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Control of cryptosporidiosis in neonatal calves: use of halofuginone lactate in two different calf rearing systems
No full textTo date there is no effective treatment for bovine cryptosporidiosis. This study describes the use of halofuginone lactate in preventing cryptosporidiosis in naturally infected neonatal calves on a dairy farm with a high prevalence of infection. The animals were kept in two different calf rearing systems. A randomized double-blind trial was carried out with 32 naturally infected calves, divided into four groups. The two prophylactic halofuginone lactate treated groups were kept in either individual or group pens. Similarly, the animals receiving the placebo were housed in either individual pens or together in a large pen. A total of ten faecal samples were collected periodically during the 28 days study from each calf and tested for the presence of Cryptosporidium spp. using microscopic and molecular methods. Generalized estimating equations models were used to determine if the effects of the various treatments and/or rearing systems on the presence of diarrhoea and infection were statistically significant. Further analysis (classification trees models) was carried out to explore possible risk factors for cryptosporidiosis and interactions between treatments and rearing systems. Halofuginone lactate was shown to be effective in reducing clinical signs of cryptosporidiosis and environmental contamination. However, the treatment did not delay the onset of diarrhoea and did not reduce the risk of infection amongst calves reared together in a highly contaminated environment. The use of halofuginone lactate in combination with good hygienic measures, such as rearing animals in clean individual pens, was the most effective method to reduce the risk of cryptosporidiosis amongst 7-13 days old calves. It was concluded that the control of the parasite could be achieved by the combination of using effective preventive drugs, such as halofuginone lactate and good animal husbandry procedure
Research priorities for neglected infectious diseases in Latin America and the Caribbean Region
No full textBarriers of access to care in a managed competition model: lessons from Colombia
No full textBACKGROUND: The health sector reform in Colombia, initiated by Law 100 (1993) that introduced a managed competition model, is generally presented as a successful experience of improving access to care through a health insurance regulated market. The study's objective is to improve our understanding of the factors influencing access to the continuum of care in the Colombian managed competition model, from the social actors' point of view. METHODS: An exploratory, descriptive-interpretative qualitative study was carried out, based on case studies of four healthcare networks in rural and urban areas. Individual semi-structured interviews were conducted to a three stage theoretical sample: I) cases, II) providers and III) informants: insured and uninsured users (35), health professionals (51), administrative personnel (20), and providers' (18) and insurers' (10) managers. Narrative content analysis was conducted; segmented by cases, informant's groups and themes. RESULTS: Access, particularly to secondary care, is perceived as complex due to four groups of obstacles with synergetic effects: segmented insurance design with insufficient services covered; insurers' managed care and purchasing mechanisms; providers' networks structural and organizational limitations; and, poor living conditions. Insurers' and providers' values based on economic profit permeate all factors. Variations became apparent between the two geographical areas and insurance schemes. In the urban areas barriers related to market functioning predominate, whereas in the rural areas structural deficiencies in health services are linked to insufficient public funding. While financial obstacles are dominant in the subsidized regime, in the contributory scheme supply shortage prevails, related to insufficient private investment. CONCLUSIONS: The results show how in the Colombian healthcare system structural and organizational barriers to care access, that are common in developing countries, are widened by both the insurers' use of mechanisms that limit the utilization and the public healthcare providers' change of behavior in a competition environment. They provide evidence to question the promotion of the managed competition model in low and middle-income countrie
Anaphylaxis in an airplane after insecticide spraying
No full textFlights departing from malarious areas are sprayed with pyrethroids. They are presumed to be safe since reports of adverse responses among passengers or crew were only anecdotal. However, asthmatic reactions after domestic and occupational exposure have been published. We present the first case description of pyrethroid allergy in an airplan
Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions
No full textCryptococcal immune reconstitution inflammatory syndrome (IRIS) may present as a clinical worsening or new presentation of cryptococcal disease after initiation of antiretroviral therapy (ART), and is thought to be caused by recovery of cryptococcus-specific immune responses. We have reviewed reports of cryptococcal IRIS and have developed a consensus case definition specifically for paradoxical crytopcoccal IRIS in patients with HIV-1 and known cryptococcal disease before ART, and a separate definition for incident cryptococcosis developed during ART (termed ART-associated cryptococcosis), for which a proportion of cases are likely to be unmasking cryptococcal IRIS. These structured case definitions are intended to aid design of future clinical, epidemiological, and immunopathological studies of cryptococcal IRIS, to standardise diagnostic criteria, and to facilitate comparisons between studies. As for definitions of tuberculosis-associated IRIS, definitions for cryptococcal IRIS should be regarded as preliminary until further insights into the immunopathology of IRIS permit their refinemen
Condom use with steady partners among heterosexual people living with HIV in Europe: testing the information-motivation-behavioral skills model
No full textGuided by a modified information-motivation-behavioral skills model, this study identified predictors of condom use among heterosexual people living with HIV with their steady partners. Consecutive patients at 14 European HIV outpatient clinics received an anonymous, standardized, self-administered questionnaire between March and December 2007. Data were analyzed using descriptive statistics and two-step backward elimination regression analyses stratified by gender. The survey included 651 participants (n = 364, 56% women; n = 287, 44%). Mean age was 39 years for women and 43 years for men. Most had acquired HIV sexually and more than half were in a serodiscordant relationship. Sixty-three percent (n = 229) of women and 59% of men (n = 169) reported at least one sexual encounter with a steady partner 6 months prior to the survey. Fifty-one percent (n = 116) of women and 59% of men (n = 99) used condoms consistently with that partner. In both genders, condom use was positively associated with subjective norm conducive to condom use, and self-efficacy to use condoms. Having a partner whose HIV status was positive or unknown reduced condom use. In men, higher education and knowledge about condom use additionally increased condom use, while the use of erectile-enhancing medication decreased it. For women, HIV disclosure to partners additionally reduced the likelihood of condom use. Positive attitudes to condom use and subjective norm increased self-efficacy in both genders, however, a number of gender-related differences appeared to influence self-efficacy. Service providers should pay attention to the identified predictors of condom use and adopt comprehensive and gender-related approaches for preventive interventions with people living with HI
Autopsy causes of death in HIV-positive individuals in sub-Saharan Africa and correlation with clinical diagnoses
No full textDespite the persistently high HIV-related mortality in sub-Saharan Africa, limited information on the causes of death is available. Pathological autopsies are the gold standard to establish causes of death. In this review we describe the autopsy series performed among HIV-infected individuals in sub-Saharan Africa over the last two decades. We identified nine complete and 11 partial or minimally invasive autopsy series. Complete autopsies were performed in 593 HIV-positive adults and 177 HIV-positive children. Postmortem diagnoses were mainly infectious diseases. Tuberculosis was the most frequent, present in 21-54% of HIV-positive adults and was considered the cause of death in 32-45%. Overall, pulmonary infections accounted for approximately 66% of pathology and central nervous system infections for approximately 20%. A high discordance between clinical and postmortem diagnoses was observed. This review emphasizes the need for reliable information on causes of death in order to improve HIV patient care, guide further research, and inform health policy
Methodology for assessing determinants of manure use in urban areas of Africa
No full textThe objectives of this study were to identify the major determinants (e.g. zootechnical and socio-economic parameters) of manure management practised by urban livestock keepers. Data were collected from four single-visit, multi-object surveys in three cities of Africa. The livestock keepers were classified either as 'good user' or 'bad user' of manure depending on how they use the manure. The results of this study indicate that the habit of manure utilization shows geographical differences. In general, livestock keepers engaged in agricultural activities are good manure users. Furthermore, manual workers, traders or the self-employed are better manure users than other professional groups. The manure utilization varies also in function of the livestock numbers. In Brazzaville, the habit of selling animals influenced manure management positively. Experience of keeping livestock before the civil war in Brazzaville was also a determining factor of manure use in the post-war urban livestock keeping in 2001. When designing policies to reduce the environmental effects of urban livestock keeping, the highlighted factors can assist city planners to understand how urban livestock keepers use manure. Using the non-parametric classification tree method CART, two approaches were used to select an optimal classification of 'bad' manure users: the 'Cook and Goldman rule' and the 'Classification with different misclassification cost ratios' method. The optimal tree was selected by using receiver operating characteristics curve information. This method can be useful in assessing other aspects of waste management