Background: Staphylococcus aureus (SA) infections are common and important within the hospital environment. The case fatality rate of invasive Staphylococcus aureus (SA) infections is between 20-40%. Whether the infection is due to methicillin resistant SA (MRSA) or methicillin sensitive SA (MSSA) may determine outcomes. Literature to date is inconclusive regarding whether antimicrobial resistance in SA affects patient outcomes. Host factors, infection-host interactions, and treatment-related factors may also influence case fatality. Objectives: The purpose of this study was to determine if patients with MRSA invasive infections were more likely to die than those with MSSA invasive infections, and what factors were associated with death. Methods: A retrospective matched case control study was designed, comparing cases of MRSA with controls of MSSA invasive disease from hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP). Two analyses were run: the first, to identify the variables associated with MRSA vs. MSSA infections, and the second, to determine the variables associated with death in invasive Staphylococcal aureus (S. aureus) infections. Backward logistic regression analysis was used for the MRSA vs. MSSA analysis and a hierarchical logistic regression model for assessment of risk factors for death. Results: In the logistic regression MRSA model the variables: recent prior use of antibiotics, Charlson Comorbidity Index score > 2 and not having received appropriate empiric antibiotics were associated with MRSA vs. MSSA infections. The hierarchical model identified older age, higher CCI scores, immunosuppression, bloodstream infection, septic shock, neurological dysfunction and not receiving appropriate empiric antibiotic as associated with death. MRSA infection was not more likely to be associated with increased mortality than MSSA infection. Those with a resistant infection (MRSA) however, were less likely to receive appropriate empiric antibiotic treatment. Conclusions: Appropriate empiric antibiotics are the most important and only modifiable risk factor identified. Elderly patients who are on immunosuppressive drugs and have chronic comorbid conditions need to be monitored and screened more often since they are more at risk for death than others.

No description available.

Thesis (Ph. D.)--University of Hawaii at Manoa, 1995. / Includes bibliographical references (leaves 180-199). / Microfiche. / xii, 199 leaves, bound ill. 29 cm

To obtain more complete mortality data following HIV and AIDS diagnosis in Australia, HIV/AIDS diagnoses between 1980 and 2003 were linked to the National Death Index. Based on 6900 known deaths, and 1455 known non-deaths, sensitivity and specificity of the linkage was estimated to be 82% and 92% respectively. Mortality rates were compared by calendar period, pre-ART (<1990), pre- and early-HAART (1990-1996) and late-HAART (1997-2003). Mortality following AIDS decreased from 590.2/1000 person years pre-ART to 77.4 during the late-HAART period. Mortality following HIV diagnosis prior to AIDS increased from 9.7 to 20.2/1000 person years. The total number living with diagnosed HIV infection in Australia was estimated to have increased from 7873 at the end of 1989 to 12828 in 2003. Risk factors for survival following HIV and AIDS diagnosis were assessed using Cox regression. Age >40 years and certain HIV exposure results were associated with poorer survival following HIV. Predictors of poorer survival following AIDS were age >40 years, females exposed to HIV through receipt of blood, CD4 count <20 and certain AIDS illnesses. Parametric models of survival following HIV and AIDS diagnosis were assessed using likelihood based criteria. Goodness of fit was assessed by comparing observed with model predicted numbers of deaths. Weibull models were found to fit best to both survival following HIV and AIDS. Parametric survival models were used to project deaths after HIV and AIDS across three scenarios of HAART usage. Deaths following HIV were projected to remain low, but to increase from 223 in 2005 to 288, 292 and 282 in 2010 if the HAART usage remains stable at 2005 levels, increases to 70% of all people with diagnosed HIV by 2010 and decreases to 39% of all people with diagnosed HIV respectively. Deaths after AIDS diagnosis were projected to increase unless if HAART usage increases to 100% of AIDS diagnoses by 2010.

Undernutrition in prevalent in Aboriginal communities, in utero, infancy and childhood. It influences childhood morbidity and mortality and growth patterns. Undernutrition and poor socio-economic status also contribute to endemic and epidemic infectious disease, including scabies and streptococcal infection. It has been suggested that early undernutrition, and streptococcal and scabies infection are risk factors for renal disease, which is at epidemic levels and increasing. This thesis examines the prevalence of undernutrition in newborns and infants in an Aboriginal community over time, and its impact on childhood growth and child and adult renal markers. The association between skin lesions, streptococcal serology, post-streptococcal glomerulonephritis (PSGN) and renal markers as evaluated through a community wide screening program in 1992-1995 is also examined. Birthweights have increased since the 1960s, but they are still much lower than the non-Aboriginal values. Weights in infancy have decreased since the 1960s. At screening in childhood stunting was common, reflecting the presence of long-term poor nutrition in infancy. In both adults and children, birth weight and infant weights were negatively associated with albuminuria measured by the albumin to creatine ratio (ACR).

The Moehau Kiwi Sanctuary is one of five sanctuaries established in 2000 and managed by the Department of Conservation. The objective of the sanctuaries is to protect the most endangered kiwi taxa, and increase kiwi survivorship. Operation Nest Egg (ONE) is a programme utilised by the Moehau Kiwi Sanctuary for artificially incubating abandoned Kiwi eggs and captive rearing chicks until they begin to show a gain in weight. ONE chicks were then released back onto Moehau or adjacent protected areas. Kiwi populations are declining on the mainland at an average of about 3% per year in areas where predators of kiwi are not controlled. The main cause for this decline is chick mortality due to predation by stoats (Mustela erminea). During natal dispersal kiwi are known to disperse significant distances of between 5–20 km, and this has influenced the size of management areas needed for the protection of kiwi (10,000 hectares). The type of forest-cover is an important element in determining where management areas are located, as kiwi has preferences for certain forest types over others. This study conducted at Moehau, Coromandel, on the North Island Brown Kiwi advances our knowledge of kiwi by examining differences in rates and distances of dispersal among chicks, sub-adults, non-territorial and territorial adults, as well as between genders. This study investigates kiwi selective use of roost site types, ground-cover types, forest types and physiographical features. Addressed in this study are differences in dispersal, habitat selection and mortality among age-classes and between genders over the months of the year, and across elevations. Comparisons between ONE and wild-reared kiwi dispersal and mortality are included. Data were collected between 2001 and 2008 from observations of kiwi located during daytime hours. The data recorded included the grid reference, elevation, ground-cover type, forest type, physiography, and the type of roost site. The sample size for this study was significantly larger than for any previous studies thus enabling a greater confidence in estimated dispersal rates and dispersal distances, habitat selection and factors relating to mortality. All wild-reared kiwi displayed dispersal and were not philopatric to their natal area. Dispersal distances were found to be further than previously estimated, with the net distance of natal dispersal differing among age-classes, from an average of 834m (SE +/- 131) for kiwi chicks to 7,553m (SE = +/- 1167) for non-territorial adults. Female sub-adult kiwi dispersed further (7,215m) than male sub-adult kiwi (4,226m) (p = 0.04). The time taken to travel one km during natal dispersal ranged from an average of 131days/km (SE = +/- 9) for chicks to 89 days/km (SE = +/- 13) for sub-adults. Habitat selection has been observed in other studies on kiwi but not specifically for Coromandel North Island Brown Kiwi, and selection for ground-cover types by kiwi when roosting on the surface has never been previously studied. Roost site selection of kiwi differed among age-classes (p <0.001), between gender (p <0.001), and across elevations (p <0.001). Female kiwi were found more often in surface roosts (64%) than hole roosts (32%), and male kiwi were found at similar frequencies in holes (46%) and on the surface (47%). Sub-adults used holes to a greater extent as elevation increased, and selected for sub-alpine forest over broadleaf forest (p <0.001). This study is the first to recognise that selection of ground-cover types by kiwi differs among age-classes (p <0.001). Kiwi chicks were more often found on the surface under dead fern fronds and debris (39%) than other ground-cover types. The mortality rate was highest in chicks (33%), with predation responsible for 60% of these deaths; conservation management techniques were responsible for a further 20% of deaths; the remaining 20% of deaths were due to natural or unknown causes. Summer (December-February) was the season in which 81% of kiwi chick deaths occurred. The high proportion of deaths from monitoring techniques and the use of radio-transmitters (22%) indicates improvements need to be made to current management practices. ONE chicks were found to disperse shorter distances and had a greater mortality rate than wild-reared chicks. Therefore, recommendations are made for changes to ONE management practices. Further recommendations are made for the enhancement of kiwi habitat that could reduce kiwi mortality, and for increasing the habitat available to kiwi, thereby potentially increasing population sizes and/or densities.

This thesis presents a series of longitudinal studies of HIV-outcomes in Australia and the Asia-Pacific region since highly active antiretroviral therapy (HAART) became available. The primary source of data is the Australian HIV Observational Database (AHOD). AHOD is an observational cohort of more than 2000 patients with HIV recruited via hospitals, sexual health centres and general medical practices specialising in HIV medicine. Chapter five of this thesis addresses whether there were any differences in antiretroviral therapy use and virological response that might explain the different trends in new HIV diagnosis rates between state jurisdictions in Australia in recent years. Analysis of data from cohort studies of primary and chronic HIV infection, gay community surveys and national prescription data suggest that, for the most part, antiretroviral therapy use and virological response were similar in each jurisdiction during the first decade of HAART. Chapter six describes the prevalence of, and risk factors for, an incomplete immune response despite sustained viral suppression in patients on HAART in AHOD. The clinical relevance of this phenomenon is also explored in terms of AIDS and death during follow-up. Of those with sustained viral suppression, one third of patients did not achieve immune recovery greater than 350 cells/??l in the 12-24 months after starting their first or second HAART regimen, and this was associated with a lower CD4 cell count at baseline. Chapter seven describes cause-specific mortality in patients with HIV in the Asia-Pacific region. Immunodeficiency was associated with non-AIDS and AIDS mortality, and the risk of non-AIDS mortality increased with age. Less conclusive was the relationship between country-income level and risk of death from AIDS or non-AIDS causes because of the relatively high proportion of unknown causes of death in low-income settings. Chapter eight presents hospitalisation rates, risk factors and associated diagnoses in patients with HIV in Australia. Older, sicker individuals, as indicated by markers of advanced immunodeficiency or frequency of hospitalisation, were at greater risk of hospitalisation and death in the AHOD cohort. Despite effective antiretroviral therapy, patients with HIV are currently hospitalised at higher rates than people of similar age in the general population.

[Truncated abstract. Please see pdf format for complete text.] Background : The excess burden of mortality born by young Indigenous Australians and the disparity in infant and childhood mortality between Indigenous and non-Indigenous Australians have been well documented. The accuracy and completeness of national data describing the health of Indigenous Australians is inconsistent. The Western Australia (WA) Maternal and Child Health Research Database (MCHRDB), is a linked total population database that includes perinatal maternal and infant data, and infant and childhood morbidity and mortality data. Overall, these data are more than 99% complete, with a similar high level of completeness and validity for Indigenous Western Australians. Aim : The aim of this thesis is to measure Indigenous infant (0 to <1 year) and childhood (>=1 to <19 years) mortality and the disparity between Indigenous and non-Indigenous infants and children in WA for birth cohorts from 1980 to 1997 inclusive. To achieve this aim a number of secondary aims were identified, including the measurement of certain maternal and infant variables, and the age-specific, all-cause and cause-specific mortality for WA infants and children. Method : The study comprises a longitudinal birth cohort study, the primary data source being the MCHRDB. Data included on the MCHRDB are complete for all births in WA from 1980 onwards, with new birth cohorts linked on an annual basis. Maternal and infant variables and the geographical location of the residence and the time of birth and death were included in the descriptive and multivariate analyses. Each infant and childhood death was coded using a three-digit code developed primarily for research purposes. The descriptive analyses of mortality referred to the probability of dying in infancy and in childhood as the cumulative mortality risk (CMR), for various diseases and various population subgroups. Age-specific childhood rates were also calculated. The results of multivariate analyses included the fitting of Cox and Poisson regression models, and estimates of effect were represented as hazard ratios (Cox regression) and relative rates (Poisson regression). Results : Between 1980 and 1997, births to Indigenous mothers accounted for 6% of total WA births. Approximately 46% of Indigenous births were to mothers living in a remote location compared to 9% of non-Indigenous births. Indigenous mothers gave birth at an earlier age (30% of births were to teenage mothers compared to 6% of non-Indigenous births), and were more likely to be single than non-Indigenous mothers (40% Indigenous, 9% non-Indigenous). Indigenous infants had more siblings, were born at an earlier gestation and with a lower birth weight and percentage of expected birth weight. The CMR for Indigenous infants was 22 per 1000 live births compared with 6.7 for non- Indigenous infants, a relative risk (RR) of 3.3 (95%CI 3.0, 3.6). While there was a decrease in the CMR over the birth year groups for both populations, the disparity between the rate of Indigenous and non-Indigenous infant mortality increased. The Indigenous postneonatal (>28 to 365 days) mortality rate (11.7 per 1,000 neonatal survivors) was higher than the neonatal (0 to 28 days) mortality rate (10.3 per 1,000 live births). This profile differed from that for non-Indigenous infants, where the neonatal mortality rate (4.3 per 1,000 live births) was nearly twice that of the postneonatal mortality rate (2.4 per 1,000 neonatal survivors). The main causes of infant mortality among Indigenous infants were potentially preventable. These causes were infection followed by Sudden Infant Death Syndrome (SIDS), which differed from the main causes for non-Indigenous infants, sequelae of prematurity and birth defects. The CMR attributable to SIDS increased over the years amongst Indigenous infants and decreased significantly over the years in the non-Indigenous population. Furthermore, the disparity in mortality between the two populations increased and, in 1995 to 1997, was over seven times higher amongst Indigenous infants. The CMR was highest amongst infants living in remote locations for all causes of death except for Indigenous deaths attributable to SIDS, where the risk of death was highest amongst infants living in metropolitan locations. With the exception of infection, there was no difference in cause-specific mortality amongst Indigenous infants according to geographical location. Indigenous infants living in a remote location were at a significantly increased risk of death due to infection compared with their peers living in a rural or metropolitan location. The risk of death for Indigenous children was more than three times higher than for non-Indigenous children. This risk was significantly increased when most of the perinatal maternal and infant variables were considered.

Thesis (M.S.)--Georgia State University, 2007. / Title from file title page. Yichuan Zhao, committee chair; Yu-Sheng Hsu , Xu Zhang, Yuanhui Xiao , committee members. Electronic text (54 p.) : digital, PDF file. Description based on contents viewed Feb. 25, 2008. Includes bibliographical references (p. 30-32).

Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.