Immune Response of Cattle Infected with African Trypanosomes

Trypanosomosis is the most economically important disease constraint to livestock productivity in sub-Saharan Africa and has significant negative impact in other parts of the world. Livestock are an integral component of farming systems and thus contribute significantly to food and economic security in developing countries. Current methods of control for trypanosomosis are inadequate to prevent the enormous socioeconomic losses resulting from this disease. A vaccine has been viewed as the most desirable control option. However, the complexity of the parasite's antigenic repertoire made development of a vaccine based on the variable surface glycoprotein coat unlikely. As a result, research is now focused on identifying invariant trypanosome components as potential targets for interrupting infection or infection-mediated disease. Immunosuppression appears to be a nearly universal feature of infection with African trypanosomes and thus may represent an essential element of the host-parasite relationship, possibly by reducing the host's ability to mount a protective immune response. Antibody, T cell and macrophage/monocyte responses of infected cattle are depressed in both trypanosusceptible and trypanotolerant breeds of cattle. This review describes the specific T cell and monocyte/macrophage functions that are altered in trypanosome-infected cattle and compares these disorders with those that have been described in the murine model of trypanosomosis. The identification of parasite factors that induce immunosuppression and the mechanisms that mediate depressed immune responses might suggest novel disease intervention strategies.

The social transition of risk factors for cardiovascular disease in the African region: evidence from three cross-sectional surveys in the Seychelles.

OBJECTIVES: To examine the association between socioeconomic status (SES) and several cardiovascular disease risk factors (CVRFs) and to assess whether this association has changed over a 15-year observation period. METHODS: Three independent population-based surveys of CVRFs were conducted in representative samples of all adults aged 25-64 years in the Seychelles, a small island state located east to Kenya, in 1989 (N=1081), 1994 (N=1067) and 2004 (N=1255). RESULTS: Among men, current smoking and heavy drinking were more prevalent in the low versus the high SES group, and obesity was less prevalent. The socioeconomic gradient in diabetes reversed over the study period from lower prevalence in the low versus the high SES group to higher prevalence in the low SES group. Hypercholesterolemia was less prevalent in the low versus the high SES group in 1989 but the prevalence was similar in the two groups in 2004. Hypertension showed no consistent socioeconomic pattern. Among women, the SES gradient in smoking tended to reverse over time from lower prevalence in the low SES group to lower prevalence in the high SES group. Obesity and diabetes were more common in the low versus the high SES group over the study period. Heavy drinking, hypertension and hypercholesterolemia were not socially patterned among women. CONCLUSION: The prevalence of several CVRFs was higher in low versus high SES groups in a rapidly developing country in the African region, and an increase of the burden of these CVRFs in the most disadvantaged groups of the population was observed over the 15 years study period.

Predictors of nonresponse in a questionnaire-based outcome study of vocational rehabilitation patients.

OBJECTIVE: To identify predictors of nonresponse to a self-report study of patients with orthopedic trauma hospitalized for vocational rehabilitation between November 15, 2003, and December 31, 2005. The role of biopsychosocial complexity, assessed using the INTERMED, was of particular interest. DESIGN: Cohort study. Questionnaires with quality of life, sociodemographic, and job-related questions were given to patients at hospitalization and 1 year after discharge. Sociodemographic data, biopsychosocial complexity, and presence of comorbidity were available at hospitalization (baseline) for all eligible patients. Logistic regression models were used to test a number of baseline variables as potential predictors of nonresponse to the questionnaires at each of the 2 time points. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N=990) hospitalized for vocational rehabilitation over a period of 2 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Nonresponse to the questionnaires was the binary dependent variable. RESULTS: Patients with high biopsychosocial complexity, foreign native language, or low educational level were less likely to respond at both time points. Younger patients were less likely to respond at 1 year. Those living in a stable partnership were less likely than singles to respond at hospitalization. Sex, psychiatric, and somatic comorbidity and alcoholism were never associated with nonresponse. CONCLUSIONS: We stress the importance of assessing biopsychosocial complexity to predict nonresponse. Furthermore, the factors we found to be predictive of nonresponse are also known to influence treatment outcome and vocational rehabilitation. Therefore, it is important to increase the response rate of the groups of concern in order to reduce selection bias in epidemiologic investigations.

Effectiveness of interventions targeting frequent users of emergency departments: a systematic review

L'article publié de le cadre de cette thèse est intitulé "Effectiveness of interventions targeting frequent users of emergency departments: A systematic review." Il a été publié par les "Annals of Emergency Medicine (AEM)" en juillet 2011. Le titre en français pourrait être: "Efficacité des interventions ciblant les utilisateurs fréquents des services d'urgence: Une revue systématique." Le titre du journal américain pourrait être: "Annales de Médecine d'Urgence". Il s'agit du journal du "Collège Américain des Médecins d'Urgence", en anglais "American College of Emergency Physicians (ACEP)". L'article a été soumis à l'AEM en raison de l'intérêt que ses rédacteurs en chef portent pour le sujet des utilisateurs fréquents des services d'urgence, démontré depuis plus de dix ans par la publication de nombreux articles dans ce domaine. Le facteur d'impact de l'AEM est de surcroît le plus important des journaux d'urgence, assurant ainsi une large diffusion des articles publiés. Lors de sa publication, l'article a été accompagné d'un éditorial signé par le Docteur Maria C. Raven, médecin au Centre Hospitalier de Bellevue à New York, Etats-Unis.¦Contexte et enjeux¦La Direction Générale du Centre Hospitalier Vaudois (CHUV) finance, dans le cadre du plan stratégique 2009-2013, un axe "populations vulnérables". Cet axe est porté en grande partie par des projets développés au sein de la Policinlique Médicale Universitaire et l'Unité des Populations Vulnérables qui prend en charge, enseigne la prise en charge et s'interroge sur la prise en charge des personnes les plus vulnérables. C'est dans ce contexte que nous avons été amenés à réfléchir à l'existence éventuelle de marqueurs de vulnérabilité; l'utilisation fréquente des services d'urgence par certains individus constitue à n'en pas douter l'un de ces marqueurs. Il existe une importante littérature décrivant en détail ces utilisateurs fréquents des services d'urgence, raison pour laquelle nous avons décidé de faire un pas supplémentaire et de nous interroger sur l'efficacité des interventions (quelle qu'elles soient) ciblant cette population particulière. Nous avons ainsi entrepris une revue systématique de la littérature scientifique médicale et sociale pour approfondir cette question, et c'est précisément le résultat de cette recherche qui constitue ce travail de thèse.¦Conclusions et perspectives¦Les utilisateurs fréquents des services d'urgence sont des individus particulièrement vulnérables, et ce aussi bien aux Etats-Unis, qu'en Europe ou en Australie: ils présentent par exemple une mortalité supérieure aux autres utilisateurs des urgences; ils sont également plus à risque de présenter une consommation abusive d'alcool ou de drogues, une maladie mentale, ou une maladie chronique. Ils sont plus souvent sans abri, sans assurance et d'un statut socio-économique bas.¦De nombreuses interventions on été développées pour prendre en charge les utilisateurs fréquents des urgences. Le but de ces interventions est d'une part de réduire la consommation des services d'urgence et d'autre part d'améliorer la santé au sens large de ces patients vulnérables. C'est en ces termes (réduction de la fréquence d'utilisation des services d'urgence et amélioration de la santé) que l'efficacité d'une intervention est mesurée.¦Parmi l'ensemble des interventions étudiées, l'une semble particulièrement efficace pour réduire le nombre de visites aux urgences et améliorer un certain nombre de marqueurs sociaux (accès à un logement ou à une assurance-maladie). Cette intervention est appelée "case management" (ou "gestion de cas", difficile tentative de traduction de ce concept en français), et consiste en une approche multidisciplinaire (médecins, infirmiers, assistants sociaux) fournissant un service individualisé, dans le cadre de l'hôpital et souvent également dans la communauté. L'approche consiste à évaluer les besoins précis du patient, à l'accompagner dans son parcours de soin, à l'orienter si nécessaire et à mettre en place autour de lui un réseau communiquant de manière adaptée.¦Le "case management" ayant montré son efficacité dans la prise en charge des utilisateurs fréquents des services d'urgence, y-compris en termes de coûts, notre conclusion va dans le sens d'encourager les hôpitaux à évaluer l'importance de ce phénomène dans leur propre pratique et à mettre en place des équipes de prise en charge de ces patients, dans le double but de soutenir des patients particulièrement vulnérables et de réduire la consommation des services d'urgence. Suite à la réflexion suscitée par ce travail de thèse, une telle équipe a été mise en place en 2010, dans un cadre de recherche-action, au niveau du CHUV. Ce projet est dirigé par le Dr Patrick Bodenmann, responsable de l'Unité Populations Vulnérables de la Policlinique Médicale Universitaire de Lausanne. Le Dr Bodenmann est également le directeur de cette thèse et le dernier auteur de la revue systématique.

IPH response to draft Sustainable Development Strategy 'Everyone's Involved'

The Institute of Public Health in Ireland (IPH) aims to improve health on the island of Ireland by working to combat health inequalities and influence public policies in favour of health.  IPH promotes cooperation between Northern Ireland and the Republic of Ireland in public health research, training and policy advice. Its key focus is on efforts to improve health equity. The work of IPH (www.publichealth.ie) includes health impact assessment, building and sharing evidence for public health development, developing Ireland and Northern Ireland’s population health observatory (INISPHO www.inispho.org ), and providing public health policy advice in areas such as health inequalities, obesity, fuel poverty and food poverty.   Health is influenced by a wide range of social determinants, including economic, environmental, social and biological factors. IPH has a key interest and significant experience in raising awareness and developing work to influence these wider social and environmental determinants in ways which improve health. Sustainable development and public health are inextricably linked, in ways which are described in section 3.  Sustainable development is essentially at the heart of healthy communities and individuals as well as a healthy environment and sustainable economic development   - all factors at the heart of public health.

Noves tecnologies per l'estudi de l'arqueologia de Patagònia (Amèrica del Sud)

The goal of this project was the historical study of Patagonia, the southernmost human settled area of the world. Our aim has been the anlysis of those societies to understand how they maintained their socioeconomic system, that is to say, how social reproduction allowed resolving the basic contradiction between production and reproduction, which is characteristic of all hunter-gatherer societies. New computational technologies have allowed a bettwer integration of the big amount and diversity of data needed. We have analyzed the historical evolution of inter-group and intra-group social relationships among nomad patagonian societies. We have compared different social answers in front of the radical change of their immediate reality produced by european colonization. We have exhaustively analyzed the results of archaeological excavations from diferent regions. We have also integrated information from anthropology, ethnohistory and geography. We are developing computing programs to integrate geographical actual data with paleoenvironmental data about the dynamic nature of soil formation, vegetation, hidrography, etc., with information about the history of productive action and how products were distributed among different human groups.

Information systems for water resources management improvement in developing countries

Water resources management, as also water service provision projects in developing countries have difficulties to take adequate decisions due to scarce reliable information, and a lack of proper information managing. Some appropriate tools need to be developed in order to improve decision making to improve water management and access of the poorest, through the design of Decision Support Systems (DSS). On the one side, a DSS for developing co-operation projects on water access improvement has been developed. Such a tool has specific context constrains (structure of the system, software requirements) and needs (Logical Framework Approach monitoring, organizational-learning, accountability and evaluation) that shall be considered for its design. Key aspects for its successful implementation have appeared to be a participatory design of the system and support of the managerial positions at the inception phase. A case study in Tanzania was conducted, together with the Spanish NGO ONGAWA – Ingeniería para el Desarrollo. On the other side, DSS are required also to improve decision making on water management resources in order to achieve a sustainable development that not only improves the living conditions of the population in developing countries, but that also does not hinder opportunities of the poorest on those context. A DSS made to fulfil these requirements shall be using information from water resources modelling, as also on the environment and the social context. Through the research, a case study has been conducted in the Central Rift Valley of Ethiopia, an endhorreic basin 160 km south of Addis Ababa. There, water has been modelled using ArcSWAT, a physically based model which can assess the impact of land management practices on large complex watersheds with varying soils, land use and management conditions over long periods of time. Moreover, governance on water and environment as also the socioeconomic context have been studied.

Coffee consumption and digestive tract cancers.

The relationship between coffee drinking and the risk of digestive tract neoplasms was analyzed in a case-control study of 50 cases of cancer of the mouth or pharynx, 209 of the esophagus, 397 of the stomach, 455 of the colon, 295 of the rectum, 151 of the liver, 214 of the pancreas, and 1944 control subjects admitted for acute, non-digestive tract disorders. There was no significant or consistent association between coffee and cancers of the mouth or pharynx, esophagus, stomach, liver, or pancreas. In particular, for pancreatic cancer, the multivariate relative risks for the intermediate and upper tertiles were 1.05 and 1.01, respectively. There were significant inverse trends in risk with measures of coffee consumption for colon and rectal cancers, the multivariate relative risks according to tertiles of coffee consumption being 0.86 and 0.64 for colon and 0.97 and 0.66 for rectum. This apparent protection is in agreement with some (but not all) previous epidemiological evidence and finds a possible biological interpretation in terms of interference on bile secretion, causing reduced bile acid and neutral sterol concentrations in the bowel. In conclusion, the results of this study, the major interest of which lies in the opportunity of drawing up an overall pattern of risk for various digestive neoplasms, offer further reassurance as regards the effects of coffee on digestive tract carcinogenesis.

Nematode Infections Are Risk Factors for Staphylococcal Infection in Children

Nematode infection may be a risk factor for pyogenic liver abscess in children and we hypothesized that the immunomodulation induced by those parasites would be a risk factor for any staphylococcal infection in children. The present study was designed to compare, within the same hospital, the frequency of intestinal nematodes and Toxocara infection in children with and without staphylococcal infections. From October 1997 to February 1998, 80 children with staphylococcal infection and 110 children with other diseases were submitted to fecal examination, serology for Toxocara sp., evaluation of plasma immunoglobulin levels, and eosinophil counts. Mean age, gender distribution, birthplace, and socioeconomic conditions did not differ significantly between the two groups. Frequency of intestinal nematodes and positive serology for Toxocara, were remarkably higher in children with staphylococcal infections than in the non-staphylococcal group. There was a significant correlation between intestinal nematodes or Toxocara infection and staphylococcal infection in children, reinforced by higher eosinophil counts and higher IgE levels in these children than in the control group. One possible explanation for this association would be the enhancement of bacterial infection by the immunomodulation induced by helminth infections, due to strong activation of the Th2 subset of lymphocytes by antigens from larvae and adult worms.

Comparison of the clientele of an anonymous HIV test centre and persons tested in the general population.

This study compares the clientele of a Swiss anonymous test centre with the general population tested. Information was obtained through similar questionnaires submitted to two samples of HIV-tested people aged from 17 to 45 years: the first administered in the context of a general population telephone survey (n = 245) and the second completed during face-to-face interviews of the clientele of an anonymous test centre (n = 250). The test centre sample has higher proportions of younger and single people. Attenders for anonymous testing were more likely to have acquired a new regular partner during the year preceding the interview (48.0% versus 14.4%). These differences remain when controlling for age and gender. Decision to test comes mostly from the respondent's own initiative, but suggestion from a doctor is more frequent in the general population (23.8% versus 0.8%), whereas suggestion from partner or friends is more frequent in the anonymous centre (44.4% versus 3.0%). The anonymous test centre clientele is not different from the general population tested except for the relational situation and origin of decision for testing. The test centre has become a place where the general population finds a response to a situation-specific need for HIV testing.

Seroprevalence of Hepatitis B virus infection among an afro-descendant community in Brazil

Furnas dos Dionísios is an Afro-Brazilian black community whose descendants were mainly fugitive slaves that established themselves in the State of Mato Grosso do Sul (MS), Brazil. The population is comprised mainly of low socioeconomic individuals who are engaged in agricultural activities. The objective of this study was to investigate the prevalence of hepatitis B (HB) and its correlation with epidemiological data obtained from the community. The studied population totaled 260 individuals with ages varying from 1 to 79 years (median 20). One hundred thirty-three (51.2%) were females and 127 (48.8%) were males. A high prevalence for anti-HBc was observed (42.7%), with present infection detected in 9.2% of the subjects who were also HB surface antigens (HBs Ag) positive; 27.3% were anti-HBc and anti-HBs reactive, and 6.2% had anti-HBc as only marker. The prevalence for anti-HBc was proportional to age, reaching its highest peak in age categories greater than 50. No serological marker was detected in children under the age of 2 years, however anti-HBc was present in 12 subjects with ages between 2 and 14 years, of these 8 (7.4%) were HBsAg positive. Among individuals over the age of 15 years, 99 were anti-HBc reactive, of these 16 (10.5%) were also HBsAg positive, thus suggesting an increased prevalence of HBV carriers among children and adolescents. The risk factors observed in this community that were significantly associated with anti-HBc positivity were age (over 20 years) and having an anti-HBc positive mother. Both HBeAg and anti-HBe were detected in 44.4% of the samples tested. HBsAg subtypes found in the studied population were adw2 (77.7%) and ayw2 (23.3%). While intrafamilial transmission was most likely responsible for HBV infection among children, other routes such as sexual contact might be considered for individuals with ages over 15 years.

Médecine sociale en 2013 : quand la précarité précède la pauvreté [Social medicine : does it still make sense in 2013?]

Social medicine is a medicine that seeks to understand the impact of socio-economic conditions on human health and diseases in order to improve the health of a society and its individuals. In this field of medicine, determining the socio-economic status of individuals is generally not sufficient to explain and/or understand the underlying mechanisms leading to social inequalities in health. Other factors must be considered such as environmental, psychosocial, behavioral and biological factors that, together, can lead to more or less permanent damages to the health of the individuals in a society. In a time where considerable progresses have been made in the field of the biomedicine, does the practice of social medicine in a primary care setting still make sense? La médecine sociale est une médecine qui cherche à comprendre l'impact des conditions socio-économiques sur la santé humaine et les maladies, dans la perspective d'améliorer l'état de santé d'une société et de ses individus. Dans ce domaine, la détermination du statut socio-économique des individus ne suffit généralement pas à elle seule pour expliquer et comprendre les mécanismes qui sous-tendent les inégalités sociales de santé. D'autres facteurs doivent être pris en considération, tels que les facteurs environnementaux, psychosociaux, comportementaux et biologiques, facteurs qui peuvent conduire de manière synergique à des atteintes plus ou moins durables de l'état de santé des individus d'une société. A une époque où les connaissances, les compétences et les moyens à disposition en biomédecine ont fait des progrès considérables, la pratique de la médecine sociale en cabinet a-t-elle encore sa place en 2013?

Human toxocariasis: a seroepidemiological survey in schoolchildren of Sorocaba, Brazil

A seroepidemiological survey for toxocariasis, among 180 schoolchildren of the public schools of Sorocaba City, state of São Paulo, Brazil, was carried out from August 2000 to July 2001. ELISA test was performed using excretory and secretory antigens for the detection of IgG anti-Toxocara antibodies. Information regarding the children was obtained from the parents or legal guardians. The results showed that the mean age was 5.4 ± 1.4 years, the infection coefficient (IC) was 38.3 and the infection risk was higher among the children living in the city outskirts (IC = 47.4) where the socioeconomic conditions were worse than in the central region of the city (IC = 11.1). There was an association between higher frequency of seroreactivity in the ELISA test and the condition of living in a house with a yard and/or unpaved street. The same was observed in relation to a history of enteroparasitism. There was also an association between a seronegative ELISA test and previous treatment of pet dogs and/or cats with vermifuge. Based on these results, the authors propose that public health programs should include anthelmintic for dogs and cats during the antirabies vaccination campaigns, in order to diminish environmental contamination with Toxocara spp. eggs and consequently human infection.

Inequalities in Health in an Aging Population: Patterns, Causes and Consequences

The increase in life expectancy that we continue to observe raises a complex set of challenges for policy. Among these challenges is the need to respond to the heterogeneity that remains in life expectancy within the older population. Most important is that life expectancy, even at older ages, differs markedly by socioeconomic position. In addition, despite increases in longevitymany individuals now effectively retire before state pension age and a large proportion of these are dependent on benefit income. In contrast, the contribution by older people to informal careprovision and other services has the potential to provide an important input into society, the economy and their own well-being. A crucial question, therefore, is which sections of the older population will live healthy active lives and which will be dependent on formal and informal sources of support. To answer this, we need to understand how inequalities in health are distributed in the older population and what the underlying causal processes are.