By O. Dimitar. Stonehill College.

Activities that can increase stress and thus increase disease susceptibility order losartan 25mg line, include the transportation and/or translocation of animals buy losartan 50 mg free shipping, isolation discount losartan 50mg line, restraint and overstocking (factors particularly relevant to the spread of disease of livestock). Other stressors are as diverse as hunting, increased genetic homogeneity and long-term toxin exposure. Rapid environmental changes caused by human activity have amplified the role of disease as regulation factors in species survival. Fragmentation of habitat by human encroachment can result in vulnerable isolated wildlife populations in human-made ‘island ecosystems’ which are at increased risk of diseases and their impacts. Air, water, light, noise and thermal pollution must also be considered as stressors or drivers of disease in wetland systems. Nutritional stress (lack of, poor, or imbalanced nutrition) can lead to immunological impairment and often tip the balance between health and disease in animals (e. These stressors and drivers of disease should not be considered in isolation as several factors often contribute (synergistically) to the emergence of a wetland disease. The impact of climate change on animal disease Climate change is having an unprecedented worldwide impact on the emergence and re-emergence of animal diseases, including zoonoses. The recent rise in emerging infectious diseases has included considerable increases in the number of vector borne-emerging infectious diseases during the 1990s. Climate change is thought to play a significant role in this with compelling evidence of variations in climate impacting diseases such as malaria, dengue fever and plague in humans, bluetongue in livestock and other diseases of amphibians and corals. As the climate continues to change, the effect of pathogens on wildlife, livestock and humans is also likely to change. Although there is a consensus among scientists that climate change will result in general increases in disease incidence and distribution, it is worth noting that due to the complexities of climate change-disease interactions some diseases are likely to decrease in frequency or prevalence. Mosquitoes can now be found at Everest base camp, traditionally a place where low temperatures and high altitude have deterred the insect; annual temperature increases of 0. Temperature changes may also affect vectors by altering biting rates or length of the transmission period. In the Arctic, southern species, such as white-tailed deer Odocoileus virginianus, are invading areas normally occupied by caribou Rangifer tarandus. The deer can carry ticks and therefore have the potential to distribute tick-borne parasites such as those responsible for Lyme disease. Rodent populations are known to increase following mild/wet winters in temperate regions, rodent-borne diseases include: Lyme disease, tick-borne encephalitis and hantavirus pulmonary syndrome. Grazers would also suffer with restricted food availability due to limited vegetation growth. Such stresses would predispose animals to greater parasite load and greater risk of diseases progressing from a sub-clinical to a clinical state [► example below]. In China rising temperatures causing increased glacial runoff into nearby wetlands has been cited as one reason why unusually large numbers of geese are remaining at Qinghai Lake over winter instead of migrating to India. With greater concentrations of birds comes greater concern about increased transmission of avian viruses such as highly pathogenic avian influenza H5N1. Local land use changes are also expected to exert temperature and rainfall changes (e. Climate models predict that such changes will alter the distribution of malaria in Africa - in tropical Africa and in parts of the Sahel the spread of malaria will decrease and the risk of malaria epidemics will shift southwards. Example: African lions, drought and disease An example of how increasing extreme weather may cause the expansion of animal diseases occurred in 1994 and 2001 in Tanzania. During these years there was unusually high mortality of lions Pathera leo due to canine distemper, an endemic disease that is not usually fatal. Post mortem analyses had also revealed higher than usual levels of the tick-borne parasite Babesia leo and it was this co-infection that had reduced the lions’ immunity and caused them to succumb to canine distemper. A link was drawn between the environmental conditions and the deaths: in 1994 and 2001 there had been extended droughts that had weakened the local herbivore population and allowed the ticks that parasitised the herbivores to prosper; the lions feeding on the weakened herbivores were then exposed to greater infection by Babesia causing susceptibility to canine distemper. With climate change expected to increase the number of drought events in Africa, lion populations are likely to continue to suffer large losses to an already threatened population. Yet the emergence of numerous and novel diseases related to human activities can negatively impact biodiversity and contribute to species declines and even extinctions. The previously discussed drivers of disease affecting the wider environment, host populations, parasites and their vectors, together with factors specific to wildlife, such as, intensive conservation management of wildlife, effects of providing supplemental food including feeding stations, and translocations have all contributed to the negative consequences of disease at a population level. The introduction of rinderpest virus to Africa altered abundance and distribution of herbivore populations dramatically throughout the continent. Communities can be impacted additionally when species, such as ‘keystone species’, are negatively affected by disease. Perhaps this is best illustrated by effects of diseases on corals, with dramatic changes throughout communities and ecosystems. Small populations lose heterozygosity and are thus inherently more genetically susceptible to disease (and immunologically naïve isolated populations, such as island species, tend to have relatively limited genetic diversity). The overall effect can be to create populations at greater risk of disease where the impacts can be particularly serious, causing either extinction or further loss of heterozygosity, further disease susceptibility and possibly jeopardising the survival of the population. Whooping crane Grus americana, a threatened species which has suffered from diseases whilst sympatric more abundant sandhill cranes Grus canadensis have been relatively unaffected (Ramsar). To illustrate that disease has become a cross cutting conservation issue, we have used as a proxy, an analysis of multilateral environmental agreement instruments, specifically under the Convention on Migratory Species, of the number of instruments mentioning the terms ‘health’ or ‘disease’.

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There is evidence that people’s ability to pay affects whether they seek and receive appropriate medical care for chronic hepatitis B and hepatitis C discount losartan 50 mg. The committee recognizes that uncertainties in funding and health-care reform may make implementation of such a pro- gram challenging order 25mg losartan with visa. General Population Various factors can lead to diffculties in accessing screening discount 50 mg losartan, preven- tion, testing, and care related to viral hepatitis. Obstacles to obtaining such services may be limitations in private or public insurance coverage and cost- sharing, lack of access to public health insurance, lack of public funding to support implementation of state viral hepatitis plans, lack of hepatitis awareness and health literacy, inadequacy of sites or practice settings where health-care services are received, transportation needs, social stigmas, fear of legal prosecution related to drug use and immigration, and such cultural factors as religious beliefs, beliefs about biologic products, health percep- tions, and language. Among those, however, the most important barriers to receipt of existing services are inadequacy of health-insurance coverage and lack of money to pay for services. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. As discussed in Chapter 4, health insurance must provide strong coverage for immunization, counseling services, medical treatment, and prescription drugs, or the insurance’s cost-sharing features will prevent use of services. High deductibles (amounts to be paid out of pocket before coverage begins) or beneft limits are common in insurance policies that are provided by medium and small employers or in-network plans (which provide different coverage in network from out of network). The current fragmentation of viral hepatitis services involving vaccina- tion, risk-factor screening, laboratory testing, and medical management is a major obstacle to the effective delivery of needed services and makes com- pliance more diffcult. The lack of coordination between services can inhibit use by requiring people to travel to multiple sites to obtain care, impairs the development of trusting relationships among multiple providers, and taxes a health system’s ability to transfer information where and when it is needed for good clinical care. One important consequence of the fragmentation of viral-hepatitis ser- vices is inconsistency in referral of people who have chronic viral hepatitis for appropriate medical care. That gap refects defciencies primary-care providers’ knowledge, and it can be substantial when there are barriers, such as physical barriers (that is, screening and testing services in a different location from medical-management services), economic barriers, and cultu- ral barriers. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. In addition, it traced the outcome of therapy and continued to follow those who did not respond. A relatively large percentage of patients (45%) were evaluated in the clinic and underwent liver biopsy. On the basis of the extent of fbrosis on biopsy, 124 patients received anti- viral therapy—32% of the patients referred to the clinic and 24% of those who had viremia. The federal government is the largest purchaser of health insurance nationally, with about 8 million people covered through the Federal Em- ployees Health Benefts Program and those covered through Medicare, Medicaid, and the Children’s Health Insurance Program. Federally funded health-insurance programs— such as Medicare, Medicaid, and the Federal Employees Health Ben- efts Program—should incorporate guidelines for risk-factor screening for hepatitis B and hepatitis C as a required core component of pre- Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The committee has included recommendations regarding coverage of vaccination for infants, children, and adults in Chapter 4. Foreign-Born People There are over 37 million foreign-born residents in the United States; they represent about 12% of the nation’s population (U. Census Bureau, 2008), and 40,000–45,000 legal immigrants from these countries enter the United States each year (U. It is increasingly urgent that culturally appropriate programs provide hepatitis B screening and related services to this high-risk population. Efforts to deliver hepatitis B–related services to the foreign-born popu- lation have been sparse. At the federal level, there are limited and frag- mented resources to track and fund such services. However, 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.

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Communicating the importance of patient and personnel safety includes safety focused management ‘walk-rounds’ purchase losartan 25mg mastercard, safety briefings order losartan 50mg without prescription, error reporting without reprisal generic losartan 50mg amex, and time-outs called when the safety of patients and personnel is not assured. Safety within an organization’s culture can be enhanced by: (i) comparing quality/safety performance to benchmarks; (ii) employing error analysis methods such as root cause analysis and failure mode effects analysis; (iii) moving beyond benchmarks to highest attainable levels; (iv) measuring performance improvement over time; and (v) establishing ‘recognition triggers’ of potential/real errors. Medical errors affect not only patients and their families, but also caregivers and the institutions in which care has been delivered. Health care is a complex, personnel intensive process, often functioning in a high intensity environment. Errors can happen because people are involved in the process, and the organization should make every effort, wherever possible, to establish mechanisms to prevent errors from adversely affecting patients. Still, errors cannot be prevented in their entirety, nor can patients be protected entirely from them. Consequently, some errors will harm patients, and the employees associated with that harm will undoubtedly feel terrible. An organization must have a process in place to support those employees and help them recover from the dismay accruing from the errors and resulting harm. Some rules are available to align the safety activities and incentives of an organization. They include: (i) unification of strategic, quality improvement and financial plans towards an emphasis on patient and personnel safety; (ii) incorporation of safety and quality goals and measures into criteria for employee compensation and advancement; (iii) design of work processes to enhance safety; (iv) assurance that the right thing is the easy thing to do; (v) standardization of work processes to reduce variation; (vi) provide an emphasis on teamwork; (vii) trust and empower employees; and (viii) match work tasks to people’s strengths. An organization committed to patient and personnel safety should provide a management structure that follows a number of procedural guidelines, including: (i) responsibilities of individuals must be communicated clearly, and understanding of the responsibilities must be ensured; (ii) responsibilities entrusted to individuals must be within the scope of the individuals’ education and ability; (iii) early warnings of risk must be present wherever possible; (iv) employees must be able to learn from the mistakes of others through a non-punitive error reporting process; (v) corrective actions to mitigate errors must be documented and communicated; (vi) periodic performance audits and peer review must be conducted; and (vii) when and where available, accreditation of specific health care facilities should be obtained. A number of initiatives have been developed recently to help ensure the safety and appropriateness of medical imaging. An Image Gently campaign focused on paediatric radiology was launched in 2008 by the Alliance for Radiation Safety in Pediatric Imaging [4]. This campaign has had a major impact on reducing radiation dose to paediatric patients by ‘right-sizing’ imaging protocols to patient sizes. Within the Image Gently campaign, the Step Lightly Initiative focuses on the reduction of radiation dose in interventional radiologic procedures [5]. The Image Wisely campaign is modelled, in part, on the Image Gently campaign and is focused on appropriate and safe use of medical imaging for adult patients [6]. This initiative is a cooperative effort of the American College of Radiology, American Association of Physicists in Medicine, American Society of Radiologic Technologists, and the Radiological Society of North America. The Choosing Wisely programme is an effort by the American Board of Internal Medicine Foundation to encourage physicians to be better stewards of finite health care resources, including the use of imaging procedures [7]. Instilling a culture of safety in an organization encompasses several processes and steps, many of which are outlined in this paper. Foremost, it requires leadership from the top of the organization, and recognition by all employees that safety is everyone’s responsibility. The radiation dose to the population of the United States of America from medical radiation is now almost equal to that of background radiation, and increased more than seven times in the 25 years from the early 1980s to 2006. There has been an inexorable rise in the range and numbers of minimally invasive interventional techniques being performed using fluoroscopy, and these techniques have offered enormous benefits to many patients who otherwise may not be candidates for more invasive surgery. The range of radionuclides that can be used in medicine has also increased and the types of specific radiotherapy have become more complex. Despite these huge benefits, health professionals have to accept that some procedures deliver high radiation doses to patients. Radiation injuries, in interventional radiology and cardiology, and accidental exposures in radiotherapy are fortunately not common compared to the number of procedures or treatments performed, but were increasingly reported in the 1990s and 2000s. It is now 11 years since the International Conference on the Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy was held in March 2001, in Malaga, Spain. This landmark conference is now often referred to simply as the ‘Malaga conference’ among radiological protection professionals, which is a reflection of the significance of the event. These included optimization with an emphasis on reducing doses and risks without compromising image quality or treatment effectiveness, recognition of high dose procedures, monitoring doses from multiple examinations, and the development of adequate infrastructures to support the safe use of ionizing radiation in medicine. The subsequent Action Plan addressed issues of education and training of health professionals; appropriate exchange of information, with wider dissemination of that related to protection of patients; and the provision of practice specific guidance documents in collaboration with professional bodies and international organizations. Many national and international organizations have worked on initiatives to improve patient safety. Guidance on the use of appropriate imaging investigations for a wide range of clinical problems have been produced to aid clinicians and to reduce the unnecessary irradiation of patients. A learning, no blame culture has been encouraged by the establishment of databases, e. Two campaigns in the United States of America have been established to raise awareness of radiation and to lower doses where possible.

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