Empowering Veterinarians to Be Planetary Health Stewards Through Policy and Practice

Veterinarians are established public health professionals, committing to promote public health when they take their veterinary oath. The issue of climate change and its impact on planetary health is vital to public health, and therefore, it is critical that climate change is regarded as within the veterinary scope of practice. However, climate change is a multi-faceted issue which requires interdisciplinary collaboration and integrated stakeholder involvement in order to establish effective solutions and impactful policies. As a result, in this perspective, we discuss how policy is critical to support veterinarians in the climate change space and argue that more explicit support is needed for veterinarians to take an active role in climate change adaption, resilience, and mitigation. We address the discrepancies between the human health and veterinary professions with respect to providing policy support and capacity for practitioners to be stewards to promote planetary health and shed light on the lack of veterinary capacity in this area. We stress that veterinary professional societies are well equipped to bolster their policies, expand education for veterinary professionals and students in policy and advocacy, and establish calls to action to address climate change and planetary health issues. Ultimately, as public health professionals, veterinarians are uniquely poised to be contributors to climate change solutions and they should be actively involved in policy decision-making and empowered to take active roles in interdisciplinary conversations surrounding this important issue.

Lactate Metabolism and Signaling in Tuberculosis and Cancer: A Comparative Review

Infection with Mycobacterium tuberculosis (Mtb) leading to tuberculosis (TB) disease continues to be a major global health challenge. Critical barriers, including but not limited to the development of multi-drug resistance, lack of diagnostic assays that detect patients with latent TB, an effective vaccine that prevents Mtb infection, and infectious and non-infectious comorbidities that complicate active TB, continue to hinder progress toward a TB cure. To complement the ongoing development of new antimicrobial drugs, investigators in the field are exploring the value of host-directed therapies (HDTs). This therapeutic strategy targets the host, rather than Mtb, and is intended to augment host responses to infection such that the host is better equipped to prevent or clear infection and resolve chronic inflammation. Metabolic pathways of immune cells have been identified as promising HDT targets as more metabolites and metabolic pathways have shown to play a role in TB pathogenesis and disease progression. Specifically, this review highlights the potential role of lactate as both an immunomodulatory metabolite and a potentially important signaling molecule during the host response to Mtb infection. While long thought to be an inert end product of primarily glucose metabolism, the cancer research field has discovered the importance of lactate in carcinogenesis and resistance to chemotherapeutic drug treatment. Herein, we discuss similarities between the TB granuloma and tumor microenvironments in the context of lactate metabolism and identify key metabolic and signaling pathways that have been shown to play a role in tumor progression but have yet to be explored within the context of TB. Ultimately, lactate metabolism and signaling could be viable HDT targets for TB; however, critical additional research is needed to better understand the role of lactate at the host-pathogen interface during Mtb infection before adopting this HDT strategy.

Host-directed therapy targeting the Mycobacterium tuberculosis granuloma: a review

Infection by the intracellular bacterial pathogen Mycobacterium tuberculosis (Mtb) is a major cause of morbidity and mortality worldwide. Slow progress has been made in lessening the impact of tuberculosis (TB) on human health, especially in parts of the world where Mtb is endemic. Due to the complexity of TB disease, there is still an urgent need to improve diagnosis, prevention, and treatment strategies to control global spread of disease. Active research targeting avenues to prevent infection or transmission through vaccination, to diagnose asymptomatic carriers of Mtb, and to improve antimicrobial drug treatment responses is ongoing. However, this research is hampered by a relatively poor understanding of the pathogenesis of early infection and the factors that contribute to host susceptibility, protection, and the development of active disease. There is increasing interest in the development of adjunctive therapy that will aid the host in responding to Mtb infection appropriately thereby improving the effectiveness of current and future drug treatments. In this review, we summarize what is known about the host response to Mtb infection in humans and animal models and highlight potential therapeutic targets involved in TB granuloma formation and resolution. Strategies designed to shift the balance of TB granuloma formation toward protective rather than destructive processes are discussed based on our current knowledge. These therapeutic strategies are based on the assumption that granuloma formation, although thought to prevent the spread of the tubercle bacillus within and between individuals contributes to manifestations of active TB disease in human patients when left unchecked. This effect of granuloma formation favors the spread of infection and impairs antimicrobial drug treatment. By gaining a better understanding of the mechanisms by which Mtb infection contributes to irreversible tissue damage, down regulates protective immune responses, and delays tissue healing, new treatment strategies can be rationally designed. Granuloma-targeted therapy is advantageous because it allows for the repurpose of existing drugs used to treat other communicable and non-communicable diseases as adjunctive therapies combined with existing and future anti-TB drugs. Thus, the development of adjunctive, granuloma-targeted therapy, like other host-directed therapies, may benefit from the availability of approved drugs to aid in treatment and prevention of TB. In this review, we have attempted to summarize the results of published studies in the context of new innovative approaches to host-directed therapy that need to be more thoroughly explored in pre-clinical animal studies and in human clinical trials.

A study on risk factors associated with inconsistent condom and lubricant use among men who have sex with men in central Karnataka, India

BACKGROUND

Among the sexual minority groups, the Men who have Sex with Men (MSM) community is a large and scattered network. Sexual activity among MSM is frequent and often unplanned. STI and HIV are major medical problems faced by this vulnerable group. Stigma and discrimination towards this group result in poor access to preventive services that encourage condom and lubricant usage.

METHOD

A cross-sectional, community-based study of 309 MSM was carried out in the Davangere district between December 2008 and February 2010. Participants were identified in three stages: cruising venue identification and mapping; determining eligibility and willingness to participate; and recruitment to the study. Consecutive sampling was used to recruit the participants with the help of a snowball technique, obtaining informed and written consent.

RESULTS

Of the participants 79.61% and 88.03% reported inconsistent use of condom and lubricant during the three months prior to the interview, respectively. In multivariate analysis, middle socioeconomic class, sex in a public place and increased frequency of sex were significantly associated with inconsistent condom use. Whereas, practising both types of anal sex (receptive and insertive), not using a condom during the last sexual encounter and increased frequency of sex were significantly associated with inconsistent lubricant use.

CONCLUSION

Many social and behavioural factors are involved in the inconsistent use of condom and lubricant among MSM. Preventive programmes must identify these factors in order to target consistent condom and lubricant use among the MSM community.

Sickness Absenteeism, Morbidity and Workplace Injuries among Iron and Steel workers - A Cross Sectional Study from Karnataka, Southern India

BACKGROUND

The study of illnesses causing absence of workers from work in industries is a practical method to study the health status of industrial workers and to identify occupational health hazards. The iron and steel industries are particularly hazardous places of work. Published data from India on health status of iron and steel workers is limited, therefore this study was undertaken to investigate the sickness absenteeism, morbidity and workplace injuries among this population.

METHOD

Workers were selected using stratified random sampling. A structured pre-tested interview schedule was used to collect the data. A p value of < 0.05 was considered for statistical significance.

RESULTS

From a total of 2525 workers, 353 (mean age 55.1 yrs, male 69.4%) participated in the study. The overall proportion of sickness absenteeism was 66.9% (95% CI: 0.62 - 0.71). Overall 16.4 days were lost per worker per year (male = 16.5 & female = 16.2) due to sickness absence. A blue collar worker lost 21.5 days compared to 11.9 days by a white collar worker (p > 0.01). Among workers, health ailments related to the musculoskeletal system (31.4%), gastrointestinal system (25.8%), hypertension (24.4%), respiratory system (18.1%) and other minor ailments (19.3%) were found to be high.

CONCLUSION

Sickness absenteeism is significantly higher among iron and steel workers when compared to other occupations in India. Blue collar workers and shift workers loose higher number of days due to sickness absence, and they face problems related to musculoskeletal system, gastrointestinal system and hypertension in higher proportions compared to their counterparts. Women experienced hypertension as the common health problem and higher proportions of injuries outside the work environment.

Effects of barley grain processing and dietary ruminally degradable protein on urea nitrogen recycling and nitrogen metabolism in growing lambs1

The objective of this study was to determine how interactions between dietary ruminally degradable protein (RDP) level and ruminally fermentable carbohydrate (RFC) alter urea N transfer to the gastrointestinal tract (GIT) and the utilization of this recycled urea N in rapidly growing lambs fed high-N diets. Four Suffolk ram lambs (34.8 +/- 0.5 kg of BW) were used in a 4 x 4 Latin square design with 21-d periods and a 2 x 2 factorial arrangement of dietary treatments. The dietary factors studied were 1) dry-rolled vs. pelleted barley as the principal source of RFC and 2) dietary levels of RDP of 60 vs. 70% (% of CP). All diets contained 28.8 g of N/kg of DM. Experimental diets were composed of 80% concentrate mixture and 20% barley silage (DM basis) and were fed twice daily at 0900 and 1700 as total mixed rations. Nitrogen balance was measured from d 15 to 20, and urea N kinetics were measured from d 15 to 19 using intrajugular infusions of [(15)N(15)N]-urea. Nitrogen intake (P = 0.001) and fecal (P = 0.002) and urinary (P = 0.03) N excretion increased as dietary RDP level increased, but the method of barley processing had no effect. Feeding dry-rolled compared with pelleted barley (P = 0.04) as well as feeding 60% RDP compared with 70% RDP (P = 0.04) resulted in a greater N digestibility. Whole-body N retention was unaffected (P >/= 0.74) by dietary treatment. Dietary treatment had no effect on endogenous production of urea N and its recycling to the GIT; however, across dietary treatments, endogenous production of urea N (45.8 to 50.9 g/d) exceeded N intake (42.3 to 47.9 g/d). Across dietary treatments, 30.6 to 38.5 g/d of urea N were recycled to the GIT, representing 0.67 to 0.74 of endogenous urea N production; however, 0.64 to 0.76 of urea N recycled to the GIT was returned to the ornithine cycle. In summary, although dietary treatment did not alter urea N kinetics, substantial amounts of hepatic urea N output were recycled to the GIT under the dietary conditions used in this study, and additional research is required to determine how this recycled urea N can be efficiently captured by bacteria within the GIT.