Additional Information:• This paper was accepted for publication in the journal Preventive Vet- Del Rio, V., Voller, F., Montibeller, G., Franco, L. A., Sribhashyam, S., Watson, E., Hartley, M., & Gibbens, J.2013. An integrated process and management tools for ranking multiple emerging threats to animal health. Abstract: The UK's Department for Environment, Food and Rural Affairs supports the use of systematic tools for the prioritisation of known and well defined animal diseases to facilitate long and medium term planning of surveillance and disease control activities. The recognition that emerging events were not covered by the existing disease-specific approaches led to the establishment of the Veterinary Risk Group (VRG), constituted of government officials and supporting structures, the risk management cycle and the emerging threat highlight report (ETHiR), to facilitate the identification, reporting and assessment of emerging threats to UK's animal health. Since its inception in November 2009 to the end of February 2011, the VRG reviewed 111 threats and vulnerabilities (T&V) reported through ETHiR. In July 2010 a decision support system based on multi-criteria-decision-analysis (MCDA) improved ETHiR to allow the systematic prioritisation of emerging T&V. The DSS, known as e-THiR, allows the regular ranking of emerging T&V by calculating a set of measurement indices related to the actual impact, possible impact on public perception, and level of available capabilities associated with every T&V. The systematic characterisation of the processes leading to the assessment of T&V by the VRG has led to a consistent, auditable and transparent approach to the identification and assessment of emerging risks. The use of MCDA to manage a portfolio of emerging risks represents a different and novel application of MCDA in a health related context. This paper describes and discusses the characterisation and management of emerging risks by the VRG since its inception, and results from a pilot application of the e-THiR system to a reduced set of emerging threats.
A qualitative risk assessment was undertaken to analyse the likelihood of the incursion of selected exotic infectious disease into deer populations in GB and the potential impacts these animals could have on effective disease control. In order to identify the exposure pathways, it was necessary to consider not only the epidemiology of the pathogens but also to understand the impact of the ecology and behaviour of wild deer on disease transmission. It was concluded that the greatest risk of exotic disease incursion into wild deer in GB was disease incursions occurring in domestic ruminants first then transmitting to wild deer. The qualitative risk assessment considered geographic spread and habitats of wild deer and the susceptibility of wild deer to notifiable exotic diseases of domestic ruminants. Data of some diseases in some deer species is limited and the overall assessment of impact varied between diseases and deer species. Red deer pose the highest risk of the species reviewed. The overall risk assessment of low is primarily influenced by the low risk of incursion of exotic diseases generally into the UK.
Objective. Evaluating the rates of childbirth in women over 40 years of age in Tuscany (Italy) outlining the indications for caesarean section in this parturient population. Methods. 227,871 women who delivered in Tuscany from 2011 to 2018 using data of Birth Assistance Certificate linked with hospital discharge registry were observed. Caesarean section indications were reported as dismissal diagnoses. Logistic models (adjusted for parity, ART and BMI) were carried out for the maternal age risk factor. Results. The caesarean section rate increases significantly with age. Multivariate analysis confirmed that women over 40 years of age have a higher risk of a caesarean section due to pathologies such as diabetes or eclampsia which are clearly more frequent in these categories of women. Furthermore, the data shows that the caesarean section in some cases was carried out due solely to the age of a primiparous woman. Conclusions. The phenomenon affects health services and social costs and should make us reflect upon the underlying reasons that bring women to delay their reproductive project and where necessary implement appropriate political strategies. SOMMARIO Scopo. Valutare il parto nelle donne over 40 in Toscana e descrivere le indicazioni al taglio cesareo in questa popolazione. Metodi. Da Certificato di Assistenza al Parto linkato con la SDO sono state estratte 227.871 donne che hanno partorito in Toscana tra il 2011 e il 2018. Attraverso le diagnosi di dimissione è stato possibile identificare le principali indicazioni al cesareo. Per queste sono stati effettuati dei modelli logistici (univariati e multivariati aggiustati per parità, PMA e BMI) per il fattore di rischio età materna. Risultati. Aumenta significativamente all'aumentare dell'età il ricorso al taglio cesareo, soprattutto quello di elezione e quello in urgenza, a testimonianza di una maggiore incidenza di condizioni patologiche. L'analisi multivariata conferma per le over 40 un rischio maggiore di taglio cesareo a causa di patologie come il diabete o l'eclampsia che risultano chiaramente più frequenti in queste categorie di donne. I dati mostrano inoltre che in alcuni casi il cesareo viene effettuato solo per indicazione materna. Conclusioni. Questo incide sui servizi sanitari e sui costi sociali e dovrebbe fare riflettere sulle motivazioni che conducono le donne a ritardare il loro progetto riproduttivo mettendo in atto scelte politiche conseguenti e adeguate.
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