The objective of this research was to investigate the occurrence of mycoflora in rice plants and rice seeds in South Africa and their negative impact. A total of six species of Fusarium were isolated from diseased rice plants and rice seeds and identified as F. anthophilum, F. chlamydosporum, F. compactum, F. equiseti, F. fujikuroi and F. semitectum. In the translation elongation factor data set, Fusarium equiseti isolates grouped together within the F. incarnatum - equiseti Species Complex (FIESC). The isolates from rice clustered together in a single clade with the F. equiseti and F. incarnatum isolates forming two separate sub-clades.The isolates of F. equiseti present a new phylogenetically distinct species in FIESC. In the pathogenicity tests, isolates of both F. anthophilum and F. fujikuroi caused bakanae disease to rice plants. Fifty four rice cultivars and lines were tested by the standardized test tube inoculation method for resistance and susceptibility against bakanae isolate of F. anthophilum and the bakanae isolate of F. fujikuroi. None of the rice cultivars and lines was found to be resistant to bakanae isolates of Fusarium spp. The fungicide, benomyl was found to be most effective as a seed treatment for controlling bakanae disease of rice due to isolates of both F. anthophilum and F. fujikuroi. Thiram was found to be the least effective fungicide for controlling bakanae disease of rice caused by isolates of both the Fusarium spp. Apart from Fusarium species, other fungi that were also isolated from diseased rice plants and rice seeds were identified as Alternaria alternata, Alternaria longipes, Cochliobolus miyabeanus, Nigrospora sphaerica, Phoma eupyrena, Phoma jolyana, Phoma sorghina and Pithomyces sp. In mycotoxin tests, the isolates of both F. anthophilum and F. fujikuroi produced moniliformin. None of the isolates of F. anthophilum and F. fujikuroi produced fumonisins. This research is important as it identifies many fungal species in rice plants and seeds in South Africa for the first time. Currently, there is very little literature that makes reference to such findings under South African conditions. In addition, this investigation unravels previously unknown information on the resistance of rice to bakanese disease. Finally, information is provided on the effectiveness of commonly used fungicides (benomyl and thiram) to control rice diseases. This knowledge is crucial information that is useful to plant pathologists, the farming community and the scientists that are involved in strategies of fighting or reducing rice diseases so as to help contribute to food security. / Environmental Sciences / D. Phil. (Environmental Science)

As creches estão relacionadas ao aumento do risco de doenças transmissíveis e programas de controle de infecção são necessários. Foi realizado estudo descritivo para identificar normas de controle de doenças em creches hospitalares do município de São Paulo. Rotina escrita para a lavagem de mãos foi encontrada em 36% e para a troca de fraldas em 24%. Havia luvas descartáveis em 68%, porém rotina escrita para o descarte de luvas usadas em 12% e instruções sobre precauções padrão em 28%. Normas para o afastamento por doença transmissível existiam em 16%. Treinamento padronizado em controle de infecção era oferecido em 12%. As creches hospitalares não possuem normas suficientes para reduzir a transmissão de doenças. Padronização dos procedimentos e regulamentação são necessárias para promover o controle de infeccção / Child day-care centers (DCC) are known for the spread of infectious diseases. Standards for infection control in child care have been established worldwide. A study was conducted to obtain policies used to reduce disease in hospital day-care centers in São Paulo, Brazil. Written handwashing procedures were available at 36% and written instructions on diapering at 24%. Gloves were used in 68% but written disposal procedures were available in 12% and at 28% were instructions offered on standard precautions. A policy for exclusion due to communicable illness was obtained in 16%. Standard staff training on infection control was offered in only 12%. Hospital DCC's lack policies and routine procedures for reducing the spread of disease. Child care standards and regulation are needed in order to promote disease control

Objetivo: i) Estudar os casos de tuberculose (TB) por transmissão recente em brasileiros e migrantes sul-americanos, quantificar a transmissão cruzada recente entre ambas as populações e estudar seus fatores associados; ii) Avaliar, isoladamente, os fatores associados à transmissão recente da TB e o impacto da migração e de outras vulnerabilidades nos casos da doença no município. Métodos: Estudo transversal em indivíduos brasileiros e migrantes de origem sul-americana, residentes de distritos centrais do município de São Paulo (MSP) com grande proporção de populações vulneráveis e elevada presença recente de migrantes. Estudaram-se os casos de TB pulmonar por M. tuberculosis (Mtb) notificados entre 2013 e 2014, confirmados por meio de cultura de escarro. Foram utilizados os dados do Sistema Estadual de Notificação (SINAN-TB), de unidades de saúde e do laboratório central do Instituto Adolfo Lutz. Analizaram-se as variáveis sociodemográficas, clínicas e a presença de clusters simples e mistos, obtidos pelo agrupamento dos isolados de Mtb por RFLP-IS6110. i) Descreveu-se a distribuição dos clusters mistos e outras variáveis em brasileiros e migrantes sul-americanos e, investigou-se os fatores independentemente associados à presença de clusters mistos na amostra por meio de regressão logística simples e múltipla; ii) Investigaram-se os fatores independentemente associados à ocorrência de clusters mediante regressão logística simples e múltipla e estimou-se o impacto da transmissão recente da TB por meio da Fração Atribuível Populacional (PAF). Resultados: Foram amostrados 347 indivíduos, 19 por cento dos casos na área estudada. Desses, 76 por cento eram brasileiros e 24 por cento migrantes sul-americanos. O primeiro estudo mostrou que a proporção de clusters foi de 40,5 por cento , sendo 28 por cento desses compartilhados por brasileiros e migrantes sul-americanos (clusters mistos). Clusters mistos foram mais frequentemente encontrados em migrantes sul-americanos do que em brasileiros (OR=6,05), porém sugeriu-se transmissão cruzada em ambas as direções. A análise de sensibilidade, removendo usuários de drogas, HIV positivos e alcóolicos, teve pouco efeito no número de clusters mistos porém reduziu o de clusters simples em vi brasileiros, sugerindo maior transmissão recente do Mtb entre indivíduos brasileiros e migrantes não pertencentes a esses grupos de risco. O segundo estudo sugeriu que o uso de drogas está independentemente e diretamente associados a clusters sugestivos de transmissão recente (ORaj=3,18) e o alcoolismo (ORaj=0,30) está inversamente associado à transmissão recente. Foi encontrada baixa prevalência de comorbidades e outros fatores de risco entre migrantes sul-americanos, tanto em clusters quanto em perfis únicos. A transmissão recente entre usuários de drogas foi atribuída a cerca de 15 por cento dos casos de TB em brasileiros. Conclusões: Verificou-se que a transmissão recente, tanto entre brasileiros quanto entre migrantes sul-americanos, desempenha um papel importante nas regiões centrais do MSP. No entanto, sugere-se que a migração possa desempenhar um papel menos importante na transmissão/reativação da TB do que o uso de drogas e outras condições de vulnerabilidade. Dessa forma, no contexto dos crescentes movimentos migratórios para grandes cidades de países de média e baixa renda, a migração se soma à vulnerabilidade social, reforçando a necessidade de políticas intersetoriais para controle da TB. / Objective: i) to study recent tuberculosis (TB) transmission in Brazilians and South-American migrants, to estimate the proportion of recent cross-transmission occurring between both populations and to study potential associated factors to cross-transmission; ii) to study associated factors to cross-transmission and to estimate the impact of South-American migration and other vulnerabilities on TB cases. Methods: we conducted a cross-sectional study with TB patients in a central area of São Paulo (MSP) with a strong presence of South-American migrants and vulnerable populations. We selected notified pulmonary TB (PTB) cases confirmed by sputum culture between 2013 and 2014 among Brazilians and South-American migrants. We used the Tuberculosis State Notification System (SINAN-TBWEB), health facilities and the State Reference Laboratory (Instituto Adolfo Lutz) as data sources. We typed M. tuberculosis isolates by IS6110-RFLP, which were clustered by similarity. Clusters were considered mixed when isolates from at least one Brazilian and one South-American migrant were similar; and were considered simple when the cluster contained isolates from patients of only one nationality. We study demographic and clinical variables from TB patients and the presence of clusters within the sample. i) We described the distribution of simple and mixed clusters and other variables amongst Brazilians and South-American migrants and study associated factors to cross-transmission using logistic regression; ii) we estimated the proportion of recent transmission in the sample and investigated the factors associated with the presence of clusters by multiple logistic regression. Results: We sampled 347 individuals, 19 per cent of cases that occurred in the study area. Nearly 76 per cent were Brazilians and 24 per cent South-Americans. The first study demonstrated that 40.5 per cent of cases were clustered, of which approximately 30 per cent were mixed. South-American migrants were more likely to have mixed clusters than Brazilians (OR=6.05) and the results suggest that TB transmission occurred in both directions. We conducted a sensitivity analysis removing drug users, HIV positive and alcoholics, which suggested higher transmission amongst Brazilian and migrants outside these groups. In the second study we demonstrated that drug users were more likely to viii belong to clusters (ORadj=3.18) while individuals who abuse alcohol were more likely to belong to unique profiles (ORadj=0.30). South American migrants had lower prevalence of comorbidities and other risk factors. Nearly 15 per cent of PTB cases among Brazilians were attributed to recent transmission among drug users. Conclusions: We conclude that general recent transmission of TB and cross-transmission between Brazilian and South American migrants play an important role in the central regions of MSP. Nevertheless, we suggest that social vulnerability and drug use in TB transmission may be more important than migration status itself. In the context of increasing migration to large cities of low- and middle-income countries, our findings add migration to other social vulnerabilities, reaffirming the need for inter-sectoral policies on TB control.

A informação sobre a dinâmica espaço-temporal de doenças de plantas é de importância fundamental em estudos epidemiológicos, podendo ser utilizada para descrever e entender o desenvolvimento das doenças, desenvolver planos de amostragem, planejar experimentos controlados e caracterizar perdas na produção ocasionadas pela doença. O estudo de padrões espaciais de doenças de plantas, que são reflexos do processo de dispersão dos patógenos, é importante em estudos epidemiológicos, como o de doenças dos citros, para se definirem estratégias mais adequadas para o controle das doenças, diminuindo os prejuízos causados. A Citricultura é uma das principais atividades agrícolas do Brasil e representa a principal atividade econômica de mais de 400 municípios do Triângulo Mineiro e do Estado de São Paulo, onde se encontra a maior área de citros do país e a maior região produtora de laranjas do mundo. Na avaliação do padrão espacial, diferentes métodos têm sido utilizados, dentre os quais incluem-se o ajuste de distribuições, como, por exemplo, a distribuição beta-binomial, o estudo da relação variância-média, o cálculo de correlação ao intraclasse, a utilização de técnicas de autocorrelação espacial, métodos de classes de distâncias e o ajuste de modelos estocásticos espaço-temporais. Diante da importância de se estudarem padrões espaciais da incidência de doenças em plantas e da necessidade de se conhecer melhor a epidemiologia da morte súbita dos citros e do cancro cítrico, uma técnica baseada em verossimilhança para o ajuste de modelos estocásticos espaço-temporais foi utilizada na caracterização de padrões espaciais. Modificações na metodologia original, buscando uma diminuição do tempo gasto nas análises, foram propostas nesse estudo. Os resultados mostram que as modificações propostas resultaram em uma diminuição significativa no tempo de análise, sem perda de acurácia na estimação dos parâmetros dos modelos considerados. / The information about the spatial-temporal dynamics is of fundamental importance in epidemiological studies for describing and understanding the development of diseases, for developing efficient sampling plans, for planning controlled experiments, for evaluating the effect of different treatments, and for determining crop losses. The Citriculture is the major economic activity of more than 400 municipalities in Minas Gerais and São Paulo States. This is the largest citrus area in Brazil, and the largest sweet orange production area in the world. Therefore, it is very important to study and to characterize spatial patterns of plant diseases, such as citrus canker and citrus sudden death. In the spatial dynamics study, many different methods have been used to characterize the spatial aggregation. These include the fitting of distributions, such as the beta-binomial distribution, the study of variance-mean relationships, the calculation of intraclass correlation, the use of spatial autocorrelation techniques, distance class methods and, the fitting of continuous time spatiotemporal stochastic models. In this work, an improved technique for fitting models to the spatial incidence data by using MCMC methods is proposed. This improved technique, which is used to investigate the spatial patterns of plant disease incidence, is considerably faster than Gibson’s methodology, in terms of computational time, without any loss of accuracy.

Black American women have the highest screening rates for cervical cancer among all the ethnic groups in the United States. Even though evidence from the literature suggests that the number of deaths from cervical cancer in the United States could be reduced by preventive screening, this particular minority population still suffers disproportionately higher mortality from the disease than the other minority and majority populations in the United States. This study was proposed to investigate cancer screening disparities among different subpopulations of women residing in the United States during 1999, and to recommend public health interventions that could potentially increase cervical cancer screening rates, thereby decreasing differential mortality rates for cervical cancer among these subpopulations. The Preventive Health Model in conjunction with data from the 1999 Behavioral Risk Factor Surveillance System was used to identify the covariates of cervical cancer screening behavior in an ethnically diverse population of American women residing in the United States during the specified timeframe. Univariate, bivariate and multivariable logistic regression procedures were used to evaluate the association between each one of the independent variables and the dependent variable (compliance with the 1999 cervical screening guidelines of the American Cancer Society). One of the major findings of this study was that Black, White and Hispanic American women were more similar in their screening behavior than dissimilar. The study also showed that the disparity in cervical cancer screening behavior in this population is in age, rather than in ethnic origin. Black, White and Hispanic American women of child-bearing age (18-44 years) were more likely to be compliant with the 1999 cervical cancer screening guidelines of the American Cancer Society, than Black, White and Hispanic American women who were not of child-bearing age (45 to 64 years). Implications for public health intervention studies are discussed, and recommendations made for future research in this area of cervical cancer screening behavior.

Soybean rust (SBR), caused by the fungus Phakopsora pachyrhizi Syd., is a real threat to soybean crops in South Africa. Its ability to spread rapidly and its potential to severely reduce yields have earned it the reputation as the most destructive foliar disease of soybeans. SBR has been reported in South Africa every year since its arrival in 2001. While extensive research had been done on the epidemiology and fungicide application requirements in South Africa, no work into the long term climatic vulnerability of soybean production areas to SBR had been done. This meant soybean producers do not know whether SBR is a threat in their areas. Through this research a SBR algorithm was developed using readily available climate data, viz. temperature and rainfall, to create a daily index specifying the climatic vulnerability of SBR infection. The algorithm was applied to a 50 year historical climate database, and a series of maps was created illustrating the long term vulnerability of different areas to SBR infection. These maps allow soybean producers to understand the climatic vulnerability of their area to SBR infection. Time series graphs were created for selected key soybean production areas to allow soybean producers to distinguish periods of high and low climatic risk during the season. This may help with decisions regarding the planting times, the maturation rate of different cultivars as well as the timing and application of fungicides. The framework for a near real time forecasting system was created outlining how the system could amalgamate recently recorded and forecasted weather data, run it through the SBR algorithm and provide a near real time, as well as forecasted vulnerability, based on the climatic conductivity for SBR infection. Anticipated limitations and difficulties on developing the forecasting system are also outlined. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression

The objective of this research was to investigate the occurrence of mycoflora in rice plants and rice seeds in South Africa and their negative impact. A total of six species of Fusarium were isolated from diseased rice plants and rice seeds and identified as F. anthophilum, F. chlamydosporum, F. compactum, F. equiseti, F. fujikuroi and F. semitectum. In the translation elongation factor data set, Fusarium equiseti isolates grouped together within the F. incarnatum - equiseti Species Complex (FIESC). The isolates from rice clustered together in a single clade with the F. equiseti and F. incarnatum isolates forming two separate sub-clades.The isolates of F. equiseti present a new phylogenetically distinct species in FIESC. In the pathogenicity tests, isolates of both F. anthophilum and F. fujikuroi caused bakanae disease to rice plants. Fifty four rice cultivars and lines were tested by the standardized test tube inoculation method for resistance and susceptibility against bakanae isolate of F. anthophilum and the bakanae isolate of F. fujikuroi. None of the rice cultivars and lines was found to be resistant to bakanae isolates of Fusarium spp. The fungicide, benomyl was found to be most effective as a seed treatment for controlling bakanae disease of rice due to isolates of both F. anthophilum and F. fujikuroi. Thiram was found to be the least effective fungicide for controlling bakanae disease of rice caused by isolates of both the Fusarium spp. Apart from Fusarium species, other fungi that were also isolated from diseased rice plants and rice seeds were identified as Alternaria alternata, Alternaria longipes, Cochliobolus miyabeanus, Nigrospora sphaerica, Phoma eupyrena, Phoma jolyana, Phoma sorghina and Pithomyces sp. In mycotoxin tests, the isolates of both F. anthophilum and F. fujikuroi produced moniliformin. None of the isolates of F. anthophilum and F. fujikuroi produced fumonisins. This research is important as it identifies many fungal species in rice plants and seeds in South Africa for the first time. Currently, there is very little literature that makes reference to such findings under South African conditions. In addition, this investigation unravels previously unknown information on the resistance of rice to bakanese disease. Finally, information is provided on the effectiveness of commonly used fungicides (benomyl and thiram) to control rice diseases. This knowledge is crucial information that is useful to plant pathologists, the farming community and the scientists that are involved in strategies of fighting or reducing rice diseases so as to help contribute to food security. / Environmental Sciences / D. Phil. (Environmental Science)

Objetivo: i) Estudar os casos de tuberculose (TB) por transmissão recente em brasileiros e migrantes sul-americanos, quantificar a transmissão cruzada recente entre ambas as populações e estudar seus fatores associados; ii) Avaliar, isoladamente, os fatores associados à transmissão recente da TB e o impacto da migração e de outras vulnerabilidades nos casos da doença no município. Métodos: Estudo transversal em indivíduos brasileiros e migrantes de origem sul-americana, residentes de distritos centrais do município de São Paulo (MSP) com grande proporção de populações vulneráveis e elevada presença recente de migrantes. Estudaram-se os casos de TB pulmonar por M. tuberculosis (Mtb) notificados entre 2013 e 2014, confirmados por meio de cultura de escarro. Foram utilizados os dados do Sistema Estadual de Notificação (SINAN-TB), de unidades de saúde e do laboratório central do Instituto Adolfo Lutz. Analizaram-se as variáveis sociodemográficas, clínicas e a presença de clusters simples e mistos, obtidos pelo agrupamento dos isolados de Mtb por RFLP-IS6110. i) Descreveu-se a distribuição dos clusters mistos e outras variáveis em brasileiros e migrantes sul-americanos e, investigou-se os fatores independentemente associados à presença de clusters mistos na amostra por meio de regressão logística simples e múltipla; ii) Investigaram-se os fatores independentemente associados à ocorrência de clusters mediante regressão logística simples e múltipla e estimou-se o impacto da transmissão recente da TB por meio da Fração Atribuível Populacional (PAF). Resultados: Foram amostrados 347 indivíduos, 19 por cento dos casos na área estudada. Desses, 76 por cento eram brasileiros e 24 por cento migrantes sul-americanos. O primeiro estudo mostrou que a proporção de clusters foi de 40,5 por cento , sendo 28 por cento desses compartilhados por brasileiros e migrantes sul-americanos (clusters mistos). Clusters mistos foram mais frequentemente encontrados em migrantes sul-americanos do que em brasileiros (OR=6,05), porém sugeriu-se transmissão cruzada em ambas as direções. A análise de sensibilidade, removendo usuários de drogas, HIV positivos e alcóolicos, teve pouco efeito no número de clusters mistos porém reduziu o de clusters simples em vi brasileiros, sugerindo maior transmissão recente do Mtb entre indivíduos brasileiros e migrantes não pertencentes a esses grupos de risco. O segundo estudo sugeriu que o uso de drogas está independentemente e diretamente associados a clusters sugestivos de transmissão recente (ORaj=3,18) e o alcoolismo (ORaj=0,30) está inversamente associado à transmissão recente. Foi encontrada baixa prevalência de comorbidades e outros fatores de risco entre migrantes sul-americanos, tanto em clusters quanto em perfis únicos. A transmissão recente entre usuários de drogas foi atribuída a cerca de 15 por cento dos casos de TB em brasileiros. Conclusões: Verificou-se que a transmissão recente, tanto entre brasileiros quanto entre migrantes sul-americanos, desempenha um papel importante nas regiões centrais do MSP. No entanto, sugere-se que a migração possa desempenhar um papel menos importante na transmissão/reativação da TB do que o uso de drogas e outras condições de vulnerabilidade. Dessa forma, no contexto dos crescentes movimentos migratórios para grandes cidades de países de média e baixa renda, a migração se soma à vulnerabilidade social, reforçando a necessidade de políticas intersetoriais para controle da TB. / Objective: i) to study recent tuberculosis (TB) transmission in Brazilians and South-American migrants, to estimate the proportion of recent cross-transmission occurring between both populations and to study potential associated factors to cross-transmission; ii) to study associated factors to cross-transmission and to estimate the impact of South-American migration and other vulnerabilities on TB cases. Methods: we conducted a cross-sectional study with TB patients in a central area of São Paulo (MSP) with a strong presence of South-American migrants and vulnerable populations. We selected notified pulmonary TB (PTB) cases confirmed by sputum culture between 2013 and 2014 among Brazilians and South-American migrants. We used the Tuberculosis State Notification System (SINAN-TBWEB), health facilities and the State Reference Laboratory (Instituto Adolfo Lutz) as data sources. We typed M. tuberculosis isolates by IS6110-RFLP, which were clustered by similarity. Clusters were considered mixed when isolates from at least one Brazilian and one South-American migrant were similar; and were considered simple when the cluster contained isolates from patients of only one nationality. We study demographic and clinical variables from TB patients and the presence of clusters within the sample. i) We described the distribution of simple and mixed clusters and other variables amongst Brazilians and South-American migrants and study associated factors to cross-transmission using logistic regression; ii) we estimated the proportion of recent transmission in the sample and investigated the factors associated with the presence of clusters by multiple logistic regression. Results: We sampled 347 individuals, 19 per cent of cases that occurred in the study area. Nearly 76 per cent were Brazilians and 24 per cent South-Americans. The first study demonstrated that 40.5 per cent of cases were clustered, of which approximately 30 per cent were mixed. South-American migrants were more likely to have mixed clusters than Brazilians (OR=6.05) and the results suggest that TB transmission occurred in both directions. We conducted a sensitivity analysis removing drug users, HIV positive and alcoholics, which suggested higher transmission amongst Brazilian and migrants outside these groups. In the second study we demonstrated that drug users were more likely to viii belong to clusters (ORadj=3.18) while individuals who abuse alcohol were more likely to belong to unique profiles (ORadj=0.30). South American migrants had lower prevalence of comorbidities and other risk factors. Nearly 15 per cent of PTB cases among Brazilians were attributed to recent transmission among drug users. Conclusions: We conclude that general recent transmission of TB and cross-transmission between Brazilian and South American migrants play an important role in the central regions of MSP. Nevertheless, we suggest that social vulnerability and drug use in TB transmission may be more important than migration status itself. In the context of increasing migration to large cities of low- and middle-income countries, our findings add migration to other social vulnerabilities, reaffirming the need for inter-sectoral policies on TB control.

As creches estão relacionadas ao aumento do risco de doenças transmissíveis e programas de controle de infecção são necessários. Foi realizado estudo descritivo para identificar normas de controle de doenças em creches hospitalares do município de São Paulo. Rotina escrita para a lavagem de mãos foi encontrada em 36% e para a troca de fraldas em 24%. Havia luvas descartáveis em 68%, porém rotina escrita para o descarte de luvas usadas em 12% e instruções sobre precauções padrão em 28%. Normas para o afastamento por doença transmissível existiam em 16%. Treinamento padronizado em controle de infecção era oferecido em 12%. As creches hospitalares não possuem normas suficientes para reduzir a transmissão de doenças. Padronização dos procedimentos e regulamentação são necessárias para promover o controle de infeccção / Child day-care centers (DCC) are known for the spread of infectious diseases. Standards for infection control in child care have been established worldwide. A study was conducted to obtain policies used to reduce disease in hospital day-care centers in São Paulo, Brazil. Written handwashing procedures were available at 36% and written instructions on diapering at 24%. Gloves were used in 68% but written disposal procedures were available in 12% and at 28% were instructions offered on standard precautions. A policy for exclusion due to communicable illness was obtained in 16%. Standard staff training on infection control was offered in only 12%. Hospital DCC's lack policies and routine procedures for reducing the spread of disease. Child care standards and regulation are needed in order to promote disease control