Improving delivery of primary care for vulnerable migrants: Delphi consensus to prioritize innovative practice strategies.

OBJECTIVE: To identify and prioritize innovative strategies to address the health concerns of vulnerable migrant populations. DESIGN: Modified Delphi consensus process. SETTING: Canada. PARTICIPANTS: Forty-one primary care practitioners, including family physicians and nurse practitioners, who provided care for migrant populations. METHODS: We used a modified Delphi consensus process to identify and prioritize innovative strategies that could potentially improve the delivery of primary health care for vulnerable migrants. Forty-one primary care practitioners from various centres across Canada who cared for migrant populations proposed strategies and participated in the consensus process. MAIN FINDINGS: The response rate was 93% for the first round. The 3 most highly ranked practice strategies to address delivery challenges for migrants were language interpretation, comprehensive interdisciplinary care, and evidence-based guidelines. Training and mentorship for practitioners, intersectoral collaboration, and immigrant community engagement ranked fourth, fifth, and sixth, respectively, as strategies to address delivery challenges. These strategies aligned with strategies coming out of the United States, Europe, and Australia, with the exception of the proposed evidence-based guidelines. CONCLUSION: Primary health care practices across Canada now need to evolve to address the challenges inherent in caring for vulnerable migrants. The selected strategies provide guidance for practices and health systems interested in improving health care delivery for migrant populations.

Ecosystem approach to promoting appropriate antibiotic use for children in indigenous communities in Ecuador.

OBJECTIVE: To collect baseline data on infectious diseases and antibiotic use in two Andean indigenous communities in Ecuador in order to determine the feasibility and acceptability of applying an ecosystem approach to address associated problems. METHODS: In visits to 65 households with children under age 5 years, environmental risk factors for infectious diseases were evaluated through rapid assessment. Caregivers' knowledge, attitudes, and practices related to antibiotic use were determined through a knowledge, practices, and coverage survey; antibiotic use was gleaned from inspection of medicine chests; and overall health of the 91 children (including nutritional status) was assessed. A workshop was held to share results and to craft a multicomponent intervention using an ecohealth framework. RESULTS: Numerous environmental risk factors were identified, especially related to water and sanitation. Knowledge, attitudes, and practices revealed use of traditional and Western medicines and serious knowledge gaps. Antibiotics were present in 60.9% of households in Correuco and 46.8% in La Posta; malnutrition rates were 22.2% in Correuco and 26.1% in La Posta; diarrheic episodes were experienced in the previous month by 26.7% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 50.0% and 47.1% of cases, respectively; and acute respiratory infections were incurred by 28.9% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 53.8% and 50.0% of cases, respectively. CONCLUSIONS: Environmental, social, and cultural factors must be addressed to prevent antibiotic resistance in addition to training health personnel. An ecosystem approach is well-suited for this goal.

Meat properties and fatty acid profile of swine fed cashew bagasse bran in qualitative food restriction program

The purpose of this study was to evaluate the effects of qualitative dietary restriction diet on carcass characteristics, meat quality, fatty acid profile, and performance of finishing pigs fed diets containing cashew bagasse bran. Forty pigs (20 females and 20 males) with initial weight of 60.00±5.24 kg of body weight (BW) were used. The diets were formulated with corn, soybean meal, cashew bagasse bran, vegetable oil, and mineral and vitamin mixture for finishing pigs. The experimental design was in randomized blocks with five treatments and four replicates, with two animals per experimental unit, one of each sex. Parameters related to performance, carcass characteristics, meat quality, and fatty acids profiles were used. The treatments used in the experiment did not affect feed intake and daily weight gain; however, in relation to feed conversion, a linear effect was observed with the increase of cashew bagasse bran levels in the diet. The same effects were also observed in carcass yield, backfat thickness, and fat area. The meat:fat ratio increased linearly with the increase of fiber in the diet. The level of 22.5% of cashew bagasse bran in finishing pig diets is recommended.(AU)

Bran palm giant with exogenous enzymes addition in pig nutrition on growth / Farelo de palma gigante (Opuntia fícus-indica) na alimentação de suínos em crescimento

The objective of this study was to evaluate the use of giant palm meal (FPG) in diets with or without enzymatic supplementation for growing pigs. For the evaluation of the digestibility, ten castrated male pigs with a mean weight of 34.3±6.7 kg, housed in metabolic cages for 15 days (nine of adaptation and six of total collection of feces and urine) were used. The animals were fed twice a day (eight and 15 hours) according to the metabolic weight, five of which received the control diet and five received a test diet with a 30% inclusion of the FPG. The samples were taken daily, homogenized and a 20% aliquot was taken and stored in a freezer. Subsequently, the samples were analyzed in the laboratory of animal nutrition. In the performance test, twenty animals with 28.62±3.66kg were used, distributed in randomized blocks, with five treatments and four replicates. The treatments consisted of inclusion levels of the giant palm meal, associated or not to the enzymatic complex (EC) (0; 5; 10; 5 + EC and 10% + EC). The FPG digestible energy value for pigs in the growing phase was 1113.83 kcal/kg. It was observed that the weight gain and the absolute weight of the organs of the pigs were not influenced by the diets. Feed conversion, feed intake, economic viability of the diets and the relative weight of the organs presented differences between the treatments. It is recommended to include 10% FPG associated with the complex.

Objetivou-se avaliar a utilização do farelo de palma gigante (FPG) em dietas com ou sem suplementação enzimática para suínos em crescimento. Para avaliação da digestibilidade foram utilizados dez suínos machos castrados com peso médio de 34,3 ± 6,7kg, alojados em gaiolas metabólicas por quinze dias (nove de adaptação e seis de coleta total de fezes e urina). Os animais foram alimentados duas vezes ao dia (oito e 15hs) de acordo com o peso metabólico, sendo que cinco receberam a ração controle e cinco receberam dieta teste com 30% de inclusão do FPG. As coletas foram realizadas diariamente, homogeneizadas e retirada uma alíquota de 20% e armazenada em freezer. Posteriormente, as amostras foram analisadas no laboratório de nutrição animal. No ensaio de desempenho foram utilizados vinte animais com 28,62 ± 3,66kg, distribuídos em blocos ao acaso, com cinco tratamentos e quatro repetições. Os tratamentos consistiram em níveis de inclusão do farelo de palma gigante, associado ou não ao complexo enzimático (CE) (0; 5; 10; 5 + CE e 10% + CE). O valor da energia digestível do FPG para suínos na fase de crescimento foi de 1113,83 kcal/kg. Observou-se que o ganho de peso e o peso absoluto dos órgãos dos suínos não foram influenciados pelas dietas. A conversão alimentar, o consumo de ração, a viabilidade econômica das dietas e o peso relativo dos órgãos apresentaram diferenças entre os tratamentos. Recomenda-se a inclusão de 10% de FPG associado ao complexo.

Bran palm giant with exogenous enzymes addition in pig nutrition on growth / Farelo de palma gigante (Opuntia fícus-indica) na alimentação de suínos em crescimento

The objective of this study was to evaluate the use of giant palm meal (FPG) in diets with or without enzymatic supplementation for growing pigs. For the evaluation of the digestibility, ten castrated male pigs with a mean weight of 34.3±6.7 kg, housed in metabolic cages for 15 days (nine of adaptation and six of total collection of feces and urine) were used. The animals were fed twice a day (eight and 15 hours) according to the metabolic weight, five of which received the control diet and five received a test diet with a 30% inclusion of the FPG. The samples were taken daily, homogenized and a 20% aliquot was taken and stored in a freezer. Subsequently, the samples were analyzed in the laboratory of animal nutrition. In the performance test, twenty animals with 28.62±3.66kg were used, distributed in randomized blocks, with five treatments and four replicates. The treatments consisted of inclusion levels of the giant palm meal, associated or not to the enzymatic complex (EC) (0; 5; 10; 5 + EC and 10% + EC). The FPG digestible energy value for pigs in the growing phase was 1113.83 kcal/kg. It was observed that the weight gain and the absolute weight of the organs of the pigs were not influenced by the diets. Feed conversion, feed intake, economic viability of the diets and the relative weight of the organs presented differences between the treatments. It is recommended to include 10% FPG associated with the complex.(AU)

Objetivou-se avaliar a utilização do farelo de palma gigante (FPG) em dietas com ou sem suplementação enzimática para suínos em crescimento. Para avaliação da digestibilidade foram utilizados dez suínos machos castrados com peso médio de 34,3 ± 6,7kg, alojados em gaiolas metabólicas por quinze dias (nove de adaptação e seis de coleta total de fezes e urina). Os animais foram alimentados duas vezes ao dia (oito e 15hs) de acordo com o peso metabólico, sendo que cinco receberam a ração controle e cinco receberam dieta teste com 30% de inclusão do FPG. As coletas foram realizadas diariamente, homogeneizadas e retirada uma alíquota de 20% e armazenada em freezer. Posteriormente, as amostras foram analisadas no laboratório de nutrição animal. No ensaio de desempenho foram utilizados vinte animais com 28,62 ± 3,66kg, distribuídos em blocos ao acaso, com cinco tratamentos e quatro repetições. Os tratamentos consistiram em níveis de inclusão do farelo de palma gigante, associado ou não ao complexo enzimático (CE) (0; 5; 10; 5 + CE e 10% + CE). O valor da energia digestível do FPG para suínos na fase de crescimento foi de 1113,83 kcal/kg. Observou-se que o ganho de peso e o peso absoluto dos órgãos dos suínos não foram influenciados pelas dietas. A conversão alimentar, o consumo de ração, a viabilidade econômica das dietas e o peso relativo dos órgãos apresentaram diferenças entre os tratamentos. Recomenda-se a inclusão de 10% de FPG associado ao complexo.(AU)

Qualitative feed restriction for late finishing pigs on meat quality and fatty acid profile / Restrição alimentar qualitativa para suínos em fase de terminação sobre a qualidade da carne e perfil de ácidos graxos

The aim of this study was to evaluate the effects of including cashew bagasse bran (CBB) as a food ingredient in qualitative feed restriction programs on the carcass traits and meat quality of barrows and gilts. Twentyfour crossbred pigs (12 barrows and 12 gilts) were used, with an average initial body weight of 57.93 ± 3.67 kg/LW. The experimental design was a randomized block 3x2 factorial arrangement with three levels (0%, 15% and 30% CBB), two sexes (barrows and gilts) and four repetitions. The treatments were composed of the basal diet (BD) formulated with corn, soybean meal and a commercial base mix for finishing pigs, to which different levels of CBB were added. At the end of the trial period, the animals were slaughtered for the evaluation of the meat quality and carcass traits. The inclusion of CBB in the diets did not affect the carcass traits of the gilts but affected the carcass traits of the barrow positively, increasing theyield of meat in the chilled carcass and reducing the thickness of subcutaneous fat. In the longissimus dorsi muscle and in the adipose tissue of the pigs, the myristic (C14:0), palmitoleic (C16:1), oleic (C18:1), linoleic (C18:2), linolenic (C18:3) and arachidonic (C20:4) fatty acids were evaluated, and no effect was observed (P > 0.05) from the levels of CBB in the diets. In the comparisons between the sexes, a greater concentration of C20

Objetivou-se com este estudo avaliar os efeitos do farelo do bagaço de caju (CBB) como ingrediente de rações em programas de restrição alimentar sobre as características da carcaça e da qualidade da carne de suínos machos castrados e fêmeas. Foram utilizados vinte e quatro suínos mestiços (12 machos castra dos e 12 fêmeas) com peso médio inicial de 57,93 ± 3,67 kg/PV. O delineamento experimental foi o de blocos casualizados em um esquema fatorial 3x2, sendo três níveis (0%, 15% e 30% de CBB), dois sexos e quatro repetições. Os tratamentos foram compostos por uma dieta basal (DB) formulada com milho, farelo de soja e núcleo comercial para suínos em terminação, contendo diferentes níveis de CBB. No final do período experimental os animais foram abatidos para a avaliação da carcaça e da qualidade de carne. A inclusão de CBB nas dietas não afetou a qualidade das carcaças das fêmeas, mas interferiu positivamente nas carcaças dos machos castrados, aumentando o rendimento de carne na carcaça resfriada e reduzindo a espessura de toucinho. Foram identificados no músculo Longissimus dorsi e no tecido adiposo das fêmeas e machos castrados os ácidos graxos Mirístico, C14:0; Palmitoléico, C16:1; Oléico, C18:1; Linoléico, C18:2; Linolênico C18:3 e Aracdônico C20:4, mas, não foram afetados (P > 0,05) pelos níveis de CBB nas dietas. Quando se comparou os resultados entre sexo, observou-se m

Partition of the P excreted in the faeces and urine of growing pigs, fed with diets containing different levels of Phytase enzyme / Partição do P excretado nas fezes e urina de suínos em fase de crescimento, alimentados com dietas contendo diferentes níveis de enzima fitase

This study had as purpose to evaluate the partition of P excreted in the faeces and urine of growing pigs fed with diets containing different levels of inclusion of phytase enzyme, through the use of radioisotope P-32.). Twenty pigs crossbred barrows were evaluated in a randomized block design experiment, with five treatments, 0; 250; 500; 750 and 1000PUkg diet, and four replicates. The animals were kept in metabolic cages for a 10-day adaptation period and seven days for total collection of feces and urine. Blood samples were taken for five days. On the first day of the collection period each animal was injected intravenously with 7.4MBq 32P phytase. The use of Phytase in diets for pigs provides reduction of P total and soluble excreted in the feces. On diets for growing pigs containing corn and soybean meal, you can reduce by 50% of the supplementation of the dicalcium phosphates, adding 500UF/kg diet, without causing damage to animal physiological system.

Este estudo teve como propósito avaliar a partição do P excretados nas fezes e urina de suínos em fase de crescimento, alimentados com dietas contendo diferentes níveis de inclusão de enzima fitase, através do uso do radioisótopo P-32. Foram utilizados 20 suínos, machos castrados, em delineamento de blocos ao acaso, com cinco tratamentos 0; 250; 500; 750 e 1000UF/kg da ração - e quatro repetições. Os animais foram alojados em gaiolas metabólicas por 17 dias, sendo dez dias para adaptação e sete dias para coleta de fezes e urina. Amostras de sangue foram coletadas por cinco dias. No primeiro dia da fase experimental, cada animal recebeu por via endovenosa uma solução radioativa com 7,4MBq de 32P. O uso de fitase em dietas para suínos proporciona redução do P total e solúvel excretados nas fezes. Pode-se reduzir em 50% a suplementação de P por fosfato bicálcico nas dietas para suínos em crescimento, adicionando 500UF/kg de dieta, sem provocar prejuízos ao sistema fisiológicos dos animais.

Partition of the P excreted in the faeces and urine of growing pigs, fed with diets containing different levels of Phytase enzyme / Partição do P excretado nas fezes e urina de suínos em fase de crescimento, alimentados com dietas contendo diferentes níveis de enzima fitase

This study had as purpose to evaluate the partition of P excreted in the faeces and urine of growing pigs fed with diets containing different levels of inclusion of phytase enzyme, through the use of radioisotope P-32.). Twenty pigs crossbred barrows were evaluated in a randomized block design experiment, with five treatments, 0; 250; 500; 750 and 1000PUkg diet, and four replicates. The animals were kept in metabolic cages for a 10-day adaptation period and seven days for total collection of feces and urine. Blood samples were taken for five days. On the first day of the collection period each animal was injected intravenously with 7.4MBq 32P phytase. The use of Phytase in diets for pigs provides reduction of P total and soluble excreted in the feces. On diets for growing pigs containing corn and soybean meal, you can reduce by 50% of the supplementation of the dicalcium phosphates, adding 500UF/kg diet, without causing damage to animal physiological system.(AU)

Este estudo teve como propósito avaliar a partição do P excretados nas fezes e urina de suínos em fase de crescimento, alimentados com dietas contendo diferentes níveis de inclusão de enzima fitase, através do uso do radioisótopo P-32. Foram utilizados 20 suínos, machos castrados, em delineamento de blocos ao acaso, com cinco tratamentos 0; 250; 500; 750 e 1000UF/kg da ração - e quatro repetições. Os animais foram alojados em gaiolas metabólicas por 17 dias, sendo dez dias para adaptação e sete dias para coleta de fezes e urina. Amostras de sangue foram coletadas por cinco dias. No primeiro dia da fase experimental, cada animal recebeu por via endovenosa uma solução radioativa com 7,4MBq de 32P. O uso de fitase em dietas para suínos proporciona redução do P total e solúvel excretados nas fezes. Pode-se reduzir em 50% a suplementação de P por fosfato bicálcico nas dietas para suínos em crescimento, adicionando 500UF/kg de dieta, sem provocar prejuízos ao sistema fisiológicos dos animais.(AU)

Ecosystem approach to promoting appropriate antibiotic use for children in indigenous communities in Ecuador / Enfoque ecosistémico de promoción del uso adecuado de antibióticos en niños de comunidades indígenas del Ecuador

Objetivo. Recopilar datos iniciales sobre las enfermedades infecciosas y el uso deantibióticos en dos comunidades indígenas andinas del Ecuador, con el objeto de determinar la factibilidad y la aceptabilidad de aplicar un enfoque ecosistémico para abordar los problemas asociados.Métodos. Mediante visitas a 65 hogares con niños menores de 5 años, se valoraron los factores de riesgo ambientales de las enfermedades infecciosas mediante una evaluación rápida. Se identificaron los conocimientos, las actitudes y las prácticas de los cuidadores relacionados con el uso de antibióticos por medio de una encuesta de conocimientos, prácticas y cobertura; el uso de antibióticos se dedujo a partir de lainspección de los botiquines; y se evaluó el estado general de salud de los 91 niños (incluido su estado de nutrición). Se organizó un taller para transmitir los resultadosy para diseñar una intervención de múltiples componentes basada en un marco ecosistémico de la salud. Resultados. Se encontraron numerosos factores de riesgo ambientales, especialmentelos relacionados con el agua y el saneamiento. El análisis del conocimiento, las actitudes y las prácticas reveló el uso de medicamentos tradicionales y occidentales, y profundas brechas de conocimiento. Había antibióticos en 60,9% de los hogares de Correuco y en 46,8% de La Posta; las tasas de desnutrición eran de 22,2% en Correuco y de 26,1% en La Posta; el mes anterior a la encuesta 26,7% de los niños de Correuco y 47,8% de los niños de La Posta habían tenido episodios de diarrea, con prescripción de antibióticos en 50,0% y 47,1% de los casos, respectivamente; y 28,9% de los niños de Correuco y 47,8% de los niños de La Posta habían tenido infecciones respiratorias agudas, con prescripción de antibióticos en 53,8% y 50,0% de los casos, respectivamente...

Objective. To collect baseline data on infectious diseases and antibiotic use in two Andean indigenous communities in Ecuador in order to determine the feasibility and acceptability of applying an ecosystem approach to address associated problems. Methods. In visits to 65 households with children under age 5 years, environmental risk factors for infectious diseases were evaluated through rapid assessment. Caregivers’knowledge, attitudes, and practices related to antibiotic use were determined through a knowledge, practices, and coverage survey; antibiotic use was gleaned from inspection of medicine chests; and overall health of the 91 children (including nutritional status) wasassessed. A workshop was held to share results and to craft a multicomponent intervention using an ecohealth framework. Results. Numerous environmental risk factors were identified, especially related to waterand sanitation. Knowledge, attitudes, and practices revealed use of traditional and Western medicines and serious knowledge gaps. Antibiotics were present in 60.9% of households inCorreuco and 46.8% in La Posta; malnutrition rates were 22.2% in Correuco and 26.1% in La Posta; diarrheic episodes were experienced in the previous month by 26.7% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 50.0% and 47.1% of cases, respectively; and acute respiratory infections were incurred by 28.9% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 53.8% and 50.0% of cases, respectively. Conclusions. Environmental, social, and cultural factors must be addressed to preventantibiotic resistance in addition to training health personnel. An ecosystem approach is wellsuited for this goal.

Qualitative feed restriction for late finishing pigs on meat quality and fatty acid profile / Restrição alimentar qualitativa para suínos em fase de terminação sobre a qualidade da carne e perfil de ácidos graxos

The aim of this study was to evaluate the effects of including cashew bagasse bran (CBB) as a food ingredient in qualitative feed restriction programs on the carcass traits and meat quality of barrows and gilts. Twentyfour crossbred pigs (12 barrows and 12 gilts) were used, with an average initial body weight of 57.93 ± 3.67 kg/LW. The experimental design was a randomized block 3x2 factorial arrangement with three levels (0%, 15% and 30% CBB), two sexes (barrows and gilts) and four repetitions. The treatments were composed of the basal diet (BD) formulated with corn, soybean meal and a commercial base mix for finishing pigs, to which different levels of CBB were added. At the end of the trial period, the animals were slaughtered for the evaluation of the meat quality and carcass traits. The inclusion of CBB in the diets did not affect the carcass traits of the gilts but affected the carcass traits of the barrow positively, increasing theyield of meat in the chilled carcass and reducing the thickness of subcutaneous fat. In the longissimus dorsi muscle and in the adipose tissue of the pigs, the myristic (C14:0), palmitoleic (C16:1), oleic (C18:1), linoleic (C18:2), linolenic (C18:3) and arachidonic (C20:4) fatty acids were evaluated, and no effect was observed (P > 0.05) from the levels of CBB in the diets. In the comparisons between the sexes, a greater concentration of C20

Objetivou-se com este estudo avaliar os efeitos do farelo do bagaço de caju (CBB) como ingrediente de rações em programas de restrição alimentar sobre as características da carcaça e da qualidade da carne de suínos machos castrados e fêmeas. Foram utilizados vinte e quatro suínos mestiços (12 machos castra dos e 12 fêmeas) com peso médio inicial de 57,93 ± 3,67 kg/PV. O delineamento experimental foi o de blocos casualizados em um esquema fatorial 3x2, sendo três níveis (0%, 15% e 30% de CBB), dois sexos e quatro repetições. Os tratamentos foram compostos por uma dieta basal (DB) formulada com milho, farelo de soja e núcleo comercial para suínos em terminação, contendo diferentes níveis de CBB. No final do período experimental os animais foram abatidos para a avaliação da carcaça e da qualidade de carne. A inclusão de CBB nas dietas não afetou a qualidade das carcaças das fêmeas, mas interferiu positivamente nas carcaças dos machos castrados, aumentando o rendimento de carne na carcaça resfriada e reduzindo a espessura de toucinho. Foram identificados no músculo Longissimus dorsi e no tecido adiposo das fêmeas e machos castrados os ácidos graxos Mirístico, C14:0; Palmitoléico, C16:1; Oléico, C18:1; Linoléico, C18:2; Linolênico C18:3 e Aracdônico C20:4, mas, não foram afetados (P > 0,05) pelos níveis de CBB nas dietas. Quando se comparou os resultados entre sexo, observou-se m

Acompanhamento e controle de pacientes com hipertensão arterial sistêmica na Estratégia Saúde da Família Mais Viver, no município de Janaúba - Minas Gerais

A Hipertensão Arterial Sistêmica é uma condição clínica de alta prevalência, mas com taxas baixas de controle. É considerada um dos principais fatores de risco para as doenças cardiovasculares, as quais se configuram a principal causa de morte em nosso país e responsáveis por alta frequência de internações, ocasionando custos elevados. A equipe de saúde elegeu a falta de controle da Hipertensão Arterial Sistêmica como problema prioritário da área de abrangência por ter constatado um sub diagnóstico dessa condição, pela falta de acompanhamento adequado dos pacientes e pela importância desse problema para a saúde pública. Este trabalho tem como objetivo propor um plano de intervenção para melhorar o controle da pressão arterial de pacientes da área de abrangência da Estratégia Saúde da Família "Mais Viver". Para subsidiar a elaboração do plano de ação foi realizada uma pesquisa bibliográfica nos bancos de dados da Biblioteca Virtual em Saúde para identificar as evidências já existentes sobre o tema objeto deste estudo. Para a elaboração do plano de ação foram utilizados os passos do Planejamento Estratégico Situacional com a finalidade de ajudar a equipe a melhorar o seu desempenho junto aos usuários. Isto será possível através da implantação de ações como diagnosticar precocemente e cadastrar os hipertensos, manter a população bem informada sobre o assunto, estratificar o risco cardiovascular de todos os usuários diagnosticados como hipertensos e organizar o serviço para melhor atender aos hipertensos