Development of a Mobile-First Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies.

BACKGROUND: Web-based participant recruitment registries can be useful tools for accelerating enrollment into studies, but existing Alzheimer's disease (AD)-focused recruitment registries have had limited success enrolling individuals from underrepresented racial and ethnic groups. Designing these registries to meet the needs of individuals from these communities, including designing mobile-first, may facilitate improvement in the enrollment of underrepresented groups. OBJECTIVES: Evaluate the usability of a prototype mobile-first participant recruitment registry for AD prevention studies; assess users' perceptions of and willingness to sign up for the registry. DESIGN AND SETTING: Quantitative usability testing and an online survey; online setting. PARTICIPANTS: We recruited 1,358 adults ages 45-75 who self-reported not having a diagnosis of mild cognitive impairment, AD, or other forms of dementia (Study 1: n=589, Study 2: n=769). Black/African American and Hispanic/Latino participants were specifically recruited, including those with lower health literacy. METHODS AND MEASUREMENTS: Study 1 measures the prototype's usability through observed task success rates, task completion times, and responses to the System Usability Scale. Study 2 uses an online survey to collect data on perceptions of and willingness to sign up for the mobile-first registry. RESULTS: Study 1 findings show the prototype mobile-first recruitment registry website demonstrates high usability and is equally usable for Black / African American, Hispanic/Latino, and White user groups. Survey results from Study 2 indicate that users from underrepresented communities understand the registry's purpose and content and express willingness to sign up for the registry on a mobile device. CONCLUSIONS: Designing mobile-first participant recruitment registries based on feedback from underrepresented communities may result in more sign-ups by individuals from minoritized communities.

Understanding Barriers and Facilitators to Signing Up for a Mobile-Responsive Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies.

BACKGROUND: Alzheimer's disease (AD) disproportionately affects Black/African American and Hispanic/Latino adults, yet they are underrepresented in AD studies. Recruitment challenges for these populations limit generalizability of findings. OBJECTIVES: This study explores barriers and facilitators to signing up for an AD participant recruitment registry website intended to optimize recruitment of these adults. The registry is geared toward recruitment on smartphones and tablets (mobile devices), as research suggests that mobile-first approaches may be more successful within these populations. DESIGN: In 2020, we conducted four focus groups (n = 39) and an online survey (n = 1010) with Black/African American and Hispanic/Latino adults. The survey also included Whites as a comparison group. SETTING: Focus groups were in-person at research facilities in New Orleans, Louisiana, and Los Angeles, California. The online survey was distributed by a survey panel company to participants nationwide. PARTICIPANTS: Black/African American (n = 360), Hispanic/Latino (n = 359), or White (n = 330) individuals, 45-75 years old, who self-reported not having mild cognitive impairment (MCI), dementia, or AD. MEASUREMENTS: Barriers and facilitators explored in the focus groups and survey were related to health and AD (e.g., AD-related concerns and past participation/willingness to participate in health or AD studies); current use of mobile devices (e.g., comfort using devices and receptivity to the AD recruitment registry); and participant characteristics and beliefs (e.g., demographics, health literacy level, and trust in government and the scientific community). RESULTS: The focus groups and survey revealed similar findings. Participants commonly use mobile devices to go online and perform health-related activities. They were aware of AD, expressed concerns with developing it, and were willing to participate in AD-related studies (motivated by personal connection to AD, altruism, and compensation). When presented with the AD recruitment registry, most provided positive feedback (e.g., easy to use and informative) and shared an interest in joining. Barriers to joining the registry with a mobile device included complex or multistep enrollment processes, beliefs that studies are primarily for those with a specific disease, and confusion about how studies can prevent AD among those low-risk for AD. The focus groups also revealed that Black/African American participants expressed more hesitation than Hispanic/Latinos in joining the registry due to greater distrust in the government and scientific community. CONCLUSIONS: Recruiting more Black/African American and Hispanic/Latino participants into AD studies is vitally important. This mixed methods study suggests that adults in these underrepresented groups are motivated to prevent AD and willing to sign up for an AD participant recruitment registry using mobile devices. Most barriers to joining a registry can be addressed through slight modifications to the registry's design and functionality and by adding content. These findings can help enhance the appeal of joining AD recruitment registries to ultimately enroll more diverse, representative groups of participants and increase the generalizability of AD study findings.

Issues surrounding consumer-bought food-allergy testing.

BACKGROUND: Allergy is increasingly reported by patients and members of the public, and there is evidence that the prevalence is increasing. Not all diagnoses have been made by clinicians, as direct-to-consumer (DTC) allergy tests are widely available online. AIM: To determine if DTC allergy tests are processed in accredited laboratories and utilize validated methods, while providing an overview of the DTC allergy tests available. METHODS: Internet searches using 'allergy test kit' and 'intolerance test' were performed to identify DTC food-allergy tests. Each company was contacted to enquire if they had ISO15189 accreditation, what methods of testing they used and what was the extent of individual clinical input used to guide the test requested or result interpretation. RESULTS: In total, 24 online companies providing DTC food-allergy testing were identified, of which 22 were contactable. One laboratory had ISO15189 accreditation, which was also the only laboratory using clinically recognized specific IgE testing and had a clinician involved in the process. Other laboratories used bioresonance or IgG and involved a nutritionist at most. CONCLUSION: Online DTC food-allergy tests are largely misleading to the consumer and provided by unaccredited laboratories using controversial methodology. The dermatologist must politely discount these results and assess the role of food allergy in a patient's skin disease on the merit of clinical history, supported by specific IgE testing as appropriate.

Hypertension is associated with narrower retinal arteriolar calibre in persons with and without coronary artery disease.

The aims of this study were to investigate independent associations between hypertension and retinal vessel calibre in a high cardiovascular risk cohort and to determine whether these associations also exist in patients without coronary artery disease (CAD). The Australian Heart Eye Study is an observational study that surveyed 1680 participants presenting to a tertiary referral hospital for the evaluation of potential CAD by coronary angiography. Hypertension was defined as systolic >140 mm Hg, diastolic >90 mm Hg or treated (use of antihypertensive medications). Retinal arteriolar and venular calibres were measured from retinal photographs. CAD was quantified using severity (Gensini) and extent scores. Subanalyses were performed for people with and without CAD and for men and women. A total of 1114 participants had complete data on hypertension, coronary vessel evaluation and retinal vessel measurements and were included in cross-sectional analyses. Among persons with CAD, those with hypertension (compared with without) had narrower retinal arteriolar calibre (mean arteriolar calibre difference 2.1 µm, P=0.02), adjusting for age, sex, ethnicity, body mass index, smoking status and fellow vessel calibre. This association was also present among persons without CAD (mean difference 5.0 µm, P=0.04). Stratification by sex indicated that women with hypertension had marginally narrower retinal arterioles compared with normotensive women (multivariable-adjusted P=0.04). No significant association between hypertension and retinal arteriolar calibre was observed in men (P=0.13). No significant differences in retinal venular calibre were observed (P>0.05). In conclusion, in both subjects with and without CAD, hypertension was independently associated with narrower retinal arterioles.

Neotropical Hemerodromia Meigen (Diptera: Empididae), a world of discovery I: new generic record and new species from Brazilian Amazon Basin.

Ten new species of Hemerodromia Meigen, 1822 are described and illustrated from the Brazilian state of Amazonas: H. amazonensis sp. nov., H. breviradia sp. nov., H. cercusdilatata sp. nov., H. collini sp. nov., H. epandriocurvialis sp. nov., H. jauensis sp. nov., H. lamellata sp. nov., H. longilamellata sp. nov., H. maturaca sp. nov., H. smithi sp. nov. This is the first record of the genus from the Brazilian Amazon Basin.

Heterogeneity in the spatial distribution of bacterial sexually transmitted infections.

OBJECTIVES: Detailed knowledge of the spatial distribution of disease is required to inform service delivery and plan effective interventions. In order to elucidate the spatial epidemiology of three common sexually transmitted infections (STI) further, any significant spatiotemporal clustering of gonorrhoea, chlamydia or syphilis cases in New South Wales (NSW) was detected and described. METHODS: Eleven years of notified STI case data were analysed. Calculation of age and sex-stratified incidence rates was followed by spatiotemporal cluster analyses to investigate differences in the epidemiology of gonorrhoea, chlamydia and syphilis. RESULTS: More than one-third of all gonorrhoea, chlamydia and syphilis cases in NSW were detected within cluster areas. Gonorrhoea cases were the most highly clustered, followed by syphilis, then chlamydia. Clusters were highly significant and relative risk estimates ranged from 1.6 to 22.9. CONCLUSION: The findings establish the high degree of geographical heterogeneity in STI incidence in NSW and indicate that the postal area of residence is an important predictor of STI incidence. Geographical surveillance could be incorporated into routine STI surveillance to identify populations in need of intervention. The evidence presented in this report indicates a need to implement geography-specific and phase-appropriate STI prevention and control strategies.

SARS transmission in Vietnam outside of the health-care setting.

To evaluate the risk of transmission of SARS coronavirus outside of the health-care setting, close household and community contacts of laboratory-confirmed SARS cases were identified and followed up for clinical and laboratory evidence of SARS infection. Individual- and household-level risk factors for transmission were investigated. Nine persons with serological evidence of SARS infection were identified amongst 212 close contacts of 45 laboratory-confirmed SARS cases (secondary attack rate 4.2%, 95% CI 1.5-7). In this cohort, the average number of secondary infections caused by a single infectious case was 0.2. Two community contacts with laboratory evidence of SARS coronavirus infection had mild or sub-clinical infection, representing 3% (2/65) of Vietnamese SARS cases. There was no evidence of transmission of infection before symptom onset. Physically caring for a symptomatic laboratory-confirmed SARS case was the only independent risk factor for SARS transmission (OR 5.78, 95% CI 1.23-24.24).

Joining the DOTS in Bali: private practitioners' perceptions of tuberculosis control.

SETTING: The Indonesian island of Bali has both a national public tuberculosis (TB) programme and a significant private sector that provides treatment for patients with TB. OBJECTIVE: To explore private practitioners' perceptions of barriers to the treatment of patients with TB in Bali to inform strategies for future programme development. DESIGN: Semi-structured interviews were conducted with private practitioners who treated TB patients in their private practice. RESULTS: The main barriers to improved TB control in Bali identified by private practitioners reflect difficulties encountered within the following four areas: patient nonadherence to treatment, limitations of public services, public-private integration and limitations of private services. Private practitioners identified the need for improvements in the level of community education regarding TB, the degree of public-private interaction, the quality of diagnostic services and practitioner access to training. CONCLUSION: This study identified both strengths and weaknesses for TB control in the private sector, as well as considerable variations in perceptions and practice among private practitioners. The development of strategies to address these difficulties and utilise the inherent strengths of both public and private practitioners will be essential for improved service provision and TB control in Bali.

Does smoking explain sex differences in the global tuberculosis epidemic?

To date there has been no satisfactory explanation of the worldwide excess of tuberculosis (TB) notifications among adult males. We investigated the epidemiological basis for sex differences in TB notifications in high-burden countries using available group-level data. Multiple linear regression analysis was used to explore the ecological relationship between smoking and sex differences in TB notifications among high-burden countries. Cigarette consumption was a significant predictor of the sex ratio of TB notifications, and explained 33% of the variance in the sex ratio of TB notifications. Our findings suggest that smoking is an important modifiable factor which has a significant impact on the global epidemiology of TB, and emphasize the importance of tobacco control in countries with a high incidence of TB. This analysis provides support for the interpretation of sex differences in worldwide TB notification rates as indicative of true differences in the epidemiology of TB between males and females.

The association between subjective and clinical indicators of health in prospective Vietnamese migrants.

We conducted a cross-sectional survey of 1669 prospective Vietnamese migrants who had applied to migrate to Australia to describe the association between self-reported health status and several commonly used clinical indicators of health among prospective Vietnamese migrants. Participants were recruited from the International Organization for Migration's standardised medical screening program.' We found that clinical indicators of health are related to self-reported health status among prospective Vietnamese migrants. Self-reported health status, which was assessed using a modified version of the Short Form-36 health survey, was significantly associated with clinical indicators of health, including the number of body system abnormalities identified during medical screening, evidence of tuberculosis on chest radiograph, and self-reported weight loss over the previous six months. These findings support the validity of self-reported health status assessment among prospective migrants, although the assessment of subjective indicators of health during compulsory medical screening may be limited by reporting bias.

Results of tuberculosis screening in applicants for migration in Vietnam and Cambodia.

SETTING: Pre-migration medical screening programmes in Ho Chi Minh City, Vietnam and Phnom Penh, Cambodia. OBJECTIVE: To compare the rates of newly diagnosed bacteriologically confirmed tuberculosis (TB) in a cohort of migration applicants in Vietnam and Cambodia with current estimates of the TB burden in these countries. DESIGN: Interviews and medical screening of 5108 Vietnamese and 910 Cambodian migration applicants who applied for an Australian visa. RESULTS: On initial testing, the rate of bacteriologically confirmed TB among the Vietnamese cohort was 157 per 100,000 population compared to 989/100,000 among the Cambodian cohort. When cases detected during follow-up testing were included, the rate in the Vietnamese cohort was 489/100,000 compared to 1209/100,000 in the Cambodian cohort. CONCLUSIONS: Although it has been suggested that the rate of newly diagnosed bacteriologically confirmed TB among migration applicants would underestimate the prevalence of TB in the Vietnamese and Cambodian populations, the rates found were substantially higher than current point estimates of the prevalence of TB, particularly for Vietnam. Our findings suggest that current published estimates of the tuberculosis burden in Vietnam and Cambodia may be conservative.

Clinic staff perceptions of tuberculosis treatment delivery in Bali.

A number of studies have investigated patient perceptions of tuberculosis (TB) treatment delivery, but few have systematically investigated the perceptions of clinic staff. We therefore conducted individual interviews using Q-methodology with 25 staff directly involved in the delivery of TB treatment services in 18 different public sector health centres in Bali. Factor analysis was used to identify shared perceptions of TB treatment delivery in Bali among the sample studied. Three distinct perspectives emerged, indicating that all staff do not have shared understandings of difficulties and priorities in TB treatment. The main areas of difference in staff perceptions concerned the existence of barriers to treatment and the focus on the community context of TB treatment. The demonstrated variation in the perceptions of TB treatment delivery in Bali has important implications for the design of strategies to improve treatment delivery and the control of TB.

Late Blight Caused by Phytophthora infestans on Solanum sarrachoides in Northeastern Maine.

The area bordering three 110-ha (270-acre) fields of blighted potatoes (Solanum tuberosum L.) in three northeastern Maine locations was surveyed during the summer of 2004 for the occurrence of late blight on cultivated and noncultivated host plants. Special attention was directed to solanaceous weed species. Hundreds of Solanum sarrachoides Sendt. ex. Mart. (hairy nightshade) plants with numerous leaf lesions and moderate defoliation were seen. The frequency of blighted hairy nightshade approximated the frequency of late blight in the adjoining potato fields. Lesions typically contained extensive, white, superficial mycelia colonizing the abaxial and adaxial leaf surfaces. Samples placed in a moist chamber produced lemon-shaped sporangia. On the basis of morphological characteristics, the pathogen was tentatively identified as Phytophthora infestans (Mont.) de Bary. Isolates were obtained by surface-disinfecting leaf sections collected from two locations for 2 to 3 min in 0.5% NaOCl and placing the sections on rye grain medium amended with antibiotics (100 ppm each of penicillin G, pimaricin, and polymyxin). P. infestans was confirmed after reisolating onto rye-lima bean medium. Pathogenicity was tested on detached potato, tomato, and hairy nightshade leaves; the undersides of all leaflets from replicate plants were inoculated with droplets of swimming zoospores (≥500 zoospores per droplet), the leaves were kept at 17°C and 100% humidity, and the extent of sporulation was evaluated after 4, 6, and 7 days. With eight isolates obtained from S. sarrachoides, Koch's postulates were completed on potato and hairy nightshade. Radial growth responses of these strains on rye grain agar amended with 1, 10, or 100 µg per ml of metalaxyl (Ridomil 2E) yielded 50% effective dose values greater than 100 µg per ml, since percentage growth at the highest fungicide concentration exceeded 50% of the no metalaxyl control. These resistance levels are typical of the metalaxyl-insensitive strains of P. infestans isolated from potatoes in this area in recent years, which were previously found to correlate with metalaxyl resistance in bioassays using potato tissues (1). Eight single-sporangial isolates were homozygous for glucose-6-phosphate isomerase and peptidase (Gpi 100/111/122, Pep 100/100). All eight were A2-mating type and mitochondrial haplotype Ia, characteristics common to the US-8 clonal lineage of P. infestans from potato (2), which may infect a wider host range than the old US-1 clonal lineage. When evaluated on differential hosts, three isolates were tomato race PH-1 and complex potato race R 0,1,2,3,4,9,11. DNA fingerprint analysis with probe RG57 further established that the eight hairy nightshade isolates were identical to each other and to local P. infestans isolates from potato. To our knowledge, this is the first report of infection of S. sarrachoides by P. infestans in Maine. The pathogen was previously isolated from this host during field surveys in southern California in the 1980s in connection with late blight of tomato (4). Hairy nightshade has been shown to be a host for US-1, US-8, and US-11 isolates of P. infestans in a laboratory setting (3). The epidemiological significance of S. sarrachoides as an alternative or overwintering host of P. infestans is currently being assessed. References: (1) K. L. Deahl et al. Am. Potato J. 70:779, 1993. (2) S. B. Goodwin et al. Phytopathology 88:939, 1998. (3) H. W. Platt. Can. J. Plant Pathol. 21:301, 1999. (4) V. G. Vartanian and R. M. Endo Plant Dis. 69:516, 1985.

A syphilis outbreak in remote Australia: epidemiology and strategies for control.

This paper describes the epidemiology of a syphilis outbreak in remote Australia, and explores contributing factors and control strategies. Between 1 August 2000 and 31 January 2002, 74 cases of early syphilis (42 female, 32 male) were identified in 73 Kimberley residents. Syphilis rates in age groups 10-19 and 20-29 years were 583 and 439 per 100000 person years respectively. Factors contributing to the outbreak included incompleteness of sexually transmitted infection (STI) clinical management, untimely contact tracing, staffing and management issues, and poor community knowledge about STIs. Outbreak control strategies addressed factors that could be influenced by changes in health service delivery, and focused on providing education and support to health staff, and efforts to increase community knowledge about sexual health. Although some improvements have occurred, the outbreak is still continuing. Until open and honest discussion and a collaborative approach is taken toward STI problems affecting Indigenous Australians, outbreaks such as this will continue to occur.

Tuberculosis treatment delivery in Bali: a qualitative study of clinic staff perceptions.

SETTING: Little is known about the challenges of delivering tuberculosis (TB) treatment in Indonesia's southern province of Bali. OBJECTIVE: We aimed to explore staff perceptions of TB treatment delivery and barriers to improved TB control in Bali to inform strategies for programme development. DESIGN: Semi-structured interviews were conducted with staff who were involved in the delivery of TB treatment services in the public sector. RESULTS: The main issues perceived by staff to influence TB treatment delivery include: the low level of community awareness of TB; delays to treatment seeking and the frequent use of private treatment providers; diagnostic difficulties; non-adherence to treatment; and a low level of staff education specific to TB. CONCLUSION: Staff perceived a number of significant barriers to the early diagnosis and successful treatment of TB in Bali. The development of strategies to address these identified difficulties in TB control is essential to support improved programme effectiveness and enhanced TB control in Bali.

Osteoblast cell membrane hybrid bilayers for studying cell-cell interactions.

Osteoblast-like cells were grown on a surface that presents cell membrane components to the cells in culture. The culture surface was a bimolecular layer formed by the interaction of osteoblast plasma membrane vesicles with an alkanethiol monolayer. The potential of these osteoblast-membrane hybrid bilayers for promoting osteoblast adhesion, growth and differentiation was examined. UMR-106 osteoblast-like cells cultured on these surfaces are normal in appearance, and in the presence of serum, proliferate as well or better than on control surfaces. The level of alkaline phosphatase production in the presence and absence of serum suggests that the osteoblast-like cells retain their differentiated phenotype, and appear to respond to the cell surface ligands presented by the osteoblast-membrane biomimetic surface. These observations suggest that biomimetic membrane films prepared from osteoblast cell membranes support osteoblast cell growth, allow the cells to maintain their differentiation state and may be suitable as a model system to probe cell-cell interactions.

Tuberculosis rates among migrants in Australia and Canada.

Multiple linear regression analysis was used to compare the regression coefficients for Australia and Canada on the association between tuberculosis (TB) rates among migrants and the estimated incidence in the country of birth. Regression coefficients predicting the rate of TB among migrants based on the incidence of TB in the country of birth are not significantly different between populations of migrants in Australia and Canada. Our findings support the ability of the incidence of TB in the country of birth to predict variation in the incidence of TB in migrants groups in two migration receiving countries. This information can be used to focus TB treatment and prevention efforts towards high-risk groups.

Predictors of tuberculin reactivity among prospective Vietnamese migrants: the effect of smoking.

We investigated the prevalence and predictors of positive tuberculin skin test (TST) results among prospective Vietnamese migrants. We interviewed and medically screened 1395 Vietnamese people aged over 15 years who had applied to migrate to Australia. Approximately 44% of applicants had an induration of 10 mm or more, and 18.6% had an induration of 15 mm or more. A positive tuberculin skin test at 5 mm, 10 mm and 15 mm of induration cut-points was significantly associated with age (OR 1.01-1.02 per year) and duration of smoking (OR 1.03-1.12 per year). Smoking appears to be an important factor associated with increased susceptibility to mycobacterial infection. It is not yet clear whether the increased tuberculin reactivity associated with smoking reflects an increased risk of tuberculosis among these migrants.