Monitoring emerging pathogens using negative nucleic acid test results from endemic pathogens in pig populations: Application to porcine enteric coronaviruses.

This study evaluated the use of endemic enteric coronaviruses polymerase chain reaction (PCR)-negative testing results as an alternative approach to detect the emergence of animal health threats with similar clinical diseases presentation. This retrospective study, conducted in the United States, used PCR-negative testing results from porcine samples tested at six veterinary diagnostic laboratories. As a proof of concept, the database was first searched for transmissible gastroenteritis virus (TGEV) negative submissions between January 1st, 2010, through April 29th, 2013, when the first porcine epidemic diarrhea virus (PEDV) case was diagnosed. Secondly, TGEV- and PEDV-negative submissions were used to detect the porcine delta coronavirus (PDCoV) emergence in 2014. Lastly, encountered best detection algorithms were implemented to prospectively monitor the 2023 enteric coronavirus-negative submissions. Time series (weekly TGEV-negative counts) and Seasonal Autoregressive-Integrated Moving-Average (SARIMA) were used to control for outliers, trends, and seasonality. The SARIMA's fitted and residuals were then subjected to anomaly detection algorithms (EARS, EWMA, CUSUM, Farrington) to identify alarms, defined as weeks of higher TGEV-negativity than what was predicted by models preceding the PEDV emergence. The best-performing detection algorithms had the lowest false alarms (number of alarms detected during the baseline) and highest time to detect (number of weeks between the first alarm and PEDV emergence). The best-performing detection algorithms were CUSUM, EWMA, and Farrington flexible using SARIMA fitted values, having a lower false alarm rate and identified alarms 4 to 17 weeks before PEDV and PDCoV emergences. No alarms were identified in the 2023 enteric negative testing results. The negative-based monitoring system functioned in the case of PEDV propagating epidemic and in the presence of a concurrent propagating epidemic with the PDCoV emergence. It demonstrated its applicability as an additional tool for diagnostic data monitoring of emergent pathogens having similar clinical disease as the monitored endemic pathogens.

Risk factors associated with dengue complications and death: A cohort study in Peru.

BACKGROUND: Dengue has emerged as an unprecedented epidemic in Peru, and it is anticipated that this issue will escalate further owing to climate change. This study aimed to determine the risk factors associated with death from dengue in patients treated at Hospital II in Pucallpa, Peru. METHODOLOGY: This retrospective cohort study collected information from the medical records of patients with a diagnosis of dengue treated at Hospital II Pucallpa-Peru between January 2019 and March 2023. The primary outcome was death, and the secondary outcome was death, development of severe dengue, or Intensive Care Unit (ICU) admission. Cox regression models were used to determine risk factors. FINDINGS: The clinical records of 152 patients were evaluated, with a median age of 27.5 years (interquartile range, 11-45). Among all patients, 29 (19.1%) developed severe dengue, 31 (20.4%) were admitted to the ICU, and 13 (8.6%) died during follow-up. In the survival analysis, bilirubin >1.2 mg/dL was associated with a higher risk of death aHR: 11.38 (95% CI: 1.2 106.8). Additionally, factors associated with poor prognosis included having 1 to 3 comorbidities aRR: 1.92 (1.2 to 3.2), AST ≥251 U/L aRR: 6.79 (2.2 to 21.4), history of previous dengue aRR: 1.84 (1.0 to 3.3), and fibrinogen ≥400 mg/dL aRR: 2.23 (1.2 to 4.1). SIGNIFICANCE: Elevated bilirubin was associated with death from dengue, whereas an increase in comorbidities and a history of previous dengue were related to a poor prognosis of the disease. Early identification of severe dengue would be more feasible with improved access to laboratory testing, particularly in tropical areas with a high dengue incidence.

Fungal infections in patients after recovering from COVID-19: a systematic review.

Background and aims: The presence of fungal infections has been described in patients after recovering from COVID-19. This study aims to conduct a systematic review of studies that reported fungal infections (Mucor spp., Pneumocystis jirovecii, or Aspergillus spp.) in adults after recovering from COVID-19. Methods: We performed a systematic review through PubMed, Web of Science, OVID-Medline, Embase, and Scopus. The study selection process was performed independently and by at least two authors. We performed a risk of bias assessment using the Newcastle-Ottawa Scale for cohort and case-control studies, and the Joanna Briggs Institute's Checklists for Case Series and Case Reports. Results: The systematic search found 33 studies meeting all inclusion criteria. There was a total population of 774 participants, ranging from 21 to 87 years. From them, 746 developed a fungal infection. In 19 studies, Mucor spp. was reported as the main mycosis. In 10 studies, P. jirovecii was reported as the main mycosis. In seven studies, Aspergillus spp. was reported as the main mycosis. Regarding the quality assessment, 12 studies were classified as low risk of bias and the remaining studies as high risk of bias. Conclusion: Patients' clinical presentation and prognosis after recovering from COVID-19 with fungal infection differ from those reported patients with acute COVID-19 infection and those without COVID-19 infection.

Mpox infection in animals: A systematic review and meta-analysis.

Mpox is a zoonotic disease that became epidemic in multiple countries in 2022. There is a lack of published systematic reviews on natural animal infection due to Mpox. We performed a systematic literature review with meta-analysis to assess animal Mpox prevalence. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI) for prevalence studies. After the screening, 15 reports were selected for full-text assessment and included in qualitative and quantitative analyses. Ten reports assessed Mpox infection by molecular or serological tests (n = 2680), yielding a pooled prevalence of 16.0% (95%CI: 3.0-29.0%) for non-human primates; 8.0% (95%CI: 4.0-12.0%) for rodents and 1.0% (95%CI: 0.0-3.0%) for shrews. Further studies in other animals are required to define the extent and importance of natural infection due to Mpox. These findings have implications for public human and animal health. OneHealth approach is critical for prevention and control.

Quality of life and its associated factors in chronic kidney disease patients undergoing hemodialysis from a Peruvian city: A cross-sectional study.

OBJECTIVE: To assess quality of life and explore its associated factors in a group of patients with chronic kidney disease (CKD) undergoing hemodialysis in Peru. METHODOLOGY: We conducted a cross-sectional analysis of patients with CKD treated at two medical centers in Tacna, Peru; between July and September 2023. We conducted a survey via telephone interviews with eligible patients using the Short Form 36 (SF 36) to assess their quality of life. RESULTS: Of 257 patients with CKD undergoing hemodialysis, we successfully interviewed 207 (59.9% males, median age: 62 years, median time on hemodialysis: 3.5 years). In the context of the SF-36 assessment, the dimensions with the lowest scores were physical role (mean: 13.9), emotional role (32.2), and physical function (32.4). Regarding the SF-36 summary scores, the average scores were 42.2 in the mental health domain and 32.0 in the physical health domain. In the adjusted model, the physical health domain score was higher in males (ß = 2.7) and those with economic self-sufficiency (ß = 3.0) and lower in older adults (ß = -2.5). The score in the mental health domain was higher in those with a higher level of education (ß = 4.1), in those with economic self-sufficiency (ß = 3.8), and in those receiving care at one of the centers included (ß: 4.2). CONCLUSION: Quality of life was affected, particularly in the realms of physical and emotional well-being. Furthermore, both the physical and mental health domains tend to show lower scores among women, older individuals, those lacking economic self-sufficiency, individuals with lower educational levels, and those with comorbidities.

Porcine Deltacoronavirus Occurrence in the United States Breeding Herds since Its Emergence in 2014.

PDCoV, an enveloped RNA virus, causes atrophic enteritis in neonatal piglets, leading to diarrhea, malabsorption, dehydration, and death. The study aims to fill the gap in the current epidemiological information about PDCoV in the U.S. pig population after its emergence in 2014. Data from the Morrison Swine Health Monitoring Project (MSHMP) between January 2015 and December 2023 were analyzed, representing approximately 60% of the U.S. breeding herd. Participating herds report weekly PDCoV health status. In total, 244 PDCoV outbreaks occurred in 186 sites from 22 production systems across 16 states. Case counts peaked during winter, and incidence ranged from 0.44% in 2017 to 4.28% in 2023. For sites that experienced more than one PDCoV outbreak during the study period, the interval between outbreaks was a median of 2.11 years. The South and Midwest regions reported the majority of cases. In 2017, a shift in the spatial distribution of cases from the Midwest to the South was observed. The findings underscore the importance of continued monitoring and strengthened control measures to mitigate the impact of PDCoV in U.S. breeding herds.

Improvements in swine herd biosecurity reduce the incidence risk of porcine reproductive and respiratory syndrome virus in breeding herds in the Midwestern United States.

OBJECTIVE: Porcine reproductive and respiratory syndrome (PRRS) is a significant disease of swine. The purpose of this study was to determine whether application of a comprehensive, science-based approach to breeding herd biosecurity, known as next-generation biosecurity (NGB), could reduce PRRS incidence risk across a large commercial production company. ANIMALS: Pigs (381,404 sows across 76 breeding herds). METHODS: From 2009 to 2020, the annual incidence risk of PRRS in sow farms managed by the same company averaged 33%, ranging from 20% to 50%. To measure the effect of NGB on PRRS incidence risk, a retrospective cohort study was conducted from July 1, 2021, to June 30, 2023, across breeding herds managed by the same company. During the analysis, 2 groups of herds emerged: those that implemented protocols for all phases of NGB (NGB COMPLETE), and those that implemented all described protocols of biosecurity except for air filtration (NGB INCOMPLETE). RESULTS: During the 2-year assessment period, 56 breeding herds were classified as NGB COMPLETE, while 20 herds were NGB INCOMPLETE. The PRRS incidence risk in NGB COMPLETE herds was 8.9% as compared to 40.0% in NGB INCOMPLETE herds. From disease year 1 (July 1, 2021, to June 30, 2022) and disease year 2 (July 1, 2022, to June 30, 2023), system-wide PRRS incidence risk was 8.6% and 9.2%, respectively. The association between NGB status and PRRS incidence risk for the 2-year period was statistically significant at a P value of .006. CLINICAL RELEVANCE: Results of the present report provided evidence that improvements in biosecurity result in lower PRRS incidence risk under large-scale commercial swine production conditions.

First assessment of weeks-to-negative processing fluids in breeding herds after a Senecavirus A outbreak.

Senecavirus A (SVA) causes vesicular disease in swine and has been responsible for a rampant increase in the yearly number of foreign animal disease investigations conducted in the United States. Diagnostic investigations for SVA are typically performed by sampling animals individually, which is labor-intensive and stressful. Developing an alternative aggregate sampling method would facilitate the detection of this virus at the population level. In a preliminary study, SVA was detected in processing fluids (PF) collected in a breeding herd before and after outbreak detection. The objective of this study was to estimate the average number of weeks PF remain SVA-positive after an SVA outbreak. Ten farrow-to-wean breeding herds volunteered to participate in this studyby longitudinally collecting PF samples after an SVA outbreak was detected and submitting samples for RT-rtPCR testing. The PF samples from the 10 farms were SVA-positive for an average of 11.8 weeks after the outbreak. Here, we show that testing of PF may be a cost-effective method to detect SVA and help halt its spread in SVA-endemic regions.

Survival of Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) in the Environment.

Porcine reproductive and respiratory syndrome (PRRS) is one of the most economically important diseases of swine, with losses due to poor reproductive performance and high piglet and growing pig mortality. Transmission of porcine reproductive and respiratory syndrome virus (PRRSV) may occur by both direct and indirect routes; the latter includes exposure to PRRSV-contaminated fomites, aerosols, and arthropod vectors. This review has collected available data on the ex-vivo environmental stability and persistence of PRRSV in an effort to highlight important sources of the virus and to determine the role of environmental conditions on the stability of the virus, especially temperature. The ex-vivo settings include fomites (solid, porous, and liquid fomites), insects, people, and pork meat, as well as the role of environmental conditions on the stability of the virus, especially temperature.

Unveiling invisible farm-to-farm PRRSV-2 transmission links and routes through transmission tree and network analysis.

The United States (U.S.) swine industry has struggled to control porcine reproductive and respiratory syndrome (PRRS) for decades, yet the causative virus, PRRSV-2, continues to circulate and rapidly diverges into new variants. In the swine industry, the farm is typically the epidemiological unit for monitoring, prevention, and control; breaking transmission among farms is a critical step in containing disease spread. Despite this, our understanding of farm transmission still is inadequate, precluding the development of tailored control strategies. Therefore, our objective was to infer farm-to-farm transmission links, estimate farm-level transmissibility as defined by reproduction numbers (R), and identify associated risk factors for transmission using PRRSV-2 open reading frame 5 (ORF5) gene sequences, animal movement records, and other data from farms in a swine-dense region of the U.S. from 2014 to 2017. Timed phylogenetic and transmission tree analyses were performed on three sets of sequences (n = 206) from 144 farms that represented the three largest genetic variants of the virus in the study area. The length of inferred pig-to-pig infection chains that corresponded to pairs of farms connected via direct animal movement was used as a threshold value for identifying other feasible transmission links between farms; these links were then transformed into farm-to-farm transmission networks and calculated farm-level R-values. The median farm-level R was one (IQR = 1-2), whereas the R value of 28% of farms was more than one. Exponential random graph models were then used to evaluate the influence of farm attributes and/or farm relationships on the occurrence of farm-to-farm transmission links. These models showed that, even though most transmission events cannot be directly explained by animal movement, movement was strongly associated with transmission. This study demonstrates how integrative techniques may improve disease traceability in a data-rich era by providing a clearer picture of regional disease transmission.

Emergent Molecular Techniques Applied to the Detection of Porcine Viruses.

Molecular diagnostic tests have evolved very rapidly in the field of human health, especially with the arrival of the recent pandemic caused by the SARS-CoV-2 virus. However, the animal sector is constantly neglected, even though accurate detection by molecular tools could represent economic advantages by preventing the spread of viruses. In this regard, the swine industry is of great interest. The main viruses that affect the swine industry are described in this review, including African swine fever virus (ASFV), porcine reproductive and respiratory syndrome virus (PRRSV), porcine epidemic diarrhea virus (PEDV), and porcine circovirus (PCV), which have been effectively detected by different molecular tools in recent times. Here, we describe the rationale of molecular techniques such as multiplex PCR, isothermal methods (LAMP, NASBA, RPA, and PSR) and novel methods such as CRISPR-Cas and microfluidics platforms. Successful molecular diagnostic developments are presented by highlighting their most important findings. Finally, we describe the barriers that hinder the large-scale development of affordable, accessible, rapid, and easy-to-use molecular diagnostic tests. The evolution of diagnostic techniques is critical to prevent the spread of viruses and the development of viral reservoirs in the swine industry that impact the possible development of future pandemics and the world economy.

Fetal death and its association with indicators of social inequality: 20-year analysis in Tacna, Peru.

OBJECTIVE: The aim of this study was to evaluate the rates of fetal mortality in a Peruvian hospital between 2001 and 2020 and to investigate the association of indicators of social inequality (such as access to prenatal care and education) with fetal mortality. METHODOLOGY: We conducted a retrospective cohort study, including all pregnant women who attended a Peruvian hospital between 2001 and 2020. We collected data from the hospital's perinatal computer system. We used Poisson regression models with robust variance to assess the associations of interest, estimating adjusted relative risks (aRR) and their 95% confidence intervals (95% CI). RESULTS: We analyzed data from 67,908 pregnant women (median age: 26, range: 21 to 31 years). Of these, 58.3% had one or more comorbidities; the most frequent comorbidities were anemia (33.3%) and urinary tract infection (26.3%). The fetal mortality ratio during the study period was 0.96%, with the highest rate in 2003 (13.7 per 1,000 births) and the lowest in 2016 (6.1 per 1,000 births), without showing a marked trend. Having less than six (aRR: 4.87; 95% CI: 3.99-5.93) or no (aRR: 7.79; 6.31-9.61) prenatal care was associated with higher fetal mortality compared to having six or more check-ups. On the other hand, higher levels of education, such as secondary education (aRR: 0.73; 0.59-0.91), technical college (aRR: 0.63; 0.46-0.85), or university education (aRR: 0.38; 0.25-0.57) were associated with a lower risk of fetal death compared to having primary education or no education. In addition, a more recent year of delivery was associated with lower fetal mortality. CONCLUSION: Our study presents findings of fetal mortality rates that are comparable to those observed in Peru in 2015, but higher than the estimated rates for other Latin American countries. A more recent year of delivery was associated with lower fetal mortality, probably due to reduced illiteracy and increased access to health care between 2000 and 2015. The findings suggest a significant association between indicators of social inequality (such as access to prenatal care and education) with fetal mortality. These results emphasize the critical need to address the social and structural determinants of health, as well as to mitigate health inequities, to effectively reduce fetal mortality.

Porcine Reproductive and Respiratory Syndrome (PRRSV2) Viral Diversity within a Farrow-to-Wean Farm Cohort Study.

Describing PRRSV whole-genome viral diversity data over time within the host and within-farm is crucial for a better understanding of viral evolution and its implications. A cohort study was conducted at one naïve farrow-to-wean farm reporting a PRRSV outbreak. All piglets 3-5 days of age (DOA) born to mass-exposed sows through live virus inoculation with the recently introduced wild-type virus two weeks prior were sampled and followed up at 17-19 DOA. Samples from 127 piglets were individually tested for PRRSV by RT-PCR and 100 sequences were generated using Oxford Nanopore Technologies chemistry. Female piglets had significantly higher median Ct values than males (15.5 vs. 13.7, Kruskal-Wallis p < 0.001) at 3-5 DOA. A 52.8% mortality between sampling points was found, and the odds of dying by 17-19 DOA decreased with every one unit increase in Ct values at 3-5 DOA (OR = 0.76, 95% CI 0.61-0.94, p = 0.01). Although the within-pig percent nucleotide identity was overall high (99.7%) between 3-5 DOA and 17-19 DOA samples, ORFs 4 and 5a showed much lower identities (97.26% and 98.53%, respectively). When looking solely at ORF5, 62% of the sequences were identical to the 3-5 DOA consensus. Ten and eight regions showed increased nucleotide and amino acid genetic diversity, respectively, all found throughout ORFs 2a/2b, 4, 5a/5, 6, and 7.

Spatiotemporal relative risk distribution of porcine reproductive and respiratory syndrome virus in the United States.

Porcine reproductive and respiratory syndrome virus (PRRSV) remains widely distributed across the U.S. swine industry. Between-farm movements of animals and transportation vehicles, along with local transmission are the primary routes by which PRRSV is spread. Given the farm-to-farm proximity in high pig production areas, local transmission is an important pathway in the spread of PRRSV; however, there is limited understanding of the role local transmission plays in the dissemination of PRRSV, specifically, the distance at which there is increased risk for transmission from infected to susceptible farms. We used a spatial and spatiotemporal kernel density approach to estimate PRRSV relative risk and utilized a Bayesian spatiotemporal hierarchical model to assess the effects of environmental variables, between-farm movement data and on-farm biosecurity features on PRRSV outbreaks. The maximum spatial distance calculated through the kernel density approach was 15.3 km in 2018, 17.6 km in 2019, and 18 km in 2020. Spatiotemporal analysis revealed greater variability throughout the study period, with significant differences between the different farm types. We found that downstream farms (i.e., finisher and nursery farms) were located in areas of significant-high relative risk of PRRSV. Factors associated with PRRSV outbreaks were farms with higher number of access points to barns, higher numbers of outgoing movements of pigs, and higher number of days where temperatures were between 4°C and 10°C. Results obtained from this study may be used to guide the reinforcement of biosecurity and surveillance strategies to farms and areas within the distance threshold of PRRSV positive farms.

Imposter syndrome and its associated factors in medical students in six Peruvian faculties.

OBJECTIVE: To determine the factors associated with impostor syndrome in medical students from six regions of Peru. MATERIAL AND METHODS: A multicentre, cross-sectional study was conduced on students from first to the sixth year in six Peruvian regions. Sociodemographic, academic, and psychological characteristics were included through the Depression, Anxiety, and Stress Scale-21, the Rosenberg Self-Esteem Scale and the Clance Imposter Phenomenon Scale. Generalised linear models were performed using crude and adjusted estimated prevalence ratios. RESULTS: Of 2,231 medical students, 54.3% were female and 30.6% had the impostor phenomenon. An association was found between the PI and those who suffered from depression (aPR=1.51; 95%CI, 1.27-1.79), anxiety (aPR=2.25; 95%CI, 1.75-2.90), stress (aPR=1.37; 95%CI, 1.19-1.57), and being female (aPR=1.12; 95%CI, 1.01-1.26). CONCLUSIONS: Three out of 10 medical students suffer from PI; having some level of depression, anxiety, stress, being a woman, and/or attending the fourth academic year were predisposing factors for their development.

Disentangling transport movement patterns of trucks either transporting pigs or while empty within a swine production system before and during the COVID-19 epidemic.

Transport of pigs between sites occurs frequently as part of genetic improvement and age segregation. However, a lack of transport biosecurity could have catastrophic implications if not managed properly as disease spread would be imminent. However, there is a lack of a comprehensive study of vehicle movement trends within swine systems in the Midwest. In this study, we aimed to describe and characterize vehicle movement patterns within one large Midwest swine system representative of modern pig production to understand movement trends and proxies for biosecurity compliance and identify potential risky behaviors that may result in a higher risk for infectious disease spread. Geolocation tracking devices recorded vehicle movements of a subset of trucks and trailers from a production system every 5 min and every time tracks entered a landmark between January 2019 and December 2020, before and during the COVID-19 pandemic. We described 6,213 transport records from 12 vehicles controlled by the company. In total, 114 predefined landmarks were included during the study period, representing 5 categories of farms and truck wash facilities. The results showed that trucks completed the majority (76.4%, 2,111/2,762) of the recorded movements. The seasonal distribution of incoming movements was similar across years (P > 0.05), while the 2019 winter and summer seasons showed higher incoming movements to sow farms than any other season, year, or production type (P < 0.05). More than half of the in-movements recorded occurred within the triad of sow farms, wean-to-market stage, and truck wash facilities. Overall, time spent at each landmark was 9.08% higher in 2020 than in 2019, without seasonal highlights, but with a notably higher time spent at truck wash facilities than any other type of landmark. Network analyses showed high connectivity among farms with identifiable clusters in the network. Furthermore, we observed a decrease in connectivity in 2020 compared with 2019, as indicated by the majority of network parameter values. Further network analysis will be needed to understand its impact on disease spread and control. However, the description and quantification of movement trends reported in this study provide findings that might be the basis for targeting infectious disease surveillance and control.

Estimating the effectiveness of control actions on African swine fever transmission in commercial swine populations in the United States.

Given the proximity of African swine fever (ASF) to the U.S., there is an urgent need to better understand the possible dissemination pathways of the virus within the U.S. swine industry and to evaluate mitigation strategies. Here, we extended PigSpread, a farm-level spatially-explicit stochastic compartmental transmission model incorporating six transmission routes including between-farm swine movements, vehicle movements, and local spread, to model the dissemination of ASF. We then examined the effectiveness of control actions similar to the ASF national response plan. The average number of secondary infections during the first 60 days of the outbreak was 49 finisher farms, 17 nursery farms, 5 sow farms, and less than one farm in other production types. The between-farm movements of swine were the predominant route of ASF transmission with an average contribution of 71.1%, while local spread and movement of vehicles were less critical with average contributions of 14.6% and 14.4%. We demonstrated that the combination of quarantine, depopulation, movement restrictions, contact tracing, and enhanced surveillance, was the most effective mitigation strategy, resulting in an average reduction of 79.0% of secondary cases by day 140 of the outbreak. Implementing these control actions led to a median of 495,619 depopulated animals, 357,789 diagnostic tests, and 54,522 movement permits. Our results suggest that the successful elimination of an ASF outbreak is likely to require the deployment of all control actions listed in the ASF national response plan for more than 140 days, as well as estimating the resources needed for depopulation, testing, and movement permits under these controls.

Síndrome del impostor y sus factores asociados en estudiantes de Medicina de seis facultades peruanas

Objetivo: Determinar los factores asociados con el síndrome del impostor (IP) en estudiantes de Medicina de 6 facultades peruanas. Material y métodos: Estudio multicéntrico transversal analítico realizado en estudiantes del primer al sexto año en 6 regiones peruanas. Se incluyeron características sociodemográficas, académicas y psicológicas mediante la escala de depresión, ansiedad y estrés, la escala de autoestima de Rosenberg y la escala del Fenómeno del Impostor de Clance. Los modelos lineales generalizados se construyeron mediante razones de prevalencia estimada brutas y ajustadas. Resultados: De 2.231 estudiantes de Medicina, el 54,3% eran mujeres y el 30,6% padecía IP. Se encontró asociación entre el IP y la depresión (RPa = 1,51; IC95%, 1,27-1,79), la ansiedad (RPa = 2,25; IC95%, 1,75-2,90), el estrés (RPa = 1,37; IC95%, 1,19-1,57) y el sexo mujer (RPa = 1,12; IC95%, 1,01-1,26). Conclusiones: De cada 10 estudiantes de Medicina, 3 sufren IP; tener depresión, ansiedad o estrés, ser mujer y/o cursar el cuarto anno fueron los factores predisponentes.

Objective: To determine the factors associated with impostor syndrome in medical students from six regions of Peru. Material and methods: A multicentre, cross-sectional study was conduced on students from first to the sixth year in six Peruvian regions. Sociodemographic, academic, and psychological characteristics were included through the Depression, Anxiety, and Stress Scale-21, the Rosenberg Self-Esteem Scale and the Clance Imposter Phenomenon Scale. Generalized linear models were performed using crude and adjusted estimated prevalence ratios. Results: Of 2,231 medical students, 54.3% were female and 30.6% had the impostor phenomenon. An association was found between the PI and those who suffered from depression (aPR=1.51; 95%CI, 1.27-1.79), anxiety (aPR = 2.25; 95%CI, 1.75-2.90), stress (aPR=1.37; 95%CI, 1.19-1.57), and being female (aPR = 1.12; 95%CI, 1.01-1.26). Conclusions: Three out of 10 medical students suffer from PI; having some level of depression, anxiety, stress, being a woman, and/or attending the fourth academic year were predisposing factors for their development.

Farm management practices associated with influenza A virus contamination of people working in Midwestern United States swine farms.

Indirect transmission of influenza A virus (IAV) contributes to virus spread in pigs. To identify farm management activities with the ability to contaminate farmworkers' hands and clothing that then could be a source of virus spread to other pigs, we conducted a within-farm, prospective IAV surveillance study. Hands and clothes from farmworkers performing the activities of piglet processing, vaccination, or weaning were sampled before and after the activities were performed. Samples were tested by IAV rRT-PCR and virus viability was assessed by cell culture. A multivariate generalized linear model was used to detect associations of the activities with IAV contamination. Of the samples collected for IAV rRT-PCR testing, there were 16% (12/76) collected immediately after processing, 96% (45/48) collected after vaccination, and 94% (29/31) collected after weaning that tested positive. Samples collected immediately after vaccination and weaning, i.e., activities that took place during the peri-weaning period when pigs were about 3 weeks of age, had almost 6 times higher risk of IAV detection and had more samples IAV positive (p-value < 0.0001) than samples collected after processing, i.e., an activity that took place in the first few days of life. Both, hands and clothes had similar contamination rates (46% and 55% respectively, p-value = 0.42) and viable virus was isolated from both. Our results indicate that activities that involve the handling of infected piglets close to weaning age represent a significant risk for IAV dissemination due to the high level of IAV contamination found in farmworkers' hands and coveralls involved in the activities. Biosecurity protocols that include hand sanitation and changing clothing after performing activities with a high-risk of influenza contamination should be recommended to farmworkers to control and limit the mechanical spread of IAV between pigs.

Mapping the Dynamics of Contemporary PRRSV-2 Evolution and Its Emergence and Spreading Hotspots in the U.S. Using Phylogeography.

The repeated emergence of new genetic variants of PRRSV-2, the virus that causes porcine reproductive and respiratory syndrome (PRRS), reflects its rapid evolution and the failure of previous control efforts. Understanding spatiotemporal heterogeneity in variant emergence and spread is critical for future outbreak prevention. Here, we investigate how the pace of evolution varies across time and space, identify the origins of sub-lineage emergence, and map the patterns of the inter-regional spread of PRRSV-2 Lineage 1 (L1)-the current dominant lineage in the U.S. We performed comparative phylogeographic analyses on subsets of 19,395 viral ORF5 sequences collected across the U.S. and Canada between 1991 and 2021. The discrete trait analysis of multiple spatiotemporally stratified sampled sets (n = 500 each) was used to infer the ancestral geographic region and dispersion of each sub-lineage. The robustness of the results was compared to that of other modeling methods and subsampling strategies. Generally, the spatial spread and population dynamics varied across sub-lineages, time, and space. The Upper Midwest was a main spreading hotspot for multiple sub-lineages, e.g., L1C and L1F, though one of the most recent emergence events (L1A(2)) spread outwards from the east. An understanding of historical patterns of emergence and spread can be used to strategize disease control and the containment of emerging variants.