Strategies to Control Classical Swine Fever: Cost and Risk Perspectives

The paper examines the importance of pig population density in the area of an outbreak of CSF for the spread of the disease and the choice of control measures. A sector-level market and trade model and a spatial, stochastic, dynamic epidemiological simulation model for the Netherlands were used. Outbreaks in sparsely and densely populated areas were compared under four different control strategies and with two alternative trade assumptions. Results indicate that the control strategy required by current EU legislation is enough to eradicate an epidemic starting in an area with sparse pig population. By contrast, additional control measures are necessary if the outbreak begins in an area with high pig population density. The economic consequences of using preventive slaughter rather than emergency vaccination as an additional control measure depend strongly on the reactions of trading partners. Reducing the number of animal movements significantly reduces the size and length of epidemics in areas with high pig density.Classical Swine Fever epidemics, pig population density, animal transport, emergency vaccination, preventive slaughter, the Netherlands, Farm Management,

Updated cost-effectiveness and risk-benefit analysis of two infant rotavirus vaccination strategies in a high-income, low-endemic setting.

Since 2013, a biennial rotavirus pattern has emerged in the Netherlands with alternating high and low endemic years and a nearly 50% reduction in rotavirus hospitalization rates overall, while infant rotavirus vaccination has remained below 1% throughout. As the rotavirus vaccination cost-effectiveness and risk-benefit ratio in high-income settings is highly influenced by the total rotavirus disease burden, we re-evaluated two infant vaccination strategies, taking into account this recent change in rotavirus epidemiology

Consumers' preferences for freezing of meat to prevent toxoplasmosis- A stated preference approach.

Consumption of raw or undercooked meat increases the risk of infection with Toxoplasma gondii. Freezing meat products can eliminate this risk. Freezing of meat may affect consumers' valuation of meat products in two different ways: it may be valued positively because of increased food safety or valued negatively because of (perceived) loss of quality. In a Discrete Choice Experiment on four different meat products we studied the difference in willingness to pay for frozen and non-frozen meat products in the Netherlands. Analyses revealed that most Dutch consumer groups prefer non-frozen meat. Price was important in consumer decisions, whereas the meat being frozen appeared to play a minor role in the decision to purchase meat products. Even though it may seem obvious that people would prefer safe food to unsafe food, in a context where consumers presume food being safe, many consumers appear unwilling to pay for freezing of meat as additional measure to reduce the risk of food borne infections such as toxoplasmosis

Agreement between diagnoses of childhood lymphoma assigned in Uganda and by an international reference laboratory

BACKGROUND: Correct diagnosis is key to appropriate treatment of cancer in children. However, diagnostic challenges are common in low-income and middle-income countries. The objective of the present study was to assess the agreement between a clinical diagnosis of childhood non- Hodgkin lymphoma (NHL) assigned in Uganda, a pathological diagnosis assigned in Uganda, and a pathological diagnosis assigned in The Netherlands. METHODS: The study included children with suspected NHL referred to the Mulago National Referral Hospital, Kampala, Uganda, between 2004 and 2008. A clinical diagnosis was assigned at the Mulago National Referral Hospital, where tissue samples were also obtained. Hematoxylin and eosin-stained slides were used for histological diagnosis in Uganda, and were re-examined in a pathology laboratory in The Netherlands, where additional pathological, virological and serological testing was also carried out. Agreement between diagnostic sites was compared using kappa statistics. RESULTS: Clinical and pathological diagnoses from Uganda and pathological diagnosis from The Netherlands was available for 118 children. The agreement between clinical and pathological diagnoses of NHL assigned in Uganda was 91% (95% confidence interval [CI] 84–95; kappa 0.84; P < 0.001) and in The Netherlands was 49% (95% CI 40–59; kappa 0.04; P = 0.612). When Burkitt’s lymphoma was considered separately from other NHL, the agreement between clinical diagnoses in Uganda and pathological diagnoses in Uganda was 69% (95% CI 59–77; kappa 0.56; P < 0.0001), and the corresponding agreement between pathological diagnoses assigned in The Netherlands was 32% (95% CI 24–41; kappa 0.05; P = 0.326). The agreement between all pathological diagnoses assigned in Uganda and The Netherlands was 36% (95% CI 28–46; kappa 0.11; P = 0.046). CONCLUSION: Clinical diagnosis of NHL in Uganda has a high probability of error compared with pathological diagnosis in Uganda and in The Netherlands. In addition, agreement on the pathological diagnosis of NHL between Uganda and The Netherlands is very low

A social cost-benefit analysis of two One Health interventions to prevent toxoplasmosis

In the Netherlands, toxoplasmosis ranks second in disease burden among foodborne pathogens with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €45 million annually. Therefore, effective and preferably cost-effective preventive interventions are warranted. Freezing meat intended for raw or undercooked consumption and improving biosecurity in pig farms are promising interventions to prevent Toxoplasma gondii infections in humans. Putting these interventions into practice would expectedly reduce the number of infections; however, the net benefits for society are unknown. Stakeholders bearing the costs for these interventions will not necessary coincide with the ones having the benefits. We performed a Social Cost-Benefit Analysis to evaluate the net value of two potential interventions for the Dutch society. We assessed the costs and benefits of the two interventions and compared them with the current practice of education, especially during pregnancy. A ‘minimum scenario’ and a ‘maximum scenario’ was assumed, using input parameters with least benefits to society and input parameters with most benefits to society, respectively. For both interventions, we performed different scenario analyses. The freezing meat intervention was far more effective than the biosecurity intervention. Despite high freezing costs, freezing two meat products: steak tartare and mutton leg yielded net social benefits in both the minimum and maximum scenario, ranging from €10.6 million to €31 million for steak tartare and €0.6 million to €1.5 million for mutton leg. The biosecurity intervention would result in net costs in all scenarios ranging from €1 million to €2.5 million, due to high intervention costs and limited benefits. From a public health perspective (i.e. reducing the burden of toxoplasmosis) and the societal perspective (i.e. a net benefit for the Dutch society) freezing steak tartare and leg of mutton is to be considered

Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes

Objective: To explore how changing incentive designs influence wellness participation and health outcomes. Methods: Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes. Results: Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL)(P \u3c 0.01), three with improved blood pressure (P \u3c 0.001), and two with improved fasting glucose (P \u3c 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk. Conclusion: Incentive design and organizational characteristics impact population-level participation and health outcomes

Current status and future prospects of epidemiology and public health training and research in the WHO African region

Background To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders. Methods A bibliometric analysis was performed to identify published epidemiological research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire. Results From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC) = 10.1%, P for trend 90%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P < 0.001, each vs South Africa). Independent predictors of relevant research productivity were ‘in-country numbers of epidemiology or public health programmes' [incidence rate ratio (IRR) = 3.41; 95% confidence interval (CI) 1.90-6.11; P = 0.03] and ‘number of HIV/AIDS patients' (IRR = 1.30; 95% CI 1.02-1.66; P < 0.001). Conclusions Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the continen

Language and rigour in qualitative research: Problems and principles in analyzing data collected in Mandarin

In collaborative qualitative research in Asia, data are usually collected in the national language, and this poses challenges for analysis. Translation of transcripts to a language common to the whole research team is time consuming and expensive; meaning can easily be lost in translation; and validity of the data may be compromised in this process. We draw on several published examples from public health research conducted in mainland China, to highlight how language can influence rigour in the qualitative research process; for each problem we suggest potential solutions based on the methods used in one of our research projects in China