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1.
J Zoo Wildl Med ; 55(2): 453-461, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38875202

RESUMO

Chytridiomycosis caused by Batrachochytrium dendrobatidis (Bd) has been documented in greater sirens (Siren lacertina) in the wild and in the pet trade. This study evaluated the use of terbinafine-impregnated implants for chytridiomycosis prophylaxis in greater sirens exposed to Bd. Implants were placed intracoelomically in both control (blank implant, n = 4) and treatment (24.5 mg of terbinafine implant, n = 4) groups. Sirens were exposed to Bd zoospores via 24-h immersion bath at 1 and 2 mon postimplant placement. Blood was collected monthly for plasma terbinafine levels, and skin swabs were collected weekly for Bd quantitative PCR. Animals with terbinafine implants had detectable concentrations of plasma terbinafine ranging from 17 to 102 ng/ml. Only one terbinafine-implanted animal had a peak concentration above the published minimum inhibitory concentration for terbinafine against Bd zoospores (63 ng/ml); however, it is unknown how plasma terbinafine concentrations relate to concentrations in the skin. There was no difference between the two treatment groups in clinical signs or Bd clearance rate, and no adverse effects from implants were observed. These findings indicate using intracoelomic drug implants for drug delivery in amphibians is safe; however, terbinafine efficacy in preventing Bd chytridiomycosis in sirens remains unclear. Further investigation of the use of intracoelomic implants and identification of effective drugs and doses in other amphibian species against Bd and other infectious diseases is warranted, as this may provide a practical method for long-term drug delivery in wildlife.


Assuntos
Antifúngicos , Terbinafina , Terbinafina/administração & dosagem , Terbinafina/uso terapêutico , Terbinafina/farmacologia , Animais , Projetos Piloto , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Antifúngicos/farmacocinética , Implantes de Medicamento , Batrachochytrium/efeitos dos fármacos , Masculino , Micoses/veterinária , Micoses/tratamento farmacológico , Anfíbios
2.
Public Health ; 231: 31-38, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38603977

RESUMO

OBJECTIVES: Currently, there is no comprehensive picture of the global surveillance landscape. This survey examines the current state of surveillance systems, levels of integration, barriers and opportunities for the integration of surveillance systems at the country level, and the role of national public health institutes (NPHIs). STUDY DESIGN: This was a cross-sectional survey of NPHIs. METHODS: A web-based survey questionnaire was disseminated to 110 NPHIs in 95 countries between July and August 2022. Data were descriptively analysed, stratified by World Health Organization region, World Bank Income Group, and self-reported Integrated Disease Surveillance (IDS) maturity status. RESULTS: Sixty-five NPHIs responded. Systems exist to monitor notifiable diseases and vaccination coverage, but less so for private, pharmaceutical, and food safety sectors. While Ministries of Health usually lead surveillance, in many countries, NPHIs are also involved. Most countries report having partially developed IDS. Surveillance data are frequently inaccessible to the lead public health agency and seldomly integrated into a national public health surveillance system. Common challenges to establishing IDS include information technology system issues, financial constraints, data sharing and ownership limitations, workforce capacity gaps, and data availability. CONCLUSIONS: Public health surveillance systems across the globe, although built on similar principles, are at different levels of maturity but face similar developmental challenges. Leadership, ownership and governance, supporting legal mandates and regulations, as well as adherence to mandates, and enforcement of regulations are critical components of effective surveillance. In many countries, NPHIs play a significant role in integrated disease surveillance.


Assuntos
Saúde Global , Humanos , Estudos Transversais , Saúde Global/estatística & dados numéricos , Inquéritos e Questionários , Vigilância em Saúde Pública/métodos , Integração de Sistemas
3.
Psychol Trauma ; 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38451715

RESUMO

OBJECTIVE: The current study examined group differences in peritraumatic tonic immobility (TI) and posttraumatic symptoms among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) females and their straight, cisgender counterparts. METHOD: Adult female sexual assault (SA) survivors (N = 86; 41.9% LGBTQ+) completed a questionnaire battery assessing demographics, TI experience, posttraumatic stress disorder symptoms, dissociative symptoms, and posttraumatic cognitions. Chi-square analyses, analyses of variance, and hierarchical linear regressions were used to characterize the associations among these variables. RESULTS: Individuals identifying as LGBTQ+ endorsed higher rates and severity of TI as well as greater posttraumatic stress symptoms compared to their straight, cisgender counterparts. Both LGBTQ+ status and TI experience predicted greater posttraumatic stress symptoms. CONCLUSIONS: Findings suggest that LGBTQ+ individuals who endorse TI during SA experience greater posttraumatic symptoms than their non-LGBTQ+ and non-TI counterparts. These findings have important implications for future research and treatment of female SA survivors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

4.
Acta Neuropathol ; 147(1): 29, 2024 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-38308693

RESUMO

The aggregation, mislocalization, and phosphorylation of TDP-43 are pathologic hallmarks of several neurodegenerative diseases and provide a defining criterion for the neuropathologic diagnosis of Limbic-predominant Age-related TDP-43 Encephalopathy (LATE). LATE neuropathologic changes (LATE-NC) are often comorbid with other neurodegenerative pathologies including Alzheimer's disease neuropathologic changes (ADNC). We examined whether TDP-43 regulated cryptic exons accumulate in the hippocampus of neuropathologically confirmed LATE-NC cases. We found that several cryptic RNAs are robustly expressed in LATE-NC cases with or without comorbid ADNC and correlate with pTDP-43 abundance; however, the accumulation of cryptic RNAs is more robust in LATE-NC with comorbid ADNC. Additionally, cryptic RNAs can robustly distinguish LATE-NC from healthy controls and AD cases. These findings expand our current understanding and provide novel potential biomarkers for LATE pathogenesis.


Assuntos
Doença de Alzheimer , Demência , Proteinopatias TDP-43 , Humanos , Encéfalo/patologia , Proteinopatias TDP-43/patologia , Doença de Alzheimer/genética , Doença de Alzheimer/patologia , Envelhecimento/genética , Envelhecimento/patologia , Proteínas de Ligação a DNA/metabolismo , Éxons
5.
bioRxiv ; 2024 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-38328211

RESUMO

Lewy body dementia (LBD), a class of disorders comprising Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB), features substantial clinical and pathological overlap with Alzheimer's disease (AD). The identification of biomarkers unique to LBD pathophysiology could meaningfully advance its diagnosis, monitoring, and treatment. Using quantitative mass spectrometry (MS), we measured over 9,000 proteins across 138 dorsolateral prefrontal cortex (DLPFC) tissues from a University of Pennsylvania autopsy collection comprising control, Parkinson's disease (PD), PDD, and DLB diagnoses. We then analyzed co-expression network protein alterations in those with LBD, validated these disease signatures in two independent LBD datasets, and compared these findings to those observed in network analyses of AD cases. The LBD network revealed numerous groups or "modules" of co-expressed proteins significantly altered in PDD and DLB, representing synaptic, metabolic, and inflammatory pathophysiology. A comparison of validated LBD signatures to those of AD identified distinct differences between the two diseases. Notably, synuclein-associated presynaptic modules were elevated in LBD but decreased in AD relative to controls. We also found that glial-associated matrisome signatures consistently elevated in AD were more variably altered in LBD, ultimately stratifying those LBD cases with low versus high burdens of concurrent beta-amyloid deposition. In conclusion, unbiased network proteomic analysis revealed diverse pathophysiological changes in the LBD frontal cortex distinct from alterations in AD. These results highlight the LBD brain network proteome as a promising source of biomarkers that could enhance clinical recognition and management.

6.
Sci Transl Med ; 15(712): eadg4122, 2023 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-37672565

RESUMO

Alzheimer's disease (AD) is a neurodegenerative disease with heterogenous pathophysiological changes that develop years before the onset of clinical symptoms. These preclinical changes have generated considerable interest in identifying markers for the pathophysiological mechanisms linked to AD and AD-related disorders (ADRD). On the basis of our prior work integrating cerebrospinal fluid (CSF) and brain proteome networks, we developed a reliable and high-throughput mass spectrometry-selected reaction monitoring assay that targets 48 key proteins altered in CSF. To test the diagnostic utility of these proteins and compare them with existing AD biomarkers, CSF collected at baseline visits was assayed from 706 participants recruited from the Alzheimer's Disease Neuroimaging Initiative. We found that the targeted CSF panel of 48 proteins (CSF 48 panel) performed at least as well as existing AD CSF biomarkers (Aß42, tTau, and pTau181) for predicting clinical diagnosis, FDG PET, hippocampal volume, and measures of cognitive and dementia severity. In addition, for each of those outcomes, the CSF 48 panel plus the existing AD CSF biomarkers significantly improved diagnostic performance. Furthermore, the CSF 48 panel plus existing AD CSF biomarkers significantly improved predictions for changes in FDG PET, hippocampal volume, and measures of cognitive decline and dementia severity compared with either measure alone. A potential reason for these improvements is that the CSF 48 panel reflects a range of altered biology observed in AD/ADRD. In conclusion, we show that the CSF 48 panel complements existing AD CSF biomarkers to improve diagnosis and predict future cognitive decline and dementia severity.


Assuntos
Doença de Alzheimer , Proteínas do Líquido Cefalorraquidiano , Doença de Alzheimer/líquido cefalorraquidiano , Doença de Alzheimer/diagnóstico , Humanos , Prognóstico , Biomarcadores/líquido cefalorraquidiano , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Determinação de Ponto Final , Ensaios de Triagem em Larga Escala , Proteínas do Líquido Cefalorraquidiano/análise , Tomografia por Emissão de Pósitrons , Hipocampo/diagnóstico por imagem , Hipocampo/patologia , Tamanho do Órgão
7.
Neurobiol Dis ; 186: 106286, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37689213

RESUMO

Cognitive impairment in the elderly features complex molecular pathophysiology extending beyond the hallmark pathologies of traditional disease classification. Molecular subtyping using large-scale -omic strategies can help resolve this biological heterogeneity. Using quantitative mass spectrometry, we measured ∼8000 proteins across >600 dorsolateral prefrontal cortex tissues with clinical diagnoses of no cognitive impairment (NCI), mild cognitive impairment (MCI), and Alzheimer's disease (AD) dementia. Unbiased classification of MCI and AD cases based on individual proteomic profiles resolved three classes with expression differences across numerous cell types and biological ontologies. Two classes displayed molecular signatures atypical of AD neurodegeneration, such as elevated synaptic and decreased inflammatory markers. In one class, these atypical proteomic features were associated with clinical and pathological hallmarks of cognitive resilience. We were able to replicate these classes and their clinicopathological phenotypes across two additional tissue cohorts. These results promise to better define the molecular heterogeneity of cognitive impairment and meaningfully impact its diagnostic and therapeutic precision.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Idoso , Humanos , Proteoma , Proteômica , Encéfalo
8.
Emerg Infect Dis ; 29(10): 1-7, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37735750

RESUMO

The world's reptiles and amphibians are experiencing dramatic and ongoing losses in biodiversity, changes that can have substantial effects on ecosystems and human health. In 2022, the first Global Amphibian and Reptile Disease Conference was held, using One Health as a guiding principle. The conference showcased knowledge on numerous reptile and amphibian pathogens from several standpoints, including epidemiology, host immune defenses, wild population effects, and mitigation. The conference also provided field experts the opportunity to discuss and identify the most urgent herpetofaunal disease research directions necessary to address current and future threats to reptile and amphibian biodiversity.


Assuntos
Ecossistema , Saúde Única , Humanos , Animais , Anfíbios , Répteis , Biodiversidade
9.
J Trauma Stress ; 36(6): 1031-1043, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37776211

RESUMO

Extant research has shown that sexual violence disproportionately affects lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals, conferring risk for the development of posttraumatic stress symptoms (PTSS) and related mental health conditions. However, little research has focused on specific vulnerabilities among LGBTQ+-identified sexual assault (SA) survivors (e.g., minority stress) and their associations with post-SA psychopathology. To address this gap, we examined associations between experiences of minority stress and post-SA psychopathology in a sample of LGBTQ+ individuals who experienced SA (N = 92) and completed a battery of self-report measures. Results revealed significant differences in internalized stigma, community connectedness, alcohol use, and cannabis use across sexual orientation and gender modality groups, ηp 2 = .08-11. Additionally, regression analyses indicated that experiences of violence and victimization were significantly associated with higher PTSS, ß = .31, p = .020; anxiety, ß = .39, p = .003; and alcohol use severity, ß = .31, p = .027, over and above other experiences of minority stress and psychopathology risk factors. Internalized stigma was significantly associated with cannabis use severity, ß =.34, p = .011. Finally, community connectedness was significantly associated with lower anxiety symptom severity, ß = -.42, p = .001. Although longitudinal work is needed, findings indicate that experiences of minority stress may serve as risk or maintenance factors for post-SA psychopathology. These results offer important considerations for future treatment approaches tailored to LGBTQ+ survivors of SA.


Assuntos
Delitos Sexuais , Minorias Sexuais e de Gênero , Transtornos de Estresse Pós-Traumáticos , Pessoas Transgênero , Feminino , Humanos , Masculino , Pessoas Transgênero/psicologia , Saúde Mental , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Comportamento Sexual
10.
Nat Med ; 29(8): 1979-1988, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37550416

RESUMO

Alzheimer's disease (AD) pathology develops many years before the onset of cognitive symptoms. Two pathological processes-aggregation of the amyloid-ß (Aß) peptide into plaques and the microtubule protein tau into neurofibrillary tangles (NFTs)-are hallmarks of the disease. However, other pathological brain processes are thought to be key disease mediators of Aß plaque and NFT pathology. How these additional pathologies evolve over the course of the disease is currently unknown. Here we show that proteomic measurements in autosomal dominant AD cerebrospinal fluid (CSF) linked to brain protein coexpression can be used to characterize the evolution of AD pathology over a timescale spanning six decades. SMOC1 and SPON1 proteins associated with Aß plaques were elevated in AD CSF nearly 30 years before the onset of symptoms, followed by changes in synaptic proteins, metabolic proteins, axonal proteins, inflammatory proteins and finally decreases in neurosecretory proteins. The proteome discriminated mutation carriers from noncarriers before symptom onset as well or better than Aß and tau measures. Our results highlight the multifaceted landscape of AD pathophysiology and its temporal evolution. Such knowledge will be critical for developing precision therapeutic interventions and biomarkers for AD beyond those associated with Aß and tau.


Assuntos
Doença de Alzheimer , Proteômica , Humanos , Doença de Alzheimer/líquido cefalorraquidiano , Doença de Alzheimer/genética , Doença de Alzheimer/fisiopatologia , Biomarcadores/metabolismo , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Mutação , Idade de Início
11.
J Affect Disord ; 339: 640-647, 2023 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-37442451

RESUMO

BACKGROUND: Individuals with posttraumatic stress symptoms (PTSS) use a variety of safety behaviors: strategies intended to prevent, avoid, or manage distress in anxiety-provoking situations. However, when used in the absence of threat, safety behaviors maintain PTSS by preventing collection of disconfirming evidence about potential danger. Thus, individuals with PTSS may benefit from eliminating their maladaptive safety behavior use. METHODS: The current study evaluated a brief, computer-based safety behavior reduction intervention, Safety Behavior Elimination for Traumatic Stress (SBETS). Seventy-five participants were recruited based on trauma exposure and elevated PTSS. Participants were randomly assigned to the SBETS condition or a physical health control. In the intervention, participants selected two behaviors to reduce or eliminate over the coming month. Participants were given reminders to reduce those behaviors twice a week, and treatment outcomes were assessed at two weeks and one month following the intervention. RESULTS: Hierarchical regressions demonstrated that while participants in the two conditions did not differ in their reported safety behavior use at follow-up, individuals in the SBETS condition reported significantly lower month 1 PTSS (Cohen's d = 0.56). While week 2 safety behavior use and week 2 negative affect did not mediate the relationship between treatment condition and month 1 PTSS, this relationship was fully mediated by week 2 use of the two behaviors selected for elimination. LIMITATIONS: The current study was limited by its homogenous sample and brief follow-up period. CONCLUSIONS: Results suggest that SBETS has a significant effect on PTSS, and may represent an acceptable, accessible treatment option for trauma survivors.


Assuntos
Comportamento Problema , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Ansiedade , Comportamentos Relacionados com a Saúde , Resultado do Tratamento
12.
Sci Data ; 10(1): 261, 2023 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-37160957

RESUMO

Alzheimer's disease (AD) is the most common form of dementia, with cerebrospinal fluid (CSF) ß-amyloid (Aß), total Tau, and phosphorylated Tau (pTau) providing the most sensitive and specific biomarkers for diagnosis. However, these diagnostic biomarkers do not reflect the complex changes in AD brain beyond amyloid (A) and Tau (T) pathologies. Here, we report a selected reaction monitoring mass spectrometry (SRM-MS) method with isotopically labeled standards for relative protein quantification in CSF. Biomarker positive (AT+) and negative (AT-) CSF pools were used as quality controls (QCs) to assess assay precision. We detected 62 peptides (51 proteins) with an average coefficient of variation (CV) of ~13% across 30 QCs and 133 controls (cognitively normal, AT-), 127 asymptomatic (cognitively normal, AT+) and 130 symptomatic AD (cognitively impaired, AT+). Proteins that could distinguish AT+ from AT- individuals included SMOC1, GDA, 14-3-3 proteins, and those involved in glycolysis. Proteins that could distinguish cognitive impairment were mainly neuronal proteins (VGF, NPTX2, NPTXR, and SCG2). This demonstrates the utility of SRM-MS to quantify CSF protein biomarkers across stages of AD.


Assuntos
Doença de Alzheimer , Humanos , Doença de Alzheimer/diagnóstico , Bioensaio , Biomarcadores , Proteínas do Líquido Cefalorraquidiano , Espectrometria de Massas
13.
J Wildl Dis ; 59(3): 479-486, 2023 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-37179488

RESUMO

Wildlife diseases are a major threat for species conservation, and there is a growing need to implement more comprehensive disease response programs to better identify these diseases of concern. During March 2017, we observed moribund and dead eastern newts, Notophthalmus viridescens, in a single pond in middle Tennessee. All moribund individuals were emaciated. We euthanized and processed all individuals immediately on-site and later performed histopathology and quantitative PCR for ranavirus, the protist Perkinsea, and chytrid fungi Batrachochytrium dendrobatidis and Batrachochytrium salamandrivorans. One newt was positive for ranavirus. Histopathology showed no evidence of ranavirosis but did reveal overwhelming coccidiosis. Overlapping partial sequences of coccidian 18S subunit DNA showed a 96.4% match with Eimeria steinhausi, suggesting that lesions were due to a previously undescribed Eimeria sp. In 2019, two more moribund newts were encountered at the same pond. Histopathology revealed the same suspicious parasitic organisms, and one individual was positive for B. dendrobatidis. Further research on how seasonal and other environmental parameters may influence coccidia-associated morbidity and mortality is warranted. These events highlight the importance of histopathologic evaluation of mortality events and provide guidance for investigation of future outbreaks.


Assuntos
Quitridiomicetos , Coccidiose , Eimeria , Ranavirus , Animais , Notophthalmus viridescens , Tennessee/epidemiologia , Coccidiose/epidemiologia , Coccidiose/veterinária , Salamandridae
14.
PLoS Pathog ; 19(4): e1010893, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37014917

RESUMO

In settings with high tuberculosis (TB) endemicity, distinct genotypes of the Mycobacterium tuberculosis complex (MTBC) often differ in prevalence. However, the factors leading to these differences remain poorly understood. Here we studied the MTBC population in Dar es Salaam, Tanzania over a six-year period, using 1,082 unique patient-derived MTBC whole-genome sequences (WGS) and associated clinical data. We show that the TB epidemic in Dar es Salaam is dominated by multiple MTBC genotypes introduced to Tanzania from different parts of the world during the last 300 years. The most common MTBC genotypes deriving from these introductions exhibited differences in transmission rates and in the duration of the infectious period, but little differences in overall fitness, as measured by the effective reproductive number. Moreover, measures of disease severity and bacterial load indicated no differences in virulence between these genotypes during active TB. Instead, the combination of an early introduction and a high transmission rate accounted for the high prevalence of L3.1.1, the most dominant MTBC genotype in this setting. Yet, a longer co-existence with the host population did not always result in a higher transmission rate, suggesting that distinct life-history traits have evolved in the different MTBC genotypes. Taken together, our results point to bacterial factors as important determinants of the TB epidemic in Dar es Salaam.


Assuntos
Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Tanzânia/epidemiologia , Tuberculose/epidemiologia , Genótipo , Virulência
15.
16.
Biomed Signal Process Control ; 73: 103433, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36567677

RESUMO

An approach based on fractal scaling analysis to characterize the organization of the SARS-CoV-2 genome sequence was used. The method is based on the detrended fluctuation analysis (DFA) implemented on a sliding window scheme to detect variations of long-range correlations over the genome sequence regions. The nucleotides sequence is mapped in a numerical sequence by using four different assignation rules: amino-keto, purine-pyrimidine, hydrogen-bond and hydrophobicity patterns. The originally reported sequence from Wuhan isolates (Wuhan Hu-1) was considered as a reference to contrast the structure of the 2002-2004 SARS-CoV-1 strain. Long-range correlations, quantified in terms of a scaling exponent, depended on both the mapping rule and the sequence region. Deviations from randomness were attributed to serial correlations or anti-correlations, which can be ascribed to ordered regions of the genome sequence. It was found that the Wuhan Hu-1 sequence was more random than the SARS-CoV-1 sequence, which suggests that the SARS-CoV-2 possesses a more efficient genomic structure for replication and infection. In general, the virus isolated in the early 2020 months showed slight correlation differences with the Wuhan Hu-1 sequence. However, early isolates from India and Italy presented visible differences that led to a more ordered sequence organization. It is apparent that the increased sequence order, particularly in the spike region, endowed some early variants with a more efficient mechanism to spreading, replicating and infecting. Overall, the results showed that the DFA provides a suitable framework to assess long-term correlations hidden in the internal organization of the SARS-CoV-2 genome sequence.

17.
Int J Tuberc Lung Dis ; 26(12): 1144-1150, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36447323

RESUMO

SETTING: One hundred high TB burden facilities in nine counties in Kenya.OBJECTIVES: 1) To increase uptake of TB preventive therapy (TPT) among child contacts aged <5 years, and 2) to increase TB diagnosis in children aged <15 years presenting to health facilities for routine care.DESIGN: For objective 1, a clinic-based child contact management strategy incorporating transport/healthcare cost reimbursement, monitoring and evaluation tools, and healthcare worker education was utilized. For objective 2, community health screeners were established in pediatric outpatient departments to perform verbal screening, flagging symptomatic children for further evaluation.RESULTS: Over 15 months, identification of 8,060 individuals diagnosed with bacteriologically confirmed TB led to 2,022 child contacts. Of these, 1,848 (91%) were evaluated; 149 (8%) were diagnosed with TB disease, leaving 1,699 (92%) eligible for TPT; 1,613 (95%) initiated TPT and 1,335 (83%) completed TPT. In outpatient settings, 140,444 children were screened; 54,236 (39%) had at least two TB symptoms; 2,395 (4%) were diagnosed with TB diseaseCONCLUSION: Health system strengthening supporting a clinic-based child contact management program increased the number of children initiating TPT. Systematic screening in outpatient clinics can lead to increased TB case notifications; however, optimal screening tools and clearer diagnostic pathways for the evaluation of these children are needed.


Assuntos
Tuberculose , Criança , Humanos , Instituições de Assistência Ambulatorial , Antibioticoprofilaxia/estatística & dados numéricos , Quênia/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Lactente , Pré-Escolar , Adolescente , Programas de Rastreamento
18.
J Food Sci Technol ; 59(12): 4853-4862, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36276526

RESUMO

A coarse canola oil-in-water (O/W) emulsion (dispersed mass fraction 0.1) was prepared by adding oil to whey protein hydrolysate (WPH)-citric pectin (CP) soluble complex (1% total biopolymer weight; WPH to CP mass ratio 6:1; pH 4.25) aqueous phase using a high shear homogenizer (4000 rpm, 2 min). The coarse O/W emulsion was further homogenized to obtain emulsions (Ex) with different mean droplet sizes (4000, 3000, 120 and 60 nm). A full-fat yogurt (YC; 26 ± 0.3 g milk fat L-1) was prepared from reconstituted whole milk powder (WMP, 3% milk fat) and skim milk powder (SMP, 0.01% milk fat). Reduced-milk fat yogurt (YEx 13 ± 0.3 g milk fat L-1) variations were prepared from WMP + SMP + Ex, where Ex substituted 50% of the milk-fat contained in YC. The viscosity and viscoelastic moduli were lower for YEx than for YC; the effect was more pronounced for E60 and E120. Aroma was non-significantly different between YC and YEx. A multivariate analysis showed that YEx overall acceptability was linked to taste and after taste attributes and to the viscosity perceived in mouth. The loss modulus showed anti-correlation directionality with the overall acceptance. The smaller mean droplet sized YEx exhibited the highest overall acceptability. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-022-05573-3.

19.
ATS Sch ; 3(3): 433-448, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36312797

RESUMO

Background: Structural health inequities and racism adversely affect patient health and the culture of academic medicine. Formal training to educate fellows and faculty on antiracism is lacking. Objective: Our objective was to design, implement, and assess the feasibility and preliminary efficacy of a year-long antiracism curriculum within a pulmonary, critical care, and sleep medicine division. Methods: This was a pre- and postintervention observational study conducted between July 2020 and June 2021. The curriculum was offered during an allotted educational meeting time slot at a single-center pulmonary, critical care, and sleep medicine division at a large academic institution to fellows and faculty. The curriculum consisted of 13 1-hour virtual interactive workshops delivered by local experts in diversity, equity, and inclusion topics. Surveys assessed knowledge on racism in medicine; opinions, understanding, and comfort surrounding race and racism in medicine; as well as additional questions to solicit feedback on the curriculum itself via visual analog scale and write-in comments. Results: Before initiating the curriculum, 74% (n = 28) of respondents reported interest in an antiracism curriculum, and the majority (95%, n = 36) believed that discrimination affects medical staff and patients. Respondents reported only moderate comfort in talking about race (median, 58; interquartile range 41-70 on visual analog scale 0-100, where 100 is strongly agree with "I feel comfortable talking about race"). The postintervention survey demonstrated stability of the belief of the presence of racial discrimination and a 15% increase in self-directed learning about related topics. Although knowledge related to the use of race in medical algorithms improved, 14% fewer participants reported interest in continuing to engage in a division-wide structured antiracism curriculum. Conclusion: Implementation of a curriculum on justice, equity, diversity, and inclusion within a fellowship program is feasible and addresses an unmet need within graduate medical education.

20.
J Child Sex Abus ; 31(6): 672-691, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35821644

RESUMO

Despite a series of high-profile media reports of sexual abuse in sport over the past few years, little research has been done to explore the scope of the problem in the United States. The current article reports on prevalence of child sexual assault in elite athletes in the United States. Using a retrospective web survey, adults answered questions on their experiences in sport. Of the 473 elite athletes surveyed, 3.8% (n = 18) reported being sexual assaulted as a minor in the sporting context. Of those reporting assault, most (61%) reported being abused by an adult authority figure (usually a coach) and 44% reported being assaulted by a peer. Abused athletes were significantly more likely to report having been diagnosed with a mental disorder (Fisher's exact test; p < .001). The findings can be utilized to improve prevention and child protection measures and other safeguarding initiatives in sport.


Assuntos
Abuso Sexual na Infância , Adulto , Criança , Humanos , Prevalência , Saúde Mental , Estudos Retrospectivos , Atletas
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