Thesis (doctoral)--Universität Hamburg, 1978.

Cartas al Editor

Diarrhea diseases remain one of the greatest health problems in many parts of the world. In some cases, the disease is mild and self-limiting; however, the symptoms may be very severe in the elderly and young children (Smith and Cheasty, 1998), as well as in immune compromised patients such as HIV/AIDS patients. The disease is one of the hallmarks of HIV/AIDS in developing countries and is also a cardinal clinical manifestation of water borne infections (Obi et al., 2007). According to a World Health Organization report (WHO, 2004), diarrhea was rated second, after respiratory infections out of the eight deadliest diseases worldwide and was responsible for 1.8 million deaths per year. This infectious disease which can cause dehydration is primarily a symptom of gastrointestinal infection, but chemical irritation of the gut or non-infectious bowel disease can also result in diarrhoe. Studies have shown that the predominant causative agents of acute and persistent diarrhoe are Gram-negative rods such as Escherichia coli, Vibrio cholerae, Aeromonas, Campylobacter, Salmonella species, Shigella species, Plesiomonas shigelloides and Yersinia enterocolitica (Obi et al., 1995, 1998, 2003; Lainson and Silva, 1999; Coker et al., 2002; Oyofo et al., 2002). Aside from bacterial agents of diarrhoea, other causative pathogens include protozoa such as Giardia lamblia and Cryptosporidium parvum; viruses such as norwalk virus and rota virus. Although fungal agents such as Candida have been shown to be prevalent in children with diarrhoe (Enweani et al. 1994), a more recent study (Forbes et al., 2001), associated higher Candida counts with recent antibiotic use. Faecal concentrations of Candida were higher in patients with diarrhoe, but the study confirmed no association between faecal candida or other yeasts and diarrhoe. Norwalk viruses, calci-like viruses and rota viruses are the major viral agents of diarrhoe. According to Parashar et al., (2006), rota virus is the leading cause of diarrhoe hospitalisation among children worldwide, causing 440,000 annual deaths in children under 5 years of age.

Background: Medical complications in pregnancy can be a significant source of stress for pregnant women and their partners. Despite this, and evidence that anxiety is very common among perinatal women, little is known about the relationship between perinatal anxiety and medical complications in pregnancy. Purpose: The purpose of this research was to conduct a systematic review of the extant literature pertaining to medical complications of pregnancy and anxiety. Specific objectives were to (a) investigate differences in anxiety experience (symptoms and/or disorder) between women experiencing a medically complicated pregnancy and women experiencing a medically uncomplicated pregnancy, and (b) investigate the nature and scope of perinatal anxiety among women whose pregnancy is fraught with medical problems. Methods: The review was guided by the PRISMA reporting process. The electronic databases MEDLINE and PsycINFO were searched to identify studies that met the study inclusion criteria. Data were extracted and presented in a narrative form including tables and figures. An adapted form of the Newcastle-Ottawa Quality Assessment Scale for case-control and prevalence studies was used to perform a quality assessment review. Results: Twelve studies met the inclusion criteria. Findings indicated that anxiety symptom severity was greater among women experiencing a medically complicated pregnancy compared to those experiencing an uncomplicated pregnancy. The prevalence studies in which symptoms of anxiety were assessed at various times during pregnancy indicate that, among women experiencing a medically high-risk pregnancy, reported symptoms were most severe at initial assessment. Though an exact estimate cannot be provided due to methodological differences, these studies reported the prevalence rates of anxiety symptoms to range from 7.8% to 46.9%. The included studies that used DSM-IV criteria concluded that the risk may be most significant for two disorders: obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD). Based on the overall quality of the available studies, the findings cannot be called as bias-free Conclusions: Women experiencing a medically complicated pregnancy appear to experience significantly more symptoms of anxiety compared to women experiencing a healthy pregnancy. / Graduate

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Magister Scientiae (Medical Bioscience) - MSc(MBS) / Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria called red complex (Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes which can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother’s immune system to infection by these periodontopathogens, brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the prevalence of red complex, using BANA and PCR in subginginval plaque samples from pregnant women. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending a Mitchells Plain ante-natal clinic. Plaque samples were analyzed by the enzymatic BANA-test for detection of the presence of red complex and DNA was extracted and analyzed using 16 rDNA-Polymerase Chain Reaction (PCR). Seventy-nine percent of pregnant women showed gingival index scores of ≥ 1 of which 74.24% harboured by at least one of the members of the red complex. P.gingivalis was the most prevalent of the three members of the red complex. Findings of this study confirmed a need for dental preventive measures in pregnant women and microbial monitoring of suspected periodontopathogenes. This could be achieved by joint cooperation between Maternity Obstetric Units (MOU), Dentistry and oral microbiology departments. The results of this study revealed that although PCR is more sensitive than BANA in detecting members of the red complex, BANA showed a better association with the indices used to diagnose periodontal disease. / South Africa

Severe maternal morbidity generally refers to the most severe complications of pregnancy and includes: hemorrhage, embolism, acute renal failure, stroke, acute myocardial infarction, and other complications. These complications affect more than 50,000 women in the United States every year, with rates significantly increasing from 1998 to 2011. In an effort to reduce these increasing complication rates, clinicians and researchers have emphasized the need to identify potential modifiable risk factors for severe maternal morbidity, and the need to study the relationships between these risk factors and severe maternal morbidity. The overall goal of this study is to improve the understanding of the increasing rates of severe maternal morbidity. The objective of the first study is to examine the association between prepregnancy BMI and severe maternal morbidity in women residing in Florida who had a live birth during 2007-2014. Additionally, the specific association between prepregnancy BMI and the most common individual conditions that comprise the composite measure of severe maternal morbidity will also be examined. We conducted a population-based retrospective cohort study using Florida’s linked birth certificate and maternal hospital discharge data for the years 2007-2014. The risk of severe maternal morbidity associated with BMI was then estimated by odds ratios (OR) and 95% confidence intervals (CI) derived using generalized estimating equations (GEE) for logistic regression. This final model was rerun separately for the most common conditions that comprise severe maternal morbidity as the outcome measure to assess differences by type of condition. Unadjusted rates of severe maternal morbidity increased with increasing BMI; however, after risk adjustment overweight and obese women had slightly protective odds of severe maternal morbidity when compared with normal weight women. The association between prepregnancy BMI and severe maternal morbidity differs by types of severe maternal morbidity. A protective dose-response relationship was seen for blood transfusion and disseminated intravascular coagulation, with the odds of morbidity decreasing with increasing BMI. The odds of heart failure, adult respiratory distress syndrome, and ventilation all increased with increasing BMI. This study shows that severe maternal morbidity is a complex measure and not just a single condition. In future studies, it will be imperative to analyze severe maternal morbidity as a composite measure and as individual conditions to identify modifiable risk factors to focus on for interventions. The objective of the second study is to identify potential determinants of the increase in the rate of severe maternal morbidity among women residing in Florida who had a live birth during 2005-2014. We examined severe maternal morbidity rates and related risk factors in live births to Florida women between 2005 and 2014, using Florida’s linked birth certificate and hospital discharge data. We initially conducted a Kitagawa analysis to evaluate the components of the increased rate of severe maternal morbidity between 2005 and 2014. Additionally, we performed a multivariable regression analysis to estimate the contribution of the multiple factors to differences in the rate of severe maternal morbidity in 2005 and 2014. The rate of severe maternal morbidity in 2014 was 19.3 per 1,000 live births, which was 1.65 times higher than the rate in 2005. Nearly all of the excess severe maternal morbidity and blood transfusions in 2014 can be explained by differences in the rate of severe maternal morbidity and blood transfusion between the two time periods. In total, sociodemographic factors, medical factors, and individual and hospital health service factors explained 9.1% of the overall severe maternal morbidity increase in 2014 compared with 2005, and only explained 2.5% of the increase in blood transfusions during this time period. Our study findings indicate that the increase in the rate of severe maternal morbidity is comprised almost entirely by an increase in the rate of blood transfusions. Further research will need to be conducted to explain the increase in the rate of severe maternal morbidity and blood transfusions. Consistent with national trends, the rates of severe maternal morbidity have been increasing in Florida. This increase is driven almost entirely by blood transfusions and cannot be explained by traditional factors that are readily available in current datasets. In addition to the differences between the trends of blood transfusions and the 20 severe maternal morbidity conditions, there are also differences in risk factors associated with these different conditions. Prepregnancy overweight and obesity is associated with a protective effect with blood transfusions and disseminated intravascular coagulation that is not seen in the other conditions. Therefore, initiatives to decrease the rates of severe maternal morbidity will need to take these differences into account.

No description available.

M.A. (Psychology) / The Post Traumatic Amnesic Syndrome, which follows a mild closed head injury, seems to be a common occurrence in the field of neuropsychology. The syndrome is primarily characterised by a transient memory loss of daily events, normally commencing within days after the injury. The symptoms include absent-mindedness, an inability to remember names, dates, numbers and faces, commands and orders given at work. Due to the relatively uncomplicated nature of a mild closed head injury, the syndrome is often overlooked and underestimated in terms of its intensity and psychological damage. Patients are sent home after a brief observation period and medical staff are of the opinion that the patients will recover successfully, without experiencing much psychological or cognitive strain. It is usually thought that the syndrome does not last for more than three to four months. The aim of the research was to determine the nature of the experience of not being able to remember daily events, as part of the post traumatic amnesic syndrome. The influence of the syndrome on the patients' support persons was also investigated

The thesis charts the rate of perioperative complications after removal of the uterus from non-malignant causes in two different medical facilities and compares them with the indicators in the DRG classification system to determine whether this is suitable for tool for the quality assesment of health care in health facilities.