Dissertations / Theses on the topic 'Political aspects of Communicable diseases'

[Truncated abstract] In March 2005, the Indian Ocean island of Reunion, a former colony and now overseas department of France, saw the first cases of what was to become a massive epidemic of the mosquito borne viral infection Chikungunya. More than 250,000 people, one third of the Island's population, were subject to high fevers, rash, and joint and muscle pains over the next 18 months, yet the public health authorities in metropolitan France were arguably slow to take the epidemic seriously. The research presented here explores attitudes underlying the management of the epidemic by examining both metropolitan and local representations of mosquito borne disease from historical, epidemiological and media perspectives. The research seeks to answer the general question Does colonial history continue to influence the representation and management of mosquito borne disease in Reunion? Three parallel approaches are taken to answering this question, using a common framework of tropicality (a Western discourse that exalts the temperate world over its tropical counterpart, and overlaps with colonialism and orientalism). ... Several factors are likely to have contributed to the persistence of tropicality in public health practice in Reunion: Othering as a universal phenomenon; the cost of administering interventions to combat tropical diseases in the remote environments of French overseas departments and territories; the denial of a serious public health risk as a cultural trait in Reunion; and the significant role of the colonies in forming and maintaining the French national identity. It has to be acknowledged that historically, tropicalism does appear to have played one positive role in the management of mosquito borne disease:

The purpose of this study has been to examine and analyze the salient medical and legal aspects related to the educational placement of children in public schools with the human immunodeficiency virus (HIV) infection. The study attempts to provide information that will serve as a resource to public school personnel who are among the professionals that must make informed decisions on public school attendance policies for children with a lethal, complex, and controversial disease. New developments in medicine and in the courts have crucial implications for existing policies and for the development of new policies related to the issue. By examining precedents and patterns in the emerging area of AIDS litigation and legislation, the study serves as a resource for school officials enabling them to make informed proactive decisions. The methodology used in the study was legal research. Primary and secondary sources of law were utilized. Nonlegal research materials included medical research and data that might serve as evidence in legal disputes concerning the educational placement of children with the HIV infection. In addition to medical evidence related to educational placement issues, the information gathered for the study included an examination of the state antidiscrimination disease laws, state special education laws, state communicable disease laws, and state and selected local policy statements for sixteen states; an analysis of the relevant legal issues of the Education of the Handicapped Act (EHA) and Section 504 of the Rehabilitation Act of 1973; and an examination of the constitutional issues pertinent to educational placement of children with AIDS. Case law “in point” or “analogous” to the issue was presented. The concluding chapter summarizes the findings from Chapters Two, Three, Four and includes recommendations for decision-making and policy based on the medical and legal information presented. There is no medical evidence to support the exclusion of children from regular school attendance based on the suspicion of or identification of HIV infection. Awareness of sound medical evidence to support educational decision-making provides a means of projecting a solidly grounded policy to the school population and community at large. Health care precautions should be taken and routine procedures established for the removal of blood and/or body fluids in cases of accident or injury. Routine precautions should be followed by all school personnel regardless of whether an HIV-infected individual is present.
Ed. D.

Human Immunodeficiency Virus (HIV)-associated stigma is pervasive throughout the world. This stigma affects the ability of HIV-positive individuals to cope with their illness and it also affects behaviors around sexual practices, disclosure to others and the use of healthcare. The purpose of the research project was to examine the experience of internalized stigma among HIV-positive persons and their perceptions of stigmatizing attitudes in the community. The study also examined disclosure of HIV serostatus and identified factors contributing to disclosure and stigma in Senegal, a low prevalence Muslim country in West Africa. A cross-sectional study was conducted at Centre Hospitalier Universitaire de Fann in the form of a structured interview using a newly developed stigma instrument. The interviews were carried out in French and/or Wolof and the participants were interviewed during a routine visit to Fann Hospital. 15 men and 28 women aged between 19 and 55 years participated in the study. The mean period of time since diagnosis was 3.6 years (+/- 2.5 years). The stigma instrument showed a mean internalized stigma score of 5.4 +/- 3.5 (maximum score: 15) and an even higher level of perceived stigmatizing attitudes in the community of 7.9 +/- 4.8. Males had greater stigma scores than females. Almost 80 percent of the people interviewed had received some counseling, yet less than two-thirds of the study participants had disclosed their HIV status to others. People who had disclosed their HIV status used counseling less. The majority of subjects reported positive experiences with healthcare personnel in the Infectious Diseases Clinic of Fann Hospital. The level of internalized stigma and the perception of stigmatizing attitudes in the community are high with males experiencing more guilt. About three-fifths of the participants in the study had not disclosed their HIV status to even one other person; men disclosed their serostatus more frequently than women. Women were more likely to use counseling services compared to their male counterparts, and individuals who had disclosed their serostatus attended counseling less. Finally, despite the level of stigma perceived, the majority of people interviewed reported positive experiences with healthcare workers.

The fight against epidemics/pandemics is one of man versus nature. Technological advances have not only improved existing methods for monitoring and controlling disease outbreaks, but have also provided new means for investigation, such as through modeling and simulation. This dissertation explores the relationship between social structure and disease dynamics. Social structures are modeled as graphs, and outbreaks are simulated based on a well-recognized standard, the susceptible-infectious-removed (SIR) paradigm. Two independent, but related, studies are presented. The first involves measuring the severity of outbreaks as social network parameters are altered. The second study investigates the efficacy of various vaccination policies based on social structure. Three disease-related centrality measures are introduced, contact, transmission, and spread centrality, which are related to previously established centrality measures degree, betweenness, and closeness, respectively. The results of experiments presented in this dissertation indicate that reducing the neighborhood size along with outside-of-neighborhood contacts diminishes the severity of disease outbreaks. Vaccination strategies can effectively reduce these parameters. Additionally, vaccination policies that target individuals with high centrality are generally shown to be slightly more effective than a random vaccination policy. These results combined with past and future studies will assist public health officials in their effort to minimize the effects of inevitable disease epidemics/pandemics.

As you probably know, to board the B777-300ERi in Geneva for Anchorage via London, is not just that simple. With your ticket you bought several days before, you come to the airport, check in, pay airport's fees, go through the customs and security checks, walk in the terminal following signs, maybe you stop in the duty free shops, and finally find your gate. By this time, you are ready to board, about one hour after you enter the airport.
We will be essentially interested in air law that is why, the purpose of this master's thesis is to consider the legal aspect of facilitation in civil aviation. The term facilitation refers to the process that passengers, crew, luggage, cargo and mail have to go through when they cross borders to fly from a point A to a point B.
Recently, an aspect of facilitation took an outstanding importance: health issues. At the end of last year, the Severe Acute Respiratory Syndrome (SARS) outbreak was a real threat to international civil aviation because passengers (and crews) could have been exposed to an infected person inside the terminal or on board the plane, also, aircrafts were considered a fast vector of this disease through the world. The economic consequences for airlines and airports were very painful.
iBoeing 777-300 Extended Range.

The obligate intracellular bacterium Chlamydia pneumoniae (Cp), a common human pathogen, has been associated with atherosclerotic cardiovascular disease. The aetiology of non-rheumatic aortic valve sclerosis has, however, not been clarified. In two prospective studies of 42 and 46 patients undergoing surgical valve replacement because of aortic valve stenosis, the presence of Cp DNA could be demonstrated by polymerase chain reaction (PCR) in 49% and 35% of the sclerotic valves as compared to 9 % and 0%, respectively, of valves from forensic control cases with no heart valve disease. Some inflammatory and infectious diseases are associated with trace element changes. Eleven of 15 trace elements showed changed concentrations in sclerotic valve tissue compared to control valves in support of an active process in the sclerotic valves. Notable was an increased iron concentration in the patients´ valves suggesting a possible link to Cp. Furthermore, a disturbed trace element balance existed in the patients´ sera, the pattern of which was compatible with ongoing infection. In a prospective study of 38 patients operated on for thoracic aortic aneurysm or dissection, Cp DNA was detected byPCR in 12 % of the aneurysms and the result was confirmed byelectron microscopy(EM). In none of the dissection patients could Cp be demonstratedin the removed tissues. The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) values for doxycycline and azithromycin increased with longer Cp preincubation times when tested in vitro. EMwas performed to visualise the inactivation at a cellular level.Thus, the results demonstrate Cp in the tissues in non-rheumatic aortic valve sclerosis and in thoracic aortic aneurysm but not in aortic dissection.

Thesis (MPhil (Communicable Diseases)) (Dept of Interdisciplinary Health Sciences. Community Health))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: Global control of the tuberculosis (TB) epidemic remains one of the greatest health challenges of the 21st century, despite the availability of effective treatment over the past 50 years. The rising incidence of transmitted (primary) drug resistant TB threatens the very fabric of conventional TB control efforts, which are already strained by a rampant human immunodeficiency virus (HIV) epidemic. Ongoing transmission of Mycobacterium tuberculosis is a key factor that sustains the TB epidemic in endemic areas such as the socio-economically deprived townships of Cape Town, South Africa. My research explores the disease context, or social terrain, of TB in this endemic setting. It is primarily concerned with how the social terrain of endemic TB may contribute to ongoing transmission and the potential that it holds for enhancing TB control efforts. Analyses of qualitative data from eight township research sites in and around Cape Town show that pragmatic and novel approaches are required to pierce through the enormity of TB as a political and economic problem. Broadening the current biomedical focus on treating individual patients, to include more holistic community-based interventions, can and should be developed. Data were collected as part of qualitative pre-intervention community surveys conducted in 2005 and 2006 for a public health intervention trial (ZAMSTAR) performed in Zambia and South Africa. Twenty-four communities were selected as research sites and this study draws on the survey data collected in the trial’s eight South African sites. Although the data were collected for the ZAMSTAR trial, the aims and analyses presented in this study - which seek to improve our understanding of how the social terrain is meaningful for TB control - remain independent of ZAMSTAR. Through a retrospective analysis of the South African data, I inductively present three distinctive ways in which the social terrain is meaningful for TB control. First, the interaction between social cohesion and social diversity may be an important variable that predicts community response to public health interventions aimed at reducing the prevalence of TB in these endemic areas. This is demonstrated by triangulating ZAMSTAR’S adaptation of a social systems model with further analysis of the research sites. Second, the study identifies a common discourse running through the sites that stigmatizes TB as both a dirty and HIV-related disease. It is argued that this may be significantly contributing to TB diagnostic delay and I call for more holistic approaches to TB control that can reduce perceived marginalization and TB-HIV stigma. Third, congregate settings emerge as noteworthy visible features of social terrain that clearly have the potential to facilitate TB transmission within communities. The pre-intervention surveys qualitatively described public spaces within each research site and the use thereof. Basic principles of TB transmission are applied to these descriptions, developing a novel method of mapping the relative transmission risk possibly posed. Innovative use of similar approaches could identify likely transmission “hot spots” that may serve as focal points for targeted interventions, such as adjustments that increase ventilation or encourage TB suspects to seek urgent medical diagnosis and treatment.
AFRIKAANSE OPSOMMING: Die beheer van tuberkulose (TB) bly steeds een van die grootste gesondheids uitdagings van die 21ste eeu, ten spyte van die beskikbaarheid van effektiewe behandeling vir die afgelope 50 jaar. Die stygende insidensie van oorgedraagde (primêre) middelweerstandige TB bedreig die wese van konvensionele TB kontrole programme, wat reeds gebuk gaan onder die oorweldigende impak van die menslike immuungebrek virus (MIV) epidemie. Ononderbroke oordrag van Mycobacterium tuberculosis is ‘n kardinale faktor wat die epidemie onderhou in areas soos die sosioekonomies agtergeblewe dele van Kaapstad, Suid-Afrika. My navorsing ondersoek sosiale terrein (konteks) van TB in hierdie hiperendemiese konteks. Dit is primêr gemoeid met die moontlike bydrae van die sosiale terrein tot voortgaande TB oordrag en die potensiaal wat dit mag inhou om TB kontrole te verbeter. Analise van kwalitatiewe data van agt agtergeblewe gemeenskappe in en om Kaapstad wys dat nuwe en pragmatiese benaderings benodig word om die volle omvang van TB as ‘n politieke en ekonomiese problem aan te spreek. Data is versamel as deel van kwalitatiewe pre-intervensie gemeenskapsopnames wat gedoen is gedurende 2005 en 2006 vir ‘n publieke gesondheid intervensie studie (ZAMSTAR) in Zambië en Suid-Afrika. Die studie sou poog om die TB prevalensie betekenisvol te verlaag in gemeenskappe wat erg geaffekteer word deur MIV. Vir navorsings doeleindes is vier-en-twintig gemeenskappe geselekteer, waaronder agt Suid-Afrikaanse gemeenskappe. My studie analiseer kwalitatiewe data wat versamel is in hierdie agt gemeenskappe, wat verskeie observasie en deelnemende tegnieke ingespan het. Die studie poog om algemene begrip te verbeter van hoe die sosiale terrein betekenisvol kan wees in TB kontrole; dit is my eie werk en is totaal onafhanklik van die groter ZAMSTAR studie. Induktiewe retrospektiewe analise van data identifiseer drie voorbeelde wat illustreer hoe die sosiale terrein betekenisvol mag wees vir TB kontrole. Eerstens, die interaksie tusses sosiale kohesie en sosiale diversiteit mag ‘n belangrike verandelike wees wat gemeenskapsrespons tot publieke gesondheidsintervensies voorspel. Dit word geïllustreer deur die toepassing van ‘n sosiale sisteme model (soos aangepas deur ZAMSTAR) en analise van ander aanvullende data. Tweedens, identifiseer die studie ‘n gemeenskaplike diskoers in alle navorsings gemeenskappe wat TB stigmatiseer as beide ‘n vuil en MIV-verwante siekte. Dit word geargumenteer dat hierdie verskynsel moontlik betekenisvol bydra tot vertraging van TB diagnose en die nodigheid vir meer holistiese benaderings wat marginalisasie en TB-HIV stigma kan verminder word uitgewys. Derdens blyk dit dat openbare vergaderplekke ‘n belangrike deel van die sosiale terrein vorm en duidelik die potensiaal het om TB oordrag binne gemeenskappe te fasiliteer. Die pre-intervensie opnames het alle openbare vergaderplekke sorgvuldig beskryf en basiese beginsels van TB oordrag is gebruik om vergaderplekke geografies te kaart volgens die moontlike transmissie risiko wat dit mag inhou. Innoverende gebruik van GIS-gebasseerde benaderings, soortgelyk aan die metode wat gebruik is om potensiële “transmission hot spots” te kaart, mag bydra om intervensies beter te fokus, deur bv. verbeterde ventilasie te verskaf of mense met simptome van TB aan te moedig om dringend mediese hulp te soek.

Disease prevalence varies with geographic location. This research pursues a medical geographic perspective and examines the spatial variations in disease patterns between Obuasi, a gold mining town and Asankrangwa, a non gold mining town in Ghana, West Africa. Political ecology/economy and the human ecology frameworks are used to explain the prevalence of diseases. Mining alters the environment and allows disease causing pathogens and vectors to survive more freely than in other similar environments. Certain diseases such as upper respiratory tract infections, ear infections, sexually transmitted diseases such as HIV/AIDS and syphilis, certain skin diseases and rheumatism and joint pains may have a higher prevalence in Obuasi when compared to Asankrangwa due to the mining in Obuasi.

Thesis (MA)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: The HIV-epidemic that is evident in South Africa today is infecting more women than men. This is mostly due to the vulnerability that women are facing in sexual relationships, where they are not able to negotiate the terms and conditions of their sexual engagement. Patriarchy, the culture of masculinity and a general male dominance influence women’s dependency on their man and agency inside and outside of the home, and contribute to the oppression of women both generally in society and sexually. Women have by this not the control over their own bodies and are for this reason in a high-risk position of contracting HIV. The vulnerability is further linked to the stigmatisation that women experience if they do try to negotiate preventative measures to reduce the risk of transmission. The fear of being stigmatised as ‘loose’ or HIV-positive by both men and women if suggesting condom use, inhibits women to propose the necessary actions for protection. Stigmatising behaviours also impact on a person’s fear of becoming HIV-positive and reduces the likelihood of getting tested, disclose one’s status to sexual partners and receive treatment. This thesis examines cultural and socio-economic issues that contribute to gender inequality in South Africa, and can generate stigma towards women on the basis of HIV and AIDS. This is done by using radical feminism as the theoretical framework for contextualising how women are situated in the South African society, in terms of general and sexual agency. Through the method of content analysis and the findings from the theoretical framework, the thesis further analyses how the three HIVprevention campaigns loveLife, Brothers for Life and TAC manage to address the issues related to stigma based on HIV/AIDS, which are directed towards women. Race, class and gender are all factors that influence the likelihood of becoming HIV-infected and of becoming stigmatised. Women’s low social status situates women in a position where they are more probable to be the object of stigmatisation since they already are considered lower in rank. If the women also are of colour, poor and low educated the chances of becoming stigmatised on the basis of HIV and AIDS are even more likely, the same is the chances of becoming HIV-infected. This indicates that poor, uneducated black women are the group that is most vulnerable towards stigmatisation as well as towards HIV-transmission. Socio-economic and cultural factors have a strong influence on the gender inequality in sexual relationships found in South Africa, which cause HIV to spread and can generate stigmatising behaviours. Stigmatisation on the basis of HIV/AIDS is therefore important to address in order to reduce the number of new HIV-infections. The three campaigns analysed for this thesis did neither directly address stigma on a general level nor directed towards women. The campaigns are therefore considered to be missing an important feature of HIV-prevention in South Africa.
AFRIKAANSE OPSOMMING: Die huidige Suid-Afrikaanse Vigsepidemie infekteer meer vroue as mans. Dit is die geval weens die kwesbaarheid wat vroue ervaar in seksuele verhoudings, waar vroue nie die mag het om die omstandighede van hul seksuele interaksies te onderhandel nie. Patriargie, die kultuur van manlikheid en ‘n algemene manlike dominansie beïnvloed vroue se mag en dra by tot die onderdrukking van vroue, beide in die samelewing in die algemeen en in seksuele verhoudings. Om hierdie rede het vroue nie beheer oor hul eie liggame nie en daarom ervaar hulle ‘n hoë risiko om MIV op te doen. Hierdie kwesbaarheid word ook verbind aan die stigmatisering wat vroue ervaar wanneer hulle probeer om voorkomende aksie te neem ten einde die risiko van Vigsoordrag te verminder. Die vrees om deur mans en ander vroue gestigmatiseer te word as iemand met ‘losse sedes’, of as iemand wat MIV-positief is wanneer hulle kondoomgebruik voorstel, weerhou vroue daarvan om die nodige voorkomende aksie vir selfbeskerming te neem. Stigmatiserende gedrag het ook ‘n impak op ‘n mens se vrees om MIV-positief te word en verminder die waarskynliheid dat jy jouself vir die virus sal laat toets, dat iemand hul status aan seksuele maats sal verklaar, of behandeling sal ontvang. Diegene wat reeds MIV onder lede het is bang om hul status te verklaar weens die gepaardgaande stigma. Hierdie tesis ondersoek kulturele en sosio-ekonomiese kwessies wat bydra tot geslagsongelykheid in Suid-Afrika, en wat stigma kan veroorsaak teenoor vroue met betrekking tot MIV and Vigs. Die studie analiseer dan of Vigsveldtogte hierdie stigma kan aanspreek. Dit word gedoen deur radikale feminisme toe te pas as ‘n teoretiese raamwerk om vroue se plek in die Suid-Afrikaanse samelewing te kontekstualiseer, beide in terme van algemene en seksuele mag. Die metode van inhoudsanalise word toegepas om drie Vigsvoorkomingsveldtogte (loveLife, Brothers for Life en TAC) te analiseer en vas te stel of en hoe hulle kwessies wat betrekking het op stigma teenoor vroue aanspreek. Sosio-ekonomiese en kulturele faktore het ‘n sterk invloed op die geslagsongelykeid in seksuele verhoudings in Suid-Afrika; dit lei daartoe dat MIV versprei word en kan stigmatiserende gedrag vererger. Om hierdie rede is dit belangrik dat MIV/Vigsvoorkomingsveldtogte stigmatisering aanspreek ten einde gedrag te wysig en om die getal nuwe Vigsbesmettings te laat daal. Die drie veldtogte wat in hierdie tesis geanaliseer is het beide nagelaat om stigma direk aan te spreek op ‘n algemene vlak, en was ook nie direk gerig op vroue nie. Die veldtogte kan daarom beskou word as ontoereikend deurdat hulle belangrike komponente van MIV-voorkomig in Suid-Afrika misgekyk het.

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.

Background Climate variation has affected diverse physical and biological systems worldwide. Population health is one of the most important impacts of climate variation. Although the impact of climate variation on infectious diseases has been of significant concern recently, the relationship between climate variation and infectious diseases, including vector-borne diseases and enteric infections, needs greater clarification. Australia is grappling with developing politically acceptable responses to global warming. In China, few studies have been conducted to examine the effect of climate variation, including global warming, on population health. As residents of developing countries may suffer more from climate change compared with people living in more developed countries, this thesis has significance for both countries. Aims This study aims to contribute to a better understanding of the impact of climate variation on population health, and to provide scientific evidence for policy makers, researchers, public health practitioners and local communities in the development of public health strategies at an early stage, in order to prevent or reduce future risks associated with ongoing climate change. The objectives of this study include: (1) to quantify the association between climate variation and selected vectorborne diseases and enteric infections in different climatic regions in Australia and China; (2) to project the future burden of selected vector-borne diseases and enteric infections based on climate change scenarios in different climatic regions in Australia and China. Methods This ecological study has two components. The first uses time-series analyses to quantify the relationship between meteorological variables and infectious diseases, whereas the second projects the burden of selected infectious diseases using future climate and population scenarios. Temperate and subtropical climatic zones in both Australia and China were selected as the primary study areas, and a study of an Australian tropical region was also conducted. Study of Australia’s temperate zones was conducted in Adelaide, South Australia, as well as the Murray River region in that State. The study of China’s temperate zone was carried out in Jinan, Shandong Province. Subtropical studies were conducted in Baoan, Guangdong Province, China, and Brisbane in Queensland, whilst research for the tropics centred on Townsville, also in Queensland, Australia. The selected infectious diseases - one vector-borne disease and one enteric infection in each country - are Ross River Virus (RRV) infection and salmonellosis in Australia, and malaria and bacillary dysentery in China. Study periods vary from eight to sixteen years (depending upon the availability of data). Climate data, infectious disease surveillance data and demographic data were collected from local authorities. Data analyses conducted in the ecological studies include Spearman correlation analysis, time-series adjusted Poisson regression and the Seasonal Autoregressive Integrated Moving Average (SARIMA) model with consideration of lag effects, seasonality, long-term trends, and autocorrelation, on a weekly or monthly basis depending on data availability, and Hockey Sticky model to detect potential threshold temperatures. In the burden of disease component, analyses include the calculation of an indicator of the burden of disease - Years Lost due to Disabilities (YLDs) - and use scenario-based models to project YLDs for the selected diseases in 2030 and 2050 in Australia and 2020 and 2050 in China respectively. The projections consider both different scenarios of projected temperature and future population change. Results Relationship between climate variation and selected infectious diseases In all the study regions in Australia, maximum temperature, minimum temperature, rainfall and humidity are all significantly related to the number of RRV infections, with lag effects varying from 0 to 3 months. Additionally, high tides in the two seaside regions with tropical (Townsville) or subtropical (Brisbane) climates, and river flow in the temperate region (Murray River region), are related to the number of cases without any lag effects. A potential 1°C increase in maximum or minimum temperature may cause 4%~23% extra cases of RRV infection in the temperate region, 5~8% in the subtropical region, and 6%~15% in the tropical region. Maximum temperature, minimum temperature, humidity and air pressure are significantly related to malaria cases in the temperate city Jinan and subtropical city Baoan in China, with a lag effect range of 0 to 1 month. An association between rainfall and malaria cases was not detected in either region. A potential 1°C increase in maximum or minimum temperature may lead to 4%~15% extra malaria cases in the temperate region, and 12%-18% in the tropical region in China. Maximum temperature, minimum temperature, rainfall and humidity are all significantly related to the number of salmonellosis cases in the three study cities in Australia, with lag effects varying from 0 to 1 month. A potential 1°C increase in maximum or minimum temperature may cause 6%~19% extra salmonellosis cases in the temperate region (Adelaide), 5%~10% in the subtropical region (Brisbane), and 4%~15% in the tropical region (Townsville). The thresholds for the effects of maximum and minimum temperatures are 20ºC and 12ºC respectively in Adelaide. No threshold temperatures are detected in Townsville and Brisbane. Maximum temperature, minimum temperature, humidity, air pressure and rainfall are significantly related to bacillary dysentery cases in the temperate city Jinan and subtropical city Baoan in China, with the lag effect range of 0 to 2 months. A potential 1°C increase in maximum or minimum temperature may cause 7%~15% extra bacillary dysentery cases in the temperate region and 10% ~ 19% in the subtropical region in China. The thresholds for the effects of maximum and minimum temperatures on bacillary dysentery are 17ºC and 8ºC respectively in Jinan. No threshold temperatures are detected in Baoan. Projection of YLDs from target diseases In Australia, considering both climatic and population scenarios, if other factors remain constant, compared with the YLDs observed in 2000, the YLDs for salmonellosis might increase by up to 48% by 2030, and nearly double by 2050 in South Australia, while the YLDs might double by 2030 and increase by up to 143% by 2050 in Brisbane, Queensland. The YLDs for RRV infection might increase by up to 66% by 2030, and nearly double by 2050 in South Australia. They might increase by up to 61% by 2030 and double by 2050 in Brisbane, Queensland. In China, considering both climatic and population scenarios, if other factors remain constant, compared with the YLDs observed in 2000, the YLDs for bacillary dysentery might double by 2020 and triple by 2050 in both Jinan and Baoan. The YLDs for malaria might increase by up to 108% by 2020 and nearly triple by 2050 in Jinan, the temperate city, and increase by up to 144% by 2020 and nearly triple by 2050 in Baoan, the subtropical city. Conclusions 1. Both maximum and minimum temperatures are important in the transmission of vector-borne diseases in various climatic regions in both Australia and China. River flow or high tides may also play an important role in the transmission of such diseases. 2. Both maximum and minimum temperatures play an important role in the transmission of enteric infections in various climatic regions in both Australia and China, with a threshold temperature detected in the temperate regions but not in subtropical and tropical regions. 3. The effects of rainfall and relative humidity on selected infectious diseases vary in different study areas in Australia and China. 4. The burden of temperature-related infectious diseases may greatly increase in the future if there is no effective preventive intervention. Public health implications 1. Implication for health practice • Public health practitioners, together with relevant government organisations, should monitor trends in infectious diseases, as well as other relevant indexes, such as vectors, pathogens, and water and food safety. They should advise policy makers of the potential risks associated with climate change and develop public health strategies to prevent and reduce the impact of infectious disease associated with such change. • Doctors and other clinical practitioners should be prepared and supported in the provision of health care for any expected extra cases associated with climate variation and should play an important role in relevant health education on climate change. • Community participation is of significance to adapt to and mitigate the risk of climate change on population health. Community involvement helps to deliver programmes which more accurately target local needs. Therefore, community should be involved in the partnerships of climate change as early as possible. • Relevant education programs on the potential health impact of climate change should be conducted by government at all levels for different stakeholders, including industries, governments, communities, clinicians and researchers. • Advocacy for adapting to and mitigating climate change should be a longstanding public health activity. 2. Implication for researchers • The main task for researchers is to identify the independent contribution made by key climatic variables and whether there are exposure thresholds for infectious disease transmission. Further studies should include various infectious diseases in different climatic regions. • Developing countries and rural regions are more vulnerable to the impact of climate change so more research should be conducted for people living in those regions. • Studies using summary measures that combine prevalence of disease, quality of life and life expectancy, such as Disability Adjusted Life Years (DALYs), to assess the burden of disease due to climate change is necessary to assist in decision making. • More research should be conducted on the assessment of adaptive strategies and mitigation to future climate change. 3. Implication for policies • Public and preventive health strategies that consider local climatic conditions and their impact on vector and food borne diseases are important in reducing such impact due to climate change in the future. • The extra health burden that may be caused by future climate change may have a great impact on the currently overloaded public health system in both developed and developing countries. Long-term planning about health resource allocation, infrastructure establishment, and relevant response mechanisms should be developed at relevant government levels. • Effective prevention and intervention strategies will be possible only if the efforts of relevant sectors, including governments, communities, industries, research institutions, clinical professionals and individuals, have coordinated responses. • International and regional collaborations are necessary to address this global issue. In addition, strategies of an international dimension should be translated into regional and local actions. This is extremely important to developing countries such as China and India. • Sustainable development policies with consideration given to reducing green house gases and environmental degradation need immediate action which will benefit future generations. Health priorities should include the prevention of climate change.
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Thesis(Ph.D.)-- School of Population Health and Clinical Practice, 2007

M.Cur.
Statistics prove that the monster called HIV/AIDS invades our country. More women are said to be HIV positive in comparison to men. The midwives are the frontline health workers who have to care for these pregnant HIV positive women and therefore are at occupational risk of HIV infection because of their caring role. The experience of midwives regarding the delivery of the babies of HIV positive women was not well addressed before as limited studies have been undertaken about the experiences of midwives, therefore inspiring the researcher to undertake this study. The purpose of this study was to: • Explore and describe how midwives experienced the delivery of the babies of HIV positive women. • Describe the guidelines for health professionals to support midwives in order for them to render good midwifery care. The paradigmatic perspective of this study was guided by the Theory for Health Promotion in Nursing (Rand Afrikaans University, Department of Nursing Science, 1992:2-15), which reflects the focus on the whole person.

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services.
Health Studies
MPH (Health Studies)

Diarrhoea, particularly infectious diarrhoea, in children below five years of age is recognised as one of the leading cause of morbidity and mortality throughout the world. This is especially true in residential areas of developing countries where there is substandard sanitation and overcrowding which are reservoirs for farther transmission. Shigellosis is endemic in developing countries and in Sub-Saharan Africa, including South Africa, a region where unique geographic, economic, political, sociocultural, and personal factors interact to create distinctive continuing challenges to prevention and control. Our study was undertaken to establish baseline information on incidences of Shigella, its serotype and resistant pattern of isolates from human faeces from residents of Johannesburg, South Africa. All stools received from January to April 2013 from the private health care system were cultured on standard media for isolation of Shigella and confirmed by standard biochemical reactions and serological method. Antibiotic sensitivity test was determined by the agar diffusion method. 11009 stool samples were assayed from patients aged between 22 days to 94 years with a 110 Shigella isolates yield, of which 47 (43%) were S. flexneri, 61 (55%) S. sonnei and 1 (1%) of S. dysentriae and S. boydii respectively. Majority of patients 76 (69%) were children between < 1 to 5 years old followed by those between 6 to 10 years 13(12%). Of the four species isolated from children of up to 10 years old, S. sonnie was confirmed in 52 cases (59%) and S. flexneri in 36 cases (41%). A total of 53 (48%) males and 57 (52%) females were infected. However, a hundred per cent susceptibility to ciprofloxacin and ceftriaxone but high levels of resistance to Co-trimoxazole (83%), tetracycline (72%), and ampicillin (26%) was noted. From the 110 isolates, 96 (87%) were resistant to one or more drugs while 14 (13%) were fully susceptible. These results show that S. sonnei followed by S. flexneri as predominating aetiology of shigellosis and Ceftriaxone and ciprofloxacin as effective drugs against all four Shigella species.
Health Studies
M. Sc. (Life Sciences)

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

Indiana University-Purdue University Indianapolis (IUPUI)
Vaccinia virus (VV) is the prototypical member of the orthopoxvirus genus of the Poxviridae family, and is currently being evaluated as a vector for vaccine development and cancer cell-targeting therapy. Despite the importance of studying poxvirus effects on the human immune system, reports of the direct interactions between poxviruses and primary human leukocytes (PHLs) are limited. We studied the specific molecular events that determine the VV tropism for major PHL subsets including monocytes, B cells, neutrophils, NK cells, and T cells. We found that VV exhibited an extremely strong bias towards binding and infecting monocytes among PHLs. VV binding strongly co-localized with lipid rafts on the surface of these cell types, even when lipid rafts were relocated to the cell uropods upon cell polarization. In humans, monocytic and professional antigen-presenting cells (APCs) have so far only been reported to exhibit abortive infections with VV. We found that monocyte-derived macrophages (MDMs), including granulocyte macrophage colony-stimulating factor (GM-CSF)-polarized M1 and macrophage colony-stimulating factor (M-CSF)-polarized M2, were permissive to VV replication. The majority of virions produced in MDMs were extracellular enveloped virions (EEV). Visualization of infected MDMs revealed the formation of VV factories, actin tails, virion-associated branching structures and cell linkages, indicating that infected MDMs are able to initiate de novo synthesis of viral DNA and promote virus release. Classical activation of MDMs by LPS plus IFN-γ stimulation caused no effect on VV replication, whereas alternative activation of MDMs by IL-10 or LPS plus IL-1β treatment significantly decreased VV production. The IL-10-mediated suppression of VV replication was largely due to STAT3 activation, as a STAT3 inhibitor restored virus production to levels observed without IL-10 stimulation. In conclusion, our data indicate that PHL subsets express and share VV protein receptors enriched in lipid rafts. We also demonstrate that primary human macrophages are permissive to VV replication. After infection, MDMs produced EEV for long-range dissemination and also form structures associated with virions which may contribute to cell-cell spread.

Since the earliest reported cases of HIV/AIDS probably in 1959 in Africa, there has been a consistent progression in the new HIV/AIDS infection cases. In South Africa, Gauteng, records one of the highest HIV/AIDS prevalence rates in the country. The Department of Health (DOH) South Africa conducts ongoing studies on HIV/AIDS at provincial levels; these studies monitor the prevalence of HIV/AIDS amongst pregnant women attending antenatal clinics, as a tool for determining and monitoring the prevalence, trends, patterns and spread of the disease in the general population. This study analyses sentinel and spatial data collected from the (DOH) and Statistics South Africa (StatsSA) respectively, and depicts them in the form of spatial maps, and then critically analyses the spatial patterns that occur. The research findings would hopefully contribute to the overall knowledge of HIV/AIDS and provide framework and relevant literature for further investigation.
Geography
M.Sc. (Geography)

A higher infant mortality rate and shorter life expectancy, coupled with a high prevalence of a variety of diseases commonly associated with malnutrition, are usually a reflection of the social conditions of poverty in a society. By arguing that apartheid formed the basis of inequality and therefore the main underlying cause of an unacceptable burden of the diseases of poverty among black South Africans, this thesis, Poverty, Health and Disease in the Era of High Apartheid: South Africa, 1948-1976, locates these health problems within their social, economic and political context. It further argues that if health and disease are measures of the effectiveness with which human beings, using the available biological and cultural resources, adapt to their environment, then this relationship underpins the convergence of medical and cultural interests. Under the impact of modern technology and society's dependence upon it, profound cultural changes have taken place and issues of health and the etiology of disease are among the areas most affected by these changes. This thesis explains why, in a pluralistic medical setting, where only modern (scientific) medicine was recognised as legitimate medicine by the apartheid government, for the majority of black South Africans the advent of modern medicine was viewed not so much as displacing indigenous (African) medicine but as increasing the medical options available to them. It is therefore contended here that for most black South Africans, indigenous medicine has played a critical role; it has mitigated the impact of apartheid medicine. Since differences that people perceive in these two medical systems are crucial to the medical choices that they make at the onset of illness, this thesis argues that knowing and understanding the reasons for making such choices would not only have practical value for health authorities in their efforts to improve local, regional and national health service delivery, but would also contribute to a general understanding of human therapy-seeking behaviour in this age of the HIV/AIDS pandemic.
History
Thesis (D. Litt. et Phil. (History))

Indiana University-Purdue University Indianapolis (IUPUI)
Vaccinations are an important step in preventing childhood illnesses and disease outbreaks in the community. Complete immunizations before school assure eligibility for enrollment and protect children against severe illness. The fact that foreign-born children of Latino immigrants face health disparities in receiving vaccinations is well documented. However, there is little information in the literature about the actual experience of immigrants facing the complexities of the health system, and through their eyes, which factors ultimately affect vaccination rates of immigrant Latino children. The purpose of this study is to give voice to Latino immigrant families who have recently immigrated to the United States, in terms of the issues they encountered when engaging the health care system for vaccinations.

Purpose This research project was an attempt to determine situational aspects of HIV and AIDS among the designated farming communities in the Vhembe and Mopani districts of Limpopo Province. Questions arising from the pilot project were premised on the capacity of farmers in these areas to adequately address the daunting reality and prevalence of HIV and AIDS in their communities. Research Design and Methodology The research was designed to facilitate the integration of both qualitative and quantitative approaches. A sample of 228 respondents was involved in a triangulated participatory action research method. To the extent that the data collection techniques were triangulated in both nature and focus, HIV/AIDS-related data and information within the designated farming communities was attained with a maximum degree of validity. The data collection techniques used in this regard were: questionnaires, which were distributed to 228 respondents; participant observation; exploratory investigation; unstructured interviews; naturalistic observation; focus group interviews and discussion; and review of documents. The reviewed documents include (primary) sources on HIV/AIDS by the Department of Health and (secondary) sources of literature by various authors presenting a range of perspectives on HIV/AIDS in farming areas. Findings The results of the study revealed the absence of a coordinated policy on HIV/AIDS in particular, and health in general; and a vacuous prevalence of basic HIV/AIDS-related information. For instance, knowledge on condom usage as a prevention strategy was ostensibly scant. Currently, primary healthcare services in the area are not available. The sampled farm workers themselves unanimously corroborated that there was no HIV/AIDS policy on the SAFM farms. Conclusion Based on the main findings established above, it has become indispensable that comprehensive and multidisciplinary HIV/AIDS policy interventions be initiated by all the relevant stakeholders. Local and provincial healthcare authorities need to provide policy guidelines for the development of such policy, taking the particular needs and circumstances of farm workers. The pervasive degree of insufficient HIV/AIDS knowledge among this group necessitates that such a policy should integrate both a labour perspective and healthcare orientation, rather than perpetuating a separation of the two paradigms. This form of integration ensures that the observance of a human rights dimension becomes a sacrosanct component of the prevention of HIV/AIDS among farm workers, as well as their education concerning their healthcare-related rights as farm employees. Furthermore, the prevalence of a national HIV and AIDS policy is mainly aimed at facilitating broad guidelines, not addressing the specific contexts of every public, corporate and rural employment sector (DoH, 2007: 11-12; Muhlemann, et al., 1992: 479). In order that the education, prevention and treatment initiatives in the Vhembe and Mopani farming communities are achieved, the most important parameters of the policy should indicate: ,,X The systematic institutionalisation of local, provincial, and national HIV and AIDS programmes, notwithstanding the provision of healthcare facilities such as clinics; ,,X The promotion of basic healthcare education in general, and HIV/AIDS awareness and prevention among farm workers in particular; ,,X The development of HIV/AIDS work place policy by SAFM as employer; ,,X The systematic involvement and formation of partnerships between policy makers, local and international funders, HIV/AIDS healthcare workers and practitioners, NGOs and SAFM. As a critical factor and unit of analysis in the study, SAFM is expected to fulfil a developmental function among its employees, their families, and the local communities. This function could be enhanced further with the collaboration between SAFM and other farmers in the distribution of basic information regarding HIV/AIDS and other sexually transmitted diseases at the workplace, as well as extensive healthcare education and training for their farming personnel. Trained personnel, especially managers, are a salient factor in the implementation of organisational health and safety requirements (DoH, 2007: 6, 8; Muhlemann, et al., 1992: 478-479).
Health Studies
D. Litt. et Phil. (Health Studies)