Schistosomiasis is a major parasitic disease caused by parasitic helminths of the genus Schistosoma which affects children in Africa, with negative impacts on general health, growth and cognitive development. Infection and morbidity are controlled by treatment with the antihelminthic drug praziquantel. Preschool children (aged ≤5 years old) have been neglected both in terms of research and control, and it is only recently that the World Health Organization (WHO) recommended praziquantel treatment and the inclusion of preschool children in control programmes. However, the burden of disease in this age group still remains poorly understood, and the performance of the currently available tools for detecting infection and morbidity is still yet to be systematically evaluated. The aim of this thesis was to compare the utility of currently available tools for diagnosing S. haematobium infection and related morbidity. The initial study cohort consisted of 438 Zimbabwean children (age range: 1-10 years) who were endemically exposed. Point-of-care schistosome-related morbidity markers applicable in the field, as well as serological biomarkers (CHI3L1, CRP, ferritin, resistin and SLPI) and inflammatory cytokines (IL-4, IL-5, IL-10, IL-13 and IFN-γ) that could predict early stages of immune-mediated pathology due to schistosomiasis were measured. Using a combination of applied statistical methods, the effect of treatment on factors associated with S. haematobium exposure, infection and morbidity in children aged 1-5 years was determined and the findings compared with those observed in children aged between 6-10 years old, who are the current targets of the schistosome control programmes. In this thesis, I able to demonstrate that preschool children carried significant infection, further reiterating the need for their inclusion in control programmes. Furthermore, this study demonstrated the importance of using additional sensitive diagnostic methods as this has implications on the required intervention strategies for the targeted populations. This study further revealed that preschool children can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. Urinalysis markers microhaematuria, proteinuria and albuminuria are recommended in this thesis as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in the field. Additionally, it was shown that the praziquantel treatment regimens aimed at controlling schistosome infection and morbidity currently designated for primary school-aged children and older populations are applicable to preschool-aged children. The involvement of serum biomarkers and immune correlates in the biological processes of inflammation suggests that these markers can be potential early predictors of schistosome-related pathology. Further research efforts are required to establish the relationship between these biomarkers and presence of schistosome-related morbidity as measured using point-of-care indicators in larger cohorts of populations chronically exposed to schistosome infections. In summary, the findings of this thesis highlight the need for the refinement of existing diagnostic methods for accurate detection of infection and morbidity in children. This will enable appropriate and timely intervention strategies, aimed at improving the current and future health of preschool aged-children to be implemented. The findings presented here will aid researchers and other stakeholders in making informed choices about intervention tools for control programmes targeting young children.

Syftet med undersökningen är att se på fysik med de minsta barnen på förskolan, hur det uppfattas och hur det arbetas med. Har man bra material för att arbeta med fysik och känner man att man kan det? Metoden som används i undersökningen är intervjuer av det kvalitativa slaget. Fyra förskollärare och två förskolechefer intervjuades utifrån 2 frågescheman som skiljde sig lite åt ifall man var förskollärare eller förskolechef.  Resultatet visade att förskollärarna ansåg att de inte hade så jättemycket kunskap inom fysikområdet och att det kan vara lite knepigt att arbeta med. Att se vilket material som passar att använda i en fysiksituation sågs inte som superlätt av två stycken medans två ansåg att det mesta gick att använda. / The purpose with this survey is to look at physics with the smallest children at the preschool, how it is perceived and how it is worked with. Do they have good materials to work with physics and do they feel that they can work with it? The method that is being used in this survey is interviews of the qualitative style. Four preschool teacher and two preschool directors was interviewed according to a schedule that was different if you were a preschool teacher or a preschool director. The result showed that the preschool teachers considered that they didn’t have that much knowledge in physics and that it was a little bit tricky to work with. To see which material that would fit best to use in a physics situation was perceived as hard by two teachers while two teachers thought that most materials could be used.

Made available in DSpace on 2016-01-26T12:51:51Z (GMT). No. of bitstreams: 1 vaniapiatto_dissert.pdf: 265912 bytes, checksum: d6bd354613ca0a9752b4acad6612d8cd (MD5) Previous issue date: 1998-12-18 / The aim of this study was to evaluate the hearing and the prevalence of hearing impairment among children, in the age groups of 3 to 6 years old, from Municipal Nursery and Pre-schools of São José do Rio Preto, S.P. At first stage, audiometries in a free field were performed for screening in 103 children, both sexes in 8 Nursery and 8 Pre-schools previously selected. At second stage, the ones who presented audiometric alterations were referred to the Phonoaudiological Service of FAMERP to perform conventional pure tone audiometer. The classification of hearing impairment in relation to grade was made according to W.H.O. approaches. A male child (0.97%) was found with light grade of conductive hearing impairment in the left ear ( LE=35 dB). There was no significant difference among the ratio of hearing impairment in both sexes (p=1.00). Nine children (8.73%) showed alterations in the hearing thresholds by air conduction in 4000, 6000 and/or 8000 Hz sharp frequencies. The ratio among alterations in these frequencies was not statistically significant in both sexes (p=1.00). There is need of further studies to evaluate the result found in children with alterations in those sharp frequencies. The found prevalence of hearing impairment in this studied population can chek the need of use of prevention programs and earlier diagnosis of hearing impairments. / Este estudo teve como objetivo realizar a avaliação da audição e o levantamento da prevalência de deficiência auditiva em amostra de crianças, na faixa etária de 3 a 6 anos, em creches e pré-escolas municipais de São José do Rio Preto, etapa, em 103 crianças de ambos os sexos, na referida faixa etária, em 8 creches e 8 pré-escolas previamente selecionadas. As crianças que apresentaram alterações audiométricas na triagem, foram encaminhadas ao ambulatório de fonoaudiologia da famerp para realização de audiometria tonal convencional, em uma segunda etapa. A classificação da deficiência auditiva, em relação ao grau, foi feita segundo os critérios da oms. Foi encontrado uma criança do sexo masculino (0,97%) com deficiência auditiva condutiva de grau leve na orelha esquerda (m oe=35 db). Não houve diferença significativa entre as proporções de deficiência auditiva em ambos os auditivas, por via aérea, nas freqüências agudas de 4000, 6000 e/ ou 8000 hz. Nota de Resumo Não foi estatisticamente significante a diferença entre as proporções de alterações nas freqüências acima descritas em ambos os sexos (p=1,00). Há necessidade de posteriores estudas para avaliação do resultado encontrado em relação ás crianças com alterações nas referidas freqüências agudas. A prevalênciaencontrada de deficiência auditiva na população do estudo, pode comprovar a necessidade da implantação de programas de prevenção e diagnóstico precoce da deficiência auditiva. Unitermos: surdez- métodos de avaliação, classificação; crianças- pré-escolares; audiometria-tonal, da fala.

Made available in DSpace on 2016-01-26T12:51:49Z (GMT). No. of bitstreams: 1 vaniapiatto_dissert.pdf: 265912 bytes, checksum: d6bd354613ca0a9752b4acad6612d8cd (MD5) Previous issue date: 1998-12-18 / The aim of this study was to evaluate the hearing and the prevalence of hearing impairment among children, in the age groups of 3 to 6 years old, from Municipal Nursery and Pre-schools of São José do Rio Preto, S.P. At first stage, audiometries in a free field were performed for screening in 103 children, both sexes in 8 Nursery and 8 Pre-schools previously selected. At second stage, the ones who presented audiometric alterations were referred to the Phonoaudiological Service of FAMERP to perform conventional pure tone audiometer. The classification of hearing impairment in relation to grade was made according to W.H.O. approaches. A male child (0.97%) was found with light grade of conductive hearing impairment in the left ear ( LE=35 dB). There was no significant difference among the ratio of hearing impairment in both sexes (p=1.00). Nine children (8.73%) showed alterations in the hearing thresholds by air conduction in 4000, 6000 and/or 8000 Hz sharp frequencies. The ratio among alterations in these frequencies was not statistically significant in both sexes (p=1.00). There is need of further studies to evaluate the result found in children with alterations in those sharp frequencies. The found prevalence of hearing impairment in this studied population can chek the need of use of prevention programs and earlier diagnosis of hearing impairments. / Este estudo teve como objetivo realizar a avaliação da audição e o levantamento da prevalência de deficiência auditiva em amostra de crianças, na faixa etária de 3 a 6 anos, em creches e pré-escolas municipais de São José do Rio Preto, etapa, em 103 crianças de ambos os sexos, na referida faixa etária, em 8 creches e 8 pré-escolas previamente selecionadas. As crianças que apresentaram alterações audiométricas na triagem, foram encaminhadas ao ambulatório de fonoaudiologia da famerp para realização de audiometria tonal convencional, em uma segunda etapa. A classificação da deficiência auditiva, em relação ao grau, foi feita segundo os critérios da oms. Foi encontrado uma criança do sexo masculino (0,97%) com deficiência auditiva condutiva de grau leve na orelha esquerda (m oe=35 db). Não houve diferença significativa entre as proporções de deficiência auditiva em ambos os auditivas, por via aérea, nas freqüências agudas de 4000, 6000 e/ ou 8000 hz. Nota de Resumo Não foi estatisticamente significante a diferença entre as proporções de alterações nas freqüências acima descritas em ambos os sexos (p=1,00). Há necessidade de posteriores estudas para avaliação do resultado encontrado em relação ás crianças com alterações nas referidas freqüências agudas. A prevalênciaencontrada de deficiência auditiva na população do estudo, pode comprovar a necessidade da implantação de programas de prevenção e diagnóstico precoce da deficiência auditiva. Unitermos: surdez- métodos de avaliação, classificação; crianças- pré-escolares; audiometria-tonal, da fala.