Control Program Research Articles

Etiology, risk factors and outcomes of bacteremia in patients with hematologic malignancies and febrile neutropenia in Uganda

Abstract Background We determined the etiology, risk factors and outcomes associated with bacteremia in patients with hematologic malignancies and febrile neutropenia (FN) at the Uganda Cancer Institute (UCI). Methods UCI adult and pediatric inpatients with hematologic malignancies and FN were prospectively enrolled and followed up to determine 30-day mortality. Blood drawn from participants with FN was cultured in the BACTEC 9120 blood culture system. Antimicrobial susceptibility testing was performed with the disk diffusion method on identified bacteria. Logistic regression and Cox proportional hazards regression were applied to estimate associations between participant characteristics and FN, bacteremia, and mortality. Results Of 495 participants, majority (N=306, 62%) were male. Median age was 23 years (IQR:11-42 years). Of the 132 participants who experienced FN, 43 (33%) had bacteremia. Participants with younger age (OR:0.98, p=0.05), severe neutropenia (OR: 2.9, p=0.01), hypotension (OR: 2.46, p=0.04), mucositis (OR: 2.77, p=0.01) and receiving chemotherapy (OR:2.25, p=0.03) were more likely to have bacteremia. Fifty (78%) bacteria isolated were Gram negative. E. coli (n=25, 50%) was predominant. Thirty-seven (86%) out of 43 episodes were caused by multidrug resistant (MDR) bacteria. 30-day overall survival for participants with bacteremia was significantly lower than that for participants with no bacteremia (p=0.05). MDR bacteremia (HR=1.84, p=0.05) was associated with increased risk of death. Conclusion Bacteremia was frequent in patients with hematologic cancer and FN and was associated with poor survival. MDR bacteria were the main cause of bacteremia and mortality. There is a need for robust infection control and antimicrobial stewardship programs in cancer centers in sub-Saharan Africa.

Effects of establishing infection control program with core components of World Health Organization on reducing the risk of residents' infections and improving staff infection control competency in a nursing home.

Nursing homes (NHs) are high-risk facilities with limited infection control resources and residents susceptible to infectious diseases. The evidence regarding World Health Organization (WHO) core components in NHs is lacking. This study evaluates the effectiveness of establishing an infection prevention and control (IPC) program with WHO's core components in an NH. The IPC program, encompassing evidence-based guidelines, education and training, surveillance, multimodal strategies, monitoring and feedback, workload and staffing considerations, and the built environment, was implemented in a 130-bed NH for one year. The effects were assessed based on the number of infections among residents, the level of knowledge, and the performance of infection control among staff. The risk of infection was analyzed across three phases: pre-implementation phase, implementation phase (6 and 12 months after intervention initiation), and sustainability phase (3, 6, and 12 months after intervention was finished). Staff data were analyzed before and after the intervention. Analysis of 18,124 resident-days revealed that during the sustainability phase, the risk of respiratory tract infection was significantly lower than before intervention implementation (odds ratio [OR] 0.51, 95% CI 0.30-0.86, p = 0.012). Moreover, a significant improvement was observed in staff knowledge (p = 0.002) and performance (p < 0.001) after the intervention compared to before. WHO's core components may have a potential effect on reducing healthcare-associated infections among residents and enhancing the infection control competency of staff in the NH with limited IPC resources.

Climatic and ecological factors responsible for distribution of Phlebotomine Sand flies and occurrence of Cutaneous Leishmaniasis, in Himachal Pradesh India

Background &amp; objectives: Subalpine valley along the Sutlej River has been identified as an endemic focus for Cutaneous Leishmaniasis (CL) in Himachal Pradesh (H.P.). The present study was undertaken with aim to find out the climatic and ecological determinants responsible for distribution of sand flies and occurrence of Cutaneous Leishmaniasis in Himachal Pradesh. Methods: Collections of sand flies were made in the Shimla, Kullu, and Nichar districts of H.P. during 2017 and 2019. The climatic data were procured from Indian Meteorological centre, Shimla (H.P). The satellite images (Indian remote sensing satellite (IRS)-Linear imaging self-scanner (LISS)-IV sensor multispectral data) having resolution of 5.8m were procured from National Remote Sensing Centre Hyderabad, India. The relationship between the incidence of CL and Land use was analysed. Results: A total of 332 sand flies were collected. The transmission of CL was favoured by temperatures exceeding 20°C over a period of six months, specifically from April to September. The valley with an elevation ranging between 1000 to 1250 meters reported 90% of the CL cases. The correlation between CL incidence and land use patterns revealed a notable rise in barren land (8%) and scrub land (5%) from 2013 to 2017. Interpretation &amp; conclusion: The findings reveals that specific meteorological conditions and land cover play significant role in determining the presence of sand flies in Himachal Pradesh. To effectively control CL, it is recommended to implement control programs primarily between June and September, focusing particularly on regions with elevations ranging from 1000 to 1250 meters.

Impact of integrating traditional care with the modern healthcare system in reducing tuberculosis diagnosis delays in Ethiopia: a clustered randomized controlled study.

Diagnosis and treatment initiation delays for tuberculosis (TB) are significant challenges in resource-limited settings. These delays can result in poor treatment outcomes, disease transmission, and increased costs. This study aimed to assess the effect of integrating traditional care with modern healthcare systems on reducing TB diagnosis delay. A cluster randomized controlled trial was conducted among TB patients, with 510 participants, 255 individuals were assigned to the intervention group and 255 to the control group. Training in the intervention group was provided for both traditional and modern healthcare providers in three rounds to enhance their knowledge, attitudes, and skills in TB screening and referral. A non-parametric independent sample test was used to compare the baseline and end-line data. The effect size was determined using Cohen's d. To account for individual and cluster-level variations, a mixed-effect parametric survival model was employed. Furthermore, conditional (fixed only) and marginal (random effects) graphs were used to compare between the intervention and control groups. A total of 510 participants were included in the baseline study, with a similar number of participants included in the endline study. In the intervention group, the delay in diagnosis was 4.185 per 1000 person-days post-intervention, compared to 4.608 per 1000 person-days pre-intervention. In the control group, the delay for diagnosis was 4.759 per 1000 person-days pre-intervention and 5.031 per 1000 person-days post-intervention. The median time to diagnosis was 135days. The non-parametric comparison showed that the intervention significantly reduced patient delays in the intervention group compared to the control group (p = 0.006), with a Cohen's d effect size of 0.246. The intervention also significantly reduced diagnosis delay in the intervention group compared to the control group (p = 0.036), with a Cohen's d effect size of 0.187. The diagnosis of TB was accelerated by 1.076 times due to the integration of traditional care with the modern healthcare system in the intervention group compared to the control group (δ: 1.076; 95% CI 1.021, 1.134). The involvement of traditional care providers in TB control programs significantly reduced diagnosis delays in Ethiopia. These findings suggest the need for integrating traditional care with modern healthcare systems for the effective prevention of TB in high-burden countries. Clinical trial registration ClinicalTrials.gov ID: NCT05236452.

In-hospital outcomes of healthcare-associated COVID-19 (Omicron) versus healthcare-associated influenza: a retrospective, nationwide cohort study in Switzerland.

As COVID-19 is integrated into existing infectious disease control programs, it is important to understand the comparative clinical impact of COVID-19 and other respiratory diseases. We conducted a retrospective cohort study of patients with symptomatic healthcare-associated COVID-19 or influenza reported to the nationwide, hospital-based surveillance system in Switzerland. Included patients were adults (≥18 years) hospitalized for ≥3 days in tertiary care and large regional hospitals. Patients had COVID-19 symptoms and a RT-PCR-confirmed SARS-CoV-2 infection ≥3 days after hospital admission between 1 February 2022 and 30 April 2023, or influenza symptoms and a RT-PCR-confirmed influenza A or B infection ≥3 days after hospital admission between 1 November 2018 and 30 April 2023. Primary and secondary outcomes were 30-day in-hospital mortality and admission to intensive care unit (ICU), respectively. Cox regression (Fine-Gray model) was used to account for time-dependency and competing events, with inverse probability weighting to adjust for confounding. We included 2901 patients with symptomatic healthcare-associated COVID-19 (Omicron) and 868 patients with symptomatic healthcare-associated influenza from nine hospitals. We found a similar case fatality ratio between healthcare-associated COVID-19 (Omicron) (6.2%) and healthcare-associated influenza (6.1%) patients; after adjustment, patients had a comparable subdistribution hazard ratio for 30-day in-hospital mortality (0.91, 95%CI 0.67-1.24). A similar proportion of patients were admitted to ICU (2.4% COVID-19; 2.6% influenza). COVID-19 and influenza continue to cause severe disease among hospitalized patients. Our results suggest that in-hospital mortality risk of healthcare-associated COVID-19 (Omicron) and healthcare-associated influenza are comparable.

Quantifying the impact of vaccination on transmission and diversity of influenza A variants in pigs.

Global evolutionary dynamics of influenza A virus (IAV) are fundamentally driven by the extent of virus diversity generated, transmitted, and shaped in individual hosts. How vaccination affects the degree of IAV genetic diversity that can be transmitted and expanded in pigs is unknown. To evaluate the effect of vaccination on the transmission of genetically distinct IAV variants and their diversity after transmission in pigs, we examined the whole genome of IAV recovered from the nasal cavities of pigs vaccinated with different influenza immunization regimens after being infected simultaneously by H1N1 and H3N2 IAVs using a seeder pig model. We found that the seeder pigs harbored more diversified virus populations than the contact pigs. Among contact pigs, H3N2 and H1N1 viruses recovered from pigs vaccinated with a single dose of an unmatched modified live vaccine generally accumulated more extensive genetic mutations than non-vaccinated pigs. Furthermore, the non-sterilizing immunity elicited by the single-dose-modified live vaccine may have exerted positive selection on H1 antigenic regions as we detected significantly higher nonsynonymous but lower synonymous evolutionary rates in H1 antigenic regions than non-antigenic regions. In addition, we observed that the vaccinated pigs shared significantly less proportion of H3N2 variants with seeder pigs than unvaccinated pigs. These results indicated that vaccination might reduce the impact of transmitted influenza variants on the overall diversity of IAV populations harbored in recipient pigs and that within-host genetic selection of IAV is more likely to occur in pigs vaccinated with improperly matched vaccines.IMPORTANCEUnderstanding how vaccination shapes the diversity of influenza variants that transmit and propagate among pigs is essential for designing effective IAV surveillance and control programs. Current knowledge about the transmission of IAV variants has primarily been explored in humans during natural infection. However, how immunity elicited by improperly matched vaccines affects the degree of IAV genetic diversity that can be transmitted and expanded in pigs at the whole-genome level is unknown. We analyzed IAV sequences from samples collected daily from experimentally infected pigs vaccinated with various protocols in a field-represented IAV co-infection model. We found that vaccine-induced non-sterilizing immunity might promote genetic variation on the IAV genome and drive positive selection at antigenic sites during infection. In addition, a smaller proportion of H3N2 viral variants were shared between seeder pigs and vaccinated pigs, suggesting the influence of vaccination on shaping the virus genomic diversity in recipient pigs during the transmission events.

Effects of COVID-19, control measures, and program adaptation on prevention of mother-to-child HIV transmission service uptake in Central Region, Uganda.

Coronavirus disease 2019 (COVID-19) control measures presented impediments for prevention of mother-to-child transmission of HIV (PMTCT) programming in Uganda. Nationwide control measures implemented April-June 2020 included a public transport ban and mandatory travel permits for pregnant women to access clinics. Program adaptations instituted for continuity of services included community drug delivery and home-based DNA-PCR testing for HIV-exposed infants (HEI). We examined the effect of COVID-19 control measures and program adaptations on PMTCT service uptake in central Uganda. We analysed data for pregnant women living with HIV (WLHIV) and HEI receiving PMTCT services in eight districts in central Uganda. We abstracted data from medical records at 96 public clinics for six months pre-lockdown (October 2019-March 2020), three months of lockdown (April-June 2020), and six months post-lockdown (July-December 2020). We measured monthly antiretroviral therapy (ART) refill attendance, health facility deliveries, and timely DNA-PCR testing of HEI for HIV (within two months of birth). We conducted segmented ordinary least squares regression of interrupted time series and adjusted for month-to-month changes using Cumby-Huizinga test. We reported results using coefficients and 95% confidence intervals (CIs). At the start of pre-lockdown (October 2019), there were 448 deliveries, 2,676 ART refills and 556 timely HEI tests. The pre-lockdown trend for ART refills increased while deliveries and HEI tests declined. At the start of lockdown (April 2020), all indicators declined, although significantly for facility deliveries (-60; 95% CI: -102, -18). Lockdown monthly trends were positive with 68 more HEI tested per month (95% CI:42, 93) and 51 more deliveries (95% CI: 9, 94) but insignificantly negative for ART refills. At start of post-lockdown (July 2020), HEI testing declined (-28; 95%CI: -48, -8). Post-lockdown HEI testing trend was negative with 70 fewer HEI tested per month (95%CI: -79, -62) while no difference in trend for deliveries and ART refills. COVID-19 control measures had a significant immediate negative impact on pregnancy deliveries at health facilities. During lockdown, all service rates rapidly recovered through program adaptations, significantly for HEI testing and deliveries. Maintaining these adaptations might help restore the positive trend in timely HIV testing for HEI.

Inter-Laboratory Comparison of qPCR Assays for Piscirickettsia salmonis in Atlantic Salmon (Salmo salar L.) in 11 Chilean Laboratories.

Real-time PCR (qPCR) testing is an essential component of early detection surveillance systems for Piscirickettsia salmonis infection in Atlantic salmon farms in Chile. Currently, all 11 laboratories in the authorised diagnostic laboratory network use assays based on published protocols. Compared with other P. salmonis qPCR assays, these assays have the advantage of targeting two different genes, that is, the 16S ribosomal gene and the internal transcribed spacer (ITS), potentially allowing for higher diagnostic accuracy. However, variation and lack of harmonisation of qPCR testing systems (e.g., primers/probe, RNA/DNA as target, extraction methods, etc.) may contribute to among-laboratory variation in qPCR results and an increased frequency of false-negative and false-positive results. The purpose of the ring trial reported herein was to compare qPCR results from 11 laboratories in Chile routinely testing Atlantic salmon for P. salmonis as part of a national control program. The panel of 14 samples included duplicates of three concentrations of P. salmonis in a homogenised head kidney, LF89 and EM90 bacteria and two negative controls (blank and a suspension of Flavobacterium psychrophilum). The sample order was randomised across labs, samples were tested blinded and analysed without knowledge of the source lab. Of the laboratories, 8 (72.7%) had at least one incorrect result out of 14 tested samples. Low-concentration samples (Ct of about 30) were more often incorrectly classified by reverse transcription-qPCR (RT-qPCR) (3/6 labs) than by qPCR (0/5). Six (54.5%) labs had at least one false-positive result indicating that cross-contamination was likely during sample processing. Affected laboratories are advised to conduct internal investigations to confirm the causes of false-positive results and recommendations for design and implementation of future ring trials are discussed.

Analysis of the current status of the protection in children from of polio

Introduction. There is a risk of an exponential increase in the incidence of polio in the world, if there is a deviation from the current plan of measures to localize endemic areas of polio and until global eradication of the virus achieved. Routine immunization against polio and widespread vaccination is the main goal of the polio control strategy. There is currently no need to strengthen planned vaccination work in Russia to consolidate the results of the polio control program, as evidenced by the data of dynamic serological monitoring. Aim: Evaluate the level of seroconversion after administration of poliovaccine and the duration of protective antibody titer maintenance in children. Materials and methods. A single-stage, single-center determination of the titer of antibodies to poliovirus types 1 and 3 was carried out using the neutralization method. There were studied 162 samples collected as part of the assignment from the Center of Hygiene and Epidemiology of the Republic of Buryatia (1.44% of the pediatric population of the children’s polyclinic): three groups of 1–2 years, 3–4 years and 15–17 years children. The average age in the group 1 was 1.64 ± 0.48 years, group 2 — 3.48 ± 0.54 years, and group 3 — 15.38 ± 0.67 years. Medical documentation was analyzed and compared: completed preventive vaccination cards (form 063/u) and preventive vaccination sheet in the child development card (form 112/u) for a complete collection children’s vaccination history. Results. Deviations of vaccination dates from the current national calendar of preventive vaccinations noted in all age groups with a high frequency. In our analysis, 100% of children demonstrate the presence of protective antibodies to poliomyelitis types 1 and 3. The duration of preservation of neutralizing antibodies is 13.05 ± 0.94 years, with an average of 9–15 years. Conclusion. The analyzed serological monitoring of postvaccinal immunity to poliomyelitis testifies to the high efficiency of the preventive work.

Abstract 4125957: Feasibility and Acceptability of Behavioral Weight Loss Programs for Men in Trade and Labor Occupations

Objective: Men who work in trade and labor occupations experience high rates of obesity and related cardiovascular disease due to high rates of sedentary leisure time and poor diet. Despite this, they are underrepresented in weight control programs. This pilot randomized trial evaluated the feasibility and acceptability of a 6-month program tailored to this occupational group versus a non-tailored standard-of-care behavioral weight loss program. Methods: Men with overweight or obesity working in trade and labor occupations were randomly assigned to either a tailored program or the DPP Group Lifestyle Balance program delivered via 16 one-hour virtual group sessions. In-person assessments were conducted at baseline, 3, and 6 months. Semi-structured interviews and self-report were used to assess the acceptability of the interventions. Feasibility was assessed using recruitment metrics and proportion group sessions and study assessments completed. Results: Participants (N = 28; median 44.0 years, interquartile range (IQR): 38.5-54.5), median 31.8 BMI, IQR 31.1-39.6) were recruited into the study over 7 months, and 71% and 79% were retained for assessments at 3 and 6 months, respectively. Overall, participants attended a median of 7 of the 16 group sessions (IQR 2.5-11.5). The tailored group completed a median of 11 of 16 weekly online progress reports (IQR 5-15). All participants reported that they would recommend the programs to other men and felt confident that they would continue using the strategies learned in the programs. Though the trial focused on feasibility rather than efficacy, median weight losses at 6 months were -3.0% in the tailored group (95% CI -9.3, -0.6) and -1.9% in the standard group (95% CI -7.4, 2.0). Conclusions: Results suggest that both the tailored and standard weight loss interventions were well received by this group, but engagement was low. Future research should focus on understanding how to increase engagement rather than exclusively tailoring the program to this occupational group to enhance this group's involvement with cardiovascular disease prevention programs.

Associations of linear growth with body composition of perinatally HIV-infected African adolescents.

The prevalence of poor linear growth among African children with perinatally acquired HIV remains high. There is concern that poor linear growth may to lead to later total and central fat deposition and associated non-communicable disease risks. We investigated associations between height-for-age Z score (HAZ) and total and regional fat and lean mass measured by dual-energy X-ray absorptiometry, expressed as internal population Z scores, among 839 Zimbabwean and Zambian perinatally HIV-infected male and female adolescents aged 11-19 years. Stunting (HAZ < -2) was present in 37 % of males and 23 % of females. HAZ was strongly positively associated with total, trunk, arm and leg fat mass and lean mass Z scores, in analyses controlling for pubertal stage, socio-economic status and HIV viral load. Associations of linear growth with lean mass were stronger than those with fat outcomes; associations with total and regional fat were similar, indicating no preferential central fat deposition. There was no evidence that age of starting antiretroviral therapy was associated with HAZ or body composition. Non-suppressed HIV viral load was associated with lower lean but not fat mass. The results do not support the hypothesis that poor linear growth or stunting are risk factors for later total or central fat deposition. Rather, increased linear growth primarily benefits lean mass but also promotes fat mass, both consistent with larger body size. Nutritional and/or HIV infection control programmes need to address the high prevalence of stunting among perinatally HIV-infected children in order to mitigate constraints on the accretion of lean and fat mass.

Design of optimum spacecraft reorientation control with a combined criteria of quality based on the quaternions

Specifical original problem of attitude controlling for spacecraft was proposed in this paper. Problem of optimal rotation from a known initial state in a prescribed spatial orientation was studied in detail (turnaround time is not fixed). Design of optimal program of reorientation is based on new indicator of quality that combines energy costs including the contribution of controlling torques and integral of rotary energy (in a known proportion) and reorientation time; presence of duration factor bounds time of rotation finish. To construct an optimal control of angular momentum changing, quaternionic method and the maximum principle were applied. Differential equation that relates spacecraft angular momentum and quaternion of spacecraft orientation is a base to obtain analytic solution to a problem. We reveal the properties of optimum control program analytically, and study key features of optimum motion in details. Also, we write the formalized equations, mathematical formulas to design optimal law for change of spacecraft’s angular momentum. Analytic relations and equations are given for finding the optimal solution. Control law (in as explicit dependence between phase variables and con-trolling variables has been formulated. Main relations determining optimum values of parameters for rotation control algorithm were given. The closed-form law for rotation was obtained for dynamically symmetric solids. Numerical example as well as results of mathematical modeling of spacecraft motion that formed using optimum control are presented. This data as addition to the made theoretic descriptions shows reorientation process (in virtual form) and demonstrates practical feasibility of the developed control method. A designed algorithm for optimal control of rotation improves an efficiency of attitude system, and originates more economical performing of space vehicle during its flight along orbit.

Construction Method of a Digital-Twin Simulation System for SCARA Robots Based on Modular Communication

Due to the high cost of robots, the algorithm testing cost for physical robots is high, and the construction of motion control programs is complex, with low operation fault tolerance. To address this issue, this paper proposes a low-cost, cross-platform SCARA robot digital-twin simulation system based on the concept of digital twins. This method establishes a 5D architecture based on the characteristics of different platforms, classifies data and integrates functions, and designs a data-processing layer for motion trajectory calculation and data storage for a virtual-reality robot. To address the complexity of data interaction under different cross-platform communication forms, an editable, modular, cross-platform communication system is constructed, and various control commands are encapsulated into simple programming statements for easy invocation. Experimental results showed that, based on modular communication control, users can accurately control data communication and synchronous motion between virtual and physical models using simple command statements, reducing the development cost of control algorithms. Meanwhile, the virtual-robot simulation system, as a data mapping of the real experimental platform, accurately simulated the physical robot’s operating state and spatial environment. The robot algorithms tested using the virtual simulation system can be successfully applied to real robot platforms, accurately reproducing the operating results of the virtual system.

Addressing Hypertension and Diabetes through Community-Engaged Systems (ANDES) in Puno, Peru: rationale and study protocol for a hybrid type 2 effectiveness and implementation randomized controlled trial

BackgroundHypertension is the most common cardiovascular disease in Peru despite the availability of cost-effective, evidence-based treatment. Here we describe the rationale and study design for a hybrid type 2 randomized controlled trial to test the implementation and effectiveness of a community health worker (CHW)-led hypertension control program within the national primary care system in Puno, Peru.MethodsWe will recruit 1068 adult participants with hypertension aged ≥ 18 years in Puno, Peru, via facility-based enrollment and community health fairs. Participants will be individually randomized (1:1) to either continue with usual care or participate in a 12-month CHW-led home-based hypertension control program consisting of blood pressure monitoring, medication adherence support, and healthy lifestyle counseling. Outcome development and reporting are guided by the Consolidated Framework for Implementation Research (CFIR), the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, and the Proctor et al. framework. Clinical effectiveness outcomes include mean change in systolic blood pressure (primary outcome), diastolic blood pressure, and HbA1C. Implementation outcomes include fidelity (i.e., CHW protocol adherence and dose), reach, adoption, sustainability, acceptability, and cost-effectiveness.DiscussionThe ANDES trial is testing the first CHW-led multicomponent strategy for hypertension and type 2 diabetes management in Peru. This type 2 hybrid trial will provide critical insights into the individual, community, and system-level factors necessary for successful implementation and effectiveness. These data can inform the future adaptation and scaling of the ANDES strategy in Peru and other LMICs, as well as influence policies at the system level to support this transition. Furthermore, by addressing both hypertension and diabetes, the ANDES strategy supports integrated care approaches advocated by the WHO HEARTS technical package, ultimately enhancing health outcomes and reducing morbidity and mortality in the region.Trial registrationClinicalTrials.gov, ID: NCT05524987, Addressing Hypertension and Diabetes through Community-Engaged Systems in Puno, Peru (ANDES study), prospectively registered on September 1, 2021.

Prevalence and predictors of coronary heart disease among individuals with and without obesity in North Dakota.

Coronary heart disease (CHD) is the most common cardiovascular disease in the United States and heart disease is the leading cause of death in North Dakota. Although obesity is a major risk factor for CHD, some studies have reported an inverse relationship between body mass index (BMI) and CHD outcomes. Understanding the epidemiology of CHD among individuals with and without obesity is essential to guide health planning. Therefore, the objectives of this study were to estimate the prevalence and identify predictors of CHD among North Dakota adults with and without obesity. Behavioral Risk Factor Surveillance System data from 2017 to 2021 were provided by the North Dakota Department of Health and Human Services. Weighted prevalence estimates and 95% confidence intervals (CIs) were computed for CHD and potential risk factors among respondents with and without obesity (BMI ≥30 kg/m2). Multivariable logistic regression was used to identify significant predictors of CHD in both groups. A total of 17,092 respondents were included in the study. Respondents with obesity had a higher prevalence of CHD (4.7%, 95% CI: 4.2-5.4) than those without obesity (3.0%, 95% CI: 2.7-3.4). Predictors of CHD among both groups included age, sex, self-reported general health, high blood pressure, high cholesterol, chronic obstructive pulmonary disease, and diabetes. Having a personal doctor (Odds Ratio [OR] = 1.91, 95% CI: 1.13-3.23) and arthritis (OR = 1.72, 95% CI: 1.34-2.22) were significant predictors of CHD among respondents without obesity, but not among those without obesity. While the prevalence of CHD was significantly higher among adults with obesity compared to those without obesity, the findings of the stratified analysis indicated that predictors of the condition tended to be similar for the two groups. This study provides useful information to guide health planning and control programs that aim to reduce the burden of CHD in North Dakota.

Integrating an industrial hygienist into the infection prevention and control program.

Integrating an industrial hygienist into the infection prevention and control program.

Overview of CHIC symposia series: Summary of Africa and South Asia symposia

This article presents an overview of the main challenges and lessons learned that were presented during the symposia organized by the Coalition to Strengthen the HPV Immunization Community (CHIC) in Africa and South Asia in 2022. Discussions at these meetings revolved around introduction, planning, implementation, and sustainability of HPV prevention and control programmes, with a particular focus in HPV immunisation, as well as cervical cancer screening in South Asian countries. This article also discusses the recently endorsed off-label single-dose HPV vaccination schedule and its potential impact on programme delivery and access. Furthermore, it highlights the importance of intersectional collaboration, effective communication and advocacy strategies, and the need for robust health information systems. Some of the critical factors identified for reducing the burden of cervical cancer in low- and middle-income countries (LMICs) included strategies for increasing access and coverage, addressing vaccine hesitancy, and building capacity among health care providers. The symposia emphasized the importance of face-to-face interactions for collaboration and decision making, with live translation services enabling full participation by stakeholders from diverse backgrounds. The paper concludes with a call for continued collaboration to make progress in reducing the burden of cervical cancer in LMICs.

Metabolomics reveals altered biochemical phenotype of an invasive plant with potential to impair its biocontrol agent’s establishment and effectiveness

A plausible, but largely unexplored reason for many weed biocontrol agents failing to establish or being ineffective, could involve abiotically induced changes to an invasive plants’ biochemical phenotype and consequent enhanced herbivore resistance. Considerable literature demonstrates that chemically altered plant phenotypes can impair insect life history performance. Heather beetle, (Lochmaea suturalis), introduced to control invasive heather (Calluna vulgaris) in New Zealand (NZ) was difficult to establish and displays variable effectiveness. Using UHPLC-MS non-targeted metabolomics, we analysed primary and secondary metabolites of C. vulgaris from its native range (Scotland) and it’s introduced range (NZ), between which, differences in soil nutrients and ultraviolet light exist. We also explored secondary metabolite variation between sites within each range. New Zealand samples had the highest number of amplified metabolites, most notably defensive phenylpropanoids, supporting the concept of abiotically induced upregulation of key biosynthetic pathways. Analysis of secondary metabolite variation within each range revealed differences between sites but found little correlation of phenylpropanoid levels being influenced by variable soil nutrients. These results validate questions about the possibility of abiotically altered biochemical phenotypes in invasive plants, influencing weed biocontrol agent establishment and effectiveness, and show the potential for metabolomics in assisting future, or retrospectively analysing biological control programmes.

Role of Tick Commensal Bacteria in the Propagation of Emerging Infectious Diseases: Data Gaps and One Health Implications

Ticks are obligate hematophagous ectoparasites notorious for their role as vectors of pathogens that affect humans and animals, particularly relative to the propagation of emerging infectious diseases (EIDs). Two important factors facilitating the role of ticks in the propagation of EIDs are their potential for the development of resistance to acaricides and the expansion of nonindigenous tick species into new geographic regions. The acquisition of acaricide resistance enables tick populations to be less susceptible to vector control programs. Expansion of the geographic distribution of tick populations increases the likelihood of access to new host species as well as new pathogens. Understanding of the microbiome of ticks continues to evolve, providing critical insights into tick biology. The tick microbiome largely comprises endosymbionts, pathogenic organisms, and commensal bacteria. Endosymbionts are highly preserved and vertically transmitted in ticks from mother to offspring, and their role in the survival of ticks is well recognized. Similarly, the role of ticks as vectors of pathogens is well established. However, commensal bacteria in ticks are acquired from the environment and while ingesting a blood meal. Because many tick species spend most of their lifetime off the hosts, it can be assumed that the richness and diversity of commensal bacteria are highly variable and dependent on the ecosystem in which the tick exists. This mini-review identifies some of the critical data gaps relevant to the role of and influence of commensal bacteria on the vectorial capacity of ticks. As ticks move into new habitats, are locally acquired commensal bacteria playing a role in adaptation to the new habitat? Apart from the conventionally understood mechanisms of acaricide resistance in ticks, are the commensal bacteria influencing the development of acaricide resistance at the population level?

Assessing agricultural practices and insecticides resistance for effective malaria vector control in northwestern Iran

BackgroundAfter three years with no local transmission of malaria, an outbreak occurred in Iran in 2022. Key malaria control methods in Iran are including indoor residual spraying (IRS), long-lasting insecticide-treated nets (LLINs), and prompt diagnosis and treatment of malaria cases. Anopheles sacharovi is one of the main malaria vectors in Iran. This study aimed to determine the insecticides resistance status of An. sacharovi in northwestern Iran, to inform effective vector control programs in this region.MethodsLarval stages of An. sacharovi were collected from various larval habitats located in the villages along the Aras River. Adult susceptibility tests were performed on An. sacharovi using diagnostic doses of insecticides accordance to World Health Organization (WHO) guidelines. The study also evaluated agricultural insecticide and fertilizer usage alongside the presence of natural mosquito predators in breeding sites in the study area.ResultsAlongside various chemicals such as silica, humic acid, superphosphate, sulfur, urea, and solupotasse at different dose levels, organophosphorus and pyrethroid insecticides are commonly used in rice fields and orchards. Anopheles sacharovi displayed diverse reactions to insecticides, demonstrating resistance to DDT but sensitivity to malathion, and showing similar reactions to carbamate and pyrethroid insecticides.ConclusionsThese results provide significant insights into agricultural practices and the presence of mosquito larvae in the study area. The extensive use of a specific herbicide illustrates its popularity among farmers for weed control, while other agricultural products focus on enhancing soil fertility and productivity. The absence of mosquito larvae in habitats with predators indicates the usefulness of these predators in controlling the population of mosquitoes. The resistance of mosquitoes to certain insecticides highlights the need for careful selection and intermittent use of insecticides in vector control programs. These findings can inform the development of targeted strategies to reduce malaria transmission risks. Further research is essential for assessing the effectiveness of these interventions.