From Manaus to Maputo: Toward a Public Health and Biodiversity Framework

The linkages between human health, biodiversity, ecosystems, and the life-supporting services that they provide are varied and complex. The traditional neglect of this nexus by policy-makers perpetuates threats posed to ecosystems with potentially critical impacts on global health. The Convention on Biological Diversity and the World Health Organization recently co-convened two regional workshops on these intricate but vital linkages. From discussions held with policy-makers and experts in the biodiversity and health sectors, spanning some 50 countries in Africa and the Americas, we derive a broad framework for the development of national and regional public health and biodiversity strategies relevant to strategic planning processes in the emerging post-2015 development context

Connecting global priorities: biodiversity and human health: a state of knowledge review.

Healthy communities rely on well-functioning ecosystems. They provide clean air, fresh water, medicines and food security. They also limit disease and stabilize the climate. But biodiversity loss is happening at unprecedented rates, impacting human health worldwide.The report, Connecting Global Priorities: Biodiversity and Human Health, focuses on the complex and multi-faceted connections between biodiversity and human health, and how the loss of biodiversity and corresponding ecosystem services may negatively influence health. One of the first integrative reviews of its kind, the report brings together knowledge from several scientific disciplines, including public health, conservation, agriculture, epidemiology and development. The book is a joint publication of the Convention on Biological Diversity and World Health Organization. Danny Hunter, Senior Scientist, Bioversity International is one of the Lead Coordinating Authors of the book and co-lead author on two chapters:Chapter 5: Agricultural biodiversity and food security Chapter 6: Biodiversity and nutritio

Our planet, our health, our future. Human health and the Rio conventions: biological diversity, climate change and desertification

Health is our most basic human right and one of the most important indicators of sustainable development. We rely on healthy ecosystems to support healthy communities and societies. Wellfunctioning ecosystems provide goods and services essential for human health. These include nutrition and food security, clean air and fresh water, medicines, cultural and spiritual values, and contributions to local livelihoods and economic development. They can also help to limit disease and stabilize the climate. Health policies need to recognize these essential contributions. The three so-called Rio Conventions arising from the 1992 Earth Summit – the Convention on Biological Diversity, the United Nations Framework Convention on Climate Change and the United Nations Convention to Combat Desertification – together aim to maintain well-functioning ecosystems for the benefit of humanity. There is growing evidence of the impacts of global environmental changes on ecosystems and people, and a renewed consciousness among peoples and nations of the need to act quickly to protect the planet’s ecological and climatic systems. In the last two decades, the Rio Conventions have brought global attention to the impacts of anthropogenic change on the ecosystems of the planet. Increasingly unsustainable practices are placing pressure on natural resources to meet the demands of our economies and the needs of a rapidly growing global population, resulting in soil, water and air pollution, increased emissions of greenhouse gases, deforestation and land use change, expanded urban areas, introduction of non-native species, and inadequately planned development of water and land resources to meet food and energy needs. These changes are having both direct and indirect impacts on our climate, ecosystems and biological diversity. More than ever, the pursuit of public health, at all levels from local to global, now depends on careful attention to the processes of global environmental change. Traditional knowledge and scientific evidence both point to the inexorable role of global environmental changes in terms of their impact on human health and well-being. In many countries, anthropogenic changes to agriculture-related ecosystems have resulted in great benefits for human health and well-being, in particular through increased global food production and improved food security. These positive impacts, however, have not benefited everyone, and unsustainable levels of use of ecosystems have resulted in irreparable loss and degradation, with negative consequences for health and well-being. These range from emerging infectious diseases to malnutrition, and contribute to the rapid rise in noncommunicable diseases. Large-scale human transformation of the environment has contributed to increased disease burdens associated with the expansion of ecological and climatic conditions favourable for disease vectors. For all humans, the provision of adequate nutrition, clean water, and long-term food security depend directly on functioning agro-ecosystems and indirectly on the regulating ecosystem services of the biosphere; these ecosystem services can be eroded if overexploited and poorly managed

Cell Blood Count Alterations and Patterns of Anaemia in Autoimmune Atrophic Gastritis at Diagnosis: A Multicentre Study

Background: Autoimmune atrophic gastritis (AAG) leads to iron and/or vitamin B12 malabsorption, with subsequent haematological alterations which could represent the sole clinical manifestation. We aimed to assess patterns of anaemia and micronutrient deficiencies in patients with AAG at the time of diagnosis. Methods: Observational, multicentre, cross-sectional study including consecutive adult patients diagnosed with AAG within the last ten years. Cell blood count, red cell distribution width, serum vitamin B12, and ferritin were collected. Multivariate analysis for predictive factors of anaemia was computed. Results: 654 AAG patients (mean age 59.2 \ub1 13.8 years, female (F): male (M) ratio = 2.3:1) were included. Anaemia was present in 316 patients (48.3%; mean age 60.1 \ub1 15.8 years, F:M ratio = 2.3:1). Pernicious anaemia (132/316 cases, 41.7%) was more common in males (27.1% versus 12.4%; p = 0.001) and in older patients (63.0 \ub1 14.6 versus 58.9 \ub1 14.9 years; p = 0.014), while iron deficiency anaemia (112/316 cases, 35.4%) was more common in females (16.9% versus 10.0%; p = 0.039) and in younger patients (56.8 \ub1 16.6 versus 60.2 \ub1 14.6 years; p = 0.043). The prevalence of iron deficiency was equally distributed between anaemic and non-anaemic patients (p = 0.9). Anisocytosis (odds ratio: 10.65, 95% confidence interval: 6.13-18.50, p < 0.0001) was independently associated with anaemia. Conclusions: Anaemia is a common manifestation in AAG patients, mostly due to micronutrient deficiencies. Scant haematologic alterations and micronutrient deficiencies may precede overt anaemia

Cell Blood Count Alterations and Patterns of Anaemia in Autoimmune Atrophic Gastritis at Diagnosis: A Multicentre Study

Background: Autoimmune atrophic gastritis (AAG) leads to iron and/or vitamin B12 malabsorption, with subsequent haematological alterations which could represent the sole clinical manifestation. We aimed to assess patterns of anaemia and micronutrient deficiencies in patients with AAG at the time of diagnosis. Methods: Observational, multicentre, cross-sectional study including consecutive adult patients diagnosed with AAG within the last ten years. Cell blood count, red cell distribution width, serum vitamin B12, and ferritin were collected. Multivariate analysis for predictive factors of anaemia was computed. Results: 654 AAG patients (mean age 59.2 ± 13.8 years, female (F): male (M) ratio = 2.3:1) were included. Anaemia was present in 316 patients (48.3%; mean age 60.1 ± 15.8 years, F:M ratio=2.3:1). Pernicious anaemia (132/316 cases, 41.7%) wasmore common inmales (27.1% versus 12.4%; p = 0.001) and in older patients (63.0 ± 14.6 versus 58.9 ± 14.9 years; p = 0.014), while iron deficiency anaemia (112/316 cases, 35.4%) was more common in females (16.9% versus 10.0%; p = 0.039) and in younger patients (56.8 ± 16.6 versus 60.2 ± 14.6 years; p = 0.043). The prevalence of iron deficiency was equally distributed between anaemic and non-anaemic patients (p = 0.9). Anisocytosis (odds ratio: 10.65, 95% confidence interval: 6.13–18.50, p < 0.0001) was independently associated with anaemia. Conclusions: Anaemia is a common manifestation in AAG patients, mostly due to micronutrient deficiencies. Scant haematologic alterations and micronutrient deficiencies may precede overt anaemia

Real-time gastric juice analysis with EndoFaster for H. pylori diagnosis: A large, multicentre study

Background Helicobacter pylori infection is the main cause of the most frequent gastroduodenal diseases. Because its prevalence is decreasing in developed countries, gastric biopsies are negative in several patients. By measuring ammonium in the gastric juice, EndoFaster allows to exclude H. pylori infection during endoscopy. This study aimed to assess the accuracy of device versions working with either 6 ml or 3 ml of gastric juice. Study design This prospective study involved 12 endoscopic units. During endoscopy, EndoFaster testing was performed and standard five gastric biopsies were taken. The accuracy was calculated by considering histological assessment as the gold standard for H. pylori diagnosis. Results Gastric juice analysis was attempted in 1279 patients, but it failed in 131 (15.5%) and in 10 (2.3%), with the 6 ml and the 3 ml device, respectively (P < 0.001). Overall, EndoFaster detected H. pylori infection with an 86.3% sensitivity, 83.3% specificity, 52.7% positive predictive value, 96.6% negative predictive value and 83.8% accuracy. The performance was not affected either by ongoing proton pump inhibitor therapy or a previous H. pylori eradication. No significant difference in accuracy emerged between the two versions of the device. Conclusion The novel version of the EndoFaster device operating with 3 ml gastric juice may be performed in virtually all patients, and it allows excluding H. pylori infection with a very high accuracy. Gastric biopsies can be avoided in a definite portion of cases without endoscopic lesions or other clinical indications

An Italian prospective multicenter study on colonoscopy practice and quality: What has changed in the last 10 years

Background: A relevant number of adenomas can be missed during colonoscopy. Aims: Assess the current status of colonoscopy procedures in Italian centers. Methods: A prospective observational study involving 17 hospitals (34 endoscopists) included consecutive patients undergoing standard colonoscopy. In the first phase, endoscopists performed consecutive colonoscopies. In the second phase, retraining via an online learning platform was planned, while in the third phase data were collected analogously to phase 1. Results: A total of 3,504 patients were enrolled. Overall, a BBPS score ≥6 was obtained in 95.6% of cases (94.8% and 96.9% in the pre- and post-training phases, respectively). 88.4% of colonoscopies had a withdrawal time ≥6 min (88.2% and 88.7% in the pre- and post-training phases). Median adenoma detection rate (ADR) was 39.1%, with no significant differences between the pre- and post-training phases (40.1% vs 36.9%; P = 0.83). In total, 81% of endoscopists had a ADR performance above the 25% threshold. Conclusion: High colonoscopy quality standards are achieved by the Italian hospitals involved. Quality improvement initiatives and repeated module-based colonoscopy-training have been promoted in Italy during the last decade, which appear to have had a significant impact on quality colonoscopy metrics together with the activation of colorectal cancer screening programs