Rift Valley Fever Epidemiology, Surveillance, and Control: What Have Models Contributed?

Background: Rift Valley fever (RVF) is an emerging vector-borne zoonotic disease that represents a threat to human health, animal health, and livestock production, particularly in Africa. The epidemiology of RVF is not well understood, so that forecasting RVF outbreaks and carrying out efficient and timely control measures remains a challenge. Various epidemiological modeling tools have been used to increase knowledge on RVF epidemiology and to inform disease management policies.

Interlaboratory comparison of real-time polymerase chain reaction methods to detect Coxiella burnetii, the causative agent of Q fever

The bacterium Coxiella burnetii, which has a wide host range, causes Q fever. Infection with C burnetii can cause abortions, stillbirth, and the delivery of weak offspring in ruminants. Coxiella burnetii infection is zoonotic, and in human beings it can cause chronic, potentially fatal disease. Real-time polymerase chain reaction (PCR) is increasingly being used to detect the organism and to aid in diagnosis both in human and animal cases. Many different real-time PCR methods, which target different genes, have been described. To assess the comparability of the C. burnetii real-time PCR assays in use in different European laboratories, a panel of nucleic acid extracts was dispatched to 7 separate testing centers. The testing centers included laboratories from both human and animal health agencies. Each laboratory tested the samples using their in-house real-time PCR methods. The results of this comparison show that the most common target gene for real-time PCR assays is the IS1111 repeat element that is present in multiple copies in the C. burnetii genome. Many laboratories also use additional real-time PCR tests that target single-copy genes. The results of the current study demonstrate that the assays in use in the different laboratories are comparable, with general agreement of results for the panel of samples.

The role of regret minimisation in lifestyle choices affecting the risk of coronary heart disease

This paper introduces the discrete choice model-paradigm of Random Regret Minimisation (RRM) to the field of health economics. The RRM is a regret-based model that explores a driver of choice different from the traditional utility-based Random Utility Maximisation (RUM). The RRM approach is based on the idea that, when choosing, individuals aim to minimise their regret–regret being defined as what one experiences when a non-chosen alternative in a choice set performs better than a chosen one in relation to one or more attributes. Analysing data from a discrete choice experiment on diet, physical activity and risk of a fatal heart attack in the next ten years administered to a sample of the Northern Ireland population, we find that the combined use of RUM and RRM models offer additional information, providing useful behavioural insights for better informed policy appraisal.

Exploratory Space-Time Analyses of Rift Valley Fever in South Africa in 2008-2011

Background: Rift Valley fever (RVF) is a zoonotic arbovirosis for which the primary hosts are domestic livestock (cattle, sheep and goats). RVF was first described in South Africa in 1950-1951. Mechanisms for short and long distance transmission have been hypothesised, but there is little supporting evidence. Here we describe RVF occurrence and spatial distribution in South Africa in 2008-11, and investigate the presence of a contagious process in order to generate hypotheses on the different mechanisms of transmission. Methodology/Principal Findings: A total of 658 cases were extracted from World Animal Health Information Database. Descriptive statistics, epidemic curves and maps were produced. The space-time K-function was used to test for evidence of space-time interaction. Five RVF outbreak waves (one in 2008, two in 2009, one in 2010 and one in 2011) of varying duration, location and size were reported. About 70% of cases (n = 471) occurred in 2010, when the epidemic was almost country-wide. No strong evidence of space-time interaction was found for 2008 or the second wave in 2009. In the first wave of 2009, a significant space-time interaction was detected for up to one month and over 40 km. In 2010 and 2011 a significant intense, short and localised space-time interaction (up to 3 days and 15 km) was detected, followed by one of lower intensity (up to 2 weeks and 35 to 90 km). Conclusions/Significance: The description of the spatiotemporal patterns of RVF in South Africa between 2008 and 2011 supports the hypothesis that during an epidemic, disease spread may be supported by factors other than active vector dispersal. Limitations of under-reporting and space-time K-function properties are discussed. Further spatial analyses and data are required to explain factors and mechanisms driving RVF spread. © 2012 Métras et al.

Management of cystic fibrosis

The pharmacological treatment of cystic fibrosis, together with implications for health economics, therapeutic monitoring and adherence, are discussed

Economic evaluation and its place in dentistry

Objective: This review intends to examine current research surrounding economic assessment in the delivery of dental care. Economic evaluation is an acknowledged method of analysing dental care systems by means of efficiency, effectiveness, efficacy and availability. Though this is a widely used method in medicine, it is underappreciated in dentistry. As the delivery of health care changes there has been recent demand by the public, the profession, and those funding dental treatment to investigate current practices regarding programs themselves and resource allocation.
Methods: A meta-analysis was conducted regarding health economics. The initial search was carried out using Pubmed, Google Scholar, Science Direct, and The Cochrane Library with search terms “health AND economics AND dentistry”. A secondary search was conducted with the terms “heath care AND dentistry AND”. The third part of the entry was changed to address the aims and included the following terms: “cost benefit analysis”, “efficiency criteria”, “supply & demand”, “cost-effectiveness”, “cost minimisation”, “cost utility”, “resource allocation”, “QALY”, and “delivery and economics”. Limits were applied to all searches to only include papers published in English within the last eight years.
Results: Preliminary results demonstrated a limited number of economic evaluations conducted in dentistry. Those that were carried out were mainly confined to the United Kingdom. Furthermore analysis was mainly restricted to restorative dentistry, followed by orthodontics, and maxillofacial surgery, thereby demonstrating a need for investigation in all fields of dentistry.
Conclusion: Health economics has been overlooked in the past regarding delivery of dental care and resource allocation. Economic appraisal is a crucial part of generating an effective and efficient dental care system. It is becoming increasingly evident that there is a need for economic evaluation in all dental fields.

Did the Millennium Development Goals Change Trends in Child Mortality?

There has been little assessment of the role the MDGs have had in progressing international development. There has been a 41 per cent reduction in the under-5 mortality rate worldwide from 1990 to 2011 and an acceleration in the rate of reduction since 2000. This paper explores why this has occurred and results for all developing countries indicate that it is not due to more healthcare or public health interventions but is driven by a coincidental burst of economic growth. Although the MDGs are considered to have played an important part in securing progress against poverty, hunger and disease there is very little evidence to back this viewpoint up. A thorough analysis of the successes and failures of the MDGs is therefore necessary before embarking on a new round of global goals.

Free-roaming dogs control activities in one Italian province (2000-2013): Is the implemented approach effective?

In Italy, standards for the management of free-roaming dogs (FRDs) are defined by regional norms, generating a high variability of approaches around the country. Despite efforts carried out by the competent authorities, FRDs are still a reality impacting upon animal health and welfare and public costs. A similar scenario can be found in many other Mediterranean and Balkan counties. Here we present 14 years of data (2000–2013) retrieved from the admission dog registry of a public shelter (PS) responsible for the collection of stray dogs from one Italian province. The aim of this retrospective study was to describe the local FRD population, identifying its source and to evaluate the effectiveness of the actions implemented by the local authorities. In the investigated period, 7,475 dogs were admitted to the PS. Despite the intense sterilisation plan (mean 381.7 sterilisations per year), the overall number of dogs entering PS did not decrease consistently across the years. Results highlighted a lack of responsibility of owners by failing to sterilise and identify their dogs and allowing intact animals to roam free, therefore producing uncontrolled and unwanted litters. The current dog population management strategy, based on both sheltering and capture-neuter-release programmes, is insufficient to tackle the straying phenomenon. Educational and sterilisation programmes should be an integral part of a successfully implemented FRD control plan. Our results provide further insight on free-roaming dog population dynamics and control systems, and may have important implications for many other local contexts across Europe trying to overcome the straying phenomenon.

Diversity of Aeromonas species from different environments in Portugal

Espécies de Aeromonas encontram-se distribuídas por diferentes habitats, estando especialmente relacionadas com ambientes aquáticos. O seu papel em complicações na saúde humana e animal é reconhecido. De facto, não só pelo seu potencial de virulência, mas também pelos determinantes genéticos de resistência a antibióticos que possam conter, estes organismos constituem uma preocupação na medicina humana e veterinária. Assim, é essencial o estudo da diversidade de espécies de Aeromonas bem como explorar as suas características fenotípicas e genéticas que podem conduzir a impactos negativos. A água constitui um importante veículo de transmissão de microrganismos e espécies de Aeromonas estão amplamente distribuídas em águas tratadas e não tratadas. Em Portugal é ainda comum o consumo de águas não tratadas cuja qualidade, na maioria das vezes, não é sujeita a monitorização, como acontece por exemplo, em explorações agrícolas de gestão familiar. Neste estudo, investigou-se a presença de Aeromonas em águas não tratadas para consumo. Estabeleceu-se também uma linha horizontal de colheitas de diferentes amostras de origem agrícola com o intuito de avaliar a possibilidade de a água ser uma das vias de contaminação de culturas agrícolas e animais por espécies de Aeromonas. Obtiveram-se 483 isolados que foram discriminados por RAPD-PCR. 169 estirpes distintas foram identificadas ao nível da espécie por análise filogenética baseada no gene gyrB. Verificou-se uma frequente ocorrência bem como uma diversidade considerável de espécies de Aeromonas. Em alguns casos, as relações genotípicas entre isolados de diferentes amostras eram muito próximas. Adicionalmente, a maioria das amostras continha diferentes espécies e estirpes distintas da mesma espécie. A. media e A. hydrophila foram as espécies mais ocorrentes. Um grupo de isolados apresentou variantes moleculares de gyrB diferente das conhecidas até agora, o que indica que poderão constituir espécies não descritas. O perfil de susceptibilidade da colecção de Aeromonas a diferentes antibióticos foi estabelecido, constituindo um perfil típico do género, com algumas excepções. Estirpes multirresistentes foram encontradas. A presença de genes tet e bla foi investigada por estudos de PCR, hibridação e, em alguns casos, de sequenciação. Como era esperado, cphA/imiS foi o mais detectado. A detecção de integrões fez-se por PCR e hibridação e a sua caracterização foi feita por sequenciação de DNA; a sua ocorrência foi reduzida. A maioria das estirpes sintetizou enzimas extracelulares com actividade lipolítica e proteolítica que potencialmente contribuem para virulência. A análise por PCR e hibridação permitiram a detecção de vários determinantes genéticos que codificam moléculas possivelmente envolvidas em processos patogénicos. Diversas espécies de Aeromonas apresentando características relacionadas com resistência a antibióticos e potencialmente de virulência estão frequentemente presentes em produtos para consumo humano e animal em Portugal. ABSTRACT: Aeromonas spp. are present in a wide range of ecological niches, being mainly related to aquatic environments. Their role in human and animal health complications is recognised. In fact, not only for their putative virulence but also for the antibiotic resistance genetic determinants Aeromonas may harbour, these organisms constitute an issue of concern in human and veterinary medicine. Thus, it is essential to get knowledge on Aeromonas sp. diversity and on their genotypic and phenotypic characteristics that may lead to negative impacts. Water constitutes a good contamination route for microorganisms and Aeromonas are widespread in untreated and treated waters from different sources. In Portugal there is still an extensive use of untreated water which is not regularly monitored for quality. This is often the case in family smallholding farms. In this study untreated drinking and mineral waters were assessed for their content in Aeromonas spp. Furthermore, a sampling scheme was designed to investigate the occurrence and diversity of Aeromonas sp. in different agricultural correlated sources and to assess the possibility of water being the transmission vehicle between those sources. 483 isolates were obtained and discriminated by RAPD-PCR. Identification at the species level for 169 distinct strains was done by gyrB based phylogenetic analysis. Results demonstrated the frequent occurrence and considerable diversity of Aeromonas spp. In some cases, genotypic close relations were found between isolates from different sources. Also, most samples contained different species and distinct strains of the same species. A. media and A. hydrophila were the most occurring. A group of isolates displayed gyrB gene sequences distinct from the previously known, indicating that they may constitute representatives of non-described species. The antibiotic susceptibility profile of the aeromonads collection was established and constituted a typical profile of the genus, although few exceptions. Multiresistance patterns were found. The presence of tet and bla genes was investigated by PCR, hybridisation and, in some cases, sequencing analysis. As expected, cphA/imiS was the most detected. Integrons were screened by PCR and hybridisation and characterised by DNA sequencing; low occurrence was recorded. The bulk of strains was able to produce extracellular enzymes with lipolytic and proteolytic activities, which may contribute to virulence. PCR and hybridisation surveys allowed the detection of distinct genetic determinants coding for molecules putatively involved in pathogenic processes. Diverse Aeromonas sp. presenting distinct antibiotic resistance features and putative virulence traits are frequently present in many sources for human and animal consumption in Portugal.

Contaminated soil exposure assessment in Portugal and in the EU

Este estudo baseou-se na análise dos mecanismos de transferência de elementos potencialmente tóxicos (PTE’s) entre o solo, a solução do solo e as plantas como forma de realizar uma avaliação mais eficaz do risco em áreas agrícolas. Foram aplicados conceitos recentemente desenvolvidos para a avaliação da reactividade biogeoquímica de contaminantes no solo e da sua partição sólido:solução recorrendo-se a modelos empíricos (tipo Freundlich). Estes modelos permitiram analisar a transferência de PTE’s ao longo da cadeia alimentar e avaliar o impacto da contaminação do solo na qualidade da alimentação animal (forragens) e Humana (vegetais e carne) em Portugal. Os modelos empíricos de transferência solo-planta de PTE’s foram utilizadas para obter limites críticos para estes elementos em solos agrícolas em Portugal, a partir dos seus limites legais nos alimentos para animais e teores máximos nos géneros alimentícios. Simultaneamente, modelos de exposição Humana a contaminantes do solo, desenvolvidos noutros países da UE foram analisados e foi proposto um modelo de exposição para Portugal. Este trabalho é uma contribuição para o desenvolvimento de critérios de qualidade de solos para áreas agrícolas em Portugal, tendo em vista a protecção da saúde animal e Humana. Contribuiu também para o desenvolvimento de uma estratégia de harmonização de políticas de protecção do solo (nomeadamente no que diz respeito aos problemas de contaminação) na União Europeia.

Emerging horizons for tick-borne pathogens: from the ‘one pathogen–one disease’ vision to the pathobiome paradigm

Ticks as vectors of several notorious zoonotic pathogens, represent an important and increasing threat for human, animal health in Europe. Recent application of new technology revealed the complexity of the tick microbiome that might impact upon its vectorial capacity. Appreciation of these complex systems is expanding our vision of tick-borne pathogens leading us to evolve a more integrated view that embraces the “pathobiome” representing the pathogenic agent integrated within its abiotic and biotic environments. In this review, we will explore how this new vision will revolutionize our understanding of tick-borne diseases. We will discuss the implications in terms of research approach for the future in order to efficiently prevent and control the threat posed by ticks.

A proteomic study of the effects of nutrient restriction in utero on postnatal metabolism

It is widely recognized that protein restriction in utero may cause metabolic and endocrine adaptations, which may be of benefit to the neonate on a short-term basis but may cause adverse long-term conditions such as obesity, Type 2 diabetes, metabolic syndrome, hypertension and cardiovascular diseases. Adequate foetal and early post natal nutrient and energy supply is therefore essential for adult animal health, performance and life span. In this project it was investigated the progressive adaptations of the hepatic proteome in male mink offspring exposed to either a low protein (FL) or an adequate protein (FA) diet in utero fed either on a low protein (LP) or on an adequate (AP) diet from weaning until sexual maturity. Specifically, the aim was to determine the metabolic adaptations at selected phases of the animal’s first annual cycle and establish the metabolic priorities occurring during those phases. The three different morphological stages studied during the first year of development included, end of bone growth at 4 months of age, maximal fat accretion at 6 months of age and sexual maturity at 12 months of age. A reference proteome of mink liver coming from these different animal groups were generated using 2D electrophoresis coupled to MALDI-TOF analysis and the way in which dietary treatment affect their proteome was established. Approximately 330 proteins were detected in the mink liver proteome. A total of 27 comparisons were carried out between all different animal groups which resulted in 20 differentially expressed proteins. An extensive survey was conducted towards the characterization of these proteins including their subcellular localization, the biological processes in which they are involved and their molecular functions. This characterization allowed the identification of proteins in various processes including the glycolysis and fatty acid metabolism. The detailed analysis of the different dietary treatment animal groups was indicative of differences in metabolism and also to changes associated with development in mink.

Evaluation and Potential Cost-Effectiveness of Active Surveillance Pharmacovigilance for First-Line HAART in Namibia

Thesis (Ph.D.)--University of Washington, 2016-02