A community-engaged infection prevention and control approach to Ebola.

The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS.

Y-chromosome analysis reveals genetic divergence and new founding native lineages in Athapaskan- and Eskimoan-speaking populations.

For decades, the peopling of the Americas has been explored through the analysis of uniparentally inherited genetic systems in Native American populations and the comparison of these genetic data with current linguistic groupings. In northern North America, two language families predominate: Eskimo-Aleut and Na-Dene. Although the genetic evidence from nuclear and mtDNA loci suggest that speakers of these language families share a distinct biological origin, this model has not been examined using data from paternally inherited Y chromosomes. To test this hypothesis and elucidate the migration histories of Eskimoan- and Athapaskan-speaking populations, we analyzed Y-chromosomal data from Inuvialuit, Gwich'in, and Tlich populations living in the Northwest Territories of Canada. Over 100 biallelic markers and 19 chromosome short tandem repeats (STRs) were genotyped to produce a high-resolution dataset of Y chromosomes from these groups. Among these markers is an SNP discovered in the Inuvialuit that differentiates them from other Aboriginal and Native American populations. The data suggest that Canadian Eskimoan- and Athapaskan-speaking populations are genetically distinct from one another and that the formation of these groups was the result of two population expansions that occurred after the initial movement of people into the Americas. In addition, the population history of Athapaskan speakers is complex, with the Tlich being distinct from other Athapaskan groups. The high-resolution biallelic data also make clear that Y-chromosomal diversity among the first Native Americans was greater than previously recognized.

Knowledge, Beliefs, and Experience Regarding Slow Lorises in Southern Thailand: Coexistence in a Developed Landscape.

Natural landscapes are being converted for agriculture and other human uses across Asia and this development presents potential threats for specialist species of primates, like the Endangered slow lorises of Thailand (Nycticebus bengalensis and N. coucang). It is crucial to understand the interface between humans and slow lorises in order to conserve these primates. Local ecological knowledge provides valuable information about these cryptic nocturnal species. We conducted 36 semi-structured interviews in Khao Lak, in southern Thailand, asking (1) where slow lorises were seen, (2) what they were doing, (3) how often people see slow lorises, and (4) what people knew about them. We converted the interviews to free lists and determined the importance of key words. Our results show that the informants saw lorises frequently in six general locations: forests/trees (58%), electric wires (47%), towns/villages (36%), plantations (33%), homesteads (28%), and roads (17%). The most prominent places were forests/trees, wires, and plantations. Eleven key concepts defined local beliefs, with the most prominent being that lorises are awake at night (69%), eat fruit (42%), are not aggressive (25%), are bad omens (25%), and there used to be more of them (25%). Due to a minimal presence of persecution or exploitation of slow lorises by humans in the study area and general tolerance in the face of competition for the same resources and spaces, we suggest that, despite extensive persecution for the illegal photo prop trade in nearby Phuket, the people of Khao Lak seem to live in a state of passive coexistence with slow lorises. However, we did find some evidence that the pet and photo prop trade are still present in the area. It is crucial that coexistence be struck within the context of deforestation and urbanization so that conservation initiatives can take place within the community to further improve the lives of humans and the status of lorises.

Impact of community-based interventions on condom use in the Tlicho region of Northwest Territories, Canada.

BACKGROUND: Since 2005, the Tlicho Community Services Agency (TCSA) in Canada's Northwest Territories (NT) has addressed rising rates of sexually transmitted infections (STI). In 2009, STI rates in the NT were ten times higher than the national rate and Tlicho regional rates were nearly four times that of the NT--91 cases per 1000 people. We describe a social audit process that assessed the impact of an evidence-based community-led intervention. METHODS: A baseline survey of sexual health knowledge, attitudes and behaviours in 2006/07 provided evidence for a Community Action Research Team (CART) to develop and to put in place culturally appropriate interventions in the Tlicho region. A follow-up study in 2010 sought to assess the impact of CART activities on condom use and underlying conscious knowledge, attitudes, subjective norms, intention to change, sense of agency and discussions related to condom use and STI risks. We report the contrasts using Odds Ratios (OR) and 95% confidence intervals (CI). RESULTS: One in every three follow-up respondents (315/808) participated in at least one CART activity. Participation in highly ranked interventions was associated with increased condom use during the last sexual encounter (OR 1.45, 95%CI 1.07-1.98). Those exposed to three or more activities were more likely to talk openly about condoms (OR 2.08, 95%CI 1.41-3.28), but were also less likely to be monogamous (OR 0.49, 95%CI 0.29-0.90). CONCLUSIONS: The measurable impact on condom use indicates a strong beginning for the Tlicho community intervention programmes. The interventions also seem to generate increased discussion, often a precursor to action. The Tlicho can use the evidence to improve and refocus their programming, increase knowledge and continue to improve safe condom use practices.

Suspect screening and prioritization of chemicals of concern (COCs) in a forest-water reuse system watershed.

Much research has assessed organic chemicals of concern (COCs) in municipal wastewater and receiving waters, but few studies have examined COCs in land treatment systems. Many prior studies have implemented targeted methods that quantify a relatively small fraction of COCs present in wastewater and receiving waters. This study used suspect screening to assess chemical features in ground- and surface waters from a watershed where secondary-treated wastewater is irrigated onto 900 ha of temperate forest, offering a more holistic view of chemicals that contribute to the exposome. Chemical features were prioritized by abundance and ToxPi scoring across seasonal sampling events to determine if the forest-water reuse system contributed to the chemical exposome of ground- and surface waters. The number of chemical features detected in wastewater was usually higher than on- and off-site ground- and surface waters; in wastewater, chemical features trended with precipitation in which greater numbers of features were detected in months with low precipitation. The number of chemical features detected in off- and on-site waters was similar. The lower overlap between chemical features found in wastewater and downstream surface waters, along with the similar numbers of features being detected in upstream and downstream surface waters, suggests that though wastewater may be a source of chemicals to ground and surface waters on-site, dissipation of wastewater-derived features (in number and peak area abundance) likely occurs with limited off-site surface water export by the forested land treatment system. Further, the numbers of features detected on site and the overlap between wastewater and surface waters did not increase during periods of low rainfall, counter to our initial expectations. The chemical features tentatively identified in this watershed appear common to features identified in other studies, warranting further examination on the potential for resulting impacts of these on humans and the environment.

Survey of practitioners handling slow lorises (Primates: Nycticebus): an assessment of the harmful effects of slow loris bites.

Slow lorises (Nycticebus spp.) are one of six venomous mammals, and the only known venomous primate. In the wild envenomation occurs mainly during conspecific competition for mates and territory, but may also be used as an application against parasites or for predator defense. Envenomation in humans is documented, with the most extreme accounts detailing near-fatal anaphylactic shock. From September 2016 - August 2017, we received questionnaire responses from 80 wild animal practitioners working with Nycticebus spp. in zoos, rescue centres and in the wild. We identified 54 practitioners who had experience of being bitten or were otherwise affected by slow loris venom, and an additional 26 incomplete entries. No fatalities were reported. Fifteen respondents noted that medical intervention was required, 12 respondents indicated no reaction to being bitten (9 of these indicated they were wearing gloves). Symptoms for those affected included: anaphylactic shock, paraesthesia, haematuria, dyspnoea, extreme pain, infection and general malaise. Impact of slow loris bites ranged from instantaneous to long-persisting complications, and healing time ranged from 1 day to >8 months. Extremities, including hands and arms, were mostly affected from the bites. Six of nine species of slow loris were reported to bite, with N. pygmaeus being the most common in our sample. We make suggestions regarding the use of these highly threatened yet dangerous primates as unsuitable tourist photo props and zoo animal ambassadors. We discuss the medical complications experienced in relation to protein sensitisation, and bacterial pathogenesis. We recommend future work to ascertain the protein content of slow loris venom to aid in enabling mitigation of risks posed.

Knowledge profiling as emergent theory in community-based participatory research.

BACKGROUND: Many sources of valid knowledge may be relevant to a research question. Communities need a mechanism to explore the full range of knowledge that could enrich community-based research. A knowledge profile (KP) is an integrated description of the knowledge and expertise that, once assembled, can help to explore a research issue. OBJECTIVE: This article describes the establishment of a KP as a purposive process whereby the initial research team identifies the kinds of knowledge that can help to articulate and refine a research question, and assemble the right research team and resources. METHOD: The KP process is conducted by a core team, which may expand to include additional expertise. The four phases of a KP are (1) creating the research space, (2) articulating and negotiating, (3) identifying the research question, and (4) creating the resource inventory. The process is illustrated by a case study. The outcomes of a successful KP include an inventory of existing and required resources, a strong research team operating in an ethical and safe research space, and clear articulation of the research question. The KP can be revisited regularly throughout a project to evaluate the effectiveness of the research team. CONCLUSION: KP provides a road map for community-based research teams to navigate through the early phase of research development.

Community-coordinated Research as HIV/AIDS Prevention Strategy in Northern Canadian Communities.

The Tlichǫ Community Services Agency's (TCSA) Healing Wind Strategy identifies a number of activities and interventions to address the prevention of STI/HIV/AIDS in the Tlichǫ region of the Northwest Territories of Canada. As a part of this strategy, the TCSA and CIET facilitated research to develop a foundation for interventions targeting sexually transmitted infections. The project recruited and trained community-based researchers who conducted a research survey on sexual health attitudes and behaviours in the four Tlichǫ communities, covering 65% of the population above 9 years of age. The research process, outcomes, and the strategic plan that arose from the research findings produced a clear framework for interventions that are grounded in the community, but could also influence national and territorial policy. The approach may be relevant in other settings.