had a high prevalence of intention to be vaccinated, there are still subgroups that have levels of intention that may be insufficient to predict the presence of community immunity. In this sense, knowing the estimates of vaccination intention rates, as well as the associated sociodemographic and psychological factors, can be used to plan actions and interventions that will inform about the safety and benefits of vaccines, as well as strengthen trust in health authorities.

Isolated systolic hypertension (ISH) is a growing health concern in the United States (US) black population. The stratified prevalence of untreated ISH has not been fully investigated in non-Hispanic blacks. Cross-sectional data on 4625 non-Hispanic blacks aged ≥18 years were collected from the National Health and Nutrition Examination Survey 1999-2010, representing a probability sample of the US civilian noninstitutionalized black population. The 6-year prevalence of ISH and 95% confidence intervals (CIs) were estimated by conducting weighted frequency and logistic procedures. The prevalence of untreated ISH was 11.2% among non-Hispanic black adults in 1999-2010. Individuals who received lower education (high school or below) had higher prevalence of untreated ISH than those with higher education (12.8% (95% CI: 11.3-14.2%) vs. 9.0% (95% CI: 7.5-10.6%)). The prevalence of untreated ISH was higher in young men than in young women (4.3% (95% CI: 3.3-5.4%) vs. 1.8% (95% CI: 0.9-2.7%)), and higher in middle-aged adults with lower education than in middle-aged adults with higher education (14.1% (95% CI: 11.4-16.7%) vs. 7.7% (95% CI: 5.5-9.8%)). Compared with 1999-2004, the prevalence of untreated ISH in 2005-2010 decreased for old individuals (27.7% vs. 40.8%), old men (24.4% vs. 40.0%) and old individuals who received higher education (21.4% vs. 40.7%). Untreated ISH is more prevalent in old blacks, and significant reduction of the prevalence in this group suggests that public health interventions, lifestyle modifications or health awareness are in the right direction.