In a population prevalence questionnaire study we demonstrated that constipation and fecal incontinence are common problems in the general Swedish population with a similar magnitude as in other Western countries. 95.6% of the population had between three bowel movements per day and three per week. Constipation was mostly defined by “hard stools” and “the need of using laxatives”. Irritable Bowel Syndrome (IBS) is characterized by abdominal pain/discomfort and abnormal bowel habits. The diagnostic criteria of IBS are based on clinical symptoms. Division of IBS patients into symptom subgroups appears important as their bowel symptoms are characterized by heterogeneity. International criteria to subgroup IBS (Rome II) are based on expert consensus and not on evidence. We investigated the variation of stool consistency and defecatory symptoms in 135 IBS patients by symptom diary cards. Most patients had alternating stool consistency. When subgroups were based on stool consistency, all kinds of defecatory symptoms (straining, urgency, and feeling of incomplete evacuations) were frequently present in all subgroups. Stool frequency was in the normal range in the majority of patients. We propose that IBS subgroups should be based on stool consistency. We suggest that Rome II supportive criteria must be reconsidered as the determination of presence or absence of specific symptoms does not work as an instrument for categorization of IBS patients into diarrhoea- and constipation-predominant. We also propose that abnormal stool frequency should be excluded to define subgroups of IBS. Alternating stool consistency and presence of different defecatory symptoms, regardless of stool consistency should be included as criteria for IBS. Stress is known to play an important role in the onset and modulation of IBS symptoms. From experimental studies there is evidence for a stress-dependent alteration of visceral sensitivity. The biological mechanisms responsible for the causal link between stress and IBS symptoms are not completely understood, but the hypothalamic-pituitary-adrenocortical axis and the autonomous nervous system seem to play a prominent role in the pathophysiology of IBS. We investigated visceral sensitivity and the effect of repeated maximal tolerable rectal distensions on salivary cortisol levels and skin conductance in patients with IBS, chronic constipation and healthy volunteers. We found that the expectancy of the experimental situation per se (provocation of bowel symptoms by rectal distensions) compared to non-experimental days at home measured as salivary cortisol had a high impact on the level of arousal in IBS. IBS patients had higher skin conductance values than controls in the beginning of distension series and lower rectal thresholds for first sensation, urge and discomfort than healthy controls and constipation patients. IBS patients demonstrated habituation to repeated subjective maximal tolerable rectal distensions according to sympathetic activity although patients continued to rate their discomfort as maximal. Constipation patients had lower sympathetic activity than IBS patients before and during repeated rectal distensions. None of the groups demonstrated a significant increase in cortisol after repetitive rectal distensions. We conclude that Rome II supportive criteria for IBS should be reconsidered according to our findings. IBS patients are more sensitive to pre-experimental stress than healthy controls and patients with constipation. This should be considered in the design of experimental IBS studies. IBS patients habituated to subjective maximal tolerable, repetitive rectal distensions with decreasing sympathetic activity. Since responses to repeated stimuli of close-to-pain intensities are resistant to habituation this finding could be caused by psychological influences on perception, that is, perceptual response bias.

<p>The program that was studied is part of the Child Health Program devised and supported by CARE International and implemented in Kanyama, a high density and low cost community found on the outskirts of Lusaka, Zambia. Diarrhoea was identified as one of the three most common diseases affecting the children under the age of five years. Through community participation, the program was implemented by the Kanyama residents to reduce the cases of diarrhoea, malaria and pneumonia among children aged five years and under. The main aim of this study was to explore the perceptions of the impact of community participation by the community leaders and community members in the diarrhoea prevention program and to establish constraints affecting participation.</p>

<p>The program that was studied is part of the Child Health Program devised and supported by CARE International and implemented in Kanyama, a high density and low cost community found on the outskirts of Lusaka, Zambia. Diarrhoea was identified as one of the three most common diseases affecting the children under the age of five years. Through community participation, the program was implemented by the Kanyama residents to reduce the cases of diarrhoea, malaria and pneumonia among children aged five years and under. The main aim of this study was to explore the perceptions of the impact of community participation by the community leaders and community members in the diarrhoea prevention program and to establish constraints affecting participation.</p>

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2006. / Härtill 5 uppsatser.

My thesis deals with hygienic knowledge monitoring of pupils at the age of 6 up to 10 years attending Hradská Elementary School in Humpolec. Further it is focused on pupil´s education related to the significance of observing hygienic rules and potential consequences which can result in case of their breach. In the end, after carrying out the education, I evaluated the pupils´ knowledge of the problems in question. The initial part of my thesis gives information about hygiene history, basic hygienic habits, selected infectious diseases of child age, these infections epidemiologic characteristic, diagnostics, clinical knowledge, precautionary measures and vaccination problems. This part was elaborated by using method of secondary data analysis. The quantitative research and lecture on the theme "Precaution of infectious disease with practising the right method of washing hands? were carried out in the second part of my thesis. The data acquired via two questionnaire inquiries are evaluated statistically by means of graphs. The acquired results are under discussion in the third part of my thesis. The pupils have basic knowledge of body care; they know which hygienic habits they should observe. Unfortunately they do not always do it. The necessity of hygienic rules observance is not preferred by children because they do not realize their importance. Children should improve their dental hygiene and method of washing hands. Observing hygiene is important in infectious diseases precaution and indisputably also because of everybody's feeling fine. In my opinion the education has an influence on improving the knowledge level in the field of hygienic habits and therefore its implementation makes sense. My thesis can be used as information material for work in the given field. Its results can be used to increase the children's knowledge level in personal hygiene.

Magister Public Health - MPH / Introduction: In-house contamination of drinking water stored in wide-mouthed buckets (even with lids) has been widely reported in epidemiologic investigations as vehicles for diarrhoea disease transmission. The long handled mukombe cup (LHM cup), recently developed by the National Institute of Health Research (NIHR), a department of the Ministry of Health and Child Care (MoHCC) in Zimbabwe, is a promising low cost dipping devise for extraction of water from wide-mouthed containers. Aim: The study aim was to assess the effectiveness and household acceptability of the long handled mukombe cup in reducing bacteriological contamination of drinking water stored in wide-mouthed vessels in the home in a peri urban settlement in Harare, Zimbabwe. Methodology: A randomised controlled trial of a long handled mukombe cup was conducted in Hatcliffe, Harare. After collecting baseline data on demographics, household water quality, and other sanitation and water handling practices, households were given basic health education before the two selected communities were randomly assigned to one of the two groups of 119 households each. The intervention group received the LHM cup while the control group received no intervention. Households were followed up after two months and assessed effectiveness and user acceptability of the intervention. Data Analysis: Data analysis was conducted using STATA 11. Descriptive statistics were calculated and reported as percentages, proportions, frequencies and measures of central tendency. Bivariate statistics were carried out to test independent associations between use of the LHM cup and E. coli. All analyses were conducted in an intention-to-intervene analysis. Results: A total of 230 households were analysed during follow-up. Samples of stored drinking water from intervention households were significantly lower in E. coli levels than those of control households (geometric mean E. coli of 0.8/100 ml vs 13.0/100 ml, p <0.0001). Overall, 78.4% (987/111) of samples from the intervention households met World Health Organization (WHO) guideline value of 0 cfu/100ml sample, while 52.1% of the 119 samples from control households met such a benchmark (p < 0.0001). In addition, 94.6% of intervention household samples were in compliance with this intervention or presented low risk, 27.7% of samples from control group households presented intermediate or high risk. There was a statistically significant association between LHM cup use and reduced E. coli bacterial contamination in stored drinking water (p < 0.05). There was no statistically significant difference in turbidity in both intervention and control groups, both for turbidity <5 and >5 (p = 0.071). Acceptability of the LHM cup was very high (100%). Conclusion: To our knowledge, this is the first study on the evaluation and acceptability of the LHM cup in the Sub-Saharan Africa. Positive results were recorded that showed that the LHM cup was effective in minimising E. coli contamination in the intervention group as compared to the control group. It is postulated that this is because the LHM cup reduces hand contact with stored water during scooping, thus maintaining improved water quality in communities in Zimbabwe that collect and store drinking water in wide-mouthed containers with lids where extraction is by scooping. However, more research is required to document the LHM cup's continued and effective use, durability and overall sustainability in the absence of any serious sampling or monitoring.

The purpose of this study was to explore the knowledge and practices of caregivers/mothers of under-five children with diarrhoea-related illnesses admitted at the referral hospital. The setting for this qualitative study was the referral hospital located in the Sol Plaatje Municipality, Northern Cape Province. Unstructured interviews were conducted with caregivers/mothers of under-five children with diarrhoea admitted to the referral hospital. Colliazzi’s seven steps of data analysis (1998) as cited in Bazeley (2013:65) were used to analyse data. The study population was the caregivers/mothers of children with diarrhoea admitted to the referral hospital. The findings assisted us in understanding the knowledge the caregivers/mothers had with regard to the management of diarrhoea and in improving the health education guide used to teach caregivers/mothers. / Health Studies / M.A (Public Health)