The public health significance of campylobacters lies in their role as enteropathogens of man. Zoonotic in origin, they are the most commonly reported bacterial cause of gastrointestinal infection in the developed world. Approximately 46,000 laboratory-confirmed cases are reported annually in England and Wales, and this figure underestimates community disease by a factor of eight. Infection is unpleasant and, whilst self-limiting, a tenth of cases require hospital admission for their illness. Sequelae such Irritable Bowel Syndrome, Reactive Arthritis and Guillain-Barré Syndrome compound the problem. Despite the significant public health burden posed by campylobacters, our understanding of the epidemiology of Campylobacter infection is limited. This deficiency relates to a combination of the natural history of the microorganism, the high disease incidence which exists and the epidemiological tools applied thus far to its study. In order to gain a better understanding of the epidemiology of Campylobacter infection the Campylobacter Sentinel Surveillance Scheme was conceived in 1998 and established in 1999. Through the integration of standardised epidemiological and microbiological data, it aimed to generate systematically new hypotheses for potential vehicles of infections, or transmission pathways, for campylobacteriosis. Twenty-two health authorities, representing all NHS regions at that time in England and in Wales and with a population of over 12 million people, participated in the study, which ran from May 2000 until April 2003. Standardised epidemiological data were captured on over 20,000 cases over the surveillance period and these were combined with microbiological data from detailed strain characterisation of patients‟ strains, referred at the same time. Case-case comparisons and disease determinant analysis were the epidemiological tools most commonly applied to the data. The research carried out by the candidate demonstrated that age, gender, ethnicity, occupation and socioeconomic status are major determinants for Campylobacter infection in England and Wales, and that variation in behaviour throughout the week also has a bearing on risk. It has shown that campylobacteriosis cannot be considered a single disease, as exposure differences exist in cases infected with different Campylobacter species or subspecies, and these differences can be confounded by foreign travel status. The fact that disease incidence amongst foreign travellers is country-specific suggests that the above exposure differences will be confounded further by travel destination. It has shown that outbreaks of campylobacteriosis occur more commonly than described previously, suggesting that an opportunity for furthering our understanding of infection is being missed. Finally, the dose-response relationship for Campylobacter infection has been investigated, highlighting potential implications for the design of future epidemiological studies. Policy makers should be aware that future case-control studies of Campylobacter infection will need to be larger or more complex, and hence more costly. Such costs should be weighed against the opportunity for a more accurate assessment of disease risk, leading to improved evidence-based policy development. Researchers should focus on assessing rapidly and by non-invasive means, previous exposure to campylobacters amongst healthy controls, improving further the accuracy of case-control studies, which remain the epidemiological method of choice for studying this disease. This study has demonstrated that the systematic collection of standardised epidemiological information on all cases of Campylobacter infection, reported from large, well defined populations over a prolonged period, coupled with detailed strain characterisation, can lead to public health gains.

Submitted by Jordan (jordanbiblio@gmail.com) on 2017-05-26T15:57:24Z No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-05-26T16:48:39Z (GMT) No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) / Made available in DSpace on 2017-05-26T16:48:39Z (GMT). No. of bitstreams: 1 DISS_2014_Fabiane Blanco Silva.pdf: 1317399 bytes, checksum: a556a8cda4c48546fc263aa81c5f1c45 (MD5) Previous issue date: 2014-02-07 / CAPES / A caderneta de saúde da criança é um instrumento que visa o acompanhamento integral de saúde da criança, pautado na vigilância à saúde. No Brasil, este instrumento configura-se como o principal documento para o registro das informações de saúde da criança e serve também como ferramenta de diálogo entre as famílias e os profissionais que atuam em diferentes espaços assistenciais voltados à esta população. Este estudo tem por objetivo analisar a percepção dos profissionais que atuam na atenção à criança na rede básica de saúde de Cuiabá-Mato Grosso, sobre a utilização da caderneta de saúde da criança. Trata-se de um estudo exploratório de abordagem qualitativa, que teve como sujeitos oito médicos, oito enfermeiros e quatro agentes comunitários de saúde, totalizando 20 profissionais que atuavam em unidades básicas de saúde deste município. A coleta dos dados foi realizada no período de fevereiro a março de 2013, por meio de entrevista semiestruturada, analisada pela técnica de análise temática. A análise dos dados possibilitou o agrupamento das informações em três eixos temáticos: as diversas finalidades da caderneta de saúde da criança; o preenchimento da caderneta de saúde da criança pelos profissionais e a utilização da caderneta de saúde da criança pela família. Os profissionais atribuem à caderneta a interpretação de que ela é um documento importante por conter diversas informações da saúde da criança, antes mesmo do seu nascimento. Além disso, possuem diferentes opiniões sobre a finalidade da mesma. Em relação aos dados a serem preenchidos no documento, os profissionais os percebem como importantes para o acompanhamento da saúde infantil, no entanto, para eles o registro desses ainda não recebe a devida importância em todos os atendimentos à criança. Para os profissionais, o preenchimento dos dados é de responsabilidade da equipe de saúde, médico, enfermeiro e técnicos de enfermagem. Houve discordância de opinião sobre a participação da família neste preenchimento, sendo que para uns a família não deve preencher nenhum dado, enquanto que para outros os dados de identificação, desenvolvimento e intercorrências com a criança podem ser registrados pela família. Segundo os entrevistados, vários são os fatores que influenciam o uso adequado da caderneta, tais como: perda ou esquecimento do instrumento pela mãe, burocracia do serviço, grande demanda de atividades na unidade, dentre outros. Na percepção dos participantes do estudo, apesar de a família ser orientada sobre a caderneta, esta ainda a utiliza muito pouco. Para os entrevistados, além de a família ter o direito de cobrar dos profissionais o registro dos dados na caderneta, esse comportamento da família demonstra o seu interesse pela saúde do filho e auxilia o trabalho dos profissionais. Nota-se também preocupação dos participantes do estudo quanto à utilização plena da caderneta. Assim, para que este instrumento se efetive como instrumento de vigilância e de promoção à saúde infantil, tanto os profissionais quanto as famílias deverão atribuir lhe maior valor. / The child health handbook is an instrument which aims the integral monitoring of child health, based on health surveillance. In Brazil, this instrument is configured as the main document for the information of child's health and also serves as a tool for dialogue between families and the professionals who work in different spaces for assistance to this population. This study aims to analyze the perceptions of professionals working in child care in basic health network of Cuiabá – Mato Grosso, on the use of child health handbook. This is an exploratory study of qualitative approach, which had as its subject eight doctors, eight nurses and four community health agents, totaling 20 professionals who acted in basic health units of this municipality. The data collection was carried out from February to March 2013, through a semi-structured interview, analyzed by the technique of thematic analysis. The data analysis allowed the grouping of information in three thematic axes: the several purposes of maternal and child health; the fill of the child health handbook by the professionals and the use of the child health handbook by the family. The professionals attach to the booklet the interpretation that it is an important document because it contains various information of child health, even before his birth. In addition, there are different opinions about the purpose of the same. Regarding the data to be filled in the document, the professionals refer to be important for the monitoring of children's health, however, for them the record of those still does not receive due weight in all attendances to the child. For professionals the padding of the data is of the responsibility of the health team, doctor, nurse and nursing technicians. There was disagreement of opinion on the participation of the family in this fill, and for some the family must not fill any data, while for other identification data, development and complications with the child can be registered by the family. There are many factors that influence the use of booklet by professionals such as loss or forgetfulness of the instrument by her mother, bureaucracy, high demand for service activities in the unit, among others. In the perception of the participants of the study, although the family be oriented about the booklet, the same still uses very little. For the interviewees, beyond the family having the right to ask for registration data from the professionals in the booklet, this family's behavior demonstrates its interest in the health of the child and assists the work of professionals. It is noted, also, a concern of the participants of the study regarding the full use of the notebook. Thus, for this instrument being effective such as surveillance and promotion document to child health both the professionals and the families should assign more value to it.