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Background The mainstay of soil-transmitted helminth (STH) control is repeated mass drug administration (MDA) of anthelmintics to endemic populations. Individual longitudinal compliance treatment patterns are important for identifying pockets of infected individuals who remain untreated and serve as infection reservoirs. Methods The Geshiyaro Project censused the study population in Wolaita, Ethiopia at baseline in 2018. Individual longitudinal compliance was recorded for six rounds of community-wide MDA (cMDA). The probability distribution of treatment frequency was analysed by age and gender stratifications. Probabilities of transmission interruption for different compliance patterns were calculated using an individual-based stochastic model of Ascaris lumbricoides transmission. Results The never-treated (0.42%) population was smaller than expected from a random positive binomial distribution. The observed compliance frequency was well described by the beta-binomial distribution. Preschool-age children (odds ratio [OR] 10.1 [95% confidence interval {CI} 6.63 to 15.4]) had the highest never-treated proportion of the age groups. Conversely, school-age children (SAC) and adults (OR 1.03 [95% CI 0.98 to 1.09]) had the highest always-treated proportion of the age groups. Conclusions The study reports the largest dataset of individual longitudinal compliance to cMDA for STH control. Clear pattens are shown in the age-dependent distribution of individual compliance behaviour. The impact of compliance on the probability of elimination is significant, highlighting the importance of recording the full frequency distribution, not just the never-treated proportion. [ABSTRACT FROM AUTHOR]

Background: This paper documents changes in the prevalence and intensity of soil-transmitted helminth (STH) infections in the Geshiyaro project in the Wolaita zone of Southern Ethiopia., Methods: The Geshiyaro project comprises three intervention arms. Arm 1 is subdivided into the Arm 1 pilot (one district) and Arm 1 (four other districts), both receiving integrated community-wide mass drug administration MDA (cMDA) with intensive water, sanitation, and hygiene (WaSH) interventions. Arm 2 involves 18 districts with cMDA interventions plus the existing government-led One WaSH program, while Arm 3 serves as a control with school-based MDA (sMDA) interventions plus the existing government-led One WaSH program in three districts. The study is designed as a cohort investigation over time, with the establishment of longitudinal sentinel sites where infection levels are assessed annually. A total of 45 longitudinal parasitological surveillance sentinel sites are being used across all three intervention arms to monitor STH prevalence and intensity of infection. From each of the 45 sentinel sites, 150 individuals were randomly selected, stratified by age and gender. The t-test and analysis of variance (ANOVA) were employed to compare infection prevalence and intensity across the three study arms over time., Results: The prevalence of STH decreased significantly from 34.5% (30.6%, 38.5%) in 2019 to 10.6% (8.3%, 13.4%) in 2022/2023 (df = 1, P < 0.0001) in the Arm 1 pilot, from 27.4% (25.2%, 29.7%) in 2020 to 5.5% (4.4%, 6.7%) in 2023 (df = 1, P < 0.0001) in Arm 1, from 23% (21.3%, 24.8%) in 2020 to 4.5% (3.7%, 5.3%) in 2023 (df = 1, P < 0.001) in Arm 2, and from 49.6% (47.4%, 51.7%) in 2021 to 26.1% in 2023 (df = 1, P < 0.0001) in Arm 3. The relative reduction in the prevalence of any STH was the highest in the arms employing cMDA, namely Arm 2, with a decrease of 82.5% (79.3%, 84.2%), followed by Arm 1 with a reduction of 80.1% (75.3%, 84.6%), and then the Arm 1 pilot with a decrease of 69.4% (60.1%. 76.6%). Arm 3 employing sMDA had the lowest decrease, with a reduction of 46.9% (43.6%, 51%). The mean intensity of infection (based on Kato-Katz egg count measures) for Ascaris lumbricoides species, which was the dominant STH species present in the study area, decreased significantly in Arms 1 and 2, but only slightly in Arm 3. The prevalence of hookworm and Trichuris trichiura infections were found to be very low in all arms but also decreased significantly., Conclusions: The reduction in the prevalence and intensity of STH in Arms 1 and 2 revealed steady progress towards transmission interruption based on cMDA intervention, but additional efforts with MDA coverage and WaSH interventions are needed to achieve a prevalence threshold < 2% based on the quantitative polymerase chain reaction (qPCR) diagnostic method., (© 2024. The Author(s).)

Background: This paper describes changes in the prevalence and intensity of schistosome parasite infections in a project integrating mass drug administration (MDA), water, sanitation, and hygiene (WaSH), and behavioral change interventions., Methods: The Geshiyaro Project comprises three intervention arms. Arm 1 is subdivided into "Arm 1 pilot" (one district) and Arm 1 (four other districts), both receiving integrated community-wide MDA with intensive WaSH interventions. Arm 2 involves 17 districts with community-wide MDA interventions, while Arm 3 serves as a control with school-based MDA interventions in three districts. A total of 150 individuals, stratified by age group, were randomly selected from each of the 45 sentinel sites. Arm sizes were 584 (Arm 1 pilot), 1636 (Arm 1), 2203 (Arm 2), and 2238 (Arm 3). Statistical tests were employed to compare infection prevalence and intensity across the different arms., Results: The prevalence of schistosome parasite infection ranged from 0% to 2.6% and from 1.7% to 25.7% across districts, employing the Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA) diagnostics, respectively. The mean infection intensity level showed no marked difference between baseline and follow-up surveys when measured by KK, except in Arm 2 (t = 6.89, P < 0.0001). Infection prevalence decreased significantly in Arm 1 (t = 8.62, P < 0.0001), Arm 2 (t = 6.94, P < 0.0001), and Arm 3 (t = 8.83, P < 0.0001), but not in Arm 1 pilot (t = 1.69, P = 0.09) by POC-CCA, when trace was considered positive. The decrease was significant only in Arm 1 (t = 3.28, P = 0.0001) and Arm 2 (t = 7.62, P < 0.0001) when the trace was considered negative in POC-CCA. Arm 2 demonstrated a significant difference in difference (DID) compared to the control group, Arm 3, regardless of whether trace in POC-CCA was considered positive (DID = 3.9%, df = 8780, P = 0.025) or negative (DID = -5.2, df = 8780, P = 0.0004)., Conclusions: The prevalence of schistosomiasis was low when employing the KK diagnostic but moderate in some locations by the POC-CCA diagnostic. The infection level had decreased across all arms of the Geshiyaro study at mid-term of the 7-year project, but further efforts are needed to reduce the rate of parasite transmission based on the POC-CCA diagnostic scores., (© 2024. Crown.)

Objectives: Deworming programmes of soil-transmitted helminths are generally monitored and evaluated by aggregating drug coverage and infection levels at a district level. However, heterogeneity in drug coverage at finer spatial scales means indicators may remain above thresholds for elimination as a public health problem or of transmission in some areas. This paper aims to highlight the misleading information that aggregating data at larger spatial scales can have for programme decision making., Methods: Drug coverage data from the Geshiyaro project were compared at two spatial scales with reference to the World Health Organisation's targets. District (woreda) and village (kebele) level were compared. The association between infection levels and drug coverage was analysed by fitting a weighted least-squares function to the mean intensity of infection (eggs per gram of faeces) against drug coverage., Results: The data show clearly that when the evaluation of coverage is aggregated to the district level, information on heterogeneity at a finer spatial scale is lost. Infection intensity decreases significantly (p = 0.0023) with increasing drug coverage., Conclusion: Aggregating data at large spatial scales can result in prematurely ceasing deworming, prompting rapid infection bounce-back. There is a strong need to define context-specific spatial scales for monitoring and evaluating intervention programmes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rayment Gomez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Current WHO strategies for reaching soil-transmitted helminths (STH) elimination as a public health problem excludes treating certain adult populations in endemic areas, creating infection reservoirs that drive 'bounce back' of STH infection to pretreatment levels post-mass drug administration (MDA). Predisposition is a widespread, but poorly understood phenomena among helminth infections where individuals are predisposed to reinfection after repeated treatments., Methods: This analysis uses Geshiyaro project data, an STH control programme exploring transmission interruption by community-wide MDA and enhanced water, sanitation and hygiene during 2019-2023. Parasitological survey data from longitudinal cohorts are analysed using Kendall's Tau-b rank correlation to assess the evidence for predisposition to light or heavy infection between four consecutive rounds of MDA., Results: Correlation analyses revealed the strongest evidence for predisposition to heavy or light Ascaris lumbricoides infection was between survey 1 and 2 (Tau-b 0.29; p<0.001). Overall patterns were not observed for Trichuris trichiura or hookworm infections, however, some significant and notable correlations were recorded for some stratifications and time points., Conclusions: Evidence for predisposition in endemic settings in southern Ethiopia with low STH prevalence suggests that more targeted approaches to MDA in those predisposed to infection may be a sensible control strategy if cheap, point of care diagnostics are available., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

The accuracy and flexibility of artificial intelligence (AI) systems often comes at the cost of a decreased ability to offer an intuitive explanation of their predictions. This hinders trust and discourage adoption of AI in healthcare, exacerbated by concerns over liabilities and risks to patients' health in case of misdiagnosis. Providing an explanation for a model's prediction is possible due to recent advances in the field of interpretable machine learning. We considered a data set of hospital admissions linked to records of antibiotic prescriptions and susceptibilities of bacterial isolates. An appropriately trained gradient boosted decision tree algorithm, supplemented by a Shapley explanation model, predicts the likely antimicrobial drug resistance, with the odds of resistance informed by characteristics of the patient, admission data, and historical drug treatments and culture test results. Applying this AI-based system, we found that it substantially reduces the risk of mismatched treatment compared with the observed prescriptions. The Shapley values provide an intuitive association between observations/data and outcomes; the associations identified are broadly consistent with expectations based on prior knowledge from health specialists. The results, and the ability to attribute confidence and explanations, support the wider adoption of AI in healthcare., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cavallaro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The life cycle of parasitic organisms that are the cause of much morbidity in humans often depend on reservoirs of infection for transmission into their hosts. Understanding the daily, monthly and yearly movement patterns of individuals between reservoirs is therefore of great importance to implementers of control policies seeking to eliminate various parasitic diseases as a public health problem. This is due to the fact that the underlying spatial extent of the reservoir of infection, which drives transmission, can be strongly affected by inputs from external sources, i.e., individuals who are not spatially attributed to the region defined by the reservoir itself can still migrate and contribute to it. In order to study the importance of these effects, we build and examine a novel theoretical model of human movement between spatially-distributed focal points for infection clustered into regions defined as 'reservoirs of infection'. Using our model, we vary the spatial scale of human moment defined around focal points and explicitly calculate how varying this definition can influence the temporal stability of the effective transmission dynamics - an effect which should strongly influence how control measures, e.g., mass drug administration (MDA), define evaluation units (EUs). Considering the helminth parasites as our main example, by varying the spatial scale of human movement, we demonstrate that a critical scale exists around infectious focal points at which the migration rate into their associated reservoir can be neglected for practical purposes. This scale varies by species and geographic region, but is generalisable as a concept to infectious reservoirs of varying spatial extents and shapes. Our model is designed to be applicable to a very general pattern of infectious disease transmission modified by the migration of infected individuals between clustered communities. In particular, it may be readily used to study the spatial structure of hosts for macroparasites with temporally stationary distributions of infectious focal point locations over the timescales of interest, which is viable for the soil-transmitted helminths and schistosomes. Additional developments will be necessary to consider diseases with moving reservoirs, such as vector-born filarial worm diseases., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Counselling helplines or hotlines are key support services for young people with mental health concerns or in suicide and self-harm crises. We aimed to describe young peoples' use of a national youth helpline (Kids Helpline, Australia, KHL) to understand how usage changed over time. A descriptive analysis was conducted on 1,415,228 answered contacts between 2012-2018. We described the trend of service usage over the observed period, the types of youth who used the service, and the problems young people contacted the service about. Phone (APC = -9.1, KHL: -10.4 to -7.8, p < 0.001) and email (APC = -13.7, 95%CI: -17.1 to -10.2, p < 0.001) contacts decreased over time whereas webchat contacts increased (APC = 16.7, 95%CI: 11.7 to 22.0, p < 0.001). With this increase in webchat contacts, there was an associated increase in total webchat contact duration. Concerns raised in contacts to the service were primarily related to emotional wellbeing and mental health concerns (53.2% phone, 57.3% webchat, 58.2% email) followed by social relationship issues (20.4% phone, 20.3% webchat, 16.8% email) and family relationships (19.4% phone, 17.2% webchat, 21.8% email). The increased preference for online text-based information and counselling services can help inform development of services for young people and allocation of staff/service training and resources.

Background: Electronic decision support systems could reduce the use of inappropriate or ineffective empirical antibiotics. We assessed the accuracy of an open-source machine-learning algorithm trained in predicting antibiotic resistance for three Gram-negative bacterial species isolated from patients' blood and urine within 48 h of hospital admission., Methods: This retrospective, observational study used routine clinical information collected between January 2010 and October 2016 in Birmingham, UK. Patients from whose blood or urine cultures Escherichia coli, Klebsiella pneumoniae or Pseudomonas aeruginosa was isolated were identified. Their demographic, microbiology and prescribing data were used to train an open-source machine-learning algorithm-XGBoost-in predicting resistance to co-amoxiclav and piperacillin/tazobactam. Multivariate analysis was performed to identify predictors of resistance and create a point-scoring tool. The performance of both methods was compared with that of the original prescribers., Results: There were 15 695 admissions. The AUC of the receiver operating characteristic curve for the point-scoring tools ranged from 0.61 to 0.67, and performed no better than medical staff in the selection of appropriate antibiotics. The machine-learning system performed statistically but marginally better (AUC 0.70) and could have reduced the use of unnecessary broad-spectrum antibiotics by as much as 40% among those given co-amoxiclav, piperacillin/tazobactam or carbapenems. A validation study is required., Conclusions: Machine-learning algorithms have the potential to help clinicians predict antimicrobial resistance in patients found to have a Gram-negative infection of blood or urine. Prospective studies are required to assess performance in an unselected patient cohort, understand the acceptability of such systems to clinicians and patients, and assess the impact on patient outcome., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: It has often been reported that young people are at high risk of mental health concerns, more so than at any other time in development over their life span. The situational factors that young people report as impacting their well-being are not addressed as often: specifically, family discord. Kids Helpline, a national service in Australia that provides free counseling online and by telephone to young people in distress, report that family discord and well-being issues are one of the major concerns reported by clients. In order to meet the preferences that young people seek when accessing counseling support, Kids Helpline has designed and trialed a custom-built social network platform for group counseling of young people experiencing family discord that impacts their well-being., Objective: In this exploratory study, we communicate the findings of Phase 1 of an innovative study in user and online counselor experience. This will lead to an iterative design for a world-first, purpose-built social network that will do the following: (1) increase reach and quality of service by utilizing a digital tool of preference for youth to receive peer-to-peer and counselor-to-peer support in a safe online environment and (2) provide the evidence base to document the best practice for online group counseling in a social network environment., Methods: The study utilized a participatory action research design. Young people aged 13-25 years (N=105) with mild-to-moderate depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the social networking site (SNS) for peer-to-peer and counselor-to-peer group support. Subjects were grouped into age cohorts of no more than one year above or below their reported age and assigned to groups of no more than 36 participants, in order to create a community of familiarity around age and problems experienced. Each group entered into an 8-week group counseling support program guided by counselors making regular posts and providing topic-specific content for psychoeducation and discussion. Counselors provided a weekly log of events to researchers; at 2-week intervals, subjects provided qualitative and quantitative feedback through open-ended questions and specific psychometric measures., Results: Qualitative results provided evidence of user support and benefits of the online group counseling environment. Counselors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes of mood or affect. Counselors and users suggested improvements to the platform to increase user engagement., Conclusions: Phase 1 provided proof of concept for this mode of online counseling delivery. Users and counselors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000518460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370381., (©Andrew James Campbell, Brad Ridout, Krestina Amon, Pablo Navarro, Brian Collyer, John Dalgleish. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.12.2019.)

Background: There is strong evidence that plain cigarette packaging and health warning labels (HWLs) reduce brand appeal and increase health knowledge. There is limited evidence examining this population-level public health approach for cannabis packaging. This issue is of particular importance in light of the recent legalization of recreational cannabis in Canada. The current study examined perceptions of plain packaging and HWLs for cannabis packages among young adults., Methods: An online experimental study was conducted with a sample of university students in Alberta, Canada (n = 656). Respondents were randomly assigned to view cannabis packages in one of four conditions: Condition 1: branded pack, Condition 2: plain pack (uniform color, brand imagery removed, standardized font), Condition 3: branded pack with a HWL, and Condition 4: plain pack with a HWL. Respondents in Conditions 3 and 4 viewed five text-based HWLs, each corresponding to a health effect associated with cannabis use: (1) brain development, (2) mental health issues, (3) impaired driving, (4) nonlethal overdose, and (5) addiction. After viewing packs, respondents rated packs and health warnings on various measures., Results: Branded packages without HWLs were rated as most appealing compared to all other packs (p < 0.001 for all contrasts). No differences were found in ratings of appeal when comparing branded and plain packs with HWLs. Warning messages for cognitive development and impaired driving were rated highest on levels of perceived effectiveness, believability, and fear, whereas the addiction warning was rated among the lowest. In general, there were gaps in health knowledge related to cannabis use, however after viewing packs with warnings (compared to viewing packs without warnings) levels of health knowledge increased across all health effects (p < 0.01 for all). Lastly, a significant majority of young adults reported they would purchase the branded pack without a HWL (39.5%), compared to all other pack types (p < 0.05 for all contrasts). The lowest proportion of young adults reported they would purchase a plain pack with a HWL (1.1%)., Conclusions: Plain packaging and health warnings may reduce brand appeal and increase health knowledge among young adults.