National and state-level trends in the availability of mental health treatment services tailored to individuals ordered to treatment by a court: United States, 2016, 2018, and 2020.

PURPOSE: We sought to identify trends and characteristics associated with the availability of tailored mental health services for individuals involved in the criminal justice system and ordered to treatment by a court, nationally in the US and by state. METHODS: We used National Mental Health Services Survey to identify outpatient mental health treatment facilities in the US (2016 n = 4744; 2018 n = 4626; 2020 n = 4869). We used clustered multiple logistic regression to identify changes over time as well as facility- and state-level factors associated with the availability of specialty court-ordered services. RESULTS: Slightly more than half of the outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation between states. Nationally, there was a significant increase in the odds of offering court-ordered treatment in 2020 compared to 2016 (aOR = 1.16, 95% CI = 1.06-1.27, p < 0.01). Notable associations included offering integrated substance use treatment (versus none, aOR = 2.95, 95% CI = 2.70-3.22, p < 0.0001) and offering trauma therapy (versus none, aOR = 2.05, 95% CI = 1.85-2.27, p < 0.0001). CONCLUSION: The availability of mental health services for individuals ordered to treatment by a court is growing nationally but several states are lagging behind. Court ordered treatment is a promising strategy to improve health and reduce reliance on the carceral system as a healthcare provider. At the same time, we express caution around disparities within behavioral health courts and advocate for equity in access to incarceration alternatives.

Gastroprotective mechanism of Talinum triangulare on ethanol-induced gastric ulcer in Wistar rats via inflammatory, antioxidant, and H+/K+-ATPase inhibition-mediated pathways.

The increase in the incidence of gastric ulcer (GU) has posed major threat on public health. This research aimed to evaluate gastroprotective properties of the aqueous leaf extract of Talium triangulare (AETT) in ethanol-induced gastric ulceration. GU was induced via oral administration of single dose of 5 mLkg-1 of 90% ethanol in rats and protection of 200 mgkg-1 bw of AETT and 20 mgkg-1 bw of omeprazole was investigated for 14 d via oral treatment. Influence of AETT on anti-inflammatory, redox assays, ulcer index (UI), and gastric mucosa histological alterations were evaluated. Significant increase in myeloperoxidase (MPO) and tumor necrosis factor-alpha levels compared to untreated group established gastric inflammation in rats induced by ethanol. Gastric ulcerated group exhibited heightened oxidative stress with concurrent decline in activities of antioxidant enzymes. Ethanol exposure to rats resulted in induction of lipid peroxidation, prominently elevating gastric malondialdehyde (MDA) concentration. Nevertheless, treatment with AETT or omeprazole exhibited substantial anti-inflammatory effects within gastric mucosa by attenuating expression of markers associated with inflammation. AETT demonstrated reduction in concentrations of MDA and H2O2, thereby alleviating progression of lipid peroxidation cascades. Also, AETT exhibited mitigating effect on ethanol-induced oxidative harm by enhancing the functionality of protective enzymes and elevating glutathione (GSH) concentration. Overall, AETT exhibited enhancements in activities of cytoprotective antioxidant enzymes, mitigated impact of oxidative stress and inflammation, inhibited lipid peroxidation, and decreased UI score. These beneficial effects could be attributed to phytochemicals present in AETT including 6,10,14-trimethyl-2-pentadecanone and Phytol. Outcome of this study established the traditional herbal claims of AETT.

Comprehensive and Integrated Services in Specialty Mental Health Treatment Facilities in the US: Differences by the Racial/Ethnic Composition of the Facility's Clientele, 2020.

The integration of multiple ancillary services into mental health treatment settings may improve outcomes, but there are no national studies addressing whether comprehensive services are distributed equitably. We investigated whether the availability of a wide range of service types differs based on the facility's racial/ethnic composition. We used the 2020 National Mental Health Services Survey to identify twelve services offered in outpatient mental health treatment facilities (N = 1,074 facilities). We used logistic regression to model each of the twelve services, predicted by the percentage of a facility's clientele that was White, Black, and Hispanic, adjusted for covariates. Facilities with the highest proportions of Black and Hispanic clientele demonstrated the lowest predicted probabilities of offering comprehensive and integrated services. Our findings offer context around upstream factors that may, in part, drive treatment disparities. We orient our findings around frameworks of structural racism and inequities in mental healthcare.

Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY.

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.

Impact of MiraNet® long-lasting insecticidal net against Anopheles arabiensis wild population of Northern Tanzania.

Despite high levels of pyrethroid resistance reported in malaria vectors, long-lasting insecticidal nets (LNs) still play a key role in controlling malaria transmission. This study tested the efficacy of MiraNet®, a pyrethroid-based LN against a wild population of Anopheles arabiensis in northern Tanzania. DuraNet® was used as a positive control in this evaluation. Standard WHO laboratory bioefficacy evaluations of MiraNet and DuraNet that were unwashed or had been washed 20 times indicated optimal knockdown and mortality for both net types against a susceptible strain of Anopheles gambiae s.s. Standard experimental hut evaluations were conducted to evaluate the efficacy of both nets against a wild population of An. arabiensis. The killing effect of MiraNet was 54.5% for unwashed and 50% for 20 times washed while DuraNet achieved 44.4% mortality for unwashed and 47.4% for 20 times washed against wild An. arabiensis. Both DuraNet and MiraNet exhibited significantly higher killing effects (> 44.4%). There was no significant difference in deterrence or induced exophily detected between the treatment arms for either net. Additionally, there were no adverse effects reported among hut sleepers. The results of this study indicate that the pyrethroid net MiraNet can be used effectively against wild populations of An. gambiae s.l. of low to moderate resistant levels from Northern Tanzania.

How Good Is a Tactical-Grade GNSS + INS (MEMS and FOG) in a 20-m Bathymetric Survey?

This paper examines how tactical-grade Inertial Navigation Systems (INS), aided by Global Navigation Satellite System (GNSS) modules, vary from a survey-grade system in the bathymetric mapping in depths less than 20 m. The motivation stems from the advancements in sensor developments, measurement processing algorithms, and the proliferation of autonomous and uncrewed surface vehicles often seeking to use tactical-grade systems for high-quality bathymetric products. While the performance of survey-grade GNSS + INS is well-known to the hydrographic and marine science community, the performance and limitations of the tactical-grade micro-electro-mechanical system (MEMS) and tactical-grade fiber-optic-gyro (FOG) INS aided with GNSS require some study to answer the following questions: (1) How close or far is the tactical-grade GNSS + INS performance from the survey-grade systems? (2) For what survey order (IHO S-44 6th ed.) can a user deploy them? (3) Can we use them for navigation chart production? We attempt to answer these questions by deploying two tactical-grade GNSS + INS units (MEMS and FOG) and a survey-grade GNSS + INS on a survey boat. All systems collected data while operating a multibeam system with the lever-arm offsets accurately determined using a total station. The tactical-grade GNSS + INSs shared one pair of antennas for heading, while the survey-grade system used an independent antenna pair. We analyze the GNSS + INS results in sequence, examine the patch-test results, and the sensor-specific SBET-integrated bathymetric surfaces as metrics for determining the tactical-grade GNSS + INSs' reliability. In addition, we evaluate the multibeam's sounding uncertainties at different beam angles. The bathymetric surfaces using the tactical-grade navigation solutions are within 15 cm of the surface generated with the survey-grade solutions.

Burnout Among Doctors and Nurses at The University of Uyo Teaching Hospital, South-South, Nigeria: A Comparative Study

BACKGROUND: Burnout remains a crucial occupational health challenge to healthcare professionals given its immediate and remote harmful effects. Doctors and nurses are highly susceptible to burnout due to the essence and demands of their services. The study aimed to determine and compare the prevalence of burnout among doctors and nurses working at the University of Uyo Teaching Hospital, Southern Nigeria. MATERIALS AND METHODS: A comparative, cross-sectional study of 553 doctors and nurses was conducted using a stratified random sampling technique. A pretested, self-administered MBI - Human Services Survey for Medical Personnel - MBI-HSS (MP) was used for data collection and analysis using IBM Statistical Product and Service Solutions (SPSS) software version 23. The Chi-square and Fisher's exact tests were applied with a statistical significance level set at α<0.05. RESULTS: The mean ages for doctors and nurses were 37.1 ± 5.3 and 39.0 ± 9.2 respectively (p=0.003). Burnout prevalence among doctors was 9.7% compared to 5.5% among nurses (p =0.062). Out of 553 respondents, 247 (46.7%) had high emotional exhaustion (EE), 70 (12.7%) had high depersonalization (DP), and 342 (61.9%) had low personal accomplishments (PA). Furthermore, 132 (47.3%) doctors had high EE, 43 (15.4%) had high DP and 159 (57%) had low PA. While 115 (42%) nurses had high EE, 27 (9.9%) had high DP and 183 (66.8%) had a low PA (p=0.041). Excessive workload (p=0.042) and lengthy years in a workplace position (p=0.002) were significantly associated with burnout among doctors compared to family size (p=0.045) and workplace support or community (p=0.005) among nurses. CONCLUSION: The study found burnout prevalence to be higher among doctors than nurses. Work-related factors contributed significantly to burnout development. Recreating and/or modifying workplace environments is essential to mitigating the adverse effects of burnout among healthcare workers.

CONTEXTE: Le burnout demeure un défi crucial pour la santé au travail des professionnels de la santé compte tenu de ses effets immédiats et à distance. Les médecins et les infirmières sont hautement susceptibles au burnout en raison de la nature et des exigences de leurs services. L'étude visait à établir et à comparer la prévalence du burnout parmi les médecins et les infirmières travaillant à l'Hôpital Universitaire de Uyo, dans le sud du Nigéria. MATÉRIEL ET MÉTHODES: Une étude comparative et transversale a été menée auprès de 553 médecins et infirmières à l'aide d'une technique d'échantillonnage aléatoire stratifié. Une enquête préalablement testée, auto-administrée, l'Inventaire d'épuisement professionnel humain pour le personnel médical (MBI-HSS [MP]), a été utilisée pour la collecte et l'analyse des données à l'aide du logiciel IBM Statistical Product and Service Solutions (SPSS) version 23. Les tests du Chi carré et de Fisher ont été appliqués avec un seuil de signification statistique fixé à α<0,05. RÉSULTATS: Les âges moyens des médecins et des infirmières étaient de 37,1 ± 5,3 et 39,0 ± 9,2 respectivement (p = 0,003). La prévalence de l'épuisement professionnel parmi les médecins était de 9,7 % par rapport à 5,5 % parmi les infirmières (p = 0,062). Sur les 553 répondants, 247 (46,7 %) présentaient un épuisement émotionnel élevé (EE), 70 (12,7 %) présentaient une dépersonnalisation élevée (DP) et 342 (61,9 %) présentaient un faible accomplissement personnel (PA). De plus, 132 (47,3 %) médecins avaient un EE élevé, 43 (15,4 %) avaient une DP élevée et 159 (57 %) avaient un PA faible. Tandis que 115 (42 %) infirmières avaient un EE élevé, 27 (9,9 %) avaient une DP élevée et 183 (66,8 %) avaient un PA faible (p = 0,041). Une charge de travail excessive (p = 0,042) et de nombreuses années passées à un poste de travail (p = 0,002) étaient significativement associées à l'épuisement professionnel parmi les médecins, par rapport à la taille de la famille (p = 0,045) et au soutien au travail ou à la communauté (p = 0,005) parmi les infirmières. CONCLUSION: L'étude a révélé une prévalence plus élevée du burnout parmi les médecins que parmi les infirmières. Les facteurs liés au travail ont contribué de manière significative au développement du burnout. Recréer et/ ou modifier les environnements de travail est essentiel pour atténuer les effets néfastes du burnout chez les travailleurs de la santé Mots-clés: épuisement professionnel, épuisement émotionnel, dépersonnalisation, accomplissement personnel, médecins, infirmières, hôpital Universitaire, Uyo, Nigéria.

Support for evidence-informed opioid policies and interventions: The role of racial attitudes, political affiliation, and opioid stigma.

Political affiliation, racial attitudes, and opioid stigma influence public support for public health responses to address opioid use disorders (OUD). Prior studies suggest public perceptions of the opioid epidemic are less racialized and less politically polarized than were public perceptions of the crack cocaine epidemic. Analyzing a cross-sectional, nationally representative sample (n = 1161 U.S. adults) from the October 2020 AmeriSpeak survey, we explored how political affiliation, racial attitudes (as captured in the Color-Blind Racial Attitudes Scale [CoBRAS]), and OUD stigma were associated with respondents' expressed views regarding four critical domains. Respondents with unfavorable attitudes towards Black Americans were less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and distributing naloxone for overdose prevention. Democratic Party affiliation was associated with greater support for all three of the above measures, and increased support for mandatory treatment, which may be seen as a substitute for more punitive interventions. Black respondents were also less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and of distributing naloxone. Our finding suggest that negative attitudes towards African-Americans and political differences remain important factors of public opinion on responding to the OUD epidemic, even after controlling for opioid stigma. Our findings also suggest that culturally-competent dialogue within politically conservative and Black communities may be important to engage public support for evidence-informed treatment and prevention.

Effect of Health Education on the Knowledge of Cervical Cancer and Uptake of Papanicolaou Smear Test among Teachers in Uyo, Akwa Ibom State Nigeria: An Interventional Study.

BACKGROUND: Evidence exists that the uptake of cervical cancer screening is low in Nigeria despite the availability of effective tools. This study determined the effect of health education on the knowledge of cervical cancer and uptake of Papanicolaou (Pap) smear test among teachers in public secondary schools in Uyo, Nigeria. METHODS: This was an interventional study among public secondary school teachers in Uyo, Akwa Ibom State, Nigeria. It entailed a baseline survey, administration of health education sessions on cervical cancer and its screening tests to the intervention group and a post-intervention evaluation. Data was captured using a semi-structured questionnaire and analyzed with Stata software Version 10. RESULTS: There were 185 respondents each in the interventional and control groups. The mean ages of the teachers were 38.7 ± 8.1 years and 37.1 ± 7.7 years respectively. Post-intervention, knowledge of cervical cancer symptoms increased from 10.1% to 66.5% in the intervention group compared to an increase from 7.0% to 12.0% in the control group (p< 0.001). Similarly, risk factor knowledge improved from 6.1% to 59.5% in the intervention group compared to 4.9% to 7.2% in the control group (p< 0.001). Also, the uptake of the Pap smear test increased from 11.9% to 22.2% in the intervention group (p = 0.01) compared to an increase from 4.9% to 7.0% in the control group (p=0.379). CONCLUSION: Health education brought about a significant increase in the knowledge of cervical cancer symptoms/risk factors and uptake of Pap smear test and should therefore, be encouraged among teachers in secondary schools.

CONTEXTE: Il est prouvé que le dépistage du cancer du col de l'utérus est peu pratiqué au Nigeria malgré la disponibilité d'outils efficaces. Cette étude a déterminé l'effet de l'éducation sanitaire sur la connaissance du cancer du col de l'utérus et le recours au test de Papanicolaou (Pap) chez les enseignants des écoles secondaires publiques d'Uyo, au Nigeria. MÉTHODES: Il s'agissait d'une étude interventionnelle parmi les enseignants des écoles secondaires publiques d'Uyo, Etat d'Akwa Ibom, Nigeria. Elle comportait une enquête de base, l'administration de séances d'éducation sanitaire sur le cancer du col de l'utérus et ses tests de dépistage au groupe d'intervention et une évaluation postintervention. Les données ont été recueillies à l'aide d'un questionnaire semi-structuré et analysées avec le logiciel Stata version 10. RÉSULTATS: Il y avait 185 répondants dans les groupes d'intervention et de contrôle. L'âge moyen des enseignants était respectivement de 38,7 ± 8,1 ans et 37,1 ± 7,7 ans. Après l'intervention, la connaissance des symptômes du cancer du col de l'utérus a augmenté de 10,1% à 66,5% dans le groupe d'intervention par rapport à une augmentation de 7,0% à 12,0% dans le groupe de contrôle (p< 0,001). De même, la connaissance des facteurs de risque s'est améliorée de 6,1 % à 59,5 % dans le groupe d'intervention, contre 4,9 % à 7,2 % dans le groupe témoin (p< 0,001). De même, le recours au test de Papanicolaou a augmenté de 11,9% à 22,2% dans le groupe d'intervention (p = 0,01) par rapport à une augmentation de 4,9% à 7,0% dans le groupe de contrôle (p=0,379). CONCLUSION: L'éducation à la santé a entraîné une augmentation significative de la connaissance des symptômes/facteurs de risque du cancer du col de l'utérus et du recours au test de Papanicolaou et devrait donc être encouragée parmi les enseignants des écoles secondaires. Mots clés: Cancer du col de l'utérus, symptômes, facteurs de risque, recours au test de Papanicolaou, enseignant.

Cultural adaptation and psychometric evaluation of the Yoruba version of the Health Literacy Questionnaire.

Background: Health literacy is an important multidimensional concept of public health concern and a determinant of health outcomes and access to healthcare which requires robust measurement. The objective of this study was to culturally adapt and establish the psychometric properties of the Yoruba version of the Health Literacy Questionnaire. Methods: A cross-sectional survey of Nigeria Yoruba speaking adults was conducted with the Health Literacy Questionnaire following its translation and adaptation. Data were subject to psychometric evaluation (confirmatory factor analysis, composite reliability, Cronbach's alpha, intra class correlation) and association with sociodemographic variables. Results: A total of 258 adults with mean age 26.7 years participated in the study. The easiest scale to score highly was 'Actively managing my health' and hardest was 'Ability to find good health information' and 'Navigating the healthcare system'. Six one-factor models fitted well without correlated residuals but the other three had a good fit after model modification. Composite reliability and Cronbach's α of ≥ 0.7 were observed for all scales, suggesting good internal consistency of the scales. Test-retest reliability of the Yoruba translation of the Health Literacy Questionnaire was moderate to good in all scales, intra class correlation ranging from 0.66 to 0.76. Conclusion: The Health Literacy Questionnaire was successfully translated and culturally adapted and demonstrated good content and construct validity and high composite reliability. The Yoruba translation of the Health Literacy Questionnaire has the potential of being a useful clinical tool for the assessment of health literacy, especially among Yoruba speaking community of Nigeria. Thereby helping to improve the health outcomes through access to healthcare.

Expanding access to HIV services during the COVID-19 pandemic-Nigeria, 2020.

BACKGROUND: To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February-September 2020. METHODS: Adapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3-6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring. RESULTS: During February-September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%. CONCLUSIONS: A rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic.

Translation and psychometric evaluation of the Yoruba version of the STarT Back tool among persons with long-term non-specific low-back pain.

Conclusion: The Y-SBT have acceptable psychometric properties. It is recommended for use among Yoruba speaking patients with LBP. Background: Translating questionnaires into local languages is essential as it aids easy accessibility and understanding of such questionnaires by patients and their health caregivers. The STarT Back Tool (SBT), validated tool used to classify subgroups of persons with Low-Back Pain, has few translated versions. We translated the STarT Back Tool into the Yoruba language and established its psychometric properties among patients with long-term non-specific Low-Back Pain. Methods: Following the Lenz protocol, the SBT was successfully cross-culturally adapted into the Yoruba language. One hundred consenting patients (mean age = 57.0±11.43 years, 55% females) took part in the validation phase, while 53 of them participated in the test-retest phase. Psychometric indices of the Y-SBT assessed showed internal consistency, intraclass correlation coefficient (ICC), ceiling and floor effects and divergent validity. Results: The sub- and total Cronbach's α score for Y-SBT was 0.704 and 0.857, respectively. The test-retest reliability of the sub- and total scores of the Y-SBT yielded an ICC of 0.82 (95% CI: 0.74 - 0.87) and 0.89 (95% CI: 0.84 - 0.93), respectively. The divergent validity for sub- and total-scores of the Y-SBT based on Quadruple Visual Analogue Scale score for on-going pain was r = 0.374 (p = 0.001) and r = 0.432 (p = 0.001), respectively. The Y-SBT had no ceiling or floor effects.

May Measurement Month 2018: an analysis of blood pressure screening results from Nigeria.

Hypertension remains the dominant cardiovascular risk factor worldwide. May Measurement Month (MMM) is an annual global programme of the International Society of Hypertension aimed at screening for undetected hypertension in the general population. We report the outcome of MMM 2018 in Nigeria. An opportunistic screening of adults aged at least 18 years was conducted in the six geopolitical zones of Nigeria in the month of May, 2018. Screening for hypertension was done by trained volunteers with the use of validated digital and mercury sphygmomanometers following the MMM protocol. Hypertension was defined as blood pressure (BP) ≥140/90 mmHg or the use of BP-lowering medication. There were 6398 participants (53.0% female) with a mean (SD) age of 41.7 (15.0) years. Hypertension was present in 36.4% of the participants with 51.1% of the hypertensives aware of their status, 41.8% on medication, of whom 43.1% were controlled. Overall, only 18.0% of all hypertensive participants had their BP under control. The proportion with hypertension is high, and awareness, treatment, and control rates are low. Concerted efforts are needed to improve awareness and treatment of hypertension in Nigeria in order to reduce the high rate of complications associated with uncontrolled BP.

Food Hygiene Knowledge and Practice among Food Vendors in Uyo, Nigeria.

BACKGROUND: The role of food vendors in food hygiene and safety is an important one which, if neglected, could lead to outbreaks of food borne illnesses, currently major causes of morbidity and mortality, especially in sub-Saharan Africa and East Asia. OBJECTIVE: The aim of this study was to assess the food hygiene knowledge and practices of food vendors in Uyo, Nigeria. METHODS: This was a descriptive cross-sectional study. Data were collected using a pre-tested semi-structured questionnaire and analyzed with SPSS version 20. RESULTS: A total of 125 respondents participated in the study. The mean age was 31.99 ± 10.51 years, with a male: female ratio of 1:1.04. Thirty-six (28.8%) respondents had good food hygiene knowledge (>75% of maximum scores) which was significantly associated with tertiary level of education and female sex (p<0.05). Only 11 (8.8%) however had good practice (>75% of maximum scores). Tertiary education, working less than 6 hours daily and food hygiene training were significantly associated with good practice scores (p<0.05). The relationship between food hygiene knowledge and practice was statistically significant (p=0.00). There were also statistically significant associations between having good knowledge of food hygiene and use of apron, hair covering, observing good sanitary conditions, water supply, waste disposal and protection of food from flies (p<0.05). CONCLUSION: A link existed between having good level of knowledge and the hygiene practices of the respondents. Food vendors should therefore be adequately trained to equip them to offer sufficiently hygienic services, thus ensuring food safety among the consumers.

Latent Tuberculosis in a Paediatric Health Worker: A Case Report.

BACKGROUND: Latent Tuberculosis (LTBI) affects approximately a third of the world population. Paediatric health workers caring for adolescent Tuberculosis (TB) patients in high TB endemic regions are particularly susceptible as they are exposed to TB in the community and in the work place. However, there is a paucity of reports on LTBI in paediatric health workers. OBJECTIVES: To identify the factors that could have resulted in latent TB in a paediatric health worker Methods/Results: We present a case of a 38-year old female paediatrician who was diagnosed with LTBI by a positive QuantiFERON-TB gold test during the routine new entry immigrant screening for tuberculosis on arrival in the United Kingdom for postgraduate studies. She was treated with three months course of Rifampicin and Isoniazid (plus pyridoxine). CONCLUSION: Latent TB infection may have been acquired from her involvement in the management of adolescents with adult type TB without the use of personal protective equipment. In this case, routine systematic screening of an at risk individual helped to eliminate TB infection. RECOMMENDATION: Paediatric health workers should use personal protective equipment when managing childhood TB and should also be routinely screened for latent TB.

Maize Chlorotic Mottle Virus Induces Changes in Host Plant Volatiles that Attract Vector Thrips Species.

Maize lethal necrosis is one of the most devastating diseases of maize causing yield losses reaching up to 90% in sub-Saharan Africa. The disease is caused by a combination of maize chlorotic mottle virus (MCMV) and any one of cereal viruses in the Potyviridae group such as sugarcane mosaic virus. MCMV has been reported to be transmitted mainly by maize thrips (Frankliniella williamsi) and onion thrips (Thrips tabaci). To better understand the role of thrips vectors in the epidemiology of the disease, we investigated behavioral responses of F. williamsi and T. tabaci, to volatiles collected from maize seedlings infected with MCMV in a four-arm olfactometer bioassay. Volatile profiles from MCMV-infected and healthy maize plants were compared by gas chromatography (GC) and GC coupled mass spectrometry analyses. In the bioassays, both sexes of F. williamsi and male T. tabaci were significantly attracted to volatiles from maize plants infected with MCMV compared to healthy plants and solvent controls. Moreover, volatile analysis revealed strong induction of (E)-4,8-dimethyl-1,3,7-nonatriene, methyl salicylate and (E,E)-4,8,12-trimethyltrideca-1,3,7,11-tetraene in MCMV-infected maize seedlings. Our findings demonstrate MCMV induces changes in volatile profiles of host plants to elicit attraction of thrips vectors. The increased vector contact rates with MCMV-infected host plants could enhance virus transmission if thrips feed on the infected plants and acquire the pathogen prior to dispersal. Uncovering the mechanisms mediating interactions between vectors, host plants and pathogens provides useful insights for understanding the vector ecology and disease epidemiology, which in turn may contribute in designing integrated vector management strategies.

Development of an integrated electronic platform for patient self-report and management of adverse events during cancer treatment.

BACKGROUND: Significant adverse events (AE) during cancer therapy disrupt treatment and escalate to emergency admissions. Approaches to improve the timeliness and accuracy of AE reporting may improve safety and reduce health service costs. Reporting AE via patient reported outcomes (PROs), can improve clinician-patient communication and making data available to clinicians in 'real-time' using electronic PROs (ePROs) could potentially transform clinical practice by providing easily accessible records to guide treatment decisions. This manuscript describes the development of eRAPID (electronic patient self-Reporting of Adverse-events: Patient Information and aDvice) is a National Institute for Health Research-funded programme, a system for patients to self-report and manage AE online during and after cancer treatment. MATERIALS AND METHODS: A multidisciplinary team of IT experts, staff and patients developed using agile principles a secure web application interface (QStore) between an existing online questionnaire builder (QTool) displaying real-time ePRO data to clinicians in the electronic patient record at Leeds Teaching Hospitals NHS Trust. Hierarchical algorithms were developed corresponding to Common Terminology Criteria for Adverse Events grading using the QTool question dependency function. Patient advocates (N = 9), patients (N = 13), and staff (N = 19) usability tested the system reporting combinations of AE. RESULTS: The eRAPID system allows patients to report AE from home on PC, tablet or any web enabled device securely during treatment. The system generates immediate self-management advice for low or moderate AE and for severe AE advice to contact the hospital immediately. Clinicians can view patient AE data in the electronic patient record and receive email notifications when patients report severe AE. CONCLUSIONS: Evaluation of the system in a randomised controlled trial in breast, gynaecological and colorectal cancer patients undergoing systemic therapy is currently underway. To adapt eRAPID for different treatment groups, pilot studies are being undertaken with patients receiving pelvic radiotherapy and upper gastrointestinal surgery. ISRCTN88520246.

Maize Cropping Systems Mapping Using RapidEye Observations in Agro-Ecological Landscapes in Kenya.

Cropping systems information on explicit scales is an important but rarely available variable in many crops modeling routines and of utmost importance for understanding pests and disease propagation mechanisms in agro-ecological landscapes. In this study, high spatial and temporal resolution RapidEye bio-temporal data were utilized within a novel 2-step hierarchical random forest (RF) classification approach to map areas of mono- and mixed maize cropping systems. A small-scale maize farming site in Machakos County, Kenya was used as a study site. Within the study site, field data was collected during the satellite acquisition period on general land use/land cover (LULC) and the two cropping systems. Firstly, non-cropland areas were masked out from other land use/land cover using the LULC mapping result. Subsequently an optimized RF model was applied to the cropland layer to map the two cropping systems (2nd classification step). An overall accuracy of 93% was attained for the LULC classification, while the class accuracies (PA: producer's accuracy and UA: user's accuracy) for the two cropping systems were consistently above 85%. We concluded that explicit mapping of different cropping systems is feasible in complex and highly fragmented agro-ecological landscapes if high resolution and multi-temporal satellite data such as 5 m RapidEye data is employed. Further research is needed on the feasibility of using freely available 10-20 m Sentinel-2 data for wide-area assessment of cropping systems as an important variable in numerous crop productivity models.

Maize Lethal Necrosis (MLN), an Emerging Threat to Maize-Based Food Security in Sub-Saharan Africa.

In sub-Saharan Africa, maize is a staple food and key determinant of food security for smallholder farming communities. Pest and disease outbreaks are key constraints to maize productivity. In September 2011, a serious disease outbreak, later diagnosed as maize lethal necrosis (MLN), was reported on maize in Kenya. The disease has since been confirmed in Rwanda and the Democratic Republic of Congo, and similar symptoms have been reported in Tanzania, Uganda, South Sudan, and Ethiopia. In 2012, yield losses of up to 90% resulted in an estimated grain loss of 126,000 metric tons valued at $52 million in Kenya alone. In eastern Africa, MLN was found to result from coinfection of maize with Maize chlorotic mottle virus (MCMV) and Sugarcane mosaic virus (SCMV), although MCMV alone appears to cause significant crop losses. We summarize here the results of collaborative research undertaken to understand the biology and epidemiology of MLN in East Africa and to develop disease management strategies, including identification of MLN-tolerant maize germplasm. We discuss recent progress, identify major issues requiring further research, and discuss the possible next steps for effective management of MLN.

Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015.

Current Ebola virus disease (EVD) diagnosis relies on reverse transcription-PCR (RT-PCR) technology, requiring skilled laboratory personnel and technical infrastructure. Lack of laboratory diagnostic capacity has led to diagnostic delays in the current West African EVD outbreak of 2014 and 2015, compromising outbreak control. We evaluated the diagnostic accuracy of the EVD bedside rapid diagnostic antigen test (RDT) developed by the United Kingdom's Defence Science and Technology Laboratory, compared with Ebola virus RT-PCR, in an operational setting for EVD diagnosis of suspected cases admitted to Ebola holding units in the Western Area of Sierra Leone. From 22 January to 16 February 2015, 138 participants were enrolled. EVD prevalence was 11.5%. All EVD cases were identified by a positive RDT with a test line score of 6 or more, giving a sensitivity of 100% (95% confidence interval (CI): 78.2-100). The corresponding specificity was high (96.6%, 95% CI: 91.3-99.1). The positive and negative predictive values for the population prevalence were 79.0% (95% CI: 54.4-93.8) and 100% (95% CI: 96.7-100), respectively. These results, if confirmed in a larger study, suggest that this RDT could be used as a 'rule-out' screening test for EVD to improve rapid case identification and resource allocation.