Health impact assessment (HIA) practice has expanded across the world, since it was established more than two decades ago. This paper presents a snapshot of current global HIA practice based on the findings of an online questionnaire survey. HIA practitioners from all world regions were invited to participate. A total of 122 HIA practitioners from 29 countries completed the survey, following a broad international outreach effort. The large variety in the types of HIAs conducted, and the application of HIA in various fields reported by respondents, demonstrates that HIA practice has evolved over the past two decades. Although differences in the use of HIA were reported across world regions, an overall increasing trend in global HIA practice can be observed. In order to sustain this upward trend, efforts are needed to address the main barriers in the utilisation of HIA. The establishment of new national and international HIA teaching and training offerings seems to be an obvious strategy to pursue along with the strengthening of policies and legal frameworks that specify the circumstances, under which HIA is required, and to what extent.
Background: Diphtheria became rare in Vietnam following implementation of the Expanded Program on Immunization in 1981. In the late-June, 2016, two previously healthy young persons from remote areas of Binh Phuoc province, southern Vietnam, were hospitalized and died of suspected diphtheria. Here, we report the epidemiological, clinical, and microbiological investigation of this outbreak.Methods & Materials: We identified probable and confirmed cases at hospitals or through active community-based case finding. A probable case was defined as a local resident who exhibited (i) fever with a sore throat or tonsillitis with an adherent membrane or (ii) cardiac or neurological complications following upper respiratory tract symptoms. Laboratory confirmation required isolation of Corynebacterium diphtheriae by throat swab culture. We reviewed patient charts, interviewed patients and their household contacts, and performed contact tracing. C. diphtheriae isolates were tested for antibiotic susceptibilities by disk diffusion and for the presence of diphtheria toxin by polymerase chain reaction and sequencing.Results: Five confirmed and seven probable cases were detected during June 25 th -July 20 th , 2016. Of the 12 cases, nine were ≥15 years old (range of 3-36 years); seven were males; none completed the DPT3 immunization series; almost all (10 cases) were household contacts, neighbors, friends or co-workers of each other. Pseudo-membranes, myocarditis, and palatal paralysis were seen in three, eight, and two cases, respectively. Two confirmed and two probable cases reported antibiotic use prior to throat swab culture. Three probable cases died due to myocarditis, yielding an overall case fatality rate of 25% (3/12). One of 35 patient's contacts was culture-positive. All six isolates were identified as toxigenic C. diphtheriae biotype mitis, and all were susceptible to erythromycin. No evidence of C. diphtheriae was identified from 52 local residents with upper respiratory tract symptoms and epidemiologic links to confirmed or probable cases. Conclusion:We identified an outbreak of diphtheria among an unvaccinated population of adolescents and adults in a remote province of southern Vietnam. Efforts to improve vaccination coverage and administer a booster dose of diphtheria-containing vaccines are needed to prevent future outbreaks.
Casuarina equisetifolia is an exotic, fast growing, multipurpose tree species grown in Tamil Nadu. Altogether, about 40 species of insects have been recorded on C. equisetifolia in Tamil Nadu State. Among them, the bark eating caterpillar, Indarbela quadrinotata is considered as the most destructive pest in plantations. Wide variation in the infestation levels of bark eating caterpillar was noticed in Casuarina plantations grown under four agro-climatic zones of Tamil Nadu; the Cauvery Delta Zone showed highest intensity of attack, followed by the North Eastern Zone and the Southern Zone in the decreasing order of infestation, while the High Rainfall Zone was not affected by the pest. Plantations of younger age suffered from higher levels of infestation, compared to that of older ones. Among the climatological parameters, the minimum temperature had significant positive correlation with the pest infestation. Apart from the naturally occurring entomopathogenic fungus, Beauveria bassiana, the botanical formulations such as Melia azedarach seed kernel extract (5%), Pongamia pinnata seed oil (5%), Hydnocarpus pentandra seed oil (10,000 ppm) and Neem oil (5%) were found to be very effective in managing the pest under field condition.
Table 1 Medical Students Category Pretest Posttest % change P-value Derm/PE/chronic diseases/GI(21 Qs) 58/105(55.2%) 90/105(85.7%) 30.5 < 0.0001 ID/demographics (9Qs) 25/45(55.6%) 38/45(84.4%) 28.8 0.0028 Table 2 Medical Residents Category Pretest Posttest % change P-value Derm/PE/chronic diseases/GI(21 Qs) 58/84(69.0%) 80/84(95.2%) 26.2 < 0.0001 ID/demographics (9Qs) 15/36(41.7%) 26/36(72.2%) 30.5 0.0088Methods & Materials: Medical students and residents participated in a health outreach trip to Yoro, Honduras, in June 2015. All learners took a pretest with questions pertaining to dermatology, physical exam, chronic diseases, GI, infectious diseases and demographics. They rotated through the following clinical stations: 1) dermatology/physical exam 2) screening for diabetes/hypertension 3) gastrointestinal issues. Once a learner had completed rotating through all of the stations they took a post-test survey. These data were evaluated for exam performance by learner type for core knowledge specific to the stations ("Derm/PE/chronic diseases/GI") and knowledge that was emphasized on the trip but not formally taught ("ID/demographics").Results: Tables 1 and 2 Conclusion: The effectiveness of educational activities associated with a Station Based care delivery model on short-term health outreach trips has never been formally assessed. This may serve as a useful tool in enhancing the educational value of outreach trips for medical students and residents.
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