The importance of environmental sustainability in public procurement of medical devices in health care sector

The aim of this thesis was to examine the role of environmental sustainability in the procurement of medical devices in health care sector. Current literature is mainly focused on other product groups and medical devices have been left without sufficient attention. Nevertheless, EU has recently developed green public procurement criteria for medical devices (EU GPP criteria for health care EEE) in order to support and offer guidelines for purchasers in hospitals. In this study, the criteria were used as a framework in order to examine the most significant environmental aspects for medical devices. The empirical research was executed in Finnish public hospitals with mixed method approach; quantitative data was collected by a survey and qualitative data was collected by interviews held for procurement specialists. The focus was on understanding the importance of environmental sustainability in the procurement of medical devices and which environmentally sustainable features would be the most significant. Of interest was also the medical device supplier view and how they could take environmental sustainability into consideration.

Aspects of the fishery and biology of the African catfish Clarias gariepinus (Burchell, 1822) amidst environmental changes in Lake Wamala (Uganda)

Environmental changes are some of the factors that affect fisheries and biological characteristics of fishes. The African catfish Clarias gariepinus (Burchell, 1822) has biological characteristics that enable it to persist under various stressful environmental conditions. However, few studies have examined how the African catfish responds to conditions created by a changing climate. The study examined some of the fishery and biological characteristics of African catfish in Lake Wamala (Uganda) to provide an understanding of their response to changing climatic conditions using data for the period 1950 - 2013. Temperature around the lake increased by 0.02ºC/year since 1980, commensurate with the regional trend, while rainfall was above average since 1996, except in 2004 and 2008. Lake depth was strongly positively correlated with rainfall (r =0.83, n= 6, p<0.05) up to 2000, after which, lake depth decreased amidst increase in rainfall. The contribution of African catfish increased from 20% to 85% and 17% to 78% respectively to commercial and experimental catches respectively between 1975 and 2013 despite the decrease in lake depth. The modal total length, condition factor, food, and fecundity did not change. Only size at first maturity decreased from 37.5 to 30 cm TL in females and 39.5 to 34.2 cm TL in males between 1999/2000 and 2012/2013. The biological characteristics of the African catfish were comparable with those of the same species in other lakes and remained relatively stable. The results suggested that the African catfish has the capacity to persist and/or adjust appropriately under conditions created by climate variability and change, and if properly managed, can sustain the fisheries of Lake Wamala.

Put-in-Bay Harbor

This photograph shows Put-in-Bay Harbor with Gibraltar Island across the bay in the background. This image was made from a stereoview card created by A. C. Platt in the 1880s. South Bass Island was a popular destination in the 1880s for residents of Toledo, Cleveland, and Detroit.

Put-in-Bay Harbor

This picture features Put-in-Bay Harbor during the 1924 Inter-Lake Yachting Association Regatta. ILYA Regatta is the oldest event at Put-in-Bay and is still going strong. Primarily a sailing event, it attracts boats from throughout the Great Lakes for several days of racing in July and early August.

An examination of Special Forces and their transfer of skillsets under crisis management settings in Singapore

The thesis focuses on military crisis management and strategy.

Perceptions and risky behaviors associated with Leptospirosis in an endemic area in a village of Ubon Ratchathani Province, Thailand.

Background: Leptospirosis, a disease caused by Leptospira species, a spirochaete bacterium that can develop in an appropriate environment and/or grow in human and/or animal hosts, is a serious problem for the Ministry of Public Health, Thailand. Objective: To investigate people’s perceptions and behavioral risks regarding leptospirosis infection. Methods: The cross-sectional descriptive study collected data in May, 2013. Data on individuals’ perceptions and risky behaviors concerning leptospirosis were collected from 104 completed questionnaires. Results: Regarding perceptions of leptospirosis, we found them to be at a high level (97.1%) and risky behaviors regarding leptospirosis were reported at a moderate level (74.0%). The study found no correlation between perceptions and risky behaviors regarding leptospirosis (r 0.186, p-value 0.059). Conclusion: This study suggest that people in these areas have good knowledge about leptospirosis. However, some people have risky behavior associated with leptospirosis. Thus, a behavioral change campaign should be promoted to encourage people awareness of the dangers of such behavior.

Detection of all four dengue serotypes in Aedes aegypti female mosquitoes collected in a rural area in Colombia

The Aedes aegypti vector for dengue virus (DENV) has been reported in urban and periurban areas. The information about DENV circulation in mosquitoes in Colombian rural areas is limited, so we aimed to evaluate the presence of DENV in Ae. aegypti females caught in rural locations of two Colombian municipalities, Anapoima and La Mesa. Mosquitoes from 497 rural households in 44 different rural settlements were collected. Pools of about 20 Ae. aegypti females were processed for DENV serotype detection. DENV in mosquitoes was detected in 74% of the analysed settlements with a pool positivity rate of 62%. The estimated individual mosquito infection rate was 4.12% and the minimum infection rate was 33.3/1,000 mosquitoes. All four serotypes were detected; the most frequent being DENV-2 (50%) and DENV-1 (35%). Two-three serotypes were detected simultaneously in separate pools. This is the first report on the co-occurrence of natural DENV infection of mosquitoes in Colombian rural areas. The findings are important for understanding dengue transmission and planning control strategies. A potential latent virus reservoir in rural areas could spill over to urban areas during population movements. Detecting DENV in wild-caught adult mosquitoes should be included in the development of dengue epidemic forecasting models.

Vaccination of dogs with Trypanosoma rangeli induces antibodies against Trypanosoma cruzi in a rural area of Córdoba, Argentina

Dogs play a major role in the domestic cycle of Trypanosoma cruzi, acting as reservoirs. In a previous work we have developed a model of vaccination of dogs in captivity with nonpathogenic Trypanosoma rangeli epimastigotes, resulting in the production of protective antibodies against T. cruzi, with dramatic decrease of parasitaemia upon challenge with 100,000 virulent forms of this parasite. The aim of this work was to evaluate the immunogenicity of this vaccine in dogs living in a rural area. Domestic dogs, free from T. cruzi infection, received three immunisations with fixed T. rangeli epimastigotes. Dogs were not challenged with T. cruzi, but they were left in their environment. This immunisation induced antibodies against T. cruzi for more than three years in dogs in their natural habitat, while control dogs remained serologically negative.

Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study

BACKGROUND:Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status. METHODS: This study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6-8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/ fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann-Whitney U test and Pearson's chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country. RESULTS: Children with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large. CONCLUSIONS: Our findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied.

Allozyme and mtDNA variation of white seabream Diplodus sargus populations in a transition area between western and eastern Mediterranean basins (Siculo-Tunisian Strait)

To investigate the possible influence of the Siculo-Tunisian Strait on the genetic structure of white seabream Diplodus sargus, 13 polymorphic allozyme loci and a fragment of the cytochrome b mitochondrial DNA were analysed. Allozyme data indicated a moderate but significant differentiation between some north-eastern (Bizerta, Ghar El Melh Lagoon and Mahdia) and southern (Gabes Gulf and El Biban Lagoon) samples. This heterogeneity was also highlighted after removing PGM* and PGI-1* loci which may be under selection. These results can be explained by the chaotic genetic patchiness hypothesis. In contrast, the mtDNA data indicated genetic homogeneity among localities showing the absence of structure in white seabream populations across the Siculo-Tunisian Strait. Historical demography of this species suggests that it has undergone a recent population expansion as a consequence of a bottleneck event during the Pleistocene glaciations.

Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area : a systematic review

Purpose Radiation therapy (RT) is often recommended in the treatment of pelvic cancers. Following RT, a high prevalence of pelvic floor dysfunctions (urinary incontinence, dyspareunia, and fecal incontinence) is reported. However, changes in pelvic floor muscles (PFMs) after RT remain unclear. The purpose of this review was to systematically document the effects of RT on the PFM structure and function in patients with cancer in the pelvic area. Methods An electronic literature search using Pubmed Central, CINAHL, Embase, and SCOPUS was performed from date of inception up to June 2014. The following keywords were used: radiotherapy, muscle tissue, and pelvic floor. Two reviewers selected the studies in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Out of the 369 articles screened, 13 met all eligibility criteria. The methodological quality was assessed using the QualSyst scoring system, and standardized mean differences were calculated. Results Thirteen studies fulfilled all inclusion criteria, from which four were of good methodological quality. One presented strong evidence that RT affects PFM structure in men treated for prostate cancer. Four presented high-level evidence that RT affects PFM function in patients treated for rectal cancer. Meta-analysis was not possible due to heterogeneity and lack of descriptive statistics. Conclusion There is some evidence that RT has detrimental impacts on both PFMs’ structure and function. Implications for cancer survivors A better understanding of muscle damage and dysfunction following RT treatment will improve pelvic floor rehabilitation and, potentially, prevention of its detrimental impacts.