Self-reported Illness Research Articles

Implementation of a Prospective Index-Cluster Sampling Strategy for the Detection of Presymptomatic Viral Respiratory Infection in Undergraduate Students.

Index-cluster studies may help characterize the spread of communicable infections in the presymptomatic state. We describe a prospective index-cluster sampling strategy (ICSS) to detect presymptomatic respiratory viral illness and its implementation in a college population. We enrolled an annual cohort of first-year undergraduates who completed daily electronic symptom diaries to identify index cases (ICs) with respiratory illness. Investigators then selected 5-10 potentially exposed, asymptomatic close contacts (CCs) who were geographically co-located to follow for infections. Symptoms and nasopharyngeal samples were collected for 5 days. Logistic regression model-based predictions for proportions of self-reported illness were compared graphically for the whole cohort sampling group and the CC group. We enrolled 1379 participants between 2009 and 2015, including 288 ICs and 882 CCs. The median number of CCs per IC was 6 (interquartile range, 3-8). Among the 882 CCs, 111 (13%) developed acute respiratory illnesses. Viral etiology testing in 246 ICs (85%) and 719 CCs (82%) identified a pathogen in 57% of ICs and 15% of CCs. Among those with detectable virus, rhinovirus was the most common (IC: 18%; CC: 6%) followed by coxsackievirus/echovirus (IC: 11%; CC: 4%). Among 106 CCs with a detected virus, only 18% had the same virus as their associated IC. Graphically, CCs did not have a higher frequency of self-reported illness relative to the whole cohort sampling group. Establishing clusters by geographic proximity did not enrich for cases of viral transmission, suggesting that ICSS may be a less effective strategy to detect spread of respiratory infection.

Lifestyle and cardiovascular risk factors in a Swedish primary care population with self-reported psychiatric symptoms

ObjectiveIndividuals with psychiatric illness suffer from poorer physical health compared with the general population and have a higher risk of developing cardiovascular and metabolic diseases. This cross-sectional study aims to describe the prevalence of lifestyle and cardiovascular risk factors and the association with self-reported psychiatric symptoms in a population of 40-year-old individuals screened with targeted Health Dialogues in southern Sweden. MethodsAll 40-year-old individuals registered at 99 primary healthcare centers in southern Sweden were invited to participate. Self-reported lifestyle habits on a web questionnaire, anthropometric measurements, blood pressure, and blood tests were collected. The Health Dialogue resulted in a risk level assessment for different lifestyle habits and a meeting with a trained coach. ResultsA total of 1831 individuals completed a Health Dialogue between 1st January 2021 and 30th June 2022. There were more individuals with high-risk levels for several lifestyle habits in the group with self-reported psychiatric illness compared with the rest of the study population. The analysis showed that physical inactivity, unhealthy diet, high-risk alcohol intake, tobacco use, psychosocial strain, higher BMI, and waist-hip ratio were associated with increased levels of psychiatric symptoms after adjustment for sex and socioeconomic factors. ConclusionUnhealthy lifestyle habits were associated with self-reported psychiatric symptoms in 40-year-old individuals assessed with targeted Health Dialogues in a primary care context. Organized screening might contribute to early detection of modifiable risk factors for cardiovascular disease. Individuals with psychiatric symptoms should be prioritized for screening of unhealthy lifestyle behaviors.

Food Safety Practices of Food Handlers in China and their Correlation with Self-reported Foodborne Illness

Food service facilities are important sites where foodborne diseases have been reported to occur frequently. This study aims to determine the correlation between self-reported foodborne diseases and food-safety practices followed by food handlers of various food service facilities. A cross-sectional survey was conducted from March 1, 2022 to December 30, 2022 in Wuhu City, Anhui Province, China. Data were collected through face-to-face interviews and having the selected food handlers fill in a self-compiled questionnaire. Of the 1072 food handlers included in the study, 88 (8.2%) reported having experienced symptoms of foodborne diseases in the past 4 weeks. The following food-safety practices correlated with self-reported foodborne diseases: (1) infrequently using 3-compartment sinks to separately clean different types of raw food materials (P < 0.05, OR = 2.312); (2) infrequently removing non-edible parts of aquatic products outside a specific room for food processing (P < 0.001, OR = 3.916); (3) infrequently immediately refrigerating cold dishes prepared in advance to be consumed later (P < 0.001, OR = 4.048); (4) often store perishable foods at 8–60°C in the indoor environment after cooking and before eating (P < 0.05, OR = 2.068); (5) infrequently reheating cooked perishable food stored at 8–60°C for more than 2 h before eating (P < 0.05, OR = 1.934); and (6) often storing raw and cooked food in the same container (P < 0.001, OR = 3.818). Hence, a better supervision of food-safety practices of catering workers may reduce the frequency of foodborne-disease outbreaks in food service facilities.

Examining the effect of removing banknotes and implementing Goods and Services Tax on access to healthcare in India

This paper explores the effect of the banknote ban and GST, which were implemented within a span of 8 months in 2016-2017, on self-reported illnesses and healthcare consumption in India. The findings show that the increasing trend of self-reported illness from 1995-96 to 2014, reversed in 2017-2018. The reduction in healthcare consumption between 2014 and 2017-2018 is primarily within the private care sector rather than public care, indicating economic duress induced by the banknote ban and GST as its cause. The reduction in self-reported illness and healthcare consumption is more prolonged among the occupationally vulnerable. The reduction in reporting of illnesses, healthcare consumption, and out-of-pocket expenditure on health continued even after one-and-half years of the banknote ban; this may also have been exacerbated later by the implementation of GST. Data indicate that the condition of public healthcare deteriorated between 2014 to 2018. As a result, even though the weaker sections’ access to private healthcare diminished, they could not turn to public healthcare either, resulting in a reduction in overall healthcare consumption. The findings of this paper call for a robust, functioning, affordable public healthcare system in India for greater crisis resilience.

Functional capacity and its associated factors in older adults in the rural area in Brazil

Background &amp; Aim: Aging leads to bodily changes and impairment of functional capacity in older adults. The objective was to analyze the association between socio-demographic and health data, cognitive impairment, and risk of sarcopenia with functional capacity in older adults enrolled in the Family Health Strategies in the rural area of the municipality of Picos, Piauí, Brazil.&#x0D; Methods &amp; Materials: This is a quantitative and cross-sectional study that was developed with 320 older adults attending the Family Health Strategies located in the rural area of Picos, Piauí, Brazil. The participants were people 60 years old, registered in the Family Health Strategies, and living in a rural area. Data was collected in the older adults’ homes using the following instruments: Demographic profile, Self-reported illnesses, Mini-Mental State Examination, Barthel Index, Lawton and Brody Scale, and SARC-F.&#x0D; Results: It was found that 70% had cognitive impairment, 53.8% were at risk of sarcopenia, with a mean of 93.72 (SD=11.84) points for basic activities daily living, and 77.8% with partial dependence for instrumental activities daily living with a mean of 16.79 (SD=3.79) points. In the multivariate multiple regression, it was identified that there was an association between Basic Activities of Daily Living and Instrumental Activities of Daily Living with age (p&lt;0.001), number of children (p=0,025), education (p=0.003), monthly income (p=0.018), number of diseases (p&lt;0.001), sarcopenia (p&lt;0.001) and cognitive status (p&lt;0.001).&#x0D; Conclusion: A high prevalence of functional disability was identified in elderly people living in the rural area of ​​Picos, Piauí, Brazil. Therefore, it is important to pay attention to factors associated with dependence on daily activities.

Racial Differences in Self-Report of Mental Illness and Mental Illness Treatment in the Community: An Analysis of Jail Intake Data

Jails and prisons in the United States house people with elevated rates of mental health and substance use disorders. The goal of this cross-sectional study was to evaluate the frequency of racial/ethnic differences in the self-report of mental illness and psychiatric medication use at jail entry. Our sample included individuals who had been incarcerated between 2016 and 2020 at the Middlesex Jail & House of Correction, located in Billerica, MA. We used data from the “Offender Management System,” the administrative database used by the jail containing data on people who are incarcerated, and COREMR, the electronic medical record (EMR) used in the Middlesex Jail & House of Correction. We evaluated two primary outcomes (1) self-reported mental illness history and (2) self-reported use of psychiatric medication, with the primary indicator of interest as race/ethnicity. At intake, over half (57%) of the sample self-reported history of mental illness and 20% reported the use of psychiatric medications. Among people who self-reported a history of mental illness, Hispanic (AOR: 0.73, 95% CI: 0.60–0.90), Black (AOR: 0.52, 95% CI: 0.43–0.64), Asian/Pacific Islander (Non-Hispanic) people (AOR: 0.31, 95% CI: 0.13–0.74), and people from other racial/ethnic groups (AOR: 0.33, 95% CI: 0.11–0.93) all had decreased odds of reporting psychiatric medications. Mental illness was reported in about one-half of people who entered jail, but only 20% reported receiving medications in the community prior to incarceration. Our findings build on the existing literature on jail-based mental illness and show racial disparities in self-report of psychiatric medications in people who self-reported mental illness. The timing, frequency, and equity of mental health services in both the community and the jail setting deserves further research, investment, and improvement.

Examining associations between early adverse life events and health anxiety using the DanFund study

Childhood adverse life events, in particular illness-related events, have been proposed as a risk factor for development of health anxiety. ObjectiveTo examine: 1) The association between accumulated early adverse life events and health anxiety in adulthood and 2) The influence of specific types of life events, i.e., illness, injury, loss, and the impact of their exposure time on health anxiety in adulthood. MethodA population-based, cross-sectional study including 7454 participants from the Danish study of Functional Disorders (DanFunD). Health anxiety was assessed with Whiteley-6-R and early adverse life events with the Cumulative Lifetime Adversity Measure. Caseness was defined as a Whiteley-6-R score ≥ 90%ile. Generalised linear models were used to estimate the association with relative risk (RRa, adjusted for sociodemographics). ResultsA cumulative effect was found for each additional adverse life event with 8.03% increased risk of health anxiety. Two categories were associated with a higher risk: violence (RRa = 1.65, 95% CI: 1.37–1.99, P < 0.001) and relationship stress (RRa = 1.34; 95% CI: 1.15–1.57, P < 0.001). Respondents with self-reported childhood illness were also more likely to report health anxiety (RRa = 1.52, 95% CI 1.11–2.09, P = 0.009). Timewise, health anxiety seemed associated with illness during school age and injury during adolescence. ConclusionsAccumulated adverse life events, early exposure to specific categories and specific health-related life events were associated with self-reported health anxiety in adulthood. Our findings provide new knowledge on the potential role of early life events in health anxiety which could inform early intervention.

Hypothalamus volumes in adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): impact of self-reported fatigue and illness duration

Adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex illness of unknown aetiology. Emerging theories suggest ME/CFS may reflect a progressive, aberrant state of homeostasis caused by disturbances within the hypothalamus, yet few studies have investigated this using magnetic resonance imaging in adolescents with ME/CFS. We conducted a volumetric analysis to investigate whether whole and regional hypothalamus volumes in adolescents with ME/CFS differed compared to healthy controls, and whether these volumes were associated with fatigue severity and illness duration. 48 adolescents (25 ME/CFS, 23 controls) were recruited. Lateralised whole and regional hypothalamus volumes, including the anterior–superior, superior tubular, posterior, anterior-inferior and inferior tubular subregions, were calculated from T1-weighted images. When controlling for age, sex and intracranial volume, Bayesian linear regression models revealed no evidence for differences in hypothalamus volumes between groups. However, in the ME/CFS group, a weak linear relationship between increased right anterior–superior volumes and fatigue severity was identified, which was absent in controls. In addition, Bayesian quantile regression revealed a likely-positive association between illness duration and right superior tubular volumes in the ME/CFS group. While these findings suggest overall comparability in regional and whole hypothalamus volumes between adolescents with ME/CFS and controls, preliminary evidence was identified to suggest greater fatigue severity and longer illness duration were associated with greater right anterior–superior and superior-tubular volumes, respectively. These regions contain the anterior and superior divisions of the paraventricular nucleus, involved in the neuroendocrine response to stress, suggesting involvement in ME/CFS pathophysiology. However, replication in a larger, longitudinal cohort is required.

Perceptions of physical activity levels after a diagnosis of acute coronary syndrome and in the context of cardiac rehabilitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Physical activity [PA] is a core component of cardiac rehabilitation [CR] but those who consider themselves active are less likely to participate. It is unclear how CR services can better engage with this group and what support they should offer to encourage a return to PA at appropriate levels. Purpose We aimed to identify individuals from four UK CR services who considered themselves active prior to acute coronary syndrome [ACS] diagnosis and understand their PA support requirements. Methods A sequential mixed methods study, with data collected between October 2019 and April 2020. A quantitative survey examined self-reported PA levels, illness perceptions, and physical self-concept of ACS patients using validated questionniaires after their event but before the start of CR. Data were analysed via descriptive, correlational, and multiple regression analysis. Qualitative individual semi-structured telephone interviews were conducted with participants who self-reported to be at least moderately active. Data were thematically analysed. Data were integrated during study design and discussion stage. Results Sixty-seven participants (male n=53, 79.1%) with a median age of 63 (IQR = 56-71) completed the survey. Of these, 50 (74.6%) self-reported being at least moderately active before starting CR. During regression analysis, only physical self-concept for being physically active (F (9,56)=3.59, p&amp;lt;.005, adjusted R2 0.26) was significantly associated with PA level. Twenty-six participants completed qualitative interviews. Participants who perceived that they were active prior to their event based this on recollections of past PA, and step count monitoring. They made decisions about whether to engage with CR based on pre-CR information and comparison with peers. Despite considering themselves to be active, this group still required support to return to PA at appropriate intensity levels to gain secondary prevention benefits. This included information about how to self-monitor intensity effectively. Conclusions CR services should recognise that ACS survivors who consider themselves to be active prior to their event require support to return to PA at appropriate levels. Support should include exploring what patients mean when they say they are active so that CR professionals are better informed to provide indivualised advice.

Statistical Reproducibility of Meta-Analysis for Medical Mask Use in Community Settings to Prevent Airborne Respiratory Virus Infection

Many US states, cities, and counties implemented public masking orders during the coronavirus (COVID) pandemic on the notion that this intervention would delay and flatten the epidemic peak and largely benefit public health outcomes. A p-value plot can provide insights into possible inappropriateness (incorrectness) of assumptions of a statistical model. It can be used to confirm, disprove, or identify ambiguity (uncertainty) in a meta-analytic finding and research claim. P-value plotting was used to evaluate statistical reproducibility of meta-analysis studies for disposable medical (surgical) mask use in community settings to prevent airborne respiratory virus infection. Eight studies (seven meta-analysis, one systematic review) published between 1 January 2020 and 7 December 2022 were evaluated. Base studies were randomized control trials with outcomes of medical diagnosis or laboratory-confirmed diagnosis of viral (Influenza or COVID) illness. Self-reported viral illness outcomes were excluded from the evaluation because of awareness bias. No evidence was observed for a medical mask benefit to prevent respiratory virus infection in six p-value plots (five meta-analysis and one systematic review). Research claims of no benefit in three meta-analysis and the systematic review were reproduced in p-value plots. Research claims of a benefit in two other meta-analysis were not reproduced in p-value plots suggesting irreproducibility of these claims. Insufficient data was available to construct p-value plots for two other meta-analysis because of over-reliance on self-reported outcomes. Independent findings of p-value plotting show that meta-analysis of existing randomized control trials fail to demonstrate a benefit of medical mask use in community settings to prevent airborne respiratory virus infection.

Clinical Impact of Systematic Assessment and Psychoeducation in Specialized Treatment of Adolescents with Severe Functional Somatic Disorders: Results from the AHEAD Study.

Functional somatic disorders (FSD), characterized by persistent and disabling physical symptoms, are common in adolescents. Diagnostic uncertainty and insufficient illness explanations are proposed perpetuating factors that may constitute barriers for treatment engagement. This study describes the impact of manualized assessment and psychoeducation on diagnostic certainty and various clinical outcomes in adolescents with multi-system FSD. Ninety-one adolescents (15-19 years) received systematic assessment (4 h) and a subsequent psychiatric consultation (1.5 h). Clinical characteristics included self-reported physical health, symptom severity, illness perception, illness-related behavior, and psychological flexibility assessed before and approximately two months after assessment, prior to specialized treatment. Data were analyzed using t-tests. Immediately following assessment, 71 (80.7%) adolescents out of 88 reported a higher diagnostic certainty and 74 (84.1%) reported that attending assessment gave them positive expectations for future treatment. A clinically relevant improvement of physical health was not observed at two months but considerable reductions were seen in symptom severity, illness worry, negative illness perceptions, illness-related limiting behavior, and psychological inflexibility. The results emphasize that systematic assessment and psychoeducation are important in their own right in the specialized treatment of adolescents with severe FSD.

The association between parental chronic physical illness and adolescent functional somatic symptoms

BackgroundPrevious studies have found that adolescents with a chronically ill parent may experience more internalizing problems. It is less clear if this association is sex-related, and whether it is specific for functional somatic symptoms (FSSs) or concerns other internalizing or externalizing problems. MethodsIn a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 841; mean age 14.9 years), we examined the association between parental chronic illness and adolescent's FSSs, and internalizing and externalizing problems. Adolescent's internalizing and externalizing symptoms were measured using the Youth Self Report; parental chronic physical illness was reported during an interview. Associations were tested using linear regression analyses taking into account socio-demographic confounders. We also explored gender-interaction effects. ResultsHaving a chronically ill parent (n = 120; 14.3 %) was associated with more FSS in girls (B = 1.05, 95%CI = [0.23, 1.88], p = .013), but not in boys (sex-interaction: p = .013). In girls, an association was also found between parental chronic illness and more internalizing problems (B = 2.68, 95%CI = [0.41, 4.95], p = .021), but this association disappeared when FSSs were excluded from the Internalizing problem scores. LimitationsThe current study has a cross-sectional design and relied on self-reported parental chronic physical illness what may have induced misclassification. ConclusionFindings suggest that having a chronically ill parent is associated with more FSSs in adolescent girls and that this association is specific for FSSs instead of general internalizing problems. Girls with a chronically ill parent may profit from interventions to prevent the development of FSSs.

What makes a ‘good doctor’? A critical discourse analysis of perspectives from medical students with lived experience as patients

What constitutes a ‘good doctor’ varies widely across groups and contexts. While patients prioritise communication and empathy, physicians emphasise medical expertise, and medical students describe a combination of the two...

Spatial Evaluation of Dengue Transmission and Vector Abundance in the City of Dhaka, Bangladesh

In recent years, many urban areas in low and middle income countries have experienced major dengue epidemics, and the city of Dhaka, the capital city of Bangladesh, is one of them. Understanding models based on land cover and land use in urban areas in relation to vector abundance and possible disease transmission can be a major epidemiological tool in identifying disease incidence and prevalence. Demographic and human behavioral factors can also play a role in determining microenvironments for entomological distribution—which is a major risk factor for epidemicity. Data collected from a cross-sectional entomological survey in the city of Dhaka during the monsoon season of 2012 and two serological surveys—one pre-monsoon and another post-monsoon in 2012—were analyzed in this study. A total of 898 households and 1003 containers with water were inspected, and 1380 Ae. aegypti pupae and 4174 larvae were counted in these containers. All Stegomyia indices were found to be the highest in the central business and residential mixed zone. The odds ratios of risk factors for seroprevalence, including sex, age, self-reported febrile illness during the previous six months, and travel during the last six months, were calculated; age distribution was found to be a highly significant risk factor (p = value &lt; 0.0001). The study offers clear patterns of dengue viral transmission, disease dynamics, and their association with critical spatial dimensions.

Cognitive Performance Deficits Are Associated with Clinically Significant Depression Symptoms in Older US Adults

Accumulating research has described cognitive impairment in adults with depression, however, few studies have focused on this relationship during older adulthood. Our cross-sectional study investigated the association between cognitive function performance and clinically significant depression symptoms in older adults. We analysed the data from the 2011 to 2014 National Health and Nutrition Examination Survey on older (aged 60 years and above) US adults. Cognitive function was assessed as a composite score and on a test-by-test basis based on the Consortium to Establish a Registry for Alzheimer's Disease Word List Learning Test, the Word List Recall Test, and Intrusion Word Count Test, the Animal Fluency Test, and the Digit Symbol Substitution Test (DSST). Depression was defined as clinically significant depression symptoms based on the standard cut-off point of the Patient Health Questionnaire-9 (PHQ-9) score of 10 or greater. Adjusted-logistic regression analysis was employed using survey weights to examine the former relationships. Sociodemographic factors, in addition to medical history and status in terms of self-reported chronic illness and the incidence of stroke or memory-cognitive function loss, were considered as covariates. Among 1622 participants of a survey-weighted 860,400 US older adults, cognitive performance was associated with clinically significant depression symptoms (p = 0.003) after adjustment. Most prominently, older adults with significant cognitive deficits had approximately two and a half times (OR: 2.457 [1.219-4.953]) higher odds for a PHQ-9 score above threshold compared to those with the highest performance. Particularly, those with lowest DSST score had increased odds of almost four times (OR: 3.824 [1.069-13.678]). Efforts to decipher the underlying aetiology of these negative disparities may help create opportunities and interventions that could alleviate the risks from depression, cognitive impairment, and associated consequences in older adults at a population level.

Comparison of Isometric Hand Grip Strength among Computer Operators and Non-Computer Operators

Background: Most frequently self-reported work-related illness are due to musculoskeletal disorders. Highly repetitive tasks with grasping of the hands, repetitive flexing of the wrist, vibrations and localized mechanical pressure play a role in development of repeated stress injury. Many computer users complain about wrist fatigue, discomfort or pain after typing. Aim: To assess and compare isometric grip strength of computer operators and non-computer operators. Methods: This study was conducted at the Shalimar Institute of Health Sciences. A sample of 30 computer operators and 30 controls (non-computer operators) were recruited after screening hand ultrasonography. Purposive sampling was used. Isometric grip is measured with a hand-held dynamometer. Subjects were asked to hold the dynamometer with full exertion. Each reading is from a maximum contraction period of three seconds with a 30-second pause. Results: Average Hand Grip Strength of computer operators was 27.71±11.19kg and non-computer users was 37.05±11.09kg. The results were statistically significant with the p-value of 0.002. Practical Implications: Continuous computer use reduces hand grip strength therefore those who are having long term use of computers must go for hand grip strength exercises to maintain normal hand grip strength. Conclusion: Computer operators have less isometric hand grip strength than non-computer operators as it was concluded in this study. MeSH words: Isometric hand grip strength, computer operators, non-computer operator

Establishing General Working Population Norms for the Cognitive Symptom Checklist-Work.

The Cognitive Symptom Checklist-Work (CSC-W) is a self-report measure to assess cognitive symptoms (i.e., memory and executive function) in working adults with cancer. To date, general working population norm data are lacking worldwide. We established CSC-W norm values in the general working population, and assessed associations of CSC-W scores with work and health-related factors. This cross-sectional study consisted of 1,000 Dutch working adults, of whom data was collected through an online respondent panel. The sample was stratified for sex and age, and data were weighted. Summary scores of the CSC-W total scale, and memory and executive function symptoms subscales, were determined (e.g., means, percentiles). Z- and T-scores were calculated, and analysis of (co)variance has been applied. Cognitive symptom scores were relatively stable across age groups, but 18-39-year-old respondents reported lower memory and executive function than respondents in other age groups. Symptom scores of memory function (mean 29.1; SD = 16.7) were higher for all age groups and in both sexes compared to executive function (mean 22.1; SD = 16.8). No sex differences in memory and executive function were observed. Higher symptom scores were associated with performing non-manual work only, manual work only, self-reported long-term illness, and higher levels of depressive symptoms and fatigue. The CSC-W norms may enhance the interpretation and facilitate the analysis of self-reported cognitive symptoms in patients with cancer at work. Our findings may support health care professionals in identifying working adults with cancer with cognitive symptoms and in developing personalized treatment.

Genetic Validation of Psoriasis Phenotyping in UK Biobank Supports the Utility of Self-Reported Data and Composite Definitions for Large Genetic and Epidemiological Studies

Genetic Validation of Psoriasis Phenotyping in UK Biobank Supports the Utility of Self-Reported Data and Composite Definitions for Large Genetic and Epidemiological Studies

Maternal education, self-reported illness concepts, health-seeking behaviours and breastfeeding practices of rural Nigerian market women

: Child mortality from infectious diseases is still high in Nigeria. Appropriate illness concepts (IC), healthseeking behaviours (HSB) and breastfeeding practices (BFP) of mothers are critical to addressing child mortality arising from infectious diseases. This study seeks to determine the relationship between mothers’ formal education and IC, HSB, BFP, family structure and parity, in market women in rural Plateau State, Nigeria, with a view to making policy recommendations from the data. A total of 993 women from three rural markets in Plateau State were effectively recruited and studied. A structured questionnaire was used to elicit information from the women. Appropriate descriptive and inferential statistical tools were used for data analyses. About 70% of the women had received some formal education while 62.4% of them reported an infectious disease in their homes within the month prior to the study. Exclusive breastfeeding for more than 6 months was practiced by 78% of the population. Almost all the mothers had appropriate IC (99%) and proper HSB (92%). Whereas length of formal education was significantly and negatively correlated with age of mother (r = −0.525; p < 0.001), number of children (r = −0.213; p < 0.001) and family structure (r = −0.494; p < 0.001), it was not significantly correlated with IC, HSB or BFP. Informal modes of education are apparently critical to the dissemination of messages related to proper IC, HSB and BFP among rural market women, and are thus recommended.

Assessing Behavioral Risk Factors Driving Zoonotic Spillover Among High-risk Populations in Myanmar.

The increasing global emergence of zoonoses warrants improved awareness of activities that predispose vulnerable communities to greater risk of disease. Zoonotic disease outbreaks regularly occur within Myanmar and at its borders partly due to insufficient knowledge of behavioral risks, hindering participatory surveillance and reporting. This study employed a behavioral surveillance strategy among high-risk populations to understand the behavioral risks for zoonotic disease transmission in an effort to identify risk factors for pathogen spillover. To explore behavioral mechanisms of spillover in Myanmar, we aimed to: (1) evaluate the details around animal contact and types of interaction, (2) assess the association between self-reported unusual symptoms (i.e., any illness or sickness that is not known or recognized in the community or diagnosed by medical providers) and animal contact activities and (3) identify the potential risk factors including behavioral practices of self-reported illness. Participants were enrolled at two community sites: Hpa-An and Hmawbi in Southern Myanmar. A behavioral questionnaire was administered to understand participants' animal exposures, behaviors and self-reported illnesses. From these responses, associations between (1) animal contact activities and self-reported unusual illnesses, and (2) potential risk factors and self-reported unusual illness were tested. Contact with poultry seemed to be very frequent (91.1%) and many participants reported raising, handling and having poultry in their houses as well as slaughtering or being scratched/bitten by them, followed by contact with rodents (57.8%) and swine (17.9%). Compared to participants who did not have any unusual symptoms, participants who had unusual symptoms in the past year were more likely to have sold dead animals (OR = 13.6, 95% CI 6.8-27.2), slaughtered (OR = 2.4, 95% CI 1.7-3.3), raised (OR = 3.4, 95% CI 2.3-5.0) or handled animals (OR = 2.1, 95% CI 1.2-3.6), and had eaten sick (OR = 4.4, 95% CI 3.0-6.4) and/or dead animals (OR = 6.0, 95% CI 4.1-8.8) in the same year. Odds of having reported unusual symptoms was higher among those involved in animal production business (OR = 3.4, 95% CI 1.9-6.2) and animal-involved livelihoods (OR = 3.3, 95% CI 1.5-7.2) compared to other livelihoods. The results suggest that there is a high level of interaction between humans, livestock and wild animals in communities we investigated in Myanmar. The study highlights the specific high-risk behaviors as they relate to animal contact and demographic risk factors for zoonotic spillover. Our findings contribute to human behavioral data needed to develop targeted interventions to prevent zoonotic disease transmission at human-animal interfaces.