Household fuel pollution from the use of low quality biomass fuels is considered as a risk factor for respiratory tract infections (RTI) in women and children. Inhalation of fuel-derived pulmonary toxins (e.g. particulate matter (PM2.5μm) , and carbon monoxide (CO) can harm the lungs of young children, due to their under-developed immune defences. In Bangladesh acute respiratory infections (ARI) are the leading cause of child mortality (< 5 years of age). This thesis aimed to examine the relationship between RTI and household fuel pollution exposure using measured pollution data and medical diagnoses. During an 18-month longitudinal health intervention in northern Bangladesh households (n=408) were interviewed (3 times) on cooking/fuel-use practices and child health. Anthropometric data (height/weight) and finger-prick blood samples for analysis of immune status (c-reactive protein, alpha-1-acidglycoprotein (AGP) and albumin) were collected (n=321 < 5 years of age). All unwell children (62.4%) were medically examined. Household pollution levels (particulate matter (PM2.5μm) and carbon monoxide (CO) were monitored for a 24-hour period (n=61). Moderate/ severe RTI was common (24.8%) (youngest child only n=213). Poor child growth (stunted: 43.8%, underweight=66.7%, wasted: 38.4%) and immunity were detected. 98% of the households used inefficient chimneyless mud stoves and low quality biomass fuels (wood, golden, dung). The measured indoor pollution levels exceeded the WHO safety thresholds (PM2.5 μm range: 85 to 3020 μg/m³ CO range: 0-16 ppm) (PM2.5 μm>25 μm/m³, CO>9ppm). Longitudinal multivariate GLM showed that cooking practices were associated with child immune status: haemoglobin levels (F= 1.555, p=NS) were significantly associated with Bihari ethnicity and a fixed stove use (F=3.718 and F=3.716, p<0.05 respectively). Elevated log₁₀-AGP levels were found (F=4.371, p<0.05) in Saidpur in households using a fixed stove (F=4.123, F=3.780, p<0.05). The patterns in child growth z-scores were due to age only (stunting: F=7.413, p<0.01, underweight F=5.787, p<0.05). Interestingly, poorer change score for weight-for-age (F=34.893, p<0.01) was associated with low age and more frequent cooking (F=6.441 and, F=6.553, p<0.05 respectively). Logistic regression (healthy vs. RTI) identified the presence of child by the stove during cooking as the sole risk factor for RTI (absent OR= 0.257, 95% CI: 0.097 - 0.676, p<0.01). Indoor cooking and the use of a fixed stove were associated with low SES. Education may help to reduce behaviours associated with high household fuel pollution exposure via the introduction of simple healthy cooking practices.

Ren-Wang Jiang. / "July 2002." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Os adenovÃrus (Ad) sÃo agentes importantes de infecÃÃes respiratÃrias agudas (IRAs) em crianÃas, especialmente entre seis meses e cinco anos de idade. Este foi um estudo retrospectivo que teve como objetivos: estabelecer o perfil epidemiolÃgico e clÃnico das infecÃÃes respiratÃrias agudas causadas por Ad em crianÃas atendidas no Hospital Infantil Albert Sabin, na cidade de Fortaleza, no perÃodo de janeiro de 2001 a dezembro de 2006; observar a freqÃÃncia de detecÃÃo de Ad em casos de IRAs em crianÃas atendidas nesse hospital; descrever as principais caracterÃsticas clÃnicas das infecÃÃes respiratÃrias causadas por Ad; pesquisar a existÃncia de padrÃo de sazonalidade do Ad na cidade de Fortaleza; determinar a taxa de isolamento do Ad em cultura de cÃlulas HEp-2 inoculadas com amostras de secreÃÃes de nasofaringe (SNF) consideradas positivas para Ad por imunofluorescÃncia indireta (IFI); e criar um banco de cepas de Ad para futuros estudos sobre diversidade antigÃnica e genÃmica desses agentes. Foram coletadas nesse perÃodo, amostras de SNF de 3070 crianÃas com atà sete dias de sintomas de IRA. Todas as amostras foram submetidas a IFI e, dessas, 54 se mostraram positivas para Ad. Quarenta e uma dessas amostras positivas foram inoculadas em monocamadas de cÃlulas HEp-2, obtendo-se isolamento viral em 32 delas. Outras 103 amostras negativas por IFI, escolhidas aleatoriamente, foram inoculadas, resultando em trÃs isolamentos adicionais, totalizando 57 casos confirmados de infecÃÃo por Ad. A freqÃÃncia de detecÃÃo de Ad foi de 1,86% em relaÃÃo ao total de casos de IRAs e 6,1% das IRAs virais. NÃo foi observado um padrÃo de sazonalidade nem correlaÃÃo com perÃodo chuvoso ou seco. A maior parte das IRAs por Ad ocorreu em crianÃas na faixa etÃria entre sete e 24 meses com 63,15% dos casos. As IRAs por Ad foram observadas principalmente em crianÃas atendidas em ambulatÃrios (50,88%), e o diagnÃstico predominante foi a infecÃÃo de vias aÃreas superiores (70,18%). Os principais sintomas e sinais apresentados pelos pacientes com IRA por Ad foram febre, tosse, coriza, anorexia, vÃmitos e/ou diarrÃia, obstruÃÃo nasal e dispnÃia. A principal conduta terapÃutica aplicada em casos de IRAs por Ad foi o uso de aerossol / salbutamol (42,11%) / Adenoviruses (Ad) are important etiological agents of acute respiratory infections (ARI) in children, particularly between six months and five years old. This was a retrospective study, whose objectives were: to perform clinical and epidemiologic profile of adenoviral respiratory infections in children attended in Hospital Infantil Albert Sabin, in the city of Fortaleza, from January 2001 to December 2006; to observe the detection frequency of Ad in cases of ARI in children attended in that hospital; to describe the main clinical features of adenoviral respiratory infections; to search for the existence of a seasonal pattern of adenoviral infections in the city of Fortaleza; to determine the isolation rate of Ad in HEp-2 cell lines inoculated with samples of nasopharyngeal secretions (NPS) considered positive to Ad by indirect immunofluorescence (IIF); and to create a collection of Ad strains for future studies on antigenic and genomic diversity of these agents. NPS samples of 3,070 children with ARI up to seven days of the onset of symptoms were collected. IIF was applied to all of the samples, and among them, 54 were positive to Ad. Forty one of those positive samples were inoculated into HEp-2 cells, resulting in 32 viral isolations. Other 103 randomly choosen negative samples were also inoculated, resulting in more three isolations, reaching the number of 57 confirmed cases of Ad infections. The detection frequency of Ad was 1.86% of total number of cases of ARI and 6.1% of cases of viral ARI. It was not observed any seasonal pattern or correlation to rainy or dry season. Most cases of adenoviral ARI occurred in children aged seven to 24 months, representing 63.15% of cases. Ad ARI was observed mainly in children attended in the out-patient facility (50.88%), and the predominant diagnosis was upper respiratory tract infection (70.18%). The main clinical features in Ad patients were fever, cough, rhinorrhea, anorexia, vomiting or diarrhea, nasal obstruction, and dyspnea. The main therapeutic management for Ad patients was use of nebulization (about 42% of patients)

INTRODUÇÃO: Indivíduos infectados pelo HIV apresentam maior risco de quadros graves de infecção por influenza sazonal e, portanto, devem receber doses anuais da vacina contra gripe. No entanto, a capacidade dos indivíduos responderem às vacinas com títulos apropriados de anticorpos depende de variáveis como tipo de antígeno vacinal, idade e grau de comprometimento imunológico no momento da imunização. OBJETIVOS: 1) Avaliar a imunogenicidade da vacina contra influenza sazonal em 37 pacientes infectados pelo HIV, em comparação com 29 indivíduos não infectados pelo HIV 2) Realizar a vigilância dos episódios de infecções respiratórias durante o período de acompanhamento após a vacinação. MÉTODOS: Ambos os grupos receberam a vacina contra o vírus da influenza sazonal recomendada para o hemisfério sul em 2008. A resposta de anticorpos contra os antígenos H1N1, H3N2 e B foi medida em amostras de sangue extraídas 1-2h antes da vacinação (T0), após 1 mês (T1) e após 6 meses (T6; apenas no Grupo HIV). A vigilância dos sintomas respiratórios foi realizada através de telefonemas semanais, durante 6 meses após a vacinação. Em indivíduos sintomáticos para infecções respiratórios foram coletadas amostras de lavado nasofaríngeo para pesquisa de vírus respiratórios por Imunofluorescência e PCR: influenza A e B, parainfluenza 1, 2 e 3, adenovírus, metapneumovírus, vírus sincicial respiratório, rinovírus e coronavírus. RESULTADOS: A idade mediana da população de estudo foi de 12 (10-18) anos. No momento T1, ambos os grupos mostraram aumento significativo nos TMGs para todos os antígenos. Contudo, o grupo controle apresentou valores mais elevados para os antígenos A/H1N1 e A/H3N2 (p = 0,002 e 0,001, respectivamente). Houve maior aumento na porcentagem de indivíduos não infectados pelo HIV com títulos protetores A/H1N1 (96,6%) em comparação aos infectados pelo HIV (67,6%). No T1 (p=0,004). A porcentagem de indivíduos do grupo controle com aumento de quatro vezes ou mais nos títulos de anticorpos para A/H1N1 e A/H3N2 foram mais elevadas que no grupo HIV (p = 0,03 e 0,01, respectivamente). Agentes virais foram detectados em 39/60 (65%) dos episódios de infecção respiratória no grupo HIV e em 17/32 (53,1%) no grupo controle. Os vírus diagnosticados no grupo HIV e grupo controle foram respectivamente: adenovirus (8,6%), metapneumovirus (1,2%), rinovirus (16,8%), coronavirus (14,0 %) e influenza B (0,1%).CONCLUSÕES: A vacina sazonal contra os vírus da influenza foram imunogenicas em ambos os grupos. Ocorreram diferença nas taxas de soroproteção entre os grupos somente para o antígeno H1, que foi mais elevadas no grupo controle. O grupo controle também mostrou valores mais altos nos TMGs para os antígenos H1 e H3 depois da imunização. Os rinovirus (27,7%) e coronavirus (22,5%) foram os agentes mais prevalentes identificados no grupo infectado pelo HIV. No grupo controle, os vírus mais freqüentes foram os rinovirus (24,2%) e adenovirus (21,2%) / INTRODUCTION: Individuals infected with HIV are at higher risk for severe cases of seasonal influenza infection and therefore should receive annual doses of influenza vaccine. However, the ability to respond to vaccines respond appropriate antibodies titres depends on variables such as vaccine antigen, age and degree of immune impairment at immunization. OBJECTIVES: 1)To evaluate the immunogenicity of a seasonal influenza vaccine in 37 HIV-infected patients (HIV Group), compared to 29 uninfected individuals (Control Group) 2) To carry out a clinical and virological surveillance of influenza in this population during a follow-up period of six months. METHODS: Both groups received the vaccine against seasonal influenza virus recommended for the southern hemisphere in 2008. The antibody response against the antigens H1N1, H3N2 and B were measured in blood samples drawn at vaccination (T0), after 30 days (T1) and after 6 months (T6; only for HIV Group). Antibody titres >1:40 were considered protective against influenza infection A surveillance of respiratory symptoms was performed weekly by telephone calls for a post-vaccination follow-up period of 6 months. Samples were collected (nasal wash) if respiratory symptoms. DFA and real time PCR was used to diagnose influenza A virus (FLU A) and B (FLU B), respiratory syncytial virus (RSV), parainfluenza virus types 1, 2 and 3 ( Paraflu 1, 2 or 3), adenovirus, coronavirus, rhinovirus, metapneumovirus and bocavirus. RESULTS: The median age of the study population was 12 (10-18) years. At T0, there were no significant differences in the antibody geometric mean titres (GMTs) against all vaccine antigens between groups. One month after vaccination (T1), both groups showed significant increases in the antibody GMTs for all antigens. However, healthy controls showed higher values for antigens A/H1N1 and A/H3N2 (p = 0.002 and 0.001, respectively). There was a higher increase in the percentage of HIVuninfected subjects with protective A/H1N1 antibodies (96.6%) comparing to HIVinfected vaccinees (67.6%) at T1 (p = 0.004). The percentage in subjects control group with a fourfold or greater increase of A/H1N1 and A/H3N2 antibody titres was higher than that found in HIV group (p = 0.03 and p = 0.01, respectively. Viral agents were identified in 39/60 (65%) episodes of respiratory infections in HIV-infected group and in 17/32 episodes (53.1%) from the control group (P=0.273). The virus diagnosed in HIV group and control group were, respectively: Adenovirus (8;6), Metapneumovirus(1;2) Rinovirus(16;8), Coronavirus(14 ;0); Influenza B(0;1). CONCLUSIONS: The seasonal influenza vaccine was immunogenic in both groups. There were differences in seroprotection rates between groups only for AgH1, which was higher in the control group. The control group also showed a greater increase in GMTs for H1 and H3 antigens after immunization. Viral agents were identified in respiratory symptoms during the follow-up: Rhinoviruses (27.7%) and coronavirus (22.5%) were the most prevalent agents identified in HIV-infected individuals. In the control group, the viruses most frequently found were rhinoviruses (24.2%) and adenovirus (21.2%)

INTRODUÇÃO: Indivíduos infectados pelo HIV apresentam maior risco de quadros graves de infecção por influenza sazonal e, portanto, devem receber doses anuais da vacina contra gripe. No entanto, a capacidade dos indivíduos responderem às vacinas com títulos apropriados de anticorpos depende de variáveis como tipo de antígeno vacinal, idade e grau de comprometimento imunológico no momento da imunização. OBJETIVOS: 1) Avaliar a imunogenicidade da vacina contra influenza sazonal em 37 pacientes infectados pelo HIV, em comparação com 29 indivíduos não infectados pelo HIV 2) Realizar a vigilância dos episódios de infecções respiratórias durante o período de acompanhamento após a vacinação. MÉTODOS: Ambos os grupos receberam a vacina contra o vírus da influenza sazonal recomendada para o hemisfério sul em 2008. A resposta de anticorpos contra os antígenos H1N1, H3N2 e B foi medida em amostras de sangue extraídas 1-2h antes da vacinação (T0), após 1 mês (T1) e após 6 meses (T6; apenas no Grupo HIV). A vigilância dos sintomas respiratórios foi realizada através de telefonemas semanais, durante 6 meses após a vacinação. Em indivíduos sintomáticos para infecções respiratórios foram coletadas amostras de lavado nasofaríngeo para pesquisa de vírus respiratórios por Imunofluorescência e PCR: influenza A e B, parainfluenza 1, 2 e 3, adenovírus, metapneumovírus, vírus sincicial respiratório, rinovírus e coronavírus. RESULTADOS: A idade mediana da população de estudo foi de 12 (10-18) anos. No momento T1, ambos os grupos mostraram aumento significativo nos TMGs para todos os antígenos. Contudo, o grupo controle apresentou valores mais elevados para os antígenos A/H1N1 e A/H3N2 (p = 0,002 e 0,001, respectivamente). Houve maior aumento na porcentagem de indivíduos não infectados pelo HIV com títulos protetores A/H1N1 (96,6%) em comparação aos infectados pelo HIV (67,6%). No T1 (p=0,004). A porcentagem de indivíduos do grupo controle com aumento de quatro vezes ou mais nos títulos de anticorpos para A/H1N1 e A/H3N2 foram mais elevadas que no grupo HIV (p = 0,03 e 0,01, respectivamente). Agentes virais foram detectados em 39/60 (65%) dos episódios de infecção respiratória no grupo HIV e em 17/32 (53,1%) no grupo controle. Os vírus diagnosticados no grupo HIV e grupo controle foram respectivamente: adenovirus (8,6%), metapneumovirus (1,2%), rinovirus (16,8%), coronavirus (14,0 %) e influenza B (0,1%).CONCLUSÕES: A vacina sazonal contra os vírus da influenza foram imunogenicas em ambos os grupos. Ocorreram diferença nas taxas de soroproteção entre os grupos somente para o antígeno H1, que foi mais elevadas no grupo controle. O grupo controle também mostrou valores mais altos nos TMGs para os antígenos H1 e H3 depois da imunização. Os rinovirus (27,7%) e coronavirus (22,5%) foram os agentes mais prevalentes identificados no grupo infectado pelo HIV. No grupo controle, os vírus mais freqüentes foram os rinovirus (24,2%) e adenovirus (21,2%) / INTRODUCTION: Individuals infected with HIV are at higher risk for severe cases of seasonal influenza infection and therefore should receive annual doses of influenza vaccine. However, the ability to respond to vaccines respond appropriate antibodies titres depends on variables such as vaccine antigen, age and degree of immune impairment at immunization. OBJECTIVES: 1)To evaluate the immunogenicity of a seasonal influenza vaccine in 37 HIV-infected patients (HIV Group), compared to 29 uninfected individuals (Control Group) 2) To carry out a clinical and virological surveillance of influenza in this population during a follow-up period of six months. METHODS: Both groups received the vaccine against seasonal influenza virus recommended for the southern hemisphere in 2008. The antibody response against the antigens H1N1, H3N2 and B were measured in blood samples drawn at vaccination (T0), after 30 days (T1) and after 6 months (T6; only for HIV Group). Antibody titres >1:40 were considered protective against influenza infection A surveillance of respiratory symptoms was performed weekly by telephone calls for a post-vaccination follow-up period of 6 months. Samples were collected (nasal wash) if respiratory symptoms. DFA and real time PCR was used to diagnose influenza A virus (FLU A) and B (FLU B), respiratory syncytial virus (RSV), parainfluenza virus types 1, 2 and 3 ( Paraflu 1, 2 or 3), adenovirus, coronavirus, rhinovirus, metapneumovirus and bocavirus. RESULTS: The median age of the study population was 12 (10-18) years. At T0, there were no significant differences in the antibody geometric mean titres (GMTs) against all vaccine antigens between groups. One month after vaccination (T1), both groups showed significant increases in the antibody GMTs for all antigens. However, healthy controls showed higher values for antigens A/H1N1 and A/H3N2 (p = 0.002 and 0.001, respectively). There was a higher increase in the percentage of HIVuninfected subjects with protective A/H1N1 antibodies (96.6%) comparing to HIVinfected vaccinees (67.6%) at T1 (p = 0.004). The percentage in subjects control group with a fourfold or greater increase of A/H1N1 and A/H3N2 antibody titres was higher than that found in HIV group (p = 0.03 and p = 0.01, respectively. Viral agents were identified in 39/60 (65%) episodes of respiratory infections in HIV-infected group and in 17/32 episodes (53.1%) from the control group (P=0.273). The virus diagnosed in HIV group and control group were, respectively: Adenovirus (8;6), Metapneumovirus(1;2) Rinovirus(16;8), Coronavirus(14 ;0); Influenza B(0;1). CONCLUSIONS: The seasonal influenza vaccine was immunogenic in both groups. There were differences in seroprotection rates between groups only for AgH1, which was higher in the control group. The control group also showed a greater increase in GMTs for H1 and H3 antigens after immunization. Viral agents were identified in respiratory symptoms during the follow-up: Rhinoviruses (27.7%) and coronavirus (22.5%) were the most prevalent agents identified in HIV-infected individuals. In the control group, the viruses most frequently found were rhinoviruses (24.2%) and adenovirus (21.2%)

Nontypeable Haemophilus influenzas (NTHi) is recognised as a significant human pathogen causing mild to severe respiratory tract infections. At present, no vaccine is available for prevention of infection caused by this pathogen. Several outer membrane proteins (OMPs) of NTHi and its lipooligosaccharide have been investigated as possible vaccine antigens against NTHi infections. Previous investigations in our laboratory have shown that OMP26 from an NTHi 289 strain was able to significantly enhance pulmonary clearance of NTHi in a rat model in which animals were immunised via intestinal Peyer's patches and then boosted intratracheally (Kyd and Cripps, 1998; El- Adhami et al., 1999). In recent studies, the OMP26, when used as a parenteral immunogen, was also highly effective at inducing immune responses that led to significantly enhanced clearance of the chinchilla nasopharynx (Kyd et al., 2003). These studies indicate significant potential of the OMP26 as a candidate vaccine antigen and warrant further investigations for development of a vaccine against NTHi. This thesis focussed on the immunological and structural characterisation of the NTHi vaccine candidate, OMP26. Peptides of OMP26 were used as tools to localise the immunologically important regions of the OMP26. Two different E. coli expression systems, the GST gene fusion and the 6xHis tagged systems, were employed to construct the OMP26 peptides. It was found in this study that, despite efforts to optimise the system, the GST-fusion protein system failed to produce consistent results for the purification and storage of the OMP26 peptides. In contrast, the 6xHis tagged system exhibited more reliable outcomes in the production of the recombinant OMP26 peptides and the stability of the stored purified peptides. As such, the purified OMP26 peptides from the 6xHis tagged system were chosen to map major regions of immunological significance for the OMP26 protein. The regions of the OMP26 which are involved in the induction of the acquired immune responses have been identified in the present study. Based on the antigen specific lymphocyte proliferation assay, the dominant T cell epitopes for OMP26 were located between amino acid residues 95 and 197 (T3+T4 region). These identified T cell epitopes exhibited the capability of efficient T cell activation, suggesting that the epitopes within the T3+T4 region potentially had the highest affinity for binding to the MHC molecules than did any other OMP26 region. Using two different assay systems, ELISA and BIA, the predominant B cell epitopes of OMP26 were located between amino acid residues 45 and 145 (T2+T3 region). This region was also found to be immunodominant across all animal species tested, and with all immunisation regimens used. Flow cytometry analysis also revealed that these particular epitopes were expressed on the surface of NTHi cells. By integration of the data obtained from these current experimental studies and the computational analysis of the OMP26 sequence, two hypothetical models of the OMP26 were also proposed in this study. The significant outcomes obtained in this thesis provide a better understanding of the specificity of the host immune responses to the OMP26 protein These findings provide great benefit not only for the development of a future NTHi vaccine but for the development of the peptide-based immunodiagnostic reagents as well. These diagnostic reagents will be valuable, in particular, for the evaluation of efficacy of an NTHi vaccine in humans that may include OMP26 or specific conformational structures. Future studies are still required to further define the minimum epitope length required for the B and T cell responses identified in this study. The significance of these responses in immune protection against NTHi infection also requires further investigations. Human immune responses also need to be determined, but this can only be achieved following clinical trial studies.

PCR is a rapid, reproducible method for nucleic acid detection. However, this technology displays significant deficiencies when applied in clinical microbiology. This work’s aim was to improve current diagnostics and provide sensitive and quantitative real-time PCRs. Paper I describes the development of a sensitive and specific quantitative real-time PCR for the detection of Streptococcus pneumoniae, based on the Spn9802 DNA fragment. Applied to nasopharyngeal aspirates from 166 pneumonia patients, Spn9802 PCR had a sensitivity of 94% and a specificity of 98%. In Paper II the performance of a ply gene PCR for identification of pneumococcal lower respiratory tract infection (LRTI) was evaluated on bronchoalveloar lavage fluids. At the detection limit 103 genome copies/mL, 89% sensitivity but only 43% specificity was achieved. Paper III shows that S. pneumoniae DNA is detectable in plasma from acutely febrile patients. Sensitivities were low (26-42%) for detection of pneumococcal pneumonia, for bacteraemic pneumococcal pneumonia they were 60-70%. Paper IV describes evaluation of four PCR targets for Haemophilus influenzae detection. A real-time PCR based on the P6 gene was developed and applied to 166 CAP patients, using cut-off of 104 genome copies/mL the assay had a sensitivity of 97% and a specificity of 96%. In paper V, the two real-time PCRs presented in papers I and IV were combined with a PCR for detection of Neisseriae meningitidis. The analytical sensitivity of this multiplex real-time PCR was not affected by using a mixture of reagents and a combined DNA standard (S. pneumoniae/H. influenzae) in single tubes. Applied to 156 LRTI patients, this PCR had sensitivities over 90% for S. pneumoniae and H. influenzae, and specificities of 89% and 96%, respectively. In conclusion, real-time PCR assays are useful for the diagnosis of S. pneumoniae and H. influenzae. They enable detection after antibiotic installation, and quantification increases the etiological specificity of pneumonia.

Tyrimo tikslas – nustatyti antibiotikų skyrimo ypatumus Lietuvos pirminės sveikatos priežiūros įstaigose gydant suaugusių žmonių (nuo 18 m. amžiaus) kvėpavimo takų infekcijas. Tyrimo uždaviniai: 1. Nustatyti kvėpavimo takų infekcijų struktūrą. 2. Įvertinti mikrobiologinių tyrimų ir kitų diagnostinių tyrimų naudojimą suaugusiems sergantiems kvėpavimo takų infekcijomis (KTI). 3. Nustatyti antibiotikų skyrimo dažnumą gydant suaugusių KTI privačiuose centruose ir poliklinikose. 4. Nustatyti skiriamų antibiotikų struktūrą gydant suaugusių KTI privačiuose centruose ir poliklinikose. Tyrimo metodika ir apimtis. Atliktas aprašomasis retrospektyvinis paplitimo tyrimas. Daugiapakopės atsitiktinės atrankos būdu atrinktos 1767 ambulatorinės kortelės suaugusių asmenų, kurie 2004 m. gydėsi ambulatorinėse įstaigose. Surinkti ir išanalizuoti bendri duomenys apie ligonį (amžius, lytis), duomenys apie 1 metų bėgyje nustatytas infekcijas, paskirtą antimikrobinį gydymą, atliktus diagnostinius tyrimus. Duomenų tvarkymui ir analizei naudotos Epi Data, SPSS, WinPepi, Epi 6 programos. Rezultatai. Iš viso tirtiems asmenims diagnozuota 1141 infekcija, iš kurių didžiausią dalį (84,1%, 959) sudarė KTI. Daugiau diagnozuota VKTI (66,0%, 633) nei AKTI (34,0%, 326). Dažniausiai diagnozuota tarp VKTI buvo ūmi virusinė KTI (41,5%), faringitai (28,9%), o tarp AKTI - ūmūs bronchitai (52,1 %). KTI paplitimas privačiuose centruose buvo didesnis (74,1%) nei poliklinikose (36,0%) (p<0,001). Vyrų ir moterų tarpe KTI... [toliau žr. visą tekstą] / The aim of this study was to describe prescription of antimicrobials to treat adult respiratory tract infections in Lithuanian primary health care. The tasks of the investigation: 1. To define the structure of respiratory tract infections (RTIs). 2. To rate the use of microbiological and other diagnostic tests in adult patients with RTIs. 3. To determine the antibiotic prescription rates for adult RTIs in private centers and polyclinics. 4. To define the structure of prescribed antibiotics for the treatment adult RTIs in private centers and polyclinics. Methods and volume of the investigation. The retrospective prevalence study was carried. Randomly selected 1767 medical records of adult pacients, who visited physician during 2004 year were analysed. Data about patients (age, sex), infection, antimicrobial treatment, diagnostic tests were registered and analysed. Data were managed and analysed using Epi Data, SPSS, Win Pepi, Epi 6 statistical programmes. Results. There were 1141 infections diagnosed overall. RTIs were the most prevalent and composed 84,1% (959) of all diagnosed infections. Upper respiratory tract infections (URTIs) were more frequent (66,0%, 633) than lower respiratory tract infections (LRTIs) (34,0%, 326). The most frequent diagnoses were acute viral respiratory tract infection (41,5%), pharyngitis (28,9%) among URTIs and acute bronchitis (52,1 %) among LRTIs. Prevalence of RTIs was higher in private centers (74,1%0 than in polyclinics (36,0%) (p<0,001)... [to full text]

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2009. / Härtill 5 uppsatser.

Dissertation (Ph.D.)--Helsingin yliopisto, 2006. / Includes bibliographical references. Available in PDF format via the World Wide Web.