Specific DNA probes were used to identify Shiga-like-toxin (SLT) 1-and II-producing Escherichia coli from children less than 5 years of age with bloody diarrhea, in infants with diarrhea, and in controls of the same age without diarrhea in Thailand. At one hospital, SLT-producing E. coli was identified in 4 (7%) of 54 children with bloody diarrhea from whom other enteric pathogens were not identified and from 3 (6%) of 50 children without diarrhea. In the positive specimens, SLT-producing E. coli constituted only 0.3 to 4% of the 100 to 300 colonies on the replica blots. Non-toxin-encoding 933J and 933W bacteriophagelike DNA sequences were detected by colony hybridization with E. coli isolates from 18 (33%) of 54 children with bloody diarrhea and 23 (46%) of 50 controls. At another hospital, SLT-producing E. coli was not identified in 115 infants with diarrhea and 119 controls without diarrhea. One infant with diarrhea was infected with E. coli 076:H7 that hybridized with the enterohemorrhagic E. coli probe but not with the SLT probes. E. coli producing SLT I or SLT Il was isolated in small numbers from a similar proportion of Thai children with bloody diarrhea in whom no other enteric pathogen was identified and from controls without diarrhea.
JS. Factor 11 (prothrombin) coagulant activity and immunoreactive protein: detection of vitamin K deficiency and liver disease in patients with cystic fibrosis. J Pediatr 1981;99:254-7. 4 Hart JP, Schearer MJ, McCarthy PT, Rahim S. Voltammetric behaviour of phylloquinone (vitamin K,) at a glassy carbon electrode and determination of the vitamin in plasma using high performance liquid chromatography with electrochemical detection. Analyst 1984;109:477-81. 5 Shearer MJ, Rahim S, Barkhan P, Stimmler L. Plasma vitamin K1 in mothers and their newborn babies. Lantcet 1982;ii:460-3.
To determine how frequently mothers infect their infants with enteric pathogens at birth, stools were collected from 75 Thai mothers immediately before delivery and from their infants 24-48 h later. Enteropathogenic Escherichia coli (EPEC) were isolated from 25 of the 75 mothers just prior to delivery (32%), enteroviruses from six (8%), enterotoxigenic E. coli from five (7%), and shigella, salmonella and Vibrio parahaemolyticus each from one (1%). EPEC serotype 0128:K67 was isolated from one mother and from her infant, neither of whom had diarrhoea. Cultures from the other 74 mother-infant pairs did not detect identical enteric pathogens. Eighteen infants, nine of whose mothers submitted stools prior to delivery, developed diarrhoea within 5 days of birth. Five infants were infected with ETEC (28%), three with EPEC serotype 020a020cK61 (17%), one with Campylobacter jejuni (6%), and one with rotavirus (6%). None of these enteropathogens was found in 66 infants without diarrhoea. ECHO viruses of two different serotypes were isolated from two of 18 newborns with diarrhoea and unidentified enteroviruses from three of 66 without diarrhoea. Mothers and nurses are frequently infected with enteric pathogens in Thailand, but transmission to newborns at birth appears to be uncommon.
Background: With new challenges to the health system, many new competencies within the scope of teaching public health need to be addressed in medical schools’ curricula such as disaster risk management and health system science. The aims of this study were to identify the needs of public health competencies for medical doctors in Thailand and to assess the level of integration for technical collaboration in teaching public health. Method: A total of 17 out of 21 Thai medical schools participated in the national survey. Qualitative inquiries applied focus group interviews of community representatives from ten sample villages and in-depth interviews of representatives from stakeholder organizations particularly employers. The list of public health competencies framework recommended by WHO-SEARO was applied. Quantitative analysis applied descriptive analysis using STATA 15 and qualitative findings were validated by interrelating the meaning of themes from Word Clouds created in NVivo12. Data integration applied a mixed-method Quan-qual approach. Results: 17 medical schools returned the questionnaires (80.95 % yield). The most common regionally-defined public health competencies (in over 70% of schools) were shown to be: Biostatistics, Community Medicine, Epidemiology, Family Medicine, Medical Ethics and Professional Laws, Preventive Medicine, Health Promotion, Holistic Care, and Research. The curriculum in only one medical school lacked Health Economics, whilst Disaster Management was lacking in two other schools. Discipline-based subjects were found to be more prevalent than interdisciplinary competencies. A variety of methods were being applied for teaching public health. The majority of the schools applied lecture as the main teaching method and multiple-choice questions as the main assessment method. Thai communities expect the doctors to get in touch with the community more often, lead the primary health care team through training the health professionals and community health volunteers, and educate the community for better health. Conclusion: Human resource is the main challenge in addressing interdisciplinary competencies. It is necessary to establish a collaborating mechanism among the big and small medical schools and the faculties of public health to improve the teaching of public health to undergraduate students in medical schools. There is also a need to strengthen the health system science and leadership so that future MDs can lead health service delivery according to the needs of their employers such as the Ministry of Public Health and the Rural Doctors Association. The findings of this study may help to identify a national framework of public health core competencies for medical schools and create a common platform for interdisciplinary collaborations.
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