Seroprevalence of brucellosis and risk factors associated with its seropositivity in cattle, goats and humans in Iganga District, Uganda.

INTRODUCTION: The burden of brucellosis among smallholder farmers is poorly-documented in Uganda. The disease burden is likely to be high, given the high levels of endemicity, lots of exposures and due to lack of control measures. In order to designate appropriate control measures, the magnitude and risk factors for brucellosis need to be known. We established the burden of and risk factors for Brucella seropositivity in cattle, goats, and humans in Iganga district, eastern Uganda. METHODS: A cross-sectional study was conducted in in Kigulamo Parish, Iganga District. We enrolled 226 households and administered a structured questionnaire to heads of households to capture data on socio-demographic characteristics, human brucellosis-related risk factors, and livestock farming practices. Human, cattle, and goat blood samples were collected and tested serologically using commercial indirect-ELISA kits manufactured by USDA, USA. RESULTS: Of 451 human blood samples, 20 (4.4%) were positive. Among 345 cattle blood samples, 4 (1.2%) were positive and among 351 goat blood samples, one (0.3%) was positive. Persons who reported consuming locally-made dairy products had 4 times higher odds of Brucella seropositivity (OR = 4.0, CI = 1.14-14.03, p = 0.031) than those who did not. None of the risk factors we asked about were significantly associated with seropositivity in cattle and goats. CONCLUSION: The seroprevalence of brucellosis in humans in smallholder households in Kigulamo was relatively low and associated with consumption of locally made dairy products. No risk factors were significantly associated with seropositivity in livestock, likely due to the small number of seropositive animals. We recommend a One Health approach to control brucellosis simultaneously in animals and humans needed to sustainably reduce the burden of brucellosis in Uganda and beyond.

Cattle-associated risk factors for human tuberculosis in rural livestock-keeping communities, Uganda.

Tuberculosis (TB) is a leading infectious cause of human death worldwide. In cattle, TB infection results in productivity losses, trade barriers and zoonotic transmission via milk, meat or direct contact. We conducted a cross-sectional study in rural communities in Uganda between 2014 and 2016 to evaluate the association between tuberculosis skin test (TST) positivity in humans and cattle-associated risk factors: household herd positivity and raw milk consumption. Human and cattle TSTs were performed in communities followed by a survey of household practices. TST data were available on 493 humans, 184 (37.3%) with positive results, and 1,441 cattle, 50 (3.5%) with positive results. We fit separate log binomial generalized estimating equation models for the herd positivity-human TST positivity association, stratified on sex; and for the raw milk consumption-human TST positivity association, stratified on frequency of milk consumption. Having at least one TST-positive bovid in the household's herd was significantly associated with lower risk of TB among men (prevalence ratio [PR] 0.66, 95% CI 0.49, 0.87) but was not significantly associated with TB among women (PR 1.21, 95% CI 0.76, 1.95). This apparent protective effect was contrary to our a priori hypothesis of higher exposure effect among men, the primary caretakers of cattle. This finding may be the result of residual confounding by socioeconomic status; wealthier individuals may be less likely to be TB positive, but more likely to have TST-positive herds by virtue of larger herd sizes, ability to purchase new and possibly infected stock, and propensity to keep more TB-susceptible European breeds. For raw milk consumption, effect estimates were close to one and not statistically significant. Thus, in settings where bovine TB prevalence is low, such as Uganda, cattle-associated zoonotic transmission may be rare, and cattle-associated risk factors may not be important drivers of human TB burden.

Occupational Practices and Hazards of Rural Livestock Keepers in Uganda: A Cross-Sectional Study.

OBJECTIVE: In Uganda, 70% of rural poor rely on livestock for subsistence, to meet social obligations, and to insure against disaster. Livestock farming in Africa is in a state of transition from traditional management systems toward intensified modern systems, calling into question the future of traditional systems. To inform this debate, we conducted a survey in Moyo District, Uganda, to describe occupational practices and hazards of agropastoralist livestock keepers. METHODS: Household surveys were administered to heads of household (N=49) from July to September 2016. Cross-sectional data were used to generate descriptive statistics for livestock-associated practices and exposures. Logistic regression was used to estimate odds ratios and Wald-type 95% confidence intervals for risk factors for injury, defined as any animal-related injury in the household in the past year. Risk factors studied were total number of male animals; number of male cattle, sheep/goats, and pigs; proportion male by herd size; herd size; and castration practices. RESULTS: Adult men perform most livestock-associated tasks, while women, girls, and boys prepare meat, milk cattle, care for poultry, and dispose of waste. While 31 (63%) of households use professional veterinary services and most (n=28, 57.2%) are familiar with zoonoses, 25 (53.2%) do not believe sick animals may look healthy. Over 85.0% (n=41) of respondents routinely wash their hands, while only 31 (64.6%) use soap. Twenty-eight (57.0%) reported using personal protective equipment, while none used gloves or face protection. Most respondents had contact with animal waste "often", and had contact with urine and blood "sometimes". Six (12%) reported a needlestick injury while treating an animal, and 22 (45%) reported at least 1 injury from an animal. No significant association was found between the risk factors studied and animal injury, after adjustment for confounders. CONCLUSIONS: Occupational risks for female and young agropastoralists are distinct from those of men. Contact with potentially infectious material is common and current practices - handwashing without soap and low glove use - do little to prevent zoonotic transmission. While agropastoralists are familiar with zoonoses, subclinical infections may be missed. While no significant risk factors were identified for animal injury, both animal and needlestick injuries are common. As livestock agriculture intensifies, these hazards will become more pronounced; drivers of risk behavior and animal injury must be identified to inform interventions to improve the occupational health of rural livestock keepers in Uganda.

Surgical rotations: the good, the bad, and the ugly.

BACKGROUND: Every surgeon's career begins with a surgical residency. Each residency has dreaded rotations as well as those that seem ideal, but to date, no objective criteria exist to define such rotations. The aim of this study is to establish objective criteria that, when applied to a specific rotation, will define it as a "dream" or a "dreaded" rotation and, in the process, elucidate the good, the bad, and the ugly of surgical rotations in general. METHODS: All 39 residents from a multi-institutional residency program were asked to collaboratively identify the criteria they felt necessary for a dream rotation. Each resident evaluated 16 rotations at 4 hospitals using the identified criteria on a scale of "Inadequate," "Optimal," and "Ideal/Dream Rotation." Residents then gave an overall evaluation of each rotation as a dream rotation on a scale of "No," "For the Most Part," or "Yes." Finally, each resident was asked whether the individual rotations were following ACGME recommendations on duty hours. RESULTS: The best correlations with a dream rotation were: clinical experience - quality and quantity of cases (r = 0.83), operative experience (r = 0.83), patient management responsibilities (r = 0.78), and outpatient office experience (r = 0.77). All p-values were < 0.05. The following correlated less with a dream rotation: conferences (r = 0.56, p < 0.05), medical student experience (r = 0.56, p < 0.05), and hospital facilities (r = 0.28, not significant.). Scut work was the only category for which there was a negative correlation with a dream rotation (r = -0.53, p < 0.05). Eighty-six percent of residents reported compliance with ACGME work hour recommendations, with no apparent correlation with a dream rotation.

Faculty evaluations: diagnostic and therapeutic.

PURPOSE: An excellent teaching program is one that creates an atmosphere of mentorship, leadership, and professional development. The key to all of these may lie in the faculty evaluation. Currently, favorable faculty evaluations are often rewarded, whereas the more critical evaluations are downplayed and seldom used for faculty development. The purpose of this study is to investigate the efficacy of the faculty evaluation as a diagnostic tool to objectively identify individual strengths and weaknesses. Can such a tool then be used as a therapeutic modality to improve and enhance the faculty as a whole? METHODS: Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. They then anonymously evaluated each of the 44 teaching attendings on each of the 9 criteria. The results of the evaluations, which consisted of the overall mean scores and SD for each of the 9 criteria, the attending's score and SDs above or below the mean, as well as whether the residents considered them to be a Role Model, were sent to each faculty member as an intervention. Six months after the intervention, the residents evaluated the attendings using the same 9 criteria. Evaluations were collected and analyzed following the same procedure as 6 months prior. T-tests and p-values were calculated to determine any significant differences between the 2 data sets. RESULTS: Based on the results of the pre-intervention evaluations, we were able to delineate faculty members into 3 groups based on their Role Model score. Of the 10 faculty members with the lowest scores (defined as >1 SD below average), 7 improved after the intervention, 3 of them were statistically significant (2 with p < 0.05 and 1 with p < 0.10). In the middle group of 26 faculty members, 1 showed statistically significant improvement (p < 0.05). Interestingly, this was the faculty member with the lowest score in this group. Six faculty originally in the middle group improved to a score greater than 1 SD above average, defining them as a Role Model. The remaining 8 faculty members originally designated as Role Models showed no statistically significant changes in their scores after the intervention. After the intervention, the average score improved for all of the 9 criteria that make a faculty Role Model. Statistically significant improvements were seen in the categories of Provides Feedback (p < 0.05) and Didactic Teaching, Attendance at Didactic activities, and Stimulates Critical Thinking with the Use of Literature (all p < 0.10). CONCLUSIONS: (1) Faculty evaluations are a diagnostic tool with the ability to select out Role Models from the lower scoring groups. (2) After the intervention, the overall average score improved for all of the 9 criteria that make a Role Model, showing improvement of the faculty as a whole. (3) The therapeutic benefits of faculty evaluations were best seen in the faculty with the lowest scores.

Are you a surgical role model?

PURPOSE: Multiple papers have examined the recent decline in the number of surgical residency applicants. Many have concluded that a lack of role models in surgery is at least partially responsible for this decline. However, to date, the definition of a surgical role model does not exist. This paper defines a surgical role model based on criteria determined by surgery residents. METHODS: Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. The 9 criteria as defined by the residents were didactic teaching, teaching rounds, attendance at didactic activities, demonstrates skills and decision making in the operating room with confidence and virtuosity, allows [resident] to do procedures according to ability, allows autonomy to make independent decisions, provides feedback, stimulates critical thinking with use of literature, and assists [resident] to find and complete research for publication. Each resident in the program was then given a questionnaire and asked to evaluate each of the 49 teaching attendings on each of the 9 criteria, on a 3-point scale. Finally, residents evaluated each attending based on professionalism and mutual respect on a scale of I Don't Want To Emulate Him/Her, OK, or Role Model. These categories were also assigned a number (1, 2, and 3, respectively). Pearson correlation and stepwise multiple regression were used to determine the relationship between "Role Model" and the 9 criteria. The unit of analysis was the mean rating given each attending on each of the 10 scales. RESULTS: A total of 847 questionnaires were analyzed. Each of the 9 criteria correlated significantly with the Role Model rating (all p < 0.01). The average correlation was 0.73 (range, 0.64 to 0.78). Of the 9 criteria, 4 correlated best with the Role Model, as shown in. The stepwise regression indicates that 3 of the 9 criteria are uniquely associated with the Role Model variable. These 3 criteria are stimulates critical thinking with use of literature, allows autonomy to make independent decisions, and attendance at didactic activities. CONCLUSIONS: All of the 9 criteria are important factors in residents' perception of the Role Model characteristics of attending faculty. A parsimonious, operational definition of the surgical attending role model is one who stimulates the resident to think, gives the resident the opportunity to think and act independently, and is available to the resident.

The effects of coffee on enzymes involved in metabolism of the dietary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine in rats.

The effects of coffee on the metabolism and genotoxicity of the dietary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) were investigated. Coffee diminished the bacterial mutagenicity of PhIP in the Ames reversion assay through inhibition of cytochrome P450 1A2 (CYP1A2), a key enzyme involved in the metabolic activation of PhIP. When given as part of the diet (0, 1 or 5% w/w) to male Fischer-344 rats for 2 weeks, coffee affected the expression of hepatic enzymes involved in PhIP metabolism. Coffee increased the expression of CYP1A2 by 16-fold in the 5% coffee-treated group, and approximately half of this inductive effect was attributed to caffeine. Coffee also increased the expression of enzymes involved in the detoxication of PhIP. A 2-fold increase in expression of glutathione S-transferase alpha was observed, UDP-glucuronosyl transferase (UGTs) activities of p-nitrophenol increased 2-fold, while N(2)-and N3-glucuronidation of the genotoxic metabolite 2-hydroxyamino-1-methyl-6-phenylimidazo[4,5-b]pyridine (HONH-PhIP) increased by 1.3-fold in the 5% coffee-treated over the control group. The amount of PhIP (0.75 mg/kg, 24 h) eliminated in urine as the N(2)-and N3-glucuronide conjugates of HONH-PhIP increased by 1.8- and 2.5-fold, respectively, in the 5% coffee-treated group over control rats, suggesting either increased rates of N-oxidation of PhIP or N-glucuronidation of HONH-PhIP. Despite the strong induction of CYP1A2, there was no increase in PhIP-DNA adduct formation in colon and pancreas while liver adducts decreased by 50% over control animals. These data suggest that the effect of coffee on inhibition of PhIP N-oxidation and ensuing DNA damage is more important in vivo than its effect on induction of PhIP N-hydroxylation.