How the epidemiological transition affects health policy isues in three Latin American countries

The authors focus on health policy issues associated with health reform needed to meet the health needs arising from the demographic and epidemiological transitions. They illustrate these policy issues by analyzing Brazil, Colombia, and Mexico, whose populations represent about 60 percent of Latin America's population. Brazil, Colombia, and Mexico are facing an important decline in mortality and fertility rates. New health problems have arisen related to rapid urbanization and industrialization - for example, injuries, accidental intoxication and poisoning, and the occupational and noncommunicable conditions (such as hypertension and diabetes) affecting an aging population. At the same time, these countries are not free of old health problems - such as infectious and parasitic diseases - although their mortality rates are declining. That is, old and new health problems coexist while wide social disparities persist in these developing Latin American countries. The epidemiological diversity and the speed of change in disease profiles makes the health transition in many developing countries more complex than the situation developed countries faced. Most of these countries also have inadequate health infrastructure and are unlikely to be able to afford to develop them in the next decade or so. Most governments are also being pressed to adopt the therapeutic medical model to deal with noncommunicable conditions. The authors arrive at the following seven conclusions about the implications of the epidemiological transition for health policy in developing Latin American countries. The transition offers an empirical framework for strategic planning for the health system, allowing policymakers to anticipate future trends and causes of mortality and anticipate disease scenarios. Since more disease is expected among the adult and elderly populations, the health system's mission should be revised with more emphasis on disease prevention and control and less on satisfying demand. Existing inequities in the geographical distribution of health resources and in the quality of care between health institutions should be corrected to avoid greater epidemiological polarization. The health care model should be reformed to strengthen the technical capacity to provide preventive and curative services at the first level of care to control the dual burden of disease. Efficiency and quality of care need to be substantially improved to accommodate the greater demand for clinical services, especially those provided at hospitals. Criteria for setting priorities in the health sector must be defined, so resources can be allocated among competing health needs and socioeconomic groups. These countries need to strengthen their ability to analyze the health status of populations, to evaluate the health system's performance, and to design cost-effective interventions to deal with noncommunicable diseases.Health Monitoring&Evaluation,Health Systems Development&Reform,Housing&Human Habitats,Agricultural Knowledge&Information Systems,Gender and Health

Occurrence of foodborne pathogens in Italian soft artisanal cheeses displaying different intra- and inter-batch variability of physicochemical and microbiological parameters

Artisanal cheeses are produced in small-scale production plants, where the lack of full automation and control of environmental and processing parameters suggests a potential risk of microbial contamination. The aim of this study was to perform a longitudinal survey in an Italian artisanal factory producing a spreadable soft cheese with no rind to evaluate the inter- and intra-batch variability of physicochemical and microbial parameters on a total of 720 environmental and cheese samples. Specifically on cheese samples, the evaluation was additionally performed on physicochemical parameters. Cheese samples were additionally collected during 15 days of storage at constant temperatures of 2 and 8 degrees C, as well as a dynamic profile of 2 degrees C for 5 days and 8 degrees C for 10 days. Furthermore, Enterobacteriaceae isolates were identified at species level to have a better knowledge of the environmental and cheese microbiota potentially harboring human pathogens. High inter-batch variability was observed for lactic acid bacteria (LAB) and total bacteria count (TBC) in cheese at the end of production but not for pH and water activity. A temperature of 8 degrees C was associated with a significantly higher load of Enterobacteriaceae in cheeses belonging to batch 6 at the end of storage, and this temperature also corresponded with the highest increase in LAB and TBC loads over cheese shelf life. Results from generalized linear mixed models (GLMMs) indicated that drains in the warm room and the packaging area were associated with higher levels of TBC and Enterobacteriaceae in cheese. Regarding foodborne pathogens, no sample was positive for verotoxigenic Escherichia coli (VTEC) or Listeria monocytogenes, whereas six Staphylococcus aureus and one Salmonella pullorum isolates were collected in cheese samples during storage and processing, respectively. Regarding Enterobacteriaceae, 166 isolates were identified at species level from all batches, with most isolates belonging to Klebsiella oxytoca and pneumoniae, Enterobacter cloacae, Hafnia alvei, and Citrobacter freundii evidencing the need to focus on standardizing the microbial quality of cow milk and on hygienic procedures for cleaning and disinfection especially in warm and maturation rooms. Further studies should be performed to investigate the potential pathogenicity and antimicrobial resistance of the identified Enterobacteriaceae species in artisanal cheeses

Dynamic thermal treatments in green coconut water induce dynamic stress adaptation of listeria innocua that increases its thermal resistance

The global coconut water market is projected to grow in the upcoming years, attributed to its numerous health benefits. However, due to its susceptibility to microbial contamination and the limitations of non-thermal decontamination methods, thermal treatments remain the primary approach to ensure the shelf-life stability and the microbiological safety of the product. In this study, the thermal inactivation of Listeria innocua, a Listeria monocytogenes surrogate, was evaluated in coconut water and in tryptone soy broth (TSB) under both isothermal (50–60 °C) and dynamic conditions (from 30 to 60 °C, with temperature increases of 0.5, 1 and 5 °C/min). Mathematical models were used to analyse the inactivation data. The Geeraerd model effectively described the thermal inactivation of L. innocua in both TSB and coconut water under isothermal conditions, with close agreement between experimental data and model fits. Parameter estimates and analysis revealed that acidified TSB is a suitable surrogate medium for studying the thermal inactivation of L. innocua in coconut water, despite minor differences observed in the shoulder length of inactivation curves, likely attributed to the media composition. The models fitted to the data obtained at isothermal conditions fail to predict L. innocua responses under dynamic conditions. This is attributed to the stress acclimation phenomenon that takes place under dynamic conditions, where bacterial cells adapt to initial sub-lethal treatment stages, leading to increased thermal resistance. Fitting the Bigelow model directly to dynamic data with fixed z-values reveals a three-fold increase in D-values with lower heating rates, supporting the role of stress acclimation. The findings of this study aid in designing pasteurization treatments targeting L. innocua in coconut water and enable the establishment of safe, mild heat treatments for refrigerated, high-quality coconut water

Physicochemical characterisation of restructured Fenalår and safety implications of salt and nitrite reduction

There is a new trend to produce dry-cured ham from lamb in shorter times by boning the ham before salting to later obtain restructured hams that are easier to dry and slice. However, little information about the physicochemical characteristics of Norwegian Fenalårs during the process or the safety implications of their elaboration procedures is reported in the literature. The aim of this study was to characterize the colour, texture and physicochemical properties of restructured Fenalårs when using Standard Salting (SS), Salt Reduced (SR) and a Non-Nitrite Salt Reduced (NNSR) treatments. Microbiological safety implications of the elaboration process when using the different salting treatments were also assessed using predictive microbiology. To do so, sixty Fenalårs were elaborated using a Standard Salting (SS), a Salt reduced (SR) and a Non-Nitrite Salt Reduced (NNSR) treatments. Physicochemical characterization (instrumental colour and texture and Zinc Protoporphyrin content) was performed at the end of the process using thirty Fenalårs. The rest of the Fenalårs were used to characterize the product through the elaboration process (pH and aw) for the evaluation of microbiological hazards when using the different salting treatments using predictive microbiology. Results showed a significant increase in softness when reducing salt content and a decrease of redness when no nitrite was used, attributed to the formation of ZnPP content instead of nitrosylmyoglobin. In terms of risk assessment, the decrease of aw through the elaboration process reduced the growth capacity of all the microorganisms evaluated. However, microbiological safety implications in salt reduced Fenalårs are important, especially when no nitrite was added, because the considerable increase of growth potential of L. monocytogenes. The increase of growth potential of proteolytic C. botulinum is very little and no relevant effect of nitrite on growth potential of S. aureus was observed. Predictive microbiology and optimization of the process to enhance ZnPP formation can help to ensure safety and quality of salt reduced restructured Fenalårs without additives.info:eu-repo/semantics/acceptedVersio

Effectiveness of peer educators on the uptake of mobile X-ray tuberculosis screening at homeless hostels: a cluster randomised controlled trial.

To compare current practice for encouraging homeless people to be screened for tuberculosis on a mobile digital X-ray unit in London, UK, with the additional use of volunteer peer educators who have direct experience of tuberculosis, homelessness or both

Desempenho agronômico e produção de matéria seca digestível de híbridos de sorgo com capim sudão, normais e mutantes BMR (portadores de nervura marrom).

O objetivo deste trabalho foi avaliar as características agronômicas e a produção de matéria seca digestível de híbridos de sorgo com capim sudão mutantes BMR (portadores de nervura marrom) em comparação a híbridos normais. Os vinte e cinco híbridos foram avaliados quanto à altura de plantas, número de plantas por hectare, produção de matéria verde por hectare, produção de matéria seca por hectare e produção de matéria seca digestível por hectare. Os valores médios observados foram: 1,42 metros, 187 mil plantaslha, 39,62 tonlha, 3,73 tonlha e 2,65 tonlha, respectivamente para os seguintes parâmetros avaliados: altura de planta, stand de planta, produção de matéria verde, produção de matéria seca e produção de matéria seca digestíveI. De acordo com os resultados apresentados, a mutação com gene BMR expressam de forma desuniforme entre os diferentes cultivares. Em alguns cruzamentos, a inclusão do gene BMR não deprimiu significativamente as características agronômicas avaliadas. A produção de matéria seca digestível não diferiu significativamente entre os materiais avaliados devido à maior digestibilidade da matéria seca observada nos híbridos mutantes BMR

Proteína bruta e digestibilidade in vitro da matéria seca de híbridos de sorgo com capim sudão, normais e mutantes BMR (portadores de nervura marrom).

O objetivo deste trabalho foi avaliar o valor nutricional de híbridos de sorgo com capim sudão mutantes BMR (portadores de nervura marrom) em comparação a híbridos normais. Os vinte e cinco híbridos foram avaliados quanto ao teor de proteína bruta na matéria seca e a digestibilidade in vitro da matéria seca. O delineamento estatístico utilizado foi o de blocos ao acaso e a comparação das médias pelo teste Scott-Knott com 5% de significância. Os valores de proteína bruta variaram de 9,90 a 14,40% sendo que a média foi de 12,04%. Não foi observado diferença estatística entre os materiais avaliados. Os valores de digestibilidade in vitro da matéria seca variaram de 65,34 a 76,27% sendo que a média foi de 71,56%.. Para este parâmetro foi observado diferença estatística entre os materiais avaliados. A presença do gene BMR foi responsável por melhorar significativamente a digestibilidade in vitro da matéria seca dos híbridos de sorgo com capim Sudão

Meta-analysis of in vitro antimicrobial capacity of extracts and essential oils of Syzygium aromaticum, Citrus L. and Origanum L.: contrasting the results of different antimicrobial susceptibility methods

Diffusion methods, including agar disk-diffusion and agar well-diffusion, as well as dilution methods such as broth and agar dilution, are frequently employed to evaluate the antimicrobial capacity of extracts and essential oils (EOs) derived from Origanum L., Syzygium aromaticum, and Citrus L. The results are reported as inhibition diameters (IDs) and minimum inhibitory concentrations (MICs), respectively. In order to investigate potential sources of variability in antimicrobial susceptibility testing results and to assess whether a correlation exists between ID and MIC measurements, meta-analytical regression models were built using in vitro data obtained through a systematic literature search. The pooled ID models revealed varied bacterial susceptibilities to the extracts and in some cases, the plant species and methodology utilised impacted the measurements obtained (p 0.05). The ID–MIC model revealed an inverse correlation (R2=47.7%) and highlighted the fact that the extract dose highly modulated the relationship (p < 0.0001). The findings of this study encourage the use of extracts and EOs derived from Origanum, Syzygium aromaticum, and Citrus to prevent bacterial growth. Additionally, this study underscores several variables that can impact ID and MIC measurements and expose the correlation between the two types of results.The authors are grateful to the EU PRIMA program and the Portuguese Foundation for Science and Technology (FCT) for funding the ArtiSaneFood project (PRIMA/0001/2018) and for financial support through national funds FCT/MCTES to CIMO (UIDB/00690/2020). This study was supported by FCT under the scope of the strategic funding of UIDB/04469/2020 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020—Programa Operacional Regional do Norte. B.N. Silva acknowledges the financial support provided by FCT through the Ph.D. grant SFRH/BD/137801/2018. U. GonzalesBarron acknowledges the through the Institutional Scientific Employment Program contract.info:eu-repo/semantics/publishedVersio