Zoonoplasticity as an intuitive risk protocol for companion-animal-linked zoonoses.

Zoonoses are diseases transmissible between non-human and human animals. Over 200 zoonoses are known, of which at least 60 are associated with (especially exotic) companion animals. Current risk-impact assessment approaches for zoonoses are largely cumbersome and, to be meaningful, may require extensive detailed information. A literature search and review were conducted for current risk assessment protocols for common zoonoses, with subsequent development of two novel rapid scoring methods for evaluating potential risk associated with companion-animal-linked zoonoses. Accordingly, a novel, two-tier methodological concept - â€Ëœzoonoplasticity' - was prepared using an intuitive risk approach. The first tier considers risk principles for companion animals and husbandry practices, and pre-weights animals by class or species. The second tier considers established pathogen- or disease-based questions and assigns a degree of risk. Thus, the zoonoplasticity concept enables pathogens or their resultant zoonoses to be scored and provides a clear points-based protocol offering guidance concerning potential threat, in particular where more quantifiable risk assessment is unavailable because of information deficits. The zoonoplasticity concept was tested with 15 animal species and 22 known zoonoses against European Centre for Disease Prevention and Control (ECDC) operational guidance as a comparative system. Risk categorisation was 100% consistent for 21 of the 22 specific zoonoses, while requiring minimal information input, and the overall comparison rate was 98.85%. Zoonoplasticity is not intended to provide an absolute measure of risk or to replace existing methodologies, rather it is an attempt to standardise a practical judgement protocol that accounts for various relevant issues, and to offer a potentially helpful indicator of concern. The zoonoplasticity concept will be relevant to remits for medical professionals, veterinary medical professionals, public health professionals, government administrators, biomedical researchers and others.

Les zoonoses sont des maladies transmissibles entre les animaux et les humains. Plus de 200 zoonoses sont connues aujourd'hui, dont au moins 60 sont associées à des animaux de compagnie (en particulier les espèces exotiques). Les méthodes actuelles d'évaluation de l'impact du risque zoonotique sont généralement contraignantes et nécessitent de réunir un grand volume d'informations détaillées pour être pertinentes. Une recherche et une analyse documentaires ont été réalisées, afin d'avoir un aperçu des protocoles d'évaluation du risque utilisés actuellement pour les zoonoses courantes, puis deux méthodes rapides de notation ont été mises au point pour évaluer le risque potentiel de zoonoses associé aux animaux de compagnie. À partir de là, un concept méthodologique innovant à deux paliers - la « plasticité zoonotique ¼ - a été élaboré, basé sur une approche intuitive du risque. Le premier palier considère les risques inhérents aux animaux de compagnie et aux pratiques d'élevage, et réalise une appréciation préalable des animaux, par classe ou par espèce. Le deuxième palier considère les problématiques liées aux agents pathogènes ou aux maladies existantes, et assigne des niveaux de risque. Ainsi, le concept de plasticité zoonotique permet d'attribuer une note aux agents pathogènes et aux zoonoses dont ils sont la cause, et fournit un protocole clair, par points, qui donne des indications sur les menaces potentielles, en particulier dans les situations où l'absence de données empêche de procéder à une évaluation quantitative du risque. Le concept de plasticité zoonotique a été testé sur 15 espèces animales et 22 zoonoses connues, en prenant les directives opérationnelles du Centre européen de prévention et de contrôle des maladies (ECDC) comme système de comparaison. La hiérarchisation du risque a présenté une concordance de 100 % pour 21 des 22 zoonoses spécifiques tout en ne nécessitant qu'un minimum d'informations ; le taux global de concordance s'élevait à 98,85 %. La plasticité zoonotique n'est pas destinée à donner une mesure absolue du risque ni à remplacer les méthodologies existantes ; elle cherche plutôt à normaliser un protocole concret d'appréciation qui tienne compte de plusieurs problématiques pertinentes, et à offrir un indicateur potentiellement utile des aspects à prendre en compte. Le concept de plasticité zoonotique est un outil qui pourra servir aux professionnels de la médecine humaine, de la médecine vétérinaire et de la santé publique, ainsi qu'aux gestionnaires de l'action publique, aux chercheurs en sciences biomédicales et à d'autres professionnels dans l'exercice de leurs fonctions.

Las zoonosis son enfermedades que se pueden transmitir de animales no humanos al ser humano. Se conocen más de 200 de estas enfermedades, de las cuales, al menos 60 están asociadas a animales (especialmente exóticos) que son mascotas. Los actuales métodos de determinación del riesgo, aplicados a las zoonosis, son en gran parte engorrosos y pueden requerir, para tener sentido, un gran volumen de detallada información. El autor describe un proceso de búsqueda y examen de referencias bibliográficas sobre protocolos actuales de determinación del riesgo de zoonosis corrientes, tras lo cual expone dos novedosos métodos de puntuación rápida para valorar el posible riesgo de zoonosis asociada a mascotas. Partiendo de la idea del riesgo intuitivo, se acuñó un nuevo concepto metodológico, el de «zoonoplasticidad¼, que funciona en dos pasos: en primer lugar, se consideran una serie de principios y factores de riesgo ligados a las diferentes mascotas y técnicas de cría y se asigna una puntuación preliminar a los animales dependiendo de la clase o especie y de varios aspectos ligados a la cría. En el segundo paso, se plantean una serie de interrogantes clásicos sobre el agente patógeno o la enfermedad y, en función de la respuesta, se atribuye una puntuación correspondiente al grado de riesgo. El concepto de zoonoplasticidad permite, pues, «puntuar¼ al agente patógeno o la zoonosis que este causa y proporciona un claro protocolo que, a partir de esa puntuación, marca pautas ante una eventual amenaza, en especial cuando por falta de información no sea posible determinar el riesgo de manera más cuantitativa. El concepto de zoonoplasticidad fue aplicado experimentalmente a 15 especies animales y 22 zoonosis conocidas, empleando como patrón de comparación la guía operativa del Centro Europeo para la Prevención y el Control de las Enfermedades (ECDC). Con una necesidad mínima de información, la clasificación de los riesgos resultó coherente al 100% para 21 de las 22 zoonosis. Tomada en conjunto, la comparación arrojó un 98,85% de coincidencia. La zoonoplasticidad no tiene por objetivo ofrecer una medida absoluta del riesgo ni venir a sustituir los métodos existentes. Se trata más bien de una tentativa de estandarizar un protocolo práctico de valoración que tenga en cuenta una serie de aspectos importantes y de ofrecer con ello un indicador eventualmente útil que señale posibles motivos de inquietud. El concepto de zoonoplasticidad será de utilidad para la labor de profesionales de la medicina, la veterinaria y la salud pública, el personal de administraciones públicas e investigadores en biomedicina, entre otras profesiones.

Future of keeping pet reptiles and amphibians: animal welfare and public health perspective.

In a review summary on page 450, Pasmans and others discuss the future of keeping reptiles and amphibians as pets. Here, Clifford Warwick and others discuss the animal welfare and public health implications of exotic pet business.

Paracetamol and fever management.

Paracetamol is one of the most commonly used legal drugs in the western world. Its availability is good, cost is low, and its uses include 'over-the-counter' (OTC) distribution, primary care prescribed therapy, secondary care 'post-operative' application and emergency treatment. Stated benefits of paracetamol include: the drug's analgesic effects, preference to aspirin in avoidance of Reye's syndrome, good patient tolerance, and iatrogenic complications are infrequent and minor. Stated cautions include hepatotoxic effect following minor doses and short duration use and users may incur compromised immune integrity. This paper is concerned with paracetamol's role in fever management. Public concern regarding, in particular, childhood fever and febrile convulsions is largely unwarranted. Despite paracetamol's reputation as a popular fever-reducing agent the drug is poorly effective in the control of febrility and febrile convulsions showing no important advantage compared with placebo. Paracetamol is probably grossly over-prescribed for fever management and its value more perceived than real. Greater efforts are needed to inform patients of the natural benefits of the biological strategy of fever and of the highly limited and in some cases contraindicated use of paracetamol in fever management.

Cutaneous myiasis of Cordylobia anthropophaga.

We report on a case of glans penis cutaneous myiasis with Cordylobia anthropophaga acquired from Somalia. The mode of transmission and preventative measures are discussed.

Adult diagnosed Dandy Walker malformation presenting as an acute brainstem event--a case report and review of the literature.

The Dandy Walker Malformation (DWM) is an infrequent condition seen in pediatric patients. Adult presentation of DWM is extremely rare. This condition usually presents in childhood with hydrocephalus and cerebellar signs and symptoms. This case describes a woman with an undiagnosed DWM who was asymptomatic until the age of 56 when she developed the acute onset of headache, nausea, vomiting, and diplopia. Her history and physical exam were consistent with an acute brainstem infarct. MRI revealed the underlying malformation. The clinical and radiological findings are discussed as well as their implications and possible etiologies.

The New Veterinary College, Edinburgh, 1873 to 1904.

This year's BVA Congress takes place in Edinburgh, home of the Royal (Dick) School of Veterinary Studies. However, the Scottish capital has been host to more than one veterinary school over the years, as Colin Warwick and Alastair MacDonald explain.

Can we prevent postnatal depression? A randomized controlled trial to assess the effect of continuity of midwifery care on rates of postnatal depression in high-risk women.

OBJECTIVE: To evaluate the effectiveness of continuous midwifery care in reducing rates of postnatal depression in women with histories of depression. METHODS: Fifty-one women from a sample of 98 pregnant women with histories of major depressive disorder were randomly allocated, at antenatal booking, to continuous midwifery care. The remaining 47 women received standard maternity care. A total of 87 women (44 treatment, 43 control) completed baseline assessments (after randomization) and outcome assessments (at 3 months postpartum). RESULTS: Of the women allocated to continuous midwifery care, 88% complied in full with their allocated treatment protocol. Forty-nine percent of women had an episode of illness in pregnancy (DSM-III-R case of major or minor depression), 26% developed a new episode of illness after antenatal booking, and 23% were depressed in the first 3 months postpartum. There were no differences between treatment conditions in total rates, or rates within the context of social adversity, of antenatal depression, depressions which occurred post-booking, postnatal depression, and the duration of depressive episodes. CONCLUSIONS: While continuous midwifery care had no impact on psychiatric outcome, it was highly successful at engaging women in treatment and therefore has an important contribution to make in the care of child-bearing women with mental health problems.

Getting it right: the teaching of philosophical health care ethics.

This article seeks to show one way in which moral philosophy, considered by the authors to be essential to the nursing and midwifery curricula, can be presented to achieve an optimal learning experience for nurses and midwives. It demonstrates that what might be considered a standard approach, that is, one that begins with ethical principles concerned with rights and duties and then often follows a linear pattern of teaching, may be in danger of promoting a focus on standardized outcomes. Such use of philosophy could therefore actually detract from the process of care. Moral philosophy underpinning health care ethics is commonly misperceived as a method of problem solving when there is an obvious dilemma regarding appropriate care and/or treatment. However, it is readily recognized that key principles within philosophy, for example, deontology and utilitarianism, despite their approach to a standard or criterion of right action, are both deficient in terms of providing ready-made right decisions. This is because their main virtue is to expose the difficulty rather than to solve the problem. Given these difficulties, any subsequent principles such as respect, beneficence, nonmaleficence and justice, incur the same deficiencies a fortiori. It can be argued that the complexity of the environment in which nurses and midwives now practice requires them to develop a capability that begins with the philosophical construction of an issue. This can subsequently enable a recognition of the essential nature of their own involvement as a nurse or midwife. By so doing, nurses and midwives can then bring issues into a nursing or midwifery paradigm and ensure that this perspective informs debate. Ultimately the focus is on the process by which care decisions are made. The intent therefore, is not simply for nurses or midwives to learn moral philosophy or to copy what is considered by others to be right action, but to recognize that a number of right actions are possible and, in so doing, develop their ability either to choose or influence a final action through a valid process. This article proposes and demonstrates by case example that what is often considered as a chance effect for nurses and midwives learning moral philosophy should be seen as the main effect and intended outcome.

Midwives, maternity leave and continuity.

Maternity leave for midwives can cause administrative problems for trusts and heads of midwifery services The demand for continuity and team midwifery created by Changing Childbirth makes inappropriate the use of bank and agency midwives to cover maternity leave. Managers must think imaginatively to accommodate the pregnant and lactating midwife's own needs for rest, successful breastfeeding and flexible hours, so that the midwife can put into persona practice everything she has advocated for her clients.