Effectiveness of the Brazilian influenza vaccination policy, a systematic review

Since 1999, Brazil has undertaken annual influenza vaccine campaigns, free of charge, targeting the elderly population, health professionals, and immune-deficient patients. We conducted a systematic review of literature in order to evaluate the effectiveness of the initiative. We used the keywords influenza, vaccine, Brazil and effectiveness to search the main databases. Thirty-one studies matched our inclusion and exclusion criteria. Influenza vaccine coverage among the elderly is high, though not as high as suggested by the official figures. Estimates on effectiveness are scarce. The majority come from ecological studies that show a modest reduction in mortality and hospital admissions due to influenza-related causes. Such reduction is not evident in the North and Northeastern states of Brazil, a finding that is probably related to the different seasonal pattern of influenza in equatorial and tropical regions. Brazilian epidemiologists still owe society better-designed studies addressing the effectiveness of influenza vaccine campaigns.

Schaderreger im Wurzelraum von Reben (Vitis spp.) - Vorkommen, Wirkung, Interaktionen - und Möglichkeiten zu deren Kontrolle durch Maßnahmen des Integrated Pest Management (IPM)

Ziel der Untersuchungen war es, das Vorkommen, die Wirkungen und die Interaktionen bodenbürtiger Vitis-Pathogene in Pfropfrebenbeständen zu untersuchen und die Möglichkeiten ihrer Kontrolle im Rahmen des Integrated Pest Managements zu eruieren. Ein Schwerpunkt lag dabei bei den in Zusammenhang mit einem Befall der Rebstöcke durch D. vitifoliae stehenden Wuchsdepressionen und Absterbeerscheinungen. Hintergrund dieser Untersuchungen war die Hypothese, dass sich die Böden von Rebanlagen mit und ohne Wuchsdepressionen und Absterbeerscheinungen der Reben aufgrund ihrer pathogen- bzw. krankheitssuppressiven Eigenschaften unterscheiden. Andererseits wurde untersucht, ob die die Wurzeln besiedelnde Reblaus selbst durch den entomopathogenen Pilz M. anisopliae biologisch kontrolliert werden kann. Im Verlauf dieser Untersuchungen wurde im Wurzelsystem der Reben ein bis dahin unbekannter obligater Parasit aus der Gruppe der Plasmodiophorales identifiziert, der der Gattung Sorosphaera zugewiesen werden konnte. Dies gab Anlass zur morphologischen und ökologischen Untersuchung dieses neuen Organismus, der dann in der Folge als Sorosphaera viticola Kirchmair, Neuhauser, Huber beschrieben wurde. Die Ergebnisse deuten darauf hin, dass die krankheits- bzw. pathogenkonduktiven und -suppressiven Eigenschaften der Böden dafür verantwortlich sind, ob es in einer Rebanlage zu Ausfallerscheinungen kommt oder nicht, wobei ein direkter Zusammenhang mit der Bewirtschaftung der Flächen, namentlich der Versorgung der Böden mit organischer Substanz hergestellt werden konnte.

Screening and treatment to prevent sequelae in women with Chlamydia trachomatis genital infection: how much do we know?

Background. An important question for chlamydia control programs is the extent to which finding and treating prevalent, asymptomatic Chlamydia trachomatis genital infection reduces reproductive sequelae in infected women. Methods. We reviewed the literature to critically evaluate evidence on the effect of chlamydia screening on development of sequelae in infected women. Results. Two randomized controlled trials of 1-time screening for chlamydial infection—in a Seattle-area health maintenance organization and a Danish school district—revealed that screening was associated with an ∼50% reduction in the incidence of pelvic inflammatory disease over the following year. However, both of these trials had methodological issues that may have affected the magnitude of observed screening benefits and might limit generalizability to other populations. A large, nonrandomized cohort of chlamydia screening among US Army recruits, although limited by lack of outpatient data, did not find a benefit of similar magnitude to the randomized trials. Methodological limitations restrict valid conclusions about individual benefits of screening using data from historical cohorts and ecological studies. We identified no trials directly evaluating the effect of chlamydia screening on subclinical tubal inflammation or damage, ectopic pregnancy, or tubal factor infertility and no studies addressing the effects of >1 round of screening, the optimal frequency of screening, or the benefits of screening for repeat infections. Conclusions. Additional studies of the effectiveness of chlamydia screening would be valuable; feasible study designs may depend on the degree to which screening programs are already established. In addition, better natural history data on the timing of tubal inflammation and damage after C. trachomatis infection and development of more accurate, noninvasive tools to assess chlamydial sequelae are essential to informing chlamydia control efforts.

Antibiotic use in adult outpatients in Switzerland in relation to regions, seasonality and point of care tests

The use of antibiotics is highest in primary care and directly associated with antibiotic resistance in the community. We assessed regional variations in antibiotic use in primary care in Switzerland and explored prescription patterns in relation to the use of point of care tests. Defined daily doses of antibiotics per 1000 inhabitants (DDD(1000pd) ) were calculated for the year 2007 from reimbursement data of the largest Swiss health insurer, based on the anatomic therapeutic chemical classification and the DDD methodology recommended by WHO. We present ecological associations by use of descriptive and regression analysis. We analysed data from 1 067 934 adults, representing 17.1% of the Swiss population. The rate of outpatient antibiotic prescriptions in the entire population was 8.5 DDD(1000pd) , and varied between 7.28 and 11.33 DDD(1000pd) for northwest Switzerland and the Lake Geneva region. DDD(1000pd) for the three most prescribed antibiotics were 2.90 for amoxicillin and amoxicillin-clavulanate, 1.77 for fluoroquinolones, and 1.34 for macrolides. Regions with higher DDD(1000pd) showed higher seasonal variability in antibiotic use and lower use of all point of care tests. In regression analysis for each class of antibiotics, the use of any point of care test was consistently associated with fewer antibiotic prescriptions. Prescription rates of primary care physicians showed variations between Swiss regions and were lower in northwest Switzerland and in physicians using point of care tests. Ecological studies are prone to bias and whether point of care tests reduce antibiotic use has to be investigated in pragmatic primary care trials.

Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples

Antiretroviral drugs have been shown to reduce risk of mother-to-child transmission of human immunodeficiency virus (HIV) and are also widely used for post-exposure prophylaxis for parenteral and sexual exposures. Observational data, ecological studies and models suggest that sexual transmission may be lower in couples in which one partner is infected with HIV and the other is not and the infected partner is on antiretroviral therapy (ART).

Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples

Antiretroviral drugs have been shown to reduce risk of mother-to-child transmission of human immunodeficiency virus (HIV) and are also widely used for post-exposure prophylaxis for parenteral and sexual exposures. Observational data, ecological studies and models suggest that sexual transmission may be lower in couples in which one partner is infected with HIV and the other is not and the infected partner is on antiretroviral therapy (ART).

Hybridization and Introgression Between Native and Alien Species

Human activities, such intentional and unintentional transplantations, and habitat alterations including the establishment of migration corridors, generate increasing opportunities for formerly allopatric taxa to meet and to hybridize. There is indeed increasing evidence that these introduced plant and animal taxa (including crop plants and domesticated animal taxa) frequently hybridize with native relatives and with other introduced taxa, leading to a growing concern that these hybridizations may compromise the genetic integrity of native taxa to the point of causing extinctions (Abbott 1992; Rhymer and Simberloff 1996; Levin et al. 1996; Ellstrand and Schierenbeck 2000; Vilà et al. 2000). A decade ago, Rhymer and Simberloff (1996) stated in their review on this topic that the known cases are probably just the tip of the iceberg.Using the search term ‘hybridization and introgression’, the Web of Science database yields a total of 1,178 research articles, of which 935 (or 80 %) have been published after 1995 (Fig. 16.1). Indeed, the evidence for natural and man-induced hybridization and introgression appears to have increased exponentially these last few years.

Impacts of changing climate and land use on vegetation dynamics in a Mediterranean ecosystem: insights from paleoecology and dynamic modeling

Forests near the Mediterranean coast have been shaped by millennia of human disturbance. Consequently, ecological studies relying on modern observations or historical records may have difficulty assessing natural vegetation dynamics under current and future climate. We combined a sedimentary pollen record from Lago di Massacciucoli, Tuscany, Italy with simulations from the LandClim dynamic vegetation model to determine what vegetation preceded intense human disturbance, how past changes in vegetation relate to fire and browsing, and the potential of an extinct vegetation type under present climate. We simulated vegetation dynamics near Lago di Massaciucoli for the last 7,000 years using a local chironomid-inferred temperature reconstruction with combinations of three fire regimes (small infrequent, large infrequent, small frequent) and three browsing intensities (no browsing, light browsing, and moderate browsing), and compared model output to pollen data. Simulations with low disturbance support pollen-inferred evidence for a mixed forest dominated by Quercus ilex (a Mediterranean species) and Abies alba (a montane species). Whereas pollen data record the collapse of A. alba after 6000 cal yr bp, simulated populations expanded with declining summer temperatures during the late Holocene. Simulations with increased fire and browsing are consistent with evidence for expansion by deciduous species after A. alba collapsed. According to our combined paleo-environmental and modeling evidence, mixed Q. ilex and A. alba forests remain possible with current climate and limited disturbance, and provide a viable management objective for ecosystems near the Mediterranean coast and in regions that are expected to experience a mediterranean-type climate in the future.

Supporting, Regulating, and Provisioning Hydrological Services

The natural regulation of the water cycle by tropical montane forests is an important ecosystem service. Within this chapter we focus on water balance and regulation of the water cycle. Differences of rainfall-runoff generation across scales change from a near-surface event water driven system in pristine rainforest-covered micro-catchments to a more groundwater pre-event water dominated one on the mesoscale. The highly dynamic discharges are often correlated with total suspended sediment loads. However, we also observed total suspended sediment peaks at times of low flow, indicating a decoupling of erosion and stream transport and a triggering of landslides not directly related to hydrological processes. We also summarize likely future trends of water-related ecosystem services and expect an increase in human use and benefits of fresh water use whereas changes in water regulation and water purification services remain unchanged on a high level.

Ecosystem services, biodiversity and environmental change in a tropical mountain ecosystem of south Ecuador

An interdisciplinary research unit consisting of 30 teams in the natural, economic and social sciences analyzed biodiversity and ecosystem services of a mountain rainforest ecosystem in the hotspot of the tropical Andes, with special reference to past, current and future environmental changes. The group assessed ecosystem services using data from ecological field and scenario-driven model experiments, and with the help of comparative field surveys of the natural forest and its anthropogenic replacement system for agriculture. The book offers insights into the impacts of environmental change on various service categories mentioned in the Millennium Ecosystem Assessment (2005): cultural, regulating, supporting and provisioning ecosystem services. Examples focus on biodiversity of plants and animals including trophic networks, and abiotic/biotic parameters such as soils, regional climate, water, nutrient and sediment cycles. The types of threats considered include land use and climate changes, as well as atmospheric fertilization. In terms of regulating and provisioning services, the emphasis is primarily on water regulation and supply as well as climate regulation and carbon sequestration. With regard to provisioning services, the synthesis of the book provides science-based recommendations for a sustainable land use portfolio including several options such as forestry, pasture management and the practices of indigenous peoples. In closing, the authors show how they integrated the local society by pursuing capacity building in compliance with the CBD-ABS (Convention on Biological Diversity - Access and Benefit Sharing), in the form of education and knowledge transfer for application.

Nutrient additions affecting matter turnover in forest and pasture ecosystems

Nutrient inputs into ecosystems of the tropical mountain rainforest region are projected to further increase in the next decades. To investigate whether important ecosystem services such as nutrient cycling and matter turnover in native forests and pasture ecosystems show different patterns of response, two nutrient addition experiments have been established: NUMEX in the forest and FERPAST at the pasture. Both ecosystems already responded 1.5 years after the start of nutrient application (N, P, NP, Ca). Interestingly, most nutrients remained in the respective systems. While the pasture grass was co-limited by N and P, most tree species responded to P addition. Soil microbial biomass in the forest litter layer increased after NP fertilization pointing to nutrient co-limitation. In pasture soils, microorganisms were neither limited by N nor P. The results support the hypothesis that multiple and temporally variable nutrient limitations can coexist in tropical ecosystems.