International Populations Research Articles

Extensive Unexplored Human Microbiome Diversity Revealed by Over 150,000 Genomes from Metagenomes Spanning Age, Geography, and Lifestyle

SummaryThe body-wide human microbiome plays a role in health, but its full diversity remains uncharacterized, particularly outside of the gut and in international populations. We leveraged 9,428 metagenomes to reconstruct 154,723 microbial genomes (45% of high quality) spanning body sites, ages, countries, and lifestyles. We recapitulated 4,930 species-level genome bins (SGBs), 77% without genomes in public repositories (unknown SGBs [uSGBs]). uSGBs are prevalent (in 93% of well-assembled samples), expand underrepresented phyla, and are enriched in non-Westernized populations (40% of the total SGBs). We annotated 2.85 M genes in SGBs, many associated with conditions including infant development (94,000) or Westernization (106,000). SGBs and uSGBs permit deeper microbiome analyses and increase the average mappability of metagenomic reads from 67.76% to 87.51% in the gut (median 94.26%) and 65.14% to 82.34% in the mouth. We thus identify thousands of microbial genomes from yet-to-be-named species, expand the pangenomes of human-associated microbes, and allow better exploitation of metagenomic technologies.

Raising Social Awareness Through Philately and Its Effect on Philanthropy

Philately is one channel for governments to educate the populace and affect social awareness. This article examines how postage stamps may be used in educating both local and international populations about social causes and is measured by evaluating the consequent philanthropic behavior towards medical needs and goals of a specific nation. Philanthropic donations to medically-related organizations are evaluated for the year of issuance of a postage stamp on the same topic as well as donations for following years. The research results find that for the majority of medical organizations studied, philanthropic contributions increase in the zero to two years following a topically related stamp's issuance, indicating the effectiveness of philatelic materials for educating the population and raising social awareness of medical causes.

The impact of a comprehensive electronic patient portal on the health service use: an interrupted time-series analysis.

There is little empirical research on the potential benefit that electronic patient portals (EPP) can have on the care quality and health outcomes of diverse multi-ethnic international populations. The purpose of this study is to determine the extent to which an EPP was associated with improvements in health service use. Using a quasi-experimental interrupted time-series approach, we assessed health service use before (April 2012-September 2015) and after (October 2015-December 2016) the implementation of a comprehensive EPP at four hospitals in Madrid, Spain. Primary outcomes were number of outpatient visits, any hospital admission, any 30-day all-cause readmission and any emergency department visit. Implementation of the EPP was associated with a significant decline in readmissions. Among patients with chronic heart failure, EPP implementation was associated with a significant decline for all outcome measures, and among patients with COPD, a decline in all outcomes except readmissions. Among patients diagnosed with malignant hematological diseases, no significant changes were identified. EPPs hold promise for reducing hospital readmissions. Certain patient populations with chronic conditions may differentially benefit from portal use depending on their needs for communication with their providers.

Socioeconomic inequalities in exposure to environmental tobacco smoke in children in Israel

BackgroundEnvironmental tobacco smoke (ETS) exposure in infants and children causes more frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome. The aim of this study was to measure ETS exposure in children in Israel (ages 4–11 years) using urinary cotinine measurements, in order to compare exposure levels to other international populations, and to assess predictors of ETS exposure in children in Israel. MethodsA subset of children who participated in the National Health and Nutrition Survey (RAV- MABAT) in 2015–2016 were invited to participate in the Second Israel Biomonitoring Survey. We analyzed urinary cotinine and creatinine concentrations in 103 children. Parents of study participants were interviewed in person on children's exposure to ETS at home and in other environments and on sociodemographic variables. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means in children and analyzed associations in univariable and multivariable analyses, between sociodemographic variables and parental – reported exposure, and urinary cotinine concentrations. ResultsBased on urinary creatinine measurement, over 60% of children are exposed to ETS (compared to <40% based on parental report). Linear regression showed a positive association between urinary cotinine concentration and reported ETS exposure (p = 0.001). Mean cotinine concentration among children whose parents reported that they are exposed to ETS at home (5.1 μg/l) was significantly higher than the concentration among children whose parents reported they are not exposed to ETS at home (1.6 μg/l, p < 0.001). There was an inverse relationship between total family income and urinary cotinine concentration (p < 0.05). In a multivariable model adjusted for ethnicity and other factors, family income was a significant predictor of urinary cotinine level (p = 0.04, slope = −0.49). Geometric mean creatinine adjusted concentrations in children in the current study were higher than in children in Canada and selected European countries. ConclusionsWe found evidence of widespread exposure to ETS in children in the study. There is an urgent need to protect children in Israel from exposure to ETS.

US NCI's Center for Global Health Regional Centers for Research Excellence Program to Support Research Infrastructure on Noncommunicable Diseases, Metal Health, and Injuries

Background and context: To advance our broad, collective understanding of cancer epidemiology, prevention, diagnosis, and treatment. Sophisticated researchers have an inclination that populations in low- and middle-income countries (LMICs) may hold the essential keys needed to advance our understanding carcinogenesis and other disease progression. Aim: To address this need, the US NCI's Center for Global Health selected 11 meritorious, peer-reviewed teams of investigators, throughout the world, to receive Regional Centers of Research Excellence Planning Grants (RCREs). RCRE centers are designed to focus the US NCI's ongoing, international research investments in cancer epidemiology, prevention, diagnosis, and treatment in places where international populations are essential to making progress for humankind. Strategy/Tactics: The RCRE program galvanizes investigators, clinicians, and patients in LMIC communities. It answers their requests (1) by including investigators from both high-, middle-, and lower-income countries; (2) by encouraging multiple chronic conditions to be studied together; and (3) is driven by the research needs to of the people living in the LMIC communities. Program/Policy process: Furthermore, the RCRE program smooths the way for investigators to plan centers that coordinate the cancer and NCD research needs by providing the investigators with protected time. Lastly, each RCRE team is required to complete a small demonstration project in the LMICs. Outcomes: At the end of the two-year planning grant, all 11 RCRE teams will have created a plan for a Regional Center of Research Excellence. Mechanistically, this plan will have several sections, that together will recount the center's scientific impact on the region. The plan will influence researchers, clinicians, patients, policy makers, and members of civil society as they identify the cancer and other NCD research areas pertinent to their community. Six of the 11 centers focused their cancer pilot research project on breast cancer. Five of the centers focused their pilot projects on cervix, esophageal, oral, prostate, or stomach cancer research. Cancer pilot projects ranged from identifying novel risk factors for liver cancer to investigating the association of single nucleotide polymorphisms variants with metabolic syndrome. All RCREs focused on a second NCD including 6 centers focusing on cardiovascular disease and 5 centers focusing on diabetes, injury, or depression research. What was learned: With a modest financial investment, 11 2-year planning grants can be supported. These 11 grants provide finance support for multiple principal investigators, at 23 distinct institutions. These 11 RCRE centers span 16 countries and 10 NCDs. Remarkably, during the first half of their 36-month project period, they have collectively published 10 manuscripts. The NCI Center for Global Health encourages the UICC/WCC community to become involved in this exciting research program.

PCV33 - THE RATE OF CARDIOVASCULAR EVENTS IN DIABETIC PATIENTS IN COLOMBIA

To estimate the rate at which acute coronary events present themselves in diabetic patients from a Colombian insurance company through big data analysis. Based on cluster technics and association rules applied over databases of service consumption from a health insurance company with distribution across the country, diabetic patients from a sole year and those who presented acute coronary events, for at least a year or until death, were singled out for the study. Acute coronary events were defined via diagnosis and validated through registered consumption. Patients were analyzed globally and set apart by stage of treatment: monotherapy, oral combination therapy or insulinized. From 131’604.958 records from approximately 2’300.000 different users, 7,639 patients were diagnosed with type 2 diabetes mellitus for 2015 at a mean age of 56.4, from whom 37% were identified with at least one separate chronic pathology. From the specified population, 85 presented cardiovascular events; equal to a rate of 1.1%. When analyzing specifically those patients under insulinization the rate corresponded to 1.35%. The risk ratio of presenting a coronary event for the diabetic population which did not present any other pathologies was 0.39. The event rate obtained is similar to that of a study performed in international populations such as the one published in Lancet Diabetes Endocrinology in 2014. When analyzing the variations by type of population, it is proven that acute coronary events present a major risk factor in those patients with other chronic pathologies and that those patients who are insulinized have a 2.4% higher rate of presenting cardiovascular events.

Use of whole genome sequencing to complement characterisation of a typhoid fever outbreak among a Marshallese community: Oklahoma, 2015.

Typhoid fever is an illness caused by Salmonella enterica serotype Typhi. In developing regions, it affects an estimated 20 million people annually, causing 200 000 deaths. Although uncommon, cases occur in the USA each year, predominantly due to international travel. During February 2015, the Oklahoma State Department of Health (OSDH) detected an outbreak of typhoid fever among residents of northwestern Oklahoma. OSDH conducted case-patient interviews to identify the source and symptomatic contacts. Whole genome sequencing (WGS) was performed to characterise the genetic relatedness of isolates among the four outbreak-associated pulsed-field gel electrophoresis (PFGE) patterns. We identified 38 cases, 25 confirmed and 13 probable, in two states. WGS revealed a 0-10 single-nucleotide polymorphism variation between isolates. Although we were unable to determine the source, almost all case-patients were members of the Marshallese community that attended a common event in Oklahoma, or were contacts to a confirmed case. This is the largest outbreak of typhoid fever in the USA since 1989, and first to apply WGS to complement interpretation of PFGE results during a typhoid fever outbreak investigation. This investigation illustrates the potential risk of outbreaks among communities comprised of international populations from regions where typhoid fever remains endemic.

Disparities in Care Delivery and Outcomes in Young Adults With Diabetes.

This review summarizes the literature on care and outcome disparities in young adults (YA) with type 1 and type 2 diabetes, and outlines remaining needs and suggestions to reduce disparities and improve care. Despite well-documented disparities and data from large national and international diabetes populations, the role that social determinants of health play in disease management is largely unstudied. Further, mechanisms of how these risk factors interact with the unique developmental needs of racial-ethnic minority and economically vulnerable young adults with diabetes remain unknown. Little intervention research has focused on improving outcomes in this vulnerable population. More research needs to focus on identifying and addressing risk factors in racial-ethnic minority and economically vulnerable young adults with diabetes. Interventions need to be adapted and developed to meet the unique needs of this high-risk population. Clinicians and healthcare systems must recognize the inequity in care and outcomes for this group and structure clinical programs and policies to promote their optimal care.

Leveraging Common Ground: Improving International and Domestic Students’ Interaction Through Mutual Engagement

Leading institutional pedagogies and practices tend to approach increasing international student populations from a deficit-based model, which focuses on the adaptation, acculturation, and assimilation of international students to the dominant host culture. We believe a better approach to improve international and domestic students’ interaction is to move to models of mutual engagement. In this article, as practitioners, we explore four common grounds that seem to be producing positive engagements: common experience, cultural celebrations, faith, and common challenges, in which students are encouraged to meaningfully engage with each other as equals in a spirit of mutuality. The resulting discussion explores how each contributes to a culture of collaboration within institutional departments while improving and enriching the interactions between all students.

Transoral Thyroid and Parathyroid Surgery Vestibular Approach: A Framework for Assessment and Safe Exploration.

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a new approach to the central neck that avoids an anterior cervical incision. This approach can be performed with endoscopic or robotic assistance and offers access to the bilateral central neck. It has been completed safely in both North American and, even more extensively, international populations. With any new technology or approach, complications during the learning curve, expense, instrument limitations, and overall safety may affect its ultimate adoption and utility. To ensure patient safety, it is imperative to define steps that should be considered by any surgeon or group before adoption of this new approach.

Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C.

This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic. Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.

Comparison of body mass index percentiles for schoolchildren in Croatia with international reference values

The aim was to determine body mass index (BMI) percentiles in Croatian children aged 6.5-18.5 years and to compare them with theUnited States Centers for Disease Control and Prevention (USCDC 2000) and World Health Organisation (WHO 2007) BMI referencevalues in order to show the pattern of diff erences. A representative cross-sectional national survey with standardized body heightand weight measurements included 12,389 schoolchildren (6372 boys and 6017 girls) aged 6.5-18.5 years (response rate 94.5%). BMIpercentile curves were established using the Lambda-Mu-Sigma method. BMI percentiles of the Croatian schoolchildren diff eredfrom analogical percentiles in two international reference populations. The 5th percentile in boys and girls was similar to both referencepopulations until the age of about 13 years, and in the age onwards it showed an upward shift. The 50th, 85th and 95th percentilesin boys showed an upward shift in boys in all ages observed; in girls, an upward shift was observed until the age of about 14years and downward shift in the age onwards. The diff erences observed between BMI percentiles of Croatian schoolchildren andUSCDC 2000 and WHO 2007 references imply that BMI percentiles developed on a nationally representative sample would be moreappropriate for assessment of nutritional status at the national level, whereas international standards could be used for comparisonof nutritional status among diff erent populations.

Oral Health-Related Quality of Life of Children Born With Orofacial Clefts in Ethiopia and Their Parents.

To assess the oral health-related quality of life (OH-RQoL) using a translated standardized measure in an understudied population of Ethiopian children born with orofacial clefts (OFCs) and their parents. Using a descriptive study design, we assessed the OH-RQoL of 41 patients with OFCs between the ages of 8 and 17 years and their parents. Participants received multidisciplinary cleft care from 2008 to 2016. They completed an Amharic translation of the Child Oral Health Impact Profile (COHIP). There was strong internal reliability with the translated COHIP for parents and patients. Parents' COHIP scores ranged from 67 to 186, and patients' scores were 78 to 190. The mean for patients and parents was 155, indicating good OH-RQoL. The Amharic translation of the COHIP appears appropriate for use with families in Ethiopia. Both parents and patients reported OH-RQoL at similar levels as other international populations.

Career Decision Making for Korean International College Students: Acculturation and Networking

The authors examined the relationship among acculturation, career networking, and career decision self‐efficacy for Korean international college students. Networking is an essential skill for career success, and acculturation is connected to career outcomes for diverse populations; however, little research has examined the relationship between these factors. A total of 172 Korean international students (117 women, 54 men, 1 not reported) completed measures of acculturation; networking comfort, intensity, and proactivity; and career decision self‐efficacy. Using structural equation modeling, the authors found acculturation to affect career decision self‐efficacy through networking. The relationships among acculturation, networking, and career decision self‐efficacy indicated a medium to large effect size. These findings indicate that career counselors should collaboratively attend to acculturation concerns, such as stress and identity development, as well as provide opportunities for networking skill development. More research is needed on acculturation and networking among additional international student populations.

Validation of a Social Networks and Support Measurement Tool for Use in International Aging Research: The International Mobility in Aging Study.

The purpose of this study was to develop and validate a new instrument to assess social networks and social support (IMIAS-SNSS) for different types of social ties in an international sample of older adults. The study sample included n= 1995 community dwelling older people aged between 65 and 74years from the baseline of the longitudinal International Mobility in Aging Study (IMIAS). In order to measure social networks for each type of social tie, participants were asked about the number of contacts, the number of contacts they see at least once a month or have a very good relationship with, or speak with at least once a month. For social support, participants had to rate the level of social support provided by the four types of contacts for five Likert scale items. Confirmatory Factor Analysis was conducted to determine the goodness of fit of the measurement models. Satisfactory goodness-of-fit indices confirmed the satisfactory factorial structure of the IMIAS-SNSS instrument. Reliability coefficients were 0.80, 0.81, 0.85, and 0.88 for friends, children, family, and partner models, respectively. The models were confirmed by CFA for each type of social tie. Moreover, IMIAS-SNSS detected gender differences in the older adult populations of IMIAS. These results provide evidence supporting that IMIAS-SNSS is a psychometrically sound instrument and of its validity and reliability for international populations of older adults.

Influence of a Short-Term Study Abroad Experience on Professional Competencies and Career Aspirations of Graduate Students in Student Affairs

Influence of a Short-Term Study Abroad Experience on Professional Competencies and Career Aspirations of Graduate Students in Student Affairs Patty Witkowsky and Sylvia L. Mendez While the specific mission of master's-level student affairs preparation programs (SAPPs) may differ, the overarching purpose is to prepare graduates educated in student development to serve as leaders within higher education (Long, 2012; Nuss, 2003). As student populations evolve with increasing diversity, specifically in international populations (Farrugia, Bhandari, Baer, Robles, & Andrejko, 2017), SAPPs must seek ways to educate their graduate students in order to promote success in the current global environment. While an institution may assert internationalization as a goal, it will not become a reality unless the faculty, staff, policies, priorities, and opportunities are part of the infrastructure to support that goal (Schulz, Lee, Cantwell, McClellan, & Woodard, 2007). Given recent trends of increasing international student population (5.3% of overall higher education enrollment) and study abroad participation (10.4% of undergraduate students; Farrugia et al., 2017), developing culturally aware professionals to contribute to campus internationalization is increasingly paramount. The success of international students at US institutions and the promotion of study abroad and reintegration of students back to their home institutions require culturally competent student affairs professionals who are able to fulfill social justice and inclusion-related competencies (ACPA & NASPA, 2015). In response to the increasing internationalization of higher education, evidence exists of the inclusion of short-term study abroad experiences in SAPPs as a pedagogical approach to expose SAPP graduate students to higher education systems outside the country and expand students' intercultural competence (Schulz et al., 2007). Previous publications related to this approach have focused on the structure of the courses, learning outcomes, and logistical considerations for such experiences (Haber & Getz, 2011; Yakaboski & Birnbaum, 2017) but are limited in exploring its influence on SAPP graduate students' professional development. Thus, the following research question guided our study: How does participation in a short-term study abroad experience in SAPP curriculum influence graduate students' intercultural competence, work with international students, and career development? LITERATURE REVIEW Short-term study abroad experiences provide undergraduate and graduate students with the opportunity to engage in experiential learning and to grow in their intercultural competencies through cultural immersion with application to an academic discipline. These experiences aid in their personal and global awareness and confidence in contributing to an international world (Doyle, 2009; Fischer, 2009; Franklin, 2010; Haber & Getz, 2011; Kitsantas, 2004; Slotkin, Durie, & Eisenberg, 2012; Yakaboski & Birnbaum, 2017). [End Page 769] These programs have been found to provide undergraduate and graduate students with an (initial) experience abroad that fuels their chosen career path, overseas travel interests, and cultural, social, and political attitudes and views (Doyle, 2009; Fischer, 2009; Franklin, 2010; Kitsantas, 2004; Norris & Dwyer, 2005). Graduate students in SAPP have reported that international experiences directly translate to their work with students. In the other literature related to SAPP graduate student outcomes from a short-term study abroad experience, they reported improved multicultural and intercultural competence and further developed listening and empathy skills (Haber & Getz, 2011). It is no surprise directors of these preparation programs are considering ways to internationalize by embedding short-term study abroad experiences into their curricula (Schulz et al., 2007). A primary benefit of short-term study abroad programs is that typically they are led by faculty members within an academic program; therefore, the academic content is directly related to the discipline of study (Donnelly-Smith, 2009; Haber & Getz, 2011; Slotkin et al., 2012; Yakaboski & Birnbaum, 2017). The coursework and materials can be successfully integrated into programmatic goals and objectives, and the familiarity among the students and faculty allows for a more structured and modeled approach to reflect on the experiential learning being undertaken. This type of study abroad program provides considerable qualification and quantification of the present and future work-related knowledge, skills, and dispositions being developed through the experience (Doyle, 2009; Fischer, 2009; Franklin, 2010; Haber & Getz, 2011; Slotkin et al., 2012). An additional benefit of a short-term study abroad experience, rather than a semester or year-long experience, is the ability to attract broader participation across student groups as evidenced by the current statistics that 63% of study abroad...

Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

ABSTRACTBackground: Child malnutrition, a leading cause of death and disability worldwide, is particularly severe in Madagascar, where 47% of children under 5 years are stunted (low height-for-age) and 8% are wasted (low weight-for-height). Widespread poverty and a weak health system have hindered attempts to implement life-saving malnutrition interventions in Madagascar during critical periods for growth faltering.Objective: This study aimed to shed light on the most important factors associated with child malnutrition, both acute and chronic, and the timing of growth faltering, in Ifanadiana, a rural district of Madagascar.Methods: We analyzed data from a 2014 district-representative cluster household survey, which had information on 1175 children ages 6 months to 5 years. We studied the effect of child health, birth history, maternal and paternal health and education, and household wealth and sanitation on child nutritional status. Variables associated with stunting and wasting were modeled separately in multivariate logistic regressions. Growth faltering was modeled by age range. All analyses were survey-adjusted.Results: Stunting was associated with increasing child age (OR = 1.03 (95%CI 1.02–1.04) for each additional month), very small birth size (OR = 2.32 (1.24–4.32)), low maternal weight (OR = 0.94 (0.91–0.97) for each kilogram, kg) and height (OR = 0.95 (0.92–0.99) for each centimeter), and low paternal height (OR = 0.95 (0.92–0.98)). Wasting was associated with younger child age (OR = 0.98 (0.97–0.99)), very small birth size (OR = 2.48 (1.23–4.99)), and low maternal BMI (OR = 0.84 (0.75–0.94) for each kg/m2). Height-for-age faltered rapidly before 24 months, then slowly until age 5 years, whereas weight-for-height faltered rapidly before 12 months, then recovered gradually until age 5 years but did not reach the median.Conclusion: Intergenerational transmission of growth faltering and early life exposures may be important determinants of malnutrition in Ifanadiana. Timing of growth faltering, in the first 1000 days, is similar to international populations; however, child growth does not recover to the median.

Postmortem Organ Weights at a South African Mortuary

Weighing organs at autopsy provides objective evidence of pathology. Reference ranges must be locally applicable, accurate, and regularly defined. The aims of this study were the generation of postmortem organ weight reference ranges for use in South African mortuaries, analysis of factors influencing organ weights, and comparison to international populations. This was a retrospective study of autopsy reports from the Salt River medicolegal mortuary in Cape Town, South Africa, between 2013 and 2016. Disproportionate randomized stratified sampling was used to obtain sufficient cases from men and women; white, colored, and African racial groups; and decedents older and younger than 50 years. Observations from 1262 decedents older than 18 years dying traumatic on-scene deaths were recorded, excluding organs with macroscopic evidence of disease or destructive injury. Variables collected were sex, race, age, height, and body weight. Organ weights were modeled using multiple linear regression analysis. In general, sex, race, and weight are significant predictors. In general, organs from African and colored decedents weigh less than those from white decedents, and similarly pooled South African organs are smaller than those from international populations. Ideal organ weight reference ranges are proposed, and a smartphone application is offered, which calculates individualized prediction intervals. This study provides postmortem organ weight data for a South African population.

Perceived Risk Associated with MDMA (Ecstasy/Molly) Use among African Americans: What Prevention and Treatment Providers Should Know

ABSTRACTThe research literature on MDMA (ecstasy/molly) use has largely relied on samples of ravers/club-goers, gay men, and international populations (e.g., United Kingdom, Australia). As a result, very little is known about MDMA use among African Americans. This study aimed to address this gap by adding to the limited amount of research with this population. The goal of this study was to identify and characterize the perceived risks that African Americans associate with using MDMA. Surveys (n = 100) and in-depth interviews (n = 15) were conducted with African American young adults in Southwest Florida between August 2014 and November 2015. Almost the entire sample (91%) associated risks with their MDMA use. The most prevalent types of perceived risks associated with MDMA use were physical harm (e.g., dehydration, fatal overdose, and cardiac damage). Qualitative interview data are also presented to better contextualize these perceived risks. These data provide insight into the risks most salient on the minds of African Americans, and can be used to begin developing and tailoring interventions that target MDMA use among this population. While more research is needed on this topic, these results represent a step forward in our understanding of MDMA use among African Americans.

Chagas Disease Infection among Migrants at the Mexico/Guatemala Border.

Chagas disease results in the largest burden, in terms of disability-adjusted-life-years, of any parasitic disease in the Americas. Monitoring Chagas disease among migrants is critical to controlling its spread and to serving the needs of the migrant community. Therefore, we determined the prevalence and correlates of Chagas disease in regional and international migrant populations at the Mexico/Guatemala border. Data were collected as part of a larger study of human immunodeficiency virus (HIV) and migration. Participants were a sample of recent regional and international migrants who used an illicit substance or had recent problem drinking. Trypanosoma cruzi infection was classified as testing positive on two different enzyme-linked immunosorbent assays (ELISAs). Interviewer-administered surveys captured sociodemographics, migration history, Chagas disease knowledge, and access to care. We enrolled 389 recent migrants, and the prevalence of Chagas disease was 3.1%. Only 19% of the participants reported having ever heard of the disease and less than 1% had been previously tested. Trypanosoma cruzi-positive participants were more likely to have been born in a rural area or town than a city (92% yes versus 59% no, P = 0.02) and have recently lived in a house with a makeshift roof (33% yes versus 8% no, P < 0.01), walls (42% yes versus 13% no, P < 0.01), or floor (50% yes versus 21% no, P < 0.02), or cinderblock walls (92% yes versus 63% no, P = 0.04). With migration rapidly changing the distribution of Chagas disease, more work needs to be done to create targeted surveillance programs and provide access to affordable treatment among Latin American migrants.