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BACKGROUND: Accumulating evidence links excessive consumption of processed meat to an increased risk of obesity, diabetes, cardiovascular diseases, and some cancers. Yet, trends in consumption of different types of processed meat in the US have not been quantified. OBJECTIVE: The aim of the study was to characterize trends in consumption of different types of processed meat among US adults in relation to the consumption of unprocessed red meat, poultry, and fish/shellfish in the past 18 years and their purchase locations. DESIGN: Dietary data collected from U.S. adults aged 20+ years completing at least 1 valid 24-hour diet recall from 9 cycles of the National Health and Nutrition Examination Survey (NHANES) (1999–2016) were used to evaluate the trends in mean consumption of processed meat, unprocessed red meat, poultry, and fish/shellfish. PARTICIPANTS/SETTING: Nationally representative sample of 43,995 US adults aged 20+ years. MAIN OUTCOME MEASURES: Survey-weighted, energy-adjusted mean consumption of processed meat, unprocessed red meat, poultry, and fish/shellfish. STATISTICAL ANALYSIS: Trends in mean intake were assessed by treating the 2-year survey cycle as a continuous variable in survey-weighted linear regression models. Changes in mean intake was computed as the difference in mean intake between the earliest (1999–2000) and latest (2015–2016) cycle. RESULTS: The mean consumption of processed meat among US adults remained unchanged in the past 18 years (mean change = 4.22 g/wk, p-trend = 0.95). The top 5 processed meats consumed by US adults in 2015–2016 were luncheon meat (mean intake = 73.3 g/wk), sausage (45.5 g/wk), hot dog (17.5 g/wk), ham (17.5 g/wk), and bacon (8.6 g/wk), accounting for 39.3%, 24.4%, 9.4%, 9.4%, and 4.6%, respectively, of the total processed meat consumption in the US. During the same period, the mean consumption declined for unprocessed red meat (mean change = - 56.7 g/wk, p-trend

Outdoor air pollution is associated with respiratory infections and allergies, yet the role of innate lymphoid cells (ILCs) in pathogen containment and airway hyperresponsiveness relevant to effects of air pollutants on ILCs is poorly understood. We conducted a systematic review to evaluate the available evidence on the effect of outdoor air pollutants on the lung type 1 (ILC1) and type 2 ILCs (ILC2) subsets. We searched five electronic databases (up to Dec 2018) for studies on the effect of carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2), diesel exhaust particles (DEP), ozone (O3), and particulate matter (PM) on respiratory ILCs. Of 2209 identified citations, 22 full-text papers were assessed for eligibility, and 12 articles describing experimental studies performed in murine strains (9) and on human blood cells (3) were finally selected. Overall, these studies showed that exposure to PM, DEP, and high doses of O3 resulted in a reduction of interferon gamma (IFN-γ) production and cytotoxicity of ILC1. These pollutants and carbon nanotubes stimulate lung ILC2s, produce high levels of interleukin (IL)-5 and IL-13, and induce airway hyperresponsiveness. These findings highlight potential mechanisms by which human ILCs react to air pollution that increase the susceptibility to infections and allergies.

Soil-transmitted helminth infections propagate poverty and slow economic growth in low-income countries. As with many other neglected tropical diseases, environmental conditions are important determinants of soil-transmitted helminth transmission. Hence, remotely sensed data are commonly utilised in spatial risk models intended to inform control strategies. In the present study, we build upon the existing modelling approaches by utilising fine spatial resolution Landsat 8 remotely sensed data in combination with topographic variables to predict hookworm prevalence in a hilly tribal area in southern India. Hookworm prevalence data collected from two field surveys were used in a random forest model to investigate the predictive capacity of 15 environmental variables derived from two remotely sensed images acquired during dry and rainy seasons. A variable buffer radius (100–1000 m) was applied to the point-prevalence locations in order to integrate environmental conditions around the village centroids into the modelling approach and understand where transmission is more likely. Elevation and slope were the most important variables in the models, with lower elevation and higher slope correlating with higher transmission risk. A modified normalised difference water index was among other recurring important variables, likely responsible for some seasonal differences in model performance. The 300 m buffer distance produced the best model performance in this setting, with another spike at 700 m, and a marked drop-off in R2 values at 1000 m. In addition to assessing a large number of environmental correlates with hookworm transmission, the study contributes to the development of standardised methods of spatial linkage of continuous environmental data with point-based disease prevalence measures for the purpose of spatially explicit risk profiling.

OBJECTIVES: Suboptimal diet is associated with substantial cardiovascular disease (CVD) burden globally. Recognizing that populations are exposed to a complex mix of dietary factors, the aim of this study was to examine the potentially complex non-linear non-additive relationships between multiple components of diet and 10-year CVD risk using a machine learning method. METHODS: We implemented Bayesian Kernel Machine Regression (BKMR) using an R package bkmr among a group of healthy, middle-aged participants from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. Exposures were defined as common components of diet that have probable or convincing evidence of association with CVD risk. Outcome was an individual's predicted 10-year CVD risk calculated using the revised Pooled Cohort Equations for Estimating Atherosclerotic CVD Risk by the American College of Cardiology/American Heart Association. Ten-year CVD risk was modeled as a flexible kernel function of the exposure variables, adjusted for potential confounding factors. RESULTS: The mean age and predicted 10-year CVD risk of the 2193 participants were 45.75 (SD: 3.07) years old and 0.02 (SD: 0.02). We found a significant positive joint relationship between the multiple components of diet with CVD risk when all dietary factors were all above their 25th percentile. We also identified positive associations between whole grain, refined grain, red meat with CVD risk, and negative associations for vegetable and fruit. Furthermore, red meat, refined grain, whole grain and added sugar demonstrated potential non-linear relationships with the CVD risk. Our result also suggested potential interaction between refined grain with other dietary factors. CONCLUSIONS: Machine learning is a promising tool to estimate the joint associations between multiple diet components and CVD risk. It is able to identify the joint, univariate dose-response relationship between diet and CVD risk as well as component-wise interactions. FUNDING SOURCES: This work was supported by a funding from National Heart, Lung, and Blood Institute (NHLBI). SUPPORTING TABLES, IMAGES AND/OR GRAPHS

Rotavirus is a leading cause of acute diarrhea in children worldwide. Costa Rica recently started universal rotavirus vaccinations for infants with a two-dose schedule in February 2019. We aimed to study the seasonality of rotavirus during the pre-vaccination era. We retrospectively studied a six-year period of hospital admissions due to rotavirus gastroenteritis. We estimated seasonal peak timing and relative intensities using trend-adjusted negative binomial regression models with the &delta, method. We assessed the relationship between rotavirus cases and weather characteristics and estimated their effects for the current month, one-month prior and two months prior, by using Pearson correlation coefficients. A total of 798 cases were analyzed. Rotavirus cases predominated in the first five months of the year. On average, the peak of admissions occurred between late-February and early-March. During the seasonal peaks, the monthly count tended to increase 2.5&ndash, 2.75 times above the seasonal nadir. We found the strongest negative association of monthly hospitalizations and joint percentiles of precipitation and minimal temperature at a lag of two months (R = &minus, 0.265, p = 0.027) and we detected correlations of &minus, 0.218, &minus, 0.223, and &minus, 0.226 (p &lt, 0.05 for all three estimates) between monthly cases and the percentile of precipitation at lags 0, 1, and 2 months. In the warm tropical climate of Costa Rica, the increase in rotavirus hospitalizations coincided with dry and cold weather conditions with a two-month lag. The findings serve as the base for predictive modeling and estimation of the impact of a nation-wide vaccination campaign on pediatric rotaviral infection morbidity.

Heatwaves are one of the deadliest natural disasters that occur annually with thousands of people seeking medical attention. The spatio-temporal synchronization between peaks in disease manifestation and high temperature provides important insights into the seasonal timing of the heatwave and the response it may cause with respect to emergence, severity, and duration. The objectives of this study are to examine the association between hospitalizations due to heat stroke in older adults and heat in the United States (US) and explore synchronization with respect to heatwave sequence, time of arrival, and regional climate. Three large data sets were utilized: daily hospitalization records of the US elderly between 1991 and 2006, annual demographic summaries on Medicare beneficiaries maintained by the Centers for Medicare and Medicaid Services (CMS), and nationwide daily meteorological observations. We modeled seasonal fluctuations in health outcomes, such as the timing and intensity of the seasonal peak in hospitalizations using refined harmonic GLM for eight climatically similar regions. During the 16-year study period, there were 40,019 heat-related hospitalizations (HRH) in the conterminous US. The rates of HRH varied substantially across eight climatic regions: with the highest rate of 7.05 cases per million residents observed in areas with temperate arid summers and winters (TaTa) and the lowest rate of 0.67-in areas with cold moderately dry summers and arid winters (CdCa), where summer temperatures are about 18.3 °C and 12.1 °C, respectively. We detected 400 heatwaves defined as any day when the night time temperature is above its 90th percentile for the current and previous nights. The first seasonal heatwave in a season resulted in 4274 hospitalizations over 342 heatwave-days: 34.3% of 12,442 hospitalizations occurred in 26% of 1308 heatwave-days. The relative risks of increased HRH associated with the first and second heatwaves were 10.4 (95%CI: 8.5; 12.3) and 11.4 (95%CI: 9.6; 13.3), respectively, indicating the disproportional effects of early heatwave arrivals. The seasonal spike in heat stroke hospitalizations in regions with relatively similar annual temperatures, e.g. in areas with temperate moderately dry summers and winters (TdTa: 12.8 °C) and (TaTa: 11.1 °C) ranged between 4.5 (95%CI: 3.3; 5.5) and 11.0 (95%CI: 8.2; 14.9) cases per million residents, respectively, indicating substantial regional differences. The differences in heat-related hospitalizations and response to heatwaves are substantial among older adults residing in different climate regions of the conterminous US. The disproportionally high response to the early seasonal heatwave deserves special attention, especially in the context of prevention and decision support frameworks.

Objective In the presented study, we examined the impact of school holidays (Autumn, Winter, Summer, and Spring Breaks) and social events (Super Bowl, NBA Finals, World Series, and Black Friday) for five age groups ( 65 years) on four health outcomes of influenza (total tested, all influenza positives, positives for influenza A, and B) in Milwaukee, WI, in 2004-2009 using routine surveillance. Introduction Influenza viral infection is contentious, has a short incubation period, yet preventable if multiple barriers are employed. At some extend school holidays and travel restrictions serve as a socially accepted control measure 1,2 . A study of a spatiotemporal spread of influenza among school-aged children in Belgium illustrated that changes in mixing patterns are responsible for altering disease seasonality 3 . Stochastic numerical simulations suggested that weekends and holidays can delay disease seasonal peaks, mitigate the spread of infection, and slow down the epidemic by periodically dampening transmission. While Christmas holidays had the largest impact on transmission, other school breaks may also help in reducing an epidemic size. Contrary to events reducing social mixing, sporting events and mass gatherings facilitate the spread of infections 4 . A study on county-level vital statistics of the US from 1974-2009 showed that Super Bowl social mixing affects influenza dissemination by decreasing mortality rates in older adults in Bowl-participating counties. The effect is most pronounced for highly virulent influenza strains and when the Super Bowl occurs closer to the influenza seasonal peak. Simulation studies exploring how social mixing affects influenza spread 5 demonstrated that impact of the public gathering on prevalence of influenza depends on time proximity to epidemic peak. While the effects of holidays and social events on seasonal influenza have been explored in surveillance time series and agent-based modeling studies, the understanding of the differential effects across age groups is incomplete. Methods The City of Milwaukee Health Department Laboratory (MHDL), Wisconsin routinely collect tests from residents of metropolitan areas and vicinities of the Marquette University (MU). We obtained weekly counts of total tested, all influenza positives, positives for influenza A and B, from MHDL between 5/16/04-3/7/09 (before the surge of tests associated with “swine flu”). Cases for

Social outings can trigger influenza transmission, especially in children and elderly. In contrast, school closures are associated with reduced influenza incidence in school-aged children. While influenza surveillance modelling studies typically account for holidays and mass gatherings, age-specific effects of school breaks, sporting events and commonly celebrated observances are not fully explored. We examined the impact of school holidays, social events and religious observances for six age groups (all ages, ⩽4, 5–24, 25–44, 45–64, ⩾65 years) on four influenza outcomes (tests, positives, influenza A and influenza B) as reported by the City of Milwaukee Health Department Laboratory, Milwaukee, Wisconsin from 2004 to 2009. We characterised holiday effects by analysing average weekly counts in negative binomial regression models controlling for weather and seasonal incidence fluctuations. We estimated age-specific annual peak timing and compared influenza outcomes before, during and after school breaks. During the 118 university holiday weeks, average weekly tests were lower than in 140 school term weeks (5.93 vs. 11.99 cases/week, P < 0.005). The dampening of tests during Winter Break was evident in all ages and in those 5–24 years (RR = 0.31; 95% CI 0.22–0.41 vs. RR = 0.14; 95% CI 0.09–0.22, respectively). A significant increase in tests was observed during Spring Break in 45–64 years old adults (RR = 2.12; 95% CI 1.14–3.96). Milwaukee Public Schools holiday breaks showed similar amplification and dampening effects. Overall, calendar effects depend on the proximity and alignment of an individual holiday to age-specific and influenza outcome-specific peak timing. Better quantification of individual holiday effects, tailored to specific age groups, should improve influenza prevention measures.

OBJECTIVES: Linear growth faltering, failure to achieve one's potential for length or height at each age, is associated with increased risk of mortality and morbidity. Understanding the age-related patterns of growth faltering can inform timing of interventions and policies for prevention; however current knowledge is limited by cross-sectional data. We examine the longitudinal characterization of the timing of growth faltering among young children. METHODS: Using longitudinal anthropometric data originally collected as part of a food-aid cost-effectiveness trial, we investigated individual growth curves of 5,039 children aged 6–27 months in Burkina Faso (108,580 total measurements) to determine whether growth faltering occurs through intermittent episodes of slower growth, or continuously slow growth. We visualized individual growth curves and used two-stage regressions to evaluate growth curve smoothness at different levels of attained length. To do this, we first obtained model fit and diagnostic parameters from individual regressions of each child's length on their age. Parameters extracted included R(2), as a metric of curve smoothness, initial length at 6 months, and average velocity. We then regressed these parameters on individual-level attained length at study end. RESULTS: Growth faltering manifests as both continuously lower growth velocity throughout the observation period and greater heterogeneity in growth velocity amplitude. Children with lower attained length start smaller (Quintile 1 of attained length-63.1 cm initial length; Quintile 5-68.4 cm) and stay on their initial trajectories, continuously growing slower than their taller counterparts. In addition, a 0.01 increase in the R(2) (smoothness) from regression of a child's length on their age is associated with a 3.10 cm increase in attained length (95% CI: 2.80, 3.41), showing that smoother growth is also associated with higher attained length. CONCLUSIONS: Children who experience the most extreme growth faltering are likely to be less resilient to systematic growth-limiting conditions as well as episodic insults to their growth. Future research should investigate ways of improving environmental conditions to support growth. FUNDING SOURCES: Financial support provided by the Food Aid Quality Review project, funded by the United States Agency for International Development.

Summary In an Indian birth cohort, we demonstrate a high and early burden of cryptosporidiosis by polymerase chain reaction and serology. Reinfection was common and infections clustered in a subset of children. Prior infection provided some protection against subsequent infection, but not disease., Background. Cryptosporidium is a leading cause of moderate to severe childhood diarrhea in resource-poor settings. Understanding the natural history of cryptosporidiosis and the correlates of protection are essential to develop effective and sustainable approaches to disease control and prevention. Methods. Children (N = 497) were recruited at birth in semiurban slums in Vellore, India, and followed for 3 years with twice-weekly home visits. Stool samples were collected every 2 weeks and during diarrheal episodes were tested for Cryptosporidium species by polymerase chain reaction (PCR). Serum samples obtained every 6 months were evaluated for seroconversion, defined as a 4-fold increase in immunoglobulin G directed against Cryptosporidium gp15 and/or Cp23 antigens between consecutive sera. Results. Of 410 children completing follow-up, 397 (97%) acquired cryptosporidiosis by 3 years of age. PCR identified 1053 episodes of cryptosporidiosis, with an overall incidence of 0.86 infections per child-year by stool and serology. The median age for the first infection was 9 (interquartile range, 4–17) months, indicating early exposure. Although infections were mainly asymptomatic (693 [66%]), Cryptosporidium was identified in 9.4% of diarrheal episodes. The proportion of reinfected children was high (81%) and there was clustering of asymptomatic and symptomatic infections (P < .0001 for both). Protection against infection increased with the order of infection but was only 69% after 4 infections. Cryptosporidium hominis (73.3%) was the predominant Cryptosporidium species, and there was no species-specific protection. Conclusions. There is a high burden of endemic cryptosporidiosis in southern India. Clustering of infection is suggestive of host susceptibility. Multiple reinfections conferred some protection against subsequent infection.

Schistosoma haematobium transmission is influenced by environmental conditions that determine the suitability of the parasite and intermediate host snail habitats, as well as by socioeconomic conditions, access to water and sanitation infrastructure, and human behaviors. Remote sensing is a demonstrated valuable tool to characterize environmental conditions that support schistosomiasis transmission. Socioeconomic and behavioral conditions that propagate repeated domestic and recreational surface water contact are more difficult to quantify at large spatial scales. We present a mixed-methods approach that builds on the remotely sensed ecological variables by exploring water and sanitation related community characteristics as independent risk factors of schistosomiasis transmission.

Generating a detailed description of human T cell repertoire diversity is an important goal in the study of human immunology. The circulation is the source of most T cells used for studies in humans. Here we use high throughput sequencing of TCR BV19 transcripts from CD8 T cells derived from unmanipulated PBMC from an older HLA-A2 individual to provide a quantitative and qualitative description of the clonotypic CDR3 nucleotide and amino acid composition of the TCR β-chain from this subset of circulating CD8 T cells. Aggregated samples from six time points spanning ∼1.5 years were analyzed to smooth possible temporal fluctuation. BV19 encompasses the well studied RS-encoding clonotypes involved in recognition of the M1(58-66) epitope from influenza A in HLA-A2 individuals. The clonotype distribution was diverse, complex and self-similar. The amino acid composition was generally skewed in favor of glycines and there were specific amino acids observed at higher frequency at the NDN start position. The motif repertoire distribution was also diverse, complex and self-similar with respect to CDR3 length, NDN start and length.

Few studies assess agreement amongSchistosoma haematobiumeggs, measured hematuria, and self-reported metrics. We assessed agreement among four metrics at a single time point and analyzed the stability of infection across two time points with a single metric. We used data from the Eastern Region of Ghana and constructed logistic regression models. Girls reporting macrohematuria were 4.1 times more likely to have measured hematuria than girls not reporting macrohematuria (CI95%: 2.1–7.9); girls who swim were 3.6 times more likely to have measured hematuria than nonswimmers (CI95%: 1.6–7.9). For boys, neither self-reported metric was predictive. Girls with measured hematuria in 2010 were 3.3 times more likely to be positive in 2012 (CI95%: 1.01–10.5), but boys showed no association. Boys with measured hematuria in 2008 were 6.0 times more likely to have measured hematuria in 2009 (CI95%: 1.5–23.9) and those with eggs in urine in 2008 were 4.8 times more likely to have eggs in urine in 2009 (CI95%: 1.2–18.8). For girls, measured hematuria in 2008 predicted a positive test in 2009 (OR = 2.8; CI95%: 1.1–6.8), but egg status did not. Agreement between dipstick results and eggs suggests continued dipstick used is appropriate. Self-reported swimming should be further examined. For effective disease monitoring, we recommend annual dipstick testing.

OBJECTIVES: Anti-inflammatory diets have been suggested to improve psychological health. This research evaluated the combined effects of consuming an anti-inflammatory diet and caloric restriction (CR) on changes in perceived stress and health-related quality of life in a healthy, non-obese population. METHODS: We conducted a secondary analysis of the publicly available CALERIE data. Participants were randomized to a 2 year CR intervention (n = 143) or an ad libitum Control group (n = 75) and self-selected their dietary intake. An energy-adjusted dietary inflammatory index (DII) was calculated based on 28 components from self-reported food records. Self-reported stress and general health outcomes were measured using validated questionnaires. Linear mixed models were used to assess changes in each outcome from baseline to 12 and 24 months. Models were adjusted for age, sex, baseline outcome measure, change in body fat, and a treatment by DII interaction term. RESULTS: On average, participants were 38.1 ± 7.2 years old with a BMI of 25.1 ± 1.7 kg/m(2). Baseline characteristics, including the DII, stress, and general health, did not differ with randomization. There was no significant association between temporal changes in DII and changes in stress or general health in the CR or Control groups. On average, both groups tended to report higher stress at 12 months; however, there was no difference in perceived stress between groups (adjusted mean difference [MD]: 0.5; 95% confidence interval [CI]: −0.4, 1.5; P = 0.25). There was an improvement in reported general health in the CR group at 12 months (MD: 4.1; 95% CI: 2.2, 6.0; P

OBJECTIVES: Destruction of agricultural lands and fisheries due to climate-related disasters has implications for food production and food security in Indonesia. We examine how natural disasters affect the economic productivity of fishing and farming households in Indonesia by exploring whether flooding and landslide disasters trigger differing migratory behaviors by the type of farming/fishery operation. METHODS: We assessed farming and fishing households in the 5(th) Wave of the IFLS survey (2014/2015) adjusting for household survey weighting. Farming and fishing households are described by the presence or absence of migration since the previous IFLS survey (IFLS4: 2007/2008). Next, we further evaluated households by the type of disaster experienced (flooding or landslides) and other characteristics (region, urban/rural, type of operation). Logistic regression models were used to explain the likelihood of migration, assessing effect modification between the type of disaster (flooding or landslide) and type of farm business to better understand their joint influence on migration. RESULTS: Since IFLS4, approximately 33% of farming households migrated and predominantly moved within the same village or sub-district. Flooding and landslides impacted 8% of households and rice was the most common farm business type (45%). A higher percentage of fishing households were affected by flooding or landslides compared to non-fishing households (23% and 7%, respectively). There were lower odds of migration among rice (OR: 0.75 [95% CI: 0.63,0.89]), corn (0.67 [0.48,0.93]), cassava (0.49 [0.34,0.71]), coffee (0.44 [0.28,0.68]), and cattle (0.49 [0.34,0.70]) farming operations. Migration likelihood was not significantly affected by the joint effect of disaster type and operation type. CONCLUSIONS: Understanding how climate change is impacting agricultural lands and fisheries must coincide with responsive efforts to encourage food production and ensure food security in Indonesia. Our results suggest that farming households may be adapting rather than migrating in response to flooding or landslide disasters. The IFLS provides a tool for examining response efforts of farm and fishing businesses in relation to natural disasters. FUNDING SOURCES: NSF IRES US-Indonesian Research Experience #1,826,939.

OBJECTIVES: Factors associated with the double burden of underweight and overweight/obesity are not well investigated in Indonesia. Insufficient information leaves policy makers without tools to develop coherent, impactful legislation on these issues. We aim to describe and explain the association between weight status, socio-demographic factors, and food consumption patterns in Indonesia. METHODS: We used the 5th Wave of the Indonesia Family Life Survey (IFLS) collected in 2014/15. From the total sample (50,148), we included only adults aged ≥20 years (27,496). We converted BMI into three categories: underweight (BMI 25). Sociodemographic factors included location, education, sex, age category, and frequency of commonly eaten food items. We examined associations using multinomial logistic regression models (α < 0.05). RESULTS: Urban residents were less likely to be underweight (RRR = 0.90 [0.82, 0.98]; P = 0.014) and more likely to be overweight/obesity (RRR = 1.38 [1.31, 1.46]; P

OBJECTIVES: Although studies have found co-occurrence of stunting (low height-for-age) with wasting (low weight-for-height), and found that wasting often precedes stunting, none has investigated links between velocities of linear and ponderal growth over time. Understanding temporal dependencies and growth trajectories in both height and weight can help determine optimal timing of interventions to prevent wasting and stunting. METHODS: We re-analyzed monthly height and weight data from a cohort of 6112 children aged 6–23 months in a supplementary feeding trial in Burkina Faso, conducted from July 2014 to September 2016. We built mixed effects models with multiple lag periods to determine links between linear growth trajectory (cm gained/month) and ponderal growth trajectory (kg gained/month), and vice versa, controlling for age, season, study arm, and morbidities. Lag periods included growth velocity measurements taken one (t-1) to four (t-4) months prior to the outcome velocity. RESULTS: On average in these data, ponderal growth is positively associated with future linear growth, but linear growth is followed by lower future weight gain. Doubling the average ponderal growth velocity (0.18 kg/month) is associated with 3%–0.2% higher linear growth velocity one to four months later, while doubling the average linear growth velocity (0.95 cm/month) is associated with 16%–3% lower ponderal growth velocity one to four months later. In all cases, the magnitude of a growth velocity's association with future growth velocities decreases as the time interval increases. These results are all significant at the 5% level. CONCLUSIONS: We find that episodes of faster linear growth are associated with lower subsequent ponderal growth. This finding demonstrates temporal dependencies and suggests that, for infants in Burkina Faso, linear growth spurts may not be accompanied by sufficient increases in dietary intake to avoid a slowdown in weight gain. To improve child growth, programs should combine strategies that address both height and weight. FUNDING SOURCES: United States Agency for International Development, Office of Food for Peace.

OBJECTIVES: In Indonesia, exclusive breastfeeding practices are followed by only 46% of mothers, resulting in USD $118 million in health costs annually [2, 3]. Though previous studies have addressed demographic factors related to breastfeeding [5, 6], few studies have examined the relationship between exclusive breastfeeding duration and mother's psychosocial characteristics [5, 6, 7, 8]. Our study used the Indonesian Family Life Survey 5(th) Wave survey (IFLS5) from 2014–2015 to evaluate if demographic and psychosocial factors are associated with exclusive breastfeeding duration among Indonesian mothers [7, 8]. METHODS: Our study included mothers (n = 3024) with children 6 months) according to WHO standards [1]. We described individual mother's characteristics including age, education level, socioeconomic status, and psychosocial factors by these breastfeeding categories. We developed binary breastfeeding duration variables by those never breastfeeding or breastfeeding ≤4 months to perform binary logistic regression models. Finally, we examined differences between categories of breastfeeding duration using multinomial logistic models. RESULTS: Mothers with primary and secondary education had lower odds of having breastfed exclusively for ≤4 months (OR 0.43 [0.30, 0.60] and 0.64 [0.46, 0.89]), respectively, compared to mothers with higher education. Mothers with primary education were also 2.21 [1.05, 4.50] times as likely to have never breastfed relative to breastfeeding exclusively for 4–6 months compared to highly-educated mothers. Compared to younger mothers (30–39 years), older mothers (40 + years) had a greater likelihood of never exclusively breastfeeding, relative to exclusively breastfeeding for 4–6 months (RR 3.28 [1.80, 5.96]). Finally, mothers who had lower perceived life-satisfaction had a lower likelihood (RR 0.60 [0.45, 0.77]) of exclusively breastfeeding >6 months compared to mothers with very high satisfaction. CONCLUSIONS: Our results can help to inform policy makers about disparities in exclusive breastfeeding practices to better tailor services to underserved mothers within Indonesia. FUNDING SOURCES: NSF IRES US-Indonesian Research Experience #182,693.

Fish roes are consumed globally as a delicacy and an important seafood-based source of macro and micro-nutrients that is intensively produced in Indonesia. The connective material holding the roes i.e. the skeins are also high in protein and therefore could be utilized as nutritious protein supplement for food products. However, the study of the skeins is scant and their complete nutritional composition and physical appearance have not been fully described. We examined the nutritional composition and chemical resilience of fish roe skeins from the flying fish (Hirundichthys oxycephalus) that are commonly found in temperate and tropical oceans. The air-dried skeins contained 72–74 % crude protein, high-quality protein composed of essential and most non-essential amino acids, and very low carbohydrate content. High macro and micro minerals, lipids, albeit at a low amount, composed of saturated and unsaturated fatty acids and water- and lipid-soluble vitamins were also present. The roe skeins were highly durable and resistant to nutrient decomposition through over-desiccation as well bacterial contamination by Escherichia coli. In current production practices, the roe skeins are discarded as food waste. Our study proved that the roe skeins are rich in the nutrients that are valued from chicken egg whites, but provided additional essential macro- and micro-nutrients while being highly durable and resistant to bacterial contamination.

Interventions tackling multiple drivers of child malnutrition have potential, yet the evidence is limited and draws on different analysis and nutrition outcomes, reducing comparability. To better understand the advantages and disadvantages of three different analytical approaches on seven common nutrition indicators, we use panel data (2012, 2014, 2015) on 1420 households from a randomized control study of a multi-sectoral intervention in Chad. We compare program impact using three types of analysis: a cross-sectional analysis of non-matched children, a panel analysis on longitudinal outcomes following the worst-off child in the household, and a panel analysis on longitudinal outcomes of matched children. We find that the sensitivity of the nutrition outcomes to program impact increases with each subsequent analytical approach, despite the reduction in sample size, as the analysis is able to control for more non-measured child and household characteristics. In the matched child panel analysis, the odds of a child being severely wasted were 76% lower (CI: 0.59&ndash, 0.86, p = 0.001), the odds of being underweight were 33% lower (CI: 0.15&ndash, 0.48, p = 0.012), and weight-for-height z-score was 0.19 standard deviations higher (CI: 0.09&ndash, 0.28, p = 0.022) in the treatment versus control group. The study provides evidence for multi-sectoral interventions to tackle acute malnutrition and recommends the best practice analytical approach.

The research on how health and health care disparities impact response to and recovery from a disaster, especially among diverse and underserved populations is in great need for a thorough evaluation. The time series analysis utilizing most complete national databases of medical records is an indispensable tool in assessing the destruction and health toll brought about by natural disasters. In this study, we demonstrated such an application by evaluating the impact of Hurricane Katrina in 2005 on cardiovascular disease (CVD), a primary cause of mortality among older adults that can be aggravated by natural disasters. We compared CVD hospitalizations before, during and after Katrina between white and black residents of three most populated parishes in Louisiana: Orleans and Jefferson, which were severely affected by the landfall and subsequent floods, and East Baton Rouge, which hosted many of the evacuees. We abstracted 383,552 CVD hospitalization records for Louisiana&rsquo, s patients aged 65+ in 2005&ndash, 2006 from the database maintained by the Center of Medicare &amp, Medicaid Services. Daily time series of CVD-related hospitalization rates at each study parish were compiled, and the changes were characterized using segmented regression. In Orleans Parish, directly affected by the hurricane, hospitalization rates peaked on the 6th day after landfall with an increase (mean &plusmn, SD) from 7.25 &plusmn, 2.4 to 18.5 &plusmn, 17.3 cases/day per 10,000 adults aged 65+ (p &lt, 0.001) and returned to pre-landfall level after ~2 months. Disparities in CVD rates between black and white older adults were exacerbated during and following landfall. In Orleans Parish, a week after landfall, the CVD rates increased to 26.3 &plusmn, 23.7 and 16.6 &plusmn, 11.7 cases/day per 10,000 people (p &lt, 0.001) for black and white patients, respectively. The abrupt increase in CVDs is likely due to psychosocial and post-traumatic stress caused by the disaster and inadequate response. Inequities in resource allocation and access have to be addressed in disaster preparation and mitigation.

BACKGROUND: Phylloquinone is the primary form of vitamin K in the diet and circulation. Large intra- and interindividual variances in circulating phylloquinone have been partially attributed to age. However, little is known about the nondietary factors that influence phylloquinone absorption and metabolism. Similarly, it is not known if phylloquinone absorption is altered by the individual's existing vitamin K status. OBJECTIVE: The purpose of this secondary substudy was to compare plasma response with deuterium-labeled phylloquinone intake in older and younger adults after dietary phylloquinone depletion and repletion. METHODS: Forty-two older [mean ± SD age: 67.2 ± 8.0 y; body mass index (BMI; in kg/m(2)): 25.4 ± 4.6; n = 12 men, 9 women] and younger (mean ± SEM age: 31.8 ± 6.6 y; BMI: 25.5 ± 3.3; n = 9 men, 12 women) adults were maintained on sequential 28-d phylloquinone depletion (∼10 µg phylloquinone/d) and 28-d phylloquinone repletion (∼500 µg phylloquinone/d) diets. On the 23rd d of each diet phase, participants consumed deuterated phylloquinone-rich collard greens ((2)H-phylloquinone). Plasma and urinary outcome measures over 72 h were compared by age group, sex, and dietary phase via 2-factor repeated-measures ANOVA. RESULTS: The plasma (2)H-phylloquinone area under the curve (AUC) did not differ in response to phylloquinone depletion or repletion, but was 34% higher in older than in younger adults (P = 0.02). However, plasma (2)H-phylloquinone AUC was highly correlated with the serum triglyceride (TG) AUC (r(2)( )= 0.45). After adjustment for serum TG response, the age effect on the plasma (2)H-phylloquinone AUC was no longer significant. CONCLUSIONS: Plasma (2)H-phylloquinone response did not differ between phylloquinone depletion and repletion in older and younger adults. The age effect observed was explained by the serum TG response and was completely attenuated after adjustment. Plasma response to phylloquinone intake, therefore, seems to be a predominantly lipid-driven effect and not dependent on existing vitamin K status. More research is required to differentiate the effect of endogenous compared with exogenous lipids on phylloquinone absorption. This trial was registered at clinicaltrials.gov as NCT00336232.

BackgroundKnowledge of urogenital schistosomiasis can empower individuals to limit surface water contact and participate in mass drug administration campaigns, but nothing is currently known about the schistosomiasis knowledge that schoolchildren have in Ghana. We developed and implemented a survey tool aiming to assess the knowledge of urogenital schistosomiasis (treatment, transmission, prevention, symptoms) among science teaches and primary and junior high school students in the Eastern Region of Ghana.MethodsWe developed a 22-question knowledge survey tool and administered it to 875 primary and 938 junior high school students from 74 schools in 37 communities in the Eastern Region of Ghana. Teachers (n = 57) answered 20 questions matched to student questions. We compared knowledge scores (as percent of correct answers) across topics, gender, and class year and assessed associations with teacher's knowledge scores using t-tests, chi-squared tests, univariate, and multivariate linear regression, respectively.ResultsStudents performed best when asked about symptoms (mean±SD: 76±21% correct) and prevention (mean±SD: 69±25% correct) compared with transmission (mean±SD: 50±15% correct) and treatment (mean±SD: 44±23% correct) (pConclusionsOur survey parsed four components of student and teacher knowledge. We found strong knowledge in several realms, as well as knowledge gaps, especially on transmission and treatment. Addressing relevant gaps among students and science teachers in UGS-endemic areas may help high-risk groups recognize risky water contact activities, improve participation in mass drug administration, and spark interest in science by making it practical.

Because of air quality management and control, traffic-related air pollution has declined in Quito, Ecuador. We evaluated the effect of a city-wide 5-year air pollution control program on the occurrence of acute respiratory illness (ARI). We compared two studies conducted at the same location in Quito: in 2000, 2 years before the policy to control vehicle emission was introduced, and in 2007. Each study involved ~ 730 children aged 6-12 years, observed for 15 weeks. We examined associations between carboxyhemoglobin (COHb) serum concentration-an exposure proxy for carbon monoxide (CO)-ambient CO, and ARI in both cohorts. In 2007, we found a 48% reduction in the ARI incidence (RR 0.52; 95% CI 0.45-0.62, p 0.0001), and 92% decrease in the percentage of children with COHb 2.5% as compared to the 2000 study. We found no association between COHb concentrations above the safe level of 2.5% and the ARI incidence (p = 0.736). The decline in air pollution due to vehicle emissions control was associated with a lower incidence of respiratory illness in school children.

According to the Centers for Disease Control and Prevention (CDC), from 2000 to 2014, reported cases of legionellosis per 100 000 population increased by 300% in the USA, although reports on disease seasonality are inconsistent. Using two national databases, we assessed seasonal patterns of legionellosis in the USA. We created a monthly time series from 1993 to 2015 of reported cases of legionellosis from the CDC, and from 1997 to 2006 of medical claims of legionellosis-related hospitalisation in older adults from the Centers for Medicaid and Medicare Services (CMS). We split the study time interval into two segments (before and after 2003), and applied a Poisson harmonic regression model to each dataset and each segment. The time series of monthly counts exhibited a significant shift of seasonal peaks from mid-September (9.676 ± 0.164 months) before 2003 to mid-August (8.452 ± 0.042 months) after 2003, along with an alarming increase in the amplitude of seasonal peaks in both CDC and CMS data. The lowest monthly reported cases of legionellosis in 2015 (281) exceed the maximum value reported before 2003 (206). We also observed a discrepancy between CDC and CMS data, suggesting that not all cases of legionellosis diagnosed by hospital-based laboratories were reported to the CDC. Improved reporting of legionellosis is required to better inform the public and organise disease prevention.

Background Schistosomiasis is a water-related neglected tropical disease. In many endemic low- and middle-income countries, insufficient surveillance and reporting lead to poor characterization of the demographic and geographic distribution of schistosomiasis cases. Hence, modeling is relied upon to predict areas of high transmission and to inform control strategies. We hypothesized that utilizing remotely sensed (RS) environmental data in combination with water, sanitation, and hygiene (WASH) variables could improve on the current predictive modeling approaches. Methodology Schistosoma haematobium prevalence data, collected from 73 rural Ghanaian schools, were used in a random forest model to investigate the predictive capacity of 15 environmental variables derived from RS data (Landsat 8, Sentinel-2, and Global Digital Elevation Model) with fine spatial resolution (10–30 m). Five methods of variable extraction were tested to determine the spatial linkage between school-based prevalence and the environmental conditions of potential transmission sites, including applying the models to known human water contact locations. Lastly, measures of local water access and groundwater quality were incorporated into RS-based models to assess the relative importance of environmental and WASH variables. Principal findings Predictive models based on environmental characterization of specific locations where people contact surface water bodies offered some improvement as compared to the traditional approach based on environmental characterization of locations where prevalence is measured. A water index (MNDWI) and topographic variables (elevation and slope) were important environmental risk factors, while overall, groundwater iron concentration predominated in the combined model that included WASH variables. Conclusions/Significance The study helps to understand localized drivers of schistosomiasis transmission. Specifically, unsatisfactory water quality in boreholes perpetuates reliance on surface water bodies, indirectly increasing schistosomiasis risk and resulting in rapid reinfection (up to 40% prevalence six months following preventive chemotherapy). Considering WASH-related risk factors in schistosomiasis prediction can help shift the focus of control strategies from treating symptoms to reducing exposure., Author summary Schistosomiasis is a water-related neglected tropical disease that disproportionately affects school-aged children in poor communities of low- and middle-income countries. Schistosomiasis transmission risk is affected by environmental, socioeconomic, and behavioral factors, including water, sanitation, and hygiene (WASH) conditions. We used fine spatial resolution (10–30 m) remotely sensed data, in combination with measures of local water access and groundwater quality, to predict schistosomiasis risk in 73 rural Ghanaian communities. We found that applying environmental models to specific locations where people contact surface water bodies (i.e., potential transmission locations), rather than to locations where prevalence is measured, improved model performance. A remotely sensed water index and topographic variables (elevation and slope) were important environmental risk factors, while overall, groundwater iron concentration predominated. In the study area, unsatisfactory water quality in boreholes perpetuates reliance of surface water bodies, indirectly increasing schistosomiasis risk and resulting in rapid reinfection (up to 40% prevalence six months following deworming). Considering WASH-related risk factors in schistosomiasis prediction can help shift the focus of control strategies from treating symptoms to reducing exposure.

People with Parkinson’s disease (PD) often experience a decrease in their facial expressivity, but little is known about how the coordinated movements across regions of the face are impaired in PD. The face has neurologically independent regions that coordinate to articulate distinct social meanings that others perceive as gestalt expressions, and so understanding how different regions of the face are affected is important. Using the Facial Action Coding System, this study comprehensively measured spontaneous facial expression across 600 frames for a multiple case study of people with PD who were rated as having varying degrees of facial expression deficits, and created correlation matrices for frequency and intensity of produced muscle activations across different areas of the face. Data visualization techniques were used to create temporal and correlational mappings of muscle action in the face at different degrees of facial expressivity. Results showed that as severity of facial expression deficit increased, there was a decrease in number, duration, intensity, and coactivation of facial muscle action. This understanding of how regions of the parkinsonian face move independently and in conjunction with other regions will provide a new focus for future research aiming to model how facial expression in PD relates to disease progression, stigma, and quality of life.

Little is known about the type and longevity of the humoral response to cryptosporidial infections in developing countries. We evaluated serum antibody response to Cryptosporidium gp15 in 150 sets of maternal, preweaning and postinfection/end-of-follow-up sera from children followed up to 2 years of age to determine the influence of maternal and preweaning serological status on childhood cryptosporidiosis. Fifty two percent (N = 78) of mothers and 20% (N = 30) of children were seropositive preweaning. However, most positive preweaning samples from children were collected early in life indicating transplacental transfer and subsequent rapid waning of antibodies. Although 62% (N = 94) of children had a parasitologically confirmed cryptosporidial infection (detected by stool polymerase chain reaction) during the follow-up, only 54% (N = 51) of children were seropositive postinfection. Given there were striking differences in seropositivity depending on when the sample was collected, even though Cryptosporidium was detected in the stool of the majority of the children, this study indicates that antibodies wane rapidly. During follow-up, the acquisition or severity of cryptosporidial infections was not influenced by maternal (P = 0.331 and 0.720, respectively) as well as the preweaning serological status of the child (P = 0.076 and 0.196, respectively).

Household interviews were conducted in the Palestinian West Bank to examine the relationship between price elasticity, water insecurity and domestic water demand. Water insecurity weights were defined and quantified for each household for use in a multivariate regression model. The model demonstrated that (1) a water insecurity variable improves the ability to estimate price elasticity and that (2) increased water insecurity leads to higher levels of household water demand. The findings suggest that policy-makers can influence domestic water demand by addressing the supply constraints that underlie domestic water insecurity.

Traffic-related ultrafine particles (UFP; 12,000 hours of measurements at the central sites, 1,000 hours of measurements at each of 20 residential sites in the two study areas, and >120 hours of mobile measurements over the course of ~1 year in each study area. Our results show differences between the monitoring strategies: mean one-minute PNC on-roads were higher (64,000 and 32,000 particles/cm3 in Boston and Chelsea, respectively) compared to central-site measurements (23,000 and 19,000 particles/cm3) and both were higher than at residences (14,000 and 15,000 particles/cm3). Temporal correlations and spatial heterogeneity also differed between the platforms. Temporal correlations were generally highest between central and residential sites, and lowest between central-site and on-road measurements. We observed the greatest spatial heterogeneity across monitoring platforms during the morning rush hours (06:00–09:00) and the lowest during the overnight hours (18:00–06:00). Longer averaging times (days and hours vs. minutes) increased temporal correlations (Pearson correlations were 0.69 and 0.60 vs. 0.39 in Boston; 0.71 and 0.61 vs. 0.45 in Chelsea) and reduced spatial heterogeneity (coefficients of divergence were 0.24 and 0.29 vs. 0.33 in Boston; 0.20 and 0.27 vs. 0.31 in Chelsea). Our results suggest that combining stationary and mobile monitoring may lead to improved characterization of UFP in urban areas and thereby lead to improved exposure assignment for epidemiology studies.

Rural Ghanaian communities continue using microbiologically contaminated surface water sources due in part to undesirable organoleptic characteristics of groundwater from boreholes. Our objective was to identify thresholds of physical and chemical parameters associated with consumer complaints related to groundwater. Water samples from 94 boreholes in the dry season and 68 boreholes in the rainy season were analyzed for 18 parameters. Interviews of consumers were conducted at each borehole regarding five commonly expressed water quality problems (salty taste, presence of particles, unfavorable scent, oily sheen formation on the water surface, and staining of starchy foods during cooking). Threshold levels of water quality parameters predictive of complaints were determined using the Youden index maximizing the sum of sensitivity and specificity. The probability of complaints at various parameter concentrations was estimated using logistic regression. Exceedances of WHO guidelines were detected for pH, turbidity, chloride, iron, and manganese. Concentrations of total dissolved solids (TDS) above 172 mg/L were associated with salty taste complaints. Although the WHO guideline is 1000 mg/L, even at half the guideline, the likelihood of salty taste complaint was 75%. Iron concentrations above 0.11, 0.14 and 0.43 mg/L (WHO guideline value 0.3 mg/L) were associated with complaints of unfavorable scent, oily sheen, and food staining, respectively. Iron and TDS concentrations exhibited strong spatial clustering associated with specific geological formations. Improved groundwater sources in rural African communities that technically meet WHO water quality guidelines may be underutilized in preference of unimproved sources for drinking and domestic uses, compromising human health and sustainability of improved water infrastructure.

Background: The US population is rapidly aging, with concurrent increases in chronic disease burdens, particularly CVD. Yet, to-date, the spatial, temporal, and demographic distributions and trends in CVD incidence in the US elderly have not been characterized in detail using data with full coverage of this population. Objective: To characterize trends, 1991-2004, in CVD hospitalizations among US elderly, by single year of age/ sex/race/county/state using records from US Centers for Medicare and Medicaid (CMS), which provide full coverage of the US population aged 65+. Methods: We abstracted 108,357,431 hospitalization records compiled by CMS indicating CVD in any of 10 diagnosis codes, and tabulated total cases of CVD by sex, single year of age, state and calendar year (1991-2004). CVD incidence rates were calculated using stratum-specific population data from the US Census in conjunction with CMS records. We characterized distributions of CVD cases by single year of age for the US and further by state and calendar year, determining the sex-specific age at which the largest number of incident CVD cases were registered (peak age). Results: CVD hospitalization rates increased from 1991-2004 for women aged 65-90 and men aged 65-80, but declined in the oldest-old. In 1991, CVD hospitalization rates for women aged 75 were 48 per 100,000 population, rising to 70 per 100,000 in 2004; men aged 75 had rates of 66 per 100,000 in 1991 versus 87 per 100,000 in 2004. Nationally, peak age of CVD hospitalizations increased 1991-2004, from 77 to 83 years of age for women and from 70 to 77 years of age for men. Men and women in Southern states had among the lowest peak ages of CVD in the nation in 1991 as well as 2004. ( Figure ) Trends by race/CVD subtype are forthcoming. Conclusions: Emerging national trends and regional heterogeneity in CVD hospitalization rates and peak age of CVD hospitalization in the US elderly emphasize the need for targeted population-level policy/interventions to reduce CVD burdens and promote healthy aging.

The Flint Water Crisis-due to changes of water source and treatment procedures-has revealed many unsolved social, environmental, and public health problems for US drinking water, including opportunistic premise plumbing pathogens (OPPP). The true health impact of OPPP, especially in vulnerable populations such as the elderly, is largely unknown. We explored 108 claims in the largest US national uniformly collected data repository to determine rates and costs of OPPP-related hospitalizations. In 1991-2006, 617,291 cases of three selected OPPP infections resulted in the elderly alone of $0.6 billion USD per year of payments. Antibiotic resistance significantly increased OPPP illness costs that are likely to be underreported. More precise estimates for OPPP burdens could be obtained if better clinical, microbiological, administrative, and environmental monitoring data were cross-linked. An urgent dialog across governmental and disciplinary divides, and studies on preventing OPPP through drinking water exposure, are warranted.

Older adults are highly vulnerable to the detriment of extreme weather. The rapid non-linear increase in heat-related morbidity is difficult to quantify, hindering the attribution of direct effects of exposure on severe health outcomes. We examine the effects of ambient temperatures on heat-related hospitalizations (HH) among the elderly in presence of strong seasonality and by assessing the effects caused by the first and subsequent seasonal heatwaves. We empirically derived the thresholds for a heatwave episode in Boston MSA based on 16 years of daily observations. We compared the health risks of heatwaves using the proposed and four alternative definitions. 701 cases of HH in older residents of Boston area were examined using harmonic regression models, designed to capture the non-linear effects of ambient temperatures and heatwave episodes when the night-time temperature is above 65.5 °F for 3 consecutive nights. The overall relative risk of HH associated with a heatwave episode was 6.9 [95%CI:4.8–9.8]. The relative risk of HH associated with the first heatwave increases up to 13.3 [95%CI:7.4–24.0]. The risk declined to 3.7 [95%CI:2.4–5.8] for the subsequent heatwave. Four other commonly used heatwave definitions confirmed these findings. Public health actions have to target the first heatwave to maximize the impact of preventive measures.

OBJECTIVE: To describe spatial and temporal profiles of RTIs on different road networks in Vellore district of southern India. METHODS: Using the information in the police maintained First Information Reports (FIR), daily time series of RTI counts were created and temporal characteristics were analyzed with respect to the vehicle, road types and time of the day for the period January 2005 to May 2007. Daily incidence and trend of RTIs were estimated using a Poisson regression analysis. RESULTS: Of the reported 3262 RTIs, 52% had occurred on the National Highway (NH). The overall RTI rate on the NH was 8.8/100,000 vehicles per day with significantly higher pedestrian involvement. The mean numbers of RTIs were significantly higher on weekends. 13% of all RTIs were associated with fatalities. Hotspots are major town junctions and RTI rates differ over different stretches of the NH. CONCLUSION: In India, FIR's form a valuable source of RTI information. Information on different vehicle profile, RTI patterns, and their spatial and temporal trends can be used by administrators to devise effective strategies for RTI prevention by concentrating on the high-risk areas, thereby optimizing the use of available personnel and resources. This article is protected by copyright. All rights reserved. Language: en

By investing in healthy human life we are investing in our social capital, the primary treasure of a modern technologically advanced society. In rethinking the definition of health from a new interdisciplinary viewpoint, I argue that health can be measured by satisfaction with life fulfillment and by abilities that permit an individual to perform tasks demanded by a society. While considering health as a property of a dynamic system governed by social and environmental determinants, a balance between societal and personal responsibility for health and wellbeing has to be maintained to protect those who have limited opportunities to "use their biologically given and personally acquired potentials" or to entertain their rights of healthy living standards. Instead of separating the biologically given and personally acquired potentials, I suggest capitalizing on emerging information, technologies, and materials aiming to enhance human potentials, both physical and intellectual.

Estimating ultrafine particle number concentrations (PNC) near highways for exposure assessment in chronic health studies requires models capable of capturing PNC spatial and temporal variations over the course of a full year. The objectives of this work were to describe the relationship between near-highway PNC and potential predictors, and to build and validate hourly log-linear regression models. PNC was measured near Interstate 93 (I-93) in Somerville, MA (USA) using a mobile monitoring platform driven for 234 hours on 43 days between August 2009 and September 2010. Compared to urban background, PNC levels were consistently elevated within 100–200 m of I-93, with gradients impacted by meteorological and traffic conditions. Temporal and spatial variables including wind speed and direction, temperature, highway traffic, and distance to I-93 and major roads contributed significantly to the full regression model. Cross-validated model R2 values ranged from 0.38–0.47, with higher values achieved (0.43–0.53) when short-duration PNC spikes were removed. The model predicts highest PNC near major roads and on cold days with low wind speeds. The model allows estimation of hourly ambient PNC at 20-m resolution in a near-highway neighborhood.

Purpose To determine the cumulative worldwide incidence of infectious endophthalmitis and associated vision loss after Boston keratoprosthesis (B-KPro) Type I/II implantation and to propose both safe and inexpensive prophylactic antibiotic regimens. Methods Two retrospective methods were used to determine the incidence, visual outcomes and aetiologies of infectious endophthalmitis associated with the B-KPro divided per decade: (i) systematic review of the literature from 1990 through January 2013 and (ii) a surveillance survey sent to all surgeons who implanted B-KPros through 2010 with 1-year minimum follow-up. In addition, a single-Boston surgeon 20-year experience was examined. Results From 1990 through 2010, there were 4729 B-KPros implanted worldwide by 209 U.S. surgeons and 159 international surgeons. The endophthalmitis cumulative mean incidence declined from 12% during its first decade of use to about 3% during its second decade in the Unites States and about 5% internationally during the second decade. There remains a large incidence range both in the United States (1–12.5%) and internationally (up to 17%). Poor compliance with daily topical antibiotics is an important risk factor. While Gram-positive organisms remained dominant, fungal infections emerged during the second decade. Conclusions Daily prophylactic topical antibiotics have dramatically reduced the endophthalmitis incidence. Although Gram-positive organisms are the most common aetiology, antimicrobials must be inclusive of Gram-negative organisms. Selection of prophylactic regimens should be tailored to local antibiotic susceptibility patterns, be cost-effective, and should not promote the emergence of antimicrobial resistance. An example of a broad-spectrum, low-cost prophylactic option for non-autoimmune patients includes trimethoprim/polymyxinB once daily.

The utility of agglomerative clustering methods for understanding dynamic systems that do not have a well-defined periodic structure has not yet been explored. We propose using this approach to examine the association between disease and weather parameters, to compliment the traditional harmonic regression models, and to determine specific meteorological conditions favoring high disease incidence. We utilized daily records on reported salmonellosis and non-specific enteritis, and four meteorological parameters (ambient temperature, dew point, humidity, and barometric pressure) in Barnaul, Russia in 2004&ndash, 2011, maintained by the CliWaDIn database. The data structure was examined using the t-distributed stochastic neighbor embedding (t-SNE) method. The optimal number of clusters was selected based on Ward distance using the silhouette metric. The selected clusters were assessed with respect to their density and homogeneity. We detected that a well-defined cluster with high counts of salmonellosis occurred during warm summer days and unseasonably warm days in spring. We also detected a cluster with high counts of non-specific enteritis that occurred during unusually &ldquo, very warm&rdquo, winter days. The main advantage offered by the proposed technique is its ability to create a composite of meteorological conditions&mdash, a rule of thumb&mdash, to detect days favoring infectious outbreaks for a given location. These findings have major implications for understanding potential health impacts of climate change.

Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, collected for regulatory purposes, for public health analyses. Combining EPA impairment data and stream hydrology information we estimated the percent of stream length impaired for any use, recreational use, or drinking water use per county in the US as exposure variables. For health outcomes we abstracted county-level hospitalization rates of gastrointestinal infections, GI (ICD-9CM 001-009 excluding 008.45) and gastrointestinal symptoms, GS (ICD-9CM 558.9, 787) among US adults aged 65 years and older from the Center for Medicare and Medicaid Services (1991–2004). Linear mixed-effects models were used to assess county-level associations between percent impaired waters and hospitalization rates adjusted for population density, a proxy for person-to-person transmission. Contrary to expectation, both GI and GS were negatively associated with any water impairment in adjusted models (GI: −0.052, 95 % CI: −0.077, −0.028; GS: −0.438, 95 % CI: −0.702, −0.174). GI was also negatively associated with recreational water impairment (−0.079, 95 % CI: −0.123, −0.036 after adjustment). Neither outcome was associated with drinking water impairment. Limited state data were reported to the EPA for specific recreational (27 states) and drinking (13 states) water impairment, thus limiting the power of the study. Though limited, this analysis demonstrates the feasibility of utilizing regulatory data for public health analyses.

Background. A quasi-experimental study was conducted to determine whether or not a protected water supply (bottled drinking water) could prevent or delay cryptosporidial infections among children residing in an endemic community. Methods. A total of 176 children residing in a semiurban slum area in southern India were enrolled preweaning and received either bottled (n = 90) or municipal (n = 86) drinking water based on residence in specific streets. Weekly surveillance visits were conducted until children reached their second birthday. Stool samples were collected every month and during diarrheal episodes, and were tested for the presence of Cryptosporidium species by polymerase chain reaction. Differences in the incidence of cryptosporidiosis between bottled and municipal water groups were compared using Poisson survival models, and a propensity score model was developed to adjust for the effect of potential confounders. Results. A total of 186 episodes of cryptosporidiosis, mostly asymptomatic, were observed in 118 (67%) children during the follow-up period at a rate of 0.59 episodes per child-year. Diarrhea associated with Cryptosporidium species tended to be longer in duration and more severe. Stunting at 6 months was associated with a higher risk of cryptosporidiosis (rate ratio [RR] = 1.40; 95% confidence interval [CI], 1.03–1.91). A higher gastrointestinal disease burden was also seen in children with cryptosporidiosis. Drinking bottled water was not associated with a reduced risk of cryptosporidiosis (adjusted RR = 0.86; 95% CI, .60–1.23). Conclusions. This study documented a high burden of cryptosporidiosis among children in an endemic Indian slum community. The lack of association between drinking bottled water and cryptosporidiosis suggests possible spread from asymptomatically infected individuals involving multiple transmission pathways.

Objectives This study was designed to develop food and liquid cariogenicity indices and to preliminarily test their utility using dietary data from a study of children with and without severe early childhood caries (S-ECC), defined as 3 + smooth surface carious lesions, including at least one pulpally involved tooth. Methods Data were collected in a diverse cohort of low-income preschool-aged children made up of 454 children with S-ECC and 429 caries-free children who presented for care at pediatric dental clinics in Washington, DC, Columbus, OH, and Cincinnati, OH. The cariogenicity indices were used to score dietary data from a Food Frequency Questionnaire (FFQ) and a 24-hour recall (24HR). Results There were no statistically significant differences in mean food cariogenicity scores between groups. The liquid cariogenicity score was higher in the S-ECC group as compared with caries-free children (24HR: 5.28 versus 4.66, respectively, P

Ross River virus (RRV), Barmah Forest virus (BFV), and dengue are three common mosquito-borne diseases in Australia that display notable seasonal patterns. Although all three diseases have been modeled on localized scales, no previous study has used harmonic models to compare seasonality of mosquito-borne diseases on a continent-wide scale. We fit Poisson harmonic regression models to surveillance data on RRV, BFV, and dengue (from 1993, 1995 and 1991, respectively, through 2015) incorporating seasonal, trend, and climate (temperature and rainfall) parameters. The models captured an average of 50–65% variability of the data. Disease incidence for all three diseases generally peaked in January or February, but peak timing was most variable for dengue. The most significant predictor parameters were trend and inter-annual periodicity for BFV, intra-annual periodicity for RRV, and trend for dengue. We found that a Temperature Suitability Index (TSI), designed to reclassify climate data relative to optimal conditions for vector establishment, could be applied to this context. Finally, we extrapolated our models to estimate the impact of a false-positive BFV epidemic in 2013. Creating these models and comparing variations in periodicities may provide insight into historical outbreaks as well as future patterns of mosquito-borne diseases.

The study examined relationships among meteorological parameters, water quality and diarrheal disease counts in two urban and three rural sites in Tamil Nadu, India. Disease surveillance was conducted between August 2010 and March 2012; concurrently water samples from street-level taps in piped distribution systems and from household storage containers were tested for pH, nitrate, total dissolved solids and total and fecal coliforms. Methodological advances in data collection (concurrent prospective disease surveillance and environmental monitoring) and analysis (preserving temporality within the data through time series analysis) were used to quantify independent effects of meteorological conditions and water quality on diarrheal risk. The utility of a local calendar in communicating seasonality is also presented. Piped distribution systems in the study area showed high seasonal fluctuations in water quality. Higher ambient temperature decreased and higher rainfall increased diarrheal risk with temperature being the predominant factor in urban and rainfall in rural sites. Associations with microbial contamination were inconsistent; however, disease risk in the urban sites increased with higher median household total coliform concentrations. Understanding seasonal patterns in health outcomes and their temporal links to environmental exposures may lead to improvements in prospective environmental and disease surveillance tailored to addressing public health problems.

Stunting or reduced linear growth is very prevalent in low-income countries. Recent studies have demonstrated a causal relationship between alterations in the gut microbiome and moderate or severe acute malnutrition in children in these countries. However, there have been no primary longitudinal studies comparing the intestinal microbiota of persistently stunted children to that of non-stunted children in the same community. In this pilot study, we characterized gut microbial community composition and diversity of the fecal microbiota of 10 children with low birth weight and persistent stunting (cases) and 10 children with normal birth weight and no stunting (controls) from a birth cohort every 3 months up to 2 years of age in a slum community in south India. There was an increase in diversity indices (P

In temperate regions, influenza typically arrives with the onset of colder weather. Seasonal waves travel over large spaces covering many climatic zones in a relatively short period of time. The precise mechanism for this striking seasonal pattern is still not well understood, and the interplay of factors that influence the spread of infection and the emergence of new strains is largely unknown. The study of influenza seasonality has been fraught with problems. One of these is the ever-shifting description of illness resulting from influenza and the use of both the historical definitions and new definitions based on actual isolation of the virus. The compilation of records describing influenza oscillations on a local and global scale is massive, but the value of these data is a function of the definitions used. In this review, we argue that observations of both seasonality and deviation from the expected pattern stem from the nature of this disease. Heterogeneity in seasonal patterns may arise from differences in the behaviour of specific strains, the emergence of a novel strain, or cross-protection from previously observed strains. Most likely, the seasonal patterns emerge from interactions of individual factors behaving as coupled resonators. We emphasize that both seasonality and deviations from it may merely be reflections of our inability to disentangle signal from noise, because of ambiguity in measurement and/or terminology. We conclude the review with suggestions for new promising and realistic directions with tangible consequences for the modelling of complex influenza dynamics in order to effectively control infection.