Controlling and eliminating malaria in Indonesia is a challenging endeavour. Evidence-based strategic plans should be critically formulated to overcome a complex mosaic of infection risk across the 5000-km-long archipelago of thousand islands and distinctive habitats. This project aimed to thoroughly explore the challenges and opportunities for controlling/eliminating malaria and present the application of malaria cartographic tools to allow malaria control agencies and their partners to comprehensively assess the prospects for reaching pre-elimination, monitor and evaluate the effectiveness of future strategies against the baseline generated. First, the historical context of malaria in Indonesia and important methods of control and their impact in the context of the political systems that supported them was comprehensively described. A series of distribution maps of twenty Anopheles malaria vector mosquitoes in Indonesia were also produced, supported by comprehensive reviews of each species’ bionomics and susceptibility to insecticides. Then, the application of malaria cartographic tools for malaria control/elimination in Indonesia was explored. The first high spatial resolution (1 x 1 km) baseline endemicity maps of Plasmodium falciparum and P. vivax malaria were generated, together with corresponding estimates of population at risk and clinical burdens of each species in 2010. Low malaria prevalences of these parasites were predicted in western areas, with high prevalences in eastern Indonesia. Over 132 million people in Indonesia lived at risk of P. falciparum transmission with 70% of them in areas of unstable transmission and 30% in stable transmission. There were an estimated 7.7 million P. falciparum clinical cases across the populations at risk. Meanwhile, nearly 130 million people lived at risk of P. vivax malaria with 79% living in unstable and 21% in stable transmission areas. This infection caused 1.5 million estimated clinical cases in 2010. Both estimates were 30-fold and 6-fold higher than routinely reported numbers, respectively. Finally, this project revealed the substantial multi-faced problems that impede current efforts towards the pre-elimination agenda. High rates of undiagnosed clinical cases, insufficient competence of malaria microscopy, inadequate primaquine dosing against P. vivax malaria infections, insufficient evidence of vector control interventions, wide diversities of vector mosquitoes and their bionomics, mosquito resistance against insecticides and inadequate malaria surveillance systems are challenging the task of controlling and eliminating malaria. A diverse range of strategies enabling locally-specific approaches must be implemented for controlling and eliminating malaria in Indonesia. Strategic recommendations are listed and future research priorities are proposed for further study.

Background and Aims: The Sohar Industrial Zone (SIZ), Oman, which started to operate in 2006, contains many industries that possibly affect the health of the local population. This study was carried out to evaluate the health effects in a population living near SIZ. Methods: Retrospective health care visits for acute respiratory diseases (ARD), asthma, conjunctivitis and dermatitis were collected between 2006 and 2010 for 2 large provinces with geographic proximity to SIZ. Exposure of the surrounding villages was classified using proximity to SIZ. Three exposure zones were defined according to the distances from the SIZ: ≤5, >5-10, ≥20 km representing high, intermediate and control exposure zones respectively. Age and gender-adjusted monthly counts of visits for the selected diseases were modelled using generalised additive models controlling for time trends. The high and intermediate exposure zones were later merged together due to similarity of effects. Exposure effect modification by age, gender and socioeconomic status (SES) was also tested. Results: Living within 10 km from SIZ showed greater association for ARD (RR: 2.5; 95% CI: 2.3-2.7), asthma (RR: 3.7; 95% CI: 3.1-4.5), conjunctivitis (RR: 3.1; 95% CI: 2.9-3.5) and dermatitis (RR: 2.7; 95% CI: 2.5-3.0) when compared to the control zone, for the population of <20 years. For the population of ≥20 years, these risks were: (RR: 2.0; 95% CI: 1.9-2.2), (RR: 3.6; 95% CI: 3.0-4.4), (RR: 2.8; 95% CI: 2.5-3.2) and (RR: 2.1; 95% CI: 1.9-2.4), respectively. Greater exposure effects were observed amongst ages ≥50 years and lower SES groups in the ≥20 years group. Models showed no differences between the gender groups. Conclusion: This is the first study conducted in Oman examining the adverse health effects on the population living near SIZ. We hope that these findings will contribute to building up an evidence-based environmental and public health policy in Oman.

This study examined the strength of association between food workers and food to norovirus in comparison to bacteria associated with foodborne-related gastroenteritis by whether norovirus had a direct (physical evidence), indirect (statistical evidence), or suspect (neither of the two) association with food or food handlers. The Centers for Disease Control and Prevention considers norovirus to cause the largest number of foodborne-related gastroenteritis cases in the United States. The association of norovirus with foodborne outbreaks through its information data collection form focuses on the food worker as the typical source. Yet, many outbreaks are not foodborne in nature. The gap in the research is the evidence supporting the theory that norovirus transmission is the same as bacterial transmission. A secondary data anaylsis was conducted on the data from the electronic Foodborne Outbreak Reporting System between 1998 and 2006. An odds ratio analysis showed no similarity between proportion of the implicated and nonimplicated numbers of outbreaks from norovirus and those from Salmonella. The odds ratios also showed a stronger similarity between proportions of food handler implicated outbreaks from norovirus than from Salmonella. An analysis showed, though, a significant emphasis was not placed on the food handler but on other indirect routes of transmission of norovirus in outbreaks. The analysis also indicated that norovirus transmission was not mainly through food. Norovirus transmission appeared to be through person-to-person rather than food and had more similarities with pandemic influenza than gastroenteritis-associated bacteria. A change in approach to norovirus by local, state, and federal agencies could have social change implications for prevention, surveillance, and public health programs to reduce infection and outbreaks.

Throughout the relevant literature, research addressing the impact of a specific environmental factor, such as snowfall, on injury patterns or severity among alpine skiers and snowboarders is sparse. The foundation for inquiry into this relationship was developed based on principles of physics and traumatology coupled with findings in the available literature. Secondary analysis of trauma registry data coupled with daily snowfall measurements from one of the largest ski areas in North America illustrated a negative correlation between daily snowfall amount and injury severity (r = -.08). Concordant findings demonstrated an increased odds of sustaining an injury defined as severe or critical according to Injury Severity Score (ISS) classification when there was less than two inches of fresh snowfall (OR = 3.9; 95% CI[1.06, 16.69]). Additionally, utilizing the Abbreviated Injury Scale (AIS), a regional anatomical finding illustrated that in the absence of recent snowfall, there was an increased odds of sustaining a thoracic injury defined as severe in this patient population (OR = 10.4; 95% CI[1.62, 66.9]). Secondary research considerations detailed the variances in injury severity resulting from a collision when compared to a fall and the predilection for skiers to sustain increased lower extremity injuries when compared to snowboarders. Findings from this project may lead to positive social change as the increased understanding of predictive factors contributing to injury can be directly applied to further the current understanding of trauma care in this patient population. The benefits from this work may also extend to the public health arena through enhanced educational opportunities for skiers and snowboarders as well as enhanced resort safety initiatives tailored to the ambient conditions.

No description available.

<strong>Background</strong>: The rate of maternal death from sepsis has increased in several European countries, most notably the UK, where sepsis is now the leading cause of direct maternal death. An increase in maternal mortality also implies an increase in the number of women with severe, life-threatening morbidity. Key information gaps in the understanding of severe maternal sepsis in the UK are: the incidence, main causative organisms, infection sources, and risk factors for severe maternal sepsis. <strong>Methods</strong>: Four population-based observational studies were conducted to address these evidence gaps. <strong>Results</strong>: The incidence of severe maternal morbidity from sepsis is increasing in the UK, a trend also evident in the USA. The most common sources are respiratory tract, genital tract and urinary tract infection. The predominant organisms causing infection are E. coli, group A streptococcus, and strong circumstantial evidence of Streptococcus pneumonia. Sepsis progresses very rapidly particularly with group A streptococcal infection. Approximately 20% of women with severe sepsis progress to septic shock and 2% of women die. Risk factors for severe maternal sepsis in the UK with a large effect size are: febrile illness or antibiotics in the 2 weeks prior to onset of severe sepsis (aOR=12.1, 95% CI 8.1-18.0), caesarean section after the onset of labour (aOR= 8.1, 95% CI 4.7-14.0), multiple pregnancy (aOR= 5.8, 95% CI 1.5-21.5), infection with group A streptococcus (aOR=4.8 for progression to septic shock, 95% CI 2.2-10.8), pre-labour caesarean section (aOR= 3.8, 95% CI 2.2-6.6), low socioeconomic status (aOR=2.6, 95% CI 1.03-6.7), and operative vaginal delivery (aOR=2.5, 95% CI 1.3-4.7). Risk factors are significantly cumulative. <strong>Conclusions</strong>: Infection prior to or after delivery, even if the woman appears to be well, should be a marker for close clinical monitoring. Suspicion of group A streptococcus should be regarded as an obstetric emergency and treated ahead of laboratory confirmation.

This thesis describes the development of the idea of an 'obesity epidemic' that figures prominently in contemporary public health discourse. It uses conceptual approaches from Science and Technology Studies and the history of medicine to analyse changing ideas about obesity, particularly as formulated and mobilised by British researchers from the 1960s onwards, to show how excess body weight became understood as a significant public health problem in this period. The thesis begins by describing the post-war refocusing of medical attention in developed countries from infectious diseases, the rates of which are falling, to chronic disease such as heart disease, diabetes, cancer and stroke. Heart disease, in particular, became seen as an 'epidemic'. After World War II, increase research funding by the American government made possible the development of a new research method - the long-term prospective epidemiological study - and a new way of understanding chronic diseases as caused by risk factors such as high blood pressure, cigarette smoking and high blood cholesterol. Excess body weight was includes in this list of risk factors, and so became an object in increased medical attention. The thesis then outlines how a new public health coalition was formed around obesity in the 1970s by British biomedical researchers working on topics in the fields of nutrition, diabetes and coronary heart disease. It describes the development of what I call the 'individual paradigm' of obesity which characterises the condition as an individual problem that leads to heart disease and mechanical complaints and is treatable by weight loss diets. It then describes two key features of British obesity science in the 1980s and 1990s. The first of these is the adoption of the Body Mass Index and the standard cut-off points that are used to define overweight and obesity, which together facilitate the collection and dissemination of data on changes in average body weights, The second is the energy balance model of weight regulation, which served to unify the diverse disciplinary approaches to biomedical research incorporated into this new knowledge, but which could not account for the high rates of failure acknowledged as occurring with conventional treatments such as weight loss diets, anorectic drugs and bariatric surgery. The thesis describes how researchers in the field of obesity science than extended their institutional research to participate in the production of a series of reports for the World Health Organization, including one on the global epidemic of obesity published in 2000. This new platform, combined with data produced by prospective studies, enabled them to disseminate a new understanding of obesity and overweight - what I call the 'environmental paradigm' - which characterises it as a global health problem associated with an increased risk of many diseases and caused by structural factors such as inappropriate diet and sedentary lifestyles. Despite refocusing attention of structural determinants of ill health, however, public health experts were constrained by considerations of political practicality and commercial interest when calling for preventive measures in the areas of diet and physical activity. The thesis concludes by considering the different ways in which scholars have theorised the epidemiological transition from infectious to chronic disease. Drawing on approaches from the health inequalities literature, it argues that the conventional framings of chronic disease epidemiology have tended systematically to obscure structural links between obesity and other forms of diet-related ill health on the one hand, and relative poverty on the other.

<p>Adekvatni nadzor nad zaraznim bolestima predstavlja aktuelni izazov ne samo kod nas već i u razvijenim zemljama. Savremeni epidemiolo&scaron;ki nadzor nad zaraznim bolestima zasniva se na odgovarajućim definicijama slučaja. Njihova osnovna funkcija je olak&scaron;avanje prepoznavanja određenih bolesti i njihovo registrovanje na jednoobrazan način. Definisanje slučajeva zaraznih bolesti nije jednostavno, jer uključuje kliničke, epidemiolo&scaron;ke i laboratorijske parametre, uz istovremeno očekivanje visoke senzitivnosti i specifičnosti. Ciljevi istraživanja su bili da se utvrdi primenljivost definicija slučaja hepatitisa B i C na Klinici za infektivne bolesti Kliničkog centra Vojvodine, te da se utvrdi senzitivnost i specifičnost primenjenih definicija slučaja hepatitisa B i C. Uz postojeći dijagnostički algoritam Klinike za infektivne bolesti Kliničkog centra Vojvodine, uvedena su tri seta definicija hepatitisa B i C: Evropskog centra za prevenciju i kontrolu bolesti (ECDC) iz 2008. i 2012.godine kao i američkih Centara za kontrolu bolesti (CDC) iz 2012. godine. Istraživanje je sprovedeno na Klinici za infektivne bolesti Kliničkog centra Vojvodine i tokom 12 meseci, u skladu sa predloženim definicijama slučaja, identifikovano je 150 ispitanika obolelih od hepatitisa B i C. Utvrđene su sledeće činjenice: preporučene definicije slučaja su primenljive u Republici Srbiji za laboratorijske i kliničke kriterijume, dok uključivanje epidemiolo&scaron;ke povezanosti u definicije slučaja ima malo praktičnog značaja za prijavljivanje hepatitisa; definicije slučaja koje uključuju i obavezno prisustvo kliničkih kriterijuma (najče&scaron;će definicije verovatnog slučaja) imaju nisku senzitivnost, a visoku specifičnost, kao posledica prisustva infekcije i u odsustvu bilo kakvih kliničkih manifestacija; definicije slučaja koje se zasnivaju samo na laboratorijskim kriterijumima imaju maksimalnu senzitivnost i specifičnost.</p> / <p>Adequate surveillance of communicable diseases is the actual challenge, not only in our country but also in developed countries. Modern epidemiological surveillance of communicable diseases is based on the appropriate case definitions. Their main purpose of them is to facilitate the recognition of certain diseases and their registration in a uniform manner. Case definition of communicable diseases is not easy, because it involves clinical, epidemiological and laboratory parameters, along with the expectated high sensitivity and specificity.The objectives of the study were to determine the applicability of the casedefinitions for hepatitis B and C in the Clinic for Infectious Diseases of the Clinical Center of Vojvodina and to determine the sensitivity and specificity of the applied definition of cases of hepatitis B and C. In addition to existing diagnostic algorithm of the Clinic for Infectious Diseases, three sets of hepatitis B and C case definitions were introduced: the European Centre for Disease Prevention and Control in 2008 and 2012 as well as the US Centers for Disease Control in 2012. The study was conducted at the Clinic for Infectious Diseases Clinical Center of Vojvodina over 12 months, and in accordance with the proposed case definitions, 150 patients suffering from hepatitis B and C were identified. We found following facts: recommended case definitions are applicable in the Republic of Serbia for laboratory and clinical criteria, while the inclusion of epidemiological connection between the case definition has little practical significance for reporting hepatitis; case definitions that include the obligatory presence of clinical criteria (most common definition of probable cases) have low sensitivity and high specificity, as a result of the presence of infection in the absence of any clinical manifestations; case definitions that are based solely on laboratory criteria showed maximum sensitivity and specificity.</p>

Background: The most recent estimate for the number of Australians living with chronic hepatitis B virus (HBV) infection is 150,000, with over one million ever having been infected. One in four people with chronic infection will die as a result. Worldwide, the burden of chronic HBV infection is great. As many as 400 million people are chronically infected, and the World Health Organisation estimates that as a result HBV infection is the tenth leading cause of death. / Aim: The aim of the research presented in this thesis is to improve the accuracy and relevance of our understanding of the epidemiology and control of HBV infection in Australia, through the development of new methodological approaches to the collection and analysis of relevant epidemiological data. / Methods: Three novel approaches were adopted. First, a serosurvey of a randomised, age-structured convenience sample of over 3200 specimens was performed spanning the period from 1995 to 2005 to estimate the prevalence of markers of infection with, and immunity to HBV. Secondly, a comparative analysis of the serosurvey results with national surveillance notifications since 1971 and migration records since 1945 was undertaken. Finally, a complex deterministic mathematical model of HBV infection in Australia was constructed simulating the entire population between 1951 and 2050. / Results: The serosurvey indicates that chronic infection with HBV is more common in the Victorian population than existing national serosurvey estimates suggest, and the coverage of immunisation programs (particularly of adolescents) is far from universal. Significant geographic, age, and gender disparities in the prevalence of chronic HBV infection were identified in the serosurvey, which appear in part to relate to historical migration patterns and which could be used to develop a targeted and effective public health response. The comparative analysis of the serosurvey results with notifications and migration data demonstrates coherence of these disparate sources of information, and suggest that knowledge of migration patterns can lead to robust predictions of future notifications. The novel regression model developed implies that at least 50,000 people with chronic HBV infection are undiagnosed. The mathematical model of HBV infection in the Australian population is unique in many respects, and has been validated against external data to provide reassurance regarding the accuracy of the simulated outcomes. Some of these outcomes include an estimated 160,000 Australians living with chronic HBV infection in 2009, increasing by several thousand people every year, and that less than 5 per cent of chronic infections entering the population are able to be addressed by domestic vaccination or other prevention programs. / Conclusion: The new insights into the epidemiology of HBV infection in Australia provided by the approaches described all suggest a large and increasing burden of chronic HBV infection. New approaches are needed to provide essential policy outcomes to assist and empower Australians living with chronic HBV infection. If this does not occur, the economic and human costs to our community are likely to become great.

While research has indicated that impaired mental health partially mediates the relationship between adverse childhood experiences (ACEs) and alcohol and illicit drug use, little research has examined potential mediators in the relationship between ACEs and smoking, the number one cause of preventable mortality in the United States. Accordingly, this study examined the potential mediating effect of psychological distress on the relationship between ACES and smoking using data from Wave II of the ACE Study, a cross-sectional study completed between June and October of 1997 on a sample of adult health maintenance organization members (N = 7,211). The theoretical underpinnings for this study were grounded in the developmental psychopathological perspective which examines both environmental and biological influences as they interact to promote or impede social, emotional, and behavioral development. Mediation modeling employing both linear and logistic regression techniques indicated that, after adjusting by select covariates, psychological distress (as assessed using the SF-36 Mental Component Summary score) partially mediated the relationship between several of the ACEs examined and smoking in women. These same relationships were not found in men. This research contains several key findings with social change implications. First, additional research should be conducted to examine the causes, developmental paths, and critical points that link ACEs and psychological distress to smoking among women. Second, given the gender differences in the association between ACEs and smoking, gender-specific intervention programs that build resiliency, increase positive social support, and provide tools for developing alternative coping strategies may be important adjuncts to smoking cessation programs, particularly for women with a history of ACEs.