Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2004. / Härtill 5 uppsatser.

Licentiatavhandling (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2008. / Härtill 2 uppsatser. I boken felaktigt tryckår 2006.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 44-49).

nÃo hà / Objetivou-se com esta pesquisa construir uma escala de avaliaÃÃo da capacidade para cuidar de crianÃas expostas ao HIV (EACCC-HIV); elaborar itens e dimensÃes e avaliar as propriedades psicomÃtricas em termos de validade e confiabilidade do instrumento. A validade de conteÃdo da EACCC-HIV foi verificada pela concordÃncia entre os juÃzes (opiniÃo de cinco especialistas) e a anÃlise semÃntica por um professor de portuguÃs e tÃcnica de brainstorming. Na validade do construto comparou-se os grupos contrastados. Para a confiabilidade da escala utilizaram-se o alfa de cronbach e o teste-reteste. A pesquisa foi do tipo metodolÃgica com abordagem quantitativa, realizada em duas unidades de referÃncia no atendimento de crianÃas expostas ao HIV em Fortaleza-CE. A amostra aplicada no piloto foi constituÃda de 26 cuidadores de crianÃas expostas ao HIV. Quanto ao desenvolvimento metodolÃgico, ocorreu de fevereiro a outubro de 2008, e neste foram utilizados como instrumentos a escala inicial com 55 itens, a escala para o piloto com 70 itens e os formulÃrios para avaliaÃÃo com os juÃzes. Conforme os resultados revelaram, nos 55 itens iniciais uma concordÃncia de 98,5% (p=0,470) entre os juÃzes. No entanto, 32 itens foram mantidos, um excluÃdo e 16 incluÃdos, ficando o total de 70 itens para aplicaÃÃo no piloto. ApÃs a anÃlise semÃntica, 14 itens foram reformulados. Com 70 itens, o instrumento piloto foi aplicado na amostra de 26 cuidadores de crianÃas expostas ao HIV. A maioria dos cuidadores tinha entre 20 e 29 anos; convivia com o parceiro, a metade tinha o ensino fundamental completo e incompleto, grande parte estava desempregada e recebia menos de um salÃrio mÃnimo. Nos grupos contrastados, identificou-se nÃo ter havido associaÃÃo estatisticamente significante entre a variÃvel renda e 49 itens da escala. Existiu, porÃm, associaÃÃo significante ou valor limÃtrofe em sete itens (p<0,05). Neste caso sugere-se a variÃvel renda na aplicaÃÃo desta escala em outras pesquisas. A confiabilidade pelo alfa de cronbach apresentou valor total de 0,954 e p=0,0001. Portanto, houve consistÃncia interna dos itens, mas para o teste-reteste nÃo foi possÃvel realizar testes estatÃsticos. Na segunda fase com os juÃzes, o alfa de cronbach total para claridade, relaÃÃo dimensÃo-item e relevÃncia obteve-se o valor de 0,800 e p=0,0001, demonstrando concordÃncia entre eles. Contudo, na anÃlise para a claridade do item nÃo se observou equivalÃncia (&#945;=0,110 e p=0,262) e alguns itens do instrumento foram reformulados ou excluÃdos. Elaborou-se no final a EACCC-HIV com 52 itens e cinco dimensÃes. ApÃs a realizaÃÃo do estudo, obteve-se um instrumento confiÃvel capaz de avaliar a capacidade para cuidar de crianÃas expostas ao HIV. Este poderà ser usado amplamente na clÃnica e na pesquisa, e assim, contribuirà para a realizaÃÃo de estudos futuros com esta temÃtica. Sugere-se, ainda, a aplicaÃÃo da EACCC-HIV em amostras maiores e com testes de associaÃÃo com as variÃveis maternas e infantis, a fim de verificar a confiabilidade e a validade do instrumento com novos pesquisadores e chegar a uma escala estÃvel e replicÃvel / It was objectified with this research to construct a scale of evaluation of the capacity to take care of children displayed to HIV (EACCC-HIV); to elaborate item and dimensions and to evaluate the psychometric properties in validity terms and trustworthiness of the instrument. The validity of content of the EACCC-HIV was verified by the agreement enters the judges (opinion of five specialists) and the semantics analysis by Portuguese teacher and technique of Brainstorming. In the validity of construct were compared the contrasted groups. For the trustworthiness of the scale the Alpha of Cronbach and the test-retest had been used. The research was of the methodological type with quantitative boarding, carried through in two units of reference in the attendance of children displayed to the HIV in Fortaleza-CE. The sample applied in the pilot was constituted of 26 caregivers of children displayed to the HIV. How much to the methodological development, occurred of February to October of 2008, and in this had been used as instruments the initial scale with 55 item, the scale for the pilot with 70 item and the forms for evaluation with the judges. As the results had disclosed, in the 55 initial item an agreement of 98,5% (p=0,470) between the judges. However, 32 item had been kept, one excluded and 16 enclosed ones, being the total of 70 item for application in the pilot. After the semantics analysis, 14 item had been reformulated. With 70 item, the pilot instrument was applied in the sample of 26 caregivers of children displayed to the HIV. The majority of the caregivers had between 20 and 29 years; it coexisted the partner, the half had complete basic education and incomplete, great part was dismissed and received less from one minimum wage. In the contrasted groups, it was identified that not to have had statistical significant association between the changeable income and 49 item of the scale. It existed, however, significant association or bordering value in seven item (p<0,05). In this in case that it is suggested changeable income in the application of this scale in other research. The trustworthiness for the Alpha of Cronbach presented total value of 0,954 and p=0,0001. Therefore, it had internal consistency of the item, but for the test-retest it was not possible to carry through statistical tests. In the second phase with the judges, the total Alpha of Cronbach for clarity, relation dimension-item and relevance got the value of 0,800 and p=0.0001, demonstrating agreement between them. However, in the analysis for the clarity of the item equivalence was not observed (&#945;=0,110 and p=0,262) and some item of the instrument had been reformulated or excluded. It was elaborated in the end the EACCC-HIV with 52 item and five dimensions. After the accomplishment of the study, got a trustworthy instrument capable to evaluate the capacity to take care of children displayed to the HIV. This could widely be used in the clinic and in the research, and, thus, it will contribute for the accomplishment of future studies with this thematic one. It is suggested, still, the application of the EACCC-HIV in bigger samples and with tests of association with the infantile and maternal variable and, in order to verify the trustworthiness and the validity of the instrument with new researchers and to arrive at a steady and reapplicable scale

No description available.

Yes / Traditional public health methods for detecting infectious disease transmission, such as contact tracing and molecular epidemiology, are time-consuming and costly. Information and communication technologies, such as global positioning systems, smartphones, and mobile phones, offer opportunities for novel approaches to identifying transmission hotspots. However, mapping the movements of potentially infected persons comes with ethical challenges. During an interdisciplinary meeting of researchers, ethicists, data security specialists, information and communication technology experts, epidemiologists, microbiologists, and others, we arrived at suggestions to mitigate the ethical concerns of movement mapping. These suggestions include a template Data Protection Impact Assessment that follows European Union General Data Protection Regulations. / European Research Council Proof of Concept “Enhanced Place Finding” (grant no. 727695).

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

Thesis (MSc (Mathematical Sciences))--University of Stellenbosch, 2011. / Includes bibliography. / ENGLISH ABSTRACT: This thesis takes into account the different levels of infectiousness of the human immunodeficiency virus (HIV) infected individuals throughout their period of infection. Infectiousness depends on the time since infection. It is high shortly after the infection occurs and then much lower for several years, and thereafter a higher plateau is reached before the acquired immunodeficiency syndrome (AIDS) phase sets in. In line with this, we formulated a mathematical model which is structured according to the age of infection. To understand the dynamics of the disease, we first discuss and analyse a simple model in which the age of infection is not considered, but progression of the HIV-AIDS transmission is taken into consideration by introducing three stages of infection. Analysis of these models tells us that the disease can be eradicated from the population only if on average one infected individual infects less than one person in his or her infectious period, otherwise the disease persists. To investigate the reduction of the number of infections caused by a single infectious individual to less than one, we introduce different treatment strategies for a model which depends on the age of infection, and we analyse it numerically. Current strategies amount to introducing treatment only at a late stage of infection when the infected individual has already lived through most of the infectious period. From our numerical results, this strategy does not result in eradication of the disease, even though it does reduce the burden for the individual. To eradicate the disease from the population, everyone would need to be HIV tested regularly and undergo immediate treatment if found positive. / AFRIKAANSE OPSOMMING: Hierdie tesis hou rekening met die verskillende aansteeklikheidsvlakke van die menslike immuniteitsgebreksvirus (MIV) deur besmette individue gedurende hulle aansteeklikheidstydperk. Die graad van aansteeklikheid hang af van die tydperk sedert infeksie. Dit is hoog kort nadat die infeksie plaasvind en daarna heelwat laer vir etlike jare, en dan volg n hoer plato voordat uiteindelik die Verworwe-Immuniteitsgebreksindroom (VIGS) fase intree. In ooreenstemming hiermee, formuleer ons n wiskundige model van MIV-VIGSoordrag met n struktureer waarin die tydperk sedert infeksie bevat is. Om die dinamika van die siekte te verstaan, bespreek en analiseer ons eers n eenvoudige model sonder inagneming van die tydperk sedert infeksie, terwyl die progressie van MIV-VIGS-oordrag egter wel in ag geneem word deur die beskouing van drie stadiums van infeksie. Analise van die modelle wys dat die siekte in die bevolking slegs uitgeroei kan word as elke besmette mens gemiddeld minder as een ander individu aansteek gedurende die tydperk waarin hy of sy self besmet is, anders sal die siekte voortduur. Vir die ondersoek oor hoe om die aantal infeksies per besmette individu tot onder die waarde van een te verlaag, beskou ons verskeie behandelingsstrategiee binne die model, wat afhang van die tydperk sedert infeksie, en ondersoek hulle numeries. Die huidige behandelingstrategiee kom neer op behandeling slegs gedurende die laat sta- dium van infeksie, wanneer die besmette individu reeds die grootste deel van die aansteeklikheidsperiode deurleef het. Ons numeriese resultate toon dat hierdie strategie nie lei tot uitroeiing van die siekte nie, alhoewel dit wel die las van die siekte vir die individu verminder. Om die siekte binne die bevolking uit te roei, sou elkeen gereeld vir MIV getoets moes word en indien positief gevind, dadelik met behandeling moes begin.

This thesis focuses on the spread of organisms in both ecological and epidemiological contexts. In most of the studies presented, displacement is modeled with a spatial kernel function, which is characterized by scale and shape. These are measured by the net squared displacement (or kernel variance) and kurtosis, respectively. If organisms disperse by the assumptions of a random walk or correlated random walk, a Gaussian shaped kernel is expected. Empirical studies often report deviations from this, and commonly leptokurtic distributions are found, often as a result of heterogeneity in the dispersal process. In the studies presented in two of the included papers, the importance of the kernel shape is tested, by using a family of kernels where the shape and scale can be separated effectively. Both studies utilize spectral density approaches for modeling the spatial environment. It is concluded that the shape is not important when studying the population distribution in a habitat/matrix context. The shape is however important when looking at the invasion of organisms in a patchy environment, when the arrangement of patches deviates from randomly distributed. The introduced method for generating patch distribution is also compared to empirical distributions of patches (farms and old trees). Here it is concluded that the assumptions used for modeling of the spatial environment are consistent with the observed patterns. These assumptions include fractal properties such that the same aggregational patterns are found at different scales. In a series of papers, movements of animals are considered as vectors for between-herd disease spread. The studies are based on data found in databases held by the Swedish Board of Agricultural (SJV), consisting of reported movements, as well as farm location and characteristics. The first study focuses on the distance related probability of contacts between herds. In the following papers, the analysis is expanded to include production type and herd size. Movement data of pigs (and cattle in Paper I) are analyzed with Bayesian models, implemented with Markov Chain Monte Carlo (MCMC). This is a flexible approach that allows for parameter estimations of complex models, and at the same time includes parameter uncertainty. In Paper IV, the effects of the included factors are investigated. It is shown that all three factors (herd size, production type structure and distance related probability of contacts) are expected to influence disease spread dynamics, however the production type structure is found to be the most important factor. This emphasizes the value of keeping such information in central databases. The models presented can be used as support for risk analysis and disease tracing. However, data reliability is always a problem, and implementation may be improved with better quality data. The thesis also shows that utilizing spatial kernels for description of the spatial spread of organisms is an appropriate approach. However, these kernels must be flexible and flawed assumptions about the shape may lead to erroneous conclusions. Hence, the joint distribution of kernel shape and scale should be estimated. The flexibility of Bayesian analysis, implemented with MCMC techniques, is a good approach for this, and further allows for implementation of more complex models where other factors may be included.

Bakgrund: Antibiotikaresistenta bakterier är idag ett stort hot mot folkhälsan. Det här arbetet fokuserar på MRSA och lyfter fram problematiken som dess spridning innebär för patienten, samhället och vårdpersonal. MRSA-bärarskap kan ge både fysiskt och psykiskt lidande och en infektion orsakad av MRSA kan i värsta fall leda till döden för patienten. Sjuksköterskan har en viktig roll i att upprätthålla sin kompetens och arbeta preventivt för att förhindra spridning av MRSA. Syfte: Syftet var att identifiera och beskriva faktorer som leder till spridning av MRSA vid vårdarbetet av patienter på somatisk vårdavdelning. Metod: En litteraturstudie där 11 kvantitativa och en kvalitativ artikel analyserades utifrån Graneheim och Lundmans (2004) metod för innehållsanalys. Artiklarna kvalitetsgranskades med hjälp av Forsberg och Wengströms (2016) granskningsmallar. Resultat: Resultatet delades in i fem huvudkategorier med nio underkategorier som var och en visar på kompetensbrist hos sjuksköterskor. Litteraturstudien påvisar att faktorerna som leder till spridning av MRSA kan vara flera och att hela vårdteamet bär ett ansvar för att förhindra smittspridning. Sjuksköterskans roll i vårdteamet är att undervisa patienter och närstående, följa gällande rutiner och att upprätthålla sin egen kompetens för att arbeta evidensbaserat. Slutsats: Förhindra spridning av antibiotikaresistenta bakterier är en av sjuksköterskans viktigaste arbetsuppgifter i sin roll att lindra lidande hos patienten. Det är många faktorer som kan göra att MRSA sprids, sjuksköterskor måste reflektera och vara självkritiska i sitt arbete på vårdavdelningar. Evidensbaserat arbete var enligt Nightingale sjuksköterskans möjlighet att förhindra lidande för patienten och ligger till grund för den sjuksköterskeutbildning som finns idag. / Background: Antibiotic resistant bacteria are today a major threat to the public health. This work focuses on methicillin resistant staphylococcus aureus, highlighting the problem that it involves for the patient, society and healthcare professionals. MRSA carriership can cause both physical and mental suffering and an infection caused by MRSA can in worst case lead to the patient’s death. Nurses play an important role in maintaining their work skills to prevent MRSA from spreading in the somatic care. Aim: The aim of this study was to identify and describe factors that lead to the spread of MRSA to patients in somatic care. Method: A literature study where 11 quantitative and one qualitative article were analyzed based on Graneheim and Lundman's (2004) method. The articles quality were reviewed using Forsberg and Wengström’s (2016) checklists. Results: The results were divided into five main categories with nine subcategories; each showing that nurses had a lack of competence. The study shows that the factors that lead to the spread of MRSA may be several, and that the entire healthcare team has a responsibility to prevent infection. The nurse's role in the team is to teach patients and close relatives, follow current procedures and maintain their own skills to work evidence based. Conclusion: Preventing the spread of antibiotic resistant bacteria is one of the most important tasks in role of nursing and in alleviating patient suffering. There are many factors that can cause MRSA to spread. Nurses must reflect and be self-critical in their work in health care departments. Evidence based work was, according to Nightingale, the nurse's ability to prevent suffering for the patient and is the baseline in nursing education currently available today.