Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-16T20:08:13Z No. of bitstreams: 1 RafizaLago.pdf: 1657462 bytes, checksum: e178a84f8fcd8aac7b3989a5ac8f7741 (MD5) / Made available in DSpace on 2017-05-16T20:08:13Z (GMT). No. of bitstreams: 1 RafizaLago.pdf: 1657462 bytes, checksum: e178a84f8fcd8aac7b3989a5ac8f7741 (MD5) Previous issue date: 2014-11-28 / Among the clinical forms of leishmaniasis, the visceral leishmaniasis (VL) or kala-azar constitutes the most severe, with high levels of lethality. This study aimed to assess the situation of visceral leishmaniasis in an endemic municipality in the state of Maranhão, through a descriptive study conducted from November 2012 to November 2014. The study included 80 cases of VL reported in the city during the period 2008-2012, and 273 families in the area with the highest number of cases of VL. Control actions performed by the municipality were obtained from documentary records and interviews with officials. It was found that 97.50% cases were autochthonous and 66.30% coming from the urban area. Men (61.25%), age 5 to 9 years (43.75%), mixed race (82.50%) and people with little or no schooling (61.25%) were the most affected. The most widely used method for diagnosis was IFI (70%), and pentavalent antimony was the most used drug for treatment (93.75%). Among the reported cases, 67.50% were discharged as cured. In relation to socio-demographic and environmental characteristics of families, the majority of residences was made of bricks (82.40%) and covered with tile (96.70%). Houses had four to six people (53.80%) who living below minimum wage (53.50%) income. Services of water supply (99.30%), garbage collection (79.50%) and the presence of septic tank was reported by 68.13% of respondents. Animal husbandry (57.14%) and the presence of those animals near the home (84.25%) was mentioned. Favorable conditions for the maintenance of VL vector were cited by 25.73% of residents. VL cases were mentioned in the family (10.26%) and neighborhood (30.04%). Respondents were unaware of performing control actions to the reservoir and vector of VL in the city (93.64%). Among families with a history of VL, 56.25% reported that they were not followed during treatment. Representatives of the city describe management strategies for VL focused on early diagnosis and treatment of cases, reducing the population of sandflies, elimination of reservoirs and health education activities. Conclusion: Visceral leishmaniasis is an important public health problem in Itapecuru Mirim, with cases reported in all age groups, both sexes, in people with low education and living in the urban area of the city. Most cases resulted in cure. Observed housing conditions do not reflect the expected standard for VL, but the locals refer cases of the disease in the family and also in the neighborhood. Control strategies for VL were described in the municipality. However, such actions occur sporadically. / ntre as formas clínicas das leishmanioses, a Leishmaniose Visceral (LV) ou calazar constitui-se a mais grave, com elevados índices de letalidade. Objetivou-se avaliar a situação da Leishmaniose Visceral em um município endêmico do Estado do Maranhão, através de um estudo descritivo realizado no período de novembro de 2012 a novembro de 2014. Foram incluídos no estudo 80 casos de LV notificados no município nos anos de 2008 a 2012, e 273 famílias da área com o maior número de casos de LV. As ações de controle realizadas pelo município foram obtidas por meio de registros documentais e entrevistas com os responsáveis dos setores afins. Verificou-se que 97,50% casos eram autóctones e 66,30%, procedentes da zona urbana da cidade. O sexo masculino (61,25%), faixa etária de 5 a 9 anos (43,75%), raça parda (82,50%) e pessoas com baixa ou nenhuma escolaridade (61,25%) foram os mais afetados. O método mais utilizado no diagnóstico foi a IFI (70%) e o antimonial pentavalente foi a droga mais utilizada para tratamento (93,75%). Dos casos notificados, 67,50% receberam alta por cura. Em relação às características sóciodemográficas e ambientais das famílias, a maioria das residências era de alvenaria (82,40%) e cobertas com telha (96,70%). As casas possuíam de quatro a seis habitantes (53,80%) que viviam com renda inferior a um salário mínimo (53,50%). Serviços de água encanada (99,30%), coleta de lixo (79,50%) e a presença de fossa séptica (68,13%) foram relatados pelos entrevistados. Foi mencionada a criação de animais (57,14%) e a presença destes próximos às residências (84,25%). Foram citadas por 25,73% dos moradores condições favoráveis para a manutenção do vetor da LV. Casos de LV foram mencionados na família (10,26%) e na vizinhança (30,04%). Os entrevistados desconheciam a realização de ações de controle para o reservatório e vetor da LV no município (93,64%). Entre as famílias com história de LV, 56,25% relataram que não foram acompanhados durante o tratamento. O município descreve estratégias de controle para LV centradas no diagnóstico e tratamento precoce dos casos, redução da população de flebotomíneos, eliminação dos reservatórios e atividades de educação em saúde. Conclusão: A Leishmaniose Visceral se constitui um importante problema de saúde pública em Itapecuru Mirim, com casos registrados em todas as faixas etárias, ambos os sexos, em pessoas com baixa escolaridade e residentes na zona urbana da cidade. A maioria dos casos evoluiu para cura. As condições de moradia observadas não refletem o padrão esperado para LV, porém os moradores referem casos da doença na família e também na vizinhança. Foram descritas estratégias de controle para LV no município. No entanto, tais ações ocorrem de forma esporádica.

Chong, Ka Chun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 125-141). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Asthma is a chronic lung inflammatory disease that causes inflammation and narrowing of the airways. Swelling of the airways can be caused by the activation of cytokines that lead to an inflammatory or allergenic-like response. Environmental factors, both indoors and outdoors, have been found to increase the likelihood of asthma in children. Among those found to impact disease are air pollutants such as ozone, nitric dioxide, and particulate matter, as well as home exposures, like cockroaches and rodents. Those who have multiple or increased exposure to these pollutants are more likely to experience exacerbated symptoms and uncontrolled asthma. There currently is no cure for asthma, but effective therapies have been found to treat the symptoms associated with asthmatic episodes. During an asthma attack, due to narrowing of the airways, individuals experience wheezing, chest tightness, and even shortness of breath. To combat these occurrences, physicians use inhaled corticosteroids (ICS), Beta-agonist, or a combination of both to relieve symptoms. In the United States asthma affects 25.8 million people. This number is projected to increase as the US continuously becomes more industrialized and as environmental conditions deteriorate. Research conducted by the Center for Disease Control concluded that the prevalence of asthma increased amongst the general population, however, once the data were disaggregated by race, age, gender, and SES significant increases were noted amongst some groups but not others. Most notably, on average, children, women, Puerto Ricans, and people living in poverty as defined by federal guidelines had the highest asthma prevalence. Chronic diseases like asthma also produce substantial burdens on the healthcare system. Asthmatics on average require three-times as many prescriptions, twice as many emergency room visits and four-times as many hospitalizations as individuals without asthma in the same demographic population. Additionally, when an expenditure analysis was carried out, it revealed that children with asthma cost approximately three-times more per capita per child than adolescents without asthma. Chronic disease occurs over the duration of individual lives. Thus, poorly managed, they will cause preventable increases in disability-adjusted-life years, premature death, and health care expenditure for both the individual and the broader healthcare system. The observed increases will predominantly impact the indicated high-risk populations. The prevalence of asthma in urban settings was anticipated by researchers based on known environmental influences. However, the discovery of a higher prevalence and mortality rate of asthma within impoverished communities, in comparison to other urban communities, is not yet fully understood. Through this research an association between high-risk populations with uncontrolled asthma and a lack of patient education, low socioeconomic status, and utilization of Medicaid insurance was found, which indicates the influence of these factors on asthma control. Improving current asthma interventions by remodeling them to take a broader stance on asthma prevention, treatment and maintenance and through acknowledgement of the impact disparities, asthma will likely be better controlled for all individuals in the Unites States.

Thesis (Ph. D. (Social Work)) --University of Limpopo, 2018 / Despite the laudable progress on HIV and AIDS interventions encountered in South Africa, new HIV infection remains a challenge. Limpopo Department of Agriculture is not an exception as far as new HIV infections are concerned, regardless of the intervention efforts made. This study aimed at exploring on perceptions of LDA employees on social-behavioural and structural core drivers of HIV infection. Qualitative research methodologies were applied. A purposive sample of twenty participants (10 men and 10 women) was selected from Department of Agriculture, Mopani District, Limpopo Province. Constructivism and structuralism theoretical framework were used to navigate the study. Semi-structured, face-to-face interviews were designed. Data was collected through interviews, audio-recorded and transcribed. Eight steps of data analysis were followed as proposed by Creswell. Guidelines for the prevention of new HIV infection were developed. Some of the major findings are that: the socio-behavioural core drivers that place all partners at risk of contracting new HIV infections is the Multiple Sexual Partnerships (MSPs). Age-disparate relationships in a workplace were also socio-behavioural drivers of new HIV infection. Young women and men who enter into age-disparate relationships have intention of obtaining permanent employment. Patriarchy was found to be amongst the structural core drivers of new HIV infections. The fact that men are not tested involuntarily is viewed as a structural barrier towards eliminating the spread of new HIV infections. Stigma has been also found to be a core driver of new HIV infections. Some conclusions made are: MSPs is a closed sexual network system, characterised by “secrecy” and “trust”. Despite some reforms purporting to improve women’s status, patriarchal domination is still at its toll. Unsymbolised stigma remains a threat towards elimination of the spread of HIV infections. The major recommendations are that working women still require empowerment in number of areas of their social functioning, and the leadership involvement in the fight against the spread of new HIV infections.

This dissertation assesses the factors that lead to the emergence of infectious diseases in children, particularly the emergence of multidrug-resistant organisms (MDROs) and diarrheal pathogens in vulnerable pediatric populations. It includes three manuscripts. The initial study is a systematic review that summarized the role of antibiotic exposure on the acquisition of MDROs in children. Twenty-nine studies met the inclusion criteria and a positive association between prior antibiotic use and subsequent colonization or infection with an MDRO was identified in most studies. There were wide variations among study sites, populations, and definitions of antibiotic use and MDROs. Therefore, limited inferences could be made on which components of antibiotic exposure have the greatest impact on MDRO development. The second analysis examines the relationship between prior stay at a pediatric long-term care (LTC) facility and infection with an MDRO among hospitalized children. This study included 2,945 infections in 258,664 pediatric admissions from 2006 through 2016. At least 1 MDRO was identified in 10% of infections. Of the 1,198 children who had previously resided in a pediatric LTC facility, only 1 child (0.08%) had an MDRO infection. However, prior receipt of pediatric LTC was associated with an increased likelihood of infection (OR 2.4, CI95 1.66 – 3.43), C. difficile infection (OR 2.57, CI95 1.26 – 5.25), days of antibiotic use (OR 1.01, CI95 1.01 – 1.02), length of stay (OR 1.01, CI95 1.01 – 1.01), and death (OR 4.38, CI95 2.93 – 6.55). The concluding study evaluates the association between animals living in or near the home and diarrheal disease in children. This research is a secondary analysis of the Global Enteric Multicenter Study case control study, which investigated the epidemiology of diarrheal illness in children <5 in sub-Saharan Africa and south Asia. Of 9,439 cases and 13,128 controls, 87% had ≥1 animal in their home. In a multivariable analysis adjusting for exclusive breastfeeding, water source, sanitation facility, number of children <5 years in the household, and wealth index, any animal on a child’s compound decreased the odds of diarrhea by 33% (aOR 0.66, CI95 0.59 – 0.74). However, children with diarrhea who had an animal present were not more likely to have a positive stool culture. Overall, the three studies provide a thorough analysis of several factors associated with the infectious disease emergence in children, particularly as related to MDROs and diarrheal disease. Environmental characteristics, including antibiotic use and interaction with animals, were shown to be important factors for emergent infectious disease across diverse settings. The development of pediatric infection prevention interventions should take into consideration environmental risk factors in order to effectively mitigate the risks posed infectious disease emergence.

Due to the recent increased quantity of nutrition-related diseases worldwide, current research recommends exploring environmental factors that influence this trend. The Islands of Fiji are of particular concern because of the growing number of non- communicable diseases. On the same small island, nutrition problems vary according to demographic. Thus, the different environments of each demographic constitute diverse food environments, which are manifested in varied nutrition concerns. This study explored environmental motivators of food choice for the Fijian population. Gathering the perspectives of Fijian Islanders using a narrative inquiry research format proved to be insightful in measuring the environmental influences of decisions pertaining to food.

<p>Hypertension is one of the most common non-communicable diseases, and it is the leading cause of cardiovascular diseases, death and disability worldwide, especially in developing countries. Physical activity has been regarded as a commonly accepted modality for preventing and treating hypertension. However, despite its known benefits, this modality of treatment and prevention of&nbsp / hypertension continues to be underused. The present study aimed to determine the demographic, social and health-related factors that are associated with levels of physical activity participation among adults with hypertension in Kigali, Rwanda. This cross-sectional study was conducted with 252 adults with hypertension and 87 healthcare professionals through the Godin Leisure-Time&nbsp / Exercise Questionnaire (GLTEQ) and Physical Activity Exit Interview (PAEI). Two thirds of the participants (69.44%) were classified as sedentary. The following factors were found to be significantly&nbsp / (P&lt / 0.05) associated with the levels of physical activity: age, marital status, and level of education, residence, tobacco / past and current users, alcohol / current user, diabetes mellitus, BMI, perceived health status, self-efficacy, and blood pressure. None of the healthcare professionals were considered good physical activity counsellor. The findings of the present study highlight the need for the implementation of health promotion strategies aimed at promoting physical activity lifestyle among individuals with hypertension in Rwanda. Efforts should be made in educating people with hypertension on the benefits of integrating regular physical&nbsp / activity in their daily lives. Furthermore, healthcare professionals should be educated concerning how to promote physical&nbsp / activity to all patients especially those with hypertension.</p>

The aim of this study was to analyse how physical activity in the prevention and treatment of diseases, is portrayed in Vietnamese media. This is interesting because the traditional Vietnamese health culture differs a lot from the Western one. The topic is also of immediate importance in Vietnam, because of the increasing numbers of diseases, such as diabetes and cardiovascular diseases, even called non-communicable diseases. This is connected to the decreasing physical activity and increasing obesity in the country. A Swedish-Vietnamese project in Vietnam is going on since two years, with the aim of disseminating Swedish experiences on the topic to the health care staff and the general public. Thirty-one articles have been analysed with regard to cultural references and persuasion means. The methods include rhetorical analysis, quantitative content analysis and semiotics. The theoretical framework constitutes of previous research on characteristics of Vietnamese/Asian journalism in general, and Vietnamese preventive health education in particular. To get a better understanding of the results, various theories such as post-colonialism and cultural hegemony have been used. The findings indicate that the articles portray the health-benefits of physical activity as something new to the Vietnamese people. It was not possible to find any point of similarity to the traditional forms of Vietnamese preventive health propaganda in the articles. The different references in the articles where mostly made to Western sources. The pictures in the articles signal both threat/fear and hope and they portray both people with East Asian-and Western appearance.

For the last several decades, sequential change point problems have been studied in both the theoretical area (sequential analysis) and the application area (industrial SPC). In the conventional application, the baseline process is assumed to be stationary, and the shift pattern is a step function that is sustained after the shift. However, in biosurveillance, the underlying assumptions of problems are more complicated. This thesis investigates several issues in biosurveillance such as non-homogeneous populations, spatiotemporal surveillance methods, and correlated structures in regional data. The first part of the thesis discusses popular surveillance methods in sequential change point problems and off-line problems based on count data. For sequential change point problems, the CUSUM and the EWMA have been used in healthcare and public health surveillance to detect increases in the rates of diseases or symptoms. On the other hand, for off-line problems, scan statistics are widely used. In this chapter, we link the method for off-line problems to those for sequential change point problems. We investigate three methods--the CUSUM, the EWMA, and scan statistics--and compare them by conditional expected delay (CED). The second part of the thesis pertains to the on-line monitoring problem of detecting a change in the mean of Poisson count data with a non-homogeneous population size. The most common detection schemes are based on generalized likelihood ratio statistics, known as an optimal method under Lodern's criteria. We propose alternative detection schemes based on the weighted likelihood ratios and the adaptive threshold method, which perform better than generalized likelihood ratio statistics in an increasing population. The properties of these three detection schemes are investigated by both a theoretical approach and numerical simulation. The third part of the thesis investigates spatiotemporal surveillance based on likelihood ratios. This chapter proposes a general framework for spatiotemporal surveillance based on likelihood ratio statistics over time windows. We show that the CUSUM and other popular likelihood ratio statistics are the special cases under such a general framework. We compare the efficiency of these surveillance methods in spatiotemporal cases for detecting clusters of incidence using both Monte Carlo simulations and a real example. The fourth part proposes multivariate surveillance methods based on likelihood ratio tests in the presence of spatial correlations. By taking advantage of spatial correlations, the proposed methods can perform better than existing surveillance methods by providing the faster and more accurate detection. We illustrate the application of these methods with a breast cancer case in New Hampshire when observations are spatially correlated.

Master's thesis. / Format: PDF. Bibl.