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Roe deer (Capreolus capreolus) is the most abundant cervid in Europe and, as such, has a considerable impact over several human activities. Accurate roe deer population size estimates are useful to ensure their proper management. We tested 3 methods for estimating roe deer abundance (drive counts, pellet-group counts, and camera trapping) during two consecutive years (2012 and 2013) in the Apennines (Italy) in order to assess their precision and applicability. During the study period, population density estimates were: drive counts 21.89±12.74 roe deer/km2 and pellet-group counts 18.74±2.31 roe deer/km2 in 2012; drive counts 19.32±11.12 roe deer/km2 and camera trapping 29.05±7.48 roe deer/km2 in 2013. Precision of the density estimates differed widely among the 3 methods, with coefficients of variation ranging from 12% (pellet-group counts) to 58% (drive counts). Drive counts represented the most demanding method on account of the higher number of operators involved. Pellet-group counts yielded the most precise results and required a smaller number of operators, though the sampling effort was considerable. When compared to the other two methods, camera trapping resulted in an intermediate level of precision and required the lowest sampling effort. We also discussed field protocols of each method, considering that volunteers, rather than technicians, will more likely be appointed for these tasks in the near future. For this reason, we strongly suggest that for each method managers of population density monitoring projects take into account ease of use as well as the quality of the results obtained and the resources required. [ABSTRACT FROM AUTHOR]

Introduction: Women's reproductive health decision-making is indispensable for improving their reproductive health and achieving Sustainable Development Goal three. This study explored the association between reproductive health decision-making capacity and unintended pregnancy among women in Ghana. Materials and methods: We used data from the 2014 version of the Ghana Demographic and Health Survey. The unit of analysis for this study was pregnant women at the time of the survey (679). Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively. Results: We found that women who had the capacity to make reproductive health decision [AOR = 0.61; CI = 0.51–0.89] were less likely to experience unintended pregnancies, compared to those who did not have the capacity. Age was found to have a statistically significant influence on unintended pregnancy, with women aged 25–29 years [AOR = 0.29; CI = 0.13–0.63], 30–34 years [AOR = 0.18; CI = 0.08–0.45], and 35–39 years [AOR = 0.26; CI = 0.10–0.68] being less likely to experience unintended pregnancy compared to those aged 15–19 years. Women with primary level of education were more likely to have unintended pregnancies, compared to those with no education [AOR = 2.07; CI = 1.12–3.84]. Conclusion: This study has filled the gap in the already existing literature on the association between reproductive health decision making capacity and unintended pregnancy in Ghana and has created a room for specific interventions geared towards reducing unintended pregnancies, especially among women who are not capable of making reproductive health decisions, women aged 15–19 years, those with primary education, Traditionalists and unmarried women. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is high within the Qatari population, particularly within females, and school-based environments, contributing to increased morbidity and mortality. School-based physical activity (PA) outcomes may be mediated by physical self-concept. Low physical self-concept may negatively impact PA engagement, compromising childhood and adolescent physical fitness, which may translate into adulthood. Normative physical fitness data for the Qatari population is unavailable. Stratifying normative physical fitness appears prudent, to not only allow comparisons to be made worldwide, but enable informed decisions for public health policy and future interventions in the Qatari population. Purpose: To establish the physical fitness of young adults in Qatar, and examine differences between males and females for physical self-concept, and engagement in school-based and extra-curricular PA. Method: 186 (females n = 85) healthy participants [median (minimum—maximum) age: males = 21 (18–26), females = 21 (18–24) y; height: males = 1.74 (1.57–1.99), females = 1.61 (1.46–1.76) m; body mass: males = 71.9 (49.3–145.0), females = 56.8 (35.7–96.4) kg] completed the ALPHA-FIT test battery for adults (one leg stand, figure of eight run, handgrip strength, jump and reach, modified push-up, dynamic sit-up and 2 km walk), physical self-description questionnaire (measuring physical self-concept), and were asked to answer 'yes' or 'no' to whether they participated in school-based and extra-curricular PA. Results: Data is reported as effect size; ±90% confidence limit. Males compared to females most likely performed better for dynamic sit-up (2.2; ±0.76), very likely better for the figure of eight run (0.86; ±0.42) and likely better for handgrip strength (2.1; ±0.75). Males likely had higher physical self-concept for coordination (0.78; ±0.37) and endurance (0.66; ±0.27) compared to females. There were no differences for school-based PA (p ≥ 0.78) or for extra-curricular PA for males (p ≥ 0.26) or females (p ≥ 0.21). Conclusion: The data suggests that the young Qatari adult population has variable, yet generally low, physical fitness traits compared to individuals worldwide, likely due to their low PA. The precise aetiology for this is not well documented, yet such data may be prudent to evidence-inform strategies to improve physical fitness through increased PA (synergistic relationship), given the strong association between physical activity/fitness and morbidity/mortality. [ABSTRACT FROM AUTHOR]

Background: One of the reported causes of high malnutrition rates in Burundi and Rwanda is children's inadequate dietary habits. The diet of children may be affected by individual characteristics and by the characteristics of the households and the communities in which they live. We used the minimum dietary diversity of children (MDD-C) indicator as a proxy of diet quality aiming at: 1) assess how much of the observed variation in MDD-C was attributed to community clustering, and 2) to identify the MDD-C associated factors. Methods: Data was obtained from the 2010 Demographic and Health Surveys of Burundi and Rwanda, from which only children 6 to 23 months from rural areas were analysed. The MDD-C was calculated according to the 2007 WHO/UNICEF guidelines. We computed the intra-class coefficient to assess the percentage of variation attributed to the clustering effect of living in the same community. And then we applied two-level logit regressions to investigate the association between MDD-C and potential risk factors following the hierarchical survey structure of DHS. Results: The MDD-C was 23% in rural Rwanda and 16% in rural Burundi, and a 29% of its variation in Rwanda and 17% in Burundi was attributable to community clustering. Increasing age and living standards were associated with higher MDD-C in both countries, and only in Burundi also increasing level of education of the mother's partner. In Rwanda alone, the increasing ages of the head of the household and of the mother at first birth were also positively associated with it. Despite the identification of an important proportion of the MDD-C variation due to clustering, we couldn't identify any community variable significantly associated with it. Conclusions: We recommend further research using hierarchical models, and to integrate dietary diversity in holistic interventions which take into account both the household's and the community's characteristics the children live in. [ABSTRACT FROM AUTHOR]

Background: This study investigated the incidence and predictors of retreatment after discontinuation of either entecavir (ETV) or tenofovir disoproxil fumarate (TDF) treatment in Taiwan. Methods: A total of 535 non-cirrhotic chronic hepatitis B (CHB) patients undergoing either ETV (n = 358) or TDF (n = 177) treatment were enrolled. Patients were followed for at least 12 months after stopping ETV or TDF treatment. Most patients (86.3%) fulfilled the retreatment criteria of Taiwan's National Health Plan. Results: The 5-year cumulative rates of clinical relapse and retreatment were 52.1% and 47%, respectively, in 160 hepatitis B e antigen (HBeAg)-positive patients, and were 62% and 54.8%, respectively, in 375 HBeAg-negative patients. The median duration from the end of treatment until clinical relapse and retreatment was 40 and 57 weeks, respectively, for all patients. Multivariate Cox regression analysis revealed that discontinuing TDF treatment, old age, male gender, and higher baseline HBsAg levels were independent factors of retreatment in HBeAg-positive patients; old age, HBV genotype B, and higher baseline and end-of-treatment HBsAg levels were independent factors in HBeAg-negative patients. A total of 18.8% of retreated patients satisfied the retreatment criteria of hepatic decompensation according to Taiwan's National Health Plan. Of the 64 patients who had clinical relapse without retreatment, 17 achieved sustained virological remission and 26 did not experience clinical relapse until their last visit after clinical relapse. Four patients developed HBsAg loss. Conclusions: The 5-year retreatment rate was about 50% in HBeAg-positive and HBeAg-negative patients. Discontinuing TDF treatment was an independent factor of retreatment in HBeAg-positive patients. [ABSTRACT FROM AUTHOR]

Introduction: Despite increased treatment availability, HIV-infected individuals continue to start antiretroviral therapy (ART) late in disease progression, increasing early mortality risk. Materials and methods: Nested prospective cohort study within a randomized clinical trial of adult patients initiating ART at clinics in urban Nairobi and rural Maseno, Kenya, between 2013–2014. We estimated mortality incidence rates following ART initiation and used Cox proportional hazards regression to identify predictors of mortality within 12 months of ART initiation. Analyses were stratified by clinic site to examine differences in mortality correlates and risk by location. Results: Among 811 participants initiated on ART, the mortality incidence rate within a year of initiating ART was 7.44 per 100 person-years (95% CI 5.71, 9.69). Among 207 Maseno and 612 Nairobi participants initiated on ART, the mortality incidence rates (per 100 person-years) were 12.78 (95% CI 8.49, 19.23) and 5.72 (95% CI 4.05, 8.09). Maseno had a 2.20-fold greater risk of mortality than Nairobi (95% CI 1.29, 3.76; P = 0.004). This association remained [adjusted hazard ratio (HR) = 2.09 (95% CI 1.17, 3.74); P = 0.013] when adjusting for age, gender, education, pre-treatment drug resistance (PDR), and CD4 count, but not when adjusting for BMI. In unadjusted analyses, other predictors (P<0.05) of mortality included male gender (HR = 1.74), age (HR = 1.04 for 1-year increase), fewer years of education (HR = 0.92 for 1-year increase), unemployment (HR = 1.89), low body mass index (BMI<18.5 m/kg2; HR = 4.99), CD4 count <100 (HR = 11.67) and 100–199 (HR = 3.40) vs. 200–350 cells/μL, and pre-treatment drug resistance (PDR; HR = 2.49). The increased mortality risk associated with older age, males, and greater education remained when adjusted for location, age, education and PDR, but not when adjusted for BMI and CD4 count. PDR remained associated with increased mortality risk when adjusted for location, age, gender, education, and BMI, but not when adjusted for CD4 count. CD4 and BMI associations with increased mortality risk persisted in multivariable analyses. Despite similar baseline CD4 counts across locations, mortality risk associated with low CD4 count, low BMI, and PDR was greater in Maseno than Nairobi in stratified analyses. Conclusions: High short-term post-ART mortality was observed, partially due to low CD4 count and BMI at presentation, especially in the rural setting. Male gender, older age, and markers of lower socioeconomic status were also associated with greater mortality risk. Engaging patients earlier in HIV infection remains critical. PDR may influence short-term mortality and further studies to optimize management will be important in settings with increasing PDR. [ABSTRACT FROM AUTHOR]

Introduction: Micronutrient deficiencies are prevalent in Nepal where starchy foods constitute a large proportion of diets and consumption of micronutrient-rich foods is inadequate. We conducted a study to determine whether rice would be an appropriate vehicle for micronutrient fortification in Nepal. Materials and methods: In Bajura in remote rural Nepal, we conducted a household survey to characterize rice intakes in 195 households, and a double-blinded acceptability test with 177 social safety net rice consumers ≥18 years of age. Of these, 168 tasted fortified and unfortified rice to assess whether respondents could differentiate between fortified and non-fortified rice and their sensory properties. Rice was fortified by blending hot extruded kernels containing 6 micronutrients together with non-fortified rice at a 1:99 ratio. We used binomial tests to assess whether participants could correctly differentiate fortified rice, from non-fortified rice and paired t-tests to compare scores for sensory qualities of cooked fortified and non-fortified rice. We used multiple regression to test associations between per capita consumption and age, gender, wealth and food security. Results: Per capita consumption of rice (median 216g/day, IQR 144.0, 288.0) did not vary by wealth but was +52.08g, (95% CI 10.43, 93.72) higher amongst moderately to severely food insecure households compared with food secure / mildly food insecure. Most respondents could not differentiate fortified rice from non-fortified rice: 37.5% identified uncooked fortified rice and 39.3% cooked rice, which was not different from the 33% expected by chance (p = 0.22 and p = 0.09 respectively). The sensory qualities of fortified rice were acceptable (scoring 3.9 out of 5) and did not differ from non-fortified rice (p>0.05). Conclusion: A rice fortification programme implemented through the Nepal Food Corporation’s social safety nets has potential because purchase and consumption of rice is high and fortified rice is acceptable among consumers in remote food insecure areas of Nepal. [ABSTRACT FROM AUTHOR]

Background and objective: Trial registration is widely endorsed as it is considered not only to enhance transparency and quality of reporting but also to help safeguard against outcome reporting bias and probably spin, known as specific reporting that could distort the interpretation of results thus mislead readers. We planned to investigate the current registration status of recently published randomized controlled trials (RCTs) of acupuncture, outcome reporting bias in the prospectively registered trials, and the association between trial registration and presence of spin and methodological factors in acupuncture RCTs. Methods: Acupuncture RCTs published in English in recent 5 years (January 2013 to December 2017) were searched in PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Trial registration records identified in the publications and trial registries were classified into prospectively registered, retrospectively registered, or unregistered. Primary outcomes were identified and the direction of the results was judged as statistically significant (positive) or statistically nonsignificant (negative). We compared registered and published primary outcomes to assess outcome reporting bias and assessed whether discrepancies favored statistically significant outcomes. Frequency and strategies of spin in published reports with statistically nonsignificant results for primary outcomes were then identified. We also analyzed whether the trial registration status was associated with spin and quality of methodological factors. Results: Of the 322 included RCTs, 41.9% (n = 135) were prospectively registered. Among 64 studies that were prospectively registered and specified primary outcomes, 25 trials had the discrepancies between the registered and published primary outcomes and 60% of them (15 trials) favored the statistically significant findings. Among 169 studies that specified primary outcomes, trial registration status was not associated with the direction of results, i.e., statistically significant or not. Spin was identified in 56.4% out of 78 studies with statistically nonsignificant primary outcomes and claiming efficacy with no consideration of statistically nonsignificant primary outcomes was the most common strategy for spin. Trial registration status was not statistically different between studies with and without spin. Conclusion: While trial registration seemed to have improved over time, primary outcomes in registered records and publications were often inconsistent, tending to favor statistically significant findings and spin was common in studies with statistically nonsignificant primary outcomes. Journal editors and researchers in this field should be alerted to still prevalent reporting bias and spin. [ABSTRACT FROM AUTHOR]

Overweight and obesity have become global concerns in developed and developing countries due to their rise in recent years and their association with the prevalence of non-communicable diseases including diabetes, hypertension and cardiovascular diseases. In fact, it is estimated that roughly 39% of adults worldwide are overweight and 13% are obese. Ecuador is an example of a developing country concerned with the overweight and obesity problem, where it is estimated that 30% of children, 26% of teenagers and 63% of adults are either overweight or obese and where 1 in 4 deaths are attributed to chronic diseases. To address the overweight and obesity problem via the promotion of healthy eating habits, in 2013 the country approved technical regulation for the labelling of packed processed food products. The regulation included a mandatory traffic-light (TL) supplemental nutritional information labelling system to be displayed on the package of all processed foods for sale in the country. This new labelling system displays a traffic light panel for the product content of sugar, fat and salt in addition to the traditional nutrient declaration label. The objective of this paper was to evaluate the effect of the TL supplemental nutritional information on consumers’ buying behavior in Ecuador. More specifically, we concentrated on the purchasing behavior of carbonated soft drinks. For our analysis, we used monthly aggregated purchase data (total expenditures, quantities and average prices) of carbonated soft drinks from January 2013 to December 2015 obtained from Kantar World Panel—Ecuador. We estimated a non-linear Almost Ideal Demand System where we model the demand for high sugar and low sugar carbonated soft drinks. We found that the introduction of the traffic light supplemental nutrition labelling did not have the expected effect of reducing purchases of carbonated soft drinks during its first year of implementation, especially those high in sugar. Additionally, we found that lower income-status households tend to spend more on and consume more calories from CSD than households with higher socio-economic status. Finally, we identified that over time purchases of high sugar soft drinks decreased while purchases of low and no sugar soft drinks increased. Beyond our contribution of evaluating the effect of the traffic light on the purchases of carbonated soft drinks, we also estimated price and income elasticities of carbonated soft drinks which can be useful in the evaluation of fiscal policies. [ABSTRACT FROM AUTHOR]

Agricultural activity, urban development and habitat alteration have caused the disappearance of the western spadefoot (Spea hammondii) from 80% of its geographic range in southern California. Despite the western spadefoot’s continuing decline, little research has been conducted on its natural history. The home range of adult spadefoots is unknown, and their use of upland habitat is poorly understood. Both factors are important for the long-term conservation of the species because adult spadefoots spend the majority of their lives away from breeding pools in self-excavated burrows. Between January 2012 and January 2013, we surgically implanted radio transmitters in 15 spadefoots at two locations and recorded their movements and habitat use. The mean distance moved between burrow locations was 18 m (SD ± 24.1 m, range1–204 m). The mean distance of burrows from the breeding pools was 40 m (SD ± 37.42 m, range 1–262 m). Rain was a significant predictor of spadefoot movement, with more rain predicting higher probability of movement and larger distances moved. At remote sensing scale (1 m) spadefoots selected grassland habitat for their burrow locations. At the microsite scale (< 1 m) spadefoots strongly selected duff over grass or shrub cover. Spadefoots burrowed in friable, sandy/loam soil with significantly less clay than random pseudoabsence points. This research enhances our understanding of a little-studied species and will contribute to the development of effective management plans for the western spadefoot. [ABSTRACT FROM AUTHOR]

The biology and ecology of Africa’s largest fruit bat remains largely understudied and enigmatic despite at least two highly unusual attributes. The acoustic lek mating behavior of the hammer-headed bat (Hypsignathus monstrosus) in the Congo basin was first described in the 1970s. More recently molecular testing implicated this species and other African bats as potential reservoir hosts for Ebola virus and it was one of only two fruit bat species epidemiologically linked to the 2008 Luebo, Democratic Republic of Congo, Ebola outbreak. Here we share findings from the first pilot study of hammer-headed bat movement using GPS tracking and accelerometry units and a small preceding radio-tracking trial at an apparent lekking site. The radio-tracking revealed adult males had high rates of nightly visitation to the site compared to females (only one visit) and that two of six females day-roosted ~100 m west of Libonga, the nearest village that is ~1.6 km southwest. Four months later, in mid-April 2018, five individual bats, comprised of four males and one female, were tracked from two to 306 days, collecting from 67 to 1022 GPS locations. As measured by mean distance to the site and proportion of nightly GPS locations within 1 km of the site (percent visitation), the males were much more closely associated with the site (mean distance 1.4 km; 51% visitation), than the female (mean 5.5 km; 2.2% visitation). Despite the small sample size, our tracking evidence supports our original characterization of the site as a lek, and the lek itself is much more central to male than female movement. Moreover, our pilot demonstrates the technical feasibility of executing future studies on hammer-headed bats that will help fill problematic knowledge gaps about zoonotic spillover risks and the conservation needs of fruit bats across the continent. [ABSTRACT FROM AUTHOR]

Background: TB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil. Methods: A retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT. Results: 2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08–1.54), cases of relapse (OR = 1.33; 95% CI = 1.03–1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20–1.83), transfer (OR = 2.04; 95% CI = 1.40–2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24–2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16–1.67), and mental disorders (OR = 1.83; 95% CI = 1.38–2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%. Conclusions: There was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy. [ABSTRACT FROM AUTHOR]

Japanese eel (Anguilla japonica) recruitment to Japan was very low during the early 2017−2018 recruitment season when most glass eels are usually caught, but catches increased in the late recruitment season when recruitment usually decreases. Concurrently, the Kuroshio meander south of Japan had formed again after the previous event ended in 2005. The role of the large meander and ocean circulation features such as the North Equatorial Current (NEC) in the unusual 2017−2018 Japanese eel recruitment timing-pattern was investigated using a three-dimensional particle tracking model that simulated swimming behaviors of virtual larvae (v-larvae) in addition to their drift in ocean currents. Four recruitment seasons were selected for when the Kuroshio large meander was present (2004−2005, 2017−2018) or absent (2009−2010, 2015−2016), and when NEC was shifted north (2004−2005, 2015−2016) or south (2009−2010, 2017−2018). The simulated recruitment timing-patterns were similar to the actual recent-year recruitment, with no early recruitment period v-larvae arrival to southern Japan and increased late period recruitment occurring. Rather than being related to the presence of the Kuroshio large meander, the late arrival appeared to be caused by a southward shifted, weak North Equatorial Current near the spawning area, a longer Subtropical Countercurrent eddy region retention time, and a weak Kuroshio during the early migration and recruitment period of those years. In the late recruitment period, the Kuroshio was stronger than other selected years near the East China Sea and south of Japan and v-larvae were transported more rapidly. The Kuroshio large meander may influence local eel recruitment in Japan, and the recirculation formed by the large meander could potentially enhance recruitment to the Tokai region. Oriented (northwestward) swimming v-larvae were less affected by the large meander, and showed higher recruitment success than those using along-current swimming. Although the Kuroshio large meander did not seem to be responsible for the unusual recruitment pattern in 2018, how Japanese eel larvae and glass eels actually cross out of the Kuroshio and reach coastal waters in Japan remains to be explored. [ABSTRACT FROM AUTHOR]

This paper brings advances in weather data collection and modeling, and developments in socioeconomic climate microsimulations to bear on the analysis of the implications of climate change (CC) in the design of public policies to combat food insecurity. It uses new downscaled predictions of future climate in 2050, derived from three Earth System Models calibrated with a new historical weather station dataset for Peru. This climate data is used in a three-stage socioeconomic microsimulation model that includes climate risk, and deals with the endogeneity of incomes and simultaneity of expected food consumption and its variability. We estimate the impact of CC on agricultural yields, and find results consistent and fully bounded within what the global simulations literature has found, with yields falling up to 13% in some regions. However, we show that these drops (and increases) in yields translate to much smaller changes in food consumption, and also surprisingly, to very minor impacts on vulnerability to food insecurity. The document explores what explains this surprising result, showing that in addition to characteristics that are specific to Peru, there are household and market mediating mechanisms that are available in all countries, which explain how changes in yields, and corresponding farm incomes have a reduced impact in vulnerability to food insecurity. Finally, in light of these findings, we explore which policies might have greater impact in reducing food insecurity in contexts of hunger prevalence. [ABSTRACT FROM AUTHOR]

Background: Though mass evacuation may increase the need for long-term care (LTC) services, how the need for LTC services increases and how the public LTC system affects it is not well understood. We evaluated changes in public LTC benefits for the people living in the mandatory evacuation areas established after the 2011 Fukushima nuclear disaster and examined the roles of the universal LTC insurance system in Japan. Methods: In order to evaluate the effect of the mandatory evacuation on LTC benefits, we examined the trends of LTC benefits in the Fukushima evacuation group and the nationwide non-evacuation group. We first decomposed per-elderly-individual benefits at the municipality level into the LTC certification rate and per-certified-individual benefits, and then implemented difference-in-differences analysis using these variables as outcomes. Results: Per-elderly-individual benefits significantly increased from 2012 onward in the evacuation group, and this was explained by an increase in the certification rate rather than in per-certified-individual benefits. Increases in per-elderly-individual benefits and the certification rate in the post-disaster period were observed in all but the highest care level, and the corresponding outcomes for the highest care level decreased immediately after the disaster. We also found that the increase in the certification rate had been mostly realized by an increase in the number of certified individuals. Conclusions: The increase in LTC benefits can be associated with the impact of the increase in the number of people newly certified to receive LTC benefits after the mandatory evacuation. In order to cope with the increase in utilization of long-term care and associated costs after disasters in aging societies, both formal long-term care services and social support for informal care for evacuees should be considered important. [ABSTRACT FROM AUTHOR]

Scapsipedus icipe Hugel and Tanga (Orthoptera: Gryllidae) is a newly described edible cricket species. Although, there is substantial interest in mass production of S. icipe for human food and animal feed, no information exists on the impact of temperature on their bionomics. Temperature-dependent development, survival, reproductive and life table parameters of S. icipe was generated and integrated into advanced Insect Life Cycle Modeling software to describe relative S. icipe population increase and spatial spread based on nine constant temperature conditions. We examined model predictions and implications for S. icipe potential distribution in Africa under current and future climate. These regions where entomophagy is widely practiced have distinctly different climates. Our results showed that S. icipe eggs were unable to hatch at 10 and 40°C, while emerged nymphs failed to complete development at 15°C. The developmental time of S. icipe was observed to decrease with increased in temperature. The lowest developmental threshold temperatures estimated using linear regressions was 14.3, 12.67 and 19.12°C and the thermal constants for development were 185.2, 1111.1- and 40.7-degree days (DD) for egg, nymph and pre-adult stages, respectively. The highest total fecundity (3416 individuals/female/generation), intrinsic rate of natural increase (0.075 days), net reproductive rate (1330.8 female/female/generation) and shortest doubling time (9.2 days) was recorded at 30°C. The regions predicted to be suitable by the model suggest that S. icipe is tolerant to a wider range of climatic conditions. Our findings provide for the first-time important information on the impact of temperature on the biology, establishment and spread of S. icipe across the Africa continent. The prospect of edible S. icipe production to become a new sector in food and feed industry is discussed. [ABSTRACT FROM AUTHOR]

Background: Determine TB-LAM Ag (LAM) is a point of care test developed to diagnose tuberculosis (TB). The aim of this study was to evaluate the diagnostic performance of LAM in people living with HIV using Brazilian public health network algorithm for TB diagnosis. Methods and findings: A cross-sectional study design was used to enroll 199 adult patients in two sites in Rio de Janeiro and two in São Paulo. The study enrolled HIV-infected patients with CD4 counts ≤200 cells/mm3 (in the Alere PIMA CD4 assay at study screening), patients coughing for at least 2 weeks or presenting a chest radiography suggestive of TB. LAM, in conjunction with sputum smear microscopy or Xpert MTB/RIF (Xpert) as compared to Mycobacterium tuberculosis culture, which was used as a reference standard. TB prevalence was 24.6%. Overall accuracy of LAM was 79.9% (73.8%-84.9%), positive and negative predictive values were 62.2% (46.1%-75.9%) and 84% (77.5%-88.8%), respectively. The overall LAM sensitivity was 46.9% (33.7%-60.6%) and specificity was 90.7% (84.9%-94.4%). The best performance of LAM was observed among patients with CD4 counts ≤50 cells/mm3 (sensitivity = 70.4% and specificity = 85.9%). When 2 respiratory smears were used in conjunction with LAM, sensitivity increased 22%, as compared to just 2 smears. Furthermore, LAM when used in conjunction with two respiratory smears, was as sensitive as compared to a single one. However, no improvement in TB diagnosis occurred when LAM was used with Xpert as compared to Xpert alone. Among 14 LAM false positive tests, Non-Tuberculosis Mycobacteria were isolated in three cases. Conclusion: LAM is a point of care test that increased TB diagnosis in immunosuppressed HIV-infected patients when used in conjunction with smear microscopy, but not when used with Xpert in Brazilian public health network sites. Use of LAM test should be considered in settings where immunosuppressed HIV patients need rapid TB diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between hot flashes (HFs) severity and oxidative stress (OS) in Mexican postmenopausal women. Methods: A cross-sectional study was carried out with perimenopausal women aged 40–59 years community-dwelling from Mexico City, Mexico. They participated in Menopause and Oxidative Stress Project. The baseline sample consisted of 476 women recruited to participate; 161 women were excluded due to different reasons. Hence, 315 women were selected to establish two groups, a) 145 premenopausal women (yet with menstrual bleeding), and b) 170 postmenopausal women (without menses). All women were free of cardiovascular, kidney, hepatic or cancer disease, and without antioxidant supplement intake for at least six months prior to the beginning of the study; none had previously received hormone therapy. As OS markers, we measured plasma malondialdehyde using the TBARS assay, erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GPx), uric acid, and total antioxidant status; also, we calculated SOD/GPx ratio, antioxidant gap and an oxidative stress score ranging from 0 to 7. The HFs were evaluated using the Menopause Rating Scale. The women completed Spanish version of the Athens Insomnia Scale, Zung Self-Rating Anxiety Scale and Zung Self-Rating Depression Scale and a questionnaire of pro-oxidant factors. Results: Stress score increased with HFs severity (mild 2.7±0.17, moderate 2.9±0.20 and severe 3.7±0.20, p = 0.001) in postmenopausal women. We observed a positive correlation between HFs severity and stress score, r = 0.247 (p = 0.001) in postmenopausal women; other test scores were not correlated. Severe HFs were a risk factor for OS (OR = 5.12, 95%CI: 1.99–13.17, p<0.05) in an adjusted multivariate analysis by different postmenopausal symptoms and pro-oxidant factors; we did not see any association in premenopausal women. Conclusion: Our findings suggest an association between HFs severity and OS in Mexican postmenopausal women. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) disease reactivates from distant latent infection or recent (re)infection. Progression risks increase with age. Across the World Health Organisation Western Pacific region, many populations are ageing and have the highest per capita TB incidence rates in older age groups. However, methods for analysing age-specific TB incidence and forecasting epidemic trends while accounting for demographic change remain limited. Methods: We applied the Lee-Carter models, which were originally developed for mortality modelling, to model the temporal trends in age-specific TB incidence data from 2005 to 2018 in Taiwan. Females and males were modelled separately. We combined our demographic forecasts, and age-specific TB incidence forecasts to project TB incidence until 2035. We compared TB incidence projections with demography fixed in 2018 to projections accounting for demographic change. Results: Our models quantified increasing incidence rates with age and declining temporal trends. By 2035, the forecast suggests that the TB incidence rate in Taiwan will decrease by 54% (95% Prediction Interval (PI): 45%-59%) compared to 2015, while most age-specific incidence rates will reduce by more than 60%. In 2035, adults aged 65 and above will make up 78% of incident TB cases. Forecast TB incidence in 2035 accounting for demographic change will be 39% (95% PI: 36%-42%) higher than without population ageing. Conclusions: Age-specific incidence forecasts coupled with demographic forecasts can inform the impact of population ageing on TB epidemics. The TB control programme in Taiwan should develop plans specific to older age groups and their care needs. [ABSTRACT FROM AUTHOR]

The Duffy blood group plays a key role in Plasmodium knowlesi and Plasmodium vivax invasion into human erythrocytes. The geographical distribution of the Duffy alleles differs between regions with the FY*A allele having high frequencies in many Asian populations, the FY*B allele is found predominately in European populations and the FY*Bes allele found predominantly in African regions. A previous study in Peninsular Malaysia indicated high homogeneity of the dominant FY*A/FY*A genotype. However, the distribution of the Duffy genotypes in Malaysian Borneo is currently unknown. In the present study, the distribution of Duffy blood group genotypes and allelic frequencies among P. knowlesi infected patients as well as healthy individuals in Malaysian Borneo were determined. A total of 79 P. knowlesi patient blood samples and 76 healthy donor samples were genotyped using allele specific polymerase chain reaction (ASP-PCR). Subsequently a P. knowlesi invasion assay was carried out on FY*AB/ FY*A and FY*A/ FY*A Duffy genotype blood to investigate if either genotype conferred increased susceptibility to P. knowlesi invasion. Our results show almost equal distribution between the homozygous FY*A/FY*A and heterozygous FY*A/FY*B genotypes. This is in stark contrast to the Duffy distribution in Peninsular Malaysia and the surrounding Southeast Asian region which is dominantly FY*A/FY*A. The mean percent invasion of FY*A/FY*A and FY*A/FY*B blood was not significantly different indicating that neither blood group confers increased susceptibility to P. knowlesi invasion. [ABSTRACT FROM AUTHOR]

European sea bass were fed four low FM/FO (10%/6%) diets containing galactomannan oligosaccharides (GMOS), a mixture of garlic oil and labiatae plants oils (PHYTO), or a combination of both functional products (GMOSPHYTO) for 63 days before exposing the fish to an intestinal Vibrio anguillarum infection combined with crowding stress. In order to evaluate functional diets efficacy in terms of gut health maintenance, structural, cellular, and immune intestinal status were evaluated by optical and electron microscopy and gene expression analyses. A semi-automated software was adapted to determine variations in goblet cell area and mucosal mucus coverage during the challenge test. Feeding with functional diets did not affect growth performance; however, PHYTO and GMOS dietary inclusion reduced European sea bass susceptibility to V. anguillarum after 7 days of challenge testing. Rectum (post-ileorectal valve) showed longer (p = 0.001) folds than posterior gut (pre-ileorectal valve), whereas posterior gut had thicker submucosa (p = 0.001) and higher mucus coverage as a result of an increased cell density than rectum. Functional diets did not affect mucosal fold length or the grade of granulocytes and lymphocytes infiltration in either intestinal segment. However, the posterior gut fold area covered by goblet cells was smaller in fish fed GMOS (F = 14.53; p = 0.001) and PHYTO (F = 5.52; p = 0.019) than for the other diets. PHYTO (F = 3.95; p = 0.049) reduced posterior gut goblet cell size and increased rodlet cell density (F = 3.604; p = 0.068). Dietary GMOS reduced submucosal thickness (F = 51.31; p = 0.001) and increased rodlet cell density (F = 3.604; p = 0.068) in rectum. Structural TEM analyses revealed a normal intestinal morphological pattern, but the use of GMOS increased rectum microvilli length, whereas the use of PHYTO increased (p≤0.10) Ocln, N-Cad and Cad-17 posterior gut gene expression. After bacterial intestinal inoculation, posterior gut of fish fed PHYTO responded in a more controlled and belated way in terms of goblet cell size and mucus coverage in comparison to other treatments. For rectum, the pattern of response was similar for all dietary treatments, however fish fed GMOS maintained goblet cell size along the challenge test. [ABSTRACT FROM AUTHOR]

Introduction: The success of antiretroviral treatment (ART) programs can be compromised by high rates of patient loss to follow-up (LTFU). We assessed the incidence and risk factors of LTFU in a large cohort of HIV-infected children receiving ART in Thailand. Methods: All children participating in a multicenter cohort (NCT00433030) between 1999 and 2014 were included. The date of LTFU was 9 months after the last contact date. ART interruption was defined as ART discontinuation for more than 7 days followed by resumption of treatment. Baseline and time-dependent risk factors associated with LTFU were identified using Fine and Gray competing risk regression models with death or referral to another hospital as competing events. Results: Of 873 children who were followed during a median of 8.6 years (interquartile range 4.5–10.6), 196 were LTFU, 73 died, and 195 referred. The cumulative incidence of LTFU was 2.9% at 1 year, 7.3% at 5 years and 22.2% at 10 years. Children aged 13 years and more had a 3-fold higher risk (95% confidence interval 2.06–4.78) of LTFU than those younger. Children who had interrupted ART within the previous year had a 2.5-fold higher risk (1.12–5.91) than those who had not. The risk of LTFU was lower in children stunted (height-for-age Z-scores <-2 SD) (0.42–0.96) or underweight (weight-for-age Z-scores <-2 SD) (0.24–0.97). Conclusion: Adolescence, ART interruption and absence of growth deficit were associated with LTFU. These may be warnings that should draw clinicians’ attention and possibly trigger specific interventions. Children with no significant growth retardation may also be at risk of LTFU. [ABSTRACT FROM AUTHOR]

Background: Hyperhidrosis is a pathological condition defined by excessive sweating beyond thermoregulatory physiological needs, which can cause substantial psychological impact and impairment of daily activities. Studies regarding its prevalence, however, are scarce and vary widely in their findings. The population of medical students is a particularly interesting subset for its recurring demand of physical contact during patient examination or procedures, and the potential for professional adversity. We aimed at furthering the comprehension of this disease prevalence and characteristics among medical students. Methods: Questionnaires inquiring about the presence and characteristics of Primary Hyperhidrosis (PH) were applied through either written or digital means to all eligible medical students enrolled in three Medical Schools in the State of Rio de Janeiro who agreed to take part in the study. Demographic data regarding gender, ethnicity, current age, weight and height was collected in addition to clinical data (sweat site, age of onset, familial history, severity and previous treatments). Severity was evaluated through the Hyperhidrosis Disease Severity Scale (HDSS) and a symptoms survey. Findings: Our response rate was roughly 1/3 of all eligible students (900/2700). PH prevalence was 20.56% (185/900). It was similar between men and women (23.08% and 19.41%, respectively) and strongly associated with family history of the disease (Prevalence Ratio of 4.27). Regarding ethnicity, of the total sample 73.78% (664/900) self-declared white, among which 19.28% (128/664) had PH. Mixed-race and other ethnicities encompassed 26.22% (236/900) of the sample, among which 24.15% (57/236) had PH. Most positive subjects (64.32%) presented associated forms of PH. Overall involvement of each site (both associated and isolated) was: 63.78% axillary, 50.81% palmar, 43.24% plantar, 20.54% craniofacial, 18.38% facial flushing and 2.16% gustatory sweating. Mean current age was 23.11(±4.04) years for PH patients, and age of onset was ≤18 years in 93.94% of cases. Regarding body mass index (BMI), 71.09% of PH patients had BMI<25kg/m2 and only 4.69% presented BMI≥30kg/m2, none ≥35kg/m2. Some degree of life quality impairment was reported by 89.20% of PH patients, and 23.89% had HDSS 3 or 4 (moderate to severe). Conclusions: PH prevalence among Rio de Janeiro medical students was 20.56%, similar between men and women, predominating associated presentations, axillary, palmar and plantar sites, strong familial history, age of onset before 18 years, and some degree of life impairment. [ABSTRACT FROM AUTHOR]

Background: Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment for depression that is increasingly implemented in healthcare systems across the world. A new form of rTMS called intermittent theta burst stimulation (iTBS) can be delivered in 3 min and has demonstrated comparable effectiveness to the conventional 37.5 min 10Hz rTMS protocol in patients with depression. Objectives: To compare the direct treatment costs per course and per remission for iTBS compared to 10Hz rTMS treatment in depression. Methods: We conducted a cost analysis from a healthcare system perspective using patient-level data from a large randomized non-inferiority trial (THREE-D). Depressed adults 18 to 65 received either 10Hz rTMS or iTBS treatment. Treatment costs were calculated using direct healthcare costs associated with equipment, coils, physician assessments and technician time over the course of treatment. Cost per remission was estimated using the proportion of patients achieving remission following treatment. Deterministic sensitivity analyses and non-parametric bootstrapping was used to estimate uncertainty. Results: From a healthcare system perspective, the average cost per patient was USD$1,108 (SD 166) for a course of iTBS and $1,844 (SD 304) for 10Hz rTMS, with an incremental net savings of $735 (95% CI 688 to 783). The average cost per remission was $3,695 (SD 552) for iTBS and $6,146 (SD 1,015) for 10Hz rTMS, with an average incremental net savings of $2,451 (95% CI 2,293 to 2,610). Conclusions: The shorter session durations and treatment capacity increase associated with 3 min iTBS translate into significant cost-savings per patient and per remission when compared to 10Hz rTMS. [ABSTRACT FROM AUTHOR]

Background: Falls among older adults is a common precipitating factor for unintentional injuries and represent a major health problem associated with increased morbidity, mortality, and health care cost in low-and-middle-income countries. The burden of fall in this population is well established in high-income countries and scant attention is given to this precipitating factor in low-and-middle-income countries, including Ethiopia. Therefore, this study aimed to estimate the prevalence and factors associated with fall among community-dwelling older adults in Ethiopia. Methods: A community-based cross-sectional study was conducted among community-dwelling older adults of Gondar. Multi-stage random sampling technique was used across administrative areas. Six hundred and five households were selected proportionally using systematic random sampling technique. Physical measurement and face to face interview method were employed using a structured questionnaire for data collection. Data were analyzed descriptively and through uni- and multivariate logistic regression model. Results: One hundred and seventy (n = 170, 28.4%; 95% CI 24.7–32.1) community-dwelling older adults reported having experienced fall in the past 12 months. Sex (OR = 1.91, 95% CI: 1.24–2.95), low educational status (OR = 2.37, 95% CI: 1.19–4.74), uncomfortable home environment (OR = 2.02, 95% CI: 1.34, 3.04), having diagnosed medical condition (OR = 4.659, 95% CI: 1.20–18.02), and use of medication (OR = 5.57, 95% CI: 1.19–26.21) were significantly associated risk factors of self-reported fall in the past 12 months. Most outdoor falls are associated with females and participants aged below 66 years. Conclusion: In conclusion, more than 1/4th of the community-dwelling older adults experienced at least one episode of fall and about 60% of them reported recurrent falls. Identifying risk group and risk factors that could be modified so as to prevent falls in older adults deserves attention. Outdoor falls are usually attributable to modifiable environmental aspects and improvements in outdoor environment needed. [ABSTRACT FROM AUTHOR]

Background: Limited data existed exclusively describing Mycobacterium tuberculosis lineage 3 (MTB-L3), sub-lineages, and clinical manifestations in Kampala, Uganda. This study sought to elucidate the circulating MTB-L3 sub-lineages and their corresponding clinical phenotypes. Method: A total of 141 M. tuberculosis isolates were identified as M. tuberculosis lineage 3 using Single nucleotide polymorphism (SNP) marker analysis method. To ascertain the sub-lineages/sub-strains within the M. tuberculosis lineage 3, the direct repeat (DR) loci for all the isolates was examined for sub-lineage specific signatures as described in the SITVIT2 database. The infecting sub-strains were matched with patients’ clinical and demographic characteristics to identify any possible association. Result: The data showed 3 sub-lineages circulating with CAS 1 Delhi accounting for 55% (77/141), followed by CAS 1-Kili 16% (22/141) and CAS 2/CAS 8% (12/141). Remaining isolates 21% (30/141) were unclassifiable. To explore whether the sub-lineages differ in their ability to cause increased severe disease, we used extent of lung involvement as a proxy for severe disease. Multivariable analysis showed no association between M. tuberculosis lineage 3 sub-lineages with severe disease. The risk factors associated with severe disease include having a positive smear (OR = 9.384; CI 95% = 2.603–33.835), HIV (OR = 0.316; CI 95% = 0.114–0.876), lymphadenitis (OR = 0. 171; CI 95% = 0.034–0.856) and a BCG scar (OR = 0.295; CI 95% = 0.102–0.854). Conclusion: In Kampala, Uganda, there are three sub-lineages of M. tuberculosis lineage 3 that cause disease of comparable severity with CAS-Dehli as the most prevalent. Having HIV, lymphadenitis, a BCG scar and a smear negative status is associated with reduced severe disease. [ABSTRACT FROM AUTHOR]

Over the last decades, the European hare (Lepus europaeus) has become the subject of many interdisciplinary studies due to the sharp Europe-wide population decline. In European hares, the first stage of life until weaning and the subsequent dispersal have been sparsely studied, in particular, habitat selection, movements and survival rate, as juveniles´ precocial lifestyle is dominated by concealment, motionlessness and inconspicuousness. In this study, free-living juvenile European hares (leverets) were detected systematically by thermography (n = 394), radio-tagged or marked (n = 122) from birth until the fifth week of life to research their habitat usage and pre-dispersal movements. The day-resting places and night locations, as well as the distance moved by leverets with aging, were evaluated by generalized linear mixed effect models. In addition, the habitat preference was assessed by a conservative use-availability analysis. Up to the fifth week of life, 30.5% of all leverets used cultivated areas in the daytime. In contrast, the remaining 69.4% animals inhabitated linear or small planar structures in the daytime, with the edges of field tracks, hedges and some ruderal structures clearly being preferred. At nighttime, 93% of all juveniles, which occupied linear structures in the daytime, used the adjoining fields up to 20 m away from the next linear structure. Nocturnal distances of more than 60 m to the next edge rarely occurred before the end of the pre-weaning phase. The time of day and age have a significant influence on the distance moved by juvenile hares. With increasing age, leverets moved less during the day and roamed further at night. The results are largely consistent with the behavioral patterns found in the few previous studies on pre-weaning European hares and show the importance of hiding places for leverets in early life stages. This study should contribute to a better understanding of behavior in juvenile life-history stages of European hares that may help to identify vulnerable phases in their lifecycle. In addition, the findings can refine existing population models and improve conservation efforts. [ABSTRACT FROM AUTHOR]

In the last decade a growing HIV/AIDS epidemic with increased incidence and AIDS-related mortality has been reported in Northern Brazil from which molecular data are scarce. Also, apparently healthy, adult blood donors, recently diagnosed with HIV-1 represent important sentinel populations for molecular studies. This cross-sectional study describes HIV-1 subtypes in blood donors from three reference public blood centers located in three States in Northern Brazil. HIV-1 pol sequencing (protease/PR, reverse transcriptase/RT) was performed on plasma samples of HIV-1 positive donors from HEMOAM, Manaus, Amazonas (n = 198), HEMERON, Porto Velho, Rondônia (n = 20) and HEMORAIMA, Boa Vista, Roraima (n = 9) collected from 2011–2017. HIV-1 subtypes were identified by REGA, phylogenetic inference; recombinant viruses were characterized by SIMPLOT. Young, single, males predominated, around half was first-time donors. Syphilis co-infection was detected in 17% (39 out of 227), 8% (18 out of 227) was anti-HBc positive. Subtype B represented ≥ 90% in Amazonas, Rondônia and Roraima, subtype C (3.1%) was found in Amazonas and Rondônia; subtype F1 (0.9%) and BF1 recombinants (5.3%) were only detected in Amazonas. Subtype B sequences from Amazonas (n = 179), Rondônia (n = 18) and Roraima (n = 9) were combined with viral strains representative of the BPANDEMIC (n = 300) and BCARIBBEAN/BCAR (n = 200) lineages. The BPANDEMIC lineage predominated (78%) although BCAR lineages were frequent in Roraima (56%) and Amazonas (22%). Subtype C and subtype F1 sequences identified here clustered within Brazilian CBR and F1BR lineages, respectively. Twelve BF1 mosaics showed 11 different recombination profiles: six were singleton unique-recombinant-forms/URFs, one displays a CRF28/29_BF-like recombinant pattern and the remaining four BF1 isolates branched with other Brazilian BF1 viruses previously described and may represent putative new CRF_BF1 from Northern Brazil. Our study shows a highly homogeneous molecular pattern with prevalent subtype B, followed by BF1, and sporadic subtype C and F1 in blood donors from the Northern region. Surveillance studies are important to monitor HIV-1 diversity which can reveal patterns of viral dissemination, especially in a highly endemic, remote and geographically isolated region as Northern Brazil. [ABSTRACT FROM AUTHOR]

The Asian longhorned beetle (ALB), Anoplophora glabripennis, is an invasive wood-borer in North America and Europe that threatens a variety of tree genera, including Acer and Populus. All invasive ALB populations occur in quarantine zones where they are under eradication, a process that is difficult and expensive, requiring extensive surveys and host tree removals. Although ALB has been described as an insect that is typically slow to disperse, some rare individuals that fly longer distances have the potential to start infestations outside of quarantine zones. Biological control using entomopathogenic fungi has been considered as another option for managing ALB infestations. The entomopathogenic fungus Metarhizium brunneum strain F52, registered for commercial use in the United States, is effective at killing ALB adults but information is lacking on how this entomopathogen affects ALB flight behavior before death. Using quarantine-reared ALB, flight mills were used to collect data on flight performance of beetles at multiple time points after infection. Healthy (uninfected) male ALB adults always flew significantly greater distances than females. The maximum observation for total flight distance was a healthy male that flew 10.9 km in 24 hours on a flight mill. ALB adults infected with M. brunneum F52 flew significantly shorter distances compared to healthy adults, starting one week after fungal exposure. Biological control of ALB with this fungal entomopathogen could help to reduce their dispersal in the environment and, thereby, decrease the risk of adults moving outside of quarantine zones. [ABSTRACT FROM AUTHOR]

A limited number of studies have used objective measures to examine the associations between the built environment and physical activity (PA) among older adults. This study aimed to examine geographic information systems-derived neighborhood walkability attributes and accelerometer measured PA in older adults. Data were collected from 124 older Taiwanese adults aged over 60 years (mean age: 69.9). Adjusted multiple linear regression was performed to explore the associations between five neighborhood walkability factors (population density, street connectivity, sidewalk availability, access to destinations, and public transportation) and five metrics of accelerometer-measured physical activity (total PA, moderate-to-vigorous PA, light PA, long moderate-to-vigorous PA bouts, and daily step counts). After adjusting for potential confounders, we found that greater sidewalk availability was positively associated with daily step counts in older adults (β = 0.165; 95% confidence interval: 0.006, 0.412; P = 0.043). No associations between other neighborhood environment attributes and PA metrics were observed. In conclusion, high sidewalk availability in the neighborhood may be supportive for older adults’ daily step counts. Further longitudinal research is needed to establish the causality between the built environment and objectively measured PA in older adults. [ABSTRACT FROM AUTHOR]

Background: Preterm infants are at increased risk of infections including vaccine preventable diseases. Therefore, timely vaccination is crucial to ensure adequate disease protection. Information on whether preterm infants are vaccinated according to chronological age as recommended is limited in low-income countries. Objectives: We evaluated the timeliness of vaccination and associated factors among preterm infants at Mulago hospital, Uganda. Methods: We conducted a mixed methods study between July 2016 and April 2017. Vaccination dates of preterm infants aged 6–24 months were obtained from child health cards. Additional data were collected using a questionnaire. Five key informant interviews with health workers and two focus group discussions with caregivers were conducted. Cox regression analysis was used to identify factors associated with vaccination timeliness. Qualitative data was transcribed and analysed manually using content thematic approach. Results: We enrolled 350 preterm infants, with a median age of 8.4 months (IQR 6.8–10.8). Less than half, 149/350 (42.6%) of infants received all vaccines within the recommended time range. Timely vaccination was highest for BCG (92%) and lowest for OPV (45.4%). Untimely vaccination was highest for vaccines administered at 6 weeks (DPT 1, PCV 1 and OPV 1) compared to other vaccines in the EPI schedule. Delivering from home or private clinics and vaccine stock-out were significantly associated with untimely BCG and OPV 0 vaccination. Low maternal education level and being very preterm were associated with untimely DPT 1 and DPT 3 receipt. Admission and long stay in the neonatal unit were associated with untimely DPT 1 receipt while extreme low birth weight was associated with untimely DPT 3 vaccination. Increasing parity was associated with untimely measles vaccination. Qualitative findings revealed that lack of knowledge and poor attitudes of health workers and caregivers, gaps in documentation of vaccination status and inadequate communication by health workers hindered timely vaccination. Conclusion: More than half of preterm infants attending a specialised clinic at Mulago National Referral hospital in Uganda did not receive vaccines within the recommended time range. Specific strategies to improve vaccination timeliness in preterm infants are needed especially among the extremely low birth weight, very preterm and those with prolonged hospitalisation. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) due to the emergence and spread of extended-spectrum beta-lactamase (ESBL) producing bacteria are becoming a serious global public health concern. This article aims to assess the overall prevalence of ESBLs among animals in India, with year-wise, zone-wise and species-wise stratification. Systematic search from PubMed, Google Scholar and J-Gate Plus was carried out and 24 eligible articles from 2013–2019 in India were retrieved. The R Open source Scripting software was used to perform statistical analysis. The overall prevalence of ESBLs among animals in India was 9%. The pooled prevalence of ESBLs in animals were 26, 11, 6 and 8% for north, east, south and central zones, respectively. The reported prevalence of ESBLs in animals were 12, 5, 8, 8, 12, 13 and 33% were reported for the years 2013, 2014, 2015, 2016, 2017, 2018, 2019 respectively. The species-wise stratified results showed a predominance of ESBL producing Klebsiella pneumoniae strains (11%) when compared to Escherichia coli and Pseudomonas spp. which were 7% and 5%, respectively. The prevalence data generated could be utilized in infection control and in antibiotic use management decisions for developing appropriate intervention strategies. [ABSTRACT FROM AUTHOR]

Our aim was to study Brazilian consumer attitudes towards cell-based meat and related issues. From 408 respondents from Curitiba and 218 from Joinville, the majority was women with higher level of education; 65.2% and 70.2% frequently consumed meat and 50.7% and 50.9% would not stop eating meat; 81.6% and 82.6% had little or no knowledge about cell-based meat. After watching an explanatory video, 41.9% and 34.4% stated they would eat cell-based meat without restrictions; 24.5% and 23.9% stated they would try depending on conditionals. Overall, 63.6% declared they would eat cell-based meat; among vegetarians and vegans, 24% and 8% stated they would eat cell-based meat, with additional 25.0% and 27.0% stating “it depends”; thus, the major public for cell-based meat seems to be meat eaters. Animal welfare was the principal reason for considering not eating meat and a major benefit of cell-based meat. In conclusion, the majority of respondents would not stop eating meat; additionally, they would eat cell-based meat. [ABSTRACT FROM AUTHOR]

Objective: To conduct a secondary data analysis detailing the associations between sociodemographic and behavioral factors and nutrition-related chronic disease. Methods: These analyses utilized 2014 data from the Indonesian Family Life Survey, a home-based survey that collected socioeconomic, dietary intake, physical activity, and biological data among adults. We explored four outcomes in relation to sociodemographic and behavioral determinants: 1) hypertension, 2) elevated high-sensitivity c-reactive protein (hs-CRP), and 3) central obesity, as these are critical metabolic determinants in the progression to cardiovascular disease, and 4) type 2 diabetes. Hypertension was defined as systolic blood pressure ≥140 mm or diastolic blood pressure ≥ 90mm or current use of antihypertensive medication. Elevated hs-CRP was defined as hs-CRP >3 mg/dL. Central obesity was defined as waist circumference ≥ 90 cm if male and waist circumference ≥ 80 cm if female, which are specific to South Asia. Type 2 diabetes was defined as glycated hemoglobin ≥ 6.5%. We employed separate gender-stratified multivariate logistic regression models to test the associations between sociodemographic and behavioral determinants and each nutrition-related chronic disease outcome. All analyses employed sampling weights, which account for the survey design. Results: In 2014, about 30% of adults were hypertensive and one-fifth had elevated hs-CRP. Approximately 70% of women had central obesity and 11.6% of women and 8.9% of men had diabetes. Older-age was consistently associated with nutrition-related chronic disease and being overweight was associated with hypertension, elevated hs-CRP, and type 2 diabetes. Regularly consuming instant noodles (women) and soda (men) were associated with elevated hs-CRP and soda consumption was associated with central obesity among men. Conclusions: Large segments of the adult population in Indonesia now have or are at risk for non-communicable disease. Our analyses provide preliminary empirical evidence that interventions that target healthful food intake (e.g. reduce the intake of ultra-processed foods) should be considered and that the reduction of overweight is critical for preventing chronic diseases in Indonesia. [ABSTRACT FROM AUTHOR]

Background: Chronic liver disease (CLD) is a progressive destruction of liver tissue with subsequent necrosis that persists for at least 6 months. In Ethiopia, despite the high burden report, data on CLD is limited. The objective of this study was to assess short-term clinical outcomes in patients admitted with chronic liver disease to three tertiary teaching hospitals in Ethiopia and to identify predictors of mortality. Methods: A cohort of 109 patients admitted with CLD to three tertiary teaching hospitals in Ethiopia, were prospectively followed from the time of admission to 30-days of hospital discharge. The study was conducted from April 1, 2018, to October 5, 2018. Kaplan-Maier curve was used to estimate survival and cox-regression analysis to identify predictors of mortality. Result: A total of 109 patients (80% male) diagnosed with CLD were included. Median age of the participants was 38(IQR, 30–48). The overall median length of hospital stay was 7(IQR, 4–11) days. Of the total, 39(35.8%) patients were HBsAg positive, and 12(11%) patients were anti-HCV positive. The 30-day mortality was 38(34.9%), and most of the deaths, 31(81.6%) occurred before hospital discharge. Hepatic encephalopathy at admission; being with unidentified risk factor/etiologies of CLD and total bilirubin level were independent predictors of in-hospital mortality. Patients with hepatic encephalopathy at admission had approximately 11 times increased risk of death as compared to patients without hepatic encephalopathy at admission. Similarly, the hazard of mortality was 5.8 times higher in those patients with unidentified risk factor/etiology as compared to others. The risk of dying had also increased with an increase in bilirubin (1.188[95% CI, 1.0719–1.316]) level. Conclusion: Approximately one-quarter of patients with CLD died during their hospital stay, and the risk of death continued after hospital discharge. Hepatic encephalopathy at admission, unidentified risk factor/etiology and increased level of total bilirubin are poor prognostic factors. Given that more than one third the patients had HBV-infection, access to antiviral drugs could help improve the prognosis of patients with end-stage liver disease in Ethiopia, as well as prevent the progression of the disease if initiated earlier. [ABSTRACT FROM AUTHOR]

Background: Large numbers of young people die yearly due to homicide, but little is known about homicide during adolescence. Research primarily focuses on youth violence among young men and masks important gender-related factors inherent in the adolescent age group. Although young women are less likely to be victims of homicide, violence against women is an important form of violence experienced during adolescence. In this paper, we describe the prevalence of and gender difference in adolescent homicide in South Africa in 2009. Methods: We conducted a retrospective national mortuary-based study to identify all child homicides (boys and girls < 18 years) in 2009 in a proportionate sample of mortuaries. Victim, perpetrator and crime data were collected in three phases: cases were identified from the mortuary register, the autopsy report and from police interviews. In this paper we focus on the adolescent group, aged 10 to 17 years. Findings: We identified 674 (95% CI: 520–823) adolescent homicides for 2009, with more male (520) than female (154) homicides. This gender disparity increased as children aged, with the male homicide rate 27.9/100 000 population (95% CI: 20.3–35.5), nearly 5 times the female rate (4.5:1) of 6.5/ 100 000 population (95% CI: 4.7–8.2) in older adolescents (15–17 year old). Adolescent males were significantly more likely (61.2%) to die in a public space compared to female adolescents (39.3%) but more adolescent females (48.4%) died at home compared to adolescent males (32.9%). Adolescent females (42.1%) were mainly killed by a family member or intimate partner while adolescent males were predominantly (58%) killed by an acquaintance. Conclusion: We found a distinct gender pattern for adolescent homicide in South Africa. This pattern appears to be driven by gender norms that support violence. South Africa requires an investment in developing evidence informed interventions to reduce violence. [ABSTRACT FROM AUTHOR]

Background: For women of reproductive age, overweight and obesity are an established risk factor for several medical complications. To address the increasing rate of obesity in India through public health awareness programs, the association between common behaviors and overweight and obesity needs to be investigated. This study aims to determine whether there is any association between the frequency of television watching and overweight and obesity among women of reproductive age (15–49 years) in India. Methods: This is a cross-sectional study that utilized data from the National Family Health Survey (NFHS-4), which utilized a nationally representative sample from all 29 states and 7 union territories of India. The survey itself followed a two-staged stratified random sampling technique. The primary outcome of interest was overweight (23.0 kg/m2 to <27.5 kg/m2) and obesity (≥27.5 kg/m2), measured by using the Asian body mass index cut-off. The major explanatory variable was the frequency of television watching, measured in days per week. Sample weight of NFHS-4 was adjusted during the analysis. Multilevel ordered logistic regression was conducted to identify the factors associated with overweight and obesity. To show the strength of association, both the unadjusted Crude Odds Ratio (COR) and the Adjusted Odds Ratio (AOR) were reported with a 95% confidence interval (CI). A p-value<0.05 was considered statistically significant. Results: The analysis included weighted data from 644,006 Indian women of reproductive age (15–49 years). Among the respondents, 33.5% were overweight or obese (BMI ≥23.0 kg/m2). The prevalence of overweight and obesity increased with age (p-value <0.0001) and almost half of the women aged 35–49 years were either overweight or obese (48.6%). The prevalence was significantly higher among those living in an urban area compared to a rural area (urban 46.5% vs. rural 26.5%; p-value <0.001). The prevalence of overweight and obesity increased with the frequency of watching television and was the highest among the individuals who reported watching television almost every day (p-value <0.0001). Women watching television almost every day had 24% (AOR: 1.24, 95% CI: 1.21–1.26; p-value <0.001) increased odds of being overweight and obese compared to their counterparts who never watched television. Conclusions: This study found that the likelihood of being overweight and obese significantly increased with the frequency of watching television; likely due to physical inactivity during leisure time. Further studies should examine the physical activity and food habits of this target group. Public health promotion programs in India should raise awareness regarding the harmful effects of the sedentary lifestyle associated with watching television. [ABSTRACT FROM AUTHOR]

Background: Prevention and control of hypertension has not been given due attention though previous studies indicated that hypertension is growing public health problem. Objective: This study aimed to determine the prevalence of hypertension and associated factors in Bona district, southern Ethiopia. Methods: A community based cross-sectional study was conducted on 1952 participants aged ≥25 years in Bona District, southern Ethiopia. Data were collected from consented participants recruited using multistage sampling technique. Data were entered, checked for quality and analyzed by SPSS for Windows version 20.0. Since the outcome variables were ordered categorical, we used multinomial logistic regression model to identify associated factors. Among the independent variables included in the model no multicolinearity was observed. The level of significance was set at P value ≤ 0.05. Results: The observed prevalence of hypertension (21.8%) was remarkable in rural setting. Out of hypertensive participants, 195 (45.9%) were newly diagnosed. About one third of the participants (31.4%) had central obesity measured by waist-to-height ratio ≥0.50. Being male, age advancement, high BMI (≥25.0 kg/m2) and central obesity (waist-to-height ratio ≥0.50) were positively associated with both systolic and diastolic hypertension. Systolic hypertension was negatively associated with high family income. The likely hood of developing diastolic hypertension increased in participants with family history of hypertension. Conclusion: The overall prevalence of hypertension, 21.8%, is alarmingly high that it can be said that hypertension is becoming a silent epidemic in Ethiopia. Nationwide survey is needed to get the clear magnitude of hypertension so that early detection and management strategies can be enforced. [ABSTRACT FROM AUTHOR]

Bemisia tabaci (the tobacco whitefly) is an important agricultural pest of global significance primarily because of its ability to transmit multiple damaging plant viruses. To date, UK outbreaks of the whitefly have been restricted to glasshouses and there are no records of the whitefly establishing outdoors during the summer. This is despite the fact that annual degree-day models (that estimate accumulated warmth over the year above the development threshold), indicate that B. tabaci has the thermal potential for multiple summer generations in the UK. A set of 49 climate indices calculated using the present day climate (1986–2015) were therefore compared between the UK and the south of France, where B. tabaci is able to establish outdoors, to identify the factors limiting its establishment. The number of cold days and nights in summer, as well as the time spent within the whitefly’s optimum temperature range, were most significantly different between the two areas. These indices may impact the development of B. tabaci and offer an explanation for the absence of the whitefly outdoors in the UK during the summer. Further analyses undertaken with climate projections suggest that in a 2–4°C warmer world this pest could pose a risk to outdoor UK crops in July and August. A clear south-north gradient can be demonstrated for these indices. Linking any possible northwards spread of B. tabaci populations outdoors in France with changes in these indices could therefore provide an important indicator of any change in the risks of outdoor populations of this species developing in the UK. The effectiveness of climate indices in pest risk analysis is compellingly demonstrated, and it is recommended that in-depth comparisons of climatic indices between areas of pest presence and absence are conducted in other situations where forecasting the risks of pest establishment are complex and challenging. [ABSTRACT FROM AUTHOR]

The prevalence of maternal and child malnutrition in Nepal is among the highest in the world, despite substantial reductions in the last few decades. One effort to combat this problem is Suaahara II (SII), a multi-sectoral program implemented in 42 of Nepal’s 77 districts to improve dietary diversity (DD) and reduce maternal and child undernutrition. Using cross-sectional data from SII’s 2017 annual monitoring survey, this study explores associations between exposure to SII and maternal and child DD. The study sample included 3635 mothers with at least one child under the age of five. We focused on three primary SII intervention platforms: interpersonal communication (IPC) by frontline workers, community mobilization (CM) via events, and mass media through a weekly radio program (Bhanchhin Aama); and also created an exposure scale to assess the dose-response relationship. DD was measured both as a continuous score and as a binary measure of meeting the recommended minimum dietary diversity of consuming foods from at least 5 of 10 food groups for mothers and at least 4 of 7 food groups for children. We used linear and logistic regression models, controlling for potentially confounding factors at the individual and household level. We found a positive association between any exposure to SII platforms and maternal DD scores (b = 0.09; p = 0.05), child (aged 2–5 years) DD scores (b = 0.11; p = 0.03), and mothers meeting minimum dietary diversity (OR = 1.16; p = 0.05). There were significant, positive associations between both IPC and CM events and meeting minimum DD (IPC: OR = 1.31, p = 0.05; CM: OR = 1.37; p<0.001) and also between CM events and DD scores (b = 0.14; p = 0.03) among mothers. We found significant, positive associations between mass media and meeting minimum DD (OR: 1.38; p = 0.04) among children aged 6–24 months and between mass media and DD scores (b = 0.15; p = 0.01) among children aged 2–5 years. We also found that exposure to all three platforms, versus fewer platforms, had the strongest association with maternal DD scores (b = 0.45; p = 0.01), child (aged 2–5 years) DD scores (b = 0.41; p<0.001) and mothers meeting MDD (OR = 2.33; p<0.001). These findings suggest that a multi-pronged intervention package is necessary to address poor maternal and child dietary practices and that the barriers to behavior change for maternal diets may differ from those for child diets. They also highlight the importance of IPC and CM for behavior change and as a pre-requisite to mass media programs being effective, particularly for maternal diets. [ABSTRACT FROM AUTHOR]

The impact of a rider’s and saddle’s mass on saddle thermal pattern distribution was evaluated using infrared thermography (IRT). Eighteen racehorses were ridden by four riders with their own saddle. Images of the saddle panels were captured at each of six thermographic examinations. On each image, six regions of interest (ROIs) were marked on the saddle panels. The mean temperature for each ROI was extracted. To evaluate the influence of load on saddle fit, 4 indicators were used: ΔTmax (difference between the mean temperature of the warmest and coolest ROI); standard deviation of the mean temperature of the six ROIs; right/left; bridging/rocking and front/back thermal pattern indicator. Incorrect saddle fit was found in 25 measurements (23.1%) with ΔTmax greater than 2°C. The relationships between rider and saddle fit as well as saddle fit and horse were significant (p<0.001). An average ΔTmax in rider A was significantly higher than in other riders (p<0.001). The right/left thermal pattern differed significantly from the optimal value for riders A and B; while the bridging/rocking thermal pattern differed significantly from this value for riders A, C and D (p<0.05). Front saddle thermal pattern was most frequent for rider A (41.5%), whereas back saddle thermal pattern was most frequent for rider C (85.7%). Measurement of the mean temperature in 6 ROIs on saddle panels after training was helpful in assessing the influence of rider and saddle mass on saddle fit. IRT offered a non-invasive, rapid and simple method for assessing load on thermal pattern distribution in race saddles. [ABSTRACT FROM AUTHOR]

Objectives: To assess awareness of cytomegalovirus (CMV); attitudes towards screening; and frequency of behaviors that could increase the risk of prenatal infection. Methods: We conducted a survey among 726 women at the 2017 Minnesota State Fair. Minnesota residents aged 18–44 were eligible if they had never been pregnant or had been pregnant within the past 10 years. We compared responses between never-pregnant and recently-pregnant women. Results: Only 20% of study participants had previously heard of CMV. Remarkably, recently-pregnant women were no more likely to be aware of CMV than never-pregnant women after adjusting for potential confounders. After receiving information about CMV, nearly all participants indicated they believed prenatal (96%) or newborn (96%) screening should be offered. Conclusions: Although baseline awareness of CMV was low (even among recently-pregnant women), after learning more about the risks, women supported screening. Several states have passed or proposed legislation promoting CMV education and/or screening programs. We identified important gaps in knowledge about CMV among women who may benefit from education about how to reduce their risk of exposure and who may need to decide whether they would be willing to screen for CMV in the future. [ABSTRACT FROM AUTHOR]

Brown adipose tissue (BAT) is responsible for non-shivering thermogenesis and is an attractive therapeutic target for combating obesity and related diseases. Human BAT activity has been evaluated by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) under acute cold exposure, but the method has some serious limitations, including radiation exposure. Infrared thermography (IRT) may be a simple and less-invasive alternative to evaluate BAT activity. In the present study, to establish an optimal condition for IRT, using a thermal imaging camera, skin temperature was measured in the supraclavicular region close to BAT depots (Tscv) and the control chest region (Tc) in 24 young healthy volunteers. Their BAT activity was assessed as the maximal standardized uptake value (SUVmax) by 18FDG-PET/CT. Under a warm condition at 24–27°C, no significant correlation was found between the IRT parameters (Tscv, Tc,, and the difference between Tscv and Tc,, Δtemp) and SUVmax, but 30–120 min after cold exposure at 19°C, Tscv and Δtemp were significantly correlated with SUVmax (r = 0.40–0.48 and r = 0.68–0.76). Δtemp after cold exposure was not affected by mean body temperature, body fatness, and skin blood flow. A lower correlation (r = 0.43) of Δtemp with SUVmax was also obtained when the participant’s hands were immersed in water at 18°C for 5 min. Receiver operating characteristic analysis revealed that Δtemp after 30–60 min cold exposure can be used as an index for BAT evaluation with 74% sensitivity, 92% specificity, and 79% diagnostic accuracy. Thus, IRT may be useful as a simple and less-invasive method for evaluating BAT, particularly for large-scale screening and longitudinal repeat studies. [ABSTRACT FROM AUTHOR]

Introduction: There are gaps in global understanding about how to design and implement interventions to improve sanitation. This formative study provided insights for the subsequent redesign of a government-led national sanitation campaign targeting rural populations in Tanzania. Methods: The Behaviour Centred Design approach was used to investigate the determinants of toilet building, improvement and use. Varied, novel, and interactive research tools were employed in fifty-five households in two regions of rural Tanzania. Results were analysed to articulate a Theory of Change, which then informed intervention design. Results: Participants valued hard work, enterprise, and improving their lives over many years. They wanted better toilets but felt no urgency to act quickly. A common emotional motivator for improving toilets was to protect children from disease (Nurture) but this was insufficient to drive rapid change. Disgust with traditional toilets meant they were built at a distance from the house: an ‘out of sight, out of mind’ attitude. Other powerful motives included the desire to improve living conditions (Create), and to become a modern Tanzanian (Status), albeit without ‘showing off’. Construction costs and water scarcity were the main stated barriers. Receiving information about realistic costs, support accessing materials, and visiting better latrines elsewhere were commonly reported reasons for improving latrines. Conclusions: The resulting Theory of Change recommended that the intervention should surprise people with a novel conversation about toilets, promote toilets as a means of conferring status, and introduce a perceived urgency to ‘act now’. It should suggest that modest improvements would lead to a better life. Feelings of disgust and fear with poor quality toilets should be amplified, and barriers lessened through promoting transformational toilet improvements, and improving access to modern toilet products. This research provided considerable insight into sanitation behaviours in rural Tanzania, which informed creative intervention design. [ABSTRACT FROM AUTHOR]

Background: The indications for lumbar puncture in non-HIV-infected, non-transplant (NHNT) patients with cryptococcosis without meningeal signs need to be more fully defined. Objectives: This study was designed to determine the optimal predictors of central nervous system (CNS) involvement in adult NHNT patients with cryptococcosis. Methods: The study population consisted of adult NHNT patients with culture-confirmed cryptococcosis who sought care at a university hospital in Taiwan from 2002 to 2016. We used a case-control method to identify the clinical characteristics and laboratory findings associated with CNS involvement in patients who underwent a diagnostic lumbar puncture. In the sensitivity analysis, we included additional control patients who did not undergo lumbar puncture, but were followed beyond 12 months without the development of CNS involvement in the absence of exposure to any fungicidal agents. Results: We entered 270 NHNT adult patients into the study during the 15-year period. CNS involvement was confirmed in 66 (71.0%) of 93 patients who underwent lumbar puncture. A multivariable analysis revealed that presence of neurological manifestations and elevated serum CRAG titers were independently associated with a 23.97-fold (95% confidence interval [CI], 4.37–182.23) and 1.53-fold (per 2-fold increment, 95% CI 1.26–1.92) increased odds ratio for CNS involvement, respectively. Headache and focal neurologic signs were independently associated with CNS involvement. A cut-off serum CRAG titer of ≥1:64 provided the highest diagnostic performance by Youden index (sensitivity 83% and specificity 65%). Similar findings were noted in the sensitivity analysis including 198 (73%) patients. Conclusion: Lumbar puncture is indicated for NHNT patients with cryptococcosis who have neurologic manifestations or a serum CRAG titer of ≥1:64. [ABSTRACT FROM AUTHOR]

Introduction: Over the past decades, obesity stigma has become a substantial public health issue as studies have highlighted its negative consequences for mental and physical health. However, comparative studies are scarce. In this cross-national study, we focus on the following research questions: (1) Are there differences in the magnitude of public obesity stigma between Germany and the United States (US), and (2) are there differences in the associations of sociodemographic as well as experience (i.e. former obesity experience) and contact-related (i.e. contact to a person with obesity) factors with public obesity stigma between these two countries? Material and methods: National telephone surveys in Germany and the United States were conducted (total sample = 2,802) by using vignettes for the description of a person with obesity. Fat Phobia Scale, negative reactions, and desire for social distance were assessed as components of public obesity stigma. All three stigma components were examined with multilevel linear regression analyses. Results: Overall, results show that public obesity stigma is significantly more pronounced in the US than in Germany. Relationships between obesity stigma and sociodemographic as well as experience and contact-related factors remain rather inconclusive, though, in general, stronger associations are shown in the US. Conclusions: Contrary to the normalization hypothesis, findings indicate that a comparatively high prevalence of obesity like in the US is associated with a higher level of obesity stigma. [ABSTRACT FROM AUTHOR]

Objectives: As an emerging middle-income country, Indonesia is grappling with the double burden of malnutrition across all age groups, including adolescents. Slow gains in reducing undernutrition are compounded by rapidly increasing overnutrition. This study aims to determine the patterns and determinants of this double burden, particularly stunting, thinness and overweight, among adolescent girls and boys aged 12–18 years in Indonesia. Methods: A cross-sectional survey was conducted among 2,160 girls and boys in the districts of Klaten and Lombok Barat in 2017. Data were collected on adolescents' nutritional status, sociodemographic characteristics, morbidity, dietary intake and physical activity and other relevant factors. Multivariable logistic regression models using generalized estimation equation were employed to determine risk factors for stunting, thinness and overweight. Results: About a quarter of adolescent girls (25%) and boys (21%) were stunted. Approximately 5% of girls and 11% of boys were thin, whereas 11% girls and boys each were overweight. Living in a higher wealth household (OR = 0.67; 95% CI: 0.49–0.91), compared to a lower wealth household, and living in a district with higher socioeconomic status (OR = 0.63; 95% CI: 0.51–0.79) were associated with lower odds of being stunted. Adolescent education was also protective against stunting (OR = 0.52; 95% CI: 0.33–0.88). Older adolescents aged 15–18 years were more likely to be stunted (OR = 1.88; 95% CI: 1.42–2.46). Being a girl was associated with reduced odds of being thin (OR = 0.42; 95% CI: 0.30–0.58). Higher household wealth (OR = 1.93; 95% CI: 1.27–2.97) predicted being overweight, while maternal primary or some secondary education, compared to no or incomplete primary education, was protective against adolescent overweight (OR = 0.60; 95% CI: 0.40–0.90). Conclusion: Indonesian adolescent girls and boys face both extreme spectrums of malnutrition. Addressing the dual burden of malnutrition requires a multi-pronged approach, and urgent shift is warranted in nutrition policy and programmes targeting adolescents to effectively address the associated underlying determinants. [ABSTRACT FROM AUTHOR]

Background: Studies on changes in the prevalence and determinants of obesity in older adults living in sub-Saharan Africa are scarce. We examined recent changes in obesity prevalence and associated factors for older adults in Ghana between 2007/08 and 2014/15. Methods: Data on adults aged 50 years and older in Ghana were drawn from the WHO SAGE 2007/08 (Wave 1; n = 4158) and 2014/15 (Wave 2; n = 1663). The weighted prevalence of obesity, overweight, normal weight and underweight, and of high central adiposity were compared in 2007/08 and 2014/15. Multinomial and binomial logistic regressions were used to examine whether the determinants of weight status based on objectively measured body mass index and waist circumference changed between the two time periods. Results: The prevalence of overweight (2007/08 = 19.6%, 95% CI: 18.0–21.4%; 2014/15 = 24.5%, 95% CI: 21.7–27.5%) and obesity (2007/08 = 10.2%, 95% CI: 8.9–11.7%; 2014/15 = 15.0%, 95% CI: 12.6–17.7%) was higher in 2014/15 than 2007/08 and more than half of the population had high central adiposity (2007/08 = 57.7%, 95% CI: 55.4–60.1%; 2014/15 = 66.9%, 95% CI: 63.7–70.0%) in both study periods. While the prevalence of overweight increased in both sexes, obesity prevalence was 16% lower in males and 55% higher in females comparing 2007/08 to 2014/15. Female sex, urban residence, and high household wealth were associated with higher odds of overweight/obesity and high central adiposity. Those aged 70+ years had lower odds of obesity in both study waves. In 2014/15, females who did not meet the recommended physical activity were more likely to be obese. Conclusion: Over the 7-year period between the surveys, the prevalence of underweight decreased and overweight increased in both sexes, while obesity decreased in males but increased in females. The difference in obesity prevalence may point to differential impacts of past initiatives to reduce overweight and obesity, potential high-risk groups in Ghana, and the need to increase surveillance. [ABSTRACT FROM AUTHOR]

Cholangiocarcinoma (CCA) is a primary malignant tumor of the epithelial lining of biliary track associated with endemic Opisthorchis viverrini (Ov) infection in northeastern Thailand. Ov-associated periductal fibrosis (PDF) is the precancerous lesion for CCA, and can be detected by ultrasonography (US) to facilitate early detection. However, US cannot be used to distinguish PDF from cancer. Therefore, the objective of this study was to discover and qualify potential urine biomarkers for CCA detection in at-risk population. Biomarker discovery was conducted on pooled urine samples, 42 patients per group, with PDF or normal bile duct confirmed by ultrasound. After depletion of high abundance proteins, 338 urinary proteins were identified from the 3 samples (normal-US, PDF-US, CCA). Based on fold change and literature review, 70 candidate proteins were selected for qualification by multiple reaction monitoring mass spectrometry (MRM-MS) in 90 individual urine samples, 30 per group. An orthogonal signal correction projection to latent structures discriminant analysis (O-PLS-DA) multivariate model constructed from the 70 candidate biomarkers significantly discriminated CCA from normal and PDF groups (P = 0.003). As an independent validation, the expression of 3 candidate proteins was confirmed by immunohistochemistry in CCA tissues: Lysosome associated membrane glycoprotein 1 (LAMP1), lysosome associated membrane glycoprotein 2 (LAMP2) and cadherin-related family member 2 (CDHR2). Further evaluation of these candidate biomarkers in a larger cohort is needed to support their applicability in a clinical setting for screening and monitoring early CCA and for CCA surveillance. [ABSTRACT FROM AUTHOR]

Background: Increasingly studies show that immigrants have different perinatal health outcomes compared to native-born women. Nevertheless, we lack a detailed examination of the combined effects of maternal immigrant trajectory and socioeconomic status on perinatal outcomes. Our objective was to analyze the influence of time since naturalization on low birth weight and maternal socioeconomic status in Belgium. Methods: The data came from the linkage between the Brussels birth and death registers, the national register of migrant trajectories and the social security register for the years 2004–2010. We used logistic regression to estimate the odds ratios of the associations between low birth weight (LBW) and time since naturalization, by nationality groups, taking into account socioeconomic status (SES), parity and maternal age. Results: Data relate to all singleton births to Belgian, Maghrebi, Sub-Saharan African and Turkish women (n = 76 312). The results show an U-shaped of LBW according to time since naturalization for all migrant groups. LBW declines for women naturalized since less than one year and increases significantly thereafter (p<0.0001). In parallel, we observe an increase of SES among all migrant groups. Compared to Belgians, we found a lower risk of LBW among women from Maghreb (p<0.0001) and this protection is maintained even after 10 years since naturalization. In contrast, the risk of LBW for Sub-Saharan African and Turkish mothers is lower than for Belgians after one year of naturalization but similar to that of Belgians after 10 years of naturalization. Conclusion: Our results show that, despite an improvement of their SES, LBW increases among Maghrebi, Sub-Saharan African and Turkish women with time since naturalization. Mothers from Maghreb have lower rates of LBW compared to Belgians and maintain their protection even after more than 10 years of having acquired the Belgian nationality. Additional studies need to be carried out in order to gain a better understanding of the association between migration trajectories, SES and perinatal health of immigrants. [ABSTRACT FROM AUTHOR]