Dissertations / Theses on the topic 'Household contacts'

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Effective control of leprosy has challenged the organization of health services, due to the long incubation period and the high prevalence of cases, and the sequelae and disabilities resulting from the disease. Based on this assumption, this research consists of a descriptive epidemiological and longitudinal study of recorded cases of leprosy, whose goal is to analyze the prevalence of leprosy parallel to the transmission chain in the city of Imperatriz-MA, from 2002 to 2012. s Research was performed with patients with leprosy living in the City of Imperatriz-MA, duly registered in SINAN (Information System for Notifiable Diseases). Among the findings, are: 35% of reported cases presented in the form of multibacillary borderline classification; age of most patients were ≥ 15 years; examined in relation to contacts not been possible to achieve the goal proposed by the Ministry of Health, and in some years, the low coverage did not influence the increased incidence of leprosy; decreased the number of deaths and the dropout rate significantly; and failure in completing the records of the type of reactions presented mainly in the period 2002-2005. Analyzing the epidemiological situation of leprosy in the village of Imperatriz-MA, it is concluded that the remains endemic despite the significant decrease in the number cases during this period, and that eradication of the disease in the state of Maranhão, is a distant reality, with a prevalence of cases 10:54 10.0 per thousand in 2012 in the municipality of the study.
O controle efetivo da hanseníase tem desafiado a organização dos serviços de saúde, em razão do longo período de incubação e pela alta prevalência de casos, além das sequelas e incapacidades decorrentes da doença. Partindo desse pressuposto, esta pesquisa consiste em um estudo epidemiológico descritivo e longitudinal dos casos registrados de hanseníase, cujo objetivo é analisar a prevalência da hanseníase paralela à cadeia de transmissão no Município de Imperatriz-MA, no período de 2002 a 2012. A pesquisa foi realizada com portadores de Hanseníase residentes no Município de Imperatriz-MA, devidamente registrado no SINAN (Sistema de Informação de Agravos de Notificação). Dentre os resultados encontrados, destacam-se: 35% dos casos notificados apresentaram-se na forma dimorfa de classificação multibacilar; idade da maioria dos portadores era ≥ 15 anos; em relação aos contatos examinados não foi possível atingir a meta proposta pelo ministério da Saúde, e, em alguns anos, a baixa cobertura não influenciou no aumento da incidência da hanseníase; houve redução do número de óbitos e da taxa de abandono de forma significativa; e falha no preenchimento dos registros quanto ao tipo de reações apresentadas, principalmente no período de 2002 a 2005. Ao analisar a situação epidemiológica da hanseníase no município de Imperatriz-Ma, concluise que a endemia se mantém, apesar da diminuição significativa do número de casos neste período, e que a erradicação dessa doença no estado do Maranhão, é uma realidade ainda distante, com prevalência de 10.54 casos por 10.0 mil habitantes em 2012 no município do estudo.

Objective: Describe the prevalence of Bordetella pertussis via PCR in children under 5 years old hospitalized as probable cases of pertussis and report the most common clinical features among them. Results: A positive PCR result for B. pertussis was observed in 20.5% of our samples (18/88), one-third of them were from infants between 2 and 3 months old. The most common symptoms were paroxysms of coughing (88.9%), difficulty breathing (72.2%), cyanosis (77.8%) and fever (50%). The mother was the most common symptomatic carrier (27.8%), followed by uncles/aunts (22.2%) among children with pertussis.
This work was supported by fourth research incentive of the Universidad Peruana de Ciencias Aplicadas (UPC), Lima‑Peru.
Revisión por pares

Hanseníase é uma das mais antigas e instigantes doenças que acometem o ser humano. Ferramentas moleculares e imunológicas são avaliadas em diversos estudos epidemiológicos, porém com resultados controversos devido à alta complexidade da doença e metodologias utilizadas. Este estudo descreve o uso da sorologia anti PGL-I e da detecção de DNA em swab nasal para caracterizar a epidemiologia molecular do Mycobacterium leprae em pacientes e contatos domiciliares de pacientes com hanseníase. Em pacientes com hanseníase a positividade nos testes ELISA anti PGL-I e PCR para a detecção do DNA de M. leprae em swab nasal são inversamente associadas ao teste de Mitsuda e são diretamente associadas com o índice baciloscópico e as formas clínicas no espectro da doença, aumentando em direção às formas bacilíferas. As porcentagens gerais de positividade em pacientes foram 63,3% para o ELISA anti PGL-I e 34,2% para a PCR para detecção do DNA de M. leprae em swab nasal. Nos contatos domiciliares de pacientes com hanseníase as porcentagens gerais para o ELISA anti PGL-I e para a PCR para detecção do DNA de M. leprae em swab nasal foram 13,3% e 4,7% respectivamente. Os contatos com resultados positivos nestas metodologias representam portadores sadios ou com infecção subclínica e podem participar na transmissão e manutenção do M. leprae na comunidade, mesmo que os mesmos não venham a adoecer. É imperativo para o controle da hanseníase o monitoramento de contatos domiciliares em regiões endêmicas para detecção precoce de novos casos e a quimioprofilaxia deve ser utilizada como prevenção para o desenvolvimento da doença e interrupção da transmissão.
Leprosy is one of the oldest and most instigating diseases to affect humans. Molecular and immunological tools are evaluated in epidemiological studies; however, the results present controversies mainly due to disease complexity and methodologies. This study describes the application of anti PGL-I serology and nasal swab DNA detection to characterize Mycobacterium leprae molecular epidemiology in patients and household contacts of leprosy patients. Among leprosy patients the positivity to the anti PGL-I ELISA and the PCR for the detection of M. leprae DNA in nasal swabs are inversely associated to the lepromin test and arte directly associated to the bacillary index and the clinical forms in the disease spectrum, increasing towards baciliferous forms. The overall positivity percentages were 63.3% for the anti PGL-I ELISA and 34.2% for the PCR for the detection ofM. leprae DNA in nasal swabs. Among household contacts of leprosy patients the overall percentages for the anti PGL-I ELISA and for the PCR for the detection of M. leprae DNA in nasal swabs were 13.3% e 4.7% respectively. Among leprosy patients, assays positivity is associated with the clinical presentation of the disease, increasing towards bacilliferous subtypes. Positive results in contacts represent healthy carriers and subclinical infection and these individuals can participate in transmission and spread of M. leprae in the community, even though they may not develop the disease. In endemic regions, contact monitoring is imperative in leprosy control for early case detection and chemoprophylaxis must be applied as prevention to disease development and disruption of transmission.
Dissertação (Mestrado)

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Tuberculosis (TB) is an important public health problem in Brazil, where it occupies the 18th place in the ranking of countries with the highest rates of tuberculosis. An investigation of contacts of the person diagnosed with TB is considered essential in the prevention of illness and in the early diagnosis of active TB in the population, therefore thus, be carried out mainly by primary health care, chosen as the preferred gateway to the person with TB. The study aimed to investigate the occurrence of tuberculosis among household contacts. This is a quantitative, descriptive study performed with the household contacts of tuberculosis of in the city of Caxias - MA. The study sample was composed by 64 household contacts of patients reported as a case of tuberculosis, in the period January to December 2015. Data collection occurred from April to May 2016. The incidence rate of the disease among contacts it was around 4.7%. Observed higher percentage with monthly income between one to two minimum salaries (78.7%), female (57.4%), age group 20-39 years (32.8%), brown (80.4%), single (54.1%), incomplete primary education (36.1%), and first degree relatives with the index case (62.3%). When analyzed household contacts diagnosed with the disease was observed monthly income below a minimum salary (66.7%), female (66.7%), age group 20-39 years (33.4%), white (66.7%), married / stable union (100%), complete primary education (66.7%) and the degree of non-blood relatives prevailed in all contacts (100%). With respect to the patient contact convivial time with the index case, it was observed that (66.7%) were between 06-10 years of convival. With regard the clinical form of the disease, a large percentage of contacts with diagnosis of the disease (66.7%) had pulmonary TB. By the results obtained it was possible find that the incidence of tuberculosis found among household contacts deserves better attention, because, the surveillance of contacts is an important strategy for the reduction of cases of the disease. It is expected that the results observed in this study can be used by the municipal administration, in view of that all contacts should be evaluated, thus, strengthening existing activities and creating new strategies to achieve better results.
A tuberculose (TB) é um importante problema de saúde pública no Brasil onde ocupa o 18º lugar no ranking de nações com maiores índices de tuberculose. A investigação dos contatos da pessoa diagnosticada com TB é considerada essencial na prevenção do adoecimento e no diagnóstico precoce da TB ativa na população, devendo assim, ser realizada essencialmente pela atenção primária à saúde, eleita como a porta de entrada preferencial para a pessoa com TB. O estudo buscou investigar a ocorrência de tuberculose entre contatos domiciliares. Trata-se de um estudo quantitativo, descritivo realizado com contatos domiciliares de tuberculose no Município de Caxias-MA. A amostra do estudo foi composta por 64 contatos domiciliares de pacientes notificados como caso de tuberculose, no período de Janeiro a Dezembro de 2015. A coleta de dados ocorreu no período de abril a maio de 2016. A taxa de incidência da doença entre os contatos ficou em torno de 4,7%. Observaram-se maiores percentuais com renda mensal entre um a dois salários mínimos (78,7%), sexo feminino (57,4%), faixa etária de 20 a 39 anos (32,8%), pardos (80,4%), solteiros (54,1%), ensino fundamental incompleto (36,1%), e parentesco de primeiro grau com o caso índice (62,3%). Quando analisados os contatos domiciliares diagnosticados com a doença observou-se renda mensal abaixo de um salário mínimo (66,7%), sexo feminino (66,7%), faixa etária de 20 a 39 anos (33,4%), brancos (66,7%), casado/união estável (100%), ensino fundamental completo (66,7%) e o grau de parentesco não sanguíneo predominou em todos os contatos (100%). Com relação ao tempo de convívio do contato doente com o caso índice observou-se que (66,7%) possuíam entre 06 a 10 anos de convívio. No que diz respeito a forma clínica da doença, um grande percentual dos contatos com diagnóstico da doença (66,7%) apresentaram a forma pulmonar. Pelos resultados obtidos foi possível constatar que a incidência de tuberculose encontrada entre os contatos domiciliares merece uma melhor atenção, pois, a vigilância dos contatos é uma estratégia importante para a diminuição de casos da doença. Espera-se que os resultados observados neste estudo possam ser utilizados pela gestão municipal, tendo em vista que todos os contatos devam ser avaliados, dessa forma, fortalecendo as ações já existentes e criando novas estratégias para alcançar melhores resultados.

Background The incidence of TB in children under 15 years, accounts for 8% of the global TB burden. In 2018, the World Health Organisation (WHO) estimated that there were approximately 11 000 multi-drug resistant (MDR) TB cases in South Africa. Despite having very clear guidelines on TB treatment programs and management, availability of inexpensive diagnostic tests, curative and preventive therapies, and the widespread use of the BCG vaccines, South Africa continues to have the highest the number of MDR-TB cases per capita. Levofloxacin is used as part of the group of fluoroquinolones in the drug regimen recommended in the treatment of MDR-TB patients. In addition to investigating the clinical impact of levofloxacin as preventative antibiotic therapy, the expected costs of the intervention will be a critical input to determining feasibility and costs effectiveness, which will inform policy and implementation considerations. Methods We performed a cost analysis on using existing data from the Tuberculosis Child Multi-drug-resistant Preventative Therapy (TB-CHAMP) trial, conducted from a TB control program perspective. We used data from 510 childhood household contacts of MDR-TB patients in South Africa that were treated with levofloxacin for 6 months as a preventative therapy for MDR-TB. In our analysis we evaluated the estimated health system cost associated with provision of levofloxacin to childhood contacts of MDRTB patients in South Africa. Results The mean total cost of treating a child household contact, irrespective of their weight band is ZAR 5,289.79. When the cost were analysed by weight categories we found that the cost increased by weight category; ZAR 2,146.78 (under 5 kg), ZAR 4,714.58 (between 5-15.9 kg) and ZAR 6,606.67 (over 16 kg). We performed a comprehensive sensitivity analysis and found that the scheduled clinic visits were the major cost driver. Aside from the scheduled visits we observed that there was an increase in additional health service utilization for children with a weight more than 5kg. Conclusion We envisage that based on our analysis we will be able to inform policy decisions about the management and prevention of childhood household contacts of MDR-TB patients in developing TB themselves.

Leprosy is an important health problem in Brazil, with a high detection rate despite the application of the multidrug therapy. The nasal mucosa is considered the preferential site of entry and exit of the Mycobacterium leprae, although some lesions have been found in the buccal mucosa. However, the buccal mucosa involvement in bacilli transmission has never been investigated. We have shown the presence of the M. leprae DNA in buccal swabs of leprosy patients (334) and household contacts (1288) through conventional polymerase chain reaction (PCR), and results were correlated with clinical and other laboratorial evaluations. The overall positivity for patients was 18.26%, divided into 12.03% and 21.23% for paucibacillary and multibacillary forms, respectively. Among contacts, the positivity reached 6.83%, which were considered either as healthy carriers or sub-clinically infected, when the ELISA test presented a positive anti-PGL-1 result. This study showed important evidences that the buccal mucosa may be a secondary site of M. leprae transmission and infection. Furthermore, contacts with positive PCR may be actively involved in the transmission. Our findings have great epidemiological relevance, especially for the leprosy control programs and for the dentistry clinics, and must be considered in the new strategies of control and prevention.
A hanseníase é um importante problema de saúde pública no Brasil, com elevada taxa de detecção, apesar da aplicação da poliquimioterapia. A mucosa nasal é considerada o local preferencial de entrada e saída do Mycobacterium leprae, embora algumas lesões tenham sido encontradas na mucosa bucal. No entanto, o envolvimento da mucosa oral na transmissão do bacilo nunca foi investigado. Nós mostramos a presença do DNA do M. leprae em swab bucal de pacientes com hanseníase (334) e contatos domiciliares (1288) por meio da reação em cadeia da polimerase (PCR) convencional, e os resultados foram correlacionados com outras avaliações clínica e laboratorial. A positividade geral de pacientes foi de 18,26%, dividida em 12,03% e 21,23% para as formas paucibacilares e multibacilares, respectivamente. Entre os contatos, a positividade alcançou 6,83%, que foram considerados como portadores sadios ou infectados subclínicos, quando o teste ELISA anti-PGL-1 apresentou resultado positivo. Este estudo mostrou evidências importantes de que a mucosa bucal pode ser um sítio secundário de infecção e transmissão do M. leprae. Além disso, contatos com PCR positivo podem estar envolvidos ativamente na transmissão. Nossos resultados têm grande relevância epidemiológica, especialmente para os programas de controle da hanseníase e para as clínicas de odontologia, e devem ser considerados em novas estratégias de controle e prevenção.
Mestre em Ciências da Saúde

Background: Household contacts (HHCs) of pulmonary TB patients are at high risk of Mycobacterium tuberculosis (Mtb) infection and early disease development. Tuberculin skin test (TST) has been traditionally used to identify infected individuals; however, its use is limited by low specificity in populations with high levels of BCG vaccination or significant exposure to non-tuberculosis mycobacteria (NTM), and reduced sensitivity in immunocompromised individuals. Interferon-gamma release assays (IGRAs) such as QuantiFERON-TB Gold In-Tube (QFT-GIT) using Mtb specific antigens provide an alternative to TST for infection detection. IGRAs are now widely used for the detection of Mtb infection and are included in the guidelines of many countries with a low incidence of TB. Despite a growing body of literature on IGRAs, the relationship between the magnitude of T-cell Interferon-γ responses to Mtb specific antigens and risk of progression to disease has not been studied. Objective The main objective of this study was to determine whether HHCs with high (≥10 IU/ml) levels of IFN-γ in response to Mtb specific antigens (ESAT-6, CFP-10 or TB 7.7) in the QFT-GIT assay are at higher risk of developing TB compared to those with low (> 0.35-<10 IU/ml) levels. Other secondary objectives included to determine the following: the performance and operational characteristics of QFT-GIT in a field setting; risk factors associated with positive QFT-GIT results; concordance between the two tests; incidence rates of TB in HHCs with positive and negative QFT-GIT and TST results at baseline as well as positive and negative predictive values. Method: This study was nested within a large community randomized trial called ZAMSTAR implemented in 16 communities in Zambia and 8 communities in the Western Cape Province of South Africa. A cohort of HIV-positive and HIV-negative adult (≥ 15 years) HHCs were prospectively followed for 2-4 years. Consenting HHCs had blood drawn for HIV antibodies. QFT-GIT test was performed according to the manufacturer's instructions. TST were performed according to the standard IUATLD protocol. A standardized questionnaire was used to collect information on risk factors for TB and TB treatment information (for those with TB). Results: The feasibility studies showed three main findings. Firstly, the sensitivity of QFT-GIT was greater than that of TST overall, at all the standard TST cut-offs and when stratified by HIV status. The sensitivity of QFT-GIT was 85.6% (95%CI: 77.0-91.9) (indeterminate results excluded) compared to that of TST at 51.6% (95% CI: 40.9-62.2) at a cut-off of ≥ 10 mm. Secondly, test-retest reproducibility of QFT-GIT was high at 91.74% (ICC: 0.90; 95% CI 0.82-0.97). Thirdly, in this setting, some biological and operational factors that affected the performance of QFT-GIT were identified such as HIV positivity, low CD4+ T-lymphocytes, delayed incubation of blood samples and power outages. 8 For the main study, the study population at baseline consisted of 1,789 HHCs who were predominantly women (71%); median age was 28 years (IQR: 21-43); HIV positivity rate was 27.9%. Prevalence of tuberculous infection was 63.7% as measured by QFT-GIT and 39.6% by TST. There was a low level of agreement between the tests regardless of TST cut-off point (% agreement=59.7%; kappa=0.24). QFT+/TST- discordance (575/719; 80%) was more frequent than QFT-/TST+ discordance (144/719; 20%) at TST ≥10 mm. Risk factors associated with QFT-GIT positivity were identified at baseline. In multivariable analysis adjusted for sex, age, and community, HIV status was negatively associated with QFTGIT positivity (aOR: 0.48; 95% CI: 0.37–0.63; p<0.001) whereas residing in an urban area (aOR: 2.37; 95% CI: 1.10–5.13; p<0.03), smear status of index (OR: 1.26; 95% CI: 0.91-1.76; p=0.15) and country (aOR: 1.93; 95% CI: 1.48–2.51; p<0.001) were positively associated with QFT-GIT positivity. Similar results were obtained for TST. From a total of 1789 HHCs seen at baseline, 1113 (62.2%) HHCs entered follow-up and were included in the main analysis. The overall incidence rate of TB was 20.96/1000 pyrs (95% CI: 15.93-27.58). TB incidence rate was higher among test positive HHCs compared to those who were negative (IRR for QFT-GIT: 1.65; 95% CI: 0.86-3.37; p=0.06) and for TST (IRR: 1.88; 95%CI: 1.04-3.41; p=0.01). Results were similar in univariable analysis (QFT-GIT: 1.66 (95%CI: 0.88-3.11; p=0.11) and TST: 1.89 (95%CI: 1.09-3.28; p=0.02)) and multivariable analysis adjusted for sex, age and HIV (QFT-GIT: 2.20 (95%CI: 1.14-4.25; p=0.02) and TST: 2.19 (95%CI: 1.24-3.86; p=0.007)). Overall, PPV for QFT-GIT was 5.38% (95%CI: 3.84-7.31), compared to TST, 6.57% (95% CI: 4.41- 9.36). Overall for QFT-GIT, the IRR was higher among HIV negative HHCs (IRR: 3.85; 95%CI: 0.90-34.51; p=0.07) compared to HIV positives (IRR; 1.93; 95%CI: 0.88-4.57; p=0.04). Overall for TST, the IRR for HIV negatives (IRR: 2.21; 95%CI: 0.78-6.72; p=0.05) was similar to that among HIV positives (IRR: 2.32; 95%CI: 1.09-5.00; p=0.009). Univariable analysis showed similar results for both tests. In multivariable analyses adjusted for age, sex and country as an effect modifier, the HR for developing TB was 4.72 (95%CI: 1.35-16.46; p=0.01) in HIV positive QFT-GIT positives compared to 2.13 (95%CI: 0.81-5.60; p=0.12) in HIV positives TST positive HHCs. Risk factors for TB were identified. In multivariable analyses, adjusted for age, sex , HIV status and country there was strong evidence that occasional smoking, (HR: 4.07; 95%CI:1.31-12.63), HIV positivity (HR: 4.60; 95%CI:2.48-8.56), smear positivity of the index (HR: 2.00 ; 95%CI:1.04- 3.87) and country (HR: 1.79 ; 95%1.02-3.15; p=0.04) ) were associated with incidence of TB. Out of the 1,113 HHCs who entered follow-up, 406 HHCs had IFN-γ levels <0.35 IU/ml and were excluded leaving 707 HHCs in analysis for the primary objective. Out of these 536 (75.8%) had IFN-gamma levels ≥ 0.35 and <10 IU/ml (low IFN-γ levels) while 171 (24.2%) HHCs had ≥ 10 IU/ml (high IFN-γ levels). Out of the 707 HHCs that entered follow-up, 38 (5.4%) HHCs developed active TB over 1558.0 person-years (pyrs) of follow-up, giving an incidence rate of 24.39/1000 pyrs (95% CI: 17.75- 33.52).TB incidence rates were 24.51/1000 pyrs (9 cases/367.2 pyrs) in HHCs with high levels and 24.35 (29 cases/1190.7 pyrs) among those with low levels of IFN-γ, giving an IRR of 1.0 (95% CI: 0.42-2.18; p=0.48). Overall, unadjusted HR in HHCs with high IFN-γ levels was 1.02 (95%CI: 0.48-2.15; p=0.96) while in multivariable analysis adjusted for age, sex, country and HIV as an effect modifier, HR was 1.74 (95%CI: 0.63-4.79; p=0.29). TB incidence rates in HIV positives was 51.94/1000 pyrs (3 cases/57.8 pyrs) in HHCs with high levels and 65.29/1000 pyrs (19 cases/291.0 pyrs) among those with low levels of IFN-γ, giving an IRR of 0.79 (95%CI: 0.15-2.70; p=0.38).TB incidence rates in HIV negatives were 19.56/1000 pyrs (6 cases/306.7 pyrs) in HHCs with high levels and 11.47 (10 cases/871.7 pyrs) among those with low levels of IFN-γ, giving an IRR of 1.70 (95%CI: 0.51-5.18, p=0.16). Unadjusted HR among HIV negative HHCs was 1.73 (95%CI: 0.63-4.77; p=0.29) and 0.75 (95%0.22-2.55; p=0.65) among HIV positive ones respectively. In multivariable analysis adjusted for age, sex and country, the HR remained similar as unadjusted analysis for both HIV negatives and positives. For all the groups used for sensitivity analysis of the primary question, HHCs with the highest IFN-γ levels had increased IRRs ranging from 1.5 to 2 compared to the reference sub-group. For HIV negatives, HHCs with the highest IFN-γ levels had the highest IRRs in all groups apart from one group. HIV negative HHCs with the highest IFN-γ levels had increased IRRs ranging from 4 to 5-fold compared to the reference sub-group. In comparison, HIV positive HHCs with the highest IFN-γ levels had increased IRRs ranging from 1.6 to 2.6 compared to the reference sub-group. Conclusions: The principal finding in this study is that there was no difference in incidence rates between HHCs with low and high levels (overall IRR: 1.0 (95% CI: 0.42-2.18)). Another principal finding was that there was strong evidence of a five-fold increased risk of TB in HIV positive QFT-GIT positive HHCs compared to HIV positive QFT-GIT negative ones (aHR : 4.72; 95%CI: 1.35-16.46; P=0.01). For all the groups used in the sensitivity analysis of the primary question, HHCs with the highest IFN-γ levels had increased IRRs ranging from 1.5 to 2 compared to the reference sub-group. The feasibility studies emphasized the need for stringent sample collection and processing techniques to ensure the accuracy of QFT-GIT results.

In this thesis, three stochastic epidemic models for intervention for emerging diseases are considered. The models are variants of real-time, responsive intervention, based upon observing diagnosed cases and targeting intervention towards individuals they have infected or are likely to have infected, be they housemates or named contacts. These models are: (i) a local tracing model for a disease spreading amongst a community of households, wherein intervention (vaccination and/or isolation) is directed towards housemates of diagnosed individuals, (ii) a contact tracing model for a disease spreading amongst a homogeneously-mixing population, with isolation of traced contacts of a diagnosed individual, (iii) a local tracing and contact tracing model for a disease spreading amongst a community of households, with intervention directed towards housemates of both diagnosed and traced individuals. These are quantified by deriving threshold parameters that determine whether the disease will infect a few individuals or a sizeable proportion of the population, as well as probabilities for such events occurring.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.
Title from electronic title page (viewed Feb. 17, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Anthropology." Discipline: Anthropology; Department/School: Anthropology.

Current trends indicate that American consumers are increasingly selecting products that they believe to be environmentally friendly or â natural.â In the kitchen, this trend has been expressed through greater desire for using alternative or â greenâ sanitizers instead of bleach or other common chemical sanitizers. The purpose of this work was to evaluate the effectiveness of one suggested alternative, tea tree oil, as a food contact surface sanitizer. Three foodborne bacterial pathogens (Listeria monocytogenes N3-031 serotype 1/2a, Escherichia coli O157:H7 strain E009, and Salmonella Typhimurium ATCC 14028) were applied separately onto three different food contact surfaces (high density polyethylene, glass, and Formica® laminate). Tea tree oil (TTO), borax, and vinegar (5% acetic acid) were applied individually as well as in combination for a total of seven treatment solutions. In addition, household bleach (6.15% sodium hypochlorite), sterile reverse osmosis (RO) water, and no applied treatment were used as controls. Treatments were tested using an adaptation of the Environmental Protection Agency DIS/TSS-10 test method, whereby each contaminated surface was treated with 100 µl of test solution and held for 1 min followed by submersion in neutralizing buffer and microbiological plating. Samples (0.1 ml) were plated onto TSA and incubated at 35°C for 48 h prior to colony counting. Bleach reduced microbial populations significantly with greater than 5-log reduction reported for all surfaces (Formica® laminate, glass, and HDPE), against E. coli O157:H7, L. monocytogenes, and S. Typhimurium. TTO produced reductions between four and five logs for E. coli O157:H7, L. monocytogenes, and S. Typhimurium and was not statistically different from the vinegar treatment (P>0.05). All combination recipes, including the borax treatment, failed to produce reductions in microbial populations at levels considered to be appropriate for food contact surface sanitizers. Surface type did not play a significant role in the effectiveness of the treatment (P>0.05). Although TTO and vinegar did reduce pathogen populations on surfaces, reductions were not sufficient enough to be considered an equally effective alternative to household bleach.
Master of Science in Life Sciences

This dissertation examines components of Hawaiian household economies to understand how people on the remote Nā Pali Coast of Kaua'i Island, Hawai'i, maintained continuity in domestic life well into the late nineteenth century. It focuses on two case studies, notably a series of house sites at Nu'alolo Kai and Miloli'i, two neighboring communities on the western end of Kaua'i's remote Nā Pali Coast. This research situates Hawaiian house sites of the post-contact period in the tradition of household archaeology in Polynesia more broadly. However, it considers patterns of material change in colonial settings through a framework that emphasizes persistence over progressive models of change. Moreover, it highlights the ability of people in Hawaii's hinterlands to respond to the spread of foreign goods and ideas in different ways. The study utilizes archaeological data to investigate a series of grass-thatched house or hale sites at Nu'alolo Kai and Miloli'i. The Nu'alolo Kai data was obtained from an analysis of legacy collections, as well as compiled from published and unpublished analyses. The Miloli'i data was acquired through new excavations I directed at Miloli'i in 2016 and 2017. Using individual house sites as case studies, this project models household economies in an isolated region of Hawai'i and compares these economies to case studies from more central locations in the archipelago. The research demonstrates that nineteenth-century Nā Pali Coast households continued to rely on food production at the level of the household, even as they gradually incorporated small numbers of foreign goods into household economies. Rather than using new materials and practices to recreate households in the image of outsiders, however, nineteenth-century residents of the Nā Pali Coast used foreign goods to create a distinctive version of Hawaiian domesticity. My dissertation argues that, rather than committing themselves to wholesale participation in the market economy, Nā Pali Coast households were able to strategically fashion for themselves a place on the margins of the market economy. While the remoteness of this region constrained participation in Hawai'i's emerging market economy, it also engendered resilience and autonomy during a time of large-scale social and political change in the archipelago. While this dissertation focuses on a remote region of Hawai'i, its primary findings, that Nā Pali Coast households maintained a strategic separation from the market economy in the nineteenth century, has implications studies of colonial-era change and continuity in other parts of Hawai'i and Polynesia.

xvi, 148 p. : ill. (some col.) A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.
The preservation of architecture associated with underrepresented communities has been hindered by traditional biases in preservation. The post-contact history of Native Americans of the Klamath Basin has not been exempt from this trend. Archaeologists have begun to uncover evidence of post-contact lifeways of Native Americans on the former Klamath Indian Reservation in southern Oregon. This thesis examines the influence of 19th and 20th century federal policies on reservation households, using data from archaeological investigations at a 19th century Native American homestead (the Beatty Curve Site, 35KL95). This information, coupled with historical research, is used to reconstruct the homestead and cultural setting on paper and will be useful in identifying similar properties. More importantly, this thesis adds to a regional and national narrative on Native survival, adaptation, and cultural persistence in the face of new social realities in the post-contact period. This thesis includes previously published and unpublished co-authored material.
Committee in charge: Dr. Kingston Wm. Heath, Chairperson; Dr. Rick Minor, Member

碩士
長庚大學
資訊工程學研究所
97
A topic for discussion in public health is important nowadays. An infectious disease to make damage for people life, in the past, the public health strategy was limited in finited medical treatment resource for the patient. The death rate of infectious disease is highly at present. People will be dangerous when emerging infectious diseases break out, to prevent and be isolated strategy of infectious is developing in every country, and running with next times. We based on Bipartite Graph to build up Daliy Contact Network, under network. We discuss people who interact with people and people move between the place and the place for infectious spread. We integrate Social Network and SEIR infection condition model to make Influenza Network-Oriented Epidemic Model to centre on Household, Classroom of School and Office of Company and a related Prevention Intervention Strategies.

碩士
中國醫藥大學
公共衛生學系碩士班
100
Objectives: Tuberculosis (TB) is one of important infectious diseases that threat the global public health. This study was to identify determinants associated with the acceptance of latent tuberculosis infection (LTBI) treatment among adult household contacts with patient with pulmonary tuberculosis. The primary objective of was to improve the campaign of TB control. Methods and materials: Data used in this study was the Bulletin TB Data, " National Surveillance Network of Communicable Diseases," obtained from the Centers for Disease Control, R.O.C. (Taiwan).From the records dated from January to December 2010 for Changhua County residents, we identified 519 index cases with the sputum smear-positive TB cases and 2,152 adult household contacts. Both groups were included in this study for retrospective analysis. Data analyses examined factors associated with the acceptance of LTBI treatment. Descriptive analysis was used first to examine the characteristics of the sputum smear-positive TB cases for the 519 index cases and the 356 index cases with TST positive contacts.Comparisons were also performed between subjects with TST (+) and TST (-). Comparisons were further conducted to exam difference between contacts receiving and not receiving LTBI treatment. We also assessed differences between male and female patients in age and TST finding. The association between LTBI treatment and TST finding, urbanization and effort of intervention were also assessed. Logistic regression analysis was also used to estimate the odds ratio (OR) and confidence interval (CI) to explore factors associated with the acceptance of LTBI treatment. Results: Of the 947 TB contacts, 37.9% received the LTBI treatment. Among those receiving LTBI treatment, 73.2% patients completed the treatment. The index cases were older, mainly males and living in the southern county. More than half subjects who had contacted with TB cases were in 40-59years of age (50.5%) and more likely to live with the cases (77.5%). The results of multivariate logistic regression analysis showed that the LTBI treatment was associated with ,index cases being males (OR = 1.8), patients aged 45-64 years (OR = 4.4) and≧65 years (OR=3.3), patients with completed treatment, and death. Among household contacts, subjects 50-59 years of age were more likely to accept LTBI treatment. Most of the contacts received the X-ray check-up 1-15 and 16-30 days after the index cases had been registered. The contacts with normal X-ray exam had higher LTBI treatment than those with abnormal findings (OR = 1.9). The residents of North Changhua County had higher acceptance of LTBI treatment than those lived in South areas (OR = 1.6).This study also found that active nurses involvement in the TB control program could promote the acceptance of LTBI treatment. Conclusion: The close contacts of pulmonary TB patients declining the LTBI treatment are more likely to have younger index cases. They are also reluctant to visit heath care facility for the routine TB check-up. The significant factors associated with the noncompliance of LTBI treatment among the contacts include less than 40 years of age, delayed check-up, abnormal X-ray finding, and residents of southern Changhua. Our findings can be adapted for improving the TB control strategy.

Introduction: World Health Organization recommends screening of household contact as a key to improve detection of tuberculosis cases. Ethiopia’s current tuberculosis household contact investigation strategies rely on symptomatic contacts attending health facilities for investigation. This approach has not led to the detection of additional tuberculosis (TB) cases; alternative approaches have to be considered. The purpose of the research was to develop guidelines in endorsing the implementation of a community based household contact investigation program in Addis Ababa. Methods: A mixed method research using sequential exploratory design was conducted in Addis Ababa. In the first phase, qualitative data collection and analysis methods were used to formulate intervention approach and in the second phase, a quantitative random controlled trial was conducted, with the purpose of comparing the proposed intervention measures with routine household contact tuberculosis investigation. Frequencies and logistic regression analyses were used to determine the relative risk and associated factors. Thematic analysis was used for qualitative data analysis. Results: The in-depth interview and focus group discussion findings identified themes namely household contact investigation (HHCI) implementation, misconceptions on HHCI, challenges with HHCI Approaches, opportunities for HHCI provision, contributing factors associated with household involvement, strategies for effective HHCI service and partnerships with health bureau. In phase two, the study reported that the prevalence of TB was 7.1% among the intervention group compared to 1.9% in the control groups at the end of first year follow-up. Nine guidelines were developed to support the household contact investigation system. Conclusion: The passive case detection strategy of contact investigation did not find more cases, and tuberculosis patients and their family contacts were not satisfied with this method. However, the proposed community-based strategy shows that more TB cases can be detected by using existing medical staff. Therefore, an approach that makes the service more accessible is significant and the recommended community based TB household contact tracing approaches needs to be scaled up for its performance towards identified missed cases and enhance patient and their household contacts involvement.
Health Studies
D. Litt. et Phil. (Public Health)

This study explores the difficulties which arise in complex stepfamilies, where both partners have children from previous marriages. Problems of family integration which create discord among family members include boundary ambiguity, contact consistency and role confusion. Boundary ambiguity refers to the uncertainty surrounding family membership which develops because of the extended network of family members acquired in the previous marriage(s) and the present one. Contact consistency relates to the consistency/inconsistency of patterns of contact between stepfamily members and the non-residential children or stepchildren. Role confusion applies primarily to the lack of clarity in respect to the roles and responsibilities of stepparents vis-a-vis their stepchildren. The sample in this study consists of eight remarried/cohabiting couples, with children from previous marriages. The sixteen men and women participants were interviewed separately in their homes. Their perceptions were examined in an attempt to verify whether or not these issues are indeed part of the common and recurring problems they face as parents and stepparents. The findings indicate that the most serious and recurring problems for members of this sample involve their children and stepchildren. Out of the three concepts examined in this research, role confusion represents the most crucial and difficult one, followed by contact consistency, whereas boundary ambiguity seems to be the least problematic of the three

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Health Systems and Policy. Johannesburg / RSA, 2015
Purpose: Screening of young children exposed to tuberculosis (TB) in a household setting is widely recommended, but rarely implemented in some endemic countries. The aim of this study was to screen household under five children who have been exposed to smear-positive pulmonary tuberculosis (PTB) of adult cases; to explore and describe the initial follow-up of these children by the Kweneng district health care system; and to determine clinical outcomes (occurrence of TB disease and latent tuberculosis infection) among those children. Methods and procedures: In a nested case-control type study design, under 5 years child contacts of 200 randomly selected adult smear positive pulmonary TB patients, were enrolled and evaluated for TB infection and disease. Risk factors were compared between those with TB and those without TB. Data was collected during the study period (December 2005 through November 2006) through face-to-face interviews using a pre-designed data collection tool. Child contacts were then investigated at their respective nearest health facility using Tuberculin Skin Test (TST), clinical examination, and chest x-ray (CXR). Finally child contacts were diagnosed as follow: No TB, Latent Tuberculosis Infection (LTBI), or TB disease. We defined LTBI as having a TST ≥10 mm at 48–72 hours. Major results: A total of 497 child contacts were recruited, of which 278 (55.9% [95%CI: 51.4% - 60.3%]) and 219 (44.1% [95%CI: 39.7% - 48.6%]) were respectively girls and boys both in age group: 0-24 months: 51 (10.3% [95% CI: 7.8% - 13.4%]) and 25-59 months: 446 (89.7% [95% CI: 86.6% - 92.2%]). Among all children 19 (3.8% [95% CI: 2.4% - 6.0%]) were found not vaccinated. The duration of exposure to TB case ranged from 1 to 4 months; and the social proximity of child contact to TB case was as follow: 185 (37.2% [95%CI: 33.0% - 41.7%]) were first degree relatives, 304 (61.2% [95%CI:56.7% - 65.4%]) distant relatives, and 8 (1.6% [95%CI: 0.8% - 3.3%]) child contacts were not related to the cases. The respondent dissatisfaction rate about TB screening (follow-up) by the health care system was 163 (81.50%). Of 497 child contacts, 104 (20.9% [95%CI: 17.5% - 24.8%]) were initially screened for TB at the time the TB index cases were diagnosed. 163 (81.5% [95%CI: 75.4% - 86.6%]) respondents were dissatisfied about the initial follow-up and screening of child contacts by the health care system. Among all 497 child contacts evaluated at the time of this study, LTBI prevalence rate was 35.0% [95%CI: 30.8% - 39.4%], and the prevalence of TB disease was 3.4% [95% CI: 2.1% - 5.5%]. Under five children who had been screened initially were less likely to have TB infection or disease identified during the evaluation by this study, than those who had not been screened (OR=0.296, X2 = 20.202, p < 0.001) by Kweneng health care system. Main Conclusions: This is the first comprehensive household TB contact tracing in under five children exposed to smear positive TB from adult cases in the rural Botswana. The study found that health care services in Kweneng were not adequately implementing TB contact tracing of household under five children. When children were followed up during this study, we documented a high prevalence rate of TB infection and disease among child contacts who had not been followed up and screened for TB by the health system. This not only suggests that under five child living in the same household with an adult TB case in rural Botswana is at high risk of LTBI and active TB disease; but it also evidently supports the benefice and importance of household contact tracing in enhancing case finding and prevention of tuberculosis disease (Triasih, 2015). Recommendations: A scale-up of targeted household contacts tracing for under five children followed by appropriate management can enhance early case detection and lower the risk of TB transmission among under five children. A targeted tuberculosis contact tracing with an emphasis on younger children should be made a priority by the Botswana National TB Programme (BNTP). The policy needs to clarify who is responsible and accountable for TB contact tracing services. The gap between guidelines and practice, and the human resource capacity should be addressed. An improved training of TB care providers on guidelines in Kweneng district will be important in strengthening TB contact tracing. Key words: Contact tracing, household, tuberculosis, latent tuberculosis infection, index case, child contact, under five child, follow-up, preventive therapy, TST, CXR.

The mental and physical benefits of pet ownership are well established; however, pets can also transmit pathogens to people, with children, elderly, pregnant and immunocompromised individuals at greatest risk of disease. Little is known about the public’s knowledge and practices related to pet-associated disease. Questionnaires were distributed at two general practice physician clinics and to parents/guardians of children diagnosed with diabetes or cancer at specialty practice clinics. Pet ownership and contact were common, with 64-66% of participants having a pet in their household. Acquisition of a new pet, including high-risk pets, was common (20%) following a diagnosis of cancer in children. Pet exposure outside the home was frequently reported for individuals in pet and non-pet owning households (25-52%). Education of respondents about diseases was poor, as only approximately one-third recalled receiving pet-associated disease information. Parents of cancer patients were more likely than parents of diabetes patients to recall receiving this information, yet proportions were low in both groups (32% and 13%, respectively). Respondents’ knowledge of pet-associated pathogens was similar between the groups, with pet owners and parents of diabetic children having higher knowledge. Pet (30-36%) and non-pet (~10%) owning households reported dog/cat bites or scratches during the preceding year. Within the general practice respondents, lower-risk households did not differ from higher-risk households regarding perceived disease risk of pets, zoonotic disease knowledge, recall of being asked by their medical provider if they owned pets, or recall of having received information regarding pet-associated disease risks and preventive measures. Pet ownership, husbandry and infection control practices were similar between low- and high-risk households. Husbandry practices that increase zoonotic disease risk were frequently identified, including feeding high-risk diets, allowing children to clean up fecal material and allowing reptiles to roam through the kitchen. With few exceptions, practices were not associated with the presence of higher-risk members in the household or recall of having previously received zoonotic disease education. There is a need for improved education on zoonotic disease prevention practices for pet- and non pet-owning households, particularly those with individuals at higher risk of infection and those with high-risk species.

This study explored the experiences of stepmothers of non-residential stepchildren, using a phenomenological approach and qualitative exploratory design. Participants were recruited in the Gauteng area through purposive sampling. Thematic analysis was used to analyse the information. The findings of this study indicate the following: the participants, in their role as stepmothers of non-residential stepchildren, experienced various challenges that were very stressful, especially during the early stages of stepfamily formation. The lack of acknowledgement of the stepmothers’ dedication to their stepchildren, as well as conflicting rules concerning how to care for the children, caused distress for the participants. Support from their partners, as well as improved stepfamily relationships over time, were acknowledged as contributing factors to the participants’ continued commitment to their stepfamilies. Further research on stepmothers of non-residential stepchildren is recommended
Psychology
M.A. (Clinical Psychology)