Positive deviance study to inform a Chagas disease control program in southern Ecuador

Chagas disease is caused by Trypanosoma cruzi, which is mainly transmitted by the faeces of triatomine insects that find favourable environments in poorly constructed houses. Previous studies have documented persistent triatomine infestation in houses in the province of Loja in southern Ecuador despite repeated insecticide and educational interventions. We aim to develop a sustainable strategy for the interruption of Chagas disease transmission by promoting living environments that are designed to prevent colonisation of rural houses by triatomines. This study used positive deviance to inform the design of an anti-triatomine prototype house by identifying knowledge, attitudes and practices used by families that have remained triatomine-free (2010-2012). Positive deviants reported practices that included maintenance of structural elements of the house, fumigation of dwellings and animal shelters, sweeping with "insect repellent" plants and relocation of domestic animals away from the house, among others. Participants favoured construction materials that do not drastically differ from those currently used (adobe walls and tile roofs). They also expressed their belief in a clear connection between a clean house and health. The family's economic dynamics affect space use and must be considered in the prototype's design. Overall, the results indicate a positive climate for the introduction of housing improvements as a protective measure against Chagas disease in this region.

Perception et communication du risque: du diabète à la maladie cardiovasculaire [Risk perception and communication: from diabetes to cardiovascular diseases].

Evidence-based medicine has enabled to approach disease in a more rational and scientific way. Clinical research has identified behaviours and risk factors that could cause disease often "silent" at the beginning, such as diabetes. Despite the clear impact of these evidences on public health, it seems that the individual risk perception level remains weak. To mention as well, the health professionals very often have a different views, which makes it difficult to communicate the risk with patients. In this article we describe the principles of risk perception, the diabetes related risk perception concerning cardiovascular complications, and suggest some practical strategies and tools which could improve risk communication in the everyday practice.

Report of the Iowa Antibiotic Resistance Task Force, January 24, 2012

On January 29, 1998, a task force was convened by the Iowa Department of Public Health (IDPH) to address the development of bacterial resistance to antibiotics in Iowa. The purpose of this task force was to evaluate and monitor the prevalence of resistance in Iowa, to monitor the status of the problem, and to develop strategies to diminish the risk to the population of Iowa. The goals of the Iowa Antibiotic Resistance Task Force (IARTF) are to facilitate appropriate use of antibiotics, discourage prescribing practices that promote the development of antibiotic resistance, and decrease the spread of antibiotic-resistant organisms with appropriate prevention and control measures. This group has been meeting since 1998 to accomplish these goals.

Health consultation : Former Chamberlain Manufacturing Site 550 Esther Street Waterloo, Black Hawk County, Iowa (2012)

The United States Environmental Protection Agency (EPA) has requested the Iowa Department of Public Health (IDPH) to evaluate the health impacts associated with exposure to contaminants of concern that have been found at the former Chamberlain Manufacturing Site. The EPA has been involved in the investigation and remediation of the Former Chamberlain Manufacturing Site since 2005. As part of these investigative activities, on-site soil sampling and both on-and off-site groundwater sampling has been completed. In addition, sub-slab soil gas, indoor air, and ambient air sampling at properties located near the Former Chamberlain Manufacturing Site has been completed. This health consultation addresses potential health risks to the public from exposure to the soil, groundwater and potential vapors within homes or buildings at or near the Former Chamberlain Manufacturing Site. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Prevalence of iodine inadequacy in Switzerland assessed by the estimated average requirement cut-point method in relation to the impact of iodized salt.

OBJECTIVE: To assess the iodine status of Swiss population groups and to evaluate the influence of iodized salt as a vector for iodine fortification. DESIGN: The relationship between 24 h urinary iodine and Na excretions was assessed in the general population after correcting for confounders. Single-day intakes were estimated assuming that 92 % of dietary iodine was excreted in 24 h urine. Usual intake distributions were derived for male and female population groups after adjustment for within-subject variability. The estimated average requirement (EAR) cut-point method was applied as guidance to assess the inadequacy of the iodine supply. SETTING: Public health strategies to reduce the dietary salt intake in the general population may affect its iodine supply. SUBJECTS: The study population (1481 volunteers, aged ≥15 years) was randomly selected from three different linguistic regions of Switzerland. RESULTS: The 24 h urine samples from 1420 participants were determined to be properly collected. Mean iodine intakes obtained for men (n 705) and women (n 715) were 179 (sd 68.1) µg/d and 138 (sd 57.8) µg/d, respectively. Urinary Na and Ca, and BMI were significantly and positively associated with higher iodine intake, as were men and non-smokers. Fifty-four per cent of the total iodine intake originated from iodized salt. The prevalence of inadequate iodine intake as estimated by the EAR cut-point method was 2 % for men and 14 % for women. CONCLUSIONS: The estimated prevalence of inadequate iodine intake was within the optimal target range of 2-3 % for men, but not for women.

Comportements alimentaires de jeunes utilisateurs de boîte à lunch, selon des mères québécoises

Objectif. Étudier les comportements alimentaires des enfants utilisateurs de boîte à lunch tels que décrits par les mères, en s’inspirant des descripteurs de comportements alimentaires de Jean-Pierre Poulain. Méthodes. Des entrevues individuelles et de groupes eurent lieu avec 18 mères. Une analyse de données qualitatives a été réalisée en utilisant les dimensions de Poulain comme cadre de référence. Une considération additionnelle fut intégrée dans l’analyse, celle de la dimension matérielle de la boîte à lunch. Résultats. Dimension spatiale : Les repas ont lieu dans des classes ou dans de grandes salles communes. Dimension temporelle : Le moment et la durée de la consommation du repas varient selon différents facteurs. Le moment de préparation de la boîte est aussi d’intérêt. Environnement social : Les pairs et les médias ont une grande influence dans les comportements liés à la boîte à lunch. Logique de choix : La mère est le principal décideur et acteur à l’égard du contenu. Structure de la prise : Les mères précisent des contenus associés aux repas de la veille ou des mets froids. Des desserts et des à-côtés accompagnent le repas principal. L’étude de la dimension matérielle de la boîte révèle que la facilité d’entretien est le principal critère de choix des boîtes alors que l’apparence visuelle est celui de l’enfant. L’écologie devient de plus en plus une priorité. Conclusion. Cette nouvelle approche pour l’étude des comportements alimentaires du jeune utilisateur de boîte à lunch fournit aux intervenants une autre perspective selon laquelle étudier cette activité quotidienne et/ou élaborer des projets promotionnels en santé publique.

Economic Impacts Of Air Pollution on Human Health and Property Values

The objectives of the present study are to provide a systematic descriptive documentation of the nature of air pollution of the Cochin industrial agglomeration, estimate the willingness to pay for morbidity reduction due to air pollution in observed and hypothetical markets and to estimate the value of welfare loss in the purchase of property due to reduced air quality. This study is an attempt to examine economic impacts of air pollution on the human health and property values in the industrial capital of Kerala. The process of industrialization in Kerala and the increase in air pollution created damages to human, natural and economic resources in the state. The study documents the extent of air pollution and applied econometric approaches to estimate economic impacts of air pollution on human health and property values. The Important sources of air pollution identified in Cochin are emissions from industries and automobiles.

Exploring costs and benefits of HACCP: a pilot study in the dairy and meat products industry in the European Union

Since 1995 the Directive 93/43/EEC prescribes the application of HACCP principles in food production. However, despite the major importance of food safety, there is a fundamental lack of information on the economic impact of this directive. This project aims to study costs and benefits of HACCP, including the impact of HACCP on public health. Due to the complexity of the issue, we propose to start with a pilot study, limited to dairy and meat products industry in NL, UK and I. Information will be obtained at two levels: production chain and public health. Integration of these results will result in recommendations at the levels of EU member states and industry for regulation and supporting measures, and in recommendations for an effective and efficient approach for a more comprehensive project on costs and benefits of HACCP, covering major parts of the food industry in EU member states.

Municipalities secession and uncertainty on public goods provision

This paper investigates the causes of municipalities secession in Brazil. The theoretical model proposes that the median voter is not fully informed about the efficiency effect of secession on public good provision and uses the break up decision undertaken by neighbor’s municipalities within the state to account for his voting. Our empirical results confirms that prediction

Essays on the general equilibrium effects of barriers to trade on economic growth, foreign trade and the location of economic activity in Brazil

This work presents a fully operational interstate CGE model implemented for the Brazilian economy that tries to quantify both the role of barriers to trade on economic growth and foreign trade performance and how the distribution of the economic activity may change as the country opens up to foreign trade. Among the distinctive features embedded in the model, modeling of external scale economies, port efficiency and land-maritime transport costs provides an innovative way of dealing explicitly with theoretical issues related to integrated regional systems. In order to illustrate the role played by the quality of infrastructure and geography on the country‟s foreign and interregional trade performance, a set of simulations is presented where barriers to trade are significantly reduced. The relative importance of trade policy, port efficiency and land-maritime transport costs for the country trade relations and regional growth is then detailed and quantified, considering both short run as well as long run scenarios. A final set of simulations shed some light on the effects of liberal trade policies on regional inequality, where the manufacturing sector in the state of São Paulo, taken as the core of industrial activity in the country, is subjected to different levels of external economies of scale. Short-run core-periphery effects are then traced out suggesting the prevalence of agglomeration forces over diversion forces could rather exacerbate regional inequality as import barriers are removed up to a certain level. Further removals can reverse this balance in favor of diversion forces, implying de-concentration of economic activity. In the long run, factor mobility allows a better characterization of the balance between agglomeration and diversion forces among regions. Regional dispersion effects are then clearly traced-out, suggesting horizontal liberal trade policies to benefit both the poorest regions in the country as well as the state of São Paulo. This long run dispersion pattern, on one hand seems to unravel the fragility of simple theoretical results from recent New Economic Geography models, once they get confronted with more complex spatially heterogeneous (real) systems. On the other hand, it seems to capture the literature‟s main insight: the possible role of horizontal liberal trade policies as diversion forces leading to a more homogeneous pattern of interregional economic growth.

Health related quality of life among the elderly: a population-based study using SF-36 survey

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

[How to assess the nutritional status of my patient]

Protein-energy-malnutrition is a growing problem in industrialised countries. Many studies have found malnourishment in 20-60% of hospitalized medical or surgical patients, as well as out-patients. Malnutrition negatively influences patients' prognosis, immune system, muscle strength, and quality of life. As it is a largely treatable co-morbidity, systematic screening for malnutrition and effective management will improve patient outcomes and reduce healthcare costs. Early diagnosis and assessment depends on a simple and standardised screening tool that identifies at-risk patients, allowing the medical team in charge to solve patients' nutritional problems with an interdisciplinary approach.

Encouragement to Increase the Use of Psychosocial Skills in the Diagnosis and Therapy of Patients With Functional Dysphonia.

Clinicians believe that psychosocial factors play a causal role in the etiology of many forms of functional dysphonia (FD). But for decades, all attempts to confirm such causation have failed. This paper aims to show the logic of this failure, to discuss the possibilities of employing psychology in therapy nonetheless, and to encourage clinicians to use their psychosocial knowledge and skills. The failure to confirm psychic and social factors as causal in the etiology of FD is basically a consequence of a principal shortcoming of evidence-based medicine (EBM). As the gold standard for validity, reliability, and objectivity in medical research, EBM is based on calculability and hence the processing of quantitative data. But life paths and life situations are best or sometimes only expressible in qualitative, experiential, and idiographic terms. Thus EBM-guided evaluation undervalues most psychosocial studies. This report of an experienced multidisciplinary voice team proposes alternative pathways for integrating psychosocial knowledge into the diagnosis and the treatment of FD. The difference between the fields of activity of psychotherapists and speech-language pathologists is discussed, and the latter group is shown the potential benefits of using more of their psychosocial knowledge and skills.

Use of a modified Delphi panel to identify and weight criteria for prioritization of zoonotic diseases in Switzerland

Zoonotic diseases have a significant impact on public health globally. To prevent or reduce future zoonotic outbreaks, there is a constant need to invest in research and surveillance programs while updating risk management strategies. However, given the limited resources available, disease prioritization based on the need for their control and surveillance is important. This study was performed to identify and weight disease criteria for the prioritization of zoonotic diseases in Switzerland using a semi-quantitative research method based on expert opinion. Twenty-eight criteria relevant for disease control and surveillance, classified under five domains, were selected following a thorough literature review, and these were evaluated and weighted by seven experts from the Swiss Federal Veterinary Office using a modified Delphi panel. The median scores assigned to each criterion were then used to rank 16 notifiable and/or emerging zoonoses in Switzerland. The experts weighted the majority of the criteria similarly, and the top three criteria were Severity of disease in humans, incidence and prevalence of the disease in humans and treatment in humans. Based on these weightings, the three highest ranked diseases were Avian Influenza, Bovine Spongiform Encephalitis, and Bovine Tuberculosis. Overall, this study provided a preliminary list of criteria relevant for disease prioritization in Switzerland. These were further evaluated in a companion study which involved a quantitative prioritization method and multiple stakeholders.

A space-time analysis of reported shigellosis and salmonellosis cases in Texas from 2000 to 2004

Background. The purpose of this study was to describe the risk factors and demographics of persons with salmonellosis and shigellosis and to investigate both seasonal and spatial variations in the occurrence of these infections in Texas from 2000 to 2004, utilizing time series analyses and the geographic information system digital mapping methods. ^ Methods. Spatial Analysis: MapInfo software was used to map the distribution of age-adjusted rates of reported shigellosis and salmonellosis in Texas from 2000–2004 by zip codes. Census data on above or below poverty level, household income, highest level of educational attainment, race, ethnicity, and urban/rural community status was obtained from the 2000 Decennial Census for each zip code. The zip codes with the upper 10% and lower 10% were compared using t-tests and logistic regression to determine whether there were any potential risk factors. ^ Temporal analysis. Seasonal patterns in the prevalence of infections in Texas from 2000 to 2003 were determined by performing time-series analysis on the numbers of cases of salmonellosis and shigellosis. A linear regression was also performed to assess for trends in the incidence of each disease, along with auto-correlation and multi-component cosinor analysis. ^ Results. Spatial analysis: Analysis by general linear model showed a significant association between infection rates and age, with young children aged less than 5 and those aged 5–9 years having increased risk of infection for both disease conditions. The data demonstrated that those populations with high percentages of people who attained a higher than high school education were less likely to be represented in zip codes with high rates of shigellosis. However, for salmonellosis, logistic regression models indicated that when compared to populations with high percentages of non-high school graduates, having a high school diploma or equivalent increased the odds of having a high rate of infection. ^ Temporal analysis. For shigellosis, multi-component cosinor analyses were used to determine the approximated cosine curve which represented a statistically significant representation of the time series data for all age groups by sex. The shigellosis results show 2 peaks, with a major peak occurring in June and a secondary peak appearing around October. Salmonellosis results showed a single peak and trough in all age groups with the peak occurring in August and the trough occurring in February. ^ Conclusion. The results from this study can be used by public health agencies to determine the timing of public health awareness programs and interventions in order to prevent salmonellosis and shigellosis from occurring. Because young children depend on adults for their meals, it is important to increase the awareness of day-care workers and new parents about modes of transmission and hygienic methods of food preparation and storage. ^