By Y. Avogadro. University of Tampa. 2018.

Complications of intestinal surgery include wound Small bowel surgery infection (see page 16) and anastomotic failure purchase 8 mg zofran otc medicine 831, the Smallbowelresectionisnormallyfollowedbyimmediate treatment for which is surgical drainage and exteriori- end-to-end anastomosis as the small bowel has a plen- sation order zofran 8 mg without a prescription symptoms stomach cancer. Small to medium resections have little functional consequence as there is a relative func- Gastrointestinal infections tional reserve; however, massive resections may result in malabsorption. Definition r Nutritional consequences are severe when more than Bacterial food poisoning is common and can be caused 75% of the bowel is resected. Chapter 4: Gastrointestinal infections 149 Aetiology and pathophysiology severity of each symptom and a careful history of food r Bacillus cereus has an incubation period of 30 min- intake over the past few days may point in the direction utes to 6 hours. Ingested Investigations spores (which are resistant to boiling) may cause diar- Microscopy and culture of stool is used to identify cause. Recovery All forms of bacterial food poisoning are notifiable to occurs within a few hours. The onset oftheclinicaldiseaseoccurs2–6hoursafterconsump- Management tion of the toxins. Canned food, processed meats, milk In most cases the important factor is fluid rehydration and cheese are the main source. Antibioticsare istic feature is persistent vomiting, sometimes with a not used in simple food poisoning unless there is ev- mild fever. There is a large animal reservoir (cattle, sheep, Bacilliary dysentery rodents, poultry and wild birds). Patients present with fever, headache and malaise, followed by diarrhoea, Definition sometimes with blood and abdominal pain. Recovery Bacilliary dysentery is a diarrhoeal illness caused by occurs within 3–5 days. It has an in- There are four species of Shigella known to cause diar- cubation period of 12–24 hours and recovery occurs rhoeal illness: within 2–3 days. There are more than 2000 species on the basis of r Shigella flexneri and Shigella boydii (travellers) cause antigens, which can help in tracing an outbreak. Salmonella enteritidis (one common serotype is called r Shigella dysenteriae is the most serious. The main reservoir of infection is poul- try, though person to person infection may occur. Di- Pathophysiology arrhoea results from invasion by the bacteria result- Shigella is a human pathogen without an animal reser- ing in inflammation. Spread is by person-to-person contact, faecal–oral with fever, malaise, cramping abdominal pain, bloody route or contaminated food. Acutewaterydiarrhoeawithsystemicsymptomsoffever, malaise and abdominal pain develops into bloody di- Clinical features arrhoea. Other features include nausea, vomiting and As outlined above the cardinal features of food poison- headaches. Complications include colonic perforation, ing are diarrhoea, vomiting and abdominal pain. Severe cases may be treated mon in the developing world but also found in with trimethoprim or ciprofloxacin. Outbreaks may oc- the United Kingdom, especially in immunocom- cur and require notification and source isolation. It has been suggested from retrospective studies Aetiology/pathophysiology that treatment of E. The tox- Pseudomembranous colitis ins are coded for on plasmids and can therefore be Definition transferred between bacteria. The heat labile toxin Pseudomembranous colitis is a form of acute bowel in- resembles cholera toxin and acts in a similar way. Infections are associated with contaminated food, particularly hamburgers, Investigations only a small bacterial load is required to cause dis- r At sigmoidoscopy the mucosa is erythematous, ulcer- ease. Management The broad-spectrum antibiotics should be stopped and acombination of adequate fluid replacement and oral Prevalence metronidazole is used. Geography Giardiasis Occurs worldwide but most common in the tropics and subtropics. Definition Infection of the gastrointestinal tract by Giardia lamblia a flagellate protozoa. Aetiology The condition is caused by Entamoeba histolytica,trans- Aetiology mission occurs through food and drink contamination Giardia is found worldwide especially in the tropics and or by anal sexual activity. Pathophysiology The amoeba can exist as two forms; a cyst and a tropho- Pathophysiology zoite, only the cysts survive outside the body. Following The organism is excreted in the faeces of infected pa- ingestion the trophozoites emerge in the small intestine tients as cysts.

One-fourth incorrectly indicated that blood transfusion continues to be a risk factor purchase zofran 8mg online medicine guide, and 19% erroneously be- lieved that casual household contact is a major risk factor purchase zofran 4mg cold medications. A previous study by the same researchers had also found substantial gaps in primary care providers’ knowledge about hepatitis C (Shehab et al. The gaps persisted even though 95% of the respondents in the 2001 study reported having used at least one educational tool about hepatitis C in the preceding 2 years; this suggests that primary care providers misreport their Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Recommendation Many providers are not aware of the high prevalence of chronic hepa- titis B and hepatitis C in some populations. On the basis of the evidence described above, the committee concludes that insuffcient provider knowledge leads to critical missed opportunities for providers to educate patients about prevention of hepatitis B and hepa- Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. To address that issue, the committee offers the following recommendation: Recommendation 3-1. The Centers for Disease Control and Prevention should work with key stakeholders (other federal agencies, state and local governments, professional organizations, health-care organiza- tions, and educational institutions) to develop hepatitis B and hepatitis C educational programs for health-care and social-service providers. Educational programs and materials for health-care and social-service providers should focus on improving provider awareness and adherence to practice guidelines for hepatitis B and hepatitis C. The educational programs should be targeted to primary care providers, appropriate social-service providers (such as staff of drug-treatment facilities and immigrant-services centers), and licensed and unlicensed alternative-medicine professionals (such as acupuncturists and traditional Chinese medicine practitioners) that serve at-risk populations. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Educational Institutions Schools of medicine, nursing, physician assistants, complementary and alternative medicine, and public health should develop improved curricula to ensure that their graduates are knowledgeable about chronic hepatitis B and hepatitis C. The curricula should include information on disease preva- lence, risk factors, preventive actions, appropriate diagnostics, selection of persons for testing, and appropriate followup for chronically infected patients and those susceptible to infection. Drug-treatment counselors’ education and certif- cation examinations should also include hepatitis B and hepatitis C. Although there has been no systematic effort to determine whether continuing-medical-education courses and certifcation examina- tions include questions about hepatitis B and hepatitis C, the shortcomings in knowledge among health-care providers suggest that current efforts are insuffcient, and that new approaches are needed to improve knowledge. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hospitals and nonhospital health-care facilities (such as di- alysis units, endoscopy clinics, and long-term-care facilities) should develop educational programs to reinforce the importance of adhering to recom- mended standard precautions and procedures to prevent the transmission of bloodborne infections in both inpatient and outpatient health-care settings (Thompson et al. Health-care workers should be routinely vac- cinated to protect them from hepatitis B. Successful interventions to prevent exposures known to transmit bloodborne infections have included general safety train- ing; training specifc to prevention of needle-stick injuries; modifcation of practice, staffng, and workload adjustments; and use of protective devices, such as needles that automatically retract (Clarke et al. Substance-Abuse–Related Service Providers Staff of drug-treatment programs, needle-exchange programs, and cor- rectional facilities should be participants in viral-hepatitis educational pro- grams. Over the period during which a person may inject illicit drugs, the likelihood that he or she has been in a drug-treatment program rises (Galai et al. Thus, the committee believes that providing standardized education to staff of drug-treatment and needle-exchange programs and correctional Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Alternative-Care Providers Alternative-care providers would also beneft from participating in educational programs about viral hepatitis. Lack of knowledge and awareness about hepatitis B and hepatitis C in the community often leads to misinformation, missing of opportunities for prevention and treatment, and stigmatization of infected populations. Once infected, they frequently are unaware of their infection and so run the risk of unknowingly infecting others and of not receiving appropriate medical management. Although there have been no large-scale, population- based, controlled studies of community knowledge about hepatitis B and hepatitis C, all published surveys have shown that knowledge about these diseases is sparse. A number of studies have assessed awareness and knowledge about hepatitis B Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. For example, among Vietnamese Americans, about 64% had never heard of the hepatitis B vaccine (Ma et al. Among Chinese Americans, fewer than half had been tested or vaccinated (Taylor et al. The committee was unable to fnd studies that looked at hepatitis B awareness among other foreign-born immigrants from highly endemic re- gions such as sub-Saharan Africa, the Middle East, and Eastern European nations (see Box 3-1). For example, New York City has translated its hepatitis B educational materials into Chinese, Korean, Spanish, and French (New York Department of Health and Mental Hygiene, 2008). Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. A 1990 study found that 68% of men who have sex with men and are patients at a community health center reported that they were aware of the vaccine, and 25% of those who knew about it had been vac- cinated (McCusker et al.

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Consider a tax increase for alcohol products as a way of reducing harmful alcohol consumption buy generic zofran 4 mg line symptoms 8 dpo; iii discount zofran 4mg amex symptoms nausea headache fatigue. Improve the efficiency and impact of the existing health budget by reallocating scarce health resources to targeted primary and secondary prevention measures for cardiovascular disease and diabetes, including through the Package of Essential Noncommunicable Disease Interventions; and v. Strengthen the evidence base to enable better investment planning and programme effectiveness, thereby ensuring that interventions work as intended and provide value for money. It is quite common for good policy to be developed and laws enacted in developing countries, only to find that actual implementation is neglected or not given adequate resources and attention (Thomas & Grindle, 1990). Many factors contribute to weak implementation: inadequate financing and resourcing; weak or ambiguous lines of accountability; weak monitoring and evaluation; perceptions that leaders and managers are no longer interested in the issue; and opposition to change by vested interests. The economic costs are the ineffectual use and wasted time of leaders and managers who developed a policy that was not implemented properly. This imposes a particularly high cost in the Pacific where the time, energy, and political/ bureaucratic capital of skilled leaders and managers is a precious resource that should not be wasted. The political cost is the erosion of leaders’ credibility and authority when the population fails to see tangible follow up to a declared crisis. Individual countries are in the best position to determine implementation priorities, how to budget and resource implementation, and how to hold agencies and individuals responsible and accountable for results. Tobacco control There has been some progress around the recommendations for tobacco control. All 11 countries covered by the Pacific Possible report – with the exception of Tuvalu – have increased taxes on tobacco or are in the process of doing so. However, there are significant gaps in the implementation of tobacco control recommendations. Second, countries need to proactively measure and analyze the sales, additional revenue, and consumption trends of tobacco in light of excise duties and other interventions. It does not appear that any Pacific Island countries established a baseline of sales and revenue prior to the increase in excise duties. Unfortunately, the lack of evidence base does not allow policy makers to fine tune policies and meet government objectives or to defend themselves against the inevitable criticisms of the tobacco industry. Third, countries need to invest in, and widely publicize, the implementation and prosecution of existing laws and regulations, including laws against the still widespread practice of selling cigarettes to children (Anderson, 2013a; World Bank, 2014). Fourth, countries in the Pacific need to work together and share strategies to control the consumption of home-grown and loose leaf tobacco, which is usually beyond the reach of excise duties (Hou, Xu, & Anderson, 2015). As noted previously, parts of the Pacific have some of the highest levels of obesity in the world. The change in diet from traditionally consumed fish and fruits to highly processed imported foods including biscuits, noodles, and high fat products such as turkey tails and mutton flaps, is a factor contributing to obesity levels, particularly when combined with increasingly sedentary lifestyles (DiBello et al. Excessive alcohol consumption is associated with domestic violence, traffic accidents, and certain cancers. However, many factors affect dietary choices including the price and availability of healthier fruits and vegetables, advertising, and knowledge and awareness of the benefits of healthy eating. There are also ongoing efforts to introduce food safety regulations requiring nutrition labels on processed foods. Of the few countries that have raised the price of unhealthy foods and drinks, none have measured the change in consumption levels to see if the policy is working or cost effective. There is little information available about reducing salt consumption, including in processed foods. Nor is there good information to promote the growing and marketing of more nutritious foods, including fruits and vegetables. Improving the efficiency and impact of the health budget Improving the efficiency and impact of the existing health budget by making better use of existing financial, human, and other resources in the health sector is a major strategic priority for countries. The starting point for responding to the growing challenges in the health sector is to make sure that ministries of health are making the best use of existing financial and human resources. There is a good deal of capacity to strengthen the planning, priority setting, resource allocation, and financial management of existing budgets in the Pacific Island countries. Such efforts would help free up existing resources that can be allocated to higher impact and more sustainable investments. Reallocating scarce resources to well-targeted primary and secondary preventions is particularly relevant to achieve improved health outcomes in a way that is affordable, cost- effective, and financially sustainable. Primary and secondary prevention strategies for diabetes and hypertension are particularly important policy priorities for most countries in the Pacific given the high health, financial, and economic burdens that those diseases impose on countries. Every person who adopted a healthy lifestyle and was able to avoid diabetes or keep it under control would avert direct drug costs to government of up to $367 per person per year. Effective and targeted secondary prevention is an especially strategic and potentially cost-effective intervention. That is because the pool of people at risk of progressing to insulin is limited, so targeting can be better focused. Figure 13 shows there is a similar step wise increase in the pharmaceutical costs of treating hypertension in Vanuatu. Effective and well-targeted primary and secondary prevention similarly yields health benefits for the individual and significant and sustained cost savings to government. Figure 12 Average Pharmaceutical Cumulative Costs per Annum for One Diabetes Patient in Vanuatu 400 350 300 250 200 150 100 50 0 Blood glucose Oral medication Oral medication Insulin stage* Insulin stage with testing strips (metformin) stage 2 additional (Glibenclamide) drugs** Progressive requirements of different stages of diabetes Source: (Anderson et al.

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For agricultural workers at constant risk of infection discount zofran 8 mg visa medicine 014, periodic examination and treatment may be the most feasible approach to disease control purchase zofran 4 mg mastercard treatment zone guiseley. A clean water supply and improved sanitation (including on board boats) must be provided to stop human excrement entering wetlands. This is especially important for species that parasitise animal, livestock and human hosts. Snail fever integrated control and prevention project in Tongxing Village of Wucheng Township, Yongxiu County of Jiangxi Province, P. Summary Disease issue or problem: Snail fever / Schistosomiasis interruption of cattle-parasite-cycle by means of permanent stabling of cattle (long-term); awareness raising campaign by carrying out publicity and Action taken: education activities; assessment of snail host spatial distribution; cattle examination and medical treatment. The spread of snail fever in the Tongxing Village controlled Outcomes: and prevented effectively, which saves about 30. Participatory approach – stable reconstruction according to local What went well: farmers’ needs. Project funded by German Embassy Small Grant and additional contributions from local government on different levels. Background The project area is situated in the Tongxing Village of Wucheng Township, located in the Yongxiu County of Jiangxi Province, China. The Wucheng Township lies at the lakeshore of Poyang Lake, covering a total area 2 2 of 368 km , with 47 km consisting of grasslands infested with snail fever. The highest rates of infection with snail fever in the Wucheng population occurred in 1998 with more than 15% of the total population being infected; 10% of these suffered from terminal-stage snail fever. The highly endemic situation for snail fever is explained by the extensive cattle raising on infested wetlands, maintaining a permanent snail-fever cycle among livestock. As snail fever can equally infect cattle and human beings, the ecological conditions for human infection with snail fever are, therefore, particularly hazardous throughout the entire township. Based on the abundant, grass-covered wetlands, cattle-breeding has become a major activity for local livelihoods. Therefore, the level of infection with snail fever remained alarmingly elevated, seriously hampering local economic development. Indeed, snail-fever was conceived as being a major cause for persisting poverty in the village. The recent governmental programme of integrated control of snail fever, carried out in the Yongxiu County, prioritises preventative and sanitary measures combined with the development of secure livelihoods and the provisioning of preventive medical and veterinary services. It is well understood by villagers that the cattle-parasite cycle has to be interrupted in order to sustainably reduce the environmental risks of infection with snail fever. One principal intervention strategy is modifying the ongoing practice of extensive livestock breeding aiming at maintaining cattle outside snail fever infected areas (i. Before the project started, 40 stables for the seasonal stabling of water-buffalos Bubalus bubalis already existed in the Paitou sub-village of Tongxing, but most of the stables had collapsed or were damaged. Therefore, they were not suitable for permanently keeping cattle outside the wetlands. The villagers wanted to reconstruct the stables and adapt them for permanent stabling. Activities Reconstructing existing stables: the court, the access-ways, and the interior of the stables cleaned up and stabilised; 12 collapsed stables and 28 damaged stables repaired, including their roofs and cracked walls. All stables received painting to protect the outer facade; 2 a wall was constructed around the main court covering an area of 1,200 m ; 2 the entrance was stabilised with cement covering an area of 160 m ; sewage disposal ditches were constructed over a total distance of 300 m; two concrete ponds for dung disposal constructed with a total volume of 10 m × 5 m × 2 m; one sentinel house was newly constructed. Carrying out publicity and education activities: The Yongxiu County Snail Fever Control and Prevention Station, the Yongxiu County Agricultural Bureau and the Wucheng Township Government carried out a series of publicity and education activities on snail fever integrated control and prevention in Tongxing Village, by means of training, dissemination of educational materials and posting of pictures. Conducting investigations of snail hosts: The Yongxiu County Snail Fever Control and Prevention Station conducted an investigation of snail hosts around the areas of Dahu Lake, Zhushihu Lake, Changhu Lake and Yanzihu Lake, which are frequently visited by the cattle. As result of the investigations, the spatial distribution of densities of the snail hosts 2 was surveyed. Conducting cattle examination and medical treatment: The Yongxiu County Agricultural Bureau provided examination of the cattle in Tongxing Village and free veterinary treatment. Conclusions After the implementation of the project, the newly reconstructed stables were able to house approximately 100 head of cattle. The spread of snail fever in the Tongxing village has been effectively controlled, saving approximately 30,000 Yuan each year in human and cattle medical treatment. Vaccination programmes, supplemented by other disease control measures, can help control and even eliminate epidemic diseases affecting animals and humans. The role and efficacy of vaccination as a means of control varies amongst diseases. Most commercially available vaccines are targeted against microparasites such as viruses and bacteria. Vaccination against macroparasites such as helminths (where immune responses are often more varied and less effective, and extent of disease is related to parasite burden), are generally less effective. Some vaccines may be highly effective in preventing clinical signs of the disease, preventing infection and reducing growth and shedding of the disease-causing agent.

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