麻豆AV

Augustinavicius, Jura; Graef, Viola; Massazza, Alessandro; Engels, Michelle; Eaton, Julian; Hill, Kyle; Ungar, Michael; Snider, Leslie

Intervention, Journal of Mental Health and Psychosocial Support in Conflict Affected Areas, May 31, 2022

Abstract

The climate crisis is adversely impacting mental health and wellbeing. Research on interventions to address these impacts remains scarce, particularly in humanitarian settings. This study used a modified Delphi process to identify research priorities for mental health and psychosocial support (MHPSS) and climate crisis research, drawing on the perspectives of those with demonstrated interest, engagement, and/or expertise in MHPSS and the climate crisis. The study consisted of two online surveys. In the first survey, demographic and qualitative data were collected and analysed to generate a list of research priorities and a concept map to describe the area of climate crisis and MHPSS research. In the second survey, participants ranked and rated their agreement with priorities and provided recommendations for modification of individual priorities and the concept map. In total, 91 experts working primarily but not exclusively in MHPSS programming or practice participated in the study. Consensus was reached on 20 research priorities, and 8 top-ranked priorities were identified. Given the urgency of the climate crisis, MHPSS and climate crisis research must contribute to mitigating and adapting to the climate crisis while promoting both mental health and psychosocial wellbeing and just international development.

J.P. Thornhill, S. Barkati, S. Walmsley, J. Rockstroh, A. Antinori, L.B. Harrison, R. Palich, A. Nori, I. Reeves, M.S. Habibi, V. Apea, C. Boesecke, L. Vandekerckhove, M. Yakubovsky, E. Sendagorta, J.L. Blanco, E. Florence, D. Moschese, F.M. Maltez, A. Goorhuis, V. Pourcher, P. Migaud, S. Noe, C. Pintado, F. Maggi, A.-B.E. Hansen, C. Hoffmann, J.I. Lezama, C. Mussini, A.M. Cattelan, K. Makofane, D. Tan, S. Nozza, J. Nemeth, M.B. Klein, and C.M. Orkin, for the SHARE-net Clinical Group

The New England Journal of Medicine, August 25, 2022

Abstract:

BACKGROUND: Before April 2022, monkeypox virus infection in humans was seldom reported outside African regions where it is endemic. Currently, cases are occurring worldwide. Transmission, risk factors, clinical presentation, and outcomes of infection are poorly defined.
METHODS: We formed an international collaborative group of clinicians who contributed to an international case series to describe the presentation, clinical course, and outcomes of polymerase-chain-reaction鈥揷onfirmed monkeypox virus infections.
RESULTS: We report 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. Overall, 98% of the persons with infection were gay or bisexual men, 75% were White, and 41% had human immunodeficiency virus infection; the median age was 38 years. Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection. In this case series, 95% of the persons presented with a rash (with 64% having 鈮�10 lesions), 73% had anogenital lesions, and 41% had mucosal lesions (with 54 having a single genital lesion). Common systemic features preceding the rash included fever (62%), lethargy (41%), myalgia (31%), and headache (27%); lymphadenopathy was also common (reported in 56%). Concomitant sexually transmitted infections were reported in 109 of 377 persons (29%) who were tested. Among the 23 persons with a clear exposure history, the median incubation period was 7 days (range, 3 to 20). Monkeypox virus DNA was detected in 29 of the 32 persons in whom seminal fluid was analyzed. Antiviral treatment was given to 5% of the persons overall, and 70 (13%) were hospitalized; the reasons for hospitalization were pain management, mostly for severe anorectal pain (21 persons); soft-tissue superinfection (18); pharyngitis limiting oral intake (5); eye lesions (2); acute kidney injury (2); myocarditis (2); and infection-control purposes (13). No deaths were reported.
CONCLUSIONS: In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread.

Miriam Harris, Amy Qi, Luke Jeaga, Nazi Torabi, Dick Menzies, Alexei Korobitsyn, Madhukar Pai, Ruvandhi R.Nathavitharana, Faiz Ahmad Khan

PLOS ONE September 3, 2019,

Abstract: There is a pressing need to improve outcomes for the hundreds of thousands of patients that develop MDR-TB every year. While relapse is a key measure of the efficacy of TB treatment, there is a paucity of evidence on how to minimize this outcome in patients with MDR-TB. Randomized trials are years away from completion, and only a handful of observational studies have sought to identify how to lower the risk of relapse in patients with MDR-TB. This paper reports findings from a follow-up study undertaken amongst patients successfully treated for MDR-TB in Tomsk, Russia, to determine if use of 鈥渓ong aggressive regimens鈥� (defined below) was associated with lower risk of relapse.The authors defined 鈥渁ggressive鈥� regimens as those in which the intensivephase lasts for at least 6 months following sputum culture conversion and includes at least 5 likely effective medications; and the continuation phase includes at least 4 likely effective medications. Additionally, for a regimen to be classified as aggressive, a second-line injectable agent must be used during the intensive phase, and a fluoroquinolone must be used throughout treatment. In 鈥渓ong aggressive鈥� regimens, aggressive treatment continues for at least 18 months following culture conversion.Thecohort consisted of 399 adults followed for up to 72 months after successful treatment of culture-confirmed pulmonary MDR-TB. The authors used 鈥渞ecurrence鈥� asthe primary outcome because genotyping was not performed and they could not distinguish reinfection from relapse. In multivariable analyses, recurrence risk was 78% lower among the group treated with long aggressive regimens (adjusted hazard ratio 0.22, 95% confidence interval: 0.05-0.92). These results are consistent with those we reported in a Peruvian cohort, in the only other study that has evaluated the impact of long aggressive regimens on recurrence (Franke et al.Clin Inf Dis2013).The major limitation of the study is that the authorscould not distinguish relapse and re-infection. Theyassumed that all cases of recurrence were due to true relapse. However, as explained in the Discussion, the bias resulting from this meant that the reported hazard ratio underestimated the lowering of relapse risk associated with use of long aggressive regimens.Strengths of the study included the availability of detailed data on socioeconomic status and adherence to treatment, and the exclusion of only 7% of patients due to missing information. Furthermore, the authors performed two sensitivity analyses that helped readers evaluate the results: the first assessed the impact of missing data, and the second evaluated how findings may have been affected by the assumption that all cases of recurrence were due to relapse.The study adds valuable information to the very limited evidence-base on MDR-TB relapse. By shedding light on the characteristics of treatment regimens that contribute to minimizing the risk of relapse, the results will help to inform treatment recommendations, and will also be of great interest to investigators that are developing and evaluating new regimens for MDR-TB.

Ling Yuan Kong MD, Jean Vincelette MD, Ga茅tan Laplante, Jo-Anne Duchesne, Michael Libman MD, Sapha Barkati MD MSc

CMAJ Open April 10, 2018 vol. 6 no. 2 E168-E175,

Background: The intradermal route of vaccine administration for pre-exposure rabies prophylaxis, endorsed by the Canadian National Advisory Committee on Immunization, was implemented at a large travel clinic in Montr茅al in 2008. We evaluated the effect of intradermal vaccination availability on uptake of pre-exposure rabies prophylaxis and rates of seroconversion with intradermal vaccination.

Methods: We conducted a retrospective cross-sectional study using data from December 2008 to December 2014. The number of travellers who received pre-exposure rabies prophylaxis before and after the introduction of intradermal vaccination was compared. Postvaccination antibody titres were measured in intradermal vaccination recipients. We compared demographic and travel characteristics between vaccinated and unvaccinated travellers and between travellers in the intradermal and intramuscular groups using univariate and multivariate analyses.

Results: The proportion of travellers who received pre-exposure prophylaxis increased after the introduction of intradermal vaccination (annual average of 300 travellers from December 2009 to December 2014 v. 183 travellers from December 2006 to December 2007). Seroconversion occurred in 99.9% of those in the intradermal group. Travellers who received pre-exposure prophylaxis were older (mean age 35.8 yr v. 32.1 yr) and had longer travel duration than those who did not receive pre-exposure prophylaxis. Travellers to Asia were more likely to receive pre-exposure prophylaxis, and travellers visiting friends and relatives were less likely to receive it. Travellers in the intradermal group were younger than those in the intramuscular group and were more likely to be travelling for tourism.

Interpretation: The introduction of intradermal vaccination for pre-exposure rabies prophylaxis was associated with an increase in vaccination uptake. Reduced cost may be responsible for the increased coverage among younger travellers and those travelling for tourism. The high seroconversion rate after intradermal vaccination supports the effectiveness of this route of administration for pre-exposure rabies prophylaxis in immunocompetent people.

Raphael Lencucha, Srikanth K Reddy, Ronald Labonte,Jeffrey Drope, Peter Magati, Fastone Goma, Richard Zulu and Donald Makoka

Health Policy and Planning, Volume 33, Issue 3, 1 April 2018, Pages 420鈥�428,

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia鈥�=鈥�23; Kenya鈥�=鈥�17; Malawi鈥�=鈥�15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in the form of bureaucratic silos.

Mathieu Maheu-Giroux, Juan F. Vesga, Souleymane Diabat茅, Michel Alary, Stefan Baral, Daouda Diouf, Kouam茅 Abo, Marie-Claude Boily

PLoS Medicine, 14(6): e1002321., June 15, 2017

Background National responses will need to be markedly accelerated to achieve the ambitious target of the Joint United Nations Programme on HIV/AIDS (UNAIDS). This target aims for 90% of HIV-positive individuals to be aware of their status, for 90% of those aware to receive antiretroviral therapy (ART), and for 90% of those on treatment to have a suppressed viral load by 2020, with each individual target reaching 95% by 2030. We aimed to estimate the impact of various treatment-as-prevention scenarios in Co藛te d鈥橧voire, one of the countries with the highest HIV incidence in West Africa, with unmet HIV prevention and treatment needs, and听 where key populations are important to the broader听 HIV epidemic. Methods and findings An age-stratified dynamic model was developed and calibrated to epidemiological and programmatic data using a Bayesian framework. The model represents sexual and vertical HIV transmission in听 the general population, female sex workers (FSW), and men who have sex with men (MSM). We estimated the impact of scaling up interventions to reach the UNAIDS targets, as well as the impact of 8 other scenarios, on HIV transmission听 in adults and children, compared to our baseline scenario that maintains 2015 rates of testing, ART initiation, ART discontinuation, treatment failure, and levels of condom use. In 2015, we estimated that 52% (95% credible intervals:听 46%鈥�58%) of HIV-positive individuals were aware of their status, 72% (57%鈥�82%) of those aware were on ART, and 77% (74%鈥�79%) of those on ART were virologically suppressed. Reaching the UNAIDS targets on time would avert 50%听 (42%鈥�60%) of new HIV infections over 2015鈥�2030 compared to 30% (25%鈥�36%) if the 90-90-90 target is reached in 2025. Attaining the UNAIDS targets in FSW, their clients, and MSM (but not in the rest of the population) would avert a听 similar fraction of new infections (30%; 21%鈥�39%). A 25-percentage-point drop in condom use from the 2015 levels among FSW and MSM would reduce the impact of reaching the UNAIDS targets, with 38% (26%鈥�51%) of infections averted. The study鈥檚 main limitation is that homogenous spatial coverage of interventions was assumed, and future lines of inquiry should examine how geographical prioritization could affect HIV transmission. Conclusions Maximizing the impact of the UNAIDS targets will require rapid scale-up of interventions, particularly testing, ART initiation, and limiting ART discontinuation. Reaching clients of FSW, as well as key populations, can efficiently reduce transmission.听 Sustaining the high condom-use levels among key populations should remain an important prevention pillar.

Julia E. von Oettingen, Tesha D. Brathwaite, Christopher Carpenter, Ric Bonnell, Xuemei He, Lewis E. Braverman, Elizabeth N. Pearce, Philippe Larco, Nancy Charles Larco, Eddy Jean-Baptiste, and Rosalind S. Brown

The Journal of Clinical Endocrinology & Metabolism, February 2017, 102(2):644鈥�651

Context: Iodine deficiency is the leading cause of preventable neurodevelopmental delay in children worldwide and a possible public health concern in Haiti. Objective: To determine the prevalence of iodine deficiency in Haitian young children and its influence by environmental factors. Design: Cross-sectional study, March through June 2015. Setting: Community churches in 3 geographical regions in Haiti. Participants: 299 healthy Haitian children aged 9 months to 6 years; one-third each enrolled in a coastal, mountainous, and urban region. Main Outcome Measures: Urinary iodide, serum thyrotropin (TSH), goiter assessment, and urinary perchlorate and thiocyanate. Results: Mean age was 3.361.6 years, with 51% female, median family income USD 30/week, and 16% malnutrition.Median urinary iodide levels were normal in coastal (145 mg/L, interquartile range [IQR] 97 to 241)and urbanregions (187mg/L, IQR 92 to316), but revealed mild iodine deficiency in a mountainous region (89mg/L, IQR 56 to 129), P,0.0001. Grade 1 goiters were palpated in 2 children, but TSH values were normal. Urinary thiocyanate and perchlorate concentrations were not elevated. Predictors of higher urinary iodide included higher urinary thiocyanate and perchlorate, breastfeeding, and not living in a mountainous region. Conclusions: Areas of mild iodine deficiency persist in Haiti鈥檚 mountainous regions. Exposure to two well understood environmental thyroid function disruptors is limited. (J Clin Endocrinol Metab 102: 644鈥�651, 2017)

Georges Ntakiyiruta, MD; Evan G. Wong, MD; Mathieu C. Rousseau, MD; Landouald Ruhungande, MD; Adam L. Kushner, MD; Alexander S. Liberman, MD; Kosar Khwaja, MD; Marc Dakermandji, MD; Marnie Wilson, MD; Tarek Razek, MD; Patrick Kyamanywa, MD; Dan L. Deckelbaum, MD

Canadian Journal of Surgery, 59(1):35-41:, February 2016

Background Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care. Methods We retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson 围2 and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns. Results Over the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]). Conclusion To our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions.

Karine Thivierge, Asma Iqbal, Brent Dixon, R茅jean Dion, Beno卯t Levesque, Philippe Cantin, Lyne C茅dilotte, Momar Ndao, Jean-Fran莽ois Proulx, Cedric P. Yansouni

PLoS Neglected Tropical Diseases, 10(4): e0004534., April 8, 2016

Background Cryptosporidium is a leading cause of childhood diarrhea in low-resource settings, and has been repeatedly associated with impaired physical and cognitive development. In May 2013, an outbreak of diarrhea caused by Cryptosporidium hominis was identified in the Arctic region of Nunavik, Quebec. Human cryptosporidiosis transmission was previously unknown in this region, and very few previous studies have reported it elsewhere in the Arctic. We report clinical, molecular, and epidemiologic details of a multi-village Cryptosporidium outbreak in the Canadian Arctic. Methodology/Principal Findings We investigated the occurrence of cryptosporidiosis using a descriptive study of cases with onset between April 2013 and April 2014. Cases were defined as Nunavik inhabitants of any age presenting with diarrhea of any duration, in whom Cryptosporidium oocysts were detected by stool microscopy in a specialised reference laboratory. Cryptosporidium was identified in stool from 51 of 283 individuals. The overall annual incidence rate (IR) was 420 / 100,000 inhabitants. The IR was highest among children aged less than 5 years (1290 /100,000 persons). Genetic subtyping for stool specimens from 14/51 cases was determined by DNA sequence analysis of the 60 kDa glycoprotein (gp60) gene. Sequences aligned with C. hominis subtype Id in all cases. No common food or water source of infection was identified. Conclusions/Significance In this first observed outbreak of human cryptosporidiosis in this Arctic region, the high IR seen is cause for concern about the possible long-term effects on growth and development of children in Inuit communities, who face myriad other challenges such as overcrowding and food-insecurity. The temporal and geographic distribution of cases, as well as the identification of C. hominis subtype Id, suggest anthroponotic rather than zoonotic transmission. Barriers to timely diagnosis delayed the recognition of human cryptosporidiosis in this remote setting.