Objective: To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans. Setting: Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA). Participants: Post-9/11 veterans with at least 3 years of VA care. Design: Cross-sectional, retrospective, observational study. Main Measures: International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory. Results: Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination. Conclusions: There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.

No description available.

Acute gastroenteritis (AGE) is a global public health problem causing considerable morbidity and mortality among infants and children, especially in low-income settings. Viruses including group A rotaviruses (RVA), noroviruses (NoV), adenoviruses (AdV), sapoviruses (SaV) and astroviruses (AstV) are widely acknowledged to be the most common cause of AGE in children. The importance of newly recognised viruses such as human bocavirus (HBoV) as an aetiological agent of AGE is becoming increasingly evident. The aim of this study was to investigate the molecular epidemiology of HAdV and HBoV in children aged ≤5 years hospitalised for AGE in South Africa (SA) from April 2009 to April 2015. Clinical and demographic data, along with stool specimens were collected from hospitalised children who presented with AGE. Real-time polymerase chain reaction (PCR) was used to screen for the presence of enteric DNA viruses. Genotyping was achieved by nucleotide sequence analysis or multiplex PCR. Whole genome sequencing was performed on selected strains to characterise their genetic variation and evolution. Between April 2009 and December 2014, the prevalence of HAdV in hospitalised children with AGE in SA was 18.1% (656/3623); 62.3% of the HAdV_positive children were 7–24 months of age. Human AdV was detected year round. Co-infections were found in 76.3% (222/291) cases of the HAdV_positive specimens with full enteric screening and AstV was detected most frequently as a co-infecting pathogen. Prolonged hospital stay was observed in human immunodeficiency virus (HIV)-infected children with HAdV. Human AdV-F was the most common species identified (254/603, 42.1%), with almost equally distribution of -40 and -41. Recombination breakpoints of the five HAdV41 strains varied in the number and location, indicating different evolution origins. Between April 2009 and April 2015, the prevalence of HBoV in hospitalised children with AGE in SA was 5.6% (212/3765); the majority of which were from children ≤2-year of age (92%, 195/212). Viral co-infections were found in 67% (142/212) of HBoV cases, while in fully screened specimens (virus, bacteria and parasites), 83.1% (74/89) had evidence of co-infections. In all co-infections, only HAdV was significantly associated with HBoV (adjusted Odds Ratio (aOR))=1.68; (95% CI 1.10-2.52; p=0.015) in multivariate analysis. Human BoV infections were reported throughout the year. All four HBoV genotypes were detected with HBoV1 being the most prevalent (79.6% (152/191). The variation in total number of specimens screened for HAdV and HBoV is because HAdV screening was done until December 2014; while HBoV screening was done until April 2015. The current study highlights the genetic diversity of HAdV-40 and -41 strains circulating in SA and suggests possible evolution from inter-strain recombination. Furthermore, the present study highlights the wide spectrum of HBoV genotypes in children with AGE in SA. This study presents the most comprehensive recent data on HAdV diversity in SA, and new baseline data on a HBoV-associated gastroenteritis in a country where no previous report is available. / Thesis (PhD (Medical Virology))--University of Pretoria, 2019. / Medical Virology / PhD (Medical Virology) / Unrestricted

Asthma is a chronic airway inflammatory disease that is characterized by reversible airway obstruction due to hyper-responsiveness of the tracheobronchial tree. The condition disproportionately affects male children, females, and the aged globally, and its prevalence keeps rising despite being a preventable condition in terms of relapse. Most asthmatic patients receive care in primary care settings. Various health agencies have developed asthma management guidelines to improve the quality of asthma care; however, in some cases, adherence to these guidelines is substandard. The overarching aim of this study was to determine whether primary care providers manage asthma in line with the available guidelines. A qualitative systematic review was conducted by searching for journal articles published between 2005 and 2016 relating to guideline use in primary care management of asthma. Twenty-nine primary studies evaluating adherence to asthma management guidelines were included. The collected data were analyzed through thematic data analysis techniques, and various themes emerged with regard to the research questions. Generally, the findings suggest that there is a mismatch between what is needed by patients/caregivers and what is currently provided by primary care providers (PCPs) in primary care settings and that asthma management guidelines are only partially followed or not used. Emerging themes were classified into 3 main categories: physician-, patient-, and institution-related barriers. The study provides recommendations on how adherence to asthma management can be improved.

Passed in 1985, the Texas Education Code (TEC) §38.003, Screening and Treatment of Dyslexia and Related Disorders, required public school districts and charters to identify and provide remediation services for students with dyslexia. While Texas was the first state to pass such a requirement, the question remains: What is the prevalence and proportionality of dyslexia in Texas public school districts and charters? In Phase 1 of this study, a secondary analysis using point prevalence and disproportionality calculations was conducted to analyze the impact of this more than 30-year-old law. In order to better help understand these findings, semi-structured interviews with district leaders were conducted in Phase 2 to gain insight on how students were identified with dyslexia across the state. The results of Phase 1 showed the estimated prevalence of dyslexia in Texas public school districts and charters to be low in comparison to the literature. Additionally, the findings suggested a discrepancy in identifications between gender and district type (public school versus charter) and across racial and ethnic groups. Meanwhile, the results of Phase 2 revealed that leadership, support, funding, and accountability impact dyslexia identifications. This study emphasizes the need to further explore and analyze how to best identify and service all students with dyslexia, regardless of gender, race and ethnicity, district type, and geographical location.

Immigrants are an important part of Canada and Canadian culture. Despite a large number of immigrants in Canada relatively few studies have focused on disability and immigrants. Even less research has been conducted on immigrants with visual impairments. The first paper uses the Participation Activity Limitation Survey (PALS) from 2006 to examine the prevalence of vision impairment in immigrants compared to non-immigrants, 50 years of age and over. First, descriptive statistics were used to determine the prevalence rate of vision impairment. Then, multivariate logistic regression was utilized to examine differences in providers of support and characteristics of individuals who receive support. Results disclosed that there was no difference in the prevalence rates of adult immigrants and non-immigrants over 50 years of age when controlling for age and gender. Results confirmed that there is a relationship between having a vision impairment and living in a low income household. Results also showed that receiving support is linked to severity of impairment. The second paper used qualitative analysis to examine visually impaired immigrants’ perception of vision impairment and disability and if perception influenced utilization of care. Qualitative semi-structured interviews were conducted with 8 clients of the Canadian National Institute for the Blind (CNIB). Results showed that immigrants’ employ three different views when explaining their impairment, these were; the medical view, social view and theological/ traditional view. All participants used two or more views interchangeably demonstrating that all views are important in understanding how immigrants perceive and navigate their impairment on an everyday basis. Results also suggested that negative perceptions did not keep most immigrants from accessing services; however, traditional barriers such as not being eligible to receive services and transportation were main barriers. / Thesis / Master of Arts (MA)

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to evaluate the status of a sample of children ages 6 to 36 months with regard to prevalence of tooth decay in a community with an optimum fluoridated water supply. It was determined whether a relation existed between these data and the socioeconomic level of the family. One hundred and fifty children ages 6 to 36 months born and reared in Marion County, Indiana were examined with a dental mirror, explorer and a portable light. Parents/legal guardians of these children were given a questionnaire to obtain family history. Caries prevalence for children ages 6 to 12, 13 to 18, 19 to 24, 25 to 30, and 31 to 36 months were 4%, 0%, 22%, 23%, and 26%, respectively. Age, mother's educational attainment, and Medicaid experience remained significant predictors of caries experience: the odds of caries were 1.1 times for each monthly increase in age. Gender, father's educational attainment, family household income, and single parent status remained marginally significant predictors of caries experience. Results for similar correlation studies between caries prevalence and socioeconomic status for children ages 6 to 36 months are inconsistent. Further research is needed for children ages 6 to 36 months. Caries experience begins before age one. Patients, parents, and health care professionals need to be aware that the caries process begins at an early age, and prevention should begin as early as 6 months of age.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24537号 / 社医博第129号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 近藤 尚己, 教授 山本 洋介 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

HIV/AIDS is considered the deadliest epidemic in the 21st century and has proved to be of major public health importance. Per the 2000 Zambia census, the people affected by HIV/AIDS constituted 15% of the total population, amounting to one million, of which 60% were women. Previous studies have identified sexual contact, significant exposure to infected body fluids or tissues, mother to child transmission during pregnancy, delivery, or breastfeeding as leading ways of transmission. The purpose of this study was to determine the socioeconomic factors that affect the prevalence of HIV in Zambian women. This research will help to provide more insight into this topic and aid in identifying areas that could be targeted by future intervention strategies to reduce the HIV burden. We used a cross-sectional study based on data from the 2018 Zambia Demographic and Health Survey (ZDHS). Secondary data analysis was conducted based on data for women aged 15-50 years (n=14922). Factors predicting HIV prevalence such as the age of household members, current marital status, place of residence, and the highest educational level attained were included in the analysis. Outcome variables included the result of determine HIV1/2 RDT and unigold HIV1/2 RDT. Descriptive, bivariate, and multivariate analyses were performed on all variables. Bivariate analysis was performed to determine the relationship between each predictor variable and HIV prevalence in women, using a chi-square test. Multivariate logistic regression analysis was performed using HIV test results and all predictor variables, odds ratio, confidence intervals, and P-value were reported. The prevalence of HIV in women aged 15-50 in Zambia was 9.9% in the study sample. Overall, our analysis showed that being aged 35-50 (4.7%), residing in an urban setting (6.53%), being married (6.1%), and having attained at least secondary education (4.68%) were associated with a higher HIV prevalence. All relationships were significant in the chi-square analysis at the p

INTRODUCTION: There is uncertainty in the prevalence of chronic non-cancer pain (CNCP) in military veterans. A systematic review and meta-analysis was conducted to elucidate this issue, and examine potential effect modifiers of CNCP prevalence. Additionally, chronic pain is a pervasive and debilitating condition that disproportionately affects military veterans. We recently completed a qualitative study of Canadian veterans living with chronic pain to identify their research priorities; however, the generalizability of our findings was uncertain. METHODS: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science were searched from 2013 to January 21, 2021, for observational studies reporting “chronic pain” or pain ≥ 3 months in military veterans. The random-effects meta-analysis was used for pooling data, the Grading of Recommendations, Assessment, Development and Evaluations approach was used for rating quality of evidence, and the Instrument to Assess the Credibility of Effect Modification Analyses was used to rate credibility of the subgroup analyses. Furthermore, from January to March 2021, we emailed a 45-item cross-sectional survey to a list of Canadian veterans that asked about the relative importance of 20 research priorities regarding chronic pain. We explored for statistical significance between male and female responses for any item in which the proportion of endorsement showed a ≥10% difference. RESULTS: 41 observational studies with 5,550,375 military veterans were included. The overall pooled CNCP prevalence is 34% (95% confidence interval (CI) 25% to 45%). However, significant subgroup effect was found for type of prevalence measure (generic or specific) among military veterans (test of interaction p=0.007, moderate subgroup credibility): the pooled generic CNCP prevalence of 43%, 95% CI 29% to 57% (Low-certainty evidence) vs. the pooled specific type of CNCP prevalence of 14%, 95% CI 6.7% to 23% (Moderate-certainty evidence). A multivariable meta-regression model adjusted for proportion lost to follow-up found the type of prevalence measure to be the only significant predictor of CNCP prevalence (p < 0.0001). 313 of 699 Canadian military veterans living with chronic pain completed ≥50% of the survey (45% response rate). Respondents were predominantly male (77%) with a median age of 52 (interquartile range [IQR] 44-58). All 20 research priorities listed in the survey were endorsed as very important by ≥52% of respondents, and three received endorsement by ≥85%: (I) optimizing chronic pain management after release from the military; and (II) identifying and (III) treating mental illness among veterans living with chronic pain. Women were more likely than men to endorse research on post-surgical care for chronic pain prevention or research on holistic care for chronic pain. Men were more likely than women to endorse research on physical activity or exercise for chronic pain. Individuals with higher gross income (≥$80,000) were less likely to endorse research into physiotherapy for chronic pain, or chiropractic for chronic pain compared to those with lower gross income. Individuals with greater age are less likely to endorse research on medical cannabis for chronic pain. CONCLUSIONS: The overall prevalence of CNCP is 34% among military veterans. For generic CNCP, the prevalence is 43%; for a given subtype of CNCP, the prevalence is 11%. Methodologically robust studies are required to more precisely determine CNCP prevalence. The most salient research priorities among our respondents were optimizing chronic pain management during service and after discharge from the military, including co-morbid mental illness. Differences in gender, gross income, and age are implicated in the endorsement of therapy-related priorities, which include surgery, physical activity or exercise, chiropractic, and medical cannabis. Our findings provide insight into the research priorities of Canadian military veterans living with chronic pain. These findings should be considered by granting agencies when formulating calls for proposals, and by researchers who wish to undertake research that will address the needs of military veterans living with chronic pain. / Thesis / Master of Science (MSc)