Editor- In-Chief: Pi Guo, MD, PhD Title proper: Epidemiology – Open Journal Subject: Health Care ISSN : 2473-4780 Publisher: Openventio Publishers Dates of publication: 2016 Frequency & Medium: Half-yearly , Online Language: English Country: India Indexed by: CROSSREF , ROAD , THE KEEPERS Title DOI of the Journal: 10.17140
Ovine Network in Morocco: Epizootics Spread Prevention and Identification of the At-Risk Areas for “Peste des Petits Ruminants” and “Foot and Mouth Disease”
Objectives: Because contagious diseases spread among domestic ruminants are closely linked to livestock movements, the present study aims to analyze the sheep movements network in Morocco during its two periods of regular movements and more intense movements in the festive period, to map it and identify central points and movement structures that influence its functioning, but also to highlight the articulation points at which actions should be taken to prevent or control the epizootics spread. The aim of this study is also to produce risk maps for introduction and exposure to Peste des Petits Ruminants (PPR) and Foot-and-Mouth Disease (FMD), to guide the epidemiological surveillance efforts. Methodology: This is a descriptive study, and which results placed it within the framework of epidemiological surveillance on a national scale. A two-stage random sampling was carried out in 52 provinces belonging to regions with very high sheep populations and whose municipalities have been subject to previous outbreaks of diseases, notably PPR and FMD. A sampling proportion of 25% of municipalities was adopted for each province. Within each commune, sheep farms and markets, if existed, were drawn randomly. In the absence of a breeder database, the sample relating to farms was carried out by representativeness of the sheep population for each municipality. The sample relating to markets was carried out as representative of the trading volume of the markets. An “Origindestination” survey concerning the origin and destination of sheep routes made by breeders or traders was deployed in the field. The results of this survey were entered into a database and then mapped by the Geographic Information System (GIS) to distinguish regular movements from periodic ones. After data reorganization into two movement periods, the database was processed by the network analysis method to highlight the main central points and the main structures that condition the movement. All these analyses were conducted using the “R” software. The risk analysis of introduction and exposure to PPR and FMD was also carried out. The results obtained were compared with the epidemiological data of these diseases. Results: The sheep movement network in Morocco is much more sensitive to the epizootics spread during intense movement periods corresponding to preparation for the festivities, namely Aid al Adha than during regular periods. The centrality of certain municipalities exposes them to the risk of diseases during periods of intense movement, while others appear exposed during both periods. This study has traced back the different regions by cohesive structures of movement which condition the circulation of disease pathogens across the country and which strongly contribute to their diffusion across regions which are sometimes very distant geographically. However, the movement articulation municipalities “cutpoints”, that allow to neutralize flows between these structures have been identified. The introduction and exposure risk analysis provided satisfactory results for the PPR and FMD about their validation by health epidemiological data related to outbreaks. Thus, 82.88% and 67.39% of outbreaks were included in the high to very high risk strata respectively for PPR and FMD. Conclusion: This study’s results allowed a better understanding of sheep movements extent and articulation at the national level during periods of regular movements and periods of more intense movements and consequently a better knowledge of the pathogen's dissemination paths. Highlighting “cutpoint” municipalities in addition to the at-risk municipalities for introduction and exposure to diseases represents valuable guidance for targeted actions that would contribute to remobilizing and optimizing available surveillance resources more efficiently.
Transboundary Livestock Network in Africa: How Circulate Pathogens and Where to Act to Prevent the Epizootics Spread?
Objectives: Transboundary animal diseases (TADs) of domestic ruminants are closely linked to livestock movements, consequently, understanding these latter provides information on the pathogen's dissemination pathways. This descriptive study, using the mapping and network analysis (NA) method, aims to characterize the cross-border mobility network of domestic ruminants on the African continent, to understand how it works, to identify the main countries controlling livestock mobility, to deduct their relationships with other countries, and finally, to highlight the articulation points of the network at which actions should be taken to stop the epizootics spread. Methodology: This is a synthetic, descriptive study, whose results make it possible to place it within the framework of epidemiological surveillance with a continental scope, aiming to guide the efforts of the concerned authorities. Based on deep documentary research, a total of 483 transhumant and commercial cross-border movements were identified. These movements were mapped by the geographic information system (GIS) to reconstruct the network of international movements between countries. The most regular movements, numbering 190 and constituting a more stable exchange network over time, were subjected to processing by the NA method, to highlight different indicators that permit the characterization of the network. The results obtained were then compared with health data on the distribution of the five main notifiable animal diseases circulating in the African continent in addition to rinderpest. All analyses were conducted using “R” software. Results: The centrality indicators enabled the identification of the main central countries, including the most active and unavoidable ones that contribute to diseases spread in Africa. They also made it possible to quantify their importance in the influence of movement, while the global measurements and network cohesion parameters showed that the latter is vulnerable to the spread of epizootics. This study revealed a strong livestock exchange relationship between 25 African countries, extending from nations on the Atlantic Ocean coasts to those of the Indian Ocean ones, which were found to be the most vulnerable to the establishment of contagious diseases. Different communities of countries whose livestock movements appear to be very cohesive and which presage significant mutual contamination have been highlighted. Certain African countries have proven to be key points in the articulation of flows between different countries and different regions and contribute significantly to the dissemination of diseases between the different regions of the continent. Accordingly, key countries where actions should be taken to stop the epizootics spread were identified. Conclusion: The results allowed a better understanding of diseases diffusion pathways through livestock movements across Africa and highlighted the main movement focal points which represent a high-risk of diseases spread, as well as the capacity to influence their diffusion through the control of the animal’s movement or the deployment of prophylactic actions at their level.
Investigations of PM2.5 Long-term Exposure and Subclinical Atherosclerosis in Women: An Overview
Background/Aim Evidence demonstrates that coronary artery calcification (CAC) is a biological marker for cardiovascular disease (CVD) risk prediction. Acute cardiovascular effects of temporary and chronic environmental particle exposures sensitive to ≤2.5 micrometers in diameter (here termed “PM2.5”) have been well-studied. However, there is less information on the long-term effects of PM2.5 exposures on the earlier pre-clinical stage of CVD, especially in women (in whom it is also established experience frequent cardiovascular late- and under-diagnoses). This phase of pre-diagnosis pathological activity is classified as subclinical atherosclerosis (SCA) unless and until a patient meets established clinical diagnostic criteria. In this systematic review, we summarize reported associations of long-term PM2.5 and SCA exposure, with investigators placing an emphasis on gender differences in any documented associations. Methods We conducted a comprehensive literature review for articles published from 2007 to 2022 that reported associations of long-term PM2.5 and SCA and evaluated each study with areas of particular focus including study designs, populations at risk, and exposure measures. Results Investigations representing four cohorts yielded equivocal findings related to long-term PM2.5 exposure and CAC. Three cohorts reported positive associations between long-term PM2.5 and CAC development/progression. Two studies supported a strongly positive associations among women or postmenopausal women for PM2.5 on CAC. Studies, however, evaluating PM2.5 exposure associations with carotid intima-media thickness (another biomarker of SCA), reflect increases in both men and women with ↑ PM2.5 levels but reporting no gender differences in PM2.5 exposure and this measure of SCA. Conclusion Our study identifies important gaps in current knowledge synthesis including different methods of PM2.5 estimation and linkage, a lack of consensus of what constitutes long-term air pollution, and the selection of important covariates and intermediate variables. Our aim is to outline best practices going forward in the investigation of PM2.5 long-term exposure and SCA in women.
Epidemiological Profile of Children with Neurodevelopmental Disorders in a Diagnostic Center in Southern Puerto Rico, 2006-2017
Objective This study has the purpose of developing an epidemiological profile of children with neurodevelopmental disorders in southern Puerto Rico. Methods This is an exploratory study with a mixed design that was carried out in a diagnostic center located in Ponce, Puerto Rico. The population under study were children within 0-18-years-old of both sexes diagnosed with a neurodevelopmental disorder using the diagnostic and statistical manual of mental disorders (DSM-4) and DSM-5 criteria. The sample under investigation were all the children in the secondary database of children who received health services in the diagnostic center during 2016-2017. Additionally, to the data from the secondary database, a hand-writing record review was performed to obtain data related to comorbidities and family history. The bivariate and multivariate analysis evaluated the association between each neurodevelopmental disorder, and each disease reported in the family history of diseases. Also bivariate, and multivariate analysis assessed the association between each neurodevelopmental disorder, and each comorbidity reported. Results and Conclusion The mean age and standard deviation of the sample were 5.2±3.20, and 80.5% were males. Most of the children lived in Ponce, Puerto Rico. The sample size did not have normal distribution because the sample size was too small and selected by non-probabilistic methods. Furthermore, 88.2% of the children received a previous evaluation related to the problem, and 70.5% received treatment for the symptoms. The results revealed that neurodevelopmental disorders frequently co-occurred. Also, other comorbidities commonly co-occurred with these disorders. Mental disorders were commonly reported with autism, attention deficit and hyperactivity disorder (ADHD) and communication disorders. Autism was also linked to a family history of mental disorders.
Coronavirus Disease-2019 Conspiracy Theories are Alive and Breathing on the Internet
The more detailed origin stories of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the coronavirus disease- 2019 (COVID-19) vaccines are both unknown to the layperson. These unknowns serve as opportunities for misinformation messaging to the layperson. How did pharmaceutical companies create a vaccine within a matter of months to a year for a relatively new virus? Were aborted fetal cells used to make the COVID vaccines? What if there are long-term side COVID-19 vaccine effects not yet known to scientists and the public? While the internet, without a fact-checker and combined with opportunity and individual attitudes and information preferences, may flourish with misinformation and conspiracy theories. Scientists have a professional duty to publish evidence-based data in all pursuits, but recently the scientific community has spent much time educating the public in hopes of neutralizing many of the COVID fallacies we see every day on social media.
Trends in Spatiotemporal Exposure to Air Pollutants and Adult Cardiovascular Emergency Room Visits in the Greater Pittsburgh, Pennsylvania, USA
Introduction The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very few studies have focused on spatiotemporally modeled exposure to air pollutants at the population level. This study aims to examine the short-term association of fine particulate matter (PM2.5), Ozone (O3), Nitrogen Dioxide (NO2) and Sulfur Dioxide (SO2) and CVD emergency room visits (ERV) in Allegheny County for a 13-year period using a case-crossover study design. Aim We sought to estimate the effects of acute exposure to these four pollutants adjusting for temperature on CVD ERV and to compare outcomes in 1999-2005 compared to 2006-2011. Methods Land-use regression was used to model the ground level exposures to PM2.5, O3, NO2 and SO2. CVD ER visits were requested from the local hospitals of the two health networks in Allegheny County, which operate the majority of the ER services. The discharge International Classification of Diseases-9 (ICD-9) codes were used to identify the CVD cases and CVD subgroups. We linked the Zone Improvement Plan (ZIP) code level air pollution data with the patients’ ZIP code (residence) to determine the individual level exposure estimation of both case days and control days. Conditional logistic regression with multi-pollutant and distributed lags of 0-3-days was applied to estimate the effect of acute exposure of these pollutants to CVD ER visits (ERV), adjusting for temperature. Results In the overall analyses, for every interquartile increase of O3 exposure (25.52 ppb), there was a 6.6% (95% CI: 0.8%-12.7%) increase in the odds of an acute myocardial infarction ERV. This was consistent across both time periods. Among women and Black ERV, we observed an association of PM2.5 with acute myocardial infarction, and with ischemic heart disease. Some of these associations persisted in the later years of the study period. The gaseous pollutants (NO2, SO2 and O3) were shown to increase risk of cardiovascular events in both time periods. Conclusion We found an association of PM2.5 and NO2 with CVD ER visits, and this association persisted in the stratified analyses, as well as in the later years with lower exposure levels. The findings suggest that further actions to reduce the pollution level in this area should be taken. Ozone and NO2 were related to increased risk for all CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) underscoring the importance of gaseous pollutants and their effect on coronary heart disease (CHD) risk.
Unintended Effects of Coronavirus Disease-2019
As of this writing: “Globally, as of 4:22 pm CEST, 25 May 2022, there have been 524,339,768 confirmed cases of coronavirus disease-2019 (COVID-19), including 6,281,260 deaths, reported to World Health Organization (WHO). As of 23 May 2022, a total of 11,752,954,673 vaccine doses have been administered”.1 COVID-19 pandemic emergence announcements began in January 2020. Today, 7-day case count numbers suggest ongoing high actual numbers of cases, but that number as a percentage of a population is much lower than it once was. A once dependable 3% COVID-19 mortality rate has been reduced to a global average of 1.2%. Nearly 50% or more of most nations’ populations are eligible for the vaccine, as approved (in most countries, for those over 17-years of age), and have received a third “booster” dose of the COVID-19 vaccination.
Factors Affecting Access to E-Learning during the Coronavirus Disease 2019 Pandemic Among Rural-Based Pharmacy Students in Zambia: A Qualitative Study
Background The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the education sector globally. This has resulted in learning institutions adopting e-learning techniques. E-learning implementation in higher education continues to gain prominence in both developed and developing countries. Most universities are exploring different ways of using information and communications technology (ICT). However, ICT remains a challenge more especially for students who come from rural areas. Aim This study was aimed at exploring the factors that affect access to e-learning among rural-based pharmacy students in Zambia. Methods A qualitative case study was conducted among ten (10) purposively sampled pharmacy students at the University of Zambia. The study participants were from the Manying, a district of North-Western Province, the Sinda district of Eastern Province, the Nalolo district of Western Province, the Chipili district of Luapula Province and the Mbala district of Northern Province. Semistructured interviews were used to collect data from the respondents. Data were analyzed using the framework analysis. The sociodemographic characteristics indicate that ten (10) respondents were drawn from Zambia’s five (5) provinces. Six qualitative themes were generated these included devices used for e-learning; the effectiveness of the devices; student performance; internet connectivity; and electrification of the houses. Key findings suggest that the most commonly used device was a smartphone, which posed challenges to effective learner participation in e-learning. Poor internet connectivity, non-electrification of students’ houses, electricity outages, and costs-associated with internet use negatively affected students in accessing online learning and could adversely affect their academic activities and performance. Conclusion The COVID-19 pandemic has negatively affected access to e-learning among rural pharmacy students in Zambia. The implications of the challenges faced by the rural pharmacy students are that their academic activities and performance were negatively affected. Therefore, this posed a threat to the rights to universal access to education of the rural students who were mostly venerable.
A Review of the Antiviral Activity of Ivermectin and Its Use in the Treatment of Coronavirus Disease-2019
Background The coronavirus disease-2019 (COVID-19) originated in China and was declared a pandemic by the World Health Organization (WHO) on 11th March 2020. Since its emergence in December 2019, there have been challenges in developing drugs that are effective against the virus. Currently, COVID-19 is managed using symptomatic and supportive therapies, antiviral agents, cellular and immunotherapy. Besides, most of the treatment modalities are still under investigation and treatment guidelines vary from one country to another. Ivermectin is among the drugs that are being used as part of treatment guidelines in certain countries like the Republic of Peru. However, the WHO recommends that ivermectin only be used in clinical trials. Aim The authors conducted this review to explore published studies on the possible therapeutic effects of ivermectin against active infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a causative agent of COVID-19. Methods A literature search was conducted using Google Scholar, PubMed and EMBASE for articles published from 2016 to 2021. Search words used included ivermectin, antiviral, COVID-19, efficacy, safety, dosing, lower mortality rate, hospitalised patients and the Boolean operator ‘AND’. Results A few clinical trials have shown that ivermectin is safe for use in humans at specific doses and reduces the severity of the infection. Ivermectin was seen to reduce the signs and symptoms associated with COVID-19 in some studies while others showed no significant reduction. However, more studies must be conducted to ascertain its use in treating COVID-19. Conclusion Since many clinical trials are being conducted on the use of ivermectin to treat COVID-19, full evidence will be used to support its use in humans. Currently, some countries that are using ivermectin for treating COVID-19 have reported it to be effective and reduces morbidity and mortality associated with the disease. Therefore, countries should collaborate and provide full evidence for the use of ivermectin in humans to manage COVID-19.
The emergence of the coronavirus disease-2019 (COVID-19) pandemic has given an unrequested, rare, and prominent moment to the discipline of Epidemiology. The rigors and tools of epidemiology are critical in such situations, as public health threats progress from misunderstood or poorly understood to managed to possible eradication. Those trained well can hold the dual levers of scientific knowledge and public office at the same moment and steer societies from fear and suspicion when outbreaks occur to a sense of calm accomplishment and resumption of “life as normal.” In these moments epidemiology’s true influence over the last 200 years is evident. However, no force can act alone.
Strategies and Challenges in the Development of Coronavirus Disease-2019 Vaccine
The novel coronavirus infection (coronavirus disease-2019 (COVID-19)) emerged from Wuhan in the Hubei Province of China in late 2019. Millions of people were infected with COVID-19 pandemic due to the long incubation period of the virus inside the human body and the dearth of available treatments or vaccines. High transmission rates created havoc, which highlighted the urgent need for effective interventions to stop the spread and clinical impact of the virus on patients and populations. Previous research on severe acute respiratory syndrome coronavirus (SARS-CoV) provides information on vaccination strategies that could inform how governments approach the elimination of this novel coronavirus. Numerous efforts have been made to develop vaccines against Middle East respiratory syndrome (MERS) and SARS. The spike glycoprotein or S protein is the critical target for most of the drugs and vaccines against coronavirus. The virus uses the spike (S) protein for entering the host cell, by interacting with the receptor called angiotensin converting enzyme-2 (ACE2). Various vaccine platforms are available such as nucleic acid vaccine, protein-based vaccines, virus-vectored vaccines and live or attenuated vaccines, with each having their advantages and disadvantages. This review focuses on the overview of different vaccine candidates used, those currently in development, and the challenges encountered while developing effective vaccines.
Using MapMCDA Tool for the Spatial Epidemiology of Animal Rabies in Morocco: How to Improve the Rationality of a Qualitative Risk Assessment
Objective The objective behind this article is to better characterize spatial distribution of animal rabies in Morocco through qualitative risk assessment framework. In Morocco, the occurrence of the disease is neither clearly distributed nor complete. Therefore, risk assessment methods become strongly recommended to cope with distorted geographic patterns. Methods Based on data collection set from 168 counties, qualitative changes on spatial epidemiology of rabies were analysed by mapMCDA tool covering a period from 2004 to 2017 and including information on determinants of the geographic distribution of animal rabies in Morocco defined in previous work. Results To validate the risk assessment model, the results were compared to rabies cases reported during the study period. The clustering of the rabies risk estimates is decisive and highly reliable. A significant alignment was shown between the very high and high-risk estimates. Conclusion This study is the first attempt that has been made for using MapMCDA for rabies. For a normative process aiming to avoid subjectivity related to expert-opinions, authors suggest conducting initially a statistical multiple component analysis that will provide quantified estimates of risk factors. It would be an advisable decision-making tool that helps to design oriented surveillance and allows better referral of actions to control the disease.
Better Together: Evolving Social Process between Bystanders and First Responders is a Force Multiplier for Effective Emergency Response
Bystanders are an integral part of an emergency scene. Their presence on site makes them the immediate potential responders, who can provide life-saving assistance as well as various rescue actions. Research has shown that bystanders are willing to and are capable of helping, especially (but not limited to) when a leader emerges, as the help is rooted in a collective action. In this article, we suggest a new framework for understanding the effectiveness of bystanders help, based on the evolving social process between bystanders and first responders. As we show, the transition from no help, at the very first moment right after the emergency has occurred, to an effective coordinated response where first responders and bystanders act together, goes through engagement of bystanders. Further, first responders should acknowledge the social organization of bystanders, utilize and leverage it in order to optimize their efforts. This framework has important insights for policy makers when managing emergency and disaster situations with limited resources.
Challenges Related to Antimalarial Abuse in Coronavirus Disease-2019 Treatment in the Democratic Republic of Congo
Malaria is endemic to many African countries and geographies and remains the leading cause of morbidity and mortality on the continent. Ongoing efforts by health authorities to reverse the scale of malaria are often faced to the challenges of drug resistance often generated by therapeutic abuses relating to self-medication, sub-therapeutic under dosages and poor storage and handling of drugs throughout the pharmacy supply chain system.
Sirtuin 1 (SIRT1) inhibitors can reduce replication of many viruses with certain characteristics similar to those of coronaviruses, while the p53 protein is another important factor in the down-regulation of viral growth. Tenovin is a class of small molecules that inhibit Sirtuin 1 and 2, in addition to activating the p53 protein, by means of regulating the interactions used by coronaviruses as a self-defense mechanism. By blocking virus growth and continuous replication, with already tested antiviral medicines, the promise of coronavirus disease 2019 (COVID-19) eradication exists.
Review of the article on "The Rate of Underascertainment of Novel Coronavirus (2019-nCoV) Infection: Estimation Using Japanese Passergers Data On Evacuation Flights"
According to the article “The Rate of Under ascertainment of Novel Coronavirus (2019-nCoV) Infection: Estimation Using Japanese Passengers Data on Evacuation Flights” on February 4, 2020, there are logical fallacies. In this article, many assumptions are based on author’s own simple and optimistic view of the virus without any solid real world evidence. The first assumption is that “human migration on the epidemic dynamics of 2019-nCoV will be soon visually identifiable”1; here, the author is basically quoting his previous article as the resource to support this statement without any case study or statistical facts to support this statement. The author did not explain “identifiable” in term of molecular structure. Again, the author has ignored the validity issue of under-reporting issue.
The Potential of Amniotic Fluid-Derived Extracellular Vesicles to Treat Severe Acute Respiratory Syndrome Coronavirus 2 Infection Versus Hydroxychloroquine in Human Patients
Recently a lot of attention has been focused on fast-tracking repurposed drugs for the treatment of a novel coronavirus; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent leading to the devastating coronavirus disease-2019 (Covid-19). One of the first and most well-known examples is hydroxychloroquine (HCQ), which has been used for years as a treatment for malaria, rheumatoid arthritis and lupus. HCQ was rolled out as a miracle treatment for Covid-19, which was inexpensive, effective and causing few side-effects. However, its effectiveness in treating Covid-19 has recently been questioned leaving doctors and patients confused and desperate. Here the proposed mechanisms of action of HCQ are discussed and compared with an inexpensive, safe and effective alternative, which is derived from natural, healthy amniotic fluid.
Compliance with Tobacco Control Policies and Global Youth Tobacco Survey: A Cross-Sectional Comparison between GYTS 2000 and 2015 in Maharashtra, India
Background Tobacco is the leading avertable cause of death in the world. Adolescents are the most vulnerable population to initiate the use of tobacco. Most adult users start tobacco use in their childhood or adolescence. The Global Youth Tobacco Survey (GYTS) was design to obtain information on tobacco use, exposure to tobacco smoke and other related indicators among adolescent. This study aims to compare the GYTS data between 2000 and 2015 for the state of Maharashtra in India. Methods The GYTS is a school-based two-stage cluster design survey of students aged 13-15 years. This was a self-administered crosssectional survey conducted in Maharashtra using standardized GYTS questionnaire. To record student survey responses, in 2000 optically readable answer sheets and in 2015 tablets were used. For statistical data analysis SPSS 20.0 was used. Results Between 2000 and 2015 the prevalence of tobacco use reduced from 17% to 11% among boys and 14.5% to 8.5% among girls. Age of tobacco initiation has shifted from 11 years or younger (~70%) in 2000 to older than 11 years (~70%) in 2015. Proportion of students who received pocket money increased from 20.2% to 42.7% for boys and 18.7% to 33.8% for girls in 2015. Discussions about harmful effects of tobacco in schools and at home had reduced from 2000 to 2015. Distribution of free tobacco products decreased over the years, however sale of tobacco products to minors and sale around educational institutions continued. Conclusion Prevalence of overall tobacco use has decreased. Strengthening the existing Cigarettes and Other Tobacco Products Act (COTPA) laws and improving implementation and effective monitoring will not only reduce youth’s tobacco use but might restrict future initiation among youths. Continuous tobacco education at home and at school will further strengthen the tobacco control efforts.
Determinants of Canine Rabies in Morocco: How to Make Pertinent Deductions for Control?
Objective This case control study aims to highlight risk factors to contract canine rabies, taking into account several factors like geographical affiliation, sex, age, season, socio-economic and demographic characteristics of the environment in which the canine population evolves. Design Case-control study at national level in Morocco included non-randomized comparison groups. This approach was chosen to address practical considerations and the data used correspond to a five years period. A group of 215 cases and 215 controls were needed for an odds ratio (OR) of 2.2 and the sample size was calculated for a 1:1 match, with a power of 80% and a risk of the first species at 5% (95% confidence interval). Setting Data collection is retrospective and the collection of information on the exposure of cases and controls was conducted in the same way. Subjects Target population was the general canine population of Morocco. Criteria related to age group (puppies, young, adult) and gender (female, male) have been considered in the selection of the target population. Results The Moroccan rural context characterized by a lack of basic infrastructures (education, health) makes that there are practices and cultural habits that favor the endemicity of rabies in some regions. Thus, the disease is associated with the presence of rural slaughterhouses and animal markets and landfills which appears offering unlimited food sources for stray dogs and then indirectly promotes their reproduction accordingly. Conclusion These findings support advocacy efforts for strengthening a global prevention system. In addition, socio-ecological surveys should be carried out to build understanding in depth for a better adaptation of the ongoing prophylactic programs.
Epidemiological Description of a Protracted Cholera Outbreak in Hagadera Refugee Camp and the Surrounding Host Community within Fafi Sub County and Garissa County in Kenya during March-September 2019
Background On 27th March 2019, the Hagadera Refugee Camp reported an outbreak of acute watery diarrhea. An investigation was initiated to confirm the causative organism and define the epidemiology of the outbreak to support evidence-based control measures. Method A suspected case was a resident of Hagadera Refugee Camp or the surrounding community with a sudden onset of acute watery diarrhea and vomiting between March 27 and September 16, 2019. A probable case was defined as a suspected case with a positive rapid test for Vibrio cholerae; a confirmed case was a probable case with a positive stool culture for V. cholerae. We conducted a systematic case finding by visiting health facilities and villages. We reviewed patient records to identify suspected cholera casepatients. We conducted a descriptive epidemiologic study, examining the distribution of the cases. We computed the attack rates by age, sex, and residence. The case fatality rate was calculated as the ratio of the total number of suspected cholera death to the total number of cholera case-patients. We conducted targeted interventions including spraying, handwashing demonstration, distribution of soaps health education and promotion. Results We identified 667 suspected cholera cases between March and September 2019 of these, 38% (253/667) had a positive rapid diagnostic test for V. cholerae; 6% (43) were negative and 56%(371) rapid diagnostic test (RDT) were not conducted. Out of the 94 rectal swabs for culture, 71% (64/94) were confirmed to be V. cholera O1 serotype Inaba. The epidemic curve exhibited a continuous common-source outbreak with several peaks. The mean age of the case-patients was 15-years (range: 0.2-70-years). Both males and female had an attack rate of 9/10000 respectively. The highest attack rate was in ≥30-years (14 per 10,000). Conclusion This was a continuous common source cholera outbreak caused by V. cholerae 01 serotype Inaba. We recommended strengthening the surveillance system improving early detection and effective response.
Ovine Network between Fatteners and Breeders in Middle Atlas of Morocco: Where to Act to Prevent the Spread of Epidemics?
Objective This cartographic and analytical study, using the social network analysis method, aims to characterize sheep mobility from breeders producing lambs in the Middle Atlas Mountains to the fattening centers, passing through livestock markets in order to describe the exchange network, to identify the main mobility hubs and to secure the production of fattening lambs by improving the efficiency of the epidemiological surveillance system for “peste des petits ruminants” (PPR) in lambs producers of the Middle Atlas in Morocco. Design Descriptive cross-sectional study within the framework of active epidemiological surveillance. It was carried out at a regional level, for mapping the movements of sheep and to analyze the network of exchange relating to this species by the Social Network Analysis (SNA) method in the middle atlas massif and in the zone of sheep fatteners to guide epidemiological surveillance efforts. A total of 807 breeders producing lambs, sheep fatteners and traders were surveyed, including 54 fatteners in fattening workshops (sampling fraction of 48.6%), 150 breeders and traders in livestock markets of Middle Atlas and 603 producing lamb breeders of this massif (sampling fraction at the massif level of 6.64%). Results The study revealed a very strong commercial relationship between middle Atlas breeders and fattening zone breeders whose longrange outflows mainly converge towards urban consumption centers. The major strategic livestock markets of the middle Atlas proved to be key points in the articulation of the flows, as was the commune gathering the fatteners. Centrality indicators were used to identify the main trade hubs that contribute to the spread of diseases and to quantify their importance in the influence of sheep movement, while network cohesion parameters have shown that network is vulnerable to the spread of epidemics. Conclusion The results of this survey revealed the main commercial hubs at the Middle Atlas level and at the level of the province of fatteners, which represent a great risk of spreading sheep diseases over long distances rather quickly in event of an epizootic, but also representing the ability to control the spread through the control of the movement of animals at their level.
Epizotic of (Peste des Petits Ruminants)
Aim To investigate whether the morbidities associated with ageing – loss of muscle mass with consequent weakness, increase in adipose-tissue mass, thinning of skin, loss of bone mineral density followed by increase in fracture rate, decreased energy, and reduction in bone marrow output – can be prevented or postponed by a combination of modern pharmaceutical agents. Methods Electronic databases were scrutinized for the actions and side-effects of compounds which have known and specific effects. Results Anabolic steroids, androgenic hormones and their precursors, as well as growth hormone and erythropoietin were assessed. The benefits of each of these, and their potential adverse effects, together with suggested doses at which they may be used in combination, are presented. Conclusions The data indicate that there are many probable benefits to ageing individuals in postponing morbidity by the suggested combination of compounds, although no size effects can be determined without a large population study. It is likely that there would be a low-level of side-effects. However, before a population study, a clinical trial to test these assumptions is suggested. Apart from the specific benefit to individuals, if successful the combination would engender wide-spread usage with many important benefits to society, not least on the amount and cost of care-giving.
We Should be Optimistic about Mosquito-Borne Diseases Control
Mosquito-borne diseases are those spread by the bite of an infected mosquito, and they include Zika, West Nile fever, Chikungunya, dengue, yellow fever, malaria, etc. Nearly 700 million people worldwide get a mosquito-borne illness each year resulting in over 1 million deaths.1 Vaccination is proved cost-effective in decreasing the burden of diseases. Candidate vaccines against dengue, Chikungunya and West Nile fever are being discussed, and malaria vaccine, RTS,S, was approved as of 2015 with further studies being expected in Africa in 2018.2 Moreover, a continued research and development of new vaccines are underway for controlling these mosquito-borne diseases. Alternative efforts have been focused on the control of mosquito populations. The traditionally widely used approaches include larval control by eliminating mosquito breeding sites, and adult control by mosquito traps and/or spraying residual insecticides. However, the practice of breeding sites elimination is difficult to manipulate/perform; the use of insecticides is not ecologically friendly which can hard bees and other insects; and mosquito traps do not work well and they attract other insects as well. On the other hand, the trap might not work in some unfavorable conditions.
Another Approach to Detect Malaria Epidemics and to Evaluate the Impact of their Control Measures in Situation of Lack of Information
The purpose of this study is to establish a theoretical epidemiologic threshold for the rate of reported malaria cases in order to detect epidemics and evaluate the impact of control measures. To create this epidemiologic threshold it has been used an multiple cross-over time series autoregressive integrated moving average forecasting model that reflects the dependence of the magnitude of the rate of malaria reports on the past levels of rain, temperature and vegetation density according to factors related with malaria transmission described by the MacDonald’s theory. Information available for the model derivation and accuracy testing was obtained from Médecins Sans Frontières in Karuzi, a Burundi’s province, with a health network of a 100-bed hospital and 11 health centers, that consists in the monthly malaria incidence rate estimated from clinical diagnostics in medical consultations with a 5-20% of clinical cases with microbiological confirmation in non-epidemic periods and less than 2% during outbreaks, the cumulative monthly level of precipitation and the minimum and maximum mean monthly temperature recorded by the local meteorological stations, as well as the NDVI provided by the National Oceanographic and Atmospheric Administration satellites. This available information covers the 1997-2003 period. The obtained model makes it possible to create a curve of expected non-epidemic case reports with a reliability of 95%. This model identified four epidemics in the 7-year study period and detected the impact of a malaria control campaign in the last year. The application of this methodological tool permits the timely detection of malaria epidemics and the evaluation of the impact of measures for its control.
Autoregressive integrated moving average modeling (ARIMA)
Malaria epidemiologic surveillance system
Consumption of Sugar-Sweetened Beverages Associated With Increased Odds of Depression
Objective: To evaluate the association between depression and sugary drink intake using participant data from the Behavioral Risk Factor Surveillance Survey (BRFSS). Design: Cross-sectional data from the 2012 and 2013 BRFSS were examined (N=44,603). Depression was based on self-report of symptoms within the past 30 days. Covariates included age, sex, race, employment status, body mass index (BMI), education level, and exercise in the past 30 days. Setting: Data from a national telephone survey (BRFSS) were used to assess risk factors associated with health of the participants. Subjects: Participants in the 2012 and 2013 BRFSS were included in this analysis (N=44,603). Results: Adjusting for confounders, the odds of depression increased by 5% for every sugary drink consumed (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.02-1.10). Depression was also associated with race, with non-Hispanic blacks being 60% more likely to be depressed than non-Hispanic whites. Unemployment and having a high school or less education were independently associated with depression. The association of depression and consumption of sugar sweetened beverages was stronger among women than men. Conclusion: This study indicates that consuming sugary drinks are associated with an increased odds of depression. These findings support advocacy efforts for an overall healthy lifestyle. In addition, future research should evaluate this association using a cohort design in order to establish the temporality of this association.
HPV Vaccination and Knowledge of Cervical Cancer among Female University Students in a Multiethnic Institution, USA
Objective: College-aged women are at high-risk of Human Papillomavirus (HPV) infection. Although, HPV vaccination is most effective, its rates remain quite low among college students. It may be due to inadequate understanding of the relationship between HPV and cervical cancer. Therefore, the objective of this study was to examine the level of knowledge about HPV, cervical cancer and their associations with HPV vaccination among female college students. Methods: Cross-sectional questionnaire based survey was conducted among female students in a Multiethnic University in Florida. We assessed HPV vaccination status, annual health checkup status, knowledge about HPV and cervical cancer among the students. The response rate for the survey was 91.5%. Results: Out of 141 students, 39.7% received HPV vaccine, and 38.3% did annual medical checkup within a year. Out of 4, the mean and the median knowledge score of students about cervical cancer was 2.87 and 3.0, respectively. A greater percentage of students who did annual health checkup (44%) received HPV vaccine than those who did not (15%). The odds of receiving HPV vaccine was nearly 5 times as much for the students who achieved knowledge scores about causes of cervical cancer greater than or equal to the median compared with the students with knowledge scores below the median (adjusted odds ratio [aOR]:4.85, 95% confidence interval [CI]:2.15, 10.92). The odds of receiving HPV vaccine was almost three times as much of students who knew that HPV causes cervical cancer than those who did not know it to be so (aOR:2.9, 95% CI:1.1, 8.2). Conclusion: Receipt of HPV vaccination was associated with knowing that HPV infection is a cause of cervical cancer and that it’s preventable. HPV vaccination was also associated with annual health checkup status.
Obstructive Sleep Apnea and Oral Appliances
Central sleep apnea is a sleep-related breathing disorder characterized by repetitive cessation or decrease of both airflow and respiratory effort during sleep.1 Conversely, in obstructive sleep apnea (OSA) there is a respiratory effort against a closed upper airway evidencing that patients who suffer from OSA have anatomic/functional deficits in the upper airways.2 When associated with clinical signs and symptoms such as excessive daytime sleepiness, cognitive deficit, decreased quality of life (QoL) and increased cardiovascular morbidity it is called obstructive sleep apnea syndrome (OSAS).3-5 In clinical practice it is noticeable that rarely do patients suffer from pure OSAS, the majority of them exhibits some proportion of central and/or mixed events. The coexistence of two types of apnea indicates more complex underlying disorders than just increased resistance in the upper airway. In fact, unstable respiratory
The Association of Weight Status with Dental Caries and Trachoma Among School Children in Cities of Changsha and Shenzhen, China
Dental caries and trachoma are two common diseases among children in developing countries. To examine whether weight status is associated with these two diseases, we used data from two screening surveys conducted in Changsha and Shenzhen, two cities in China. The screening surveys were part of a case-control study examining risk factors related to childhood obesity. Approximately 5,900 children (3,794 from Changsha and 2,193 from Shenzhen) participated in the screening survey in which weight and height were measured. Decayed or filled tooth counts (primary dentition) and trachoma infection status were obtained from school general health examination records (SGER). After excluding those who had missing information on weight, height, and SGER, a total of 4,073 (2,185 boys and 1,888 girls) aged 5-9 years old were included in the analysis. Body mass index (BMI) was calculated as weight (kg) divided by height (m2) and standardized for age and sex, then converted to a BMI z-score. Using BMI z-score, subjects were categorized into 4 groups as underweight (<-2), normal weight (~1.03), overweight (~1.64), or obese (>1.64). Overall, approximately 5.5% of children (6.2% girls and 4.6% boys) were underweight and 18% (11% girls and 23% boys) were overweight or obese. Comparing normal weight to underweight, overweight and obese subjects, after adjusting for age, gender, grade, and city of survey, the odds ratios (OR, [95% CI]) for dental caries were 1.12 (0.84-1.49), 0.70 (0.56-0.86), and 0.62 (0.48-0.79), (p for trends <0.001) while the ORs for trachoma were 1.65 (0.94-2.89), 0.90 (0.52-1.57), and 1.92 (1.20 -3.06). This suggests that weight status is associated with dental caries and trachoma among these Chinese children. Further study is warranted to explore the underlying mechanism(s).
Bovine Trypanosomiasis: Retrospective Investigation and Clinical Signs
Trypanosoma vivax is a protozoan that causes Bovine tripanosomiasys. Originally from Africa, the disease has become common in other countries. Bovine trypanosomiasis is a disease underdiagnosed in many parts of the world, including Brazil. The lack of knowledge regarding this protozoan is a factor that contributes to the rapid spread of the disease. Many losses are attributed to the disease, including death of animals. This study aimed to perform a retrospective investigation of cattle with T. vivax that had blood samples forwarded to Veterinary Hospital of Uberaba-Brazil by performing the Buffy coat technique. The collected data showed that in 285 suspected animals, that had samples submitted to Hospital Veterinário de Uberaba, 17.54% were positive. Separating in gender, females had 22.37% of positivity rate and males 2.13%, which is explained by the handling of the animals where handlers are able to see signs of the disease and decreased milk production, besides the use of the same needle for oxytocin application before milking that spreads the disease for many animals in a short period of time. The biggest prevalence among ages was seen in animals between 1 to 12 months (35% of positivity) and 12 to 24 months of age (61.64% of positivity), possibly because of the immune system development, younger animals do not have immunity to the disease. The breed that most showed positivity was Holstein dairy breed (100%). The opportune diagnosis of T. vivax is an important finding since the disease leads to large losses in cattle ranching and prejudices the economic system.
Geography of Diet in the UK Women’s Cohort Study: A Cross-Sectional Analysis
Diet can influence health outcomes and chronic disease risk, therefore a better understanding of factors influencing diet is important in promotion of healthier dietary choices. Many factors influence food choice, including the environment in which we live. This study aims to explore differences in dietary pattern consumption by two spatial measures: Government Office Region (a large regional unit of geography) and Output Area Classification (a small area geography combined with demographic characteristics). A cross-sectional analysis using data from the UK Women’s Cohort Study was carried out. This cohort included ~35000 middle aged women recruited between 1995 and 1999. Dietary patterns were derived using a k-means cluster analysis from diet data collected using a validated 217 item Food Frequency Questionnaire. Multinomial logit regression was used to test whether the area in which the women live, predicts their dietary pattern consumption. Results show that dietary patterns vary significantly by both spatial measures. The Government Office Region, the North West of England has the highest proportion of individuals consuming the least healthy, monotonous diets, while Greater London has the highest proportion of vegetarian diets. Individuals living in Supergroups ‘Countryside’ and ‘Prospering Suburbs’ consume healthier, more diverse diets. Those in ‘Constrained by Circumstance’ and ‘Blue Collar Communities’ consume monotonous, less healthy diets. Using a combination of spatial scales such as Government Office Region and Output Area Classification Supergroup could have a beneficial impact on targeting of public health dietary interventions and subsequent health.