6320 research outputs found
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Evidence-based semiquantitative methodology for prioritization of foodborne zoonoses
No full textOBJECTIVES: To prioritize an extended list of food- and water-borne zoonoses to allow food safety authorities to focus on the most relevant hazards in the food chain. METHODS: An evidence-based semiquantitative methodology was developed. Scores were given by 35 scientific experts in the field of animal and public health, food, and clinical microbiology and epidemiology to 51 zoonotic agents according to five criteria related to public health (severity and occurrence in humans), animal health (severity of disease coupled with economic consequences and occurrence in animals), and food (occurrence in food). The scoring procedure was standardized and evidence-based as experts were provided, for each zoonotic agent, a same set of up-to-date help information data related to the five criteria. Independently, the relative importance of the five criteria was weighted by seven food chain risk managers. The zoonotic agents were ranked based on overall weighted scores and were grouped in four statistically different levels of importance. RESULTS: The following foodborne zoonotic pathogens were classified as "most important": Salmonella spp., Campylobacter spp., Listeria monocytogenes, and verocytotoxigenic Escherichia coli. A second group of "significant importance" included Toxoplasma gondii, the agent of bovine spongiform encephalopathy, Clostridium botulinum, Staphylococcus aureus, Cryptosporidium parvum, Mycobacterium bovis, Echinococcus granulosus, Streptococcus spp., Echinococcus multilocularis, Yersinia enterocolitica, Mycobacterium avium, Fasciola hepatica, Giardia intestinalis, and Rotavirus. CONCLUSIONS: This methodology allowed to rank 51 zoonotic agents with objectivity and taking account of a combined input from risk assessors and risk managers. Applications: These results support food safety policy makers to establish the multiannual monitoring program of foodborne zoonoses. They also enable to identify knowledge gaps on specific zoonotic agents and to formulate key research questions. Principally, this method of prioritization is of general interest as it can be applied for any other ranking exercise and in any country
Molecular characterisation of Giardia duodenalis in captive non-human primates reveals mixed assemblage A and B infections and novel polymorphisms
No full textGiardia is frequently detected in stools of non-human primates (NHP). However, a molecular identification has been rarely applied to Giardia isolates from NHP, and the distribution of the zoonotic assemblages A and B remains unclear. Moreover, little is known about the genetic variability among the isolates, although this may contribute to the elucidation of the different transmission pathways, including the role of NHP as a reservoir for human giardiasis. Therefore, 258 Giardia samples from 31 NHP species housed in nine zoological gardens and one sanctuary in Belgium and The Netherlands were characterised based on an assemblage-specific PCR targeting the triose phosphate isomerase (tpi) gene to identify both assemblage A and B infections. In addition, a multi-locus sequencing approach based on the glutamate dehydrogenase, the tpi and the beta-giardin genes was used to examine both the genetic variability and the ability to allocate these isolates to different NHP groups. Overall, assemblage B was the most prevalent (78.6%), but mixed assemblage A and B infections occurred in 32.7% of the samples. Sequencing of the isolates revealed the presence of new polymorphisms for both assemblages and at the three loci examined. The majority of the assemblage B isolates could not be grouped into recently described sub-assemblages, particularly at the tpi gene. Isolates could only be allocated to a specific group when polymorphisms of the three loci were combined. The results confirm that NHP are a potential reservoir for zoonotic transmission and advocate the use of assemblage-specific primers in molecular epidemiological surveys, as mixed infections are likely to be underestimated. The high level of heterogeneity within assemblages indicates that a revised nomenclature of these sub-assemblages is needed, but points out the potency of a multi-locus sequencing approach to unravel the complex epidemiology of Giardia duodenalis
Reformas de gobiernos socialistas a las políticas de salud en Bolivia y Ecuador: el potencial subestimado de la Atención Primaria Integral de Salud para impactar los determinantes sociales en salud
No full textBackground: Selective vertical programs have
prevailed over comprehensive primary health care in
Latin America. In Bolivia and Ecuador, socialist
governments intend to redirect health policy. We
outline key features of both countries’ health
systems after reform, explore their efforts to rebuild
primary health care, identify and explain policy
gaps, and offer considerations for improvement.
Methods: Qualitative document analysis.
Findings: Neoliberal reforms left Bolivia’s and
Ecuador’s population in bad health, with limited
access to a fragmented health system. Today, both
countries focus their policy on household and
community-based promotion and prevention. The
negative effects on access to care of decentralization,
dual employment, vertical programming,
and targeting have been not received
much attention. The neglect of health care services can be understood in the light of a particular, rigid
interpretation of social medicine and social
determinants, international policy pressures, reliance
on external funding, and institutional inertia.
Current policy choices preserve key elements of
selective care and consolidate commodification.
These reforms might not improve health and may
worsen poverty.
Conclusions: Health care can be considered as a
social determinant in its own right. Primary care
needs to be founded on an integrated model of
family medicine, taking advantage of individual care
as one of the ways to act on social determinants. It
deserves a central place on the policy-makers’
priority list in Bolivia and Ecuador as elsewhere
Los estudios organizacionales en el abordaje de los determinantes de la salud
No full textThere is a lack of national and international publications on organizational studies
as a alternative to assess the role of health services in the process of health social
production y, specially as a health determinant. In present paper are exposed
features related to this matter, are proposed the conceptual bases of organizational
studies in health services to explain at local level how is produced the mentioned
contribution for population health, which are its success factor, and which are the
areas that be improved. We exposed a methodology derived from learned lessons,
and the experience gained by authors in this field during more of two decades of
work in Cuban health system
Clinical practice: diagnosis of childhood tuberculosis
No full textChildhood tuberculosis (TB) represents an important part of the disease burden, yet its diagnosis remains challenging. This review summarizes the clinical, radiological, and bacteriological approaches to diagnose TB infection and disease in children. Fever (possibly intermittent or low grade), weight loss or failure to thrive, and a persistent cough for >2 weeks are the most important clinical signs for pulmonary tuberculosis. Extra-pulmonary TB, which might occur in over 40% of the patients, can have in addition some specific clinical symptoms or signs. Chest radiographs provide important information in many patients and advanced imaging can be applied in case of (and should be restricted to) inconclusive diagnosis. The Mantoux test is positive in up to 70% of non-immunocompromised TB patients, whereas HIV co-infection or malnourishment results in a lower reactivity. Evidence of an adult TB index case is clue for diagnosis of childhood TB in low-endemic countries. Bacteriological confirmation remains difficult and is useful for doubtful cases or when drug resistance is suspected
Participation and empowerment in primary health care: from Alma Ata to the era of globalization
No full textIdentifying barriers from home to the appropriate hospital through near-miss audits in developing countries
No full textNear-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams to document and help reduce barriers to obstetric care in the most useful way and makes practical suggestions on interviews, analytical framework, ethical issues and staff motivation. Review of the evidence shows that case reviews and confidential enquiries appear particularly suitable to the understanding of delays. Criterion-based audits can also achieve this by establishing criteria for referral. However, hospital staff have limited intervention tools at their disposal to address barriers to emergency care at the community level. It is therefore important to involve the district management team and representatives of the community in auditing the health care seeking and treatment of women with near-miss complications
Seroprevalence to the antigens of Taenia solium cysticercosis among residents of three villages in Burkina Faso: a cross-sectional study
No full textBACKGROUND: There is limited published information on the prevalence of human cysticercosis in West Africa. The aim of this pilot study was to estimate the prevalence of Taenia solium cysticercosis antigens in residents of three villages in Burkina Faso. METHODS/PRINCIPAL FINDINGS: Three villages were selected: The village of Batondo, selected to represent villages where pigs are allowed to roam freely; the village of Pabré, selected to represent villages where pigs are usually confined; and the village of Nyonyogo, selected because of a high proportion of Muslims and limited pig farming. Clustered random sampling was used to select the participants. All participants were asked to answer an interview questionnaire on socio-demographic characteristics and to provide a blood sample. The sera were analysed using an AgELISA. The prevalence of "strong" seropositive results to the presence of antigens of the larval stages of T. solium was estimated as 10.3% (95%CI: 7.1%-14.3%), 1.4% (0.4%-3.5%) and 0.0% (0.0%-2.1%) in the 763 participants who provided a blood sample in Batondo, Pabré and Nyonyogo, respectively. The prevalence of "weak" seropositive test results to the presence of antigens of the larval stages of T. solium was 1.3% (0.3%-3.2%), 0.3% (0.0%-1.9%) and 4.5% (2.0%-8.8%) in Batondo, Pabré and Nyonyogo, respectively. The multivariate logistic regression, which included only Batondo and Pabré, showed that village, gender, and pork consumption history were associated with AgELISA seroprevalence. CONCLUSIONS/SIGNIFICANCE: This study illustrates two major points: 1) there can be large variation in the prevalence of human seropositivity to the presence of the larval stages of T. solium cysticercosis among rural areas of the same country, and 2) the serological level of the antigen, not just whether it is positive or negative, must be considered when assessing prevalence of human cysticercosis antigens
Nutritional profile of foods offered and consumed in a Belgian university canteen
No full textOBJECTIVE: To evaluate the nutritional profile of a lunch offered and consumed in a university canteen in Belgium. DESIGN: The qualitative and quantitative content of 4,365 meals theoretically available and 330 meals consumed was recorded during five weekdays spread over three weeks. Meal combinations were evaluated using a scoring system based on recommendations for Na content, energy from fat, and fruit and vegetable portions. SETTING: University canteen in Belgium. RESULTS: Only a 5 % of the meal combinations available and consumed complied with the three basic dietary recommendations for a hot lunch. The nutritional profile of the meals consumed was in line with that of the meals available. CONCLUSIONS: Our results show how the nutritional profile of what is eaten is largely determined by what is offered. To ensure overall compliance with dietary recommendations, considerable changes on the supply side, i.e. an increase in fruit and vegetable portions and a reduction in salt and fat of the lunch, are needed first in our setting. Our assessment provides baseline data to pilot a nutrient profiling intervention and shows how a nutrient profiling system can be used for meal evaluation purposes
Sources of information in tropical medicine
No full textThe literature of tropical medicine, like all clinical specialties, tends to be distributed throughout the medical literature, and reliance on the specialist tropical medicine literature alone will not usually be sufficient to cover adequately the total literature. It is important therefore that any search of the literature will need to encompass both the general and specialist sources. This brief guide to the information sources of tropical medicine will limit itself to the main focus of this book, i.e. clinical, diagnostic and control aspects of tropical medicine. Any systematic search of the literature must use a variety of different sources including journals, books, databases and various websites. Many traditional print resources such as journals, indexes and increasingly also books are now available online and those listed below include only a selection of the most important sources. However, an important part of this survey is on identifying the most important Internet-based resources, as a reflection that the Internet has become, de facto, the main vehicle for up-to-date information in medicine, even in the poorest regions of the world. Inevitably some web sites become unavailable, change URL or are not updated. Yet there are two regularly updated gateway sites which cover much of the source material listed: the Institute of Tropical Medicine Antwerp's Library Links to Selected Web Sites and the AED Satellife's Essential Health Links