A model to improve the accuracy of US Poison Center data collection.

by Krenzelok, E. P., Reynolds, K. M., Dart, R. C., Green, J. L. [2014-09-01]

Academic Journal

pages 8

Context. Over 2 million human exposure calls are reported annually to United States regional poison information centers. All exposures are documented electronically and submitted to the American Association of Poison Control Center's National Poison Data System. This database represents the largest data source available on the epidemiology of pharmaceutical and non-pharmaceutical poisoning exposures. The accuracy of these data is critical; however, research has demonstrated that inconsistencies and inaccuracies exist. Objective. This study outlines the methods and results of a training program that was developed and implemented to enhance the quality of data collection using acetaminophen exposures as a model. Methods. Eleven poison centers were assigned randomly to receive either passive or interactive education to improve medical record documentation. A task force provided recommendations on educational and training strategies and the development of a quality-measurement scorecard to serve as a data collection tool to assess poison center data quality. Poison centers were recruited to participate in the study. Clinical researchers scored the documentation of each exposure record for accuracy. Results. Two thousand two hundred cases were reviewed and assessed for accuracy of data collection. After training, the overall mean quality scores were higher for both the passive (95.3%; + 1.6% change) and interactive intervention groups (95.3%; + 0.9% change). Data collection accuracy improved modestly for the overall accuracy score and significantly for the substance identification component. There was little difference in accuracy measures between the different training methods. Conclusion. Despite the diversity of poison centers, data accuracy, specifically substance identification data fields, can be improved by developing a standardized, systematic, targeted, and mandatory training process. This process should be considered for training on other important topics, thus enhancing the value of these data in relation to public health safety. [ABSTRACT FROM AUTHOR]

Risk adjustment of heroin treatment outcomes for comparative performance assessment in England.

by Marsden, John, Eastwood, Brian, Jones, Hayley, Bradbury, Colin, Hickman, Matthew, Knight, Jonathan, Randhawa, Kulvir, White, Martin [2012-12-01]

Academic Journal

pages 12

Aims Variability in effectiveness of treatment for substance abuse disorder ( SUD) is an important and understudied issue. This study aimed to quantify the extent of outcome variability in the English SUD treatment system after adjusting for potential confounding variables. Design Prospective cohort study using data from the English national drug treatment outcome monitoring database. Setting All 149 administrative areas delivering publicly funded SUD services in the National Health Service and non-governmental sector. Participants New adult admissions between January 2008 and October 2010 with illicit heroin-related problems in all administrative areas, with an in-treatment review conducted between 5 and 26 weeks (mean = 129.5 days; SD = 40.0) up to 30 April 2011 ( n = 65 223; 75.6% of eligible clients). Individuals were divided randomly to form model developmental and internal validation samples. These were contrasted with an independent (external) sample of the same population admitted to treatment between November 2010 and April 2011 and followed to 31 October 2011 ( n = 13 797; 81.4% of those eligible). Measurements and analysis The outcome measure was self-reported illicit heroin use, categorized as abstinent or deteriorated (the latter by Reliable Change Index), each risk-adjusted by person-level (demographics, clinical severity and treatment complexity) and area-level ( SUD prevalence, social deprivation and severity averages) covariates by multivariable logistic regression using multiply imputed outcome and covariate data. Risk-adjusted models were assessed by information criteria and discrimination (c-index). Standardized outcome rates were compared by funnel plot with 95% and 99% control limits. Findings Models of heroin abstinence (48.4%) and deterioration (3.2%) were comparable across the developmental and validation samples (c-index = 0.70-0.71 and 0.82-0.87), with 79.2 and 94.0%, respectively, of the 149 treatment areas falling within 95% control limits. At the 99% limit, seven areas (4.7%) achieved abstinence rates above the national average, and eight had relatively poor abstinence rates (5.4%). At the 99% control limit, one area achieved very low deterioration outcomes and two (1.3%) were worse that the average. Risk adjustment served to increase abstinence rates in good performing areas by 0.63% and reduce abstinence rates by 0.37% in poor performing areas, and by 0.12% and 0.18%, respectively, for deterioration. Conclusion There is some exceptional variability in the apparent effectiveness of the English treatment system for substance use disorders. It is important to determine the source of this variability in order to inform drug treatment delivery and its evaluation both in England and overseas. [ABSTRACT FROM AUTHOR]

Academic Journal

pages 9

Background/purpose: One of the most common childhood diseases is Urinary Tract Infection (UTI). Without diagnosis and treatment, it can cause irreparable effects. Escherichia coli cause UTI in 75% of cases. Unlike diarrheagenic E. coli has certain pathotypes, E. coli causing UTI, are not well known. For further information, we considered pathogenicity determinants and epidemiology of uropathogenic E. coli (UPEC) strains isolated from children with Urinary Tract Infection (UTI) to define distinct pathotypes. Methods: One hundred E. coli strains (50 UPEC and 50 commensal) isolated from children with UTI were examined. Some virulence factors and specific genes were examined by PCR method. Genetic diversity was evaluated by phylogenetic typing groups. Results: Some pathogenicity determinants were more prevalent in UPEC strains rather than commensal E. coli strains, significantly. There were PAI IICFT073, PAI II J96, PAI I536, PAI ICFT073, PAIII536, PAI IV, gafD, focG, vat, usp, hlyD, sat, cnf1, picU, fliC(H7), kpsMTII, kpsMTIII. UPEC were mainly found in phylogenetic typing groups B2 and D, while in commensal isolates, phylogenetic groups A and D were the most common. Conclusion: We need a simple pathotypes screening test which can be used either as or could be beneficial to facilitate along with other experiments in establishing an UTI assessment. Unfortunately, due to the high variation in pathogenicity determinants of UPEC strains, pathotypes could not be determined using genotype and virulence factors. Knowledge of the molecular details of UPEC is mainstay of successful strategies development for treatment of UTI and prevention of its subsequent complications. [ABSTRACT FROM AUTHOR]

Divergent evolutionary and epidemiological dynamics of cassava mosaic geminiviruses in Madagascar.

by Hoareau, Murielle, Lett, Jean-Michel, Lefeuvre, Pierre, De Bruyn, Alexandre, Reynaud, Bernard, Harimalala, Mireille, Zinga, Innocent, Ravigné, Virginie, Martin, Darren P., Mabvakure, Batsirai M., Harkins, Gordon W., Walters, Matthew, Varsani, Arvind [2016-09-06]

Academic Journal

pages 21

Background: Cassava mosaic disease (CMD) in Madagascar is caused by a complex of at least six African cassava mosaic geminivirus (CMG) species. This provides a rare opportunity for a comparative study of the evolutionary and epidemiological dynamics of distinct pathogenic crop-infecting viral species that coexist within the same environment. The genetic and spatial structure of CMG populations in Madagascar was studied and Bayesian phylogeographic modelling was applied to infer the origins of Madagascan CMG populations within the epidemiological context of related populations situated on mainland Africa and other south western Indian Ocean (SWIO) islands. Results: The isolation and analysis of 279 DNA-A and 117 DNA-B sequences revealed the presence in Madagascar of four prevalent CMG species (South African cassava mosaic virus, SACMV; African cassava mosaic virus, ACMV; East African cassava mosaic Kenya virus, EACMKV; and East African cassava mosaic Cameroon virus, EACMCV), and of numerous CMG recombinants that have, to date, only ever been detected on this island. SACMV and ACMV, the two most prevalent viruses, displayed low degrees of genetic diversity and have most likely been introduced to the island only once. By contrast, EACMV-like CMG populations (consisting of East African cassava mosaic virus, EAMCKV, EACMCV and complex recombinants of these) were more diverse, more spatially structured, and displayed evidence of at least three independent introductions from mainland Africa. Although there were no statistically supported virus movement events between Madagascar and the other SWIO islands, at least one mainland African ACMV variant likely originated in Madagascar. Conclusions: Our study highlights both the complexity of CMD in Madagascar, and the distinct evolutionary and spatial dynamics of the different viral species that collectively are associated with this disease. Given that more distinct CMG species and recombinants have been found in Madagascar than any other similarly sized region of the world, the risks of recombinant CMG variants emerging on this island are likely to be higher than elsewhere. Evidence of an epidemiological link between Madagascan and mainland African CMGs suggests that the consequences of such emergence events could reach far beyond the shores of this island. [ABSTRACT FROM AUTHOR]

Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi.

by Angwenyi, Vibian, Aantjes, Carolien, Kajumi, Murphy, De Man, Jeroen, Criel, Bart, Bunders-Aelen, Joske [2018-07-02]

Academic Journal

pages 17

Background: The high burden of chronic communicable diseases such as HIV/AIDS, and an escalating rise of non-communicable diseases (NCDs) in Malawi and other sub-Saharan African countries, calls for a shift in how health care services are designed and delivered. Patient-centred care and patient self-management are critical elements in chronic care, and are advocated as universal strategies. In sub-Saharan Africa, there is need for more evidence around the practice of patient self-management, and how to best support patients with chronic conditions in the African context. Our study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource-constrained setting in Malawi. Methods: This is primarily a qualitative study, involving patients with different chronic conditions from one rural district in Malawi. Data are drawn from semi-structured questions of a survey with 129 patients (from the third of four-part data collection series), 14 in-depth interviews, and four focus-group discussions with patients (n = 31 respondents). A framework approach was used for qualitative analysis, and descriptive statistical analysis was performed on survey data. Results: Patients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and external factors. Factors included: 1) ability to acquire appropriate disease knowledge; 2) poverty level; 3) the presence of support from family caregivers and community-based support initiatives; 4) the nature of one’s social relations; and 5) the ability to deal with stressors and stigma. NCD and HIV comorbid patients were more disadvantaged in their access to care, as they experienced frequent drug stock-outs and incurred additional costs when referred. These barriers contributed to delayed care, poorer treatment adherence, and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of (multiple) care challenges. Conclusion: Our findings complement other research on self-management experiences in chronically ill patients with its analysis on factors and barriers that influence patient self-management capacity in a resource-constrained setting. We recommend expanding current peer-patient and support group initiatives to patients with NCDs, and further investments in the decentralisation of integrated health services to primary care level in Malawi. [ABSTRACT FROM AUTHOR]

A polymorphism in the haptoglobin, haptoglobin related protein locus is associated with risk of human sleeping sickness within Cameroonian populations.

by null, null, Ofon, Elvis, Fogue, Pythagore, Simo, Gustave, MacLeod, Annette, Noyes, Harry, Hertz-Fowler, Christiane, Mulindwa, Julius, Ilboudo, Hamidou, Simuunza, Martin, Ebo'o, Vincent, Njiokou, Flobert, Koffi, Mathurin, Bucheton, Bruno [2017-10-27]

Academic Journal

pages 16

Background: Human African Trypanosomiasis (HAT) is a neglected disease targeted for elimination as a public health problem by 2020. Elimination requires a better understanding of the epidemiology and clinical evolution of HAT. In addition to the classical clinical evolution of HAT, asymptomatic carriers and spontaneous cure have been reported in West Africa. A genetic component to human susceptibility to HAT has been suggested to explain these newly observed responses to infection. In order to test for genetic associations with infection response, genetic polymorphism in 17 genes were tested (APOL1, IL1B, IL4, IL4R, IL6, IL8, IL12B, IL12RB1, IL10, TNFA, INFG, MIF, HLA-G, HLA-A, HP, HPR and CFH). Methodology: A case-control study was performed on 180 blood samples collected from 56 cases and 124 controls from Cameroon. DNA was extracted from blood samples. After quality control, 25 samples (24 controls and 1 case) were eliminated. The genotyping undertaken on 155 individuals including 55 cases and 100 controls were investigated at 96 loci (88 SNPs and 8 indels) located on 17 genes. Associations between these loci and HAT were estimated via a case-control association test. Results: Analyses of 64 SNPs and 4 indels out of 96 identified in the selected genes reveal that the minor allele (T) of rs8062041 in haptoglobin (HP) appeared to be protective against HAT (p = 0.0002395, OR 0.359 (CI95 [0.204–0.6319])); indicating higher frequency in cases compared to controls. This minor allele with adjusted p value of 0.0163 is associated with a lower risk (protective effect) of developing sleeping sickness. Conclusion: The haptoglobin related protein HPR and HP are tightly linked and both are duplicated in some people and may lead to higher activity. This increased production could be responsible of the protection associated with rs8062041 even though this SNP is within HP. [ABSTRACT FROM AUTHOR]

Blinded by PRISMA: Are Systematic Reviewers Focusing on PRISMA and Ignoring Other Guidelines?

by Fleming, Padhraig S., Koletsi, Despina, Pandis, Nikolaos [2014-05-01]

Academic Journal

pages 7

Background: PRISMA guidelines have been developed to improve the reporting of systematic reviews (SRs). Other reporting guidelines and techniques to assess methodological quality of SRs have been developed. We aimed to assess the frequency of the use of reporting and other guidelines in SRs to assess whether PRISMA is being used inappropriately as a substitute for other relevant guidelines. Methods: Web of Knowledge was searched to identify articles citing the PRISMA guidelines over a 12-month period. The use of reporting guidelines (including PRISMA and MOOSE) and tools for assessing methodological quality (including QUADAS) was assessed. Factors associated with appropriate use of guidelines including review type, field of publication and involvement of a methodologist were investigated. Results: Over the 12-month period, 701 SRs were identified. MOOSE guidelines were cited in just 17% of epidemiologic reviews; QUADAS or QUADAS-2 was referred to in just 40% of diagnostic SRs. In the multivariable analysis, medical field of publication and methodologist involvement (OR = 1.97, 95% CI: 1.37, 2.83) were significant predictors of appropriate use of guidelines. Inclusion of a meta-analysis resulted in 73% higher odds of appropriate usage of systematic review guidelines (OR = 1.73, 95% CI: 1.22, 2.35). Conclusions: Usage of SR reporting guidelines and tools for assessment of methodological quality other than PRISMA may be under-utilized with negative implications both for the reporting and methodological quality of systematic reviews. [ABSTRACT FROM AUTHOR]

Comparing Probability and Non-Probability Sampling Methods in Ecstasy Research: Implications for the Internet as a Research Tool.

by Miller, Peter G., Johnston, Jennifer, Dunn, Matthew, Fry, Craig L., Degenhardt, Louisa [2010-02-01]

Academic Journal

pages 14

The usage of Ecstasy and related drug (ERD) has increasingly been the focus of epidemiological and other public health-related research. One of the more promising methods is the use of the Internet as a recruitment and survey tool. However, there remain methodological concerns and questions about representativeness. Three samples of ERD users in Melbourne, Australia surveyed in 2004 are compared in terms of a number of key demographic and drug use variables. The Internet, face-to-face, and probability sampling methods appear to access similar but not identical groups of ERD users. Implications and limitations of the study are noted and future research is recommended. [ABSTRACT FROM AUTHOR]

Quality Assessment of Studies Published in Open Access and Subscription Journals: Results of a Systematic Evaluation.

by Pastorino, Roberta, Milovanovic, Sonja, Stojanovic, Jovana, Efremov, Ljupcho, Amore, Rosarita, Boccia, Stefania [2016-05-11]

Academic Journal

pages 11

Introduction: Along with the proliferation of Open Access (OA) publishing, the interest for comparing the scientific quality of studies published in OA journals versus subscription journals has also increased. With our study we aimed to compare the methodological quality and the quality of reporting of primary epidemiological studies and systematic reviews and meta-analyses published in OA and non-OA journals. Methods: In order to identify the studies to appraise, we listed all OA and non-OA journals which published in 2013 at least one primary epidemiologic study (case-control or cohort study design), and at least one systematic review or meta-analysis in the field of oncology. For the appraisal, we picked up the first studies published in 2013 with case-control or cohort study design from OA journals (Group A; n = 12), and in the same time period from non-OA journals (Group B; n = 26); the first systematic reviews and meta-analyses published in 2013 from OA journals (Group C; n = 15), and in the same time period from non-OA journals (Group D; n = 32). We evaluated the methodological quality of studies by assessing the compliance of case-control and cohort studies to Newcastle and Ottawa Scale (NOS) scale, and the compliance of systematic reviews and meta-analyses to Assessment of Multiple Systematic Reviews (AMSTAR) scale. The quality of reporting was assessed considering the adherence of case-control and cohort studies to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist, and the adherence of systematic reviews and meta-analyses to Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. Results: Among case-control and cohort studies published in OA and non-OA journals, we did not observe significant differences in the median value of NOS score (Group A: 7 (IQR 7–8) versus Group B: 8 (7–9); p = 0.5) and in the adherence to STROBE checklist (Group A, 75% versus Group B, 80%; p = 0.1). The results did not change after adjustment for impact factor. The compliance with AMSTAR and adherence to PRISMA checklist were comparable between systematic reviews and meta-analyses published in OA and non-OA journals (Group C, 46.0% versus Group D, 55.0%; p = 0.06), (Group C, 72.0% versus Group D, 76.0%; p = 0.1), respectively). Conclusion: The epidemiological studies published in OA journals in the field of oncology approach the same methodological quality and quality of reporting as studies published in non-OA journals. [ABSTRACT FROM AUTHOR]

Web monitoring of emerging animal infectious diseases integrated in the French Animal Health Epidemic Intelligence System.

by Arsevska, Elena, Valentin, Sarah, Rabatel, Julien, de Goër de Hervé, Jocelyn, Falala, Sylvain, Lancelot, Renaud, Roche, Mathieu [2018-08-03]

Academic Journal

pages 25

Since 2013, the French Animal Health Epidemic Intelligence System (in French: Veille Sanitaire Internationale, VSI) has been monitoring signals of the emergence of new and exotic animal infectious diseases worldwide. Once detected, the VSI team verifies the signals and issues early warning reports to French animal health authorities when potential threats to France are detected. To improve detection of signals from online news sources, we designed the Platform for Automated extraction of Disease Information from the web (PADI-web). PADI-web automatically collects, processes and extracts English-language epidemiological information from Google News. The core component of PADI-web is a combined information extraction (IE) method founded on rule-based systems and data mining techniques. The IE approach allows extraction of key information on diseases, locations, dates, hosts and the number of cases mentioned in the news. We evaluated the combined method for IE on a dataset of 352 disease-related news reports mentioning the diseases involved, locations, dates, hosts and the number of cases. The combined method for IE accurately identified (F-score) 95% of the diseases and hosts, respectively, 85% of the number of cases, 83% of dates and 80% of locations from the disease-related news. We assessed the sensitivity of PADI-web to detect primary outbreaks of four emerging animal infectious diseases notifiable to the World Organisation for Animal Health (OIE). From January to June 2016, PADI-web detected signals for 64% of all primary outbreaks of African swine fever, 53% of avian influenza, 25% of bluetongue and 19% of foot-and-mouth disease. PADI-web timely detected primary outbreaks of avian influenza and foot-and-mouth disease in Asia, i.e. they were detected 8 and 3 days before immediate notification to OIE, respectively. [ABSTRACT FROM AUTHOR]

Safety of Daily Co-Trimoxazole in Pregnancy in an Area of Changing Malaria Epidemiology: A Phase 3b Randomized Controlled Clinical Trial.

by Manyando, Christine, Njunju, Eric M., Mwakazanga, David, Chongwe, Gershom, Mkandawire, Rhoda, Champo, Davies, Mulenga, Modest, De Crop, Maaike, Claeys, Yves, Ravinetto, Raffaella M., van Overmeir, Chantal, Alessandro, Umberto D’, Van geertruyden, Jean-Pierre [2014-05-01]

Academic Journal

pages 10

Introduction: Antibiotic therapy during pregnancy may be beneficial and impacts positively on the reduction of adverse pregnancy outcomes. No studies have been done so far on the effects of daily Co-trimoxazole (CTX) prophylaxis on birth outcomes. A phase 3b randomized trial was conducted to establish that daily CTX in pregnancy is not inferior to SP intermittent preventive treatment (IPT) in reducing placental malaria; preventing peripheral parasitaemia; preventing perinatal mortality and also improving birth weight. To establish its safety on the offspring by measuring the gestational age and birth weight at delivery, and compare the safety and efficacy profile of CTX to that of SP. Methods: Pregnant women (HIV infected and uninfected) attending antenatal clinic were randomized to receive either daily CTX or sulfadoxine-pyrimethamine as per routine IPT. Safety was assessed using standard and pregnancy specific measurements. Women were followed up monthly until delivery and then with their offspring up to six weeks after delivery. Results: Data from 346 pregnant women (CTX = 190; SP = 156) and 311 newborns (CTX = 166 and SP = 145) showed that preterm deliveries (CTX 3.6%; SP 3.0%); still births (CTX 3.0%; SP 2.1%), neonatal deaths (CTX 0%; SP 1.4%), and spontaneous abortions (CTX 0.6%; SP 0%) were similar between study arms. The low birth weight rates were 9% for CTX and 13% for SP. There were no birth defects reported. Both drug exposure groups had full term deliveries with similar birth weights (mean of 3.1 Kg). The incidence and severity of AEs in the two groups were comparable. Conclusion: Exposure to daily CTX in pregnancy may not be associated with particular safety risks in terms of birth outcomes such as preterm deliveries, still births, neonatal deaths and spontaneous abortions compared to SP. However, more data are required on CTX use in pregnant women both among HIV infected and un-infected individuals. Trial Registration: Clinicaltrials.gov NCT00711906. [ABSTRACT FROM AUTHOR]

Academic Journal

pages 16

This study utilized data from the Toronto Teen Survey to examine the sexual health topics that respondents had received information about and the topics they did or did not want to learn more about. Given the diverse sample of youth participating in the study, we placed particular emphasis in the current analysis on associations between religious affiliation and having received information on eight different sexual health topics, and the desire to learn more about the same topics. Overall, there were few associations of religious affiliation with either topics youth had received information about or with topics they wanted to learn more. Protestant youth were more likely than those with no religious affiliation to have received information about sexually transmitted infections. Muslim youth were less likely to express a desire to learn more about sexual health than those identifying no religion. Gender and age differences in sexual health topics that youth had received information about and topics they wanted to learn more about were also examined. [ABSTRACT FROM AUTHOR]

Academic Journal

pages 20

Background: Peste des petits ruminants (PPR) is a highly contagious and widespread viral infection of small ruminants (goats and sheep), causing heavy economic losses in many developing countries. Therefore, its progressive control and global eradication by 2030 was defined as a priority by international organizations addressing animal health. The control phase of the global strategy is based on mass vaccination of small ruminant populations in endemic regions or countries. It is estimated that a 70% post-vaccination immunity rate (PVIR) is needed in a given epidemiological unit to prevent PPR virus spread. However, implementing mass vaccination is difficult and costly in smallholder farming systems with scattered livestock and limited facilities. Regarding this, controlling PPR is a special challenge in sub-Saharan Africa. In this study, we focused on this region to assess the effect of several variables of PVIR in two contrasted smallholder farming systems. Methods: Using a seasonal matrix population model of PVIR, we estimated its decay in goats reared in sub-humid areas, and sheep reared in semi-arid areas, over a 4-year vaccination program. Assuming immunologically naive and PPR-free epidemiological unit, we assessed the ability of different vaccination scenarios to reach the 70% PVIR throughout the program. The tested scenarios differed in i) their overall schedule, ii) their delivery month and iii) their vaccination coverage. Results: In sheep reared in semi-arid areas, the vaccination month did affect the PVIR decay though it did not in goats in humid regions. In both cases, our study highlighted i) the importance of targeting the whole eligible population at least during the two first years of the vaccination program and ii) the importance of reaching a vaccination coverage as high as 80% of this population. This study confirmed the relevance of the vaccination schedules recommended by international organizations. [ABSTRACT FROM AUTHOR]

Prevalence of chronic hepatitis B virus infection and infrastructure for its diagnosis in Madagascar: implication for the WHO's elimination strategy.

by Andriamandimby, Soa Fy, Olive, Marie-Marie, Yusuke Shimakawa, Rakotomanana, Fanjasoa, Razanajatovo, Iony Manitra, Andrianinarivomanana, Tsarasoa Malala, Ravalohery, Jean-Pierre, Andriamamonjy, Seta, Rogier, Christophe, Héraud, Jean-Michel, Shimakawa, Yusuke [2017-08-04]

Academic Journal

pages 9

Background: WHO developed a global strategy to eliminate hepatitis B by 2030 and set target to treat 80% of people with chronic hepatitis B virus (HBV) infection eligible for antiviral treatment. As a first step to achieve this goal, it is essential to conduct a situation analysis that is fundamental to designing national hepatitis plans. We therefore estimated the prevalence of chronic HBV infection, and described the existing infrastructure for HBV diagnosis in Madagascar.Methods: We conducted a stratified multi-stage serosurvey of hepatitis B surface antigen (HBsAg) in adults aged ≥18 years using 28 sentinel surveillance sites located throughout the country. We obtained the list of facilities performing HBV testing from the Ministry of Health, and contacted the person responsible at each facility.Results: A total of 1778 adults were recruited from the 28 study areas. The overall weighted seroprevalence of HBsAg was 6.9% (95% CI: 5.6-8.6). Populations with a low socio-economic status and those living in rural areas had a significantly higher seroprevalence of HBsAg. The ratio of facilities equipped to perform HBsAg tests per 100,000 inhabitants was 1.02 in the capital city of Antananarivo and 0.21 outside the capital. There were no facilities with the capacity to perform HBV DNA testing or transient elastography to measure liver fibrosis. There are only five hepatologists in Madagascar.Conclusion: Madagascar has a high-intermediate level of endemicity for HBV infection with a severely limited capacity for its diagnosis and treatment. Higher HBsAg prevalence in rural or underprivileged populations underlines the importance of a public health approach to decentralize the management of chronic HBV carriers in Madagascar by using simple and low-cost diagnostic tools. [ABSTRACT FROM AUTHOR]


Distribution and breeding sites of Aedes aegypti and Aedes albopictus in 32 urban/peri-urban districts of Mozambique: implication for assessing the risk of arbovirus outbreaks.

by Abílio, Ana Paula, Abudasse, Gastão, Kampango, Ayubo, Candrinho, Baltazar, Sitoi, Salomão, Luciano, Jacinta, Tembisse, Dário, Sibindy, Samira, de Almeida, António Paulo Gouveia, Garcia, Gabriela Azambuja, David, Mariana Rocha, Maciel-de-Freitas, Rafael, Gudo, Eduardo Samo [2018-09-12]

Academic Journal

pages 15

Background: Aedes-borne arboviruses have emerged as an important public health problem worldwide and, in Mozambique, the number of cases and its geographical spread have been growing. However, information on the occurrence, distribution and ecology of Aedes aegypti and Ae. albopictus mosquitoes remain poorly known in the country. Methods: Between March and April 2016, a cross-sectional study was conducted in 32 districts in Mozambique to determine the distribution and breeding sites of Ae. aegypti and Ae. albopictus. Larvae and pupae were collected from a total of 2,807 water-holding containers using pipette, dipper, funnel and sweeping procedures, depending on the container type and location. Both outdoor and indoor water-holding containers were inspected. The immature forms were reared to adults and the identifications of the mosquito species was carried out with a stereomicroscope using a taxonomic key. Results: Aedes aegypti was found in every district sampled, while Ae. albopictus was only found in Moatize district, situated in Tete Province in the central part of the country. Six hundred and twenty-eight of 2,807 (22.4%) containers were positive for Ae. aegypti but only one (0.03%) was positive for Ae. albopictus. The Container Index (CI) of Aedes was highest in densely populated suburban areas of the central region (260/604; 43.0%), followed by suburban areas in northern areas (228/617; 36.9%) whilst the lowest proportion was found in urbanized southern areas (140/1586; 8.8%). The highest CI of Aedes was found in used tires (448/1268; 35.3%), cement tanks (20/62; 32.3%) and drums (21/95; 22.1%). Conclusion: Data from our study showed that Ae. aegypti is present nation-wide, since it occurred in every sampled district, whilst Ae. albopictus had a limited distribution. Therefore, the risk of transmission of dengue and chikungunya is likely to have been underestimated in Mozambique. This study highlights the need for the establishment of a national entomological surveillance program for Aedes spp. in Mozambique in order to gain a better understanding about vector bionomics and to support the development of informed effective vector control strategies. [ABSTRACT FROM AUTHOR]

Management of US men, women, and children with hemophilia and methods and demographics of the Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B- HERO-S) study.

by Buckner, Tyler W., Witkop, Michelle, Guelcher, Christine, Frey, Mary Jane, Hunter, Susan, Peltier, Skye, Recht, Michael, Walsh, Christopher, Kessler, Craig M., Owens, Wendy, Clark, David B., Frick, Neil, Rice, Michelle, Iyer, Neeraj N., Holot, Natalia, Cooper, David L., Sidonio, Robert [2017-04-02]

Academic Journal

pages 13

The Bridging Hemophilia B Experiences, Results and Opportunities Into Solutions (B- HERO-S) initiative was launched in an effort to address specific gaps in the understanding of the psychosocial impact of mild-moderate-severe hemophilia B. The original Hemophilia Experiences, Results and Opportunities ( HERO) qualitative study evaluated the needs of people with hemophilia A or B in multiple countries; however, a majority of participants had the more common moderate-severe hemophilia A. The B-HERO-S study was designed in collaboration with the hemophilia community to evaluate the needs of adults with hemophilia B and caregivers of children with hemophilia B, including affected women and caregivers of girls with hemophilia. The report presented here describes participant demographics and comorbidities, as well as treatment regimens and access to treatment. Bleeding symptoms were reported by 27% of mothers of children with hemophilia B who participated. Women were more likely than men to self-report arthritis and depression/anxiety as comorbidities associated with hemophilia B. More adults and children with hemophilia B were on routine treatment than on on-demand treatment, and a high percentage of adults with moderate hemophilia B received routine treatment (86%). Many adults with hemophilia B (78%) and caregivers (69%) expressed concern about access to factor in the next 5 years, and of adults with hemophilia B, women more commonly experienced issues with access to factor in the past than did men (72% vs 44%). The findings of the B-HERO-S study reveal potential unmet needs of some patients with mild-moderate hemophilia B, and the results may be leveraged to inform patient outreach by hemophilia treatment centers and education initiatives. [ABSTRACT FROM AUTHOR]

Seropositivity for Influenza A(H1N1) pdm09 Virus among Frontline Health Care Personnel.

by Alagappan, Kumar, Silverman, Robert A., Hancock, Kathy, Ward, Mary Frances, Akerman, Meredith, Dawood, Fatimah S., Branch, Alicia, De Cicco, Sandra, Steward-Clark, Evelene, McCullough, Megan, Tenner, Karen, Katz, Jacqueline M. [2013-01-01]

Academic Journal

pages 4

Seroprevalence of antibodies to influenza A(H1N1) pdm09 virus among 193 emergency department health care personnel was similar among 147 non-health care personnel (odds ratio 1.4, 95% Cl 0.8-2.4). Working in an acute care setting did not substantially increase risk for virus infection above risk conferred by community-based exposures. [ABSTRACT FROM AUTHOR]

Surveillance for Violent Deaths -- National Violent Death Reporting System, 18 States, 2014.

by Fowler, Katherine A., Jack, Shane P. D., Lyons, Bridget H., Betz, Carter J., Petrosky, Emiko [2018-02-02]


pages 31

Problem/Condition: In 2014, approximately 59,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 18 U.S. states for 2014. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. Reporting Period Covered: 2014. Description of System: NVDRS collects data from participating states regarding violent deaths. Data are obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 18 states that collected statewide data for 2014 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident. Results: For 2014, a total of 22,098 fatal incidents involving 22,618 deaths were captured by NVDRS in the 18 states included in this report. The majority of deaths were suicides (65.6%), followed by homicides (22.5%), deaths of undetermined intent (10.0%), deaths involving legal intervention (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (

Dengue infection in India: A systematic review and meta-analysis.

by Ganeshkumar, Parasuraman, Murhekar, Manoj V., Poornima, Veeraraghavadoss, Saravanakumar, Velusamy, Sukumaran, Krishnendu, Anandaselvasankar, Anandan, John, Denny, Mehendale, Sanjay M. [2018-07-16]

Academic Journal

pages 29

Introduction: Dengue is the most extensively spread mosquito-borne disease; endemic in more than 100 countries. Information about dengue disease burden, its prevalence, incidence and geographic distribution is critical in planning appropriate control measures against dengue fever. We conducted a systematic review and meta-analysis of dengue fever in India Methods: We searched for studies published until 2017 reporting the incidence, the prevalence or case fatality of dengue in India. Our primary outcomes were (a) prevalence of laboratory confirmed dengue infection among clinically suspected patients, (b) seroprevalence in the general population and (c) case fatality ratio among laboratory confirmed dengue patients. We used binomial–normal mixed effects regression model to estimate the pooled proportion of dengue infections. Forest plots were used to display pooled estimates. The metafor package of R software was used to conduct meta-analysis. Results: Of the 2285 identified articles on dengue, we included 233 in the analysis wherein 180 reported prevalence of laboratory confirmed dengue infection, seven reported seroprevalence as evidenced by IgG or neutralizing antibodies against dengue and 77 reported case fatality. The overall estimate of the prevalence of laboratory confirmed dengue infection among clinically suspected patients was 38.3% (95% CI: 34.8%–41.8%). The pooled estimate of dengue seroprevalence in the general population and CFR among laboratory confirmed patients was 56.9% (95% CI: 37.5–74.4) and 2.6% (95% CI: 2–3.4) respectively. There was significant heterogeneity in reported outcomes (p-values

Who’s the Boss? Explaining Gender Inequality in Entrepreneurial Teams.

by Yang, Tiantian, Aldrich, Howard E. [2014-04-01]

Academic Journal

pages 25

Sociologists have examined gender inequalities across a wide array of social contexts. Yet, questions remain regarding how inequalities arise among autonomous groups pursuing economic goals. In this article, we investigate mixed-sex entrepreneurial teams to unpack the mechanisms by which gender inequality in leadership emerges, despite strong pressures toward merit-based organizing principles. We theorize the potentially competing relationships between merit and gender and explore the contingencies moderating their effects. Drawing on a unique, nationally representative dataset of entrepreneurial teams sampled from the U.S. population in 2005, we use conditional logistic regression to test our hypotheses. We demonstrate that merit’s effect becomes much larger when multiple merit-based criteria provide consistent predictions for which team member is superior to others, and when entrepreneurial founders adopt bureaucratic templates to construct new ventures. However, gender stereotypes of leaders pervasively constrain women’s access to power positions, and gender’s effect intensifies when spousal relationships are involved. Women have reduced chances to be in charge if they co-found new businesses with their husbands, and some family conditions further modify women’s chances, such as husbands’ employment and the presence of children. [ABSTRACT FROM PUBLISHER]

An Exhaustive, Non-Euclidean, Non-Parametric Data Mining Tool for Unraveling the Complexity of Biological Systems - Novel Insights into Malaria.

by Loucoubar, Cheikh, Paul, Richard, Bar-Hen, Avner, Huret, Augustin, Tall, Adama, Sokhna, Cheikh, Trape, Jean-François, Badara Ly, Alioune, Faye, Joseph, Badiane, Abdoulaye, Diakhaby, Gaoussou, Diène Sarr, Fatoumata, Diop, Aliou, Sakuntabhai, Anavaj, Bureau, Jean-François [2011-09-01]

Academic Journal

pages 16

Complex, high-dimensional data sets pose significant analytical challenges in the post-genomic era. Such data sets are not exclusive to genetic analyses and are also pertinent to epidemiology. There has been considerable effort to develop hypothesis-free data mining and machine learning methodologies. However, current methodologies lack exhaustivity and general applicability. Here we use a novel non-parametric, non-euclidean data mining tool, HyperCube®, to explore exhaustively a complex epidemiological malaria data set by searching for over density of events in m-dimensional space. Hotspots of over density correspond to strings of variables, rules, that determine, in this case, the occurrence of Plasmodium falciparum clinical malaria episodes. The data set contained 46,837 outcome events from 1,653 individuals and 34 explanatory variables. The best predictive rule contained 1,689 events from 148 individuals and was defined as: individuals present during 1992-2003, aged 1-5 years old, having hemoglobin AA, and having had previous Plasmodium malariae malaria parasite infection ≤10 times. These individuals had 3.71 times more P. falciparum clinical malaria episodes than the general population. We validated the rule in two different cohorts. We compared and contrasted the HyperCube® rule with the rules using variables identified by both traditional statistical methods and non-parametric regression tree methods. In addition, we tried all possible sub-stratified quantitative variables. No other model with equal or greater representativity gave a higher Relative Risk. Although three of the four variables in the rule were intuitive, the effect of number of P. malariae episodes was not. HyperCube® efficiently sub-stratified quantitative variables to optimize the rule and was able to identify interactions among the variables, tasks not easy to perform using standard data mining methods. Search of local over density in m-dimensional space, explained by easily interpretable rules, is thus seemingly ideal for generating hypotheses for large datasets to unravel the complexity inherent in biological systems. [ABSTRACT FROM AUTHOR]

Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis.

by Adams, Marc A., Ding Ding, Sallis, James F., Bowles, Heather R., Ainsworth, Barbara E., Bergman, Patrick, Bull, Fiona C., Carr, Harriette, Craig, Cora L, De Bourdeaudhuij, Ilse, Fernando Gomez, Luis, Hagströmer, Maria, Klasson-Heggebø, Lena, Inoue, Shigeru, Lefevre, Johan, Macfarlane, Duncan J., Matsudo, Sandra, Matsudo, Victor, McLean, Grant, Murase, Norio [2013-01-01]

Academic Journal

pages 11

Background: Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA. Methods: A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5 ±12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country. Results: A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e.g., U.S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR= 2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR= 1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA. Conclusions: Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA. [ABSTRACT FROM AUTHOR]