Mass treatment with single-dose azithromycin for yaws.

BACKGROUND: Mass treatment with azithromycin is a central component of the new World Health Organization (WHO) strategy to eradicate yaws. Empirical data on the effectiveness of the strategy are required as a prerequisite for worldwide implementation of the plan. METHODS: We performed repeated clinical surveys for active yaws, serologic surveys for latent yaws, and molecular analyses to determine the cause of skin ulcers and identify macrolide-resistant mutations before and 6 and 12 months after mass treatment with azithromycin on a Papua New Guinean island on which yaws was endemic. Primary-outcome indicators were the prevalence of serologically confirmed active infectious yaws in the entire population and the prevalence of latent yaws with high-titer seroreactivity in a subgroup of children 1 to 15 years of age. RESULTS: At baseline, 13,302 of 16,092 residents (82.7%) received one oral dose of azithromycin. The prevalence of active infectious yaws was reduced from 2.4% before mass treatment to 0.3% at 12 months (difference, 2.1 percentage points; P<0.001). The prevalence of high-titer latent yaws among children was reduced from 18.3% to 6.5% (difference, 11.8 percentage points; P<0.001) with a near-absence of high-titer seroreactivity in children 1 to 5 years of age. Adverse events identified within 1 week after administration of the medication occurred in approximately 17% of the participants, included nausea, diarrhea, and vomiting, and were mild in severity. No evidence of emergence of resistance to macrolides against Treponema pallidum subspecies pertenue was seen. CONCLUSIONS: The prevalence of active and latent yaws infection fell rapidly and substantially 12 months after high-coverage mass treatment with azithromycin, with the reduction perhaps aided by subsequent activities to identify and treat new cases of yaws. Our results support the WHO strategy for the eradication of yaws. (Funded by Newcrest Mining and International SOS; YESA-13 ClinicalTrials.gov number, NCT01955252.).

Changes in social identities over time: the role of coping and adaptation processes.

The present studies investigated the processes by which group members integrate a new social identity. Based on a newly developed theoretical model, we anticipated that social factors (social support and need satisfaction) would be facilitators of this change process and should have an impact on the coping and adaptation strategies group members use to deal with the membership in a new group. These strategies, in turn, should predict intra-individual changes in level of identification with the new group, which should then predict enhanced psychological adjustment over time. The proposed associations were tested among university students over the course of their first academic year (Study 1) and among on-line gamers joining a newly established on-line community (Study 2). Path analyses provided support for the hypothesized associations. The results are discussed in light of recent theoretical developments pertaining to intra-individual changes in social identities.

Restructuring the multi-professional organization: professional identity and adjustment to change in a public hospital.

The present study explored the multiple identities held by health professionals in a large public hospital that was experiencing organizational change that involved the transition from the traditional use of professional hierarchies to the use of new clinical teams. Consistent with predictions from social identity theory and research, the results of an organization-wide survey (N = 615) reveal the protective role of identification with professional departments during change that threatened group status. Professional departments were the preferred target of identification of employees, and employees who preferred this target reported a stronger sense of identification. Also consistent with our predictions, employees who were members of higher status groups reported greater job satisfaction, higher levels of openness to organizational change, and reduced levels of change-related uncertainty. These results were more pronounced for employees who identified with their professional department. Implications for managing multiple identities during organizational transition are discussed.

Group-directed criticisms and recommendations for change: why newcomers arouse more resistance than old-timers.

Three experiments examine the extent to which newcomers are able to influence their groups relative to old-timers. Specifically, how group members respond to criticisms of their group was assessed as a function of the intragroup position of the speaker. When criticizing their workplace (Experiment 1; N = 116), their profession (Experiment 2; N = 106), or an Internet community (Experiment 3; N = 189), newcomers aroused more resistance than old-timers, an effect that was mediated by perceptions of how attached critics were to their group identity. Experiment 3 also showed that newcomers could reduce resistance to their criticisms by distancing themselves from a group of which they were previously members. Theoretical and practical implications of these findings are discussed.