A systematic review of economic assessments for brucellosis control interventions in livestock populations.

Brucellosis in livestock is a disease of paramount importance to animal and human health authorities due to its socio-economic and public health consequences. Benefit cost analyses can help policymakers decide whether allocation of resources is economically beneficial to cover the costs of brucellosis control interventions in populations. One broad question of interest is: what are the consequences of acting, or failing to act, on policy options of selected intervention scenarios (e.g., vaccination, test-and-slaughter, vaccination combined with test-and-slaughter, versus a status-quo scenario). The objective of the systematic review reported here was to conduct a critical appraisal of published research reports of economic assessments of brucellosis control interventions in livestock populations. The systematic review followed standard guidelines using a Population, Intervention, Comparison, Outcome, and Context framework and Preferred Reporting Items for Systematic Review and Meta-Analysis. The review targeted research reports focused on brucellosis control interventions in livestock populations at the national or regional level. Economic outcomes of interest were benefit-cost ratio (BCR), net present value, internal rate of return, or payback period. Eleven studies conducted in Brazil, China, India, Iraq, Mexico, Mongolia, Spain, Turkey, or the USA met the inclusion criteria and were included. The baseline prevalence of brucellosis in selected study populations ranged from 1.4% in cattle in Turkey to 20% in goats in Mexico. In six studies, selected intervention scenarios of vaccination alone produced BCRs that ranged from 3.2 in yaks in China or in cattle, sheep and goats in Mongolia, to 21.3 in cattle and/or buffalo in India. In three studies, interventions of test-and-slaughter produced BCRs that ranged from - 1.2 in goats in Mexico to 0.6 in cattle in Spain. In four studies, vaccination in combination with test-and-slaughter produced BCRs that ranged from 0.2 in yaks in China to 3.7 in cattle and buffalo in India. In seven studies, using sensitivity analysis, different input parameters (prevalence of brucellosis, meat price, cashmere price, vaccination coverage, test-and-slaughter coverage, milk price, vaccination protection, abortion cost, abortion rate, or price of lamb) had an impact on economic outcomes. Vaccination alone was cost-effective, but test-and-slaughter was not, for brucellosis control in selected livestock populations in focus countries. Vaccination in combination with test-and-slaughter produced profitable or nonprofitable economic outcomes. While most studies reported the cost and benefits of implementing brucellosis control interventions, only one study explained socio-economic consequences of economic outcomes, when acting, or failing to act, on selected interventions in livestock populations.

Prevalência de doenças crônicas não transmissíveis no sistema prisional: um desafio para a saúde pública / Prevalence of chronic noncommunicable diseases in the prison system: a public health challenge

Resumo Para estimar a prevalência de fatores de risco e doenças crônicas não transmissíveis em pessoas privadas de liberdade, foi realizado um estudo descritivo, transversal e quantitativo, com aplicação de questionário, atendimento clínico e exames laboratoriais. Foram sorteados 202 participantes de uma penitenciária masculina, em 2019. A análise dos dados verificou associações por meio do teste exato de Fisher e do teste qui-quadrado. O perfil sociodemográfico predominante dos participantes consistiu em solteiros, negros, maiores de 30 anos, de baixa escolaridade e alta reincidência penitenciária. A maioria era sedentária, tabagista, com alto consumo de álcool e drogas antes do encarceramento. Encontrou-se prevalência de 24,8% de hipertensão arterial, 54,5% de dislipidemia, 49,9% de excesso de peso, 16,8% de síndrome metabólica e 2,5% de diabetes. A dificuldade de acesso aos serviços de saúde associada às longas penas e ao ambiente insalubre propiciam o desenvolvimento e agravamento de doenças crônicas e seus fatores de risco, representando um desafio para a organização da atenção à saúde prisional. Esse cenário reitera a necessidade de aplicação de recursos e esforços para a efetivação do cuidado integral, longitudinal e equânime para as pessoas privadas de liberdade.

Abstract A descriptive, cross-sectional, and quantitative study was conducted in 2019 with 202 participants randomly selected from a male penitentiary, with the application of a questionnaire, clinical care, and laboratory tests to estimate the prevalence of risk factors and noncommunicable chronic diseases in people deprived of their liberty. Data analysis verified associations using Fisher's Exact Test and Chi-square Test. The predominant sociodemographic profile of the participants consisted of less-educated single, black, over 30 males with high prison recidivism. Most were sedentary smokers with high alcohol and drug consumption before incarceration. We identified prevalence levels of hypertension (24.8%), dyslipidemia (54.5%), overweight (49.9%), metabolic syndrome (16.8%), and diabetes (2.5%). The difficulty in accessing health services associated with long sentences and the unhealthy environment favors the development and deterioration of chronic diseases and their risk factors, a challenge for the organization of prison health care. This setting reiterates the need to apply resources and efforts to implement comprehensive, longitudinal, and equitable care for people deprived of liberty.

Prevalence of chronic noncommunicable diseases in the prison system: a public health challenge. / Prevalência de doenças crônicas não transmissíveis no sistema prisional: um desafio para a saúde pública.

A descriptive, cross-sectional, and quantitative study was conducted in 2019 with 202 participants randomly selected from a male penitentiary, with the application of a questionnaire, clinical care, and laboratory tests to estimate the prevalence of risk factors and noncommunicable chronic diseases in people deprived of their liberty. Data analysis verified associations using Fisher's Exact Test and Chi-square Test. The predominant sociodemographic profile of the participants consisted of less-educated single, black, over 30 males with high prison recidivism. Most were sedentary smokers with high alcohol and drug consumption before incarceration. We identified prevalence levels of hypertension (24.8%), dyslipidemia (54.5%), overweight (49.9%), metabolic syndrome (16.8%), and diabetes (2.5%). The difficulty in accessing health services associated with long sentences and the unhealthy environment favors the development and deterioration of chronic diseases and their risk factors, a challenge for the organization of prison health care. This setting reiterates the need to apply resources and efforts to implement comprehensive, longitudinal, and equitable care for people deprived of liberty.

Para estimar a prevalência de fatores de risco e doenças crônicas não transmissíveis em pessoas privadas de liberdade, foi realizado um estudo descritivo, transversal e quantitativo, com aplicação de questionário, atendimento clínico e exames laboratoriais. Foram sorteados 202 participantes de uma penitenciária masculina, em 2019. A análise dos dados verificou associações por meio do teste exato de Fisher e do teste qui-quadrado. O perfil sociodemográfico predominante dos participantes consistiu em solteiros, negros, maiores de 30 anos, de baixa escolaridade e alta reincidência penitenciária. A maioria era sedentária, tabagista, com alto consumo de álcool e drogas antes do encarceramento. Encontrou-se prevalência de 24,8% de hipertensão arterial, 54,5% de dislipidemia, 49,9% de excesso de peso, 16,8% de síndrome metabólica e 2,5% de diabetes. A dificuldade de acesso aos serviços de saúde associada às longas penas e ao ambiente insalubre propiciam o desenvolvimento e agravamento de doenças crônicas e seus fatores de risco, representando um desafio para a organização da atenção à saúde prisional. Esse cenário reitera a necessidade de aplicação de recursos e esforços para a efetivação do cuidado integral, longitudinal e equânime para as pessoas privadas de liberdade.

Beyond the Gender of the Livestock Holder: Learnings from Intersectional Analyses of PPR Vaccine Value Chains in Nepal, Senegal, and Uganda.

The peste des petits ruminants (PPR) is a deadly viral disease of small ruminants, which are an important source of livelihood for hundreds of millions of poor smallholders throughout Africa, the Middle East, and Asia. PPR vaccination efforts often focus on overcoming financial, technological, and logistical constraints that limit their reach and effectiveness. This study posits that it is equally important to pay attention to the role of gender and other intersecting social and cultural factors in determining individual and groups' ability to access PPR vaccines or successfully operate within the vaccine distribution system. We compare three study contexts in Nepal, Senegal, and Uganda. Qualitative data were collected through a total of 99 focus group discussions with men and women livestock keepers and animal health workers, 83 individual interviews, and 74 key informant interviews. Our findings show that there are not only important gender differences, but also interrelated structures of inequalities, which create additional sites of exclusion. However, these intersections are not generalizable across contexts-except for the intersection of gender and geographic remoteness, which is salient across vaccine distribution systems in the three countries-and social markers such as caste, ethnicity, and livelihood are associated with vulnerability only in specific settings. In order to address the distinct needs of livestock keepers in given settings, we argue that an intersectional analysis combined with context-dependent vaccination approaches are critical to achieving higher vaccination rates and, ultimately, PPR disease eradication by 2030.

Gender and intersectional analysis of livestock vaccine value chains in Kaffrine, Senegal.

Among livestock species, poultry and small ruminants are of particular importance to rural women in low- and middle-income countries, as means to generate income, provide nutritious food for the family, accumulate wealth, and confer social status. Newcastle disease (ND) and Peste des Petits Ruminants (PPR) are widespread livestock diseases of poultry and small ruminants, respectively. While both diseases are vaccine preventable, numerous constraints limit the availability of and access to livestock vaccines, especially among the most vulnerable populations in developing countries. The literature on equity and effectiveness of livestock vaccine distribution systems has emphasized many of these constraints, however a gendered analysis and deeper understanding of the vaccine system remain insufficient. This paper applies a gendered and intersectional transformational approach, or GITA, to highlight how gender and other social factors affect the provision and utilization of vaccines for ND and PPR diseases in the region of Kaffrine, Senegal. We first articulate and describe the vaccine value chains (VVCs) for these diseases in Kaffrine, and then analyze the gendered and intersectional dynamics at different nodes of the VVCs, including actors at the national level, through the regional and district levels, down to providers of animal health at community level and the livestock keepers themselves. Our findings indicate that actors' various experiences are shaped and defined mainly by rigid gender norms, location and remoteness, and to a lesser degree by other social stratifications of age, ethnicity, and livelihood. Given the significant role that gender norms play in the livestock vaccine value chains, differences according to the livestock species, regulation of vaccine administration, and vaccine distribution systems emerge as highly relevant for understanding barriers that women specifically face within the livestock vaccination system.

Deficiências nutricionais na cirurgia bariátrica / Nutritional deficiencies in surgery bariatric

Quando clinicamente a reeducação alimentar, uso de medicamentos e a prática de atividades físicas se torna ineficientes, a cirurgia bariátrica é a principal opção para tratamento da obesidade grau III. O paciente submetido à cirurgia bariátrica sofre mudanças anatômicas e fisiológicas que são realizadas durante o procedimento cirúrgico e juntamente com algumas deficiências nutricionais já presentes, resultam em uma diminuição maior ainda de vitaminas e minerais, dentre as principais estão o cálcio, vitamina B12, ferro e vitamina D. O objetivo deste estudo é verificar as deficiências nutricionais ocorridas devido à carência de nutrientes em pacientes submetidos à cirurgia bariátrica. Foi realizada uma pesquisa bibliográfica a partir dos artigos publicados junto ao banco de dados Medline, Lilacs e Scielo, selecionadas publicações escritas desde o início do ano de 2000 até o ano de 2014. O paciente após realizar a cirurgia bariátrica deve ter um suporte nutricional durante todo o tempo de adaptação à nova rotina de alimentação, aprendendo a fazer escolhas de alimentos saudáveis e com valor nutricional adequado, prevenindo assim as deficiências nutricionais e obtendo um bom resultado do tratamento proposto

When clinically dietary reeducation, use of medications and physical activity becomes inefficient, bariatric surgery is the main option for the treatment of morbid obesity. The patient undergoing bariatric surgery suffers anatomical and physiological changes that take place during the surgical procedure and with some nutritional deficiencies already present, resulting in a greater decrease even of vitamins and minerals, among the most important are calcium, vitamin B12, iron and vitamin D. the aim of this study is to assess the nutritional deficiencies that occurred due to the lack of nutrients in patients undergoing bariatric surgery. Was carried out a literature search from articles published by the Medline, Lilacs and Scielo, selected publications written since the beginning of the year 2000 until the year 2014. The patient after performing bariatric surgery should have a nutritional support was held during all the time to adapt to new eating routine, learning to make healthy food choices and proper nutritional value, thereby preventing nutritional deficiencies and getting a good result of treatment