Implementation of a State-Level Consortium in New Jersey: Improving Infectious Disease Prevention and Mitigation in Childcare and Educational Settings.

The COVID-19 pandemic underscored the need for effective infectious disease prevention and mitigation efforts within childcare and educational settings, supported by local health departments and state agencies. During the pandemic, rapidly evolving guidance, increased surveillance burden, and the vastly increased volume of inquiries from communities and local health departments led to the development of a state-level childcare and educational consortium in New Jersey. The consortium works with state-level partners to support infectious disease prevention and mitigation efforts of educational entities and local health departments.

Why children moralise harm to animals but not meat.

Many children care about animals yet are accepting of meat consumption. This may reflect a disconnect between children's meat eating, food-systems knowledge, and their moral evaluations. A theoretical framework is proposed for understanding the developmental trajectory of this disconnection. We discuss its components and the implications for dietary interventions.

Gender minority stress in transgender people: a major role for social network.

BACKGROUND: Gender minority individuals, on average, experience higher rates of mental health problems. Mounting work suggests that gender minority stress (GMS) contributes to mental health outcomes in transgender/gender-nonconforming individuals. AIM: We assessed whether GMS decreased in transgender people after initiating gender-affirming hormone therapy (GAHT), and we identified social predictors and hormonal associations for GMS at 2 time points. METHODS: GMS was surveyed through self-report questionnaires tapping into proximal and distal stressors and coping constructs following the minority stress framework. Eighty-five transgender persons wishing to undertake hormonal interventions were assessed prospectively at start of GAHT and after 7.7 ± 3.5 months (mean ± SD). Sixty-five cisgender persons served as a control group. OUTCOMES: (1) Proximal stressors were surveyed by the Beck Depression Inventory II, State-Trait Anxiety Inventory, Scale for Suicide Ideation, Suicidal Thoughts/Attempts, Stigma Consciousness Questionnaire, and Perceived Stress Scale; (2) distal stressors by the Everyday Discrimination Scale; and (3) coping constructs by the Resilience Scale, social network, social standing, and Marlowe Crowne Social Desirability Scale. RESULTS: Transgender people experienced higher rates of proximal stressors (Beck Depression Inventory II, State-Trait Anxiety Inventory, Scale for Suicide Ideation, Suicidal Thoughts/Attempts, Perceived Stress Scale) and had lower protective factors (social standing) prior to and during GAHT than cisgender people. Social network and resilience were lower in transgender people relative to cisgender peers only at baseline. Prospectively, decreasing trait anxiety was observed in transgender people. Social factors were adequate predictors of multiple GMS constructs. Specifically, a major role for social network emerged. As for hormonal associations, only serum estradiol levels in transgender women with GAHT were negatively associated with trait anxiety and suicidal thoughts/attempts but positively with resilience and social desirability. CLINICAL IMPLICATIONS: Stimulating a social environment supportive of diverse identities, particularly by investing in social networks as a resource for resilience, is likely to alleviate GMS. STRENGTHS AND LIMITATIONS: Longer duration of interventions with sex steroid treatment, with continued resilience-enhancing strategies, is needed to observe further alleviation of GMS in transgender persons. Also, objective and subjective GMS identification with heteronormative attitudes and beliefs should be surveyed for good measure when assessing GMS. CONCLUSION: Transgender people experienced more GMS throughout study visits than cisgender people did. With a relatively short period of GAHT, some significant changes in and predictors for experienced GMS emerged.

Patient satisfaction after remotely delivered gut-directed hypnotherapy for irritable bowel syndrome during the COVID-19 era: implications for future practice.

OBJECTIVE: Gut-directed hypnotherapy (GDH) is an evidence-based treatment for irritable bowel syndrome (IBS). Adoption of remote GDH has been accelerated by the COVID-19 pandemic. We aimed to evaluate patient experience and satisfaction following remote GDH. DESIGN: On completing 12 sessions of remote GDH via Skype using the Manchester protocol, patients with refractory IBS completed a feedback form on their experience. The proportion reporting positive outcomes (≥30% improvement in global IBS symptoms or abdominal pain, satisfaction, recommendation to family/friends) were compared by patient factors (age, gender, proximity, preferences). RESULTS: Of 52 patients completing the feedback form, 27 (52%) indicated that they would have opted for remote over face-to-face GDH, regardless of the pandemic situation. On a five-point scale (5=easy), patients rated the platform easy-to-use (mean 4.5±0.8) without impairment of communication (mean rating 4.6±0.8). Following remote GDH, 30/52 (58%) reported ≥30% global IBS symptom improvement, and 24/52 (46%) reported ≥30% pain reduction. 90% would recommend remote GDH to others. Only 39% felt they would have benefitted more from face to face. Those who would have chosen remote GDH regardless of the pandemic were more likely to be satisfied (p=0.01). Age, gender and proximity did not influence outcomes, satisfaction and likelihood of recommending remote GDH to others. Difficulties during remote sessions were infrequent in both those that were satisfied, and those that would have preferred face to face. CONCLUSION: These data support the need to continue developing remote GDH in the post-COVID era but suggest that there is still a role for face-to-face GDH, with patient choice being an important factor.

A Qualitative Study of Antibiotic Use Practices in Intensive Small-Scale Farming in Urban and Peri-Urban Blantyre, Malawi: Implications for Antimicrobial Resistance.

The routine use of antimicrobials in meat production has been identified as a driver of antimicrobial resistance (AMR) in both animals and humans. Significant knowledge gaps exist on antibiotic use practices in farming, particularly in sub-Saharan Africa. This paper sought to generate in-depth understanding of household antibiotic use practices in food animals in urban- and peri-urban Blantyre. We used a qualitative research methodology focusing on households that kept scavenging animals and those engaged in small-scale intensive farming of food animals. Methods used were: medicine-use surveys with 130 conducted with a range of households; in-depth interviews (32) with a range of participants including farmers, community based veterinary health workers and veterinary shop workers; and stakeholder interviews (17) with policy makers, regulators, and academics. Six months of ethnographic fieldwork was also undertaken, with households engaged in farming, veterinary officers and veterinary stores. Our findings suggest antibiotic use in animals was more common in households that used small-scale intensive farming techniques, but rare in households that did not. For farmers engaged in small-scale intensive farming, antibiotics were often considered vital to remain solvent in a precarious economic and social environment, with limited access to veterinary services. A complex regulatory framework governed the import, prescription, and administration of antibiotics. Veterinary stores provided easy access to antibiotics, including colistin, an antibiotic on the WHO's critically important antibiotics for human health. Our work suggests that the high dependence on antibiotics for small-scale intensive farming may contribute to the growth of drug resistant infections in Malawi. The socio-economic drivers of antibiotic use mean that interventions need to take a holistic approach to address the high dependence on antibiotics. Key interventions could include improving farmers' access to affordable veterinary services, providing information about appropriate antibiotic use including withdrawal periods and feed supplementation, as well as improvements in regulation (nationally and internationally) and enforcement of current regulations. Taken together these approaches could lead to antibiotic use being optimised in feed animals.

A qualitative study exploring hand hygiene practices in a neonatal unit in Blantyre, Malawi: implications for controlling healthcare-associated infections.

Background: Neonatal sepsis causes morbidity and mortality in sub-Saharan Africa. Antimicrobial resistance exacerbates outcomes. Poor Infection Prevention and Control practices (IPC) by healthcare workers and caregivers drive infection transmission. The Chatinkha Neonatal Unit in Malawi has experienced Klebsiella pneumoniae outbreaks of neonatal sepsis. We aimed to identify barriers to optimal IPC, focusing on hand hygiene. Methods: We used a focused ethnography to meet the study aim. Combining participant observation over a seven-month period with semi structured interviews with health care workers and patient carers (23) to provide an in-depth understanding of activities relating to hygiene and IPC existing on the ward. To analyse the data, we drew on the framework approach. Results: We found that staff and caregivers had a good understanding and recognition of the importance of ideal IPC, but faced substantial structural limitations and scarce resources, which hindered the implementation of best practices. We present two key themes: (1) structural and health systems barriers that shaped IPC. These included scarce material resources and overwhelming numbers of patients meant the workload was often unmanageable. (2) individual barriers related to the knowledge of frontline workers and caregivers, which were shaped by training and communication practices on the ward. We highlight the importance of addressing both structural and individual barriers to improve IPC practices and reduce the burden of neonatal sepsis in resource-limited settings. Conclusion: For IPC to be improved, interventions need to address the chronic shortages of material resources and create an enabling environment for HCWs and patient caregivers.

Exploring well-being: medical students and staff.

BACKGROUND: Mental illness in young people is a major public health challenge, with a higher prevalence amongst medical students. This study explores the perspectives of both students and staff in relation to the provision of well-being support within one medical school in the United Kingdom. METHODS: A total of 17 second-year medical students and five members of academic and well-being staff at Liverpool Medical School participated in one-to-one semi-structured interviews. Staff and students were asked for their views on existing support services, exploring challenges and ideas for development. Interviews were recorded, transcribed and analysed thematically to identify common themes amongst both students and staff. RESULTS: Students wanted to have more obvious support during their transition from sixth form to undergraduate studies. Perceived stigma surrounding mental health continues to prevent students seeking help over concerns this might have upon academic progress. Staff reported concerns that student expectations did not always match with what could realistically be provided by the medical school well-being service. DISCUSSION: The provision of opportunities for students to 'check-in' with staff, and the introduction of well-being topics within the curriculum, were perceived by students and staff as being of potential benefit to the mental health of students. Such interventions may also help to build rapport and encourage students to engage with medical school support services. All well-being support services are increasingly in demand amongst medical students, showing a need for them to expand and well-being to be further incorporated into the course.

Evidence to suggest that women's sexual behavior is influenced by hip width rather than waist-to-hip ratio.

Waist-to-hip ratio (WHR) is an important ornament display that signals women's health and fertility. Its significance derives from human development as a bipedal species. This required fundamental changes to hip morphology/musculature to accommodate the demands of both reproduction and locomotion. The result has been an obstetric dilemma whereby women's hips are only just wide enough to allow the passage of an infant. Childbirth therefore poses a significant hip width related threat to maternal mortality/risk of gynecological injury. It was predicted that this would have a significant influence on women's sexual behavior. To investigate this, hip width and WHR were measured in 148 women (M age = 20.93 + 0.17 years) and sexual histories were recorded via questionnaire. Data revealed that hip width per se was correlated with total number of sexual partners, total number of one night stands, percentage of sexual partners that were one night stands, number of sexual partners within the context of a relationship per year sexually active, and number of one night stands per year sexually active. By contrast, WHR was not correlated with any of these measures. Further analysis indicated that women who predominantly engaged in one night stand behavior had wider hips than those who did not. WHR was again without effect in this context. Women's hip morphology has a direct impact on their risk of potentially fatal childbirth related injury. It is concluded that when they have control over this, women's sexual behavior reflects this risk and is therefore at least in part influenced by hip width.

Patellar tendon adaptation in relation to load-intensity and contraction type.

BACKGROUND: Loading leads to tendon adaptation but the influence of load-intensity and contraction type is unclear. Clinicians need to be aware of the type and intensity of loading required for tendon adaptation when prescribing exercise. The aim of this study was to investigate the influence of contraction type and load-intensity on patellar tendon mechanical properties. METHOD: Load intensity was determined using the 1 repetition maximum (RM) on a resistance exercise device at baseline and fortnightly intervals in four randomly allocated groups of healthy, young males: (1) control (no training); (2) concentric (80% of concentric-eccentric 1RM, 4×7-8); (3) standard load eccentric only (80% of concentric-eccentric 1RM, 4×12-15 repetitions) and (4) high load eccentric (80% of eccentric 1RM, 4×7-8 repetitions). Participants exercised three times a week for 12 weeks on a leg extension machine. Knee extension maximum torque, patellar tendon CSA and length were measured with dynamometry and ultrasound imaging. Patellar tendon force, stress and strain were calculated at 25%, 50%, 75% and 100% of maximum torque during isometric knee extension contractions, and stiffness and modulus at torque intervals of 50-75% and 75-100%. Within group and between group differences in CSA, force, elongation, stress, strain, stiffness and modulus were investigated. The same day reliability of patellar tendon measures was established with a subset of eight participants. RESULTS: Patellar tendon modulus increased in all exercise groups compared with the control group (p<0.05) at 50-75% of maximal voluntary isometric contraction (MVIC), but only in the high eccentric group compared with the control group at 75-100% of MVIC (p<0.05). The only other group difference in tendon properties was a significantly greater increase in maximum force in the high eccentric compared with the control group (p<0.05). Five repetition maximum increased in all groups but the increase was significantly greater in the high load eccentric compared with the other exercise groups (p<0.05). CONCLUSION: Load at different intensity levels and contraction types increased patellar tendon modulus whereas muscle strength seems to respond more to load-intensity. High load eccentric was, however, the only group to have significantly greater increase in force, stiffness and modulus (at the highest torque levels) compared with the control group. The effects and clinical applicability of high load interventions needs to be investigated further.

Independent sector mental health care: a 1-day census of private and voluntary sector placements in seven Strategic Health Authority areas in England.

The aims of this study were (i) to map the extent of all mental health placements in the independent sector, for adults of working age, and elderly people (excluding those with a diagnosis of dementia placed in Local Authority care homes), on a census date, across the areas in which the study was commissioned; (ii) to identify the characteristics of the population in placements; (iii) to explore some of the characteristics of the placements and the patterns of use within the private and voluntary sectors; and (iv) to identify the funding source of placements, and cost differences between the private and voluntary sector. The study took place in seven Strategic Health Authority areas, and information was sought from all Primary Care Trust and Social Services commissioners of mental health services, including regional secure commissioning teams, within those areas. A cross-sectional sample was used. Information was requested in relation to every individual meeting the inclusion criteria, placed in independent (private or voluntary) psychiatric hospitals, registered mental nursing homes and care homes on a specified study 'census date' of 28 June 2004 in six of the Strategic Health Authority areas, and 7 October 2004 in the seventh. Information was recorded on a standard questionnaire specifically designed for the study. Information was obtained on 3535 adults and 1623 elderly people in private or voluntary facilities. The largest groups of adults and elderly people had diagnoses of severe mental illnesses (42.1% and 30.5%, respectively), and placements were described as 'continuing care' or rehabilitation, with a 'niche' in specialist forensic care. Around four-fifths of units were in the private sector, which for adults was significantly more expensive than the voluntary sector. A large proportion of units (47.2% of adult placements and 59.3% of placements for elderly people) had only single placements from particular commissioning authorities, whilst others had large numbers, raising issues for effective commissioning. The distance of placements from patients' area of origin, is also an issue highlighted by the study. The study findings are discussed in relation to commissioning practice, and the development of the independent sector in mental health care.

Determination of volatile anesthetics isoflurane and enflurane in mouse brain tissues using gas chromatography-mass spectrometry.

INTRODUCTION: A method for determination of the volatile anesthetics, isoflurane, and enflurane in mouse brain tissues using headspace gas chromatography-mass spectrometry (GC-MS) is described. METHODS: Halothane was used as internal standard (I.S.). Brain samples were completely homogenized in ice-cold water and isoflurane, enflurane, and I.S. were extracted with headspace. One milliliter of headspace gas was injected onto the GC-MS and separation was achieved by using porous layer open tubular (PLOT) capillary column with a solid stationary phase (GSC). As a result, isoflurane, enflurane, and halothane were cleanly separated. RESULTS: The method demonstrated satisfactory recovery (72% and 76% for isoflurane and enflurane, respectively) and linear calibration ranges of 0.015-2.20 and 0.0152-3.94 microg/sample for isoflurane and enflurane, respectively. Reproducibility calculated as CV% was 3.3-3.9% for all intraday and interday determinations. The procedure was applied for quantitation of isoflurane and enflurane in about 300 mouse brain samples for genetic behavioral study. DISCUSSION: The method was achieved and shown to be effective.

Mapping quantitative trait loci mediating sensitivity to etomidate.

Long- and Short-Sleep (LS and SS) mice were selectively bred for differences in ethanol-induced loss of the righting reflex (LORR) and have been found to differ in LORR induced by various anesthetic agents. We used a two-stage mapping strategy to identify quantitative trait loci (QTLs) affecting duration of LORR caused by the general anesthetic etomidate and brain levels of etomidate (BEL) following regain of the righting reflex. Analysis of recombinant-inbred strains derived from a cross between LS and SS mice (LSXSS) yielded a heritability estimate of 0.23 for etomidate-induced LORR and identified one marker that showed suggestive linkage for a QTL, on mouse Chromosome (chr) 12. Mapping in an F(2) population derived from a cross between inbred LS and SS (ILS and ISS) revealed a significant QTL for etomidate-induced LORR on Chr 12, and two significant QTLs mediating BEL on Chrs 6 and 12. Several QTLs showing suggestive linkage for etomidate-induced LORR and BEL were also identified in the F(2) population. Brain levels of etomidate in the RI and F(2) mice suggested that differences in LORR were due to differential central nervous system sensitivity, rather than differential etomidate metabolism. Interestingly, the region on Chr 7 has also been identified as a region influencing ethanol-induced LORR, suggesting the possibility of a common genetic mechanism mediating etomidate and ethanol sensitivity. These QTL regions need to be further narrowed before the testing of candidate genes is feasible.