Ma Shuang-Cheng. / "March 2002." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 289-324). / 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.

<p>This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough.</p><p>GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection.</p><p>In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions.</p> / On the day of the public defence the status of the articles IV and V was: Accepted.

This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough. GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection. In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions. / On the day of the public defence the status of the articles IV and V was: Accepted.

Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM). Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II &amp; III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II &amp; III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by &gt;10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP&lt;50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II &amp; III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by &gt;10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP&lt;50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 5 uppsatser.

Thesis (Ph.D. in Analytic Health Sciences, Department of Preventive Medicine and Biometrics) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 75-77). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

DISSERTATION (PH.D.)--THE UNIVERSITY OF MICHIGAN / CO-CHAIRMEN: ARNOLD MONTO; GENE HIGASHI

DISSERTATION (PH.D.)--THE UNIVERSITY OF MICHIGAN / CO-CHAIRMEN: ARNOLD MONTO; GENE HIGASHI

Made available in DSpace on 2015-07-22T20:50:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-05-25 / O Vírus Sincicial Respiratório (VSR) é o principal agente em infecções agudas do trato respiratório inferior (IATRI) antes de dois anos, com altas taxas de internação e óbito em crianças de alto risco para infecção grave pelo VSR. Objetivo: Identificar os vírus envolvidos nos quadros de infecções agudas de trato respiratório (IATR) e analisar taxas de internação e óbito em crianças submetidas à profilaxia com palivizumabe. Métodos: Coorte prospectiva com 198 crianças menores de um ano de idade nascidas antes de 29 semanas de idade gestacional e crianças menores de 2 anos de idade com cardiopatia hemodinamicamente instável ou doença pulmonar crônica que receberam palivizumabe para profilaxia contra infecções graves pelo VSR em 2008. Nesse período, em cada episódio de IATR foi coletado aspirado de nasofaringe (NPA) para identificação de VSR, adenovírus, parainfluenza 1, 2 e 3, influenza A e B por imunofluorescência direta, e rinovírus e metapneumovírus por RT-PCR. Foram monitoradas internações e óbitos nesse grupo. Resultados: Das 198 crianças acompanhadas, 117 (59,1%) apresentaram IATR, totalizando 175 episódios. Das 76 NAPs coletadas, 37 foram positivas, encontrando-se, rinovírus em 75,7% dessas amostras, VSR (18,9%), parainfluenza (28,1%), adenovírus (2,7%), metapneumovírus (2,7%) e co-infecção em três amostras. Das 48 internações, 18 ocorreram por causa respiratória, sendo apenas 1 por VSR. Em nenhuma das duas crianças que evoluíram para óbito detectou-se o VSR. Conclusão: Na vigência de profilaxia com palivizumabe, a frequência de isolamento de VSR em crianças de alto risco com IATR e naquelas que necessitaram de internação hospitalar foi baixa. / Respiratory Syncytial Virus (RSV) is the most important etiologic agent in acute lower respiratory tract infections (ALRTIs) in children under two years, with high rates of hospitalization and death in high risk children for severe RSV infection. Objective: To identify the virus present in acute respiratory tract infections (ARTIs) and to analyze rates of hospitalization and death in children who received palivizumab prophylaxis. Methods: Prospective cohort of 198 infants up to 1 year old born before 29 weeks gestation and infants less than two years of age with hemodynamically instable cardiopathy or chronic pulmonary disease, who received prophylactic palivizumab against severe RSV infections in 2008. During this period, a nasopharyngeal aspirate (NPA) was collected in each episode of ARTI for identification of RSV, adenovirus, parainfluenza 1, 2 and 3, influenza A and B by direct immunofluorescence, and rhinovirus and metapneumovirus for RT-PCR. Data regarding hospitalization and death were collected. Results: Of the 198 infants included, 117 (59,1%) presented ARTIs, with a total of 175 episodes. Of 76 NPAs collected, 35 were positive, being rhinovirus (75.7%), RSV (18.9%), parainfluenza (8.1%), adenovirus 2 (2.7%), metapneumovirus (2.7%) and 3 samples presented multiple agents. Of 48 hospitalizations, 18 presented respiratory causes, but in only one child was found RSV. None of the 2 children who died had RSV. Conclusion: During the palivizumab prophylaxis period, the frequency of RSV detected in high risk children with ARTIs and those who were hospitalized was low. / TEDE / BV UNIFESP: Teses e dissertações

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / As infecÃÃes respiratÃrias agudas (IRAs) sÃo um importante problema de saÃde pÃblica em todo o mundo, e os vÃrus parainfluenza estÃo entre os seus agentes mais freqÃentes. Este estudo teve como objetivos: determinar a freqÃÃncia de IRAs pelo vÃrus parainfluenza entre crianÃas atendidas no Hospital Infantil Albert Sabin, hospital pediÃtrico de referÃncia da cidade de Fortaleza â CE, de janeiro de 2001 a dezembro de 2006; descrever o padrÃo de sazonalidade e as caracterÃsticas clÃnico-epidemiolÃgicas destas infecÃÃes; e comparar as caracterÃsticas clÃnico-epidemiolÃgicas das infecÃÃes por parainfluenza com as das IRAs causadas por outros vÃrus. Foram coletados aspirados de nasofaringe de crianÃas com sintomas de IRAs, e foi utilizada a imunofluorescÃncia indireta para a detecÃÃo dos vÃrus: parainfluenza humano 1, 2 e 3 (VPIH-1, 2 e 3), vÃrus sincicial respiratÃrio (VSR), influenza A e B e adenovÃrus. Nos seis anos de estudo, foram colhidas amostras de 3070 crianÃas, a maioria delas previamente sadias, com a detecÃÃo de vÃrus respiratÃrios em 933 (30,39%), e dos vÃrus parainfluenza em 117 casos (3,81% do total). Dentre os casos de parainfluenza, o VPIH-3 foi o tipo mais freqÃente (83,76% dos casos), com menor detecÃÃo do VPIH-1 (11,96%) e do VPIH-2 (4,27%). A infecÃÃo pelo VPIH-3 apresentou comportamento sazonal, com maior detecÃÃo nos meses de setembro a novembro. Embora o total de casos de IRAs tenha apresentado relaÃÃo direta com os Ãndices pluviomÃtricos, o nÃmero de casos de VPIH-3 apresentou relaÃÃo inversa com a pluviometria, sendo maior nos meses secos. A maioria dos pacientes positivos para parainfluenza foi atendida na emergÃncia ou nos ambulatÃrios. A mÃdia de idades das crianÃas com infecÃÃo pelo VPIH-3 foi de 20 meses, sendo significativamente menor que a das crianÃas infectadas pelo vÃrus influenza A (34 meses), e maior que a das infectadas pelo VSR (15 meses). Os pacientes positivos para o VPIH-3 apresentaram significativamente menos dispnÃia, tosse, estertores, tiragem intercostal e alteraÃÃes radiolÃgicas que os positivos para VSR. As infecÃÃes de vias aÃreas superiores constituÃram a sÃndrome clÃnica mais freqÃente entre os casos de VPIH-3. Os pacientes positivos para VPIH-3 necessitaram menos de terapia com antibiÃticos, corticÃides, oxigÃnio, nebulizaÃÃo e/ou salbutamol que os positivos para VSR. Os resultados demonstraram um comportamento sazonal do VPIH-3, relacionado aos meses secos, o que nÃo tinha sido relatado previamente no Nordeste brasileiro, alÃm de apontarem para uma menor gravidade das infecÃÃes causadas pelo VPIH-3, na comparaÃÃo com o VSR, em crianÃas previamente sadias / Acute respiratory infections (ARI) are an important public health problem throughout the world and parainfluenza viruses are among the major etiologic agents. The objectives of this study were: a) to determine the frequency of parainfluenza infections among children attending Hospital Infantil Albert Sabin, a major pediatric hospital in Fortaleza - CE, from January 2001 to December 2006; b) to describe the seasonal pattern and the clinical and epidemiological characteristics of these infections; and c) to compare clinical and epidemiological characteristics of parainfluenza infections and infections caused by other respiratory viruses. Nasopharyngeal aspirates from children with acute respiratory symptoms were collected and submitted to indirect immunofluorescence assays to detect human parainfluenza virus 1, 2 and 3 (HPIV-1, 2 and 3), respiratory syncytial virus (RSV), influenza A and B and adenovirus. During the six-year study period, samples were collected from 3,070 generally healthy children and respiratory viruses were demonstrated in 933 cases (30.39%), of which 117 were positive for parainfluenza virus (3.81%). HPIV-3 was the most frequently detected type of parainfluenza virus accounting for 83.76% of cases, followed by HPIV-1 (11.96%) and HPIV-2 (4.27%). HPIV-3 infections were seasonal with most cases observed from September to November. Although the total number of ARIs was directly associated with the time of the rainy season, HPIV-3 infections were inversely related with rainfall indices. Most HPIV-3 infections were seen in outpatients. The mean age of patients infected by HPIV-3 was 20 months, which is significantly younger than for influenza A (mean age: 34 months) and significantly older than for RSV (mean age: 15 months). HPIV-3 patients presented significantly lower indices of dyspnea, cough, crackles, chest retractions and radiologic abnormalities than RSV patients. Upper airway infection was the most frequent clinical syndrome among HPIV-3 patients. HPIV-3 patients needed less oxygen, salbutamol, antibiotics, corticosteroids and nebulization than RSV patients. In contrast with earlier observations for Northeastern Brazil, our results demonstrate a seasonal pattern for the occurrence of HPIV-3 infections with most cases observed during the dry season. The results also suggest that infections caused by HPIV-3 are milder than infections caused by RSV in previously healthy children