Economic evaluation of a novel community-based diabetes care model in rural Mexico: a cost and cost-effectiveness study.

OBJECTIVES: Diabetes is the leading cause of disability-adjusted life years in Mexico, and cost-effective care models are needed to address the epidemic. We sought to evaluate the cost and cost-effectiveness of a novel community-based model of diabetes care in rural Mexico, compared with usual care. DESIGN: We performed time-driven activity-based costing to estimate annualised costs associated with typical diabetes care in Chiapas, Mexico, as well as a novel diabetes care model known as Compañeros En Salud Programa de Enfermedades Crónicas (CESPEC). We conducted Markov chain analysis to estimate the cost-effectiveness of CESPEC compared with usual care from a societal perspective. We used patient outcomes from CESPEC in 2016, as well as secondary data from existing literature. SETTING: Rural primary care clinics in Chiapas, Mexico. PARTICIPANTS: Adults with diabetes. INTERVENTIONS: CESPEC is a novel, comprehensive, diabetes care model that integrates community health workers, provider education, supply chain management and active case finding. OUTCOME MEASURE: The primary outcome was the incremental cost-effectiveness of CESPEC compared with care as usual, per quality-adjusted life year (QALY) gained, expressed in 2016 US dollars. RESULTS: The economic cost of the CESPEC diabetes model was US$144 per patient per year, compared with US$125 for diabetes care as usual. However, CESPEC care was associated with 0.13 additional years of health-adjusted life expectancy compared with usual care and 0.02 additional years in the first 5 years of treatment. This translated to an incremental cost-effectiveness ratio (ICER) of US$2981 per QALY gained over a patient's lifetime and an ICER of US$10 444 over the first 5 years. Findings were robust to multiple sensitivity analyses. CONCLUSIONS: CESPEC is a cost-effective, community-based model of diabetes care for patients in rural Mexico. Given the high prevalence and significant morbidity associated with diabetes in Mexico and other countries in Central America, this model should be considered for broader scale up and evaluation

Ciencias Sociales: Economía y Humanidades HANDBOOK T-I

Se presenta un breve examen de la producción y comercialización de rosa en México; un estudio en México sobre el ingreso mínimo de las familias que identifica la línea de pobreza alimentaria en el área rural del sur de México, 2012; un pequeño estudio donde hablará sobre el análisis comparado del Sector Gubernamental y la Economía Mexicana desde la perspectiva de los eslabonamientos productivos Hirshman-Rasmuss; un estudio sobre los canales de comercialización de limón persa en el municipio de Martínez de la Torre, Veracruz; una análisis del comercio estratégico en el TLCAN: El Estado en la política agrícola de biocombustibles; también se expresan acerca de la importancia de la comercialización del café en México; un diagnóstico, retos del comercio electrónico en el Sector Agroindustrial Mexicano; trabajo nos muestra y habla sobre la inversión extranjera directa y su impacto en crecimiento de México, un análisis en prospectiva: 1999-2010; un estudio acerca sobre la importancia de la Banca en México; un trabajo acerca de la competitividad de la producción agrícola en México, un análisis regional; se analizan todo acerca de el SIAL productor de quesos en Poxtla, competividad y territorio; se habla acerca de la intermediación financiera al servicio de la comunidad indígena: el fondo regional indígena Tarhiata Keri; ademas un estudio acerca de la demanda de Importaciones de durazno (Prunus pérsica L. Batsch) en México procedentes de Estados Unidos de América (1982-2011); Loera y Sepúlveda analizan los parámetros de la productividad forestal en la producción de madera en rollo; un análisis de factores sociales, ambientales y económicos del territorio rural cercano a la ciudad de México; un estudio acerca de la crisis económica mundial y su efecto sobre los flujos migratorios de América Latina; Magadán, Hernández y Escalona presentan la tipología de los sujetos sociales que intervienen en el mercado campesino de Ocotlán Oaxaca; la normalización del proceso de compostaje: una opción para desarrollar el mercado de la composta; acerca de la reestructuración del capitalismo y crisis política en México; la rentabilidad de la producción de miel en el municipio de León, Guanjuato; la economía del maíz en la región metropolitana, Chiapas, 2014; análisis de los centros de educación y cultura ambiental, necesidad de profesionalización Pedagógica de facilitadores ambientales; los Costos y competitividad de la producción del limón persa en el municipio de Martínez de la Torre, Veracruz

Estudo da relação entre lisogenia e diversificação ecotípica mediada por bacteriófagos na evolução rápida do Vibrio cholerae

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Resumo: Bacteriófagos são os organismos mais abundantes e diversos do planeta. Estima-se que 1031 partículas de fagos circulam praticamente em todos os ambientes da terra. Fagos desenvolvem complexas interações com seus hospedeiros – as bactérias, apresentando um papel ecológico de fundamental importância enquanto solubilizadores e sumidouros globais de carbono, além de controlar a abundância e diversidade bacteriana. Nem todos os ciclos infecciosos mediados por fagos resultam na morte da bactéria e fagos podem desenvolver complexos processos de lisogenia, integrando-se ao genoma e coexistindo com suas hospedeiras por tempo indeterminado. No processo de lisogenia fagos oferecem arcabouço genético às suas hospedeiras, podendo transformar fenótipos e induzir processos de conversão, como por exemplo, transformar bactérias inofensivas em virulentas. O Vibrio cholerae é uma bactéria ambiental, cuja evolução enquanto patógeno humano está associada à aquisição de genes através da infecção por um ou mais fagos temperados. Esta mudança drástica, no entanto, pode não ser um evento isolado na biologia da espécie. É possível que um grupo mais amplo de fagos interaja com a espécie nos diversos locais de sua existência, determinando alterações fenotípicas e linhagens evolutivas. O presente estudo avalia o fenômeno da conversão lisogênica do V. cholerae sob uma ótica global de evolução da espécie. O “profagoma” da espécie foi determinado em 162 sequências genômica, definindose a relação deste com a filogenia, filogeografia e relógio molecular da espécie. Diferentes relações entre fagos e populações de V. cholerae foram identificadas, mostrando que estes organismos co-evoluem com a bactéria desde o tempo de seu ancestral comum mais recente. Três cepas de V. cholerae que compunham a amostragem genômica foram estudadas detalhadamente a partir de ensaios fenotípicos, considerando diferentes faixas de temperatura, pH e concentrações de sais. Seus fenótipos foram associados com a expressão mRNA de genes de fagos, verificando-se a expressão diferencial destes genes com variações fenotípicas, sugerindo que as diferentes espécies de profagos associadas a genomas de V. cholerae configuram-se como agentes de evolução rápida e diversificação ecotípica da bactéria

Metabolic models of human gut microbiota: Advances and challenges.

The human gut is a complex ecosystem consisting of hundreds of microbial species interacting with each other and with the human host. Mathematical models of the gut microbiome integrate our knowledge of this system and help to formulate hypotheses to explain observations. The generalized Lotka-Volterra model has been widely used for this purpose, but it does not describe interaction mechanisms and thus does not account for metabolic flexibility. Recently, models that explicitly describe gut microbial metabolite production and consumption have become popular. These models have been used to investigate the factors that shape gut microbial composition and to link specific gut microorganisms to changes in metabolite concentrations found in diseases. Here, we review how such models are built and what we have learned so far from their application to human gut microbiome data. In addition, we discuss current challenges of these models and how these can be addressed in the future.info:eu-repo/semantics/publishe

Starvation responses impact interaction dynamics of human gut bacteria Bacteroides thetaiotaomicron and Roseburia intestinalis

Bacterial growth often alters the environment, which in turn can impact interspecies interactions among bacteria. Here, we used an in vitro batch system containing mucin beads to emulate the dynamic host environment and to study its impact on the interactions between two abundant and prevalent human gut bacteria, the primary fermenter Bacteroides thetaiotaomicron and the butyrate producer Roseburia intestinalis. By combining machine learning and flow cytometry, we found that the number of viable B. thetaiotaomicron cells decreases with glucose consumption due to acid production, while R. intestinalis survives post-glucose depletion by entering a slow growth mode. Both species attach to mucin beads, but only viable cell counts of B. thetaiotaomicron increase significantly. The number of viable co-culture cells varies significantly over time compared to those of monocultures. A combination of targeted metabolomics and RNA-seq showed that the slow growth mode of R. intestinalis represents a diauxic shift towards acetate and lactate consumption, whereas B. thetaiotaomicron survives glucose depletion and low pH by foraging on mucin sugars. In addition, most of the mucin monosaccharides we tested inhibited the growth of R. intestinalis but not B. thetaiotaomicron. We encoded these causal relationships in a kinetic model, which reproduced the observed dynamics. In summary, we explored how R. intestinalis and B. thetaiotaomicron respond to nutrient scarcity and how this affects their dynamics. We highlight the importance of understanding bacterial metabolic strategies to effectively modulate microbial dynamics in changing conditions.ISSN:1751-7362ISSN:1751-737

Complete Genome Sequence of a Sucrose-Nonfermenting Epidemic Strain of Vibrio cholerae O1 from Brazil

Submitted by Sandra Infurna ([email protected]) on 2018-11-29T16:27:51Z No. of bitstreams: 1 anaCP_vicente_etal_IOC_2012.pdf: 85091 bytes, checksum: 21a9ac0bb61adafc66c73f4f8f851d58 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2018-11-29T16:37:43Z (GMT) No. of bitstreams: 1 anaCP_vicente_etal_IOC_2012.pdf: 85091 bytes, checksum: 21a9ac0bb61adafc66c73f4f8f851d58 (MD5)Made available in DSpace on 2018-11-29T16:37:43Z (GMT). No. of bitstreams: 1 anaCP_vicente_etal_IOC_2012.pdf: 85091 bytes, checksum: 21a9ac0bb61adafc66c73f4f8f851d58 (MD5) Previous issue date: 2012Instituto Evandro Chagas. Laboratório de Microbiologia Ambiental. Ananindeua, PA, Brasil.Instituto Evandro Chagas. Laboratório de Microbiologia Ambiental. Ananindeua, PA, Brasil.Instituto Evandro Chagas. Secção de Bacteriologia. Ananindeua, PA, Brasil.Instituto Evandro Chagas. Centro de Inovação Tecnológica. Ananindeua, PA, Brasil.Instituto Evandro Chagas. Centro de Inovação Tecnológica. Ananindeua, PA, Brasil.Instituto Evandro Chagas. Centro de Inovação Tecnológica. Ananindeua, PA, Brasil.Instituto Evandro Chagas. Centro de Inovação Tecnológica. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ. Brasil.Instituto Evandro Chagas. Laboratório de Microbiologia Ambiental. Ananindeua, PA, Brasil.We report the genome sequence of Vibrio cholerae strain IEC224, which fails to ferment sucrose. It was isolated from a cholera outbreak in the Amazon. The defective sucrose phenotype was determined to be due to a frameshift mutation, and a molecular marker of the Latin American main epidemic lineage was identified

Genome-wide study of the defective sucrose fermenter strain of Vibrio cholerae from the Latin American cholera epidemic.

Contains fulltext : 108030.pdf (publisher's version ) (Open Access)The 7th cholera pandemic reached Latin America in 1991, spreading from Peru to virtually all Latin American countries. During the late epidemic period, a strain that failed to ferment sucrose dominated cholera outbreaks in the Northern Brazilian Amazon region. In order to understand the genomic characteristics and the determinants of this altered sucrose fermenting phenotype, the genome of the strain IEC224 was sequenced. This paper reports a broad genomic study of this strain, showing its correlation with the major epidemic lineage. The potentially mobile genomic regions are shown to possess GC content deviation, and harbor the main V. cholera virulence genes. A novel bioinformatic approach was applied in order to identify the putative functions of hypothetical proteins, and was compared with the automatic annotation by RAST. The genome of a large bacteriophage was found to be integrated to the IEC224's alanine aminopeptidase gene. The presence of this phage is shown to be a common characteristic of the El Tor strains from the Latin American epidemic, as well as its putative ancestor from Angola. The defective sucrose fermenting phenotype is shown to be due to a single nucleotide insertion in the V. cholerae sucrose-specific transportation gene. This frame-shift mutation truncated a membrane protein, altering its structural pore-like conformation. Further, the identification of a common bacteriophage reinforces both the monophyletic and African-Origin hypotheses for the main causative agent of the 1991 Latin America cholera epidemics

Population and Genetic Study of <i>Vibrio cholerae</i> from the Amazon Environment Confirms that the <i>WASA-1</i> Prophage Is the Main Marker of the Epidemic Strain that Circulated in the Region

<div><p><i>Vibrio cholerae</i> is a natural inhabitant of many aquatic environments in the world. Biotypes harboring similar virulence-related gene clusters are the causative agents of epidemic cholera, but the majority of strains are harmless to humans. Since 1971, environmental surveillance for potentially pathogenic <i>V. cholerae</i> has resulted in the isolation of many strains from the Brazilian Amazon aquatic ecosystem. Most of these strains are from the non-O1/non-O139 serogroups (NAGs), but toxigenic O1 strains were isolated during the Latin America cholera epidemic in the region (1991-1996). A collection of environmental <i>V. cholerae</i> strains from the Brazilian Amazon belonging to pre-epidemic (1977-1990), epidemic (1991-1996), and post-epidemic (1996-2007) periods in the region, was analyzed. The presence of genes related to virulence within the species and the genetic relationship among the strains were studied. These variables and the information available concerning the strains were used to build a Bayesian multivariate dependency model to distinguish the importance of each variable in determining the others. Some genes related to the epidemic strains were found in environmental NAGs during and after the epidemic. Significant diversity among the virulence-related gene content was observed among O1 strains isolated from the environment during the epidemic period, but not from clinical isolates, which were analyzed as controls. Despite this diversity, these strains exhibited similar PFGE profiles. PFGE profiles were significant while separating potentially epidemic clones from indigenous strains. No significant correlation with isolation source, place or period was observed. The presence of the <i>WASA-1</i> prophage significantly correlated with serogroups, PFGE profiles, and the presence of virulence-related genes. This study provides a broad characterization of the environmental <i>V. cholerae</i> population from the Amazon, and also highlights the importance of identifying precisely defined genetic markers such as the <i>WASA-1</i> prophage for the surveillance of cholera.</p> </div

Geographical distribution of <i>V. cholerae</i> isolates.

<p>The geographical location of rivers, streams, and wastewater plants from where the strains that were used in this study were isolated are indicated in the map. The sizes of markers indicate the number of strains in each location, markers are centered in the cities where the strains were isolated (see Table S1). Belem (yellow), Barcarena (light green), Maruda (pink), Macapá (dark green), Oiapoque (light blue), Manaus (red), Tabatinga (light blue), Rio Branco (purple), and Santa Rosa (orange). Quantities of strains isolated in each period are indicated in the bar graphs. </p