Perceived benefits and challenges of coordinated approaches to chronic disease prevention in state health departments

INTRODUCTION: Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. METHODS: A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ(2) tests, and analysis of variance were conducted. RESULTS: The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges “lack of communication across programs” (P = .02) and “funding might be reduced” differed by program area (P < .001). CONCLUSION: Findings can be used by funding agencies and state health departments for planning, training, and technical assistance. The information on perceived challenges demonstrates the need to improve communication across programs, enhance organizational support for coordinated approaches, and create benefits for organizational partners

Are health systems interventions gender blind? examining health system reconstruction in conflict affected states

Background Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women’s health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity. Methods This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks. Findings Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy. Conclusion The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies

The effect of cellulose crystallinity on the in vitro digestibility and fermentation, kinetics of meadow hay and barley, wheat and rice straws

The effect of cellulose crystallinity on in vitro digestibility (IVD) and fermentation kinetics was investigated in samples of meadow hay and barley, wheat and rice straws. A saturated solution of potassium permanganate was used to isolate the celluloses, and their crystallinity was evaluated in a Fourier transform infrared spectrometer as the ratio of the observed transmittance at two distinct wave frequencies . IVD was determined after 48 h of incubation, and the kinetics of fermentation was studied with fully automated gas production equipment. Despite significant differences (P <0.05), crystallinity showed low variation (0.30-0.42) among celluloses and correlated positively with IVD (P <0.05). Although positively correlated with maximal gas production (r = 0.91) and rates of fermentation, IVD (averaging 784 g kg-1 organic matter (OM)) was also low for all samples as compared with the usually referred values for isolated celluloses. The lowest means were observed for meadow hay and rice straw. The cumulative gas production profiles were well described by a monophasic model (r2 = 0.997, RSD (residual standard deviation) = 8.367), but all the curves had a lag phase varying from 3 to 6 h. Cellulose isolated from rice straw showed the lowest maximal gas production (366 ml g-1 OM) and highest times to reach half of the maximal gas production and maximal rate. Transmission electron microscopy (TEM) of two cellulose samples showing considerable gas production at highest rates as compared with cellulose isolated from rice straw that provided the lowest gas production at the lowest rate revealed generalised bacterial colonisation, the presence of glycocalyx fibres and cell erosion in all samples. Although samples collected after 12 h of fermentation appeared to present lower microbial attack as compared with those incubated for 24 h, TEM did not explain the observed differences in the data. Since crystallinity, IVD, gas production and rates of fermentation were shown to be associated with the nutritional availability of cellulose, further research dealing with extreme values of cellulose crystallinity may be important

The effect of cellulose crystallinity on the in vitro digestibility and fermentation, kinetics of meadow hay and barley, wheat and rice straws

The effect of cellulose crystallinity on in vitro digestibility (IVD) and fermentation kinetics was investigated in samples of meadow hay and barley, wheat and rice straws. A saturated solution of potassium permanganate was used to isolate the celluloses, and their crystallinity was evaluated in a Fourier transform infrared spectrometer as the ratio of the observed transmittance at two distinct wave frequencies . IVD was determined after 48 h of incubation, and the kinetics of fermentation was studied with fully automated gas production equipment. Despite significant differences (P <0.05), crystallinity showed low variation (0.30-0.42) among celluloses and correlated positively with IVD (P <0.05). Although positively correlated with maximal gas production (r = 0.91) and rates of fermentation, IVD (averaging 784 g kg-1 organic matter (OM)) was also low for all samples as compared with the usually referred values for isolated celluloses. The lowest means were observed for meadow hay and rice straw. The cumulative gas production profiles were well described by a monophasic model (r2 = 0.997, RSD (residual standard deviation) = 8.367), but all the curves had a lag phase varying from 3 to 6 h. Cellulose isolated from rice straw showed the lowest maximal gas production (366 ml g-1 OM) and highest times to reach half of the maximal gas production and maximal rate. Transmission electron microscopy (TEM) of two cellulose samples showing considerable gas production at highest rates as compared with cellulose isolated from rice straw that provided the lowest gas production at the lowest rate revealed generalised bacterial colonisation, the presence of glycocalyx fibres and cell erosion in all samples. Although samples collected after 12 h of fermentation appeared to present lower microbial attack as compared with those incubated for 24 h, TEM did not explain the observed differences in the data. Since crystallinity, IVD, gas production and rates of fermentation were shown to be associated with the nutritional availability of cellulose, further research dealing with extreme values of cellulose crystallinity may be important

Molecular epidemiology, phylogenetic analysis and genotype distribution of hepatitis B virus in Saudi Arabia: Predominance of genotype D1

Despite the implementation of various vaccination programs, hepatitis B virus (HBV) poses a considerable health problem in Saudi Arabia. Insight on HBV evolutionary history in the region is limited. We performed a comprehensive epidemiological and phylogenetic reconstruction based on a large cohort of HBV infected patients. Three hundred and nineteen HBV-infected patients with different clinical manifestations, including inactive and active chronic carriers and patients with cirrhosis and hepatocellular carcinoma (HCC), were enrolled in this study. The full-length large S gene was amplified and sequenced. Phylogenetic analysis was performed to determine the genotype and subgenotypes of the isolates. Phylogenetic tree analysis revealed that genotype D is the most dominant genotype among patients. Moreover, this analysis identified two strains with genotype E isolated from active carriers. Detailed phylogenetic analyses confirmed the presence of four HBV D subgenotypes, D1 (93%, n = 296), D2 (0.02%, n = 5), D3 (0.003%, n = 1), and D4 (0.003%, n = 1). In addition, six genotype D strains were not assigned to any existing HBV D subgenotype. The large S gene of eight strains showed signatures of genotype recombination between the genotypes D and A and between D and E. Several strains harbored medically important point mutations at the protein level. Along with the dominance of the HBV genotype D, isolation of the E genotype and several recombinant strains from patients with Saudi Arabian origin is an essential result for decisions involving therapeutic measures for patients. Development of vaccines and detection of diagnostic escape mutations at antigenic epitopes on the HBsAg will be valuable to public health authorities. Furthermore, the diversity at the nucleotide and amino acid levels and different proportions of dN/dS at the PreS1, PreS2, and HBsAg reveal the selective pressure trend from inactive status towards advanced liver diseases.status: Published onlin