Surveillance strategies for Classical Swine Fever in wild boar – a comprehensive evaluation study to ensure powerful surveillance

Surveillance of Classical Swine Fever (CSF) should not only focus on livestock, but must also include wild boar. To prevent disease transmission into commercial pig herds, it is therefore vital to have knowledge about the disease status in wild boar. In the present study, we performed a comprehensive evaluation of alternative surveillance strategies for Classical Swine Fever (CSF) in wild boar and compared them with the currently implemented conventional approach. The evaluation protocol was designed using the EVA tool, a decision support tool to help in the development of an economic and epidemiological evaluation protocol for surveillance. To evaluate the effectiveness of the surveillance strategies, we investigated their sensitivity and timeliness. Acceptability was analysed and finally, the cost-effectiveness of the surveillance strategies was determined. We developed 69 surveillance strategies for comparative evaluation between the existing approach and the novel proposed strategies. Sampling only within sub-adults resulted in a better acceptability and timeliness than the currently implemented strategy. Strategies that were completely based on passive surveillance performance did not achieve the desired detection probability of 95%. In conclusion, the results of the study suggest that risk-based approaches can be an option to design more effective CSF surveillance strategies in wild boar

Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia

OBJECTIVE: Exploring the associations of regional differences in infant mortality with selected socioeconomic indicators and ethnicity could offer important clues for designing public health policy measures. METHODS: Data included perinatal and infant mortality in the 79 districts of the Slovak population in 2004. Linear regression was used to analyse the contribution of education, unemployment, income and proportion of Roma population on regional differences in perinatal and infant mortality rates. RESULTS: All the explored socioeconomic indicators and ethnicity individually contributed significantly to both perinatal and infant mortality, with the exception of income. In the model exploring the influence of all these variables together on perinatal and infant mortality, only the effect of the proportion of Roma population remained significant. This model explained 34.9% of the variance for perinatal and 36.4% of the variance for infant mortality. CONCLUSIONS: Living in Roma settlements indicates an accumulation of socioeconomic disadvantage. Health literacy, health-related behaviour and many other factors might contribute to the explanation of the differences in infant mortality, and a better understanding of these processes might help us to design tailored interventions

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

Summary We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. Purpose To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. Methods Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. Results A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. Conclusions Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis

Incidência e fatores de risco de lesões em jogadores de futsal portugueses

INTRODUÇÃO: A reduzida expressão de estudos publicados sobre a incidência de lesões no Futsal em Portugal justificou a realização deste trabalho. OBJETIVO: Identificar as potenciais causas de lesões nesta modalidade, referência para o desenvolvimento de protocolos específicos de prevenção de lesões. MÉTODOS: A amostra foi constituída por 411 jogadores federados de Futsal em Portugal, masculinos e femininos, de diferentes níveis competitivos. Foram utilizados os dados coletados num questionário com informação retrospectiva. O tratamento estatístico consistiu na análise inferencial entre grupos através do teste de Kruskal-Wallis e do teste para dados não paramétricos de Mann-Whitney (nível de significância de 5%). RESULTADOS: Os resultados confirmaram a entorse da articulação tíbio-társica como a lesão de maior incidência (48,8% do total) no Futsal. As lesões com período de impedimento entre oito e 28 dias tiveram a maior expressão (52,7% do total). Este estudo não revelou diferenças significativas em relação ao gênero ou posição em que os jogadores ocupam na quadra sobre a incidência, o tipo ou a região anatômica das lesões. No entanto, verificou-se significativamente maior incidência de entorses e contraturas em situação de treino e maior incidência de roturas musculares e fraturas em jogo, sendo que essas últimas provocaram um período de impedimento maior para os atletas. Também se verificou significativamente maior incidência de lesões articulares ou ósseas, entorses e fraturas, em resultado do contato com adversários e maior incidência de lesões musculares ou ligamentares sem contato com adversários. Os resultados não evidenciaram diferenças significativas na lateralidade das lesões. CONCLUSÃO: Os resultados realçam a importância de programas específicos de prevenção da entorse da tíbio-társica, especialmente nas crianças e jovens, independentemente da posição que ocupam na quadra, particularmente em situações de contato com adversários

Knowledge into action: using research findings to inform policies in maternal and newborn health

Background: Many interventions found to be effective in research studies on maternal and newborn health and survival, fail to translate into policies and health service delivery models in settings with high maternal and newborn morbidity and mortality. IDEAS is a 5-year project funded by Bill & Melinda Gates Foundation, in three areas with high burden of maternal and neonatal mortality: Ethiopia, North-Eastern Nigeria and Uttar Pradesh in India. The project is a multi-method evaluation of complex interventions in maternal and newborn health (MNH), and is implemented by the London school of Hygiene & Tropical Medicine. One of the objectives of the project is to assess the extent to which innovative MNH care models are scaled up and to identify enabling and inhibiting factors to scale up. As part of this assessment we have undertaken a qualitative study to explore how research findings and knowledge generated in pilot projects are used by policy makers in developing policies and strategies for MNH. Methods Building on frameworks for transferring knowledge into action (Lavis et al 2009; Darmschroder et al 2009), we developed a topic guide seeking to explore views of researchers, policy makers and other stakeholders on translating research findings into policy. A total of about 75 in-depth interviews are being undertaken in Ethiopia, Nigeria and India. The topic guide is used as a flexible tool allowing participants to express opinions and raise issues that are most relevant to them. The interviews are recorded and transcribed verbatim. The transcripts are analysed by a team of researchers from London and the three countries, using framework analysis for policy research. This abstract presents emerging findings from pilot interviews in Ethiopia and India. Findings Willingness of policy makers to consider research findings depends to a great extent on how they perceive the quality of the evidence: whether it is conducted by an independent organisation, whether it is statistically significant and whether health outcomes could be attributed to particular components of complex, multi-layered programmes. The way evidence is disseminated influences the likelihood of its uptake into policy. It is more likely to be considered if it is presented by people who had legitimacy (experts in the field); if the audience included high level decision makers and donors who had the authority to act on the data; and if it included demonstartion sites (taking decision makers to the field to get emotional buy-in. Interpretation Translation of research evidence into policy depends on 1) the nature of the evidence and how the strength and validity (independence) of the evidence is perceived; 2) the way research is communicated: by whom (messenger), to whom (audience) and how (vehicle); 3) the ability and willingness of decision-makers to use evidence depending on capacity and context. References Damschroder LJ, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50. Lavis JN, et al. SUPPORT Tools for evidence-informed health Policymaking (STP). Introduction. Health Research Policy and Systems 2009, 7(Suppl 1):I

Methodological approaches to evaluation of complex interventions in maternal and newborn health: IDEAS project

The IDEAS project aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health. IDEAS is funded between 2010 and 2015 by a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. This poster outlines the reseach objectives and how research questions will be addressed