PhD thesis - University of Hertfordshire Research Archive

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the incidence in male Pakistani children under five years greatly exceeded that in female Pakistanis in the same age group, and in all other children in that age group, regardless of gender. White-collar workers were at marginally greater risk of infection than blue-collar workers, and incidence by socioeconomic status varied greatly with age and gender. This study has reemphasized that age and gender are major determinants for Campylobacter infection in England and Wales and has also demonstrated that ethnicity, occupation and socioeconomic status are important. Epidemiological studies on Campylobacter infection need to take all these factors into consideration at either the design or the analysis stage if meaningful findings are to be obtained, and this is likely to increase either their size (larger single studies) or complexity (numerous smaller studies), with obvious financial implications. Some important hypotheses concerning the role of host susceptibility in disease transmission were also generated, in that we suggest that endogenous or exogenous hormones, present at elevated levels in different genders at different stages of life, might affect the growth characteristics of any campylobacters present in vivo, altering disease risk accordingly. 55
8. Discussion. The research carried out by the candidate and documented in the aforedescribed publications which form this body of work demonstrate that the aims and objectives of this project have been met. The candidate has successfully improved current understanding of Campylobacter infection and generated new hypotheses for infection. The candidate has demonstrated that age, gender, ethnicity, occupation and socioeconomic status are major determinants for Campylobacter infection in England and Wales, and that variation in behaviour throughout the week also has a bearing on risk. The candidate has shown that campylobacteriosis cannot be considered a single disease, as exposure differences exist in cases infected with different Campylobacter species or subspecies, and these differences can be confounded by foreign travel status. The fact that disease incidence amongst foreign travellers is country-specific suggests that the above exposure differences will be confounded further by travel destination. The candidate has shown that outbreaks of campylobacteriosis occur more commonly than described previously, suggesting that an opportunity for furthering our understanding of infection is being missed. Finally, the candidate has examined the dose-response relationship for Campylobacter infection. A good marker for the significance of scientific work is its acceptance by peers. In addition to passing the peer-review process in journals with an average impact factor of 2.76, the publications which form this submission have been cited on sixty-six occasions by colleagues worldwide (table 4). In addition, the data generated from the study has been used to answer over 50 documented and many more undocumented information requests from Government, industry and academia. It has contributed to at least three Government-funded research projects, has been used to inform World Health Organisation strategy on campylobacteriosis and has been presented at local, national and international meetings. 56
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Population-Based Sentinel Surveilla
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The research carried out by the can
Page 5 and 6: Dedication. This thesis is dedicate
Page 7 and 8: 7. Results (the published work). ..
Page 9 and 10: Statement identifying the degree fo
Page 11 and 12: Paper Reference Page 6 Gillespie IA
Page 13 and 14: Statement of the candidate’s cont
Page 15 and 16: Declaration form. I, Iain Andrew Gi
Page 17 and 18: 2. History. In contrast to other co
Page 19 and 20: The application of veterinary techn
Page 21 and 22: The incidence of laboratory-confirm
Page 23 and 24: were elderly or had a pre-existing
Page 25 and 26: they would for other bacterial gast
Page 27 and 28: papers (Pearson et al., 1977; Bruce
Page 29 and 30: Studies were most frequently conduc
Page 31 and 32: The content of peer-reviewed public
Page 33 and 34: infection. An approximation of the
Page 35 and 36: hypotheses a „blank canvas‟ app
Page 37 and 38: 6. Materials and methods. Regional
Page 39 and 40: presentation and severity, foreign
Page 41 and 42: together, etc). The results of the
Page 43 and 44: and improve response during the stu
Page 45 and 46: The published work. 7.1 Epidemiolog
Page 47 and 48: community illness was more common a
Page 49 and 50: north west England and in Yorkshire
Page 51 and 52: community was no different from oth
Page 53 and 54: provide useful insights into the ep
Page 55: Cases in case-control studies of la
Page 59 and 60: The sentinel health authorities wer
Page 61 and 62: fundamentally flawed. Since the app
Page 63 and 64: control studies. The potential role
Page 65 and 66: Campylobacter spp. from cattle farm
Page 67 and 68: Cameron, S., Ried, K., Worsley, A.,
Page 69 and 70: Doyle, L. P. 1948, "The etiology of
Page 71 and 72: other industrialised countries," in
Page 73 and 74: Hanel, C. M. & Atanassova, V. 2007,
Page 75 and 76: Hudson, S. J., Lightfoot, N. F., Co
Page 77 and 78: Kessel, A. S., Gillespie, I., O'Bri
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Page 81 and 82: Department of Health and Human Serv
Page 83 and 84: Potter, R. C., Kaneene, J. B., & Ha
Page 85 and 86: Siemer, B. L., Harrington, C. S., N
Page 87 and 88: Sopwith, W., Birtles, A., Matthews,
Page 89 and 90: Campylobacter infection: a general
Page 91: The published work 90
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Table A1.1: Notable events in the h
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Year Human medicine Veterinary medi
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Levy, A. J. 1928, "A gastro-enterit
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Appendix 2. An assessment of the ro
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compare the period after 2000 with
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condition was significantly associa
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Deaths/100,000 cases 600 500 400 30
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Table A2.1: Factors affecting the u
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Appendix 3. An analytical review of
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to indigenously acquired infection
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susceptibility to Campylobacter inf
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year demonstrated that only the num
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Table A3.1 Reported epidemiological
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Table A3.3 Selected reported risk f
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Table A3.5. The effect of various r
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Deming, M. S., Tauxe, R. V., Blake,
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Harris, N. V., Weiss, N. S., & Nola
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Kist, M. & Rossner, R. 1985a, in Ca
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Oosterom, J., den Uyl, C. H., Banff
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Severin, W. P. J. 1982, "Epidemiolo
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Appendix 4. The Campylobacter Senti
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