Incidence of fungal contamination in fresh ginseng samples and mycotoxigenic potential of representative fungal isolates.

BACKGROUND: Fresh ginseng is typically accompanied by soil after harvest, leading to contamination with harmful fungi during storage and distribution. In this study, we investigated the incidence of fungal contamination in fresh ginseng (5-6 years old) purchased from 22 different stores in Geumsan, Korea. RESULTS: The incidence of fungal contamination in the samples was 67.4-111.5%. Fusarium solani was the most abundant species in the head (38.5%) and fine root (19.3%) parts of the ginseng samples, whereas F. oxysporum was the most abundant in the main root (22.0%) part. We isolated Aspergillus, Fusarium and Penicillium spp. (total number of isolates: 395) from the ginseng samples, and 138 isolates were identified using phylogenetic analysis. Polymerase chain reaction-based screening of 65 mycotoxin-producing species revealed that two P. expansum isolates were positive for citrinin and/or patulin, and five F. oxysporum isolates were positive for fumonisin biosynthesis gene. One P. expansum isolate produced 738.0 mg kg-1 patulin, and the other produced 10.4 mg kg-1 citrinin and 12.0 mg kg-1 patulin on potato dextrose agar (PDA) medium. Among the 47 representative F. oxysporum isolates, 43 (91.5%) produced beauvericin (0.1-15.4 mg kg-1) and four of them (8.5%) produced enniatin B and enniatin B1 (0.1-1.8 mg kg-1) as well. However, none of these toxins was detected in fresh ginseng samples. CONCLUSION: Fusarium solani and F. oxysporum were the most abundant species in fresh ginseng samples. Most F. oxysporum (43) and P. expansum (2) strains isolated from fresh ginseng produced beauvericin and enniatins (B and B1), and patulin or citrinin, respectively, on PDA medium. This is the first report of the mycotoxigenic potential of P. expansum and F. oxysporum strains isolated from fresh ginseng. © 2024 Society of Chemical Industry.

Flexibility for Intensity Dosing in Lingual Resistance Exercises: A Large Randomized Clinical Trial in Typically Aging Adults as Proof of Principle.

OBJECTIVE: The objective of this study was to determine the effect of intensity dosing during tongue exercise on tongue pressure generation, adherence, and perceived effort. DESIGN: This was a five-site, prospective, randomized clinical trial. Outcome measures were obtained across multiple baselines, biweekly during exercise, and 4-weeks post-intervention. SETTING: The general community at each study site. PARTICIPANTS: Typically aging adults between 55-82 years of age with no history of neurological or swallowing disorders. Eighty-four volunteers completed the study. INTERVENTIONS: Participants were randomly assigned to one of four exercise groups: (a) maximum intensity/no biofeedback, (b) progressive intensity/no biofeedback, (c) maximum intensity/biofeedback, and (d) progressive intensity/biofeedback. Half of the participants completed a maintenance exercise program. OUTCOME MEASURES: Maximum isometric pressure (MIP), regular effort saliva swallow pressure, adherence, and the Borg Rating of Perceived Exertion Scale. RESULTS: All exercise protocols were efficacious for gains in MIP (large effect sizes; Cohen's d). Group 3 made gains in regular effort saliva swallow pressure (medium effect size). There was a significant change in perceived exertion for regular effort saliva swallow pressure at 8 weeks. Tongue pressure gains were maintained at 1 month, regardless of maintenance group status. Mean adherence across groups was high. CONCLUSIONS: All groups improved pressure generation. Intensity dosing differences did not affect strength gains, adherence, or detraining. Regular effort saliva swallow pressure may be most responsive to maximum intensity with biofeedback. The findings suggest flexibility in approach to tongue exercise protocols. Tongue muscles may differ from limb muscles in terms of dose response and neuroplasticity principles.

The Effect of Genetic Taste Status on Swallowing: A Literature Review.

PURPOSE: Swallowing and taste share innervation pathways and are crucial to nutritive intake. Individuals vary in their perception of taste due to factors such as genetics; however, it is unclear to what extent genetic taste status influences swallowing physiology and function. The purpose of this review article is to provide background on genetic taste status, review the evidence on the association between genetic taste status and swallowing, and discuss research and clinical implications. METHOD: A comprehensive literature review was conducted using search terms related to swallowing and genetic taste status. Studies were included if they investigated the main effect of genetic taste status on swallowing or the interaction of genetic taste status with other variables. Studies were grouped by participant population (healthy participants or persons with a swallowing disorder), swallowing-related outcome measure, and method of genetic taste status measurement. RESULTS: The results were mixed, with five of 10 reviewed studies reporting a statistically significant main or interaction effect on swallowing. Most studies included healthy participants, with only one study investigating participants with dysphagia. Additionally, swallowing-related outcome measures and methods of determining genetic taste status varied greatly between studies conducted on separate cohorts. CONCLUSIONS: Few studies have incorporated genetic taste status as a variable in swallowing research, and results are mixed. Future research on sensation and swallowing should consider the potential effect of genetic taste status and follow standardized procedures for its determination. Despite the limited evidence, clinicians may consider how individual differences in perception shape swallowing outcomes.

Consensus statement on Singapore Perinatal Mental Health Guidelines on Depression and Anxiety.

Introduction: Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women. Method: The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members-comprising experts in the field of perinatal mental health and obstetric medicine-deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods. Results: A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore. Conclusion: Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.

Evaluation of Barley and Wheat Germplasm for Resistance to Head Blight and Mycotoxin Production by Fusarium asiaticum and F. graminearum.

Fusarium head blight (FHB) is one of the most serious diseases in barley and wheat, as it is usually accompanied by the production of harmful mycotoxins in the grains. To identify FHB-resistant breeding resources, we evaluated 60 elite germplasm accessions of barley (24) and wheat (36) for FHB and mycotoxin accumulation. Assessments were performed in a greenhouse and five heads per accession were inoculated with both Fusarium asiaticum (Fa73, nivalenol producer) and F. graminearum (Fg39, deoxynivalenol producer) strains. While the accessions varied in disease severity and mycotoxin production, four wheat and one barley showed <20% FHB severity repeatedly by both strains. Mycotoxin levels in these accessions ranged up to 3.9 mg/kg. FHB severity was generally higher in barley than in wheat, and Fa73 was more aggressive in both crops than Fg39. Fg39 itself, however, was more aggressive toward wheat and produced more mycotoxin in wheat than in barley. FHB severity by Fa73 and Fg39 were moderately correlated in both crops (r = 0.57/0.60 in barley and 0.42/0.58 in wheat). FHB severity and toxin production were also correlated in both crops, with a stronger correlation for Fa73 (r = 0.42/0.82 in barley, 0.70 in wheat) than for Fg39.

Leveraging human resources for outbreak analysis: lessons from an international collaboration to support the sub-Saharan African COVID-19 response.

Emerging infectious diseases are a growing threat in sub-Saharan African countries, but the human and technical capacity to quickly respond to outbreaks remains limited. Here, we describe the experience and lessons learned from a joint project with the WHO Regional Office for Africa (WHO AFRO) to support the sub-Saharan African COVID-19 response.In June 2020, WHO AFRO contracted a number of consultants to reinforce the COVID-19 response in member states by providing actionable epidemiological analysis. Given the urgency of the situation and the magnitude of work required, we recruited a worldwide network of field experts, academics and students in the areas of public health, data science and social science to support the effort. Most analyses were performed on a merged line list of COVID-19 cases using a reverse engineering model (line listing built using data extracted from national situation reports shared by countries with the Regional Office for Africa as per the IHR (2005) obligations). The data analysis platform The Renku Project ( https://renkulab.io ) provided secure data storage and permitted collaborative coding.Over a period of 6 months, 63 contributors from 32 nations (including 17 African countries) participated in the project. A total of 45 in-depth country-specific epidemiological reports and data quality reports were prepared for 28 countries. Spatial transmission and mortality risk indices were developed for 23 countries. Text and video-based training modules were developed to integrate and mentor new members. The team also began to develop EpiGraph Hub, a web application that automates the generation of reports similar to those we created, and includes more advanced data analyses features (e.g. mathematical models, geospatial analyses) to deliver real-time, actionable results to decision-makers.Within a short period, we implemented a global collaborative approach to health data management and analyses to advance national responses to health emergencies and outbreaks. The interdisciplinary team, the hands-on training and mentoring, and the participation of local researchers were key to the success of this initiative.

An in-depth statistical analysis of the COVID-19 pandemic's initial spread in the WHO African region.

During the first wave of the COVID-19 pandemic, sub-Saharan African countries experienced comparatively lower rates of SARS-CoV-2 infections and related deaths than in other parts of the world, the reasons for which remain unclear. Yet, there was also considerable variation between countries. Here, we explored potential drivers of this variation among 46 of the 47 WHO African region Member States in a cross-sectional study. We described five indicators of early COVID-19 spread and severity for each country as of 29 November 2020: delay in detection of the first case, length of the early epidemic growth period, cumulative and peak attack rates and crude case fatality ratio (CFR). We tested the influence of 13 pre-pandemic and pandemic response predictor variables on the country-level variation in the spread and severity indicators using multivariate statistics and regression analysis. We found that wealthier African countries, with larger tourism industries and older populations, had higher peak (p<0.001) and cumulative (p<0.001) attack rates, and lower CFRs (p=0.021). More urbanised countries also had higher attack rates (p<0.001 for both indicators). Countries applying more stringent early control policies experienced greater delay in detection of the first case (p<0.001), but the initial propagation of the virus was slower in relatively wealthy, touristic African countries (p=0.023). Careful and early implementation of strict government policies were likely pivotal to delaying the initial phase of the pandemic, but did not have much impact on other indicators of spread and severity. An over-reliance on disruptive containment measures in more resource-limited contexts is neither effective nor sustainable. We thus urge decision-makers to prioritise the reduction of resource-based health disparities, and surveillance and response capacities in particular, to ensure global resilience against future threats to public health and economic stability.

Functional roles of all five putative hydrophobin genes in growth, development, and secondary metabolism in Fusarium graminearum.

Fusarium graminearum is the causal agent of Fusarium head blight in cereal crops. As in other filamentous ascomycetes, F. graminearum contains genes encoding putative hydrophobins, which are small secreted amphiphilic proteins with eight conserved cysteine residues. Here, we investigated the roles of all five hydrophobin genes (designated FgHyd1, FgHyd2, FgHyd3, FgHyd4, and FgHyd5) in various mycological traits of F. graminearum. Gene expression analyses revealed that the five FgHyd genes, all of which were under the control of G protein signaling or velvet complex proteins, were differentially expressed under various developmental conditions. Three genes (FgHyd1, FgHyd2, and FgHyd3) were constitutively expressed in all aerial structures examined (hyphae, conidia, and perithecia), and two genes (FgHyd1 and FgHyd2) were also expressed in submerged hyphae. FgHyd3 was exclusively expressed in aerial hyphae on solid surfaces, including rice grains. These genes showed markedly reduced expression in F. asiaticum, which was a closely related to F. graminearum but exhibited different mycological traits from F. graminearum. Phenotypic analyses of various gene deletion strains, including the quintuple deletion (ΔFgHyd12345) strain, confirmed that in addition to their typical functions, all five FgHyd genes were involved in other traits, such as conidiation, pathogenicity, and secondary metabolism in F. graminearum. Both RNA-seq and chemical analyses confirmed that ΔFgHyd led to overproduction of specific terpenoid compounds (e.g., trichothecenes), which has not been reported previously. Nevertheless, the lack of complete phenotypic loss of any of the traits examined, even in the ΔFgHyd12345 strain, and little cumulative action of all five FgHyd genes strongly suggest that all five hydrophobins are redundant in function and are not absolutely essential for these fungal traits in F. graminearum.

A double-blind randomised placebo-controlled trial investigating the effects of lesogaberan on the objective cough frequency and capsaicin-evoked coughs in patients with refractory chronic cough.

Objective: Baclofen is a centrally acting γ-aminobutyric acid type B (GABAB) receptor agonist which reduces gastro-oesophageal reflux and suppresses the cough reflex; however, central nervous system side-effects limit its use. Lesogaberan is a novel peripherally acting GABAB agonist, but its effects on refractory chronic cough are unknown. Design: We performed a single-centre, placebo-controlled, double-blind randomised crossover study in patients with chronic cough, refractory to the treatment of underlying conditions. Patients were randomised to treatment with lesogaberan 120 mg modified release twice daily or matched placebo for 2 weeks and then crossed over to the alternative therapy after a 2-week washout. The primary end-point was 24-h cough frequency measured with an acoustic monitoring system. In addition, cough responses to capsaicin were measured, and gastro-oesophageal reflux assessed by 24-h pH/impedance at screening. Results: 22 patients were randomised to receive lesogaberan/placebo or placebo/lesogaberan (female (73%); mean±sd age 63.7±7.2 years; median (interquartile range) cough duration 10.5 (5.8-17.0) years; mean (95% CI) 45 (29-67) reflux events in 24 h; two patients had abnormal oesophageal acid exposure times). Although lesogaberan reduced cough counts by 26% over placebo, this did not reach statistical significance (p=0.12). However, lesogaberan did significantly improve cough responses to capsaicin (p=0.04) and the number of cough bouts (p=0.04) compared with placebo. Lesogaberan was well tolerated in this study. Conclusions: Lesogaberan improved cough hypersensitivity and the number of bouts of coughing, but not coughs per hour. This implies a possible role for peripheral GABAB receptors in refractory chronic cough.

Enhancing the caregiving experience of family care partners in Singapore through an arts programme for persons with dementia: an exploratory study.

Objectives: Arts-based programmes for persons with dementia have shown promise in alleviating some of the caregiving challenges for family care partners. The present study sought to broaden the sociocultural perspectives of arts-based programmes by investigating the impact of a locally developed Arts & Dementia programme for persons with dementia on their family care partners in Singapore.Methods: Thirty-two family care partners of persons with dementia who participated in the Arts & Dementia programme were recruited. A mixed-methodological study was employed utilising quantitative pre- and post-programme data from the Zarit Burden Interview and Gain in Alzheimer care Instrument, and qualitative data from semi-structured group interviews.Results: Although there were no self-reported short-term changes in perceived caregiving difficulties and gains, semi-structured group interviews revealed potential caregiving benefits. Six overarching themes were identified: (1) contentment and social engagement, (2) re-connecting and developing new interests, (3) positive influence on caregiving, (4) enhancements to the programme, (5) more arts programmes, and (6) more support for families living with dementia.Conclusion: The present study highlights potential benefits of community-based arts activities in enabling caregiving to be a more positive experience for care partners.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2008306'I kept blaming myself for not spending enough time with him. Communication with him is different now. Watching him on the stage, he is happy and with a purpose'. (Gary, male).

The impact of the Arts and Dementia Program on short-term well-being in older persons with dementia from Singapore.

OBJECTIVE: To investigate the impact of a locally developed Arts and Dementia Program on the short-term well-being of older persons with dementia in Singapore. METHODS: Single-arm study with 21 persons with dementia. Behavioural tendencies and mood and engagement values were assessed using Dementia Care Mapping at baseline and during the program. The averaged mood and engagement value over the mapping period produced a well-/ill-being score for each person with dementia. RESULTS: Well-/ill-being scores were significantly higher during the program compared to at baseline. The behavioural tendencies most frequently captured during the program were creative expression, reminiscence and leisure. In contrast, there were more eating or drinking behaviours during the baseline. Analyses revealed that the changes in occurrences of reminiscence, leisure, and eating or drinking behaviours across time were significant. CONCLUSIONS: The present study suggests potential benefits of the Arts and Dementia Program in enhancing the well-being of persons with dementia.

Fusarium graminearum Species Complex: A Bibliographic Analysis and Web-Accessible Database for Global Mapping of Species and Trichothecene Toxin Chemotypes.

Fusarium graminearum is ranked among the five most destructive fungal pathogens that affect agroecosystems. It causes floral diseases in small grain cereals including wheat, barley, and oats, as well as maize and rice. We conducted a systematic review of peer-reviewed studies reporting species within the F. graminearum species complex (FGSC) and created two main data tables. The first contained summarized data from the articles including bibliographic, geographic, methodological (ID methods), host of origin and species, while the second data table contains information about the described strains such as publication, isolate code(s), host/substrate, year of isolation, geographical coordinates, species and trichothecene genotype. Analyses of the bibliographic data obtained from 123 publications from 2000 to 2021 by 498 unique authors and published in 40 journals are summarized. We describe the frequency of species and chemotypes for 16,274 strains for which geographical information was available, either provided as raw data or extracted from the publications, and sampled across six continents and 32 countries. The database and interactive interface are publicly available, allowing for searches, summarization, and mapping of strains according to several criteria including article, country, host, species and trichothecene genotype. The database will be updated as new articles are published and should be useful for guiding future surveys and exploring factors associated with species distribution such as climate and land use. Authors are encouraged to submit data at the strain level to the database, which is accessible at https://fgsc.netlify.app.

The World Health Organization's public health intelligence activities during the COVID-19 pandemic response, December 2019 to December 2021.

The coronavirus disease (COVID-19) presented a unique opportunity for the World Health Organization (WHO) to utilise public health intelligence (PHI) for pandemic response. WHO systematically captured mainly unstructured information (e.g. media articles, listservs, community-based reporting) for public health intelligence purposes. WHO used the Epidemic Intelligence from Open Sources (EIOS) system as one of the information sources for PHI. The processes and scope for PHI were adapted as the pandemic evolved and tailored to regional response needs. During the early months of the pandemic, media monitoring complemented official case and death reporting through the International Health Regulations mechanism and triggered alerts. As the pandemic evolved, PHI activities prioritised identifying epidemiological trends to supplement the information available through indicator-based surveillance reported to WHO. The PHI scope evolved over time to include vaccine introduction, emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, unusual clinical manifestations and upsurges in cases, hospitalisation and death incidences at subnational levels. Triaging the unprecedented high volume of information challenged surveillance activities but was managed by collaborative information sharing. The evolution of PHI activities using multiple sources in WHO's response to the COVID-19 pandemic illustrates the future directions in which PHI methodologies could be developed and used.

Information management practices in the WHO African Region to support response to the COVID-19 pandemic.

The rapid transmissibility of the severe acute respiratory syndrome-coronavirus-2 causing coronavirus disease-2019, requires timely dissemination of information and public health responses, with all 47 countries of the WHO African Region simultaneously facing significant risk, in contrast to the usual highly localised infectious disease outbreaks. This demanded a different approach to information management and an adaptive information strategy was implemented, focusing on data collection and management, reporting and analysis at the national and regional levels. This approach used frugal innovation, building on tools and technologies that are commonly used, and well understood; as well as developing simple, practical, highly functional and agile solutions that could be rapidly and remotely implemented, and flexible enough to be recalibrated and adapted as required. While the approach was successful in its aim of allowing the WHO Regional Office for Africa (WHO AFRO) to gather surveillance and epidemiological data, several challenges were encountered that affected timeliness and quality of data captured and reported by the member states, showing that strengthening data systems and digital capacity, and encouraging openness and data sharing are an important component of health system strengthening.

Implementing epidemic intelligence in the WHO African region for early detection and response to acute public health events.

Epidemic intelligence activities are undertaken by the WHO Regional Office for Africa to support member states in early detection and response to outbreaks to prevent the international spread of diseases. We reviewed epidemic intelligence activities conducted by the organisation from 2017 to 2020, processes used, key results and how lessons learned can be used to strengthen preparedness, early detection and rapid response to outbreaks that may constitute a public health event of international concern. A total of 415 outbreaks were detected and notified to WHO, using both indicator-based and event-based surveillance. Media monitoring contributed to the initial detection of a quarter of all events reported. The most frequent outbreaks detected were vaccine-preventable diseases, followed by food-and-water-borne diseases, vector-borne diseases and viral haemorrhagic fevers. Rapid risk assessments generated evidence and provided the basis for WHO to trigger operational processes to provide rapid support to member states to respond to outbreaks with a potential for international spread. This is crucial in assisting member states in their obligations under the International Health Regulations (IHR) (2005). Member states in the region require scaled-up support, particularly in preventing recurrent outbreaks of infectious diseases and enhancing their event-based surveillance capacities with automated tools and processes.

Changing perceptions towards dementia: How does involvement in the arts alongside persons with dementia promote positive attitudes?

The prevalence of dementia in Singapore is on the rise. Due to the negative perceptions associated with the condition, persons with dementia and their care partners face an increased risk of social isolation and loneliness. One objective of the Arts and Dementia programme offered by the Alzheimer's Disease Association is to increase inclusivity of persons with dementia in the community. To investigate the impact of the programme on perceptions towards dementia, a mixed-method approach involving 75 artists and volunteers was conducted. Findings from the Approaches to Dementia Questionnaire revealed that participants involved in the programme had significantly more positive perceptions than new volunteers. A thematic analysis was conducted on the focus group discussions and four themes were identified: (1) meaningful and rewarding interactions, (2) focus on abilities, (3) learning process and (4) more can be done. These findings suggest that meaningful experiences during the programme may be a driving force behind positive perceptions towards dementia.

Patient- and Physician-Level Factors Associated With Adherence to C-CHANGE Recommendations in Primary Care Settings in Ontario.

BACKGROUND: We previously found large variation among family physicians in adherence to the Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE). We assessed the role of patient- and physician-level factors in the variation in adherence to recommendations for managing cardiovascular disease risk factors. METHODS: We conducted a retrospective study using multilevel logistic regression analyses with the Electronic Medical Record Administrative data Linked Database (EMRALD) housed at ICES in Ontario. Five quality indicators based on C-CHANGE guidelines were modelled. Effects of clustering and between-group variation, patient-level (sociodemographics, comorbidities) and physician-level characteristics (demographic and practice information) were assessed to determine odds ratios of receiving C-CHANGE recommended care. RESULTS: In all, 324 Ontario physicians practicing in 41 clinics who provided care to 227,999 adult patients were studied. We found significant variation in quality indicators, with 15% to 39% of the total variation attributable to nonpatient factors. The largest variation was in performing 2-hour plasma glucose testing in prediabetic patients. Patient-level factors most frequently associated with recommendation adherence included sex, age, and multi-comorbidities. Women were more likely than men to have their body mass index measured, and their blood pressure controlled, but less likely to receive antiplatelet medications and liver-enzyme testing if overweight or obese. CONCLUSIONS: The majority of variations in adherence were attributable to patient attributes, but a substantial proportion of unexplained variation was due to differences among physicians and clinics. This finding may signal suboptimal processes or structures and warrant further investigation to improve the quality of primary care management of cardiovascular disease in Ontario.

CONTEXTE: Nous avions déjà constaté que l'observance des recommandations canadiennes en matière de prévention et de gestion des maladies cardiovasculaires de l'initiative C-CHANGE ( C anadian C ardiovascular H armonization of N ational G uidelines E ndeavour) varie beaucoup d'un médecin de famille à l'autre. Nous avons évalué l'effet de caractéristiques des patients et des médecins sur l'observance de ces recommandations pour la gestion des facteurs de risque de maladies cardiovasculaires. MÉTHODOLOGIE: Nous avons mené une étude rétrospective reposant sur des analyses de régression logistique multiniveaux au sein de la base de données liée aux dossiers médicaux électroniques EMRALD ( E lectronic M edical R ecord A dministrative data L inked D atabase) qui se trouve à l'ICES, en Ontario. Nous avons modélisé cinq indicateurs de la qualité en nous basant sur les recommandations de l'initiative C-CHANGE. Nous avons évalué les effets de regroupement, de la variation entre les groupes, des caractéristiques des patients (données sociodémographiques, maladies concomitantes), des caractéristiques des médecins (données démographiques et renseignements sur la pratique) afin de déterminer les risques relatifs approchés associés aux soins conformes aux recommandations de l'initiative C-CHANGE. RÉSULTATS: L'étude a porté sur un total de 324 médecins ontariens pratiquant dans 41 cliniques et ayant prodigué des soins à 227 999 adultes. Nous avons observé une variation significative entre les indicateurs de qualité, et de 15 % à 39 % de la variation totale était attribuable aux caractéristiques non reliées aux patients. La variation la plus importante concernait le test d'hyperglycémie provoquée (2 heures) chez les patients prédiabétiques. Les caractéristiques des patients qui étaient le plus souvent associées à l'observance des recommandations étaient le sexe, l'âge et la présence de multiples maladies concomitantes. L'indice de masse corporelle et la pression artérielle étaient plus souvent mesurés chez les femmes que chez les hommes, mais les femmes étaient moins susceptibles de recevoir un traitement antiplaquettaire ou de subir une analyse des enzymes hépatiques si elles étaient en surpoids ou obèses. CONCLUSIONS: La plus grande partie des variations dans l'observance des recommandations était liée aux caractéristiques des patients, mais une proportion importante de variations injustifiées était associée aux différences entre les médecins et entre les cliniques. Ces observations pourraient indiquer la présence de processus ou de structures sous-optimales et méritent une analyse approfondie qui permettra d'améliorer la qualité de la prise en charge des maladies cardiovasculaires par les médecins de soins primaires en Ontario.

Characterization of Nivalenol-Producing Fusarium asiaticum That Causes Cereal Head Blight in Korea.

Fusarium asiaticum of the F. graminearum species complex causes head blight in small-grain cereals. The nivalenol (NIV) chemotypes of F. asiaticum is more common than the deoxynivalenol (DON) chemotypes of F. asiaticum or F. graminearum in Korea. To understand the prevalence of F. asiaticum-NIV in Korean cereals, we characterized the biological traits of 80 cereal isolates of F. asiaticum producing NIV or 3-acetyl-deoxynivalenol (3-ADON), and 54 F. graminearum with 3-ADON or 15-acetyl-deoxynivalenol (15-ADON). There was no significant difference in mycelial growth between the chemotypes, but F. asiaticum isolates grew approximately 30% faster than F. graminearum isolates on potato dextrose agar. Sexual and asexual reproduction capacities differed markedly between the two species. Both chemotypes of F. graminearum (3-ADON and 15-ADON) produced significantly higher numbers of perithecia and conidia than F. asiaticum-NIV. The highest level of mycotoxins (sum of trichothecenes and zearalenone) was produced by F. graminearum-3-ADON on rice medium, followed by F. graminearum-15-ADON, F. asiaticum-3-ADON, and F. asiaticum-NIV. Zearalenone levels were correlated with DON levels in some chemotypes, but not with NIV levels. Disease assessment on barley, maize, rice, and wheat revealed that both F. asiaticum and F. graminearum isolates were virulent toward all crops tested. However, there is a tendency that virulence levels of F. asiaticum-NIV isolates on rice were higher than those of F. graminearum isolates. Taken together, the phenotypic traits found among the Korean F. asiaticum-NIV isolates suggest an association with their host adaptation to certain environments in Korea.