Submitted by Natalia Vieira (natalia.vieira@famerp.br) on 2016-05-30T21:52:31Z No. of bitstreams: 1 lucianasouzajorge_dissert.pdf: 1193713 bytes, checksum: 87fe8f7c70497cf298249a806a3219b4 (MD5) / Made available in DSpace on 2016-05-30T21:52:31Z (GMT). No. of bitstreams: 1 lucianasouzajorge_dissert.pdf: 1193713 bytes, checksum: 87fe8f7c70497cf298249a806a3219b4 (MD5) Previous issue date: 2005-07-04 / Since the 1970´s Group B Streptococcus (GBS) or Streptococcus agalactiae has been considered the leading cause of early-onset neonatal disease. Even after the adoption of strategies for intrapartum antimicrobial prophylaxis (IAP) in the 1990´s, it has been observed GBS to be responsible for approximately 70% of neonatal mortality. The objective of this study was to establish prevalence of GBS colonization among pregnant women and parturients treated at Hospital de Base de Sao Jose do Rio Preto and the perinatal factors of risk related to maternal colonization. A descriptive and retrospective study was carried out. One hundred and twenty-two patients (pregnant women and parturients) selected for risk factors were submitted to collection of vaginal and rectal swabs which were then inoculated to specific Todd-Hewitt broth used to GBS identification. Statistical analysis of data was performed using logistic regression and Pearson 2 test or Fisher´s test, as appropriated. Prevalence of GBS maternal colonization was 24.6%, revealing statistically significant evidence among women with school education between 8 and 11 years (p=0.029) and those referring having had previous infant born with neonatal disease (p=0.025). The prevalence of GBS colonization of patients admitted at the studied Hospital Obstetrics Department points out the necessity for the institution to have an IAP protocol in order to avoid indiscriminate use of antimicrobial therapy for newborns admitted at the Neonatal Intensive Therapy Unit (NITU) and reduce the rate of neonatal morbidity and mortality. / Desde a década de 70, o Streptococcus do Grupo B (SGB) ou Streptococcus agalactiae é considerado a principal causa de doença neonatal precoce. Mesmo com a padronização de estratégias de profilaxia antimicrobiana intraparto (PAI) nos anos 90, tem sido verificado que o SGB é responsável por aproximadamente 70% de mortalidade neonatal. O objetivo deste estudo foi conhecer a prevalência da colonização por SGB entre gestantes e parturientes atendidas no Hospital de Base de São José do Rio Preto e os fatores de risco perinatais envolvidos na colonização materna. Foi realizado um estudo descritivo e retrospectivo em 122 gestantes ou parturientes incluídas por fatores de risco, as quais foram submetidas à coleta de material vaginal e anal, inseridos posteriormente ao caldo de crescimento específico Todd-Hewitt, que é utilizado para identificação dos SGB. A análise estatística dos dados foi realizada por regressão logística e pelo teste de quiquadrado Pearson ou teste de Fisher, quando recomendado. A prevalência de colonização materna por SGB foi de 24,6%, mostrando evidência estatisticamente significante entre mulheres com grau de escolaridade entre 8 a 11 anos (p=0,029) e que referiram história de filho anterior com doença neonatal (p=0,025). A prevalência da colonização por SGB entre gestantes e parturientes atendidas no serviço de obstetrícia no hospital estudado mostra a necessidade da instituição de um protocolo de PAI, a fim de evitar a utilização indiscriminada de antimicrobianos para recém nascidos admitidos na Unidade de Terapia Intensiva Neonatal (UTIN) e reduzir as taxas de morbidade e mortalidade neonatal.

1,708 members of the Australian Infection Control Association were surveyed to describe the practices of Australian infection control practitioners. The study details the methods infection control practitioners use to co-ordinate and measure nosocomial infections as clinical outcomes of Australian infection surveillance and control programs. Administrators' and clinicians' perceptions of the elements and infrastructure of infection surveillance and control programs and the role of the infection control were measured in 316 hospitals in New South Wales, Australia. A literature review found that the development of Australian infection surveillance and control programs is behind that of U.S.A and the United Kingdom. The survey of the infection control practitioners identified that their role and duties varied between facilities as did the time allocated to infection control tasks. The survey of infection control practitioners demonstrated variation in their levels of skill, education and experience. Infection control practitioners' use and application of evidence and associated skills was examined and found to be limited in relation to clinical decision making and policy development. The survey also examined the methods infection control practitioners use to undertake surveillance of nosocomial infections. The methods reported indicated non-standard approaches to surveillance activity. A survey of administrators and clinicians in NSW hospitals was undertaken to identify variation in administrator and clinician perceptions and to describe their level of support for recommended essential infrastructure and criteria for infection surveillance and control programs and the role of the infection control practitioner in accordance with Scheckler's model. The survey indicated divergent views regarding the role of the infection control practitioner and the essential elements of infection surveillance and control programs. The study identified that education of infection control practitioners is necessary to facilitate standard approaches to co-ordinating infection surveillance and control activity. The development of Australian infection surveillance and control programs require a strategic alliance between stakeholders. to define essential elements of infection surveillance and control programs. In addition, the role of the infection control practitioner must be defined before key stakeholders can agree on the minimum skills, qualifications and experience required by an infection control practitioner.

Background: Historically, most refugees have originated from countries with high rates of infectious diseases. However, non-communicable diseases are becoming increasingly more common in refugee populations resettling in the United States. Purpose: Examine the prevalence of selected chronic conditions among newly arriving adult Cuban refugees and compare the results to the prevalence of the same chronic conditions among the other top five incoming refugee populations: Burmese, Bhutanese, Iranians, Iraqis, and Somalis Methods: Data used in this study were derived from the Department of State’s Medical History and Physical Examination Worksheet and included all adult (≥20 years) Cuban, Burmese, Bhutanese, Iranian, Iraqi, and Somali refugees identified through the Center’s for Disease Control and Prevention Electronic Disease Notification Center, and who entered the United States during October 2008-September 2011. Data were analyzed using SPSS version 19.0. Descriptive statistics, chi-square analysis, and logistic regressions were performed to assess the prevalence of chronic conditions, check for associations between country of origin and outcome of interest, and to estimate the relative risk for Cubans compared to the remaining top five incoming refugee populations. Results: A total of 99,920 adults were included in the study. The largest population was Iraqi (27.6%), followed by Bhutanese (26.2%), Burmese (24.4%), Iranian (8.6%), Cuban (7.9%), and Somali (5.3%). All outcomes of interest were significantly associated with country of origin. Cubans were at a greater risk for asthma but were not the greatest at-risk population for the remaining outcomes of interest. Conclusion: The prevalence of non-communicable diseases was higher among the incoming refuges than has been traditionally assumed. These findings point to the need for a better understanding of the health status of refugee populations and the development of culturally appropriate health programs that include education on prevention and treatment of chronic conditions.

Human Immunodeficiency Virus (HIV)-associated stigma is pervasive throughout the world. This stigma affects the ability of HIV-positive individuals to cope with their illness and it also affects behaviors around sexual practices, disclosure to others and the use of healthcare. The purpose of the research project was to examine the experience of internalized stigma among HIV-positive persons and their perceptions of stigmatizing attitudes in the community. The study also examined disclosure of HIV serostatus and identified factors contributing to disclosure and stigma in Senegal, a low prevalence Muslim country in West Africa. A cross-sectional study was conducted at Centre Hospitalier Universitaire de Fann in the form of a structured interview using a newly developed stigma instrument. The interviews were carried out in French and/or Wolof and the participants were interviewed during a routine visit to Fann Hospital. 15 men and 28 women aged between 19 and 55 years participated in the study. The mean period of time since diagnosis was 3.6 years (+/- 2.5 years). The stigma instrument showed a mean internalized stigma score of 5.4 +/- 3.5 (maximum score: 15) and an even higher level of perceived stigmatizing attitudes in the community of 7.9 +/- 4.8. Males had greater stigma scores than females. Almost 80 percent of the people interviewed had received some counseling, yet less than two-thirds of the study participants had disclosed their HIV status to others. People who had disclosed their HIV status used counseling less. The majority of subjects reported positive experiences with healthcare personnel in the Infectious Diseases Clinic of Fann Hospital. The level of internalized stigma and the perception of stigmatizing attitudes in the community are high with males experiencing more guilt. About three-fifths of the participants in the study had not disclosed their HIV status to even one other person; men disclosed their serostatus more frequently than women. Women were more likely to use counseling services compared to their male counterparts, and individuals who had disclosed their serostatus attended counseling less. Finally, despite the level of stigma perceived, the majority of people interviewed reported positive experiences with healthcare workers.

Isolation of those ill with contagious disease has been a fundamental infection control concept for hundreds of years. However, recent studies suggest that fewer than 50% of health—care workers comply with their hospitals' isolation precaution policies and that efficacy of some of those policies is questionable. In response, two new systems, based upon fundamentally different goals, were promoted. The Centers for Disease Control, prompted by health—care worker& concerns about occupational risk of human immunodeficiency virus (HIV) from a growing number of patients with acquired immunodeficiency disease syndrome (AIDS), issued formal guidelines in 1987. This formed the basis for Universal Precautions (UP), a unifying strategy for precautions with all patients regardless of diagnosis intended to reduce risk to hospital staff members. Also in 1987, one hospital issued guidelines for Body Substance Isolation (BSI), hygienic precautions to be used with all patients based on recognition that colonized body substances are important reservoirs for cross—infection to both patients and staff members. These new strategies have been promoted widely, but there have been no formal assessments to reconcile controversies they raised nor to confirm their effectiveness. Further, necessary assessment tools have not been validated. This thesis provides new tools and new information to address three vital questions: Have hospitals adopted Universal Precautions or Body Substance Isolation? Do their staff members use the new system of precautions in daily practice? Has reliable use of a new system led to decreased risk of infection? A confidential mailed survey of all acute—care Canadian hospitals was conducted to measure rates of guideline receipt and adoption. It also obtained information on motivations for and perceived effectiveness of strategies adopted. A self—selected group of responding hospitals subsequently participated in standardized covert observation of their nurses infection control practices, then had the observed nurses complete a test examining their knowledge and beliefs. Employee health records were also examined to determine whether needlestick injury rates had changed since adoption of a new infection control strategy. Most Canadian hospitals adopted and modified new strategies based upon reasonable but unproven extensions of logic to protect health—care workers from HIV. 74% claimed UP (65%) or BSI (9%) but only 5% of 359 claiming UP and 0 of 50 claiming BSI adopted all policies expected. Many hospitals had not received key guideline publications. Guideline source, hospital size, and other variables were significantly associated with receipt. Nurses in 35 hospitals were observed to wear gloves during only z60% of procedures in which gloving was expected; rates varied widely among hospitals. Direct examination of sharps disposal containers confirmed compliance with a policy to not recap used needles (taken as recapping rate of 25%) in only 47% of 32 hospitals. Paired analysis of needlestick injury rates in 11 hospitals during comparable 90—day periods before versus after implementing UP/BSI showed no significant difference. 489 nurses completing a written test achieved their highest scores and least discordance among questions regarding procedural issues established long before UP/BSI, and lower scores or greater discordance on UP/BSJ concepts of philosophy, risk recognition and newer procedures. Positive correlation between knowledge and practice was not evident. UP and BSI now mean different things in different hospitals and have not been effective in harmonizing health—care workers’ infection control practices. Carefully standardized assessment methods are needed to guide their evolution to cost—effectiveness.

Thesis (M. Arch.)--Carleton University, 2004. / Includes bibliographical references (p. 89-90). Also available in electronic format on the Internet.

Thesis--University of Michigan, 1946.

Thesis (Ph.D.)--Michigan State University. Dept. of Anthropology, 2008. / Title from PDF t.p. (viewed on July 2, 2009) Includes bibliographical references (p. 145-166). Also issued in print.

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Thesis (M.P.H.)--University of Michigan, 1946.