Thesis (Ph.D.)--Murdoch University, 2004. / Thesis submitted to the Division of Health Sciences. Includes bibliographical references (leaves 145-167).

Thesis (M.P.H.M. (Primary Health Care Management))-- Mahidol University, 2005.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2007. / LICL has E-Thesis 0023 ; please contact computer services.

Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Experimental Medicine, Department of Medicine, Faculty of Medicine & Dentistry. Title from pdf file main screen (viewed on November 21, 2009). Includes bibliographical references.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Annually more than 3.5 million children worldwide, less than five years of age die of diarrhoea and acute lower respiratory-tract infections. Over the last two decades, the care of pre-school children outside of their homes has become more common in most parts of the world and has contributed to an increased risk of respiratory-tract and gastrointestinal infections in children. Children attending day-care centres are at an increased risk for diarrhoea and respiratory-tract infections and hands are the primary vehicle for transmission of infectious diseases. Thus, hand hygiene is essential for preventing and controlling of infection in the health care and community settings. Waterless hand sanitizer as an alternative to hand washing was investigated. Rinse-free hand sanitizer programmes in the community may be effective, safe and feasible. The aim of the study was to systematically appraise evidence on the effect of alcohol-based hand rub in the prevention of diarrhoea and acute respiratory-tract infection among children aged five years and below in community settings. The primary outcome of the study was to assess the incidence of respiratory-tract infection and diarrhea. Diarrhoea is defined by the World Health Organization as the excretion of three or more loose or liquid stools per day (or more frequent excretion than is normal for the individual). The secondary outcome was to assess mortality, admission to hospital and duration of hospital stay. A comprehensive search for relevant studies was conducted on the following databases from 1990 to 2014: EMBASE, MEDLINE, CINAHL, Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL). We searched the reference lists of all relevant articles and textbooks for more studies. Unpublished data previously presented at international and scientific meetings have been included in the review. Proceedings of international conferences on diarrhoea and respiratory-tract infection among children were searched for relevant articles. Subject experts were contacted. Two reviewers, Joelynn Steyn (JS) and Oswell Khondowe (OK) selected studies following a two-step study selection process. This review considered all published randomized controlled trials and quasi-experimental designs published from January 1990 to July 2014. The first step was the selection of studies based on titles and abstracts. Both reviewers selected eligible studies which met the set criteria. During the second step, both reviewers retrieved the full-text articles of the studies and assessed the methodological quality of the studies. Four studies were included in this review. The included studies met most of the quality assessment criteria as stipulated in the Cochrane risk assessment tool. Two studies were clusterrandomized controlled trials, one was a block randomized controlled trial and one was a randomized controlled trial. Disagreements were resolved by discussion and where a lack of consensus existed, consultation with a third reviewer occurred. The use of alcohol hand rub as compared to control interventions significantly reduced the incidence of diarrhoea in children (RR 0.79, 95% CI 0.63 to 0.99). Statistical heterogeneity was observed among the included studies (I²=69, p=0.04). However this review found no significant difference in respiratory-tract infections between intervention groups versus control as observed from the confidence interval (RR 0.98, 95% CI 0.90 to 1.07, p=0.63). The results should be interpreted with caution due to the limited number of studies conducted in communities with alcoholbased hand rub used by caregivers. Due to limited studies in this review, it makes it difficult to make strong conclusions on findings and to provide sufficient evidence to guide future research. We therefore recommend that more studies with high quality methodologies, using randomized controlled trial designs be conducted especially in poor resourced communities. / AFRIKAANSE OPSOMMING: Meer as 3.5 miljoen kinders jonger as vyf jaar oud sterf jaarliks wêreldwyd as gevolg van diarree en akute laer respiratoriese lugweginfeksies. Oor die laaste dekades het die versorging van voorskoolse kinders buite hul tuiste meer algemeen geword in die meeste dele van die wêreld wat bygedra het tot ’n risiko in die toename van respiratoriese en spysverteringskanaalinfeksies by kinders. Kinders by dagsorgsentrums het ’n groter risiko vir diarree en respiratoriese lugweë infeksies want die oordra van siekte-infeksies word veral deur die hande wat as die primêre bron daarvan beskou word, gesien. Dus is hand-higiëne noodsaaklik om infeksies in gesondheidsorg en gemeenskapsentrums te voorkom en te beheer. ’n Waterlose hande-ontsmettingsmiddel as ’n alternatief om hande te was, is ondersoek. Spoelvrye hande-ontsmettingsmiddel programme in die gemeenskap mag effektief, veilig en uitvoerbaar wees. Die doel van die studie was om sistematies die geslaagdheid van bewyse op die effek van alkoholgebaseerde hande-smeermiddel in die voorkoming van diarree en akute lugweginfeksies by kinders 5 jaar en jonger in gemeenskapsentrums te ondersoek. Die primêre uitkoms van die studie was om die voorkoms van respiratoriese lugweginfeksie en diarree te asseseer. Diarree soos gedefinieer deur die WGO is die uitskeiding van drie of meer los- of waterige stoelgange per dag (of meer gereelde uitskeiding wat normaal vir die individu is). Die sekondêre uitkoms was om mortaliteit, toelating tot die hospitaal en duur van hospitaalverblyf te assesseer. ’n Omvattende soektog vir relevante studies was op die volgende databasisse van 2004-2014 uitgevoer: EMBASE, MEDLINE, CINAHL, Google Scholar en Cochrane Sentrale Register van Beheerde Toetse. Ons het die verwysingslyste van alle relevante artikels en handboeke vir meer navorsingstudies nagegaan. Ongepubliseerde data wat voorheen aangebied is by internasionale en wetenskaplike vergaderings, is ingesluit in die oorsig. Bevindings by internasionale konferensies oor diarree en lugweginfeksies by kinders was nagegaan in die soektog na relevante artikels. Onderwerpdeskundiges was gekontak. Die twee navorsers, Joelynn Steyn (JS) en Oswell Khondowe (OK) het studies geselekteer deur ’n twee-stap studieselekteringsproses te volg. Die oorsig het alle gepubliseerde, ewekansige gekontroleerde proewe en kwasi-eksperimenteerde studies oorweeg tussen Januarie 1990 en Julie 2014. Die eerste stap was die selektering van studies gebaseer op hul titels en opsommings. Beide navorsers het geskikte studies slegs geselekteer as die studie aan die bepaalde kriteria voldoen het. Tydens die tweede stap het beide navorsers die volledige artikels geneem van die studies geselekteer en die gehalte van die metodologie geassesseer. Vierstudies is in die oorsig ingesluit. Die ingeslote studies het aan die meeste vereistes soos deur die Cochrane risiko assesseringsinstrument gestipuleer voldoen. Twee studies was groep-ewekansige gekontroleerde proewe, een was ’n blok ewekansige gekontroleerde proef en een was ’n ewekansige gekontroleerde proef. Verskille is opgelos deur bespreking en waar daar onderbreking in konsensus was, het ’n konsultasie met ’n derde beoordelaar plaasgevind. Die gebruik van ’n alkohol handreiniger, soos vergelyk met kontrole-intervensies, het die voorkoms van diarree in kinders beduidend verminder (RR 0.79, 95% CI 0.63 to 0.99). Statistiese heterogeniteit is egter tussen die ingeslote studies waargeneem (I²=69, p=0.04). Hierdie studie het geen beduidende verskille in lugweg infeksies tussen die intervensiegroepe teenoor die kontrolegroep gevind nie soos waargeneem uit die vertroue interval (RR0.98, 95% CI 0.90 to 1.07, p=0.63). Die resultate moet met omsigtigheid geïnterpreteer word as gevolg van die beperkte aantal studies wat in gemeenskappe uitgevoer was met alkohol-gebasseerde handreiniger wat deur versorgers gebruik word. As gevolg van die beperkende aantal studies in hierdie studie, is dit moeilik om sterk gevolgtrekkings te maak op bevindinge en om voldoende bewyse te gee om toekomstige navorsing te rig. Ons beveel dus aan dat meer studies met hoë kwaliteit metodologie en wat ewekansige gekontroleerde proef-ontwerpe gebruik, uitgevoer word, veral in swak-toegeruste gemeenskappe. (RR0.98, 95% CI 0.90 to 1.07, p=0.63). Die resultate moet met omsigtigheid geïnterpreteer word as gevolg van die beperkte aantal studies wat gedoen is in gemeenskappe met alkohol-

published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy

No description available.

Orientador: Rodrigo Tavanelli Herandes / Banca: Josias Rodrigues / Banca: Ricardo Seiti Yamatogi / Resumo: Escherichia coli diarreiogênica (ECD) representa uma das principais causas da diarreia infantil. Com base em seus mecanismos de virulência, podemos classificá-la em seis patotipos distintos: E. coli enteropatogênica (EPEC), E. coli enterotoxigênica (ETEC), E. coli enteroinvasora (EIEC), E. coli produtora da toxina Shiga (STEC), E. coli enteroagregativa (EAEC) e E. coli que adere difusamente (DAEC). O objetivo deste estudo foi investigar a prevalência de ECD, entre crianças diarreicas (Pacientes) e crianças saudáveis (Controles), menores de cinco anos de idade, na cidade de Botucatu/SP. Foram analisadas amostras de fezes de 200 crianças com diarreia, atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, entre os meses de Março de 2013 a Setembro de 2014, e 200 crianças saudáveis. Isolados de E. coli foram classificados nos distintos patotipos de ECD pela pesquisa de marcadores de virulência específicos através de PCR e, posteriormente, foram caracterizados quanto ao padrão de aderência em células HeLa e resistência à drogas antimicrobianas. Os isolados portadores do locus of enterocyte effacement (eae+) foram submetidos ao teste de FAS (Fluorescence Actin Staining), para avaliar a capacidade desses isolados em induzir a lesão attaching and effacing (AE). Ademais, os isolados de EPEC e STEC tiveram seu antígeno somático (O), e flagelar (H) determinados. ECD foi isolada de 18,0% das crianças diarreicas, e em 19,0% das crianças saudáveis, sendo que nenhum patotipo de ECD pode ser individualmente associado com a doença diarreica (P0,05). O patotipo EAEC foi o mais frequente, tendo sido detectado em igual proporção entre crianças diarreicas e saudáveis (10,0%). Dentre os isolados de EPEC, 16 provenientes das fezes de crianças com diarreia e 18 provenientes de crianças saudáveis, somente um foi capaz de aderir às células HeLa no padrão localizado (AL), sendo esse o único isolado classificado... / Abstract: Diarrheagenic Escherichia coli (DEC) comprises a major cause of child hood diarrhea. Based on their virulence mechanisms, DEC can be classified into six distinct pathotypes: enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteroaggregative E. coli (EAEC), enterohemorrhagic E. coli (EHEC) and diffusely adherent E. coli (DAEC). This study aims to investigate the prevalence of DEC among diarrheal children (patients) and healthy children (controls), up to five years of age in Botucatu/SP. We analyzed stool samples from 200 children with diarrhea attended at Hospital das Clínicas da Faculdade de Medicina de Botucatu, between March/2013 and September/2014, and 200 healthy children. E. coli isolates were classified in different pathotypes by detection of virulence markers (by PCR) and then, characterized regarding its adherence pattern to HeLa cells and antimicrobial resistance drugs. Isolates carrying the locus of enterocyte effacement (eae+) were submitted to FAS test (Fluorescence Actin Staining), to evaluate the ability of these isolates to induce attaching and effacing lesion (AE). In addition, EPEC and STEC isolates, had their somatic (O) and flagellar (H) antigens determined. DEC was isolated from 18.0% of diarrheal children, and 19.0% of healthy children, and none of the DEC pathotypes could be individually associated with the diarrheal disease (P>0.05). EAEC was the most frequent DEC pathotype, being detected in equal proportion between patients and controls (10.0%). Among the EPEC isolates, 16 from patients and 18 from controls, only one was able to produce the localized adherence (LA) pattern to HeLa cells, being this isolate the only typical EPEC (tEPEC) identified in this study. The remains EPEC isolates were classified as aEPEC (atypical EPEC), and detected in 8.0 and 8.5% of the patients and controls, respectively. STEC and ETEC were detected in only one child from each studied ... / Mestre

This dissertation assesses the factors that lead to the emergence of infectious diseases in children, particularly the emergence of multidrug-resistant organisms (MDROs) and diarrheal pathogens in vulnerable pediatric populations. It includes three manuscripts. The initial study is a systematic review that summarized the role of antibiotic exposure on the acquisition of MDROs in children. Twenty-nine studies met the inclusion criteria and a positive association between prior antibiotic use and subsequent colonization or infection with an MDRO was identified in most studies. There were wide variations among study sites, populations, and definitions of antibiotic use and MDROs. Therefore, limited inferences could be made on which components of antibiotic exposure have the greatest impact on MDRO development. The second analysis examines the relationship between prior stay at a pediatric long-term care (LTC) facility and infection with an MDRO among hospitalized children. This study included 2,945 infections in 258,664 pediatric admissions from 2006 through 2016. At least 1 MDRO was identified in 10% of infections. Of the 1,198 children who had previously resided in a pediatric LTC facility, only 1 child (0.08%) had an MDRO infection. However, prior receipt of pediatric LTC was associated with an increased likelihood of infection (OR 2.4, CI95 1.66 – 3.43), C. difficile infection (OR 2.57, CI95 1.26 – 5.25), days of antibiotic use (OR 1.01, CI95 1.01 – 1.02), length of stay (OR 1.01, CI95 1.01 – 1.01), and death (OR 4.38, CI95 2.93 – 6.55). The concluding study evaluates the association between animals living in or near the home and diarrheal disease in children. This research is a secondary analysis of the Global Enteric Multicenter Study case control study, which investigated the epidemiology of diarrheal illness in children <5 in sub-Saharan Africa and south Asia. Of 9,439 cases and 13,128 controls, 87% had ≥1 animal in their home. In a multivariable analysis adjusting for exclusive breastfeeding, water source, sanitation facility, number of children <5 years in the household, and wealth index, any animal on a child’s compound decreased the odds of diarrhea by 33% (aOR 0.66, CI95 0.59 – 0.74). However, children with diarrhea who had an animal present were not more likely to have a positive stool culture. Overall, the three studies provide a thorough analysis of several factors associated with the infectious disease emergence in children, particularly as related to MDROs and diarrheal disease. Environmental characteristics, including antibiotic use and interaction with animals, were shown to be important factors for emergent infectious disease across diverse settings. The development of pediatric infection prevention interventions should take into consideration environmental risk factors in order to effectively mitigate the risks posed infectious disease emergence.

Thesis (M.N.)--Memorial University of Newfoundland, 2002. / Bibliography: leaves 145-150.