63 resultados para Preventive Medicine.


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Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients' ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level. (C) 2008 Elsevier B.V. All rights reserved.

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At present, collective action regarding bio-security among UK cattle and sheep farmers is rare. Despite the occurrence of catastrophic livestock diseases such as bovine spongiform encephalopathy (BSE) and foot and mouth disease (FMD), within recent decades, there are few national or local farmer-led animal health schemes. To explore the reasons for this apparent lack of interest, we utilised a socio-psychological approach to disaggregate the cognitive, emotive and contextual factors driving bio-security behaviour among cattle and sheep farmers in the United Kingdom (UK). In total, we interviewed 121 farmers in South-West England and Wales. The main analytical tools included a content, cluster and logistic regression analysis. The results of the content analysis illustrated apparent 'dissonance' between bio-security attitudes and behaviour.(1) Despite the heavy toll animal disease has taken on the agricultural economy, most study participants were dismissive of the many measures associated with bio-security. Justification for this lack of interest was largely framed in relation to the collective attribution or blame for the disease threats themselves. Indeed, epidemic diseases were largely related to external actors and agents. Reasons for outbreaks included inadequate border control, in tandem with ineffective policies and regulations. Conversely, endemic livestock disease was viewed as a problem for 'bad' farmers and not an issue for those individuals who managed their stock well. As such, there was little utility in forming groups to address what was largely perceived as an individual problem. Further, we found that attitudes toward bio-security did not appear to be influenced by any particular source of information per se. While strong negative attitudes were found toward specific sources of bio-security information, e.g. government leaflets, these appear to simply reflect widely held beliefs. In relation to actual bio-security behaviours, the logistic regression analysis revealed no significant difference between in-scheme and out of scheme farmers. We concluded that in order to support collective action with regard to bio-security, messages need to be reframed and delivered from a neutral source. Efforts to support group formation must also recognise and address the issues relating to perceptions of social connectedness among the communities involved. (c) 2008 Elsevier B.V. All rights reserved.

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Recent developments in the fields of veterinary epidemiology and economics are critically reviewed and assessed. The impacts of recent technological developments in diagnosis, genetic characterisation, data processing and statistical analysis are evaluated. It is concluded that the acquisition and availability of data remains the principal constraint to the application of available techniques in veterinary epidemiology and economics, especially at population level. As more commercial producers use computerised management systems, the availability of data for analysis within herds is improving. However, consistency of recording and diagnosis remains problematic. Recent trends to the development of national livestock databases intended to provide reassurance to consumers of the safety and traceability of livestock products are potentially valuable sources of data that could lead to much more effective application of veterinary epidemiology and economics. These opportunities will be greatly enhanced if data from different sources, such as movement recording, official animal health programmes, quality assurance schemes, production recording and breed societies can be integrated. However, in order to realise such integrated databases, it will be necessary to provide absolute control of user access to guarantee data security and confidentiality. The potential applications of integrated livestock databases in analysis, modelling, decision-support, and providing management information for veterinary services and livestock producers are discussed. (c) 2004 Elsevier B.V. All rights reserved.

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In a cross-sectional study of 400 randomly selected smallholder dairy farms in the Tanga and Iringa regions of Tanzania, 14.2% (95% confidence interval (CI) = 11.6-17.3) of cows had developed clinical mastitis during the previous year. The point prevalence of subclinical mastitis, defined as a quarter positive by the California Mastitis Test (CMT) or by bacteriological culture, was 46.2% (95% Cl = 43.6-48.8) and 24.3% (95% Cl = 22.2-26.6), respectively. In a longitudinal disease study in Iringa, the incidence of clinical mastitis was 31.7 cases per 100 cow-years. A randomised intervention trial indicated that intramammary antibiotics significantly reduced the proportion of bacteriologically positive quarters in the short-term (14 days post-infusion) but teat dipping had no detectable effect on bacteriological infection and CMT positive quarters. Other risk and protective factors were identified from both the cross-sectional and longitudinal included animals with Boran breeding (odds ratio (OR) = 3,40, 95% CI = 1.00-11.57, P < 0.05 for clinical mastitis, and OR = 3.51, 95% CI = 1.299.55, P < 0.01 for a CMT positive quarter), while the practice of residual calf suckling was protective for a bacteriologically positive quarter (OR = 0.63, 95% Cl = 0.48-0.81, P <= 0.001) and for a CMT positive quarter (OR = 0.69, 95% Cl = 0.63-0.75, P < 0.001). A mastitis training course for farmers and extension officers was held, and the knowledge gained and use of different methods of dissemination were assessed over time. In a subsequent randomised controlled trial, there were strong associations between knowledge gained and both the individual question asked and the combination of dissemination methods (village meeting, video and handout) used. This study demonstrated that both clinical and subclinical mastitis is common in smallholder dairying in Tanzania, and that some of the risk and protective factors for mastitis can be addressed by practical management of dairy cows following effective knowledge transfer. (c) 2006 Elsevier B.V. All rights reserved.

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A cross-sectional study was conducted in Tanga and Iringa regions of Tanzania, and a longitudinal study in Tanga, to investigate tick-control methods and other factors influencing tick attachment to the cattle of smallholder dairy farms. Most farmers reported applying acaricides at intervals of 1-2 weeks, most used acaricides that require on-farm dilution and most farmers incorrectly diluted the acaricides. Rhipicephalus appendiculatus and Boophilus spp. ticks were those most-frequently encountered on the cattle, but few cattle carried ticks of any species (only 13 and 4.6% of tick counts of the cattle yielded adult R. appendiculatus and Boophilus spp., respectively). Animals were more likely to carry one or more adult Boophilus spp. ticks if they also carried one or more R. appendiculatus adults (OR = 14.4, CI = 9.2, 22.5). The use of pour-on acaricides was associated with lower odds that animals carried a R. appendiculatus tick (OR = 0.29, CI = 0. 18, 0.49) but higher odds that they carried a Boophilus spp. tick (OR = 2.48, CI = 1.55, 3.97). Animals > 4 months old and those with a recent history of grazing had higher odds of carrying either a R. appendiculatus (ORs = 3.41 and 2.58, CIs = 2.34, 4.98 and 1.80, 3.71), or a Boophilus spp. tick (ORs = 5.70 and 2.18, CIs = 2.34, 4.98 and 1.49. 3.25), but zero-grazing management did not prevent ticks attaching to cattle even when combined with high-frequency acaricide treatments. The odds that animals carried ticks varied amongst the agro-ecological zones (AEZs) and administrative districts where the farms were situated-but there was still considerable residual variation in tick infestation at the farm level. (c) 2004 Elsevier B.V. All rights reserved.

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In this paper, we apply one-list capture-recapture models to estimate the number of scrapie-affected holdings in Great Britain. We applied this technique to the Compulsory Scrapie Flocks Scheme dataset where cases from all the surveillance sources monitoring the presence of scrapie in Great Britain, the abattoir survey, the fallen stock survey and the statutory reporting of clinical cases, are gathered. Consequently, the estimates of prevalence obtained from this scheme should be comprehensive and cover all the different presentations of the disease captured individually by the surveillance sources. Two estimators were applied under the one-list approach: the Zelterman estimator and Chao's lower bound estimator. Our results could only inform with confidence the scrapie-affected holding population with clinical disease; this moved around the figure of 350 holdings in Great Britain for the period under study, April 2005-April 2006. Our models allowed the stratification by surveillance source and the input of covariate information, holding size and country of origin. None of the covariates appear to inform the model significantly. Crown Copyright (C) 2008 Published by Elsevier B.V. All rights reserved.

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Two novel benzodioxotetraaza macrocycles [2,9-dioxo-1,4,7,10-tetraazabicyclo[10.4.0]1,11-hexadeca-1(11),13,15-triene (H(2)L1) and 2,10-dioxo-1,4,8,11-tetraazabicyclo[11.4.0]1,12-heptadeca-1(12),14,16-triene (H(2)L2)] were synthesized by a [1 + 1] crablike cyclization. The protonation constants of both ligands were determined by H-1 NMR titration and by potentiometry at 25.0 degrees C in 0.10 M ionic strength in KNO3. The latter method was also used to ascertain the stability constants of their copper(II) complexes. These studies showed that the CuL1 complex has a much lower thermodynamic stability than the CuL2, and the H(2)L2 displays an excellent affinity for copper(II), due to the good fit of copper(II) into its cavity. The copper complexes of the novel ligands were characterized by electronic spectroscopy in solution and by crystal X-ray diffraction. These studies indicated that the copper center in the CuL1 complex adopts a square-pyramidal geometry with the four nitrogen atoms of the macrocycle forming the equatorial plane and a water molecule at axial position, and the copper in the CuL2 complex is square-planar. Several labeling conditions were tested, and only H(2)L2 could be labeled with Cu-67 efficiently (> 98%) in mild conditions (39 degrees C, 15 min) to provide a slightly hydrophilic radioligand (log D = -0.19 +/- 0.03 at pH 7.4). The in vitro stability was studied in the presence of different buffers or with an excess of diethylenetriamine-pentaethanoic acid. Very high stability was shown under these conditions for over 5 days. The incubation of the radiocopper complex in human serum showed 6% protein binding.

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In real-world environments it is usually difficult to specify the quality of a preventive maintenance (PM) action precisely. This uncertainty makes it problematic to optimise maintenance policy.-This problem is tackled in this paper by assuming that the-quality of a PM action is a random variable following a probability distribution. Two frequently studied PM models, a failure rate PM model and an age reduction PM model, are investigated. The optimal PM policies are presented and optimised. Numerical examples are also given.

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In the last 50 years science has provided new perspectives on the ancient art of herbal medicine. The present article discusses ways in which the evidence base for the professional use of 'Western' herbal medicine, as therapy to treat disease, known as phytotherapy, can be strengthened and developed. The evidence base for phytotherapy is small and lags behind that for the nutritional sciences, mainly because phytochemicals are ingested as complex mixtures that are incompletely characterised and have only relatively recently been subject to scientific scrutiny. While some methodologies developed for the nutritional sciences can inform phytotherapy research, opportunities for observational studies are more limited, although greater use could be made of patient case notes. Randomised clinical trials of single-herb interventions are relatively easy to undertake and increasing numbers of such studies are being published. Indeed, enough data are available on three herbs (ginkgo (Ginkgo biloba), St John's wort (Hypericum perforatum) and saw palmetto (Serenoa repens)) for meta-analyses to have been undertaken. However, phytotherapy is holistic therapy, using lifestyle advice, nutrition and individually-prescribed mixtures of herbs aimed at reinstating homeostasis. While clinical experience shows that this approach is applicable to a wide range of conditions, including chronic disease, evidence of its efficacy is scarce. Strategies for investigating the full holistic approach of phytotherapy and its main elements are discussed and illustrated through the author's studies at the University of Reading.

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Objectives: This study reports the cost-effectiveness of a preventive intervention, consisting of counseling and specific support for the mother-infant relationship, targeted at women at high risk of developing postnatal depression. Methods: A prospective economic evaluation was conducted alongside a pragmatic randomized controlled trial in which women considered at high risk of developing postnatal depression were allocated randomly to the preventive intervention (n = 74) or to routine primary care (n = 77). The primary outcome measure was the duration of postnatal depression experienced during the first 18 months postpartum. Data on health and social care use by women and their infants up to 18 months postpartum were collected, using a combination of prospective diaries and face-to-face interviews, and then were combined with unit costs ( pound, year 2000 prices) to obtain a net cost per mother-infant dyad. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness to pay thresholds held by decision makers for preventing 1 month of postnatal depression. Results: Women in the preventive intervention group were depressed for an average of 2.21 months (9.57 weeks) during the study period, whereas women in the routine primary care group were depressed for an average of 2.70 months (11.71 weeks). The mean health and social care costs were estimated at 2,396.9 pound per mother-infant dyad in the preventive intervention group and 2,277.5 pound per mother-infant dyad in the routine primary care group, providing a mean cost difference of 119.5 pound (bootstrap 95 percent confidence interval [Cl], -535.4, 784.9). At a willingness to pay threshold of 1,000 pound per month of postnatal depression avoided, the probability that the preventive intervention is cost-effective is .71 and the mean net benefit is 383.4 pound (bootstrap 95 percent Cl, -863.3- pound 1,581.5) pound. Conclusions: The preventive intervention is likely to be cost-effective even at relatively low willingness to pay thresholds for preventing 1 month of postnatal depression during the first 18 months postpartum. Given the negative impact of postnatal depression on later child development, further research is required that investigates the longer-term cost-effectiveness of the preventive intervention in high risk women.

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Three experiments examined the effects of adding information about medication benefits to a short written explanation about a medicine. Participants were presented with a fictitious scenario about visiting the doctor, being prescribed an antibiotic and being given information about the medicine. They were asked to make various judgements relating to the information, the medicine and their intention to take it. Experiment 1 found that information about benefits enhanced the judgements, but did not influence the intention to comply. Experiment 2 compared the relative effectiveness of two different forms of the benefit statement, and found that both were effective in improving judgements, but had no effect on intention to comply. Experiment 3 compared the effectiveness of the two forms of benefit information but participants were told that the medicine was associated with four named side effects. Both types of statement improved ratings of the intention to comply, as well as ratings on the other measures. The experiments provide fairly consistent support for the inclusion of benefit information in medicine information leaflets, particularly to balance concerns about side effects.

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Objective: To assess the effectiveness of absolute risk, relative risk, and number needed to harm formats for medicine side effects, with and without the provision of baseline risk information. Methods: A two factor, risk increase format (relative, absolute and NNH) x baseline (present/absent) between participants design was used. A sample of 268 women was given a scenario about increase in side effect risk with third generation oral contraceptives, and were required to answer written questions to assess their understanding, satisfaction, and likelihood of continuing to take the drug. Results: Provision of baseline information significantly improved risk estimates and increased satisfaction, although the estimates were still considerably higher than the actual risk. No differences between presentation formats were observed when baseline information was presented. Without baseline information, absolute risk led to the most accurate performance. Conclusion: The findings support the importance of informing people about baseline level of risk when describing risk increases. In contrast, they offer no support for using number needed to harm. Practice implications: Health professionals should provide baseline risk information when presenting information about risk increases or decreases. More research is needed before numbers needed to harm (or treat) should be given to members of the general populations. (c) 2005 Elsevier Ireland Ltd. All rights reserved.