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By V. Candela. Stanford University.

Slavin and Marlett (1980) found that supplementing the diet with 16 g/d of cellulose resulted in significantly greater fecal excretion of calcium resulting in an average loss of approxi- mately 200 mg/d purchase minocycline with a visa. There was no effect on the apparent absorption of calcium after the provision of 15 g/d of citrus pectin (Sandberg et al cheap minocycline 50mg with visa. Studies report no differences in magnesium balance with intake of certain Dietary Fibers (Behall et al buy 50mg minocycline overnight delivery. Astrup and coworkers (1990) showed no effect of the addition of 30 g/d of plant fiber to a very low energy diet on plasma concentrations of magnesium. There was no effect on the apparent absorption of magnesium after the provision of 15 g/d of citrus pectin (Sandberg et al. Magnesium balance was not significantly altered with the consumption of 16 g/d of cellulose (Slavin and Marlett, 1980). A number of studies have looked at the impact of fiber- containing foods, such as cereal fibers, on iron and zinc absorption. These cereals typically contain levels of phytate that are known to impair iron and zinc absorption. Coudray and colleagues (1997) showed no effect of isolated viscous inulin or partly viscous sugar beet fibers on either iron or zinc absorption when compared to a control diet. Metabolic balance studies conducted in adult males who consumed four oat bran muffins daily showed no changes in zinc balance due to the supplementation (Spencer et al. Brune and coworkers (1992) have suggested that the inhibi- tory effect of bran on iron absorption is due to its phytate content rather than its Dietary Fiber content. There are limited studies to suggest that chronic high intakes of Dietary Fibers can cause gastrointestinal distress. The con- sumption of wheat bran at levels up to 40 g/d did not result in significant increases in gastrointestinal distress compared to a placebo (McRorie et al. For instance, 75 to 80 g/d of Dietary Fiber has been associated with sensations of excessive abdominal fullness and increased flatulence in individuals with pancreatic disease (Dutta and Hlasko, 1985). Furthermore, the consumption of 160 to 200 g/d of unprocessed bran resulted in intestinal obstruction in a woman who was taking an antidepressant (Kang and Doe, 1979). Summary Dietary Fiber can have variable compositions and therefore it is difficult to link a specific fiber with a particular adverse effect, especially when phytate is also often present. It is concluded that as part of an overall healthy diet, a high intake of Dietary Fiber will not produce significant deleterious effects in healthy people. Special Considerations Dietary Fiber is a cause of gastrointestinal distress in people with irritable bowel syndrome. Those who suffer from excess gas production can consume a low gas-producing diet, which is low in dietary fiber (Cummings, 2000). Hazard Identification for Isolated and Synthetic Fibers Unlike Dietary Fiber, it may be possible to concentrate large amounts of Functional Fiber in foods, beverages, and supplements. Since the potential adverse health effects of Functional Fiber are not completely known, they should be evaluated on a case-by-case basis. In addition, projections regard- ing the potential contribution of Functional Fiber to daily Total Fiber intake at anticipated patterns of food consumption would be informative. Func- tional Fiber, like Dietary Fiber, is not digested by mammalian enzymes and passes into the colon. Thus, like Dietary Fiber, most potentially deleterious effects of Functional Fiber ingestion will be on the interaction with other nutrients in the gastrointestinal tract. Data from human studies on adverse effects of consuming what may be considered as Functional Fibers (if suffi- cient data exist to show a potential health benefit) are summarized below under the particular fiber. Chitin and Chitosan Studies on the adverse effects of chitin and chitosan are limited. While the adverse gastrointestinal effects of gums are limited, incidences of moderate to severe degrees of flatulence were reported from a trial in which 4 to 12 g/d of a hydrolyzed guar gum were provided to 16 elderly patients (Patrick et al. Gums such as the exudate gums, gum arabic, and gum tragacanth have been shown to elicit an immune response in mice (Strobel et al. When F-344 rats, known to have a high incidence of neoplastic lesions, were given 0, 8,000, 20,000, or 50,000 ppm doses of fructooligo- saccharide, the incidence of pituitary adenomas was 20, 26, 38, and 44 per- cent, respectively (Haseman et al. Clevenger and coworkers (1988) reported no difference in the onset of cancer in F-344 rats fed 0, 8,000 (341 to 419 mg/kg/d), 20,000 (854 to 1,045 mg/kg/d), or 50,000 ppm (2,170 to 2,664 mg/kg/d) doses of fructooligosaccharide compared with the controls. Henquin (1988) observed a lack of developmental toxicity when female rats were fed a diet containing 20 per- cent fructooligosaccharide during gestation. When pregnant rats were fed diets containing 5, 10, or 20 percent fructooligosaccharide during ges- tation, no adverse developmental effects were observed (Sleet and Brightwell, 1990). Fructooligosaccharide has been tested for genotoxicity using a wide range of test doses (0 to 50,000 ppm); the results indicated no genotoxic potential from use of fructooligosaccharide (Clevenger et al. Cramping, bloating, flatulence, and diarrhea was observed at intakes ranging from 14 to 18 g/d of inulin (Davidson and Maki, 1999; Pedersen et al. Consumption of 5 or 15 g/d of fructooligosaccharide produced a gaseous response in healthy men (Alles et al. Briet and coworkers (1995) reported increased flatulence as a result of consuming more than 30 g/d of fructo- oligosaccharide, increased bloating at greater than 40 g/d, and cramps and diarrhea at 50 g/d. Increased flatulence and bloating were observed when 10 g/d of fructooligosaccharide was consumed (Stone-Dorshow and Levitt, 1987). The role carbohydrate malabsorption plays in the onset of diarrhea most likely depends upon the balance between the osmotic force of the carbohydrate and the capacity of the colon to remove the carbohydrate via bacterial fermentation. In order to evaluate the significance of osmolarity, Clausen and coworkers (1998) compared the severity of diarrhea after consumption of fructooligosaccharide and lactulose, both of which are nonabsorbable carbohydrates. Although both carbohydrates are fermented by colonic microflora, they differ in osmolarity. In a crossover design, 12 individuals were given fructooligosaccharide or lactulose in increasing doses of 0, 20, 40, 80, and 160 g/d. The increase in fecal volume measured as a function of the dose administered was twice as high for lactulose as for fructooligosaccharide; however, there was substantial interindividual varia- tion in the response. The researchers concluded that fecal volume in carbohydrate-induced diarrhea is proportional to the osmotic force of the malabsorbed saccharide, even though most is degraded by colonic bacteria (Clausen et al. Anaphylaxis was observed following the intravenous administration of inulin for determining the glomerular filtration rate (Chandra and Barron, 2002). A skin-pricking test revealed hypersensitivity to each of the above foods or ingredients (Gay-Crosier et al. Pectin Pectin has been shown to have a negligible effect on zinc retention in humans (Lei et al. Polydextrose Polydextrose has showed no reproductive toxicity, teratology, muta- genicity, genotoxicity, or carcinogenesis in experimental animals (Burdock and Flamm, 1999). In humans, no reports of abdominal cramping or diarrhea were reported in men and women who were given up to 12 g/d of polydextrose (Jie et al. Furthermore, there were no complaints of abdominal distress with the consumption of 30 g/d of polydextrose (Achour et al. However, flatulence and gas-related problems were reported following the intake of 30 g/d of polydextrose (Tomlin and Read, 1988).

Only then should this be put into a white linen cloth and squeezed through a press minocycline 50mg otc. In the same manner oil of elder cheap minocycline amex, violet buy cheap minocycline online, and sweet gale is made, that is, those oils which are good in acute diseases; anointed on the liver, pulse points, temples, and palms of the hands and soles of the feet, they extinguish heat completely. Oxizaccara (¶): Oxizaccare is so called from oxi, which is vinegar, and zu- charo, ‘‘sugar. Take one pound of sugar, eight ounces of pomegranate juice, and four ounces of vinegar, and place in a tin10 vessel on the fire. And let it boil for a while, stirring constantly with a spatula, until it is reduced back to the quantity of the sugar; it should become so thick that it can be carried. It is called Paulinum because it is large, antidotum because it is given as an antidote, for it has great power and efficacy. Properly, it is given for chronic and acute coughing, which arises from a flow- ing out of rheum from the head. It is good for disorders of the chest caused by cold [when given] in the evening with warm wine. But if [the patient] is not able to take it diluted, make from it nine or eleven pills made with the juice of opium poppy. But if it has been made without the juice of opium poppy and you wish to make a laxative, give two drams with two scruples of Levant scam- mony made into pills. It purges the head and stomach of phlegm and foulness, and it takes away heaviness of the eyes. The fourth part is one pound because in each dose they put a pound and half of skimmed honey. Take eleven drams and fifteen grains of aloe; four and a half drams each of saffron, costmary, mark- ing nut, agaric, coral, myrrh, ammoniacum, turpentine, galbanum, serapinum gum, opoponax, confected cleavers, calamite storax, and Florentine iris; two drams and fifteen grains each of juice of opium poppy, frankincense, mastic  Appendix gum, bdellium, and cozumbrum; one dram and a half each of balsam and cloves; [and] two drams of balm. Take the gums—galbanum, serapinum gum, ammoniacum, and opoponax—and grind them a little bit, and let them be placed in white and moderately sweet-smelling wine for one night. Afterward, add four ounces of skimmed honey and let them continue to boil until they begin to thicken. Then, having ground thoroughly the cala- mite storax, confected cleavers, and cozumbrum with a hot pestle, let them be placed in a cauldron, stirring constantly with a spatula until they liquefy. And if you wish to test whether it is cooked, place a little bit on some marble, and if it immediately congeals into the consistency of honey, [then it is cooked]. A little later, the cauldron having been placed on the ground, let the myrrh, together with the bdellium, be added. Then the costmary, marking nut, agaric, coral, Florentine iris, juice of opium poppy, cloves, and balm. Having ground all these together and pulverized them, let them be placed in the cauldron. Then spread this whole mixture onto a slab of marble that has first been covered with oil of laurel. And let this be softened with the powder of aloe, while the saffron is ground with the spices. Populeon (¶): Unguentum populeon is so called because it is made from poplar buds [oculus populi]. It is good against the heat of an acute fever and for those who are unable to sleep if it is anointed on the temples and the pulse points and the palms of the hands and soles of the feet. This same unguent, when mixed with oil of roses or violets and anointed above the kidney, takes the heat away marvelously; when anointed on the abdomen, it provokes sweat- ing. Take one and a half pounds of poplar buds; three ounces each of red poppy, leaves of mandrake, the tips of the most delicate leaves of bramble, henbane, black nightshade, common stonecrop, lettuce, houseleek, burdock, violet, and scantuncelus (i. On the third day, gatherall the above- mentioned herbs and let them be ground well by themselves. Afterward, let the lozenges be put piece by piece in a cauldron with one pound of excellent,odoriferous wine. Afterward, Compound Medicines in the Trotula Ensemble  having squeezed it all out in a sack, drain [the mixture] well. Potio Sancti Pauli (¶): Potio Sancti Pauli is called potio from potando [drink- ing], sancti Pauli because Saint Paul created it. This is the same potion which the Romans called potio maior, because Paul the Great modified it. Properly it is given to epileptics, cataleptics, analeptics, and those suffering in the stom- ach; it is given with wine in which incense or mixed peony has been cooked. This potion is given with Esdra11 in the wintertime and in the springtime to those suffering from quartan fever. It cures when given before the hour of crisis with wine in which felwort or golden gorse and castoreum have been cooked. It likewise heals those suffering from diseases of the windpipe and paralytics when given with wine in which sage or castoreum has been cooked. Take three drams and one scruple of natron; one dram and one scruple each of castoreum, antimony, houseleek, cloves, laurel berry, willow, wild celery, parsley, fennel, wild carrot, and stavesacre; three scruples each of sweet flag, myrobalans, licorice, vitriol, peony, and pellitory; one scruple and eighteen grains of costmary, colocynth, agaric, mastic, both long and round aristolochia, roses, juice of wild cabbage, hazelwort, wood sage, cuckoopint, dittany, basil, bear’s breech, horsemint, oregano, penny- royal, wall germander or hyssop, savory, white pepper and black pepper and long pepper, and rue seed; one scruple and four grains each of watercress and frankincense; one scruple each of balsam, spikenard, saffron, camel grass, Chi- nese cinnamon, myrrh, opoponax, sulfur, mandrake, felwort, malt, spurge, poppy, and cormorant blood; one scruple minus four grains each of cinnamon, cloves, ginger, marking nut, bark of the balsam tree, rhubarb, hog’s fennel, fruit of the balsam tree, calamite storax, serapinum gum, hazelwort, dragon’s blood, hare’s rennet, sheep’s and goat’s and veal rennet, bear’s gall, goose blood, and petroleum; seven drams and four grains of cowslip; and honey as needed. This is given in the evening, in the amount of a hazelnut, or with the above- mentioned decoctions, to those suffering from diseases of the head. It is called rosata from roses; novella [new] in contrast to the old rosata, which had tibar, that is, mercury. Take one ounce and one dram and two and a half scruples each of rose, sugar, and licorice; two drams, two scruples, and two grains of cinnamon; one scruple and eight grains each of cloves, spike-  Appendix nard, ginger, galangal, nutmeg, zedoary, storax, watercress, and wild celery; and honey as needed. But if you wish to use it as a purgative, you should employ two scruples of Levant scammony and it will work more forcefully. Take three drams, three grains, plus a third of one grain of aloe; three drams each of cinnamon, wall germander, and sweet flag; two drams and sixteen grains each of saffron, cassia tree bark, and rhubarb; two and a half drams of agaric; one and half drams of spikenard, costmary, mastic, hazelwort, silphium,12 squill, asafetida, ammoniacum, bdel- lium, Indian electuary, St. It is made against the most serious diseases of the whole human body: for epileptic conditions, cataleptic, apoplectic, cephalargic, stomach-related, and migrainous. It is best for respiratory, asthmatic, blood-spitting,13 jaundiced, dropsical, perip- neumonic, and intestinal conditions, and for those having wounds in the in- testines. It improves leprous lesions and variolas and periodic chills and other diseases of long standing. It is especially good against all kinds of poisons and the bites of serpents and reptiles. But the quan- tity and quality of the doses for each disease are different, and they are written at the end. Take two drams and two scruples of tro- ches made from squill; two drams of long pepper; one dram and one scruple each of troches of Tyre and diacorallum;15 one scruple and seven grains of bal- Compound Medicines in the Trotula Ensemble  sam wood; one scruple and fourteen grains each of juice of opium poppy, agaric, Florentine iris, rose, crow garlic, wild turnip seed, cinnamon, and juice of the balsam tree; one scruple and seven grains each of rhubarb, wax, spike- nard, costmary, camel grass, ginger, cassia tree bark, calamite storax, myrrh, turpentine, frankincense, calamint, dittany, French lavender, wall germander, roots of creeping cinquefoil, parsley, and white pepper; one scruple each of cloves, gum arabic, sweet flag, burnt vitriol, serapinum gum, sealed earth or Armenian bole, juice of dodder, Celtic nard, germander, felwort, hog’s fen- nel, balsam fruit, poppy, wild celery, fennel, wild caraway, sermountain, gar- den cress, garden cress seed, anise, and St. Grind those things that need to be ground, and having melted the gums in wine, mix with the powder and with sufficient honey or grind with the spices. It is given in the amount of a hazelnut with lukewarm water to those suffering from apoplexy, scotomia, cephalargia, migraines, hoarseness of the voice, and chest pains; for these, it should be given with honey or gum tragacanth so that it can be toler- ated by the mouth. For those with blood-spitting conditions of the chest and disease of the lung, give it in a ptisan.

Notifcation of infectious diseases by general practitioners: A quantitative and qualitative study buy cheap minocycline 50mg on line. Guidelines for laboratory testing and resultGuidelines for laboratory testing and result reporting of antibody to hepatitis C virus buy 50 mg minocycline visa. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www buy minocycline 50 mg. Prevention of perinatal hepatitis B through enhanced case management—Connecticut, 1994-95, and the United States, 1994. Guidelines for national human immunodefciency virus case surveillance, includ- ing monitoring for human immunodefciency virus infection and acquired immunodef- ciency syndrome. National hepatitis C prevention strategy: A comprehensive strategy for the prevention and control of hepatitis C virus infection and its consequences. Updated guidelines for evaluating public health surveillance systems: Recom- mendations from the guidelines working group. 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Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis C virus transmission at an outpatient hemodialysis unit—New York, 2001-2008. Incidence of hepatitis B virus infection in the United States, 1976-1994: Estimates from the national health and nutrition examination surveys. Prospective evaluation of community-acquired acute-phase hepatitis C virus infection. Estimating the future health burden of chronic hepatitis C and human immunodefciency virus infections in the United States. Statewide system of electronic notifable disease reporting from clinical laboratories: Comparing automated reporting with conventional methods. Enhancing public health surveillance for infuenza virus by incorporating newly available rapid diagnostic tests. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. 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Improved case fnding of hepatitis B positive women of child-bearing age through implementation of a web-based surveillance system. Using automated medical records for rapid identifcation of illness syndromes (syndromic surveillance): The example of lower respiratory infection. Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. Updated outcomes of partner no-Updated outcomes of partner no- tifcation for human immunodefciency virus, San Francisco, 2004-2008. Prevalence of hepatitis C in drug users in Flanders: Determinants and geographic differences. Improving the diagnosis of acute hepatitis C infection using expanded viral load criteria. Acute hepatitis C virus infection in incarceratedAcute hepatitis C virus infection in incarcerated injection drug users. Acute hepatitis B virus infection: Relation of age to the clinical expression of disease and subsequent development of the carrier state. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Utilizing disease intervention specialist for follow-up on hepatitis C in indi- viduals between the ages of and years: A -month pilot program. A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifable conditions. Automatic electronic laboratory-based reporting of notifable infectious diseases at a large health system. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Major decline of hepatitis C virusMajor decline of hepatitis C virus incidence rate over two decades in a cohort of drug users. Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection. 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Rinderpest – eradication of a disease affecting all sectors Rinderpest discount 50 mg minocycline with visa, once described as “the most dreaded bovine plague known” purchase minocycline 50 mg fast delivery, became the first disease of animals to be eradicated by human intervention order cheap minocycline on line. This acute viral disease has been responsible for the death of domestic cattle for millennia, adversely affecting livestock, wildlife and agricultural livelihoods, bringing starvation and famine. In its classical, virulent form, rinderpest infection can result in 80-95% mortality in domestic cattle, yaks, buffalo and many other wild ungulate species. The disease has had far reaching conservation impacts affecting the abundance, distribution and community structure of many species as well as becoming a source of conflict between agricultural and wildlife interests. Clinical signs include: fever, depression, loss of appetite, discharges from the eyes and nose, erosions throughout the digestive tract, diarrhoea and death. Weight loss and dehydration, caused by enteric lesions, can cause death within 10-12 days. Key Actions Taken to eradicate rinderpest included the development of vaccines, disease surveillance, diagnostic tools and community-based health delivery. Initially, mass livestock vaccination programmes were implemented followed by improved disease surveillance and focussed vaccination campaigns (containing any remaining reservoirs of disease). Disease surveillance and accreditation continued until 2011, when on June 28th the world was declared free from rinderpest. Outcomes: The benefits derived from the eradication of rinderpest are numerous and include: protected rural livelihoods, increased confidence in livestock-based agriculture, an opening of trade in livestock and their products and increased food security. Veterinary services worldwide have become more proficient as a consequence of the fight against rinderpest and the conservation of numerous African ungulates has also benefited. The socio-economic benefits of rinderpest eradication are said to surpass those of virtually every other agricultural development programme and will continue to do so. Rinderpest was successfully eradicated due to ongoing, concerted, international efforts that built on existing disease control programmes in affected countries. Only through international coordination can other such transboundary diseases be controlled and eliminated, as isolated national efforts often prove unsustainable. It is important to note that different stakeholders will likely have different ideas about when interventions are required and ideally these can be addressed within management and contingency plans in ‘peacetime’ i. It is important to understand that disease management may be thwarted by poor understanding of disease ecology and dynamics, and thus the appropriate management practices to mitigate. Inappropriate disease management practices can even result in counter-productive consequences and novel disease problems. Hence, a good evidence base is important, appreciating that this may be difficult to attain due to complexities or limitations of diagnosis, surveillance, and other knowledge gaps. As human development and livestock have encroached into wild habitats, not surprisingly infectious diseases have spread between these populations, negatively affecting all three sectors. Movements of people and extensive trade in wild and domestic animals have resulted in the global spread of a number of pathogens, causing particular problems where infectious agents are novel and new hosts are immunologically naïve. The complexities of disease dynamics in wildlife have resulted in unpredicted disease emergence. Diseases of wildlife that affect humans or their livestock have sometimes led to eradication programmes targeted at wildlife which have not necessarily resulted in reduced disease prevalence but, instead, serious long term consequences for biodiversity, public health and well- being, and food security, whilst failing to address causal problems. It has become common understanding that the world can no longer deal with diseases of people, domestic livestock and wildlife in isolation and, instead, an integrated ‘One World One Health’ approach to health has developed. Delivering integrated approaches and responses across the medical, veterinary, agricultural and wildlife sectors can be problematic given existing organisational roles and structures but demonstrating the benefits this can bring should help promote this progressive way of working. The recent global eradication of rinderpest provides an example of how one disease with impacts across all sectors requires global coordinated efforts to bring about success and benefits for all. For wetlands, which provide the ‘meeting place’ for people, livestock and wildlife, a mapping of a number of important wetland diseases, according to their hosts (Figure 2-3), illustrates clearly that more diseases are shared between these sectors than are specific to any one sector. Tackling disease in one sector is unlikely to be successful in the long term without consideration of the others. Moreover, not working at an ecosystem scale, and without integrated approaches, misses opportunities for broader positive health outcomes. A number of important wetland diseases mapped according to the hosts they affect: the majority of both infectious and non-infectious diseases are common to all three sectors. Whilst this focus is no doubt important, it distorts the health equation, and does not address what ‘determines’ health (or ill- health). That failure can result in unnecessary burdens of disease for humans, domestic and wild animals. An ecosystem approach to health, instead, works further ‘upstream’ – closer to the driver of the problem. The approach is preventative recognising that ‘prevention is better than cure’ and, for wetlands, focussing at a landscape or catchment scale ensures maintenance of social and ecosystem services. This approach then seeks to establish the societal and environmental conditions for good health, bringing long-term savings for medical and veterinary costs and overall maximising benefits and minimising costs for wetland stakeholders, particularly those most likely to be affected by specific health issues. Managing disease within one sector without consideration of the others not only misses opportunities for improved health outcomes for more sectors, but importantly may result in negative health outcomes in other sectors, and feedback unintended consequences for the original sector in the long term. Seeing ‘health’ as a property of a(n eco)system, allows for more effective and widespread outcomes. The ‘One World One Health’ and ‘Ecohealth’ movements arose due to the appreciation of this interdependence on, and connectivity between, health of humans, domestic livestock and wildlife and their social and ecological environment, understanding disease dynamics in broader contexts of sustainable agriculture, socio-economic development, environment protection and sustainability, and complex patterns of global change. A fundamental aspect of taking an ecosystem approach to health is that it is participatory with stakeholders understanding that they can create or solve problems relating to their health and that of their livestock and wider environment. Given the complex relationships between humans and other biodiversity, the complexities of resource use, including barriers to sustainable resource use, improved health outcomes are maximised when more stakeholders are on-board and engaged. This is not an easy accomplishment and processes that allow for genuine co-operation and mutual understanding of quite different organisational sectors is required. It is worth appreciating the consequences of not taking an ecosystem approach to health in wetlands. Wetlands as settings for lifestyles and livelihoods can deteriorate, and negatively affect health in this way. Activities which negatively affect wetland functions and services can create wetlands which actively pose health risks such as exposures to toxic materials and/or water-borne, or vector-borne diseases. Whilst steps can be taken to ameliorate these risks, the risks can increase (sometimes dramatically) if disruption to ecosystems, and the services they provide, continues. Current wetland management practices focussed at maintaining wetland function and wetland benefits usually also address disease prevention and control. However, there will be strategies for disease management that are additional to traditional management practices that once integrated, provide additional gains. To view disease management as separate to other forms of land and wildlife management ensures that opportunities for good disease prevention will be missed. Wetland managers are the key stakeholders in delivering healthy wetlands and, as such, all efforts should be made to integrate disease management thoroughly within wetland site management plans and other stakeholder activities at wetlands. Invasive alien species of flora and fauna are considered the second biggest threat after habitat loss and destruction to biodiversity worldwide, the greatest threat to fragile ecosystems such as islands, and are a major cause of species extinction in freshwater systems.

At the federal level cheap minocycline american express, there are limited and frag- mented resources to track and fund such services cheap minocycline 50mg fast delivery. However generic minocycline 50mg otc, few of the independent programs have been replicated in other communities of at-risk foreign-born populations, so many regions in the United States that have at-risk foreign-born populations lack community-based hepatitis B screening (Rein et al. It is unknown whether the model programs developed for Asians and Pacifc Islanders could be adapted for some of those populations or whether new culturally tailored programs would need to be created. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Cultural and institutional impediments are particularly important for the foreign-born. For example, culture-specifc stigmas may be attached to a diagnosis of chronic hepatitis B. Institutional barriers include administrative procedures and the absence of culturally responsive support services. For example, a recent survey of hospitals in the San Francisco Bay area—a region where 29% of the population is foreign-born—found that fewer than half routinely collect information on patients’ birthplaces (Gomez et al. The collection of information on the birthplace of patients’ parents is even rarer—but relevant for risk assessment. English-language profciency and cultural preferences of foreign-born patients may pose additional challenges to institutions that are not prepared to work with these patient factors. Non-English-speaking patients report that physicians are intolerant and impatient toward them and fail to use interpreter services, even when available, to facilitate com- munication (Barr and Wanat, 2005; Giordano and Cooper, 2009; Giordano et al. As a result of patient–physician language discordance and impaired communication, such patients have poorer comprehension of medical conditions, testing, and treatment; have low compliance; and are more likely to miss followup appointments (Giordano and Cooper, 2009; Giordano et al. There is a need for evidence-based strategies and programs to dissemi- nate information about hepatitis B transmission, infection, and treatment to culturally and demographically diverse populations. A community-based participatory research approach, in which communities are actively engaged in equal partnership with scientists, is needed to ensure that the programs are acceptable, accessible, and sustainable in the communities where they are based. Such programs should also be fexible and scalable so that other communities can tailor them to their own needs. The committee believes that these tasks are best accomplished with the approach outlined in Rec- ommendations 3-1 and 3-2 in Chapter 3. The community-based approach as outlined in Recommendation 3-2 would be strengthened by additional Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The Centers for Disease Control and Prevention, in conjunction with other federal agencies and state agencies, should provide resources for the expansion of community-based programs that provide hepatitis B screening, testing, and vaccination services that target foreign-born populations. Illicit-Drug users Preventing bloodborne infectious diseases, particularly hepatitis C, in illicit-drug users is an important public-health challenge. It takes only a very small amount of infec- tious blood on injection equipment to result in infection. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Injection often takes place in settings that are chaotic, rushed, or otherwise not conducive to safe practices, thereby increasing the risk of disease transmission (Rhodes and Treloar, 2008). The persistence of moderate levels of unsafe injection behaviors seems to be suffcient to maintain relatively high rates of new infections (Thiede et al. Although drug use is associated with many serious acute and chronic medical conditions, health-care utilization among drug users is low com- pared with persons who do not use illicit drugs (Chitwood et al. Drug-treatment programs offer few services related to hepatitis B and hepatitis C and are constrained by lack of funding (Stanley, 1999). Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. In addition, the studies were limited to opiate- substitution programs; cocaine injectors and other non-opiate injectors may not experience similar benefts. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Drug users who are successful in avoiding infection have developed strategies to maintain control over their chaotic lives. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Safe-redrawn injection strategies require access to sterile syringes and other equipmentR01623 Hepatitis and education to promote adoption and maintenance of safe behavior. Drug treatment will reduce injection frequency and assist a modest proportion of injectors to achieve abstinence. Federal, state, and local agencies should expand programs to reduce the risk of hepatitis C virus infection through injection-drug use by providing comprehensive hepatitis C virus pre- vention programs. At a minimum, the programs should include access to sterile needle syringes and drug-preparation equipment because the shared use of these materials has been shown to lead to transmission of hepatitis C virus. Federal and state governments should expand services to reduce the harm caused by chronic hepatitis B and hepati- Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The services should include testing to detect infection, counseling to reduce alcohol use and secondary transmission, hepatitis B vaccina- tion, and referral for or provision of medical management. Programs should include education about safe drug use (avoiding the shared use of implements to administer drugs by smoking or inhalation) and reduction in sex-related risks, and all participants in the programs should be offered the hepatitis B vaccine. Innovative, effective, multicomponent hepatitis C virus prevention strategies for injection-drug users and non-injection- drug users should be developed and evaluated to achieve greater con- trol of hepatitis C virus transmission. In particular, • Hepatitis C prevention programs for persons who smoke or sniff heroin, cocaine, and other drugs should be developed and tested. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The programs are administered by state and local public-health departments and vary in reach and intensity. As mentioned in Chapter 2, many programs simply provide surveillance, and others provide comprehensive case management that even includes client home visits by local coordinators. Perinatal hepatitis B programs identify twice as many household and sexual contacts per infant as was reported to the national database, with high rates of programmatic compliance in households of foreign-born people (Euler et al. This gap has a two-fold effect in that chronically infected women do not receive the appropriate medical management and referral and perinatal transmission continues to occur. Those women require followup services to ensure that they are knowledgeable about risks posed by their chronic infection and that they receive appropriate referral for long-term medical management. Cases among household contacts are not uncommon when this risk group is pur- sued aggressively for testing. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis B services for foreign-born pregnant women are in need of improved resources that are more culturally and linguistically appropriate. The coordinators are restricted in their ability to fulfll that responsibility in culturally relevant ways, because of inadequate training and resources (Chao et al.

Adverse events associated with childhood vaccines: Evi- dence bearing on causality cheap minocycline online visa. Immunization safety review: Hepatitis B vaccine and demyelinating neurologi- cal disorders order minocycline 50 mg line. Hepatitis B im- munization coverage among Vietnamese-American children 3 to 18 years old buy minocycline 50mg low price. Vaccine shortages: Why they occur and what needs to be done to strengthen vaccine supply. Potential cost-effectiveness of a preventive hepatitis C vaccine in high risk and average risk populations in Canada. Poor valid- ity of self-reported hepatitis B virus infection and vaccination status among young drug users. Hepatitis B virus infection and immunization status in a new generation of injection drug users in San Francisco. Previously infected and recovered chimpanzees exhibit rapid responses that control hepatitis C virus replication upon rechallenge. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Cost-effectiveness analysis of a hypothetical hepatitis C vaccine compared to antiviral therapy. Economic benefts of hepatitis B vaccination at sexually transmitted disease clinics in the U. Effect of a school-entry vaccination require- ment on racial and ethnic disparities in hepatitis B immunization coverage levels among public school students. The impact of state policies on vaccine coverage by age 13 in an insured population. Adult immunization programs in nontraditional set- tings: Quality standards and guidance for program evaluation. Non-traditional settings for infuenza vaccination of adults: Costs and cost effectiveness. Community-basedCommunity-based hepatitis B screening programs in the United States in 2008. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. All kids count 1991-2004: Developing information systems to improve child health and the delivery of immunizations and preventive services. Predictors of accep- tance of hepatitis B vaccination in an urban sexually transmitted diseases clinic. Disruptions in the supplyDisruptions in the supply of routinely recommended childhood vaccines in the United States. A successful approach to immunizing men who have sex with men against hepatitis B. Risk of hepatitis B infection among young injection drug users in San Francisco: Opportunities for intervention. Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003. Association between health care providers’ infuence on parents who have concerns about vaccine safety and vaccination coverage. Associations between childhood vacci- nation coverage, insurance type, and breaks in health insurance coverage. Reducing geographic, racial, and ethnic disparities in childhood im- munization rates by using reminder/recall interventions in urban primary care practices. Hepatitis B and C in institutions forHepatitis B and C in institutions for individuals with intellectual disability. Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection. PrevalencePrevalence and clinical outcome of hepatitis C infectionand clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood-donor screening. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Preventing mother-to-child transmission of hepa- titis B: Operational feld guidelines of delivery of the birth dose of hepatitis B vaccine Manila: World Health Organization Western Pacifc Region. The impact of a simulated immunization registry on perceived childhood immunization status. School-entry vaccination requirements: A position statement of the society for adolescent medicine. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. This chapter reviews the current status of services to prevent and manage chronic hepatitis B and chronic hepatitis C. The chapter ends with an assessment of gaps in existing services, including a description of some models for services and committee recommendations to improve viral hepatitis prevention and management and to fll research needs. Hepatitis B immunization is covered in Chapter 4 and so is not discussed in detail here. The recommendations offered by the committee here are presented in the context of the current health-care system in the United States. The com- mittee believes strongly that if the system changes as a result of health-care reform efforts, viral hepatitis services should have high priority in compo- nents of the reformed system that deal with prevention, chronic disease, and primary-care delivery. The committee’s recommendations regarding viral hepatitis services are summarized in Box 5-1. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Innovative, effective, multicomponent hepatitis C virus prevention Summary of Recommendations Regarding strategies for injection drug users and non-injection-drug users should Viral Hepatitis Services be developed and evaluated to achieve greater control of hepatitis C virus transmission. Federally funded health-insurance programs—such as Medicare, Pregnant Women Medicaid, and the Federal Employees Health Benefts Program— • 5-6. The Centers for Disease Control and Prevention should provide should incorporate guidelines for risk-factor screening for hepatitis B additional resources and guidance to perinatal hepatitis B prevention and hepatitis C as a required core component of preventive care so program coordinators to expand and enhance the capacity to identify that at-risk people receive serologic testing for hepatitis B virus and chronically infected pregnant women and provide case-management hepatitis C virus and chronically infected patients receive appropriate services, including referral for appropriate medical management. The National Institutes of Health should support a study of the effectiveness and safety of peripartum antiviral therapy to reduce and Foreign-Born Populations possibly eliminate perinatal hepatitis B virus transmission from women • 5-2. The Centers for Disease Control and Prevention, in conjunction at high risk for perinatal transmission. The Centers for Disease Control and Prevention and the Depart- foreign-born populations. At Community Health Facilities a minimum, the programs should include access to sterile needle • 5-9. The Health Resources and Services Administration should pro- syringes and drug-preparation equipment because the shared use of vide adequate resources to federally funded community health facili- these materials has been shown to lead to transmission of hepatitis ties for provision of comprehensive viral-hepatitis services. Federal and state governments should expand services to reduce High Impact Settings the harm caused by chronic hepatitis B and hepatitis C. The Health Resources and Services Administration and the should include testing to detect infection, counseling to reduce alcohol Centers for Disease Control and Prevention should provide resources use and secondary transmission, hepatitis B vaccination, and referral and guidance to integrate comprehensive viral hepatitis services into for or provision of medical management.

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