Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 38 Records) |
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Responding to outbreaks of illness linked to unpasteurized milk: A needs assessment of state health and agriculture departments
Ablan M . Zoonoses Public Health 2024 AIMS: Consumption of unpasteurized milk can result in severe illness or death. In the United States, the number of people who regularly consume unpasteurized milk is relatively low, but outbreaks resulting from unpasteurized milk outnumber outbreaks linked to pasteurized milk. The sale of unpasteurized milk for human consumption through interstate commerce is prohibited at the federal level, but laws among states vary considerably with respect to the sale of unpasteurized milk. Each state has a different perspective on responding to and preventing outbreaks of illness linked to consuming unpasteurized milk. METHODS AND RESULTS: We conducted a needs assessment of state health and agriculture departments to gather information on state-level strategies to prevent illnesses linked to consuming unpasteurized milk, characterize challenges states face, and identify areas where partners can support state efforts to prevent illnesses. We deployed a survey from 6 January 2021 to 1 March 2021, using a snowball sampling strategy and had 158 respondents. Of 115 respondents, 46 (40%) believed that state laws were ineffective in preventing illnesses, and 92 (80%) agreed that consumers continue to find ways to get unpasteurized milk despite laws restricting sale. Respondents from 19 states were aware of future legislative or regulatory efforts surrounding unpasteurized milk in their state, with 14 (74%) indicating these efforts would expand consumer access. The most common outbreak prevention strategies respondents mentioned included sharing knowledge and experiences with other public health and agriculture officials, providing information to inform legislative efforts, and communicating to the public about outbreaks. Most respondents (41/50, 91%) were interested in pursuing further efforts to prevent unpasteurized milk-associated illnesses in their state. CONCLUSIONS: The results from this needs assessment can be used to inform future strategies for preventing illness outbreaks associated with unpasteurized milk consumption. |
Physical job demands in pregnancy and associated musculoskeletal health and employment outcomes: a systematic review
Macdonald LA , Johnson CY , Ming-Lun LU , Santiago-Colón A , Adam MGP , Kimmel MHJ , Napolitano PG , Saldanha IJ . Am J Obstet Gynecol 2023 OBJECTIVE: A decline in musculoskeletal health during pregnancy is an under-appreciated adverse outcome of pregnancy that can have immediate and long-term health consequences. High physical job demands are known risk factors for non-traumatic musculoskeletal disorders in the general working population. Evidence from meta-analyses suggest occupational lifting and prolonged standing during pregnancy may increase risk of adverse pregnancy outcomes. This systematic review examined associations between occupational lifting or postural load in pregnancy and associated musculoskeletal disorders and related sequalae. DATA SOURCES: Five electronic databases (Medline, Embase, CINAHL, NIOSHTIC-2 and Ergonomic Abstracts) were searched from 1990 to July 2022 for studies in any language. A Web of Science snowball search was performed in December 2022. Reference lists were manually reviewed. ELIGIBILITY CRITERIA: Eligible studies reported associations between occupational lifting or postural load and musculoskeletal health or sequelae (e.g., employment outcomes) among pregnant and postpartum workers. METHODS: Data were extracted using a customized form to document study and sample characteristics, and details of exposures, outcomes, covariates, and analyses. Investigators independently assessed study quality for seven risk of bias domains and overall utility, with discrepant ratings resolved through discussion. A narrative synthesis was conducted due to heterogeneity. RESULTS: Sixteen studies (11 cohort studies, 2 nested case-control studies, and 3 cross-sectional studies) from 8 countries were included (N=142,320 pregnant and N=1,744 postpartum workers). Limited but consistent evidence with variable quality ratings, ranging from critical concern to high, suggests that pregnant workers exposed to heavy lifting (usually defined as ≥22 lbs or ≥10 kg) may be at increased risk of functionally limiting pelvic girdle pain and antenatal leave. Moreover, reports of dose-response relationships suggest graded risk levels according to lifting frequency, ranging from 21% to 45% for pelvic girdle pain and 58% to 202% for antenatal leave. Limited but consistent evidence also suggests that postural load increases the risk of employment cessation. CONCLUSION: Limited but consistent evidence suggests that pregnant workers exposed to heavy lifting and postural load are at increased risk of pelvic girdle pain and employment cessation. Job accommodations to reduce exposure levels may promote safe sustainable employment for pregnant workers. |
Seroprevalence to schistosoma soluble egg antigen among nomadic pastoralists residing in Northern Senegal
Seck MC , Badiane AS , Thwing J , Ndiaye M , Diongue K , Ndiaye IM , Diallo MA , Sy M , Gomis JF , Ndiaye T , Gaye A , Lee YM , Secor WE , Ndiaye D , Rogier E . J Parasitol 2023 109 (6) 580-587 Urinary and intestinal schistosomiasis are endemic in Senegal, with prevalence heterogeneous throughout the country. Because of their way of life, nomadic pastoralists are not typically included in epidemiological surveys, and data on the prevalence of schistosomiasis in Senegalese nomadic populations are largely non-existent. The purpose of this study was to determine the seroprevalence of schistosomiasis in Senegalese nomadic pastoralists. A modified snowball sampling survey was conducted among 1,467 nomadic pastoralists aged 6 mo and older in 5 districts in northern Senegal. Dried blood spots from participants of all ages and data regarding demographics were collected to assess IgG antibody responses against Schistosoma mansoni soluble egg antigen (SEA) using a bead-based multiplex assay. Out of 1,467 study subjects, 1,464 (99.8%) provided IgG serological data that cleared quality assurance. Of the participants with appropriate data, 56.6% were male, the median age was 22 yr, and 31.6% were under 15 yr of age. The overall anti-SEA IgG seroprevalence was 19.1% (95% confidence interval [CI]: 17.1-21.1%) with the highest estimates observed in Dagana (35.9%) and the lowest observed in Podor nomadic groups (3.4%). Antibody responses increased significantly with age except for the oldest age groups (>40 yr of age), which saw lower levels of antibody response compared to younger adults. When controlling for age and location by multivariate regression, the male sex was associated with a 2-fold greater odds of anti-SEA IgG seropositivity (aPOR: 2.0; 95% CI: 1.5-2.7). Serosurveys for anti-SEA IgG among nomadic peoples in northern Senegal found a substantial percentage of individuals with evidence for current or previous Schistosoma spp. infection with the highest levels of exposure in the district adjacent to the Diama dam along the Senegal River. With IgG prevalence increased by age except in the older adults, and the male sex significantly associated with seropositivity, these data point toward sex-associated behavioral practices and human environmental modification as risk factors for Schistosoma exposure. |
Rate and durability of clearance of hepatitis B surface antigen in Alaska Native persons with long-term hepatitis B virus infection: 1982-2019
Bruden D , McMahon BJ , Snowball M , Towshend-Bulson L , Homan C , Johnston JM , Simons BC , Bruce MG , Cooley L , Spradling PR , Harris AM . Hepatology 2023 BACKROUND AIMS: A functional cure and therapeutic endpoint of chronic hepatitis B virus (HBV) infection is defined as clearance of hepatitis B surface antigen (HBsAg) from serum. Little is known about the long-term durability of HBsAg loss in the Alaskan Native population. APPROACH RESULTS: We performed a retrospective cohort study of Alaskan Native patients with chronic HBV-monoinfection from January, 1982 through December 2019. The original group in this cohort were identified during a 1982 to 1987 population-based screening for three HBV serologic markers in 53,000 Alaska Native persons. With close to 32,000 years of follow-up, we assessed the frequency and duration of HBsAg seroclearance (HBsAg negative for >6 mo). We examined factors associated with HBsAg clearance and followed persons for a median of 13.1 years afterwards to assess durability of HBsAg clearance. Among 1,079 persons with an average length of follow-up of 33 years, 260 (24%) cleared HBsAg at a constant rate of 0.82% per person/per year. Of 260 persons who cleared, 249 (96%) remained HBsAg negative while 11 persons had≥ 2 transient HBsAg positive results in subsequent follow-up. CONCLUSIONS: Of patients with chronic HBV monoinfection, 0.82% of people per year achieved a functional cure. HBsAg seroclearance was durable for treated and non-treated patients and lasted on average over 13 years without seroreversion. The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention. |
The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals (preprint)
Townshend-Bulson L , Roik E , Barbour Y , Bruden DJT , Homan CE , Espera HGF , Stevenson TJ , Hewitt AM , Rhodes W , Gove JE , Plotnik JN , Snowball MM , McGilvray J , Simons BC , McMahon BJ . medRxiv 2021 2021.09.03.21263089 Background Direct-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir-based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people.Methods AN/AI patients within the Alaska Tribal Health System with confirmed positive anti-HCV and HCV RNA, who were 18 years of age and older were included in the study. Pretreatment baseline patient characteristics, treatment efficacy based on sustained virologic response (SVR) 12 weeks after treatment completion, and adverse effects were assessed. The following treatments were given according to the American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV Guidance: ledipasvir/sofosbuvir, sofosbuvir plus weight-based ribavirin, and sofosbuvir/velpatasvir.Results We included 501 patients with a mean age of 54.3 (range 21.3 -78.3) in the study. Overall SVR was achieved in 95.2% of patients who received one of the three DAA regimens. For those with cirrhosis, overall SVR was 92.8% and for those with genotype 3 91.1% achieved SVR. The most common symptom experienced during treatment was headache. Joint pain was found to decrease during treatment. One person discontinued sofosbuvir plus ribavirin due to myocardial infarction and one discontinued sofosbuvir/velpatasvir due to urticaria.Conclusions In the real-world setting, sofosbuvir-based treatment is safe, effective, and well tolerated in AN/AI patients. Sustained virologic response was high regardless of HCV genotype or cirrhosis status.Competing Interest StatementPartial funding from Gilead Sciences.Funding StatementPartial funding from Gilead Sciences.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Alaska Area Institutional Review Board (IHS IRB #2) Dr. Shanda Lohse, Chair, Alaska Area IRB Terry Powell, Administrator, Alaska Area IRB 4315 Diplomacy Drive - RMCC Anchorage, AK 99508 Phone: 907-729-3924 or 907-729-3917 Email: akaalaskaareaIRB{at}anthc.orgAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAccess to data for this study is subject to tribal review. Requests for data should be directed to the Alaska Native Tribal Health Consortium Privacy Officer c/o Ethics and Compliance Services, 4315 Diplomacy Drive, Anchorage, AK 99508. |
High-risk injection-related practices associated with anti-HCV positivity among young adults seeking services in three small cities in Wisconsin
Rogers-Brown J , Sublett F , Canary L , Rein DB , Bhat M , Thompson WW , Vellozzi C , Asher A . Subst Use Misuse 2022 57 (5) 1-9 BACKGROUND: Hepatitis C virus (HCV) infection has been increasing among people who inject drugs (PWID), younger than 30 years, and living in rural or suburban areas. We examined injection-related behaviors of young PWID to determine factors associated with HCV infection. METHODS: From September 2013-May 2015, respondent-driven and snowball sampling were used in 3 suburban areas of Wisconsin to recruit PWID 18-29 years who reported injection drug use in the previous 12 months. Participants were tested for HCV antibody (anti-HCV) and reported injection-related behaviors/practices via self-administered computer-based survey. We calculated anti-HCV prevalence and assessed associated factors using multivariable logistic regression. RESULTS: Forty-two percent (117/280) of participants were male, 83% (231/280) were white, and median age was 23 years. Overall HCV prevalence was 33%, but HCV prevalence among males was 39%. Adjusting for age, sex, race/ethnicity, education, relationship status, insurance status and income, anti-HCV positivity was associated with higher injection frequency (> 100 times in the past six months) (aOR = 3.07; 95% Confidence Interval (95% CI): 1.72-5.45), ever shared syringes (aOR = 5.15; 95% CI: 2.52-10.51), past week/last use receptive rinse water sharing (aOR = 1.88; 95% CI: 1.06-3.33), past week/last use receptive filter sharing (aOR = 3.25; 95% CI: 1.61-6.54), reusing syringes (aOR = 1.91, 95% CI: 1.08-3.37), history of overdose (aOR = 8.82; 95% CI: 2.26-3.95), and having ever injected another PWID (aOR = 8.82; 95%CI 3.94-19.76). DISCUSSION: Anti-HCV positivity is associated with high-risk injection practices. Young PWID would benefit from access to evidence-based interventions that reduce their risk of infection, link those infected to HCV treatment, and provide education to reduce further transmission. |
The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals
Townshend-Bulson L , Roik E , Barbour Y , Bruden DJT , Homan CE , Espera HGF , Stevenson TJ , Hewitt AM , Rhodes W , Gove JE , Plotnik JN , Snowball MM , McGilvray J , Simons BC , Johnston JM , McMahon BJ . PLoS One 2021 16 (12) e0260970 BACKGROUND: Direct-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir- based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people. METHODS: AN/AI patients within the Alaska Tribal Health System with confirmed positive anti-HCV and HCV RNA, who were 18 years of age and older were included in the study. Pretreatment baseline patient characteristics, treatment efficacy based on sustained virologic response (SVR) 12 weeks after treatment completion, and adverse effects were assessed. The following treatments were given according to the American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV Guidance: ledipasvir/sofosbuvir, sofosbuvir plus weight-based ribavirin, and sofosbuvir/velpatasvir. RESULTS: We included 501 patients with a mean age of 54.3 (range 21.3-78.3) in the study. Overall SVR was achieved in 95.2% of patients who received one of the three DAA regimens. For those with cirrhosis, overall SVR was 92.8% and for those with genotype 3 91.1% achieved SVR. The most common symptom experienced during treatment was headache. Joint pain was found to decrease during treatment. One person discontinued sofosbuvir plus ribavirin due to myocardial infarction and one discontinued sofosbuvir/velpatasvir due to urticaria. CONCLUSIONS: In the real-world setting, sofosbuvir-based treatment is safe, effective, and well tolerated in AN/AI patients. Sustained virologic response was high regardless of HCV genotype or cirrhosis status. |
Hepatitis A vaccine immunogenicity 25 years after vaccination in Alaska
Ramaswamy M , Bruden D , Nolen LD , Mosites E , Snowball M , Nelson NP , Bruce M , McMahon BJ . J Med Virol 2021 93 (6) 3991-3994 The hepatitis A vaccine is recommended for all children greater than or equal to 1 year of age, however, the duration of vaccine protection is unknown and protection through adulthood is crucial to prevent symptomatic hepatitis later in life. We report on 25 years of follow-up of a cohort of Alaska Native individuals who were vaccinated in early childhood. We assessed the duration of vaccine protection by calculating the geometric mean concentration and proportion of participants with protective levels of IgG antibody to hepatitis A virus (anti-HAV) (≥20 mIU/mL) every 2 to 3 years. We estimated the amount of time until the anti-HAV dropped below protective levels using survival analyses. At 25 years, 43 of the original 144 participants were available, mean anti-HAV levels were 91.5 mIU/mL, and 35 (81.4%) had protective levels of anti-HAV. Using data from all persons and all time points, a survival analysis estimated 78.7% of participants had protective levels of anti-HAV at 25 years. The high level of protective antibodies in this cohort indicate that supplemental doses of hepatitis A vaccine are not needed 25 years after completion of the vaccine series. |
An international needs assessment survey of guideline developers demonstrates variability in resources and challenges to collaboration between organizations
Sultan S , Siedler MR , Morgan RL , Ogunremi T , Dahm P , Fatheree LA , Getchius TSD , Ginex PK , Jakhmola P , McFarlane E , Murad MH , Temple Smolkin RL , Amer YS , Alam M , Kang BY , Falck-Ytter Y , Mustafa RA . J Gen Intern Med 2021 37 (11) 2669-2677 BACKGROUND: The development of rigorous, high-quality clinical guidelines increases the need for resources and skilled personnel within guideline-producing organizations. While collaboration between organizations provides a unique opportunity to pool resources and save time and effort, the collaboration presents its own unique challenges. OBJECTIVE: To assess the perceived needs and current challenges of guideline producers worldwide related to guideline development and collaboration efforts. DESIGN: Survey questions were developed by the Guidelines International Network and the US GRADE Network, pilot-tested among attendees of a guideline development workshop, and disseminated electronically using convenience and snowball sampling methods. PARTICIPANTS: A total of 171 respondents representing 30 countries and more than 112 unique organizations were included in this analysis. MAIN MEASURES: The survey included free-response, multiple-choice, and seven-point Likert-scale questions. Questions assessed respondents' perceived value of guidelines, resource availability and needs, guideline development processes, and collaboration efforts of their organization. KEY RESULTS: Time required to develop high-quality systematic reviews and guidelines was the most relevant need (median=7; IQR=5.5-7). In-house resources to conduct literature searches (median=4; IQR=3-6) and the resources to develop rigorous guidelines rapidly (median=4; IQR=2-5) were perceived as the least available resources. Difficulties reconciling differences in guideline methodology (median=6; IQR=4-7) and the time required to establish collaborative agreements (median=6; IQR=5-6) were the most relevant barriers to collaboration between organizations. Results also indicated a general need for improvement in conflict of interest (COI) disclosure policies. CONCLUSION: The survey identified organizational challenges in supporting rigorous guideline development, including the time, resources, and personnel required. Connecting guideline developers to existing databases of high-quality systematic reviews and the use of freely available online platforms may facilitate guideline development. Guideline-producing organizations may also consider allocating resources to hiring or training personnel with expertise in systematic review methodologies or utilizing resources more effectively by establishing collaborations with other organizations. |
Hepatitis B Virus (HBV) Genotype: A Significant Risk Factor in Determining which Patients with Chronic HBV Infection should Undergo Surveillance for Hepatocellular Carcinoma: The Hepatitis B Alaska (HEP-B-AK) Study.
McMahon BJ , Nolen S , Snowball M , Homan C , Negus S , Roik E , Spradling PR , Bruden D . Hepatology 2021 74 (6) 2965-2973 BACKGROUND AND AIMS: Information is limited regarding hepatitis B virus (HBV) genotype and the outcome of chronic HBV (CHB) infection. We examined HBV genotype on hepatocellular carcinoma (HCC) occurrence in Alaska Native (AN) persons with CHB where five HBV genotypes are found, A2, B6, C2, D and F1. APPROACH AND RESULTS: We calculated HCC incidence per 1000 person-years of follow-up to determine which groups by age, sex, and genotype met current American Association for the Study of Liver Diseases HCC surveillance criteria. We used Poisson regression to compare HCC risk by genotype, age, sex, and Alaska region. Incidence of HCC was calculated using the sex specific AASLD cutoff recommended for the Asian population of 50 years for women and 40 years for men. HCC screening was conducted semiannually using alpha-fetoprotein levels and abdominal ultrasound. Among 1185 AN persons, median follow up was 35.1 years; 667 (63%) were male. The HBV genotype distribution was: 49% D, 18% F, 13% A, 6% C, 3% B, 0.1% H, and 12% undetermined. Sixty-three cases of HCC occurred. HCC incidence for genotype F was 5.73 per 1000 person-years of follow-up, followed by 4.77 for C, 1.28 for A, 0.47 for D and 0.00 for B. The HCC risk was higher for genotypes F (Relative rate [RR] : 12.7, 95% confidence interval [CI]: 6.1-26.4) , C (RR: 10.6, 95% CI: 4.3-26.0) and A (RR: 2.9, 95% CI: 1.0-8.0) compared to genotypes B or D. Among males < 40 years of age and females < 50 years of age, genotype F had the highest incidence (4.79/1000 person-years). CONCLUSIONS: HBV genotype was strongly associated with HCC HBV genotype should be considered in risk factor stratification. |
Culture clash of female Somali adolescents and sexual and reproductive health services in Oslo, Norway
Afroz T , Gele A , Thorsen VC . Eur J Contracept Reprod Health Care 2021 26 (4) 1-7 OBJECTIVE: Culture influences an individual's perception of health needs. The influence of culture also applies to Somali individuals' perception of their sexual and reproductive health (SRH) and uptake of related services. An understanding of female Somali adolescents' SRH needs is vital to achieve inclusive health coverage. No research has, however, been conducted to explore the SRH needs of this population group in Oslo; hence, the aim of this qualitative study was to minimise the knowledge gap. METHODS: Fourteen young women aged 16-20 years were recruited using the snowball technique with purposive sampling. In-depth interviews using a semi-structured interview guide were used to collect data, and thematic analysis was applied. RESULTS: Participants perceived SRH as a very private matter and open discussion of SRH was extremely limited owing to certain Somali cultural beliefs and values. As the participants intend to practise chastity before marriage, they believed that existing SRH services were largely irrelevant and inappropriate. Where they felt the need to access SRH services, participants wished to do so in a way they considered culturally appropriate. CONCLUSION: Somali culture markedly influences individuals' perceptions of SRH services. It is recommended to modify existing SRH services by increasing confidentiality and anonymity in order to take into account the cultural requirements of female Somali adolescents. |
Vaccination status of Alaska Native persons with hepatitis a virus infection - Alaska, 1996-2018
Plumb ID , Gounder PP , Nolen LD , Massay SC , Castrodale L , McLaughlin J , Snowball M , Homan C , Nelson NP , Singleton R , Bruce MG , McMahon BJ . Clin Infect Dis 2020 72 (12) 2212-2214 Following increases in reported cases of hepatitis A, we assessed the impact of hepatitis A vaccine in Alaska Native persons. During 1996-2018, only 6 cases of hepatitis A were identified, all in unvaccinated adults. Populations can be protected against hepatitis A by achieving sufficient vaccination coverage over time. |
The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review
Paganelli CR , Goco NJ , McClure EM , Banke KK , Blau DM , Breiman RF , Menéndez C , Rakislova N , Bassat Q . Glob Health Action 2020 13 (1) 1792682 BACKGROUND: Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes. OBJECTIVE: The aim of this narrative review is to describe historical use and evolution of needle-based postmortem procedures as a tool to ascertain the cause of death, especially in LMICs. METHODS: Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached. RESULTS: A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA. CONCLUSIONS: Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination. |
Analysis of anti-Plasmodium IgG profiles among Fulani nomadic pastoralists in northern Senegal to assess malaria exposure
Seck MC , Thwing J , Badiane AS , Rogier E , Fall FB , Ndiaye PI , Diongue K , Mbow M , Ndiaye M , Diallo MA , Gomis JF , Mbaye A , Ndiaye T , Gaye A , Sy M , Deme AB , Ndiaye YD , Ndiaye D . Malar J 2020 19 (1) 15 BACKGROUND: Northern Senegal is a zone of very low malaria transmission, with an annual incidence of < 5/1000 inhabitants. This area, where the Senegal National Malaria Control Programme has initiated elimination activities, hosts Fulani, nomadic, pastoralists that spend the dry season in the south where malaria incidence is higher (150-450/1000 inhabitants) and return to the north with the first rains. Previous research demonstrated parasite prevalence of < 1% in this Fulani population upon return from the south, similar to that documented in the north in cross-sectional surveys. METHODS: A modified snowball sampling survey of nomadic pastoralists was conducted in five districts in northern Senegal during September and October 2014. Demographic information and dried blood spots were collected. Multiplex bead-based assays were used to assess antibody responses to merozoite surface protein (MSP-119) antigen of the four primary Plasmodium species, as well as circumsporozoite protein (CSP) and liver stage antigen (LSA-1) of Plasmodium falciparum. RESULTS: In the five study districts, 1472 individuals were enrolled, with a median age of 22 years (range 1 to 80 years). Thirty-two percent of subjects were under 14 years and 57% were male. The overall seroprevalence of P. falciparum MSP-119, CSP and LSA-1 antibodies were 45, 12 and 5%, respectively. Plasmodium falciparum MSP-119 antibody responses increased significantly with age in all study areas, and were significantly higher among males. The highest seroprevalence to P. falciparum antigens was observed in the Kanel district (63%) and the lowest observed in Podor (28%). Low seroprevalence was observed for non-falciparum species in all the study sites: 0.4, 0.7 and 1.8%, respectively, for Plasmodium ovale, Plasmodium vivax and Plasmodium malariae MSP-1. Antibody responses to P. vivax were observed in all study sites except Kanel. CONCLUSION: Prevalence of P. falciparum MSP-119 antibodies and increases by study participant age provided data for low levels of exposure among this transient nomadic population. In addition, antibody responses to P. falciparum short half-life markers (CSP and LSA-1) and non-falciparum species were low. Further investigations are needed to understand the exposure of the Fulani population to P. vivax. |
HIV and transgender women in Kampala, Uganda - double jeopardy
King R , Nanteza J , Sebyala Z , Bbaale J , Sande E , Poteat T , Kiyingi H , Hladik W . Cult Health Sex 2018 21 (6) 1-14 Transgender women in Kampala face stigma, high HIV acquisition or transmission risk and poor access to health services. We explored the HIV and gender-related contexts of their lives. Snowball sampling was used to enrol 45 participants between July-October 2013. Data collection included audio-computer-assisted self-interviews, qualitative face-to-face interviews and blood tests for HIV and CD4. One in five respondents tested HIV positive. Emergent themes revealed highly varied forms of gender identity and gender expression. Almost all respondents asserted that they frequently engaged in sex work, mainly due to lack of employment. HIV-related themes included limited access to non-stigmatising health services, inconsistent condom use, inaccurate perceptions of self and partners' risk, alcohol use, receptive anal sex with men, multiple sex partners, frequent self and enacted stigma, and violence. Findings highlight the urgency of providing members of this marginalised population with tailored, innovative, comprehensive and effective HIV prevention programmes that address structural issues such as access to HIV services and limited employment as well as behavioural issues such as inconsistent condom use, multiple sexual partners, self and enacted stigma, violence and alcohol use. |
Hepatitis A vaccine immune response 22 years after vaccination
Mosites E , Gounder P , Snowball M , Morris J , Spradling P , Nelson N , Bulkow L , Bruce M , McMahon B . J Med Virol 2018 90 (8) 1418-1422 In the United States, the incidence of hepatitis A virus (HAV) infection has been reduced through universal childhood vaccination. However, the duration of immunogenicity for the hepatitis A vaccine is not known. We report on the 22 year follow-up time point of a cohort of Alaska children who were randomized to three different vaccine schedules: A) 0,1,2 months; B) 0,1,6 months; and C) 0,1,12 months. Among 46 participant available for follow-up, 40 (87%) maintained protective levels of anti-hepatitis A antibody. These results indicate that a supplemental booster dose is not yet necessary at or before the 22-year time point. This article is protected by copyright. All rights reserved. |
Framework for considering productive aging at work
Schulte PA , Grosch J , Scholl JC , Tamers SL . J Occup Environ Med 2018 60 (5) 440-448 OBJECTIVES: The U.S. population is experiencing a demographic transition resulting in an aging workforce. The objective of this article is to elucidate and expand an approach to keep that workforce safe, healthy and productive. METHODS: This article elucidates the framework for the National Center for Productive Aging at Work of the National Institute for Occupational Safety and Health. Subject matter experts used a snowball method to review published literature to substantiate elements in the framework. RESULTS: Evidence-based literature supports a productive aging framework for the workforce involving the following elements: 1) life span perspective; 2) comprehensive and integrated approaches to occupational safety and health; 3) emphasis on positive outcomes for both workers and organizations; and 4) supportive work culture for multigenerational issues. CONCLUSIONS: The productive aging framework provides a foundational and comprehensive approach for addressing the aging workforce. |
Malaria prevalence, prevention and treatment seeking practices among nomadic pastoralists in northern Senegal
Seck MC , Thwing J , Fall FB , Gomis JF , Deme A , Ndiaye YD , Daniels R , Volkman SK , Ndiop M , Ba M , Ndiaye D . Malar J 2017 16 (1) 413 BACKGROUND: Malaria transmission in Senegal is highly stratified, from low in the dry north to moderately high in the moist south. In northern Senegal, along the Senegal River Valley and in the Ferlo semi-desert region, annual incidence is less than five cases per 1000 inhabitants. Many nomadic pastoralists have permanent dwellings in the Ferlo Desert and Senegal River Valley, but spend dry season in the south with their herds, returning north when the rains start, leading to a concern that this population could contribute to ongoing transmission in the north. METHODS: A modified snowball sampling survey was conducted at six sites in northern Senegal to determine the malaria prevention and treatment seeking practices and parasite prevalence among nomadic pastoralists in the Senegal River Valley and the Ferlo Desert. Nomadic pastoralists aged 6 months and older were surveyed during September and October 2014, and data regarding demographics, access to care and preventive measures were collected. Parasite infection was detected using rapid diagnostic tests (RDTs), microscopy (thin and thick smears) and polymerase chain reaction (PCR). Molecular barcodes were determined by high resolution melting (HRM). RESULTS: Of 1800 participants, 61% were male. Sixty-four percent had at least one bed net in the household, and 53% reported using a net the night before. Only 29% had received a net from a mass distribution campaign. Of the 8% (142) who reported having had fever in the last month, 55% sought care, 20% of whom received a diagnostic test, one-third of which (n = 5) were reported to be positive. Parasite prevalence was 0.44% by thick smear and 0.50% by PCR. None of the molecular barcodes identified among the nomadic pastoralists had been previously identified in Senegal. CONCLUSIONS: While access to and utilization of malaria control interventions among nomadic pastoralists was lower than the general population, parasite prevalence was lower than expected and sheds doubt on the perception that they are a source of ongoing transmission in the north. The National Malaria Control Program is making efforts to improve access to malaria prevention and case management for nomadic populations. |
Persistence of antibody to hepatitis A virus 20 years after receipt of hepatitis A vaccine in Alaska
Plumb ID , Bulkow LR , Bruce MG , Hennessy TW , Morris J , Rudolph K , Spradling P , Snowball M , McMahon BJ . J Viral Hepat 2017 24 (7) 608-612 Hepatitis A vaccine is recommended for children ≥1 year old to prevent hepatitis A virus (HAV) infection. However the duration of vaccine-induced immunity is unknown. We evaluated a cohort of Alaska Native persons 20 years after HAV vaccination. Children aged 3-6 years had been previously randomized to receive 3 doses of HAV vaccine (360 ELISA units/dose) at: A) 0,1,2 months; B) 0,1,6 months; and C) 0,1,12 months. We measured anti-HAV antibody concentrations every 2-3 years; described geometric mean concentrations (GMC) and the proportion with protective antibody (≥20 mIU mL-1) over time; and modelled change in GMC using fractional polynomial regression. Of 144 participants, after 20 year 52 (36.1%) were available for follow-up (17, 18, 17 children in Groups A, B and C, respectively). Overall, 46 (88.5%) of 52 available participants had anti-HAV antibody concentrations ≥20mIU mL-1 and overall GMC was 107 mIU mL-1. Although GMC levels were lower in Group A (60; CI 34-104) than in Group B (110; CI 68-177), or Group C (184; CI 98-345) (B versus C: p=0.168; A versus B/C: p=0.011), there was no difference between groups after adjusting for peak antibody levels post vaccination (p=0.579). Models predicted geometric mean concentrations of 124 mIU mL-1 after 25 years, and 106 mIU mL-1 after 30 years. HAV vaccine provides protective antibody levels 20 years after childhood vaccination. Lower antibody levels in Group A may be explained by a lower initial peak response. Our results suggest a booster vaccine dose is unnecessary for at least 25-30 years. |
Infection With Hepatitis C Virus Genotype 3 is an Independent Risk Factor for End-stage Liver Disease, Hepatocellular Carcinoma, and Liver-related Death.
McMahon BJ , Bruden D , Townshend-Bulson L , Simons B , Spradling P , Livingston S , Gove J , Hewitt A , Plotnik J , Homan C , Espera H , Negus S , Snowball M , Barbour Y , Bruce M , Gounder P . Clin Gastroenterol Hepatol 2016 15 (3) 431-437 e2 BACKGROUND & AIMS: Few studies have examined factors associated with disease progression in hepatitis C virus (HCV) infection. We examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic HCV infection. METHODS: We collected data from a population-based cohort study of liver-related adverse outcomes of infection in American Indian/Alaska Native persons with chronic HCV living in Alaska, recruited from 1995 through 2012. We calculated adjusted hazard ratios (aHR) and 95% CIs for end-stage liver disease (ESLD; presence of ascites, esophageal varices, hepatic encephalopathy, or coagulopathy), hepatocellular carcinoma (HCC), and liver-related death using a Cox proportional hazards model. RESULTS: We enrolled 1080 participants followed for 11,171 person-years (mean, 10.3 years); 66%, 19%, and 14% were infected with HCV genotypes 1, 2, and 3, respectively. On multivariate analysis, persons infected with HCV genotype 3 had a significantly increased risk of developing all 3 adverse outcomes. Their aHR for ESLD was 2.1 (95% CI, 1.5-3.0), aHR for HCC was 3.1 (95% CI, 1.4-6.6), and aHR for liver-related death was 2.4 (95% CI, 1.5-4.0) compared to genotype 1. Heavy alcohol use was an age-adjusted risk factor for ESLD (aHR, 2.2; 95% CI, 1.6-3.2), and liver-related death (aHR: 2.9; 95% CI, 1.8-4.6). Obesity was a risk factor for ESLD (aHR, 1.4; 95% CI, 1.0-1.9, and diabetes was a risk factor for ESLD (aHR, 1.5; 95% CI, 1.1-2.2). Male sex was a risk factor for HCC (aHR, 3.6; 95% CI, 1.6-8.2). CONCLUSIONS: In a population-based cohort study of American Indian/Alaska Native persons with chronic HCV infection, we found those infected with HCV genotype 3 to be at high risk for ESLD, HCC, and liver-related death. |
Hepatocellular Carcinoma Risk in Alaska Native Children and Young Adults with Hepatitis B Virus: Retrospective Cohort Analysis.
Gounder PP , Bulkow LR , Snowball M , Negus S , Spradling PR , McMahon BJ . J Pediatr 2016 178 206-213 OBJECTIVES: To evaluate the hepatocellular carcinoma (HCC) risk in Alaska Native children and young adults with hepatitis B virus (HBV). STUDY DESIGN: Retrospective analysis of a population-based cohort of Alaska Native persons with HBV followed during 1982-2012. All individuals with HBV were offered HCC screening regardless of age using alpha-fetoprotein every 6 months; persons with an elevated alpha-fetoprotein or persons at high-risk for HCC, such as cirrhosis, family history of HCC, were offered ultrasound. We calculated the HCC incidence/1000 person-years from date of cohort entry until death, diagnosis of HCC, or attaining the age of 40 years (males) or 50 years (females). RESULTS: We followed 1083 subjects with HBV (56% male) comprising 5 genotypes (A2 [12.5%], B6 [1.7%], C [5.3%], D [49.7%], F1 [18.6%], unknown [12.4%]) for a median of 23.4 years/person. We observed 22 HCC cases (incidence/1000 person-years follow-up: 1.0); 19 HCC cases among persons with genotype F1. There was no significant difference in HCC incidence between males (1.4) and females (0.6). The HCC incidence was significantly higher for persons with genotype F1 (4.4) compared with genotype A2 (0.4) and D (0.2) and remained higher among persons with HBV genotype F1 excluding persons with HCC family history/cirrhosis (1.9). CONCLUSIONS: Alaska Native children and young adults with HBV genotype F1 are at high risk for HCC and should receive HCC surveillance. For males <40 years of age and females <50 years of age with HBV in regions of the world with a high genotype F prevalence, testing/confirming genotype F can identify persons who could benefit from HCC surveillance. |
A longitudinal hepatitis B vaccine cohort demonstrates long-lasting hepatitis B virus (HBV) cellular immunity despite loss of antibody against HBV surface antigen
Simons BC , Spradling PR , Bruden DJ , Zanis C , Case S , Choromanski TL , Apodaca M , Brogdon HD , Dwyer G , Snowball M , Negus S , Bruce MG , Morishima C , Knall C , McMahon BJ . J Infect Dis 2016 214 (2) 273-80 BACKGROUND: Long-lasting protection resulting from hepatitis B vaccine, despite loss of antibody against hepatitis B virus (HBV) surface antigen (anti-HBs), is undetermined. METHODS: We recruited persons from a cohort vaccinated with plasma-derived hepatitis B vaccine in 1981 who have been followed periodically since. We performed serological testing for anti-HBs and microRNA-155 and assessed HBV-specific T-cell responses by enzyme-linked immunospot and cytometric bead array. Study subgroups were defined 32 years after vaccination as having an anti-HBs level of either ≥10 mIU/mL (group 1; n = 13) or <10 mIU/mL (group 2; n = 31). RESULTS: All 44 participants, regardless of anti-HBs level, tested positive for tumor necrosis factor alpha, interleukin 10, or interleukin 6 production by HBV surface antigen-specific T cells. The frequency of natural killer T cells correlated with the level of anti-HBs (P = .008). The proportion of participants who demonstrated T-cell responses to HBV core antigen varied among the cytokines measured, suggesting some natural exposure to HBV in the study group. No participant had evidence of breakthrough HBV infection. CONCLUSIONS: Evidence of long-lasting cellular immunity, regardless of anti-HBs level, suggests that protection afforded by primary immunization with plasma-derived hepatitis B vaccine during childhood and adulthood lasts at least 32 years. |
Nursing Informatics Research Priorities for the Future: Recommendations from an International Survey.
Peltonen LM , Topaz M , Ronquillo C , Pruinelli L , Sarmiento RF , Badger MK , Ali S , Lewis A , Georgsson M , Jeon E , Tayaben JL , Kuo CH , Islam T , Sommer J , Jung H , Eler GJ , Alhuwail D . Stud Health Technol Inform 2016 225 222-226 We present one part of the results of an international survey exploring current and future nursing informatics (NI) research trends. The study was conducted by the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA-NISIG) Student Working Group. Based on findings from this cross-sectional study, we identified future NI research priorities. We used snowball sampling technique to reach respondents from academia and practice. Data were collected between August and September 2015. Altogether, 373 responses from 44 countries were analyzed. The identified top ten NI trends were big data science, standardized terminologies (clinical evaluation/implementation), education and competencies, clinical decision support, mobile health, usability, patient safety, data exchange and interoperability, patient engagement, and clinical quality measures. Acknowledging these research priorities can enhance successful future development of NI to better support clinicians and promote health internationally. |
Programmatic management of drug-resistant tuberculosis: An updated research agenda
Mitnick CD , Rodriguez CA , Hatton ML , Brigden G , Cobelens F , Grobusch MP , Horsburgh R , Lange C , Lienhardt C , Oren E , Podewils LJ , Seaworth B , van den Hof S , Daley CL , Gebhard AC , Wares F . PLoS One 2016 11 (5) e0155968 INTRODUCTION: There are numerous challenges in delivering appropriate treatment for multidrug-resistant tuberculosis (MDR-TB) and the evidence base to guide those practices remains limited. We present the third updated Research Agenda for the programmatic management of drug-resistant TB (PMDT), assembled through a literature review and survey. METHODS: Publications citing the 2008 research agenda and normative documents were reviewed for evidence gaps. Gaps were formulated into questions and grouped as in the 2008 research agenda: Laboratory Support, Treatment Strategy, Programmatically Relevant Research, Epidemiology, and Management of Contacts. A survey was distributed through snowball sampling to identify research priorities. Respondent priority rankings were scored and summarized by mean. Sensitivity analyses explored weighting and handling of missing rankings. RESULTS: Thirty normative documents and publications were reviewed for stated research needs; these were collapsed into 56 research questions across 5 categories. Of more than 500 survey recipients, 133 ranked priorities within at least one category. Priorities within categories included new diagnostics and their effect on improving treatment outcomes, improved diagnosis of paucibacillary and extra pulmonary TB, and development of shorter, effective regimens. Interruption of nosocomial transmission and treatment for latent TB infection in contacts of known MDR-TB patients were also top priorities in their respective categories. Results were internally consistent and robust. DISCUSSION: Priorities retained from the 2008 research agenda include shorter MDR-TB regimens and averting transmission. Limitations of recent advances were implied in the continued quest for: shorter regimens containing new drugs, rapid diagnostics that improve treatment outcomes, and improved methods of estimating burden without representative data. CONCLUSION: There is continuity around the priorities for research in PMDT. Coordinated efforts to address questions regarding shorter treatment regimens, knowledge of disease burden without representative data, and treatment for LTBI in contacts of known DR-TB patients are essential to stem the epidemic of TB, including DR-TB. |
The changing epidemiology and etiology of hepatocellular carcinoma from 1969 through 2013 in Alaska Native peoples
Connelly M , Bruce MG , Bulkow L , Snowball M , McMahon BJ . Liver Int 2016 36 (12) 1829-1835 BACKGROUND AND AIMS: Alaska Native peoples have an increased rate of hepatocellular carcinoma compared to the United States population. Viral hepatitis is a risk factor for malignancy and the leading cause of hepatocellular carcinoma in Alaska. With the introduction of hepatitis B immunization in 1982, as well as the emergence of hepatitis C virus in this population, the epidemiology and etiology of hepatocellular carcinoma in Alaska have changed. METHODS: Using the Alaska Native Tumor Registry, all cases of viral and non-viral hepatocellular carcinoma occurring from 1969 through 2013 were identified and reviewed. Incidence rates per 100,000 population were calculated for hepatocellular carcinoma overall and by etiologic category. RESULTS: 152 cases of hepatocellular carcinoma were identified in 148 Alaska Native persons. Overall tumor rate was 3.82 per 100,000 and did not change significantly over the study period. Hepatitis B associated cases decreased significantly over the study period (p=0.048) and were eliminated in persons under the age of 20. Hepatitis C associated cases increased significantly (P<0.001). Undetermined hepatocellular carcinoma rates also decreased. (p=0.034) CONCLUSIONS: Overall hepatocellular carcinoma rates in Alaska Native peoples remained stable over the study period, but the epidemiology and etiology are changing. Two decades after routine hepatitis B immunization, the hepatocellular carcinoma age distribution has shifted to cases presenting later in life. This is consistent with an aging hepatitis B infected population with no new infected young persons coming into the population, as well as the emergence of hepatitis C in adults. This article is protected by copyright. All rights reserved. |
Cost-effectiveness analysis of hepatocellular carcinoma screening by combinations of ultrasound and alpha-fetoprotein among Alaska Native people, 1983-2012
Gounder PP , Bulkow LR , Meltzer MI , Bruce MG , Hennessy TW , Snowball M , Spradling PR , Adhikari BB , McMahon BJ . Int J Circumpolar Health 2016 75 31115 BACKGROUND: The American Association for the Study of Liver Diseases (AASLD) recommends semi-annual hepatocellular carcinoma (HCC) screening using ultrasound (US) in persons with chronic hepatitis B (CHB) virus infection at high risk for HCC such as Asian males aged ≥40 years and Asian females aged ≥50 years. OBJECTIVE: To analyse the cost-effectiveness of 2 HCC screening methods in the Alaska Native (AN) health system: US-alone, or screening by alpha-fetoprotein (AFP) initially and switching to US for subsequent screenings if AFP >10 ng/mL (AFP-->US). DESIGN: A spreadsheet-based model was developed for accounting the costs of 2 hypothetical HCC screening methods. We used epidemiologic data from a cohort of 839 AN persons with CHB who were offered HCC screening by AFP/US semi-annually during 1983-2012. We assumed that compared with AFP-->US, US-alone identifies 33% more tumours at an early stage (defined as a single tumour ≤5 cm or ≤3 tumours ≤3 cm in diameter). Years of life gained (YLG) attributed to screening was estimated by comparing additional years of survival among persons with early- compared with late-stage tumours. Screening costs were calculated using Medicare reimbursement rates in 2012. Future screening costs and YLG were projected over a 30-year time horizon using a 3% discount rate. RESULTS: The total cost of screening for the cohort by AFP-->US would have been approximately $357,000 ($36,000/early-stage tumour detected) compared to $814,000 ($59,000/early-stage tumour detected) by US-alone. The AFP-->US method would have yielded an additional 27.8 YLG ($13,000/YLG) compared with 38.9 YLG ($21,000/YLG) for US-alone. Screening by US-alone would incur an additional $114,000 per extra early-tumour detected compared with AFP-->US and $41,000 per extra YLG. CONCLUSIONS: Although US-alone HCC screening might have yielded more YLG than AFP-->US, the reduced costs of the AFP-->US method could expand access to HCC screening in resource constrained settings. |
Nested case-control study: hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance
Gounder PP , Bulkow LR , Snowball M , Negus S , Spradling PR , Simons BC , McMahon BJ . Aliment Pharmacol Ther 2016 43 (11) 1197-207 BACKGROUND: Hepatocellular carcinoma (HCC) risk after resolving chronic hepatitis B virus (HBV) infection is unclear. AIM: To compare HCC risk between Alaska Native (AN) patients with and without hepatitis B surface antigen (HBsAg) seroclearance. METHODS: We selected persons with (case-patients) and without (control-patients) HBsAg seroclearance from a cohort of 1346 chronically HBV-infected AN patients followed during 1982-2013. We attempted to match two control-patients/case-patient on sex, HBV genotype, and age. Person-years of follow-up for case-patients began on the date of HBsAg resolution and for control-patients began on the date equivalent to the cohort entry date plus the years of HBsAg duration for their corresponding case-patient. We compared HCC risk using a Cox proportional hazards model. RESULTS: The 238 case-patients (4 with HCC) and 435 control-patients (9 with HCC) were similar in age [P-value (P) = 0.30], sex (P = 0.53) and HBV genotype (P = 0.99). Case-patients had longer person-years of follow-up than control-patients (11.7 vs. 10.1 years; P = 0.04). The HCC rate/100 000 persons was similar between case- (132) and control-patients (178; P = 0.65). The adjusted hazard ratio comparing case- and control-patients was similar for HCC [0.7; 95% confidence interval (CI): 0.2-2.4], increased for each 1-year increment for age (1.1; CI: 1.0-1.1; P < 0.01), and was greater if the initial HBeAg was positive (3.5; CI: 1.1-11.0; P = 0.03). CONCLUSIONS: Hepatitis B surface antigen seroclearance was not associated with reduced HCC risk; the HCC risk estimates are limited by wide 95% confidence intervals. Persons meeting HCC surveillance indications prior to HBsAg seroclearance could benefit from continued surveillance after seroclearance. |
Incidence of Hepatocellular Carcinoma According to Hepatitis B Virus Genotype in Alaska Native People.
Ching LK , Gounder PP , Bulkow L , Spradling PR , Bruce M , Negus S , Snowball M , McMahon BJ . Liver Int 2016 36 (10) 1507-15 BACKGROUND & AIMS: Most regions of the world have <3 co-circulating hepatitis B virus (HBV) genotypes, which limits direct comparisons of hepatocellular carcinoma (HCC) risk among HBV-infected persons by genotype. We evaluated HCC incidence by HBV genotype in a cohort of Alaska Native (AN) persons where 5 HBV genotypes (A, B, C, D, F) have been identified. METHODS: Our cohort comprised AN persons with chronic HBV infection identified during 1983-2012 who consented to participate in the study. Cohort persons were offered annual hepatitis B e antigen (HBeAg) testing and semiannual HCC screening. We developed a logistic regression model to compare HCC risk by genotype, adjusting for age, sex, region, and HBeAg status. RESULTS: Among the 1,235 consenting study participants, 711 (57.6%) were male, 510 (41.3%) were HBeAg positive at cohort entry, and 43 (3.5%) developed HCC. The HBV genotype was known for 1,142 (92.5%) persons (13.5% A, 3.9% B, 6.7% C, 56.9% D, 19.0% F). The HCC incidence/1,000 person-years of follow-up for genotypes A, B, C, D, and F was 1.3, 0, 5.5, 0.4, and 4.2, respectively. Compared with persons with HBV genotype B/D infection, the HCC risk was higher for persons with genotypes A (adjusted odds ratio [aOR]: 3.9, 95% CI: 1.14-13.74), C (aOR: 16.3, 95% CI: 5.20-51.11), and F (aOR: 13.9, 95% CI: 5.30-36.69). CONCLUSION: HBV genotype is independently associated with HCC risk. AN persons with genotypes A, C, and F are at higher risk compared with genotypes B or D. |
Understanding the poultry trade network in Kenya: implications for regional disease prevention and control
McCarron M , Munyua P , Cheng PY , Manga T , Wanjohi C , Moen A , Mounts A , Katz MA . Prev Vet Med 2015 120 321-7 Infectious diseases in poultry can spread quickly and lead to huge economic losses. In the past decade, on multiple continents, the accelerated spread of highly pathogenic avian Influenza A (H5N1) virus, often through informal trade networks, has led to the death and culling of hundreds of millions of poultry. Endemic poultry diseases like Newcastle disease and fowl typhoid can also be devastating in many parts of the world. Understanding trade networks in unregulated systems can inform policy decisions concerning disease prevention and containment. From June to December 2008 we conducted a cross-sectional survey of backyard farmers, market traders, and middlemen in 5/8 provinces in Kenya. We administered a standardized questionnaire to each type of actor using convenience, random, snowball, and systematic sampling. Questionnaires addressed frequency, volume, and geography of trade, as well as biosecurity practices. We created a network diagram identifying the most important locations for trade. Of 380 respondents, 51% were backyard farmers, 24% were middlemen and 25% were market traders. Half (50%) of backyard farmers said they raised poultry both for household consumption and for sale. Compared to market traders, middlemen bought their poultry from a greater number of villages (median 4.2 villages for middlemen vs. 1.9 for market traders). Traders were most likely to purchase poultry from backyard farmers. Of the backyard farmers who sold poultry, 51% [CI 40-63] reported selling poultry to market traders, and 54% [CI 44-63] sold to middlemen. Middlemen moved the largest volume of poultry on a weekly basis (median purchases: 187 birds/week [IQR 206]; median sales: 188 birds/week [IQR 412.5]). The highest numbers of birds were traded in Nairobi - Kenya's capital city. Nairobi was the most prominent trading node in the network (61 degrees of centrality). Many smaller sub-networks existed as a result of clustered local trade. Market traders were also integral to the network. The informal poultry trade in Kenya is dependent on the sale of backyard poultry to middlemen and market traders. These two actors play a critical role in poultry movement in Kenya; during any type of disease outbreak middlemen should be targeted for control- and containment-related interventions. |
Men who have sex with men in Kisumu, Kenya: comfort in accessing health services and willingness to participate in HIV prevention studies
Okall DO , Ondenge K , Nyambura M , Otieno FO , Hardnett F , Turner K , Mills LA , Masinya K , Chen RT , Gust DA . J Homosex 2014 61 (12) 1712-26 Men who have sex with men (MSM) are a crucial and marginalized at risk population for HIV in Africa but are poorly studied. Like other areas of Africa, homosexuality is illegal in Kenya. We assessed MSM comfort in accessing health services and willingness to participate in HIV prevention research in Kisumu, Kenya-an area of high HIV prevalence. We conducted a two-phase formative study with individual interviews (n = 15) and a structured survey (n = 51). Peer contact or snowball method (n = 43, 84.3%) was the primary recruitment strategy used to locate MSM. Exact logistic regression models were used for survey data analysis. Over 60% (32/51) of survey participants were not very comfortable seeking health services from a public hospital. Almost all MSM (49/51; 96.1%) reported willingness to be contacted to participate in future HIV research studies. Efforts to provide facilities that offer safe and confidential health services and health education for MSM is required. Continued community engagement with the MSM population in Kenya is needed to guide best practices for involving them in HIV prevention research. |
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