Hopelessness—a state of despair characterized by a negative outlook towards the future and a belief in insurmountable challenges—is a risk factor for major depression, cardiovascular disease, and all-cause mortality among older adults. It is also an understudied consequence of discrimination. Older blacks disproportionately report experiencing discrimination and, as a result, may be at greater risk of feeling hopeless. However, social and religious resources may protect against the adverse effects of discrimination. The current study examines whether social support, social engagement, religious attendance, and religiosity buffer the effects of self-reported everyday discrimination on hopelessness among a nationally representative sample of blacks.n = 1,302), and age 65 and older, representing old age (n = 887). Interaction terms tested whether each resource moderated the discrimination–hopelessness relationship controlling for depressive symptoms, socioeconomic status, and demographic characteristics.Using data from the 2010/2012 psychosocial assessment of the Health and Retirement Study, we regressed hopelessness on everyday discrimination, stratifying by 2 age groups, ages 51–64, representing middle-age , religiosity , religious attendance  were independently and inversely associated with hopelessness. For older blacks, higher levels of religiosity moderated the discrimination–hopelessness relationship  and higher levels of support  and social engagement  were independently and inversely associated with hopelessness.Greater reports of everyday discrimination were associated with higher levels of hopelessness for middle-aged and older blacks. For middle-aged blacks, the resources did not moderate the discrimination–hopelessness relationship; rather, higher levels of support (Findings suggest that self-reported everyday discrimination increases hopelessness among middle-aged and older blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older blacks as a buffer against the negative consequences of discrimination on hopelessness. Translational Significance: Self-reported everyday discrimination increases hopelessness among middle-aged and older blacks. Social and religious resources protect against hopelessness but do so differently for middle-aged and older blacks. The findings highlight the need for programs and initiatives that actively work to eliminate discrimination, foster supportive social ties, facilitate religious attendance, and foster greater religiosity to improve the mental well-being of blacks and help them hold on to hope despite the adversity they face.A large and multidisciplinary body of research has documented worse health among non-Hispanic blacks compared to non-Hispanic whites ,2 and haFor nearly 60 years, researchers across disciplines have studied hopelessness and its adverse effects on health and functioning . HopelesDiagnostic and Statistical Manual of Mental Disorders’ criteria for diagnosing depressed mood among adults  and subjective religiosity   even comAltogether, research on social and religious resources in the black community has shown that they directly protect against poor mental health outcomes. Some evidence also exists for their role as buffers against the negative mental health effects of stress and discrimination ,54. HoweAlthough some research exists on the interrelations between discrimination, social and religious resources and mental health, there is only one, to our knowledge, that specifically examined hopelessness. Odafe and colleagues  examinedThe current study addresses the stated gaps in the literature by assessing the effects of discrimination on hopelessness in a nationally representative sample of blacks in midlife and old age. We also assess the protective role of multiple social and religious resources, specifically, social support, social engagement, religious service attendance, and religiosity, to identify factors that diminish hopelessness among both middle-aged and older blacks when they are faced with discrimination.Empirical evidence indicates that age is a confounding variable in the aforementioned relationships between discrimination, social and religious resources, and hopelessness and argues for an age-stratified analysis to account for its confounding effects. First, age is positively associated with hopelessness  and inveWe hypothesize that self-reports of everyday discrimination will be positively associated with hopelessness and that each of the social and religious resources will be inversely associated with hopelessness for both age groups. However, given the previously discussed developmental differences between middle-aged and older adults, we hypothesize that social resources, a more developmentally relevant coping resource for middle-aged adults, will fully buffer the effects of discrimination on hopelessness among middle-aged blacks  and partially buffer against the effects of discrimination among older blacks . Conversely, we hypothesize that religious resources, a more developmentally relevant coping resource for older adults, will partially buffer the effects of discrimination among middle-aged blacks and fully buffer the effects of discrimination among older blacks.n = 157) were more likely to be male, have less than a high school degree, live below the poverty line, not be employed, be widowed, have lower levels of social engagement, and attend religious services less often. The HRS was approved by the University of Michigan’s Institutional Review Board (IRB) and because the present study used de-identified, publicly available data, the University of Illinois, Chicago’s IRB deemed the study exempt from review.We used data from the Health and Retirement Study (HRS), a nationally representative panel survey of the health and aging experiences of community-dwelling adults aged 51 and older, living in the contiguous United States . The HRSHopelessness was measured using four items. Two items came from Everson and colleagues : “I feelEveryday discrimination refers to unfair treatment that manifests as daily slights and indignities in everyday settings. Six items from the Everyday Discrimination Scale were used to assess the frequency of reported experiences of this interpersonal form of discrimination . The iteTwo measures each were created to assess the protective effects of social and religious resources on hopelessness, generally, and on the effects of the discrimination–hopelessness relationship, specifically. All four measures were dichotomized at their respective medians to facilitate interpretation of study findings. Sensitivity analyses with continuous versions of the resource variables did not change the substantive findings of the study in a meaningful way.—Emotional social support refers to the care, empathy, trust, and acceptance offered to another . Three i—Social engagement is a measure of contact and connection with a person’s family, friends, and neighbors. In line with previous work , we asse—Regular attendance at religious services may facilitate connection and mutual support among attendees and provide messages that help develop or sustain internal personal resources. Respondents were asked: “About how often have you attended religious services during the past year.” We compared respondents who infrequently attended religious services  to those who attended at least once a week or more. We dichotomized religious attendance in this manner because prior research suggests that most Americans in midlife and old age attend a religious service at least weekly . Moreove—Religiosity refers to the extent to which a person believes in a higher power and receives guidance and comfort from this belief. Four items assessed religiosity: “I believe in a God who watches over me,” “The events in my life unfold according to a divine or greater plan,” “I try to carry my religious beliefs over into all my other dealings in life,” and “I find strength and comfort in my religion.” Response options ranged from 0 = “strongly disagree” to 5 = “strongly agree.” We averaged the four items to construct the religiosity scale and then dichotomized the scale at its median  to distinguishes between high and low levels of religiosity. Those with a mean value equal to 5 were included in the high religiosity group, and those with a mean value less than 5 were included in the low religiosity group (reference category).All analyses were stratified by two age groups: ages 51–64 years old represented respondents in midlife and ages 65 and older represented respondents in old age. Gender, marital status, and nativity were included as demographic predictors in the model. Females are compared to males (reference category); individuals who were married or cohabiting (reference category) were compared to those who were divorced or separated, widowed, and never married; and foreign-born individual are compared to U.S.-born individuals (reference category).We also included measures of socioeconomic status because they have been shown to be associated with experiences of discrimination and hopelessness. Individuals with less than a high school degree (reference category) were compared to those with a high school degree, some college, and a college degree or higher. Employed individuals (reference category) were compared to individuals who were partly retired, retired, and not in the labor force, and individuals with household incomes at or below the Federal Poverty Line for 2010/2012 (reference category) were compared to those living above the poverty line.We included a measure of depressive symptoms in our analyses because it is associated with everyday discrimination  and hopeWe began our analyses by examining weighted descriptive statistics—means, standard errors, percentages, and sample size—of all study variables for each age group . Multiple linear regression was used to evaluate the relationship between hopelessness and everyday discrimination for middle-aged and older blacks, separately. Model 1 regressed hopelessness on everyday discrimination and demographic and socioeconomic covariates. Model 2 added the four resources: social support, social engagement, religious attendance, and religiosity. The next four models  separately assessed the interaction between discrimination and each of the four resources to determine whether social support, social engagement, religious attendance, and religiosity function as moderator of the relationship between discrimination and hopelessness. Supplemental analyses examined the distribution of discrimination attributions and regressed hopelessness on an indicator for whether or not a respondent mentions race as a reason for their experiences of discrimination and its interaction with everyday discrimination. These analyses were done to determine if the study findings differed when a general measure of discrimination is used compared to a race-specific measure. All analyses used Stata version 15.1, weights provided by the HRS and survey procedures in Stata to account for the complex sample design of the HRS.n = 1302) and older . Although the full range of values for hopelessness were seen in both age groups, approximately, 26.8% of respondents strongly disagreed with all items of the hopelessness scale and had a hopelessness score of zero. Mean levels tended to be low and were equivalent to strongly or somewhat disagreeing  with statements characterizing hopelessness. Similarly, reports of everyday discrimination were relatively low for middle-aged and older blacks. Thirty-three percent of respondents reported “never” experiencing any of the discriminatory experiences assessed in the scale and average values were equivalent to reporting never experiencing discrimination  or experiencing it less than once a year . For middle-aged blacks, two-thirds or more had high levels of social support and social engagement, slightly more than 50% had high religiosity levels, and a little less than half attended a religious service weekly. For older blacks, 60% or more of respondents had high levels of each social and religious resources.Weighted sample characteristics are presented in With regard to sociodemographic characteristics, two-thirds of middle-aged blacks were female and nearly 50% were married or partnered. An approximately equal proportion had at least a high school degree or more. Close to 50% were employed and on average middle-aged blacks reported two depressive symptoms. Two-thirds of older blacks were female and while 45% were married, nearly one in three older blacks were widowed. More than two-thirds had a high school degree or less and only 7% were employed. Older blacks also reported two depressive symptoms, on average.p < .001). Adding the social and religious resources slightly reduced but did not fully account for the effects of discrimination on hopelessness (Model 2). Individuals with high levels of social support , religious service attendance , and religiosity  had lower hopelessness levels compared to individuals with low levels of these resources; social engagement was not a statistically significant predictor of hopelessness in this model. Next, we assessed the interaction between discrimination and social support (Model 3), social engagement (Model 4), religious attendance (Model 5), and religiosity (Model 6). None of the interaction terms was statistically significant.p < .001). Social support , social engagement , and religiosity  were inversely associated with hopelessness; specifically, individuals with high levels of each resource had lower levels of hopelessness compared to those with low levels of the resource. Social support (Model 3), social engagement (Model 4), and religious attendance (Model 5) did not moderate the relationships between everyday discrimination and hopelessness. However, the interaction between discrimination and religiosity was statistically significant . Specifically, older blacks with low levels of religiosity experienced steeper increases in hopelessness due to discrimination than older blacks with high levels of religiosity (The same regression models were assessed for older blacks . Everydaigiosity .Supplemental analyses of perceived discrimination attributions revealed that 35% of respondents who report experiencing discrimination attribute their experiences to race alone, but nearly half reported some combination of race, gender, and age as the reason for these experiences see . AdditioThe current study revealed a significant positive association between discrimination and hopelessness among middle-aged and older blacks, which supports our hypothesis and aligns with prior research on the effects of discrimination on mental and physical health . The nulWe hypothesized that all of the resources examined would be protective against hopelessness regardless of age group. However, among the four resources, weekly religious service attendance was not protective for blacks in old age, and social engagement was not protective for blacks in midlife. Possible explanations for these findings are likely related to characteristics of the aging process and life course development. For instance, prior research suggests that religious attendance varies across the life course: declining in adolescence, increasing in early adulthood, remaining relatively stable in midlife, and then declining in older adulthood after a slight increase post-retirement . This deFor blacks in midlife, objective aspects of social engagement, specifically the frequency of contact with family members, neighbors, and friends, may play a lesser role in hopelessness than the subjective aspects of engagement, such as the quality of relationships and support received from different sources. Nguyen and colleagues  found thSocial support and religiosity were inversely associated with hopelessness for both age groups. These findings align with research demonstrating the protective effects of both resources on mental health ,79. SociUnlike the other resources, we found a significant interaction between everyday discrimination and religiosity, but only among older blacks. This finding is counter to our hypothesis that both weekly religious attendance and high religiosity would fully buffer the effects of discrimination on hopelessness; however, it provides some support for the protective role religiosity plays against discrimination. Prior research suggests that religiosity and similar constructs buffer the effects of discrimination on mental health. For instance, in a study of psychological distress among blacks, Ellison and colleagues  found a Although stress buffering by religiosity only occurred among older blacks, this finding may be explained by the positive association between religiosity and age . Aging iThere are limitations to this study that should be considered when interpreting the study findings and addressed in future research. First, we stratified our analyses by age based on conceptual and empirical literature suggesting differences in the experiences, exposures, behaviors, and health of those in midlife compared to old age . HoweverThere are multiple strengths to the current study, including the use of a large and nationally representative sample of blacks in midlife and old age, which improves the generalizability of our findings to the larger population of blacks in the “second half of life.” Additionally, stratifying our analyses by age acknowledges the heterogeneity in lived experiences among U.S. blacks and allowed for a more nuanced and specific examination of how discrimination affects hopelessness in the context of different types of resources aimed at offsetting and/or protecting against its deleterious effects. This study is one of the first to address this understudied area of research in a well-characterized, national sample of blacks. Lastly, but perhaps most importantly, this study identified modifiable factors that influence hopelessness in the black community. Prior research has shown that hope and hopelessness are modifiable risk factors for poor health  and we hDespite its association with an increased risk for death and disease, hopelessness remains an understudied consequence of racism and discrimination. The current study showed that more frequent reports of discrimination increase risk for hopelessness among middle-aged and older blacks and that social and religious resources generally protect against poor mental health. Our study also highlights the importance of recognizing the heterogeneity of experiences and resources within the black population at different life stages to better understand how discrimination affects their health and what factors effectively protect against hopelessness and despair. To the extent that hopelessness and the resources examined in the current study are all modifiable factors, aging researchers and practitioners should work to identify policy, community, and church-based interventions that protect against hopelessness and ultimately improve the mental health and functioning of older members of the black community.igaa044_suppl_Supplementary_Tables_S1-S3Click here for additional data file.


Previous studies have observed that infectious intestinal disease (IID) related hospital admissions are higher in more deprived neighbourhoods. These studies have mainly focused on paediatric populations and are cross-sectional in nature. This study examines recent trends in emergency IID admission rates, and uses longitudinal methods to investigate the effects of unemployment (as a time varying measure of neighbourhood deprivation) and other socio-demographic characteristics on IID admissions for adults and children in England.A longitudinal ecological analysis was performed using Hospital Episode Statistics on emergency hospitalisations for IID, collected over the time period 2012–17 across England. Analysis was conducted at the neighbourhood (Lower-layer Super Output Area) level for three age groups . Mixed-effect Poisson regression models were used to assess the relationship between trends in neighbourhood unemployment and emergency IID admission rates, whilst controlling for measures of primary and secondary care access, underlying morbidity and the ethnic composition of each neighbourhood.From 2012–17, declining trends in emergency IID admission rates were observed for children and older adults overall, while rates increased for some sub-groups in the population. Each 1 percentage point increase in unemployment was associated with a 6.3, 2.4 and 4% increase in the rate of IID admissions per year for children , adults  and older adults , respectively. Increases in poor primary care access, the percentage of people from a Pakistani ethnic background, and the prevalence of long-term health problems, in a neighbourhood, were also associated with increases in IID admission rates.Increasing trends in neighbourhood deprivation, as measured by unemployment, were associated with increases in emergency IID admission rates for children and adults in England, despite controlling for measures of healthcare access, underlying morbidity and ethnicity. Research is needed to improve understanding of the mechanisms that explain these inequalities, so that effective policies can be developed to reduce the higher emergency IID admission rates experienced by more disadvantaged communities. Previous cross-sectional studies have predominantly focused on children,To our knowledge, longitudinal methods have not been utilised to explore inequalities in hospitalisations for IID in a UK context, however these methods, whilst observational, provide better insights into temporal dynamics compared to cross-sectional analyses.We performed a longitudinal ecological analysis using data collected between 2012 and 2017, across Lower-layer Super Output Areas (LSOAs) in England. LSOAs (subsequently referred to as neighbourhoods) are small geographical areas used by the UK's Office for National Statistics (ONS), each containing a population of between 1000 and 3000 people.,We used Hospital Episode Statistics (HES) to derive our outcome: emergency hospital admissions for IID as a primary diagnosis . Emergency admissions and ONS population estimates were derived for each neighbourhood, per year from 2012 to 17, for three age groups .Several covariates were included in the analysis. Time-varying covariates related to primary care access included the number of general practitioners (GPs) per capita serving the population ; and the proportion of the population who would describe their experience of making an appointment as poor . Previous studies have found that the GPPS measure of experience of making an appointment is strongly associated with measures relevant to patients’ self-reported access to services, i.e. the ability to get an appointment, appointment convenience, ease of telephone contact and helpfulness of receptionists.We also included a measure of secondary care access, which was the average road network distance to the nearest hospital with an Accident and Emergency (A&E) department. Data from the 2011 Census were used to derive time-invariant covariates relating to the proportion of different ethnic groups, and the age-specific prevalence of long-term health problems per neighbourhood. A full description of the measures and data sources can be found in the Supplementary file.We used mixed-effect Poisson regression models to investigate the association between annual changes in unemployment and changes in emergency IID hospitalisations between neighbourhoods, from 2012 to 17, whilst controlling for measures of primary and secondary care access, underlying morbidity and the ethnic composition of each neighbourhood. Numbers of emergency admissions were modelled using the log of the population as an ‘offset’ variable, indicating the maximum number of admissions that could have occurred. We also included in the model an annual time-trend term and a random intercept for each neighbourhood to account for the longitudinal nature of the data . Analyses were conducted for three age groups , using R (version 3.6.0) and Stata (version 14).We repeated the analysis using a different definition of IID that excluded ICD-10 codes K52.9 and A09.9 (gastroenteritis and colitis of unspecified origin). This definition of IID was more specific, but was probably less sensitive, given that possible cases of IID were likely excluded. We also repeated our analyses using mixed-effect negative binomial models which would account for any overdispersion within the data. Additionally, using data collected over a longer time period (2005–17) we investigated the association between changes in unemployment and changes in emergency IID admission rates within neighbourhoods using fixed-effect Poisson models. These models include a fixed effect for each neighbourhood, and thereby indicate the relationship between unemployment trends within neighbourhoods and trends in IID admissions whilst controlling for all time-invariant differences between neighbourhoods.In total, 32,829 English neighbourhoods had available data from 2012 to 17, giving a total sample size of 196,974 LSOA-years for each age group. Prior to 2014, emergency IID admission rates were highest amongst children, followed by adults aged 65+ years, and adults aged 15–64 years . For chiResults from the regression analysis showed that increasing trends in neighbourhood unemployment were associated with increasing trends in emergency IID admission rates, for all age groups , Table 4Following adjustment for measures of primary and secondary care access, underlying morbidity and ethnic composition, the magnitudes of these associations were attenuated but remained statistically significant , Table 4For all age groups, the increasing prevalence of long-term health problems was associated with increasing emergency IID admission rates. The effects of ethnicity appeared to vary by age group, with one exception: as the percentage of people from a Pakistani ethnic background increased in a neighbourhood, emergency IID admission rates for all age groups increased.In terms of primary care access, increasing trends in the percentage of the population who would describe their experience of making a GP/nurse appointment as poor, were associated with increasing trends in emergency IID admission rates for all age groups. Increasing trends in GPs per capita were associated with decreasing trends in emergency IID admission rates for children, and increasing trends for adults aged 15–64 years. In terms of secondary care access, neighbourhoods situated closer to hospitals with A&E departments were associated with higher emergency IID admission rates for all age groups.We found similar results when repeating the analyses using mixed-effect negative binomial models and using a more specific definition of IID (Supplementary file). Fixed-effect Poisson models, which control for all time-invariant unobserved differences between neighbourhoods, also showed that increasing trends in neighbourhood unemployment were associated with increasing trends in emergency IID admission rates over a longer time period (2005–17), for all age groups (Supplementary file). These models however indicated a slightly smaller effect indicating that each 1 percentage point increase in unemployment was associated with a 1.7, 1.8 and 1.0% increase in the rate of emergency IID admissions per year for children , adults  and older adults , respectively.This longitudinal analysis of English neighbourhoods found that increasing trends in neighbourhood unemployment were associated with increasing trends in emergency infectious intestinal disease admission rates, for children, adults and older adults, despite controlling for factors such as ethnicity, underlying morbidity, travelling distance to hospital and experience of making a primary care appointment. Adjusting for these covariates attenuated much of the association between trends in neighbourhood unemployment and trends in emergency IID admission rates for adults, but not for children. Robustness tests using fixed-effect models produced effect estimates that were smaller in magnitude, suggesting that some of the association from the main analysis could be due to residual confounding, but that there appears to be an association between trends in unemployment and emergency IID admission rates even when all time-invariant unobserved confounders are controlled for.,,SomeSocially disadvantaged people tend to present to healthcare services more often, because they experience a greater burden of disease,Our study also adds to the evidence base by revealing insights about other predictive factors of emergency IID admissions. For example, the age-specific prevalence of long-term health problems was included in our models as a measure of underlying morbidity and was independently associated with increasing emergency IID admission rates for all age groups. There are several common chronic conditions that can result in secondary immunodeficiency or require immune suppressing treatments/medications or acid-suppression medications, and as such these conditions may increase susceptibility to and severity of IID.We also explored whether measures of primary care access were associated with IID admission rates, since in most cases hospitalisation for IID can be avoided through early intervention and effective management.,,,In terms of secondary care access, our results suggest that emergency IID admission rates for all age groups are higher when people have a shorter travelling distance to get to a hospital with an A&E department. Previous studies have found similar relationships between closer residential proximity to hospitals and higher all-cause or disease-specific emergency admission rates.Finally, age appeared to modify the relationship between ethnicity and emergency IID admission rates. Neighbourhoods that had a greater proportion of residents from Black, Chinese, Bangladeshi and Indian backgrounds, had lower admission rates for children, however the direction of these associations tended to be reversed for older adults. There was one exception however: as the percentage of people from a Pakistani ethnic background increased in a neighbourhood, emergency IID admission rates for all age groups increased. A previous UK-based study, which analysed those of all ages combined, found that Pakistani communities had an increased risk of laboratory-confirmed Campylobacter infection compared to White communities, whilst Black and Indian communities had a decreased risk.Our analysis shows for the first time in the UK, that trends over time in neighbourhood unemployment are associated with trends in emergency IID admission rates for children and adults. We performed a comprehensive analysis of all emergency hospital admissions for IID in England over a six year period, and as such it can be assumed that our results are generalisable to the English population. A number of robustness tests confirmed our results, using different types of models and a more specific definition of IID.There are limitations, however, that should be considered when interpreting the results. Firstly, information on repeat admissions by the same individual and hospital identifiers were not available within the dataset, which precluded the investigation of clustering at the individual and hospital level. It is not known to what extent these factors may have influenced the results of the study. However our previous studies investigating inequalities in the risks and consequences of IID using individual-level data have found that inequalities, where present, persist even after accounting for recurrent IID.In terms of study design, methodological limitations of ecological studies can include ecological bias whereby associations present at the group-level are not apparent at the individual-level, possibly due to unmeasured confounding or measurement error.,In conclusion, the findings from this study indicate that emergency IID hospitalisation (a severe consequence of having an IID) disproportionately affects disadvantaged communities. Given that most hospital admissions for IID are considered to be preventable, the findings from this study are particularly disconcerting. Unplanned admission to hospital can be distressing and disruptive for patients and families,This report is independent research part funded by: 1) the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at the University of Liverpool in partnership with Public Health England (PHE), in collaboration with University of East Anglia, University of Oxford and the Quadram Institute; and 2) the National Institute for Health Research Applied Research Collaboration North West Coast (ARC NWC). The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research, the Department of Health and Social Care, the NHS or PHE. DTR is funded by the MRC on a Clinician Scientist Fellowship (MR/P008577/1). SW is funded by a Wellcome Trust Society and Ethics Research Fellowship .TR, NA, MW, SO, JH, MV, DTR and BB conceptualised the study. TR analysed the data and drafted the manuscript with support from BB, DTR, MV and JH. TR, NA, MW, SW, SO, JH, MV, DTR and BB interpreted the data and revised the manuscript. All authors approved the submitted version of the manuscript.No ethical approval was required for this study, as it involved the use of anonymous aggregate secondary health service data and openly available data.None


The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior. Clinicaltrials.gov.Between 1994 and 2017, the National Institutes of Health (NIH) issued mandates that biomedical researchers include female participants in clinical research,Diagnostic and Statistical Manual of Mental Disorders (DSM-5) —with past-year rates of 10% among women and 18% among men, and respective lifetime rates of 23% and 36%.Most recent epidemiological results indicate a higher prevalence among men than women of AUD—defined by criteria of the fifth edition of the American Psychiatric Association’s Regarding the terminology used in this article—“sex,” “gender,” and “recovery”—the NIH definition of sex refers to biological differences between females and males in chromosomes, sex organs, and endogenous hormones, whereas gender refers to more socially based roles and behaviors that may vary by historical and cultural contexts.10Regarding recovery from AUD, there is currently no consensus in definition of this term. Historically, recovery has been associated with Alcoholics Anonymous as “ongoing cognitive, emotional, behavioral, and spiritual reconstruction of the sobered alcoholic”Lastly, the research reviewed in this paper uses diagnoses from DSM-IV and DSM-5. Whereas DSM-IV described two distinct disorders—alcohol abuse and alcohol dependence—DSM-5 combines these into a single alcohol use disorder (AUD) with mild, moderate, and severe subclassifications reflecting the number of symptoms met. The main criteria change from DSM-IV is that DSM-5 eliminates alcohol-related legal problems and adds alcohol craving as a criterion for AUD. Lastly, although the search did not exclude international research, the majority of findings reviewed are from studies conducted and/or funded in the United States.Alcohol is consistently shown to have more negative effects on women’s health than men’s, even at weight-adjusted lower levels of alcohol exposure, partly due to gender differences in pharmacokinetics of alcohol.18Stress plays an important role in the development and maintenance of AUD among both men and women.Sex hormones affect all body systems directly and indirectly, and for women there appears to be a reciprocal effect of alcohol on sex hormones.21Women with AUD report higher levels of co-occurring psychiatric conditions than do men with AUD. Co-occurrences of mental health conditions with AUD were examined using data from two waves (2001–2002 and 2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).26Among individuals with AUD, women are more likely than men to experience alcohol cravings in response to daily negative emotion and stress.29There are high rates of trauma among women receiving treatment for any substance use, and an estimated 25% to 55% of women in substance use treatment have PTSD.Research has found gender differences in the relationship between social networks, social support, and alcohol use. For example, compared to men, women with AUD are more likely to have a family history of AUD and a spouse with a history of AUD.Research has illuminated gender differences in the biopsychosocial factors contributing to the development of, and recovery from, AUD. The physical effects of alcohol are more pervasive for women than men, and sex-specific factors, such as sex hormones, have been associated with alcohol use. In terms of psychosocial differences, stress, trauma, and negative affect are particularly relevant contributors to alcohol use and development of AUD among women. Relatedly, there are gender differences in terms of rates of co-occurring mental health conditions, the rates of major depressive disorder among women with alcohol abuse being particularly high. These differences provide a context for understanding potential gender differences in AUD treatment and recovery and can be used to guide future research.A small percentage of individuals with AUD ever receive treatment, with past-year estimates of 7% of men and 5% of women with AUD receiving treatment40Among individuals who do enter AUD treatment, there are gender differences in clinical presentation. Women tend to have more severe alcohol and drug use histories, lower education and income, higher unemployment and housing needs, more children living at home, and higher parental stress, and they tend to be younger in age.44Data on gender differences in treatment retention are mixed, and most studies have been completed among samples with substance use disorder (SUD), meaning the results are not specific to AUD. For example, a review by Greenfield and colleagues reported no overall gender differences in SUD treatment retention but hypothesized that there would be different predictors and mediators of retention among men and women.45ClinicalTrials.gov for clinical trials on these AUD treatments, and reviewed publications from large clinical trials for AUD, to determine whether gender differences were analyzed and reported. Lastly, the authors searched for and reviewed reports of clinical trials, literature reviews, or meta-analyses on specific treatments to identify commentary or results regarding sex or gender. This was done to address the fact that analyses not yielding any significant gender differences may not have been identified using the search terms. Thus, for some treatments the authors were able to comment on null gender difference findings. Despite the NIH mandate to include females in biomedical research,The following review on outcomes of psychosocial treatments for AUD focuses on empirically supported treatments identified by American Psychological Association Division 12.Motivational enhancement therapy (MET) is a psychotherapy that helps patients resolve their ambivalence about engaging in treatment and reducing or stopping their substance use. Cognitive behavioral therapy (CBT) is an approach that focuses on the reciprocal effects of cognitions, emotions, and behaviors that maintain problem drinking. In treating SUD, CBT also focuses on identifying and resolving factors that reinforce or punish the substance use behavior and teaching both general coping skills and coping skills to negotiate drinking triggers. Twelve-step facilitation (TSF) treatment for AUD is based on the traditional Alcoholics Anonymous (AA) 12-step model and focuses on AA attendance, personalized spirituality, and guided introspection (“step work”).MET and CBT are among the most widely researched treatments for AUD;49Witkiewitz, Hartzler, and Donovan tested whether matching patients’ motivation level to CBT or MET was associated with better outcomes in the aftercare arm of Project MATCH.51A meta-analysis on controlled trials of brief motivational interventions examined gender as a moderator of treatment effect.54Couples-based approaches to the treatment of AUD are based in the assumptions that partners engage in malleable behaviors that reinforce and/or punish the client’s drinking behaviors, and that enhancing intimate relationships can improve problem-solving, enhance relationship functioning, and reduce likelihood of relapse. Behavioral couples therapy (BCT) and Alcohol BCT (ABCT) have been shown to be effective at increasing rates of abstinence from alcohol, decreasing alcohol-related problems, and improving relationship functioning.Several studies have tested ABCT separately among samples of men and women. An early study among men with alcohol dependence and their female partners compared three conditions: (1) ABCT, in which the spouse attended all sessions that included both alcohol- and marital-focused treatment; (2) full spousal attendance but alcohol-focused treatment only; and (3) minimal spousal involvement in alcohol-focused individual treatment.59ABCT also has been tested among women with AUD, and one study compared ABCT to a treatment arm in which women received individual CBT for AUD.Three medications are currently approved by the U.S. Food and Drug Administration for the treatment of AUD: acamprosate, naltrexone, and disulfiram. There are important gender differences in their bioavailability, distribution, metabolism, elimination,A meta-analytic study examined acamprosate for AUD treatment separately for men and women from a total of 22 studies,One of the first studies on naltrexone for AUD was a multicenter, placebo-controlled RCT of injectable naltrexone,69A third study tested high-dose naltrexone in men and women with co-occurring cocaine use disorder and AUD in a double-blind placebo RCT.72Thus, early studies suggested naltrexone for AUD was not as effective for women as for men, or that women may experience worse side effects, contributing to worse outcomes. However, more recent research has suggested that these effects may be due to study characteristics such as sample size or outcomes assessed. Baros, Latham, and Anton used data from two RCTs comparing a naltrexone plus CBT group and a placebo plus CBT group and found effect sizes favoring naltrexone in men compared to women on some outcomes (drinks per drinking day), but not others .A secondary analysis of COMBINE data tested treatment effects separately in men and women and found that both genders had better treatment response when they received naltrexone with either medication management or combined behavioral intervention , in comparison to placebo and any other combination of treatments.In 2016, Agabio et al. cited the low number of women in clinical trials on disulfiram that preclude evaluation of sex differences in efficacy and safety.Emerging digital and mobile models of treatment delivery include platforms such as telehealth sessions via videoconference; direct access computer programs such as CBT4CBT;78The preliminary research on access and use of AUD treatment via digital and mobile technologies suggests gender differences. For instance, a survey of members of an online social network site for women trying to resolve alcohol problems revealed that 47% of the site’s members had never tried any other form of support related to their drinking.Existing research suggests no major gender differences in terms of overall outcome in psychosocial or pharmacological treatments for AUD. However, this finding is qualified by the small number of studies that directly test gender differences and the low enrollment of women in clinical trials. Additionally, as demonstrated by secondary analysis of Project MATCH, moderating factors such as AUD severity and motivation may be differentially associated with outcomes for men and women.Recovery is a complicated construct, ill-defined and historically confined to a mutual care, 12-step “disease model” system that considers abstinence as the only viable outcome.Alcoholics Anonymous, the largest and most popular mutual help organization available, offers primarily mixed-gender meetings, but also some single-gender meeting options . However, AA meeting content is consistent across groups and does not necessarily include gender-specific content.Outcomes of single-gender versus mixed-gender AA meeting attendance have not been studied; however, studies on gender differences in treatment outcomes among attendees of mixed-gender AA have shown some significant results, including different moderators of attendance for men and women. One longitudinal study followed 466 men and women for 16 years who were initially untreated for problem drinking.Witbrodt and Delucchi followed participation in AA for 7 years and found that men were more likely to stop attending over the 7-year period.83In sum, research on gender differences in outcomes of AA attendance are mixed, but the most consistent findings suggest women are more likely to stay in AA longer than men, and there may be different moderators  of the efficacy of AA for men and women.In line with contemporary notions of AUD and SUD as chronic, relapsing diseases requiring a continuum of care, McKay and colleagues developed and tested stepped and continuing care interventions with various levels of intervention, including telephone counseling.In a sample of participants who used cocaine, most of whom were also alcohol dependent, McKay and colleagues found that women but not men benefited from telephone continuing care.Sliedrecht and colleagues conducted a review of 321 articles, published between 2000 and 2019, to examine the evidence for precipitants of relapse in AUD.91In another review, Walitzer and Dearing indicated that rates of alcohol relapse did not differ among men and women, but evidence did indicate different predictors of relapse by gender.92Gender differences in empirical studies on viability of non-abstinent forms of recovery have recently been studied. Analysis of gender differences in such studies needs to attend to different thresholds for risky or heavy drinking for men and women.93In a study of three clinical trials for AUD—including data from Project MATCH, the COMBINE study, and the United Kingdom Alcohol Treatment Trial—several baseline variables were tested as predictors of low-risk drinking; gender was not found to be predictive.95One study examined men and women with AUD between ages 55 and 77 in a private outpatient program.Issues such as co-occurring mental health conditions, social environment, sleep, and physical health are directly affected by problem drinking and are important independent outcomes reflecting quality of life (QoL). Literature reviews have shown that heavy drinking is associated with reduced QoL, which improves with reductions in drinking.Attention to gender differences among various forms of recovery (both in the 12-step model and in the treatment outcome literature)—including examination of abstinence, reduction of drinking, and/or secondary outcomes—has yielded some interesting results, but research is sparse so far. Predictors of relapse appear to differ between men and women, with women being more likely to relapse in response to interpersonal conflict and negative affect whereas men are more likely to relapse in response to isolation and both positive and negative affect. Also, although being married is a protective factor for men, it can act as a risk factor of relapse for women. Having at least one close friend to discuss drinking with is differentially helpful for women. Also, gender differences in treatment outcome and maintenance may depend on the outcome of interest (drinking or secondary outcomes) and the “form of recovery” studied.There are several behavioral treatments now known to be efficacious for AUD, but there is almost no examination of gender differences in the AUD psychotherapy process and mechanisms of behavior change in this research literature. For example, the authors of this paper found 49 articles published between 2000 and 2012 (26 published since 2010) studying mechanisms of change in CBT, Motivational Interviewing, or MET or examining general therapeutic alliance as a mechanism of change. Of these 49 articles, 22 were review or non-empirical papers and did not mention gender. Of the 27 empirical studies, seven (26%) provided no sample breakdown by gender, one study (4%) had an all-female sample, and 17 (63%) had mixed-gender samples . Furthermore, of these 17 mixed-gender studies, only five (29%) mentioned gender at all, typically as a statistical covariate. Since 2012, researchers have continued to examine mechanisms of change but generally have continued to ignore gender or used single-gender samples.The Women’s Recovery Group (WRG), a treatment for women with SUD (including AUD), examined mechanisms of change between men and women. WRG was compared to a traditional mixed-gender Group Drug Counseling (GDC) treatment in Stage I102Litt et al. studied Network Support Treatment (NST) for AUD, which is designed to help patients build social support networks for sobriety.Recent studies have investigated potential mechanisms of behavior change among female-only samples receiving CBT for AUD A recent review conducted by the RAND National Defense Research Institute examined 24 AUD RCTs to examine gender differences in outcome and found mixed results, with little evidence for systematic gender differences in treatment effects across studies.Our review and those by Greenfield and colleaguesAs suggested by Moyer and colleagues,It is also important to note that even among the studies that examined sex and gender differences, the sample sizes of women were often small, and analyses were likely underpowered. Given the historical differences in prevalence of AUD among men and women, this may have been justifiable in the past. However, the convergence of prevalence rates for lifetime AUD among men and women no longer justifies such small samples of women in treatment. Although studies may recruit men and women, women often comprised less than 50% of the sample, which makes it difficult to examine gender differences. If gender is considered a moderating factor, there must be enough men and women to statistically power the examination of interaction effects. Thus, in conducting clinical trials it may be important to enroll comparable numbers of men and women, with sufficient power to properly examine gender differences.Another consideration is single-gender treatment options, with female-only treatment most often a focus of research. This area of research has examined the delivery of treatment in a women-only setting, with or without including female-specific content  should be reported in AUD treatment outcome research.Research suggests gender differences in relapse precipitants. Furthering our understanding of biological, social, and psychological determinants of relapse based on gender has implications for personalized or tailored relapse prevention approaches.Clinical trials are mandated to recruit men and women, as well as analyze and report gender differences; however, the field needs to adhere more stringently to these mandates in future research. This involves consistent changes to methods such as intentional oversampling of women, randomization based on gender, and gender-specific analyses.The research reviewed here provides ample reason to believe that men and women recover from AUD differently. It is important to test and report gender differences when studying mechanisms of change—mediators, moderators, and active therapeutic ingredients—in AUD treatments.


This editorial summarizes and discusses the themes of eleven articles  published in the Special Issue “Molecular Research On Platelet Activity in Health and Disease”. They give an international picture of the up-to-date understanding of (i) platelet signalling under physiological and pathological conditions, (ii) novel technologies for monitoring platelet functions and (iii) clinical applications of platelet-based-therapy for management of pathological conditions, not directly related to haemostasis and thrombosis.  Further insights into the regulation of platelet signalling were derived from Makhoul and collaborators, who report a novel feedback inhibition mechanism in human platelet activity. They report a new site of phosphorylation of spleen tyrosine kinase (Syk), occurring on Ser297, that is mediated by protein kinase C (PKC)- and cyclic adenosine monophosphate (cAMP)-dependent pathways . ConsideE. coli in vitro and in sepsis patients, the authors demonstrate, for the first time, that platelets play a key role in sepsis, by increasing proteasome activity, as well as by upregulating the proteasome activator PA28 (PSME1) and inducing proteolytic cleavage of proteasome substrates, such as Talin-1. Upregulation of platelet proteasome activity and protein metabolism in response to infection under conditions of sepsis indicate, therefore, that proteasome is dynamic and responds to inflammatory environmental stress conditions [Grundel and collaborators gave further insights into the functional role of the proteasome system in platelets. Key proteins of this pathway, together with proteins of the ubiquitination system, are indeed expressed by platelets, although the exact role of these proteolytic systems is unclear. By using living The crucial role of platelets in response to environmental stress conditions is also the object of Kraemer and colleague’s study. They show that acute myocardial infarction leads to significant changes in heat-shock proteins (HSP), acting as chaperones and cytoskeleton stabilizers , and kinParticular attention should be paid to development of novel technologies for monitoring platelet activity, under both physiological and pathological conditions. In this context, a valuable tool for research in hemostasis and thrombosis is represented by microfluidic flow chambers (MFCs), which can mimic healthy and stenotic blood vessels and recreate various physiological and pathological shear stress conditions. These microchannels, therefore, are commonly used to study platelet adhesion over different adhesive proteins and thrombus formation, as well as inhibitory effects of antiplatelet agents. Nonetheless, the existence of several experimental variables prevents a real standardization, so the definition of common protocols is a compelling challenge. In this context, Scavone’s study is particularly interesting and promising, as the authors investigate critical aspects of microfluidic platelet adhesion assays and of common antiplatelet drugs, i.e., aspirin and cangrelor, through a new microfluidic device . This noCanault and Alessi exhaustively provide an update of structure and pathophysiological role of RasGRP2, the essential regulator of αIIbβ3 integrin activation in platelets. They show how RasGRP2 genetic variants are related to the inherited platelet-type bleeding disorder-18 (BDPLT18), also discussing strategies for diagnosis and management of patients with this congenital bleeding disorder . Barale Another important aspect in platelet research concerns clinical applications of platelet concentrate transfusion, for treating musculoskeletal conditions . This is the object of the narrative review from Mariani and Pulsatelli, who discuss different types of methodological procedures used to prepare platelet concentrates and how these preparations may differ in composition, depending on the protocol adopted. Clinical application in musculoskeletal medicine, as well as efficacy and main reported controversies, are illustrated here . The funAltogether, the studies reported in this Special Issue reveal novel aspects of platelet biology and we hope that they will be helpful towards new insights and a research impetus for those who are interested in developing new therapeutic tools for the management of pathological conditions depending on platelet dysfunctions.


An analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment.t test was used to test for variance among sentiment scores of opposing and studied neutrality statements.In order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements were identified. These statements were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independent suicide, medicine, and treatment appear frequently in opposing statements, but not in studied neutrality statements, whereas psychologists, law, and individuals appear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ .Of 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS  and 9 for euthanasia . Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (Few US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient’s desire for PAS. Physician-assisted suicide (PAS) and euthanasia are highly debated and controversial topics in the United States. In PAS, a patient ingests a drug prescribed by a physician for the purpose of causing the patient’s death, in order to relieve unacceptable symptoms or quality of life. Currently, California , Coloradphysician-assisted death (PAD), are generally more rigid in the United States than in countries where PAD is legal. For instance, in the Netherlands, PAS and euthanasia are legal for adults . Requests for PAD “often come from patients experiencing unbearable suffering with no prospect of improvement. Their request must be made earnestly and with full conviction… However, patients have no absolute right to euthanasia and doctors no absolute duty to perform it”  medical societies,” with the bracket including a name of a specialty derived from the Mayo Clinic directory. An original search was performed for each specialty in the directory, and the respective first 2 Google search pages were analyzed for societies. Second, we obtained a list of specialty societies from the American Medical Association (AMA) website . This liWe determined the positions of these societies on PAS or euthanasia, or both. These positions were organized into 5 categories: supportive, opposed, studied neutrality, acknowledgement without statement, and no statement. Studied neutrality position statements are characterized by an understanding of the practical concerns associated with PAS or euthanasia and the persistent desire of some patients for PAS or euthanasia despite these concerns. The American Academy of Hospice and Palliative Medicine (AAHPM) position statement  exemplifis, a, or the) and the name of the society were filtered out because these words provided no insights into the intent of the statement authors. The other words were sorted by frequency of use, producing a chart of each statement’s top word choices. In addition, a given statement’s words that were used more than once were processed by a sentiment analysis tool . This approach relates word choice to emotional attitude and generates a quantitative score of emotional positivity. Medhat et al.  expresses support for improved availability of palliative care services, palliative care education for AAN members, and palliative care research intended to identify more effective means to alleviate refractory suffering of dying patients. By doing so, it hopes to minimize future patient interest in hastened death” .Of note, studied neutrality statements (AAHPM and AAN) , 16 and suicide and instead use such terms as hastened death or assisted death [suicide as not being derogatory and aiding in clarity in the discussion of the topic  [suicide more frequently [psychologists, law, and individuals more frequently than opposing statements—likely a reflection of the procedures used to request PAS and the emphasis on patient autonomy in association with PAS. That said, the most popular words used in the opposing statements and studied neutrality statements are similar.The language of position statements correlates with the position taken by the societies. For instance, studied neutrality statements refrain from the word ed death , 16, 24.ed death . In conthanasia) . Unsurprequently , 27, 29.suicide [suicide and studied neutrality statements’ preference for alternative terms such as assisted death indicates a statement’s comprehensive use of emotionally positive or negative language. Therefore, we extended the linguistic analysis by exploring possible associations between linguistic sentiment and statement position through comparison of mean sentiment scores across position categories. Although studied neutrality statements commonly use phrases such as assisted death in place of suicide, our linguistic analysis showed similar mean sentiment scores for studied neutrality statements and opposing statements. Furthermore, both opposing and studied neutrality statements tended to use emotionally positive language.Statements have considered the culturally and historically negative connotations of the term suicide . Recognisuicide or an alternate. Rather, our findings suggest that use of suicide or an alternate term such as assisted death does not indicate that a position statement intentionally uses emotionally positive or negative language.Nonetheless, our analysis and findings provide no insight into the rhetorical decision to use the label A limitation of the present analysis is the small number of position statements of the organizations. Corpus-based sentiment analysis would provide a better understanding of author intent in the statements because this approach has the ability to consider phrase context more thoroughly . That saOnly a dozen secular US medical and surgical professional societies have position statements on PAS and euthanasia, and only 3 of these statements have been published in peer-reviewed journals. The reasons for these small numbers are unclear but may be related to the controversial nature of the topics, the positions of large and influential societies, and the relevancy of the topics for specific specialty societies.suicide, medicine, and treatment in opposing statements and the words psychologists, law, and individuals in studied neutrality statements, the most popular words used in opposing and studied neutrality position statements are similar. Use of the word suicide or assisted death does not appear to indicate a statement’s comprehensive use of emotionally positive or negative language.Aside from the use of the words Opposing statements generally claim PAS contradicts the healing role of the physician and that alternative approaches to symptom control exist for extreme cases . Studied neutrality statements highlight patient autonomy in decision-making associated with the dying process. The opposing statements and the studied neutrality statements cite potential long-term societal risks associated with legalization of PAS and suggest that effective palliative care can diminish a patient’s desire for PAS.Additional file 1. Table S1: Positions on PAS and Euthanasia of all Identified US Medical and Surgical Societies.


B. abortus infection has been shown. The most widely used vaccine strains to protect against Brucella infection and related abortions in cattle are strain 19 and RB51. Moreover, it is very important to note that no vaccine, which is highly protective, safe and effective is available either for bovines or human beings. Research results encourage the use of bacteriophage lysates in treatment of bovine brucellosis. One Health approach can aid in control of this disease, both in animals and man.Brucellosis is a zoonotic disease of great animal welfare and economic implications worldwide known since ancient times. The emergence of brucellosis in new areas as well as transmission of brucellosis from wild and domestic animals is of great significance in terms of new epidemiological dimensions. Brucellosis poses a major public health threat by the consumption of non-pasteurized milk and milk products produced by unhygienic dairy farms in endemic areas. Regular and meticulous surveillance is essentially required to determine the true picture of brucellosis especially in areas with continuous high prevalence. Additionally, international migration of humans, animals and trade of animal products has created a challenge for disease spread and diagnosis in non-endemic areas. Isolation and identification remain the gold standard test, which requires expertise. The advancement in diagnostic strategies coupled with screening of newly introduced animals is warranted to control the disease. Of note, the diagnostic value of miRNAs for appropriate detection of  These LPS are principal virulence factors as well as target for many immunological tests. Some outer and inner membranes along with cytoplasmic and periplasmic proteins also play a significant role in multiple cellular activities  surface antigens; the A antigen is major antigen in 4.B. abortus is the principal Brucella organism that infects cattle. However, B. suis and B. melitensis may also infect cattle  followed by Kenya (1914) and South Africa (1915) Chukwu . HoweverBrucellosis is endemic among ruminants and humans in Egypt despite the presence of control programs  of the isolates were carried out. A total of 10 B. abortus biovar 3 was isolated and based on MLVA analysis, 3 isolates were identical to Brazil  showed that overall prevalence was 1.9%. Northern China had higher prevalence compared to Southern China, and Jilin province had the highest among the provinces with more than 30%  samples and 47 herds (18.6%) to be seropositive for brucellosis  analysis (MLVA). The study also warranted the use of molecular tools to trace the source of infection . Similarly, adoption of One Health approach in controlling the endemic NTD, like brucellosis is necessary that this needs support from the global community . The persistence and localization of bacteria in these tissues follow widespread distribution of the Brucella in generalized phase of infection. Abortion in females and infertility in males result from localization of Brucellae within the female and male reproductive tracts  pathogen possessing the potential to be used as bio-weapon  cattle, if not pasteurized properly  has reported in its factsheet that around millions of cases of brucellosis are accounted every year but actual rate of incidence is still 10–25 times more than the stated number of cases. One important reason behind this condition is lack of distinct guidelines for diagnosis of brucellosis cases. Based upon study of the clinical and diverse serological pattern of disease, researchers have proposed that after acute form of brucellosis immune response is mainly comprised of IgM, secondary immune response is in the form of IgG, which generally gets weaker after improvement of condition and no permanent positivity to IgG antibody is present for longer duration. They showed that such variable serological pattern of disease suggests seven possible clinical subtypes of the disease modulating the epidemiological scenery of brucellosis , indirect ELISA and available commercial cELISA kits –soy agar (TSA) are the dehydrated basal medium available commercially. Bovine or equine serum (2–5%) must be added for the growth of strains such as B. abortus biovar 2. Blood agar base or Columbia agar provides excellent results. Serum–dextrose agar (SDA) or glycerol dextrose agar are other satisfactory media and help in observation of colonial morphology  and placental cotyledon (11.1%). However, no isolate was detected from aborted fetal abomasal contents and milk of animal  and modified Thayer Martin (mTM). Nevertheless, Farrell's medium allows inhibition of fungi during isolation; hence mCITA or FM can be used for isolation of Brucella spp.  animals were detected positive in at least any one serological test while merely 45.2% showed positivity in all five serological tests, although microserum agglutination test and fluorescence polarization assay were found to be comparatively more sensitive out of five serological tests. Overall analysis advocated that along with serological tests, bacterial culture methods should always be encouraged and practiced for confirmation of brucellosis  were found reliable for the confirmation of bovine brucellosis in aborted fetal tissue and placental cotyledons, whereas serology was useful for detection of Brucella-positive animals in a herd. Researchers also designed more accurate two-step PCR for early detection of brucellosis from 39 brucellosis cases and 25 control  cases. Multiple sequence alignments (MSA) analysis showed that N terminal region of the Omp2 protein was related with highly conserved region of the genome of Brucella , immune capture agglutination, CFT, milk ring, Coombs test, ELISA and lateral flow assay (LFA) are frequently employed to diagnose brucellosis  were found significantly associated with seropositivity  is helpful in quick confirmation of neuro-brucellosis, arthritis, epididymitis, orchitis and hydrocele , RB51 and B115 as antigens. The B115 CFT was found to be very sensitive and specific in detecting rough strain antibodies as compared to RB51 and HSE-CFT. As such, B. melitensis B115 is promising antigen for CFT for detecting antibodies against rough strains of Brucella  is a very specific test that can detect IgM and IgG1 antibodies. However, antibodies of the IgG2 type impede complement fixation resulting in exhibition of false negative results. The CFT accounts for quantitative measurement of more of the IgG1 type antibodies than the IgM type antibodies, as the inactivation process results in partial destruction of IgM antibodies. CFT is considered better for control and surveillance programs for brucellosis  treatment of serum sample. IgG antibodies are important for detection of active brucellosis and is an excellent indicator of active brucellosis. A rapid decline in the titer of IgG antibodies is indicator of successful treatment. Persistence of SAT antibodies in some successfully treated patients indicate over diagnosis of human brucellosis resulting in wrong treatment -based ELISA determined the potential use of rBfr for the serological diagnosis of brucellosis in bovines  and latex agglutination developed recently have been found to be easy to use and quick. It has been found that sensitivity as well as specificity of the LFA for culturally positive cases is more than 95% . Findings of the study demonstrated alteration of 20 miRNAs, among which, 12 were upregulated and 8 were downregulated. In this way, study proved the diagnostic value of miRNAs for appropriate detection of B. abortus infection in water buffaloes  as clinical biomarkers  of DNA as well as real-time PCR have been proved as significant, sensitive, quick and specific diagnostics for 12.Brucella and its adaptability in the macrophages  and S19 (as SL). The cocktail of these two phage lysates (RL and SL) were injected subcutaneously in 2 mL-dose and even after 3 month-period of immunization by phage cocktail, blood samples were found negative for presence of 13.Brucella infection, preventive measures to stop re-introduction of the disease in a herd  in the heifers, their calves or fetuses was observed upon challenge with B. melitensis 16 M. Influenza viral vector-B. abortus vaccine provided equivalent protection when compared with B. abortus S19 vaccine (B. melitensis 16 M infection ( vaccine . These tnfection .γ and lymphoproliferative response of splenocytes (Gomez et al. B. abortus. The antigens coding by these genes were responsible for bacterial virulence and intracellular survival of B. abortus in the host. When tested in mouse model, the DNA vaccine induced cytotoxic T cell and Th1 type immune responses, indicating the protective immune potential of such vaccine via immune cells (Gomez et al. As preventive measures against brucellosis, besides conventional vaccines, new DNA vaccines and multivalent fusion DNA vaccine have also been developed CDC . They weBrucella abortus strain 19 is the commonly recommended vaccine against animal brucellosis in India. However, several undesirable effects have seen to be associated with them when the vaccines were administered to animals or when humans were accidentally exposed. The occurrence of abortion-like adverse events was associated with three factors namely animal species, vaccination dose, and vaccination route, which was statistically authenticated (Xie et al. Brucella spp. in many other livestock or wildlife results in its failure or at best significantly decline in the human infections to some extent. Therefore, the development of novel vaccines that is highly effective and safe under field conditions, addresses the diversified host species along with improvement in other components of the regulatory program on brucellosis may significantly impact its prevalence worldwide (Olsen and Stoffregen The approval of a vaccine and its associated adverse-reaction is not fixed at all time. In fact, it requires a series of critical judgments, which may include issues that may take over the course of many years (Grabenstein 15.etc., in animals and undulant fever in human beings. The disease causes colossal economic losses globally in terms of reduced animal health and production and effect on public health, yet robust surveillance, prevention and control measures are lacking.Brucellosis is among the most prevalent animal and zoonotic diseases with worldwide occurrence. Brucellosis reveals mostly an endemic pattern of disease in developing regions especially sub-Saharan Africa. The prevalence of this disease is on the rise owing to numerous hygienic, social, economic, cultural and political factors. Brucellosis prophylaxis programs mainly depends on early, accurate and precise diagnosis of the disease. Brucellosis is diagnosed by history, symptoms of disease, bacteriological isolation and identification, serological tests, and various molecular tests including PCR-based assays. However, all the tests have some strengths and limitations. The major ailments caused by brucellosis include abortions, retained fetal membranes, endometritis, orchitis, epididymitis, Nation-wide comprehensive monitoring, surveillance programs with adequate funding in different geographical areas in all the countries where disease is prevalent should be conducted in order to assess the magnitude of the disease. Robust prevention, control and eradication strategies having collaboration of various departments should also be in force. Registration and proper identification of animals, excellent veterinary/medical services and adequate compensation are essentially required. The antibiotic treatment of brucellosis in domestic animals and humans is often unsuccessful or less successful. The ciprofloxacin and/or ceftriaxone as single drug for treatment of brucellosis cases were not reported promising. However, combination therapies are preferred over monotherapy for treatment of acute and chronic brucellosis, as reduced chances of disease relapses were reported. The multi-drug therapy including various antibiotics like doxycycline, streptomycin, gentamicin, rifampin and amikacin in different combinations are preferred to treat uncomplicated brucellosis cases and prevention of relapse.B. abortus. In case of humans, comprehensive educational and training programs are utmost necessary to control the disease in vulnerable groups like traditional small holders, healthcare providers and veterinarians. In this context, a financial investment-based collaborative approach of government, semi-government organizations, private industries and farmers is crucial in effective disease control strategies (Avila-Granados et al. Public awareness campaigns regarding disease symptoms in animals and man, epidemiology and source of infection, transmission of the disease and preventive measures in order to protect the public and for the planned control methodologies must be undertaken with full vigor. The major hurdle in controlling the disease in livestock includes meager budget allocation, lack of appropriate services to farmers having ailing animals along with restricted disease monitoring and surveillance to Brucella species is urgently required for prevention of the disease. Adequate funding and will are required at governmental level to combat this disease.Development of a vaccine which provides longer protection against all