<p>Characteristically, in infections that are caused by the zoonotic pathogen <i>Bartonella</i> naturally infected reservoir hosts are asymptomatic, where infected incidental, non-natural, hosts develop symptomatic disease. Cat-scratch disease (CSD) is a well known example. <i>Bartonella </i>infections in humans may be self-limiting or fulminant and affect different organ systems. </p><p>The objectives of the present thesis were to (1) identify and characterise <i>Bartonella </i>infection cases in Sweden, (2) to investigate certain human populations regarding <i>Bartonella </i>infections, and (3) compare natural populations of different <i>Bartonella </i>species.</p><p>Cases with typical and atypical CSD were recognised by using a combination of PCR and serology. Gene sequence comparisons of different genes in <i>B. henselae</i> isolates from the United States and Europe showed that<i> fts</i>Z gene variation is a useful tool for <i>Bartonella</i> genotyping. </p><p>Myocarditis was a common finding among Swedish elite orienteers succumbing to sudden unexpected cardiac death (SUCD). The natural cycle of <i>Bartonella</i> spp., the life style of orienteers, elevated antibody titres to <i>Bartonella</i> antigens, <i>Bartonella</i> DNA amplified from myocardium and the lack of another feasible explanation make <i>Bartonella</i> a plausible aetiological factor.</p><p>The first reported case of <i>Bartonella</i> endocarditis (<i>B. quintana</i>) was identified in an immunocompromised patient who underwent heart valve replacement. The patient had been body louse-infested during his childhood. It is hypothesised that a chronic <i>B. quintana</i> infection was activated by the immunosuppression.</p><p>There was no evidence of an ongoing trench fever (TF) epidemic in a Swedish homeless population, although an increased risk for exposure to <i>Bartonella</i> antigens was demonstrated. The lack of louse infestation might explain the absence of <i>B. quintana</i> bacteremia and low <i>B. quintana</i> antibody titres. </p><p>Comparisons of genetic loci and the whole genomes of environmental <i>B. grahamii</i> isolates from the Uppsala region, Sweden displayed variants that were not related to specific host species but to geographic locality. Natural boundaries seemed to restrict gene flow.</p>

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.

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 172-186). Also available in print.

published_or_final_version / Public Health / Master / Master of Public Health

No description available.

Characteristically, in infections that are caused by the zoonotic pathogen Bartonella naturally infected reservoir hosts are asymptomatic, where infected incidental, non-natural, hosts develop symptomatic disease. Cat-scratch disease (CSD) is a well known example. Bartonella infections in humans may be self-limiting or fulminant and affect different organ systems. The objectives of the present thesis were to (1) identify and characterise Bartonella infection cases in Sweden, (2) to investigate certain human populations regarding Bartonella infections, and (3) compare natural populations of different Bartonella species. Cases with typical and atypical CSD were recognised by using a combination of PCR and serology. Gene sequence comparisons of different genes in B. henselae isolates from the United States and Europe showed that ftsZ gene variation is a useful tool for Bartonella genotyping. Myocarditis was a common finding among Swedish elite orienteers succumbing to sudden unexpected cardiac death (SUCD). The natural cycle of Bartonella spp., the life style of orienteers, elevated antibody titres to Bartonella antigens, Bartonella DNA amplified from myocardium and the lack of another feasible explanation make Bartonella a plausible aetiological factor. The first reported case of Bartonella endocarditis (B. quintana) was identified in an immunocompromised patient who underwent heart valve replacement. The patient had been body louse-infested during his childhood. It is hypothesised that a chronic B. quintana infection was activated by the immunosuppression. There was no evidence of an ongoing trench fever (TF) epidemic in a Swedish homeless population, although an increased risk for exposure to Bartonella antigens was demonstrated. The lack of louse infestation might explain the absence of B. quintana bacteremia and low B. quintana antibody titres. Comparisons of genetic loci and the whole genomes of environmental B. grahamii isolates from the Uppsala region, Sweden displayed variants that were not related to specific host species but to geographic locality. Natural boundaries seemed to restrict gene flow.

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.

Master of Dental Surgery / This work was digitised and made available on open access by the University of Sydney, Faculty of Dentistry and Sydney eScholarship . It may only be used for the purposes of research and study. Where possible, the Faculty will try to notify the author of this work. If you have any inquiries or issues regarding this work being made available please contact the Sydney eScholarship Repository Coordinator - ses@library.usyd.edu.au

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 62-68)