Preventive Medicine Programs Research Articles

Implementing mind mapping in small-group learning to promote student engagement in the medical diagnostic curriculum: a pilot study

BackgroundMedical diagnostics is a pivotal bridge curriculum that receives much less attention from undergraduates in non-clinical medicine health profession programs with less student engagement and poor performance. Mind mapping is an active learning strategy for graphically presenting radiant thinking to culture clinical reasoning. The purpose of this study was to explore whether students’ comprehensive diagnostic skills are enhanced through increased student engagement by employing mind mapping.MethodsWe implemented mind mapping in small-grouped workshops with 86 junior undergraduates from preventive medicine program, for physical diagnostic sessions including physical examination (PE) maneuver, electrocardiogram (ECG) interpretation and medical history collection. We also conducted assessments of the above skills, as well as online surveys regarding their expectation on this course, self-evaluation of mind mapping in teaching and the learning process of all the modules.ResultsGroup members employing mind mapping in all PE sessions obtained higher scores in the heart and lung systems during the PE maneuver exam. Similarly, groups that made more in-depth mind maps achieved higher scores on the ECG quiz. In addition, groups displaying mind maps for history taking from normal classes and reformed class exhibited greater completeness of medical history with both standardized patients and real patients, which was consistent with increased collection of accompanying symptoms. Mind mapping was valued by the majority of students for its benefits in terms of acquiring PE maneuver, theoretical knowledge, medical history collection and medical records writing, clinical reasoning, communication skills, sense of teamwork and cooperation, professionalism and humanistic literacy.DiscussionThe visual feature of mind mapping evoked extensive behavioral engagement in all groups, as did cognitive and emotional engagement, as the majority of students expressed their willingness and affective reactions. In the short term, the positive feedbacks encourage growing engagement. The continuous benefits of mind mapping require long-term observation.

Application and evaluation of the hybrid "Problem-Based Learning" model based on "Rain Classroom" in experimental courses of medical molecular biology.

With the advancement of society, the cultivation of medical professionals equipped with solid theoretical knowledge, a strong sense of innovation, and critical thinking has become a crucial goal in the reform of medical higher education. Over recent years, the hybrid Problem-Based Learning (hPBL) model, a blend of Problem-Based Learning (PBL) and Lecture-Based Learning (LBL), has emerged as a novel approach in the medical education reform landscape of China. The application and efficacy of the hPBL model in medical experimental courses have piqued the interest of medical educators. The aim of this study was to appraise the application and effectiveness of the hPBL model in the experimental course of Medical Molecular Biology at Beihua University. Utilizing the "Rain Classroom" platform, students from the Preventive Medicine and Medical Imaging programs were allocated to either the hPBL or LBL method for their Medical Molecular Biology experimental courses. The hPBL model's impact on students' performance was evaluated across four domains: experimental theory, experimental operation, experimental report, and practical application. Questionnaires were employed to gauge students' experiences and perceptions. The results indicated that the final assessment scores of the hPBL group were significantly superior to those of the LBL group. Moreover, the hPBL model effectively amplified students' self-learning capability, practical application skills, and communication competencies. Students expressed a high degree of satisfaction with this blended learning model. The hPBL model, which amalgamates PBL and LBL, has demonstrated its effectiveness in medical education. Its implementation in the experimental course of Medical Molecular Biology at Beihua University yielded positive outcomes, enhancing students' performance and satisfaction levels. Consequently, it is recommended that the hPBL model be further promulgated in other medical experimental courses.

The detection of high risk HPV genotypes by the PR-PCR method in the Republic of Serbia

Abstract Introduction The association between Human Papiloma Virus (HPV) positive cervical swabs and the development of cervical cancer has lead to extensive research. Studies employing the RT-PCR method for typization in the young women demographic worldwide. Based on their proven oncogenic potential 14 HPV types have been classified as carcinogenic (HPV16,18,31,33,35,39,45,51,52,56, 58,59,66,68). The imporatnce of HPV diagnostics is a result of the existing link between viral infection and relative risk of cervical cancer, while the detection complexity reflects the large variety of HPV genotypes. Methods The samples analyzed in our study were obtained from cervical swabs of women aged 19 to 25 years between the months of October and December 2022. All collected samples were routinely screened for high risk genotype positivity (HPV16 and 18). There were no other inclusion criteria, the samples used in the study were selected at random. After DNA isolation, genotype identification was done by L2 amplification for HPV 16, the L1 for HPV 18, E6 for HPV 35, 56 and 58, and E7 for HPV 31,33,39,45,51,52,59,66 and 68 genotypes, with specific primers and flourescently labelled probes. Results The results demonstrated that among the DNA positive individuals HPV genotype distribution was as follows: 50% (31,39,56); 40,90% HPV(52,59,68); 34,10% HPV16; 22,70% HPV(35, 58, 66); 15,90% HPV 18. Individually, by type, the highest prevalence was noted for the high risk genotype HPV 16 (34,1%), followed by HPV18 (15,90%). As for group clusters, HPV(31,39,56) were most frequent, followed by HPV(52,59,68). Conclusions Given the forementioned results of our study, the most prevalent HPV genotype in the Republic of Serbia among the women of pre-set demographic is HPV 16, which is in conconcurrence with epidemiological results for Eastern Europe. By comparative analysis of the HPV16 and 31 distribution, the results imply a similarity in sensitivity to infection. Key messages • The susceptibility of young adults to HPV infection entails a well-developed preventive medicine program is paramount, and not limited to this demographic. • RT-PCR offers in-depth insight into the distribution of risk of cancer to the screening team.

Epidemiology of listeriosis in a region in central Italy from 2010 to 2019: Estimating the real incidence and space-time analysis for detecting cluster of cases.

BackgroundContamination and transmission of different Listeria monocytogenes strains along food chain are a serious threat to public health and food safety. Understanding the distribution of diseases in time and space-time is fundamental in the epidemiological study and in preventive medicine programs. The aim of this study is to estimate listeriosis incidence along 10-years period and to perform space-time cluster analysis of listeriosis cases in Marche Region, Italy. MethodsThe number of observed listeriosis cases/year was derived from regional data of surveillance of notifiable diseases and hospital discharge form. The capture and recapture method (C-R method) was applied to estimate the real incidence of listeriosis cases in Marche Region and the space-time scan statistics analysis was performed to detect clusters of space-time of listeriosis cases and add precision to the conventional epidemiological analysis. ResultsThe C-R method estimation of listeriosis cases was 119 in the 10- year period (2010–2019), with an average of 31.93 % of unobserved cases (lost cases). The estimated mean annual incidence of listeriosis was 0.77 per 100,000 inhabitants (95 %CI 0.65–0.92), accounting for 6.07 % of additional listeriosis cases per year than observed cases. Using the scan statistic, the two most likely clusters were identified, one of these was statistically significant (p < 0.05). The underdiagnosis and under-reporting in addition to listeriosis incidence variability suggested that the surveillance system of Marche Region should be improved. ConclusionsThis study provides evidence of the ability of space-time cluster analysis to complement traditional surveillance of food-borne diseases and to understand the local risk factors by implementing timely targeted interventions.

Molecular detection and characterization of a novel Theileria genotype in Dama Gazelle (Nanger dama)

Wild animals play a critical role in maintenance and transmission of various tick-borne pathogens. It is essential to identify these wild host species that can serve as important reservoirs of tickborne diseases. In the present study we investigated Dama gazelle (Nanger dama) as a potential novel reservoir of Theileria spp. A total of 53 blood samples collected from Dama gazelle as part of the Al Ain Zoo preventive medicine program were screened for Theileria spp. by qPCR using a commercial assay, followed by additional studies using conventional PCR targeting an approximate 450-base pair (bp) fragment of the V4 hypervariable region of the 18S ribosomal RNA (rRNA) gene. Sequencing and phylogenetic analysis of a subset (20) of PCR amplicons revealed Theileria isolates from gazelles of Al Ain Zoo clustered closely to Theileria sp. Dama Gazelle (AY735115) from USA and were far away or did not cluster with the known Theileria spp. of ruminants namely T. annulata, T. ovis, T. orientalis, T. luwenshuni, T.parva and T.sinensis. Theileria genotypes detected in gazelles of present study were clearly distinct from the other common theileria species of ruminants. The present finding throws light on the critical role of reservoir host in maintenance and transmission of pathogen.

A Critical Review of Preventive Medicine Strategies and Their Effectiveness: A Global Perspective

Background: Preventive medicine is a crucial aspect of healthcare to prevent diseases and promote population health. This review examines the current state of preventive medicine research, focusing on global approaches and emerging trends. Objective: This literature review aims to critically analyse and synthesize the most recent and relevant literature on preventive medicine, focusing on identifying promising strategies and interventions for improving population health. Methods: A comprehensive search of electronic databases, including Gool Escolar, Web of Science, and PubMed, was conducted to identify relevant articles published within the last five years. Keywords such as "preventive medicine", "health promotion", "population health", and "disease prevention" were used in combination to identify articles related to the topic. Results: The review identified a range of promising strategies for preventive medicine, including lifestyle interventions, immunization programs, and community-based approaches. The review also highlights the importance of a multidisciplinary and collaborative approach to preventive medicine involving healthcare providers, policymakers, and the wider community. Conclusion: The findings of this review suggest a growing body of evidence supporting the effectiveness of preventive medicine in improving population health. However, further research is needed to evaluate the long-term impact of these interventions and identify barriers to implementation and opportunities for scaling up preventive medicine programs worldwide.

Preventive Care: Improving Health of Medicare, Medicaid, and Children’s Health Insurance Program Patients Through Access to Fresh Fruit and Vegetables

Diet is the number one risk factor for deaths in the United States. Members of marginalized and impoverished communities particularly struggle to afford nutritious food. Poor diets result in health disparities along socio-economic, age, racial, ethnic, indigenous, rural, and urban lines. Despite the ever-growing social and financial burden of diet-related chronic diseases, the U.S. has failed to invest in health care-related dietary policy. This Article proposes produce prescriptions as a national dietary preventive medicine program through Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).Recently, nonprofits, governments, and health care providers have designed innovative produce prescription programs to combat diet-related chronic diseases. In these programs, clinical providers can prescribe subsidized fruit and vegetables to patients. Produce prescriptions empower patients by making dietary change affordable and by motivating patients to improve their health. Numerous studies, pilot projects, and local programs demonstrate that produce prescriptions can improve health care outcomes for individuals from diverse communities. Most at-risk members of our society receive health coverage through Medicare, Medicaid, or CHIP. This Article analyzes how to scale up produce prescriptions within these programs using law and policy.

Machine learning models can predict bottlenose dolphin health status from whistle recordings

Recently, there have been incredible strides in applying machine and deep learning methods to predict the presence of disease states in humans from recordings of voice. Pattern analyses of dolphin whistles have historically depended on human operators visually and audibly differentiating between sound types. The training and implementation of machine and deep learning strategies for audio analyses reduce human bias and may improve feature detection. Our team at the Navy Marine Mammal Program in San Diego, CA has developed a substantial vocal catalog of whistle recordings for a group of focal dolphins. Additionally, an extensive health history database for each animal is maintained as part of a preventive medicine program. Together, these result in a unique, labeled dataset comprised of tens of thousands of whistles (input) emitted during differing health states (output) that have been leveraged for training machine and deep learning models to classify health status from whistles. We present preliminary results that suggest that health information may be encoded across dolphin whistle characteristics, similar to changes in the human voice. Further, we describe the applied goals for testing and implementing these innovative tools for early predicting changes in dolphin health status from non-invasive recordings.

UROLITHIASIS IN FOXES: ASSESSMENT OF 65 UROLITH SUBMISSIONS TO THE MINNESOTA UROLITH CENTER FROM 1981 TO 2021.

This article summarizes urinary stone submissions from foxes in human care to the Minnesota Urolith Center over 40 years. A previous report documented the analysis of uroliths from foxes that were submitted between 1981 and 2007.13 New data compiled from 2008 to 2021 included an additional 38 stones submitted from foxes, totaling 65 fox urolith submissions from 1981 to 2021. Struvite and cystine uroliths were most common, with the remainder comprised of calcium phosphate, calcium oxalate, compound, mixed, or miscellaneous material. Most stones were submitted from male foxes. Seventy-two percent of the stones were urocystoliths, and from 2010 to 2021, most stones were diagnosed antemortem and removed surgically. More than half of the stones were submitted from red foxes (Vulpes vulpes) and fennec foxes (Vulpes zerda). Urolithiasis in foxes may be an underrecognized condition, and data from this study suggest that clinicians should consider routine urinalysis and diagnostic imaging as part of the preventive medicine program for fox species, especially red foxes and fennec foxes.

Reproductive one health in primates.

One Health is a collaborative trans-disciplinary approach to health; integrating human, animal, and environmental health. The focus is often on infection disease transmission and disease risk mitigation. However, One Health also includes the multidisciplinary and comparative approach to disease investigation and health of humans, animals, and the environment. One key aspect of environmental/ecosystem health is conservation, the maintenance of healthy, actively reproducing wildlife populations. Reproduction and reproductive health are an integral part of the One Health approach: the comparative aspects of reproduction can inform conservation policies or breeding strategies (in situ and ex situ) in addition to physiology and disease. Differences in reproductive strategies affect the impact poaching and habitat disruption might have on a given population, as well as ex situ breeding programs and the management of zoo and sanctuary populations. Much is known about chimpanzees, macaques, and marmosets as these are common animal models, but there is much that remains unknown regarding reproduction in many other primates. Examining the similarities and differences between and within taxonomic groups allows reasonable extrapolation for decision-making when there are knowledge gaps. For example: (1) knowing that a species has very low reproductive rates adds urgency to conservation policy for that region or species; (2) identifying species with short or absent lactation anestrus allows ex situ institutions to better plan contraception options for specific individuals or prepare for the immediate next pregnancy; (3) recognizing that progestin contraceptives are effective contraceptives, but may be associated with endometrial hyperplasia in some species (in Lemuridae but not great apes) better guides empirical contraceptive choice; (4) recognizing the variable endometriosis prevalence across taxa improves preventive medicine programs. A summary of anatomical variation, endocrinology, contraception, pathology, and diagnostics is provided to illustrate these features and aid in routine physical and postmortem examinations as well as primate management.

English

BACKGROUND Traumatic Brain Injury (TBI) is a recognized public health problem with the increasing burden of disability and death occurring globally. We wanted to assess the perceptions about traumatic brain injury and also find its overall awareness among preventive medicine residents. METHODS This cross-sectional study involved preventive medicine program residents of Aseer region. Participants were recruited from Oct 1 2019, to Sept 30 2019. After giving a brief explanation and taking voluntary consent, a 40 item self-reported questionnaire was administered to the participants. Data entry and statistical analysis were performed using Microsoft Excel and SPSS windows version 16.0 software. Descriptive statistics (means, standard deviations) were performed for the patient's age and overall awareness level. Three points Likert scale was used to assess the effects of brain injury, causes and preventive measures as reported by program residents. RESULTS The majority of respondents were less than thirty years of age (64.7 %) and residing in the R1 level (67.6 %). The number of male respondents was more than three times compared to female respondents. The majority of respondents had good awareness about preventive measures of brain injury (97.1 %) and causes of brain injury (67.6 %). A higher proportion of respondents were having poor awareness about the effect of brain injury (79.4 %). Overall awareness level regarding brain injury was observed to be 58.8 % among the residents. CONCLUSIONS This study projects the need to strengthen the awareness about TBIs in the preventive program residents. This will provide valuable feedback to the policymakers and the national prevention program managers. KEY WORDS Traumatic Brain Injury, Residents, Preventive Medicine Program

Description, Implementation, and Evaluation of a Low-Cost Preventive Medicine and Urgent Care Program for School Children in a Lower-Middle-Income Country

Description, Implementation, and Evaluation of a Low-Cost Preventive Medicine and Urgent Care Program for School Children in a Lower-Middle-Income Country

Neonatal Urine Screening Program in the Province of Quebec: Technological Upgrade from Thin Layer Chromatography to Tandem Mass Spectrometry.

The Quebec Neonatal Urine Screening Program was initiated in 1971 with overall screening inception of newborns in 1973. Forty-seven years later, over 3.5 million babies have been screened for up to 25 inborn errors of metabolism divided into two groups: (1) urea cycle disorders and organic acidurias; and (2) disorders of amino acid metabolism and transport. The main goal of this preventive genetic medicine program is the detection of treatable diseases before the onset of clinical symptoms. Urine specimens from 21-day-old babies are collected and dried on filter paper by parents at home. The participation is voluntary with a high compliance rate over the years (~90%). Specimens are analyzed by thin layer chromatography (TLC). The main objective of this evaluative research project was to assess the feasibility of a technological upgrade towards mass spectrometry. A 2.85-min flow injection method was devised, normal values established, and abnormal profiles confirmed using second-tier tests. The validated assays are sensitive, specific, and suitable for populational screening, as well as for high-risk screening laboratories. Triple H syndrome, which would not be detected in newborns by blood screening at two days of age was found to be positive in the urine of an affected patient.

Assessment of the operation of a pilot program of preventive medicine for adults in three primary care centers of Athens and Piraeus: a cross-sectional study.

SummaryObjectiveTo evaluate the operation of the pilot Program of Preventive Medicine for Adults (PPMA) from the provision of healthcare services in three primary health care centers of Athens and Piraeus (Greece).DesignAn observational, cross-sectional study was undertaken. A structured questionnaire was used to collect data.SettingThree public primary health centers of Athens, Greece.Participants142 participants, 40-55 years of age, with no previously identified/diagnosed health issues (overall healthy) that should not have undergone any type of screening in the past 12 months.Measures and resultsThe majority of participants were female (75.4%), aged 40-45 years (43.7%), Greek nationals (88%), employed (62.7%) and high school graduates (52.8%). 68.3% of participants scheduled an appointment in the first two days and 58.9% waited up to 5 minutes in the waiting room. The paramedical personnel scored higher evaluation (4.94) than the doctor (4.61), but all health care centers received a very high general evaluation (4.87). Multiple linear regression showed significant association between the evaluation of the pilot PPMA, the evaluation of health visitor/nurse (B = .240) and the communication of results to participants (B = .245).ConclusionsFindings show an extremely positive evaluation of the pilot PPMA, a result that can be used by healthcare managers for the expansion of the screening program to the general population.

EXERCISE TESTING BEYOND ST- CHANGES

Coronary artery disease is the leading cause of death in developed, developing and underdeveloped countries. Screening for any chronic diseases including coronary artery is always a complex problem, although over the years different screening tools are being validated.1 Exercise testing plays a major role in risk stratification of asymptomatic adults in reference to ST changes during exercise, other parameters which are always neglected but can be used efficiently are heart rate recovery, chronotropic response, functional capacity, and ventricular ectopy. AHA/ACC have debilitated the utilization of exercise testing as a screening apparatus.2 The rules suggest the estimation of activity testing in following subset of individuals: Understanding with patients with different risk factors for CAD for whom hazard decrease treatment should be guided, diabetes' patients who are anticipating an activity program, and in men 45 years of age and ladies 55 years of age who are in danger for CAD due to other diseases, for example, peripheral atherosclerosis and chronic renal disease and who intend to begin overwhelming activity programs and are engaged with high-risk occupations.3 Measurement of functional capacity is the most important risk marker which can be evaluated with Exercise tolerance test. Framingham Heart Study (population-based) and Cleveland Clinic Preventive Medicine Program (clinically based) studies of asymptomatic individuals have shown that functional capacity measured at exercise testing predicts risk better then both Framingham and Cleveland risk scores.4,5 The other significant marker is Chronotropic ineptitude which can be surveyed during exercise tolerance test by estimating the peak HR showing what extent of age predicted maximal HR is accomplished, and what extent of HR reserve is utilized at peak exercise (Peak HR-resting HR)/(220 - age - resting HR) Value of ≤ 0.80 higher risk.6 HR recovery indicates the decline in HR after exercise and can be measured as difference between HR at peak exercise and 1 or 2 min later. Abnormal value ≤ 12 after one minute of recovery, reflected impaired vagal tone, which is in itself predictor of risk of death in several epidemiological studies.7,8 Last but not the least ventricular ectopy occurring during or in recovery period of exercise test also has a prognostic value in term of reflection on electrical instability and altered autonomic tone. As of recently published meta-analysis suggests, ventricular ectopy occurring during exercise in the general population increase the risk of total mortality and cardiovascular mortality. Nine studies involving 62,488 members contrasting clinical results of patients with and without work out actuated VPCs were incorporated. Ventricular ectopy during recuperation was related with an expanded danger of death (RR 1.55, 95% CI 1.22 to 1.96). VPCs during exercise didn't accomplish measurable criticalness (RR 1.14, 95% CI 0.96 to 1.34).9 Taking everything into account, non-electrocardiographic measures, including HR recovery, chronotropic response, functional capacity, and ventricular ectopy, have been appeared to anticipate adverse events in asymptomatic individuals, and despite the fact that exercise testing measures have been appeared to improve the forecast of coronary artery events far beyond the Framingham Risk Score. There is no evidence that adding up this information improves the results. Applied to individuals at high risk might give us appropriate results for risk stratification.

The impact of a Facebook campaign among mothers on HPV vaccine uptake among their daughters: A randomized field study

ObjectiveThe popularity of social networks provide an incredible opportunity to enhance the impact of preventive medicine programs. We aimed to assess whether a targeted Facebook campaign among mothers may increase the uptake of human Papilloma virus (HPV) immunization among their 8th-grade daughters. MethodsThis field study was conducted among the members of a state-mandated health organization in Israel. Included were all 21,592 members who were mothers to 14 year-old daughters in the 2018-19 school-year. A total of 17,271 (80%) were randomly allocated to the campaign arm and the rest (n=4,321) were selected as a reference group. The Facebook ads addressed issues and concerns regarding HPV-related diseases and HPV vaccine. Main outcome measures were Facebook metrics on exposure to campaign and HPV immunization among eighth grade daughters of the study participants. ResultsBetween 8/2018-10/2018, Facebook ads were shown 1.8-million times (a reach of 88%). The uptake of HPV vaccine among daughters of women allocated to the campaign arm (55.3%) was similar (p = 0.749) to 55.0% in the control group. The only significant differences between study groups were observed when stratifying by SES level. In the lowest SES quartile, Facebook campaign significantly (p = .02) reduced vaccine uptake (35% vs. 39.0%), with a relative risk of 0.90 (95%CI: 0.82-0.98), while in the second SES quartile, Facebook campaign increased vaccine uptake from 52.6% to 55.8%, with a RR of 1.06 (95%CI,1.00-1.12). Among mothers in higher SES levels, daughters of exposed and unexposed mothers had similar immunization rates. ConclusionsFacebook campaign may increase the uptake of HPV vaccine among daughters to mothers of medium-to-low SES level, but it may reduce vaccination among lower SES groups.

Design of Occupational Health and Safety Management System Based on ISO 45001, for a Company that Manufactures and Commercializes Low Voltage Electrical Boards

Muchas empresas en la busqueda de darse a conocer y aumentar la visibilidad, lo que implica la transmision de confianza en los productos que ofrece, y en la ejecucion de procesos de manera segura, recurren a la implementacion de sistemas de gestion. En esta contribucion, se propone el diseno del Sistema de Gestion de la Seguridad y salud en el trabajo para una empresa que fabrica y comercializa tableros electricos de baja tension. Se tiene como proposito principal mejorar las condiciones de trabajo de sus colaboradores y la productividad de la organizacion. Todo el trabajo realizado se soporto tanto en ISO 45001:2018, asi como en la legislacion colombiana. Lo anterior permitira el crecimiento de la empresa a nivel interno, contribuira al desarrollo de procesos logicos y por etapas para una mejora continua teniendo como principio el ciclo PHVA. Es importante mencionar que, durante la fase operacional, se desarrollaron herramientas como los programas de medicina preventiva, higiene y seguridad industrial, a su vez se plantearon alternativas que involucran la verificacion del cumplimiento de los requisitos de la norma establecidos, y asi lograr los resultados deseados del sistema de gestion. Las soluciones disenadas se fundamentaron, en el analisis y desarrollo de la identificacion de riesgos y peligros como primera instancia, esto fue primordial para el diseno documental del Sistema de Gestion, donde se pretende la normalizacion de los procesos y el aumento en la efectividad en la empresa.

Vaccination Is a Suitable Tool in the Control of Aujeszky's Disease Outbreaks in Pigs Using a Population Dynamics P Systems Model.

Simple SummaryMaximizing the efficiency of pork production in line with sustainability and environmental restrictions presents a challenge for the pig industry in the coming years. It is necessary to develop practices based on cost/benefit analyses of the effects of disease on animal performance. Diseases can be controlled in various ways, such as vaccination programs and management protocols, among others, to control pathogens. We have developed a model to disentangle the effects of management and vaccination strategies to control one of the most important pig viral diseases, Aujeszky disease. Our results suggest that after confirming the diagnosis, early vaccination of most of the population is critical to decrease the spread of the virus and minimize its impact on pig productivity. However, the effect of management is negligible for the control of this virus. Thus, this model can be used to evaluate preventive medicine programs in the control of known diseases and for new ones that could appear in the future.Aujeszky’s disease is one of the main pig viral diseases and results in considerable economic losses in the pork production industry. The disease can be controlled using preventive measures such as improved stock management and vaccination throughout the pig-rearing period. We developed a stochastic model based on Population Dynamics P systems (PDP) models for a standard pig production system to differentiate between the effects of pig farm management regimes and vaccination strategies on the control of Aujeszky’s disease under several different epidemiological scenarios. Our results suggest that after confirming the diagnosis, early vaccination of most of the population (>75%) is critical to decrease the spread of the virus and minimize its impact on pig productivity. The direct economic cost of an outbreak of Aujeszky’s disease can be extremely high on a previously uninfected farm (from 352–792 Euros/sow/year) and highlights the positive benefits of investing in vaccination measures to control infections. We demonstrate the usefulness of computational models as tools in the evaluation of preventive medicine programs aimed at limiting the impact of disease on animal production.

Child Mortality in the United States: Bridging Palliative Care and Public Health Perspectives.

* Abbreviations: ED — : emergency department PPC — : pediatric palliative care Child and adolescent mortality rates in the United States have fallen fairly consistently since the 1960s.1 And yet, infant mortality and deaths in adolescents and young adults are not infrequent. In 2015, 1 out of every 270 infants in the United States died before their first birthday, while 1 out of every 1438 Americans aged 15 to 24 died.2 Among children and adolescents, nonintentional injuries, suicide, and homicide are leading causes of death (Table 1). These cause-of-death statistics provide powerful data to inform public health initiatives, preventive medicine programs, and child health advocacy around end-of-life care. View this table: TABLE 1 2015 Child and Adolescent Mortality in the United States, Both Overall and Due to Unintentional Injuries, Suicide, and Homicide (Grouped Together as Injuries) In this issue of Pediatrics , Trowbridge et al3 take the novel approach of studying modes of death rather than causes of death. Following chart review of all deaths at a freestanding children’s hospital from 2011 to 2014, they created the following 5 mutually exclusive categories: (1) withdrawal of life-sustaining technology, (2) nonescalation of care, (3) failed … Address correspondence to JoAnna K. Leyenaar, MD, PhD, MPH, Dartmouth-Hitchcock Medical Center, WTRB, 1 Medical Center Way, Lebanon, NH 03766. E-mail: joanna.k.leyenaar{at}hitchcock.org

Stray Dog Population in a City of Southern Mexico and Its Impact on the Contamination of Public Areas.

To assess the risk of zoonotic pathogen transmission as function of stray dog presence and health status, a cross-sectional study was carried out in a large city of southern Mexico that lacks comprehensive strategies for the control of stray canine populations. The photographic capture-recapture method was used to estimate the density of dogs/km2. In the same way, dog feces from 14 public parks of the city were collected to determine the prevalence and intensity of infection with gastrointestinal parasites. The canine population was estimated between 65 and 80 thousand dogs, with a population density of 1,081 dogs/km2, mostly males (71.4%). A high proportion of dogs (72.3%) were found to be in good body condition score (BCS 3). The person:dog ratio was 2.3. The likelihood of being in the BCS 2 category was lower in areas with a higher density of dogs. All feces collected from the parks contained eggs of intestinal parasites, most of them with a medium (42.9%) to high (35.7%) infection intensity, notably Ancylostoma caninum. It was recorded that cases with a low-intensity of GI infection showed polyparasitism (35.7%) associated with A. caninum. There is a large population of stray dogs that roam freely in the streets of Campeche city with access to sources of food, which is reflected by their good BCS, and dogs do not have access to preventive medicine programs (de-worming) and thus contaminate public parks with feces with significant parasitic egg loads of zoonotic importance.