Indiana University-Purdue University Indianapolis (IUPUI) / Bone marrow transplant (BMT) is being used ever more widely for advanced and refractory malignancies. The family unit and individual members are profoundly affected by this treatment process. Few studies have examined the effect of parental BMT on the family, and there are no known studies which have investigated the impact of parental BMT on children. A descriptive design with longitudinal data from 61 children, ages 10-18, examined children’s adaptation, characterized as emotional and behavioral response, during the acute phase of parental BMT. The study included 3 time points: pre-transplant, during parental hospitalization, and one month after transplantation. The Response to Stress Questionnaire, and subscales from the Child Health Questionnaire and Family Environment Scale were used to assess child, parent, and family variables associated with child adaptation. Child emotional and behavioral response significantly improved over the course of the parent’s transplant, and significant changes in children’s use of coping strategies at each time point were found. The model accounted for 27% to 46% of the explained variance in child behavioral response, and accounted for 41% of the explained variance in emotional response prior to the parent’s BMT and one month after BMT. The model did not explain the variance of child emotional response, however, during the parent’s hospitalization. Family structural change, family conflict, and disengagement coping were found to be the predominant variables significantly associated with more negative child behavioral response across the transplant trajectory. Female child gender and increased use of disengagement coping before the parent’s BMT, autologous BMT during the parent’s hospitalization, and increased family structural change when the parent returned home one month later were significantly associated with more negative emotional response in children. Additional cross-sectional and longitudinal studies, using mixed methods, and include both parent and child data, are needed to substantiate the validity of findings. The data also suggests that significant variables in this model could be further studied for their association with one another and for refining a more accurate and inclusive model that may better explain children’s adaptation.

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Main aim: To supply recommendations to implement a Hazard Analysis of Critical Control Points (HACCP) system in a hospital food service unit serving low bacterial diets in order to prevent or decrease the infection rates in Hematopoietic Stem Cell Transplant (HSCT) patients. Objectives: Firstly, to investigate the current food safety and hygiene status in a hospital food service unit, serving low bacterial diets, by means of a questionnaire and bacterial swabs taken from the food service unit. Secondly, to utilize the gathered information in a structured action plan to implement HACCP standards successfully in the appointed food service unit. The implementation of HACCP will not be done by the author. Design: The primary research was done in a food service unit of a 350 bed private hospital. One unsuspected audit with a pre-designed audit form was done. The audit consisted out of ten categories. A percentage was allocated to each category. Four swabs, as well as four food samples, were taken during the audit. The swabs and samples were tested to assess the microbiological safety of the foods prepared in the appointed hospital food service unit. The results of the audit, swabs and food samples were used to evaluate the current Food and Safety System of the hospital food service unit according to internationally approved HACCP standards. Setting: The study was conducted in the metropolitan area of Gauteng, South Africa. Results: None of the ten areas audited was of an acceptable standard and an average of 37% was scored. Category 5, the service and distribution area, scored the highest (69%) and category 10, the quality procedures and records division, scored the lowest (6%). According to United States Food and Drug Administration Baseline Report five forbidden policies could lead to increased risk of food borne illnesses. All five forbidden policies were detected in the food service unit during the audit. The microbiological tests showed relatively high microbial counts. Conclusion: The results of the study confirmed that instead of focusing mainly on the selection of food items allowed, and the cooking methods used in HSCT diets, the type of food service, together with the food and safety protocol that the food service follows, could play an important role in providing food that is safe for HSCT patient use. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2007.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Além de modular o metabolismo energético, o tecido adiposo constitui um regulador endócrino, produzindo fatores como a adiponectina (APN), adipocina pouco expressa na obesidade, com propriedades imunoreguladoras. Neste trabalho investigamos o papel da obesidade e APN em modelos murinho de transplante de pele e doença do enxerto-versus-hospedeiro (GvHD), na obesidade induzida por dieta hiperlipídica (Ob) e animais knockout (KO) para APN. Em suma, receptores Ob e APN KO apresentaram rejeição acelerada de enxerto de pele, associado inflamação do tipo Th1 e Th17. A obesidade também levou a pior GvHD, associado a maior inflamação no fígado, pulmão, intestino junto a dano hepático e intestinal, enquanto a manutenção de dieta HF após o transplante preveniu parciamente este dano. Estudos in vitro corroboraram estes resultados, mostrando maior ativação dendrítica e linfocitária em meio mimetizando a obesidade. Desta forma, este estudo sugere que a obesidade e redução de APN levam a maior rejeição de transplantes sugerindo adiante um papel importante à dieta neste processo. / In addition to modulating energy metabolism, the adipose tissue is an endocrine regulator, producing factors such as adiponectin (APN), an adipokine little in obesity, with immunoregulatory properties. In this work we investigated the role of obesity and APN in skin transplant and graft-versus-host disease (GvHD) in high-fat diet induced obesity (Ob) and knockout (KO) mice for APN. In summary, Ob and APN KO receptors showed accelerated skin graft rejection, associated with Th1 and Th17 type inflammation. Obesity also led to worse GvHD, associated with increased inflammation in liver, lung, intestines along with liver and gut damage, while maintenance of the HF diet after transplantation partially prevented this damage. In vitro studies corroborated these results, showing greater dendritic and lymphocytic activation in conditions mimicking obesity. Thus, this study suggests that obesity and reduced APN lead to greater rejection of transplants further suggesting an important role of diet in this process.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Main aim: To supply recommendations to implement a Hazard Analysis of Critical Control Points (HACCP) system in a hospital food service unit serving low bacterial diets in order to prevent or decrease the infection rates in Hematopoietic Stem Cell Transplant (HSCT) patients. Objectives: Firstly, to investigate the current food safety and hygiene status in a hospital food service unit, serving low bacterial diets, by means of a questionnaire and bacterial swabs taken from the food service unit. Secondly, to utilize the gathered information in a structured action plan to implement HACCP standards successfully in the appointed food service unit. The implementation of HACCP will not be done by the author. Design: The primary research was done in a food service unit of a 350 bed private hospital. One unsuspected audit with a pre-designed audit form was done. The audit consisted out of ten categories. A percentage was allocated to each category. Four swabs, as well as four food samples, were taken during the audit. The swabs and samples were tested to assess the microbiological safety of the foods prepared in the appointed hospital food service unit. The results of the audit, swabs and food samples were used to evaluate the current Food and Safety System of the hospital food service unit according to internationally approved HACCP standards. Setting: The study was conducted in the metropolitan area of Gauteng, South Africa. Results: None of the ten areas audited was of an acceptable standard and an average of 37% was scored. Category 5, the service and distribution area, scored the highest (69%) and category 10, the quality procedures and records division, scored the lowest (6%). According to United States Food and Drug Administration Baseline Report five forbidden policies could lead to increased risk of food borne illnesses. All five forbidden policies were detected in the food service unit during the audit. The microbiological tests showed relatively high microbial counts. Conclusion: The results of the study confirmed that instead of focusing mainly on the selection of food items allowed, and the cooking methods used in HSCT diets, the type of food service, together with the food and safety protocol that the food service follows, could play an important role in providing food that is safe for HSCT patient use. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2007.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-29T11:10:52Z No. of bitstreams: 2 Dissertação - Hugo César Pereira Santos - 2015.pdf: 3535564 bytes, checksum: 4fc7d88b1da6008bc42c01f46e4f8d7a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-29T11:20:29Z (GMT) No. of bitstreams: 2 Dissertação - Hugo César Pereira Santos - 2015.pdf: 3535564 bytes, checksum: 4fc7d88b1da6008bc42c01f46e4f8d7a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-29T11:20:29Z (GMT). No. of bitstreams: 2 Dissertação - Hugo César Pereira Santos - 2015.pdf: 3535564 bytes, checksum: 4fc7d88b1da6008bc42c01f46e4f8d7a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-19 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The human adenoviruses (HAdV) infect people of all ages worldwide, causing a wide range of clinical syndromes, depending on the viral type. In immunocompromised hosts, as transplanted patients, HAdV infection can result in a bad prognosis. Some aspects of viral pathogenesis, such as the association between viremia and/or viral load with disseminated disease and the optimal moment to start the therapy, are still not well established in adult patients that have undergone allogeneic hematopoietic stem cell transplantation (ASCT). Therefore, the main objective of this study was to monitor ASCT recipients for HAdV occurrence, and also correlate viral positivity, viral load and molecular variant with clinical symptoms and patients’ prognosis. For this, stool and serum from 21 patients were monitored in a 2 years period (from October/2012 to October/2014). Serum and fecal samples were screened by Nested-PCR, using primers targeting a partial region of the hexon gene (143bp). Fecal samples were further screened by a commercial enzyme immunoassay (EIA). In total, 57% of the patients had at least one positive sample (serum or stool) for HAdV. Patients presented high viral load (varying from 7,7x103 to 2x108 copies/mL), with a higher viral load in stool when compared to serum. Positive samples were submitted to genomic sequencing, revealing the occurrence of HAdV from C, D and F species. The main clinical symptom presented by infected patients was diarrhea, and graft-versus-host disease was the main intercurrence; however it was not possible to directly associate viral positivity to cause of death. We hope to contribute for a better understanding of the HAdV infection pattern in patients submitted to ASCT. Our data highlights the importance of the inclusion of HAdV testing in the routine laboratory exams of this group of patients. / Os adenovírus humanos (HAdV) podem infectar pessoas de todas as idades, causando uma ampla gama de quadros clínicos. Em pacientes imunocomprometidos, como os indivíduos que receberam transplante, a infecção por esses vírus pode resultar em pior prognóstico para o paciente. Determinados aspectos da patogenia viral, como a associação entre viremia e/ou carga viral com a doença disseminada, bem como o melhor momento para o início da terapia, não estão ainda bem esclarecidos em pacientes que foram submetidos ao transplante de células progenitoras hematopoiéticas (TACPH), principalmente em indivíduos adultos. Dessa forma, o principal objetivo deste estudo foi realizar o monitoramento da infecção por HAdV e a caracterização molecular das variantes virais em pacientes submetidos ao TACPH, bem como determinar a carga viral e correlacionar a infecção com o quadro clínico e prognóstico dos pacientes. Foram analisadas amostras de soro e fezes de 21 pacientes submetidos ao TACPH no período de dois anos (de outubro/2012 a outubro/2014). As amostras de fezes foram triadas por ensaio imunoenzimático e por Nested-PCR, enquanto as amostras de soro foram triadas somente por Nested-PCR de uma região parcial do gene hexon (produto esperado de 143 pb). Foram detectadas amostras positivas de soro e/ou fezes de 57% dos pacientes. De forma geral, os pacientes do presente estudo apresentaram elevadas cargas virais (variando de 7,7x103 à 2x108 CG/mL), que foram mais elevadas nas fezes. As amostras positivas foram submetidas ao sequenciamento genômico e resultados revelaram a ocorrência de adenovírus das espécies C, D e F. O principal quadro clínico apresentado pelos pacientes foi a diarreia e a principal intercorrência observada, a doença do enxerto contra o hospedeiro (DECH). Dez pacientes foram a óbito durante o período de estudo, entretanto, não foi possível associar a infecção por HAdV diretamente à causa mortis. Esperamos que os dados obtidos possam auxiliar no melhor entendimento do padrão da infecção dos HAdVs em pacientes submetidos ao TACPH, de forma a contribuir para que a pesquisa de adenovírus seja incluída na rotina de exames desses pacientes.

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