Variable Number Tandem Repeat Profiling of Mycobacterium ulcerans Reveals New Genotypes in Buruli Ulcer Endemic Communities in Ghana and Côte d'Ivoire.

Buruli ulcer (BU), a necrotic skin disease caused by Mycobacterium ulcerans, is mainly prevalent in West Africa, but cases have also been reported in other tropical parts of the world. It is the second most common mycobacterial disease after tuberculosis in Ghana and Côte d'Ivoire. Heterogeneity among M. ulcerans from different geographical locations has not been clearly elucidated, and some studies seem to suggest genetic differences between M. ulcerans in humans and in the environment. This study aimed at identifying genetic differences among M. ulcerans strains between two BU endemic countries: Ghana and Côte d'Ivoire. Clinical samples consisting of swabs, fine needle aspirates, and tissue biopsies of suspected BU lesions and environmental samples (e.g., water, biofilms from plants, soil, and detrital material) were analyzed. BU cases were confirmed via acid fast staining and PCR targeting the 16S rRNA, IS2404, IS2606, and ER domain genes present on M. ulcerans. Heterogeneity among M. ulcerans was determined through VNTR profiling targeting 10 loci. Eleven M. ulcerans genotypes were identified within the clinical samples in both Ghana and Côte d'Ivoire, whiles six M. ulcerans genotypes were found among the environmental samples. Clinical M. ulcerans genotypes C, D, F, and G were common in both countries. Genotype E was unique among the Ghanaian samples, whiles genotypes A, Z, J, and K were unique to the Ivorian samples. Environmental isolates were found to be more conserved compared with the clinical isolates. Genotype W was observed only among the Ghanaian environmental samples. Genotype D was found to be prominent in both clinical and environmental samples, suggesting evidence of possible transmission of M. ulcerans from the environment, particularly water bodies and biofilms from aquatic plants, to humans through open lesions on the skin.

Microbiology of secondary infections in Buruli ulcer lesions; implications for therapeutic interventions.

BACKGROUND: Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans and is the second most common mycobacterial disease after tuberculosis in Ghana and Côte d'Ivoire. M. ulcerans produces mycolactone, an immunosuppressant macrolide toxin, responsible for the characteristic painless nature of the infection. Secondary infection of ulcers before, during and after treatment has been associated with delayed wound healing and resistance to streptomycin and rifampicin. However, not much is known of the bacteria causing these infections as well as antimicrobial drugs for treating the secondary microorganism. This study sought to identify secondary microbial infections in BU lesions and to determine their levels of antibiotic resistance due to the prolonged antibiotic therapy required for Buruli ulcer. RESULTS: Swabs from fifty-one suspected BU cases were sampled in the Amansie Central District from St. Peters Hospital (Jacobu) and through an active case surveillance. Forty of the samples were M. ulcerans (BU) positive. Secondary bacteria were identified in all sampled lesions (N = 51). The predominant bacteria identified in both BU and Non-BU groups were Staphylococci spp and Bacilli spp. The most diverse secondary bacteria were detected among BU patients who were not yet on antibiotic treatment. Fungal species identified were Candida spp, Penicillium spp and Trichodema spp. Selected secondary bacteria isolates were all susceptible to clarithromycin and amikacin among both BU and Non-BU patients. Majority, however, had high resistance to streptomycin. CONCLUSIONS: Microorganisms other than M. ulcerans colonize and proliferate on BU lesions. Secondary microorganisms of BU wounds were mainly Staphylococcus spp, Bacillus spp and Pseudomonas spp. These secondary microorganisms were less predominant in BU patients under treatment compared to those without treatment. The delay in healing that are experienced by some BU patients could be as a result of these bacteria and fungi colonizing and proliferating in BU lesions. Clarithromycin and amikacin are likely suitable drugs for clearance of secondary infection of Buruli ulcer.

Investigating the virulence genes and antibiotic susceptibility patterns of Vibrio cholerae O1 in environmental and clinical isolates in Accra, Ghana.

BACKGROUND: Cholera has been endemic in Ghana since its detection in 1970. It has been shown that long-term survival of the bacteria may be attained in aquatic environments. Consequently, cholera outbreaks may be triggered predominantly in densely populated urban areas. We investigated clinical and environmental isolates of Vibrio cholerae O1 in Accra to determine their virulence genes, antibiotic susceptibility patterns and environmental factors maintaining their persistence in the environment. METHODS: Water samples from various sources were analyzed for the presence of V. cholerae O1 using culture methods. Forty clinical isolates from a previous cholera outbreak were included in the study for comparison. Antibiotic susceptibility patterns of the bacteria were determined by disc diffusion. Virulence genes were identified by analyzing genes for ctx, tcpA (tcpAEl Tor tcpACl), zot, ompW, rbfO1 and attRS using PCR. Physicochemical characteristics of water were investigated using standard methods. One-way ANOVA and student t - test were employed to analyze the relationship between physicochemical factors and the occurrence of V. cholerae O1. RESULTS: Eleven V. cholerae O1 strains were successfully isolated from streams, storage tanks and wells during the study period. All isolates were resistant to one or more of the eight antibiotics used. Multidrug resistance was observed in over 97% of the isolates. All isolates had genes for at least one virulence factor. Vibrio cholerae toxin gene was detected in 82.4% of the isolates. Approximately 81.8% of the isolates were positive for tcpAEl Tor gene, but also harbored the tcpAcl gene. Isolates were grouped into thirteen genotypes based on the genes analyzed. High temperature, salinity, total dissolved solids and conductivity was found to significantly correlate positively with isolation of V. cholerae O1. V. cholerae serotype Ogawa biotype El tor is the main biotype circulating in Ghana with the emergence of a hybrid strain. CONCLUSIONS: Multidrug resistant V. cholerae O1 with different genotypes and pathogenicity are present in water sources and co-exist with non O1/O139 in the study area.

Reproductive and menstrual factors and mammographic density in African American, Caribbean, and white women.

OBJECTIVE: We investigated the associations between reproductive and menstrual risk factors for breast cancer and mammographic density, a strong risk factor for breast cancer, in a predominantly ethnic minority and immigrant sample. METHODS: We interviewed women (42% African American, 22% African Caribbean, 22% White, 9% Hispanic Caribbean, 5% other) without a history of breast cancer during their mammography appointment (n = 191, mean age = 50). We used a computer-assisted method to measure the area and percentage of dense breast tissue from cranio-caudal mammograms. We used multivariable linear regression analyses to estimate the associations between reproductive and menstrual risk factors and mammographic density. RESULTS: Age was inversely associated with percent density and dense area, and body mass index (BMI) was inversely associated with percent density. Adjusting for age, BMI, ethnicity and menopausal status, later age at menarche (e.g., ß = -7.37, 95% CI: -12.29, -2.46 for age ≥ 13 years vs. ≤ 11 years), and any use of hormonal birth control (HBC) methods (ß = -5.10, 95% CI: -9.37, -0.84) were associated with reduced dense area. Ethnicity and nativity (foreign- vs. US-born) were not directly associated with density despite variations in the distribution of several risk factors across ethnic and nativity groups. CONCLUSIONS: The mean level of mammographic density did not differ across ethnic and nativity groups, but several risk factors for breast cancer were associated with density in ethnic minority and immigrant women.

The obscuring object of race: clinical breast exams and coping styles in ethnic subpopulations of women.

OBJECTIVES: Differences in breast cancer screening rates have been linked to many factors including race, access to healthcare, and breast cancer knowledge and beliefs; less frequently studied has been the role of characteristic styles of coping. In this study, we examined ethnicity and the role of coping with a possible breast cancer diagnosis in the context of whether or not women obtained clinical breast examinations (CBE). DESIGN: To measure coping, a stressor, in the form of a vignette asking participants to imagine they had just received a breast diagnosis upon a doctor's visit, was used. METHOD: Three hundred and eight women from seven ethnic subpopulations (and from three racial groups) in the USA were interviewed regarding frequency of breast screening, as well as how they would likely cope with a diagnosis of breast cancer. RESULTS: CBE rates were similar across groups and were differentially predicted by the different coping styles. Analysing the results using typical racial categories (rather than distinct ethnic groupings) obscured these results. Furthermore, avoidance predicted CBE and mammogram rates differently, specifically, predicting mammogram rates differentially for each group, with no relation to CBE rates. CONCLUSION: Recognition of the roles of problem solving, social support, and avoidance in coping with a possible breast cancer diagnosis may guide the development and provision of interventions that are more sensitive to the characteristics of specific groups of women. Examinations of psychological variables in preventive health behaviours must begin to analyse diversity by paying attention to ethnic specificity, rather than race, as well as to the underlying nature of the screening task.

The influence of coping styles on mammography screening in a multiethnic sample.

A total of 308 women from seven ethnic subpopulations (comprising major ethnic groups of Black, Hispanic, and non-Hispanic White) were interviewed to examine their coping styles in response to an imagined breast cancer diagnosis and to determine relationships among ethnicity, access to mammography, coping styles, and mammography screening. There were ethnic subpopulation differences in the five coping styles identified (problem solving, social support, positive reframing, wishful thinking, and avoidance), and in the relations between screening rates and coping styles. Specifically, ethnicity differentially moderated the relationship between screening rates and avoidance within and between major groups. Researchers studying behavior that is likely to be impacted by culture, such as health preventive behaviors, are well advised to take coping styles into account, as well as to examine potential ethnic subpopulation differences.

Influence of coping with prostate cancer threat on frequency of digital rectal examinations.

OBJECTIVES: To determine the role of personality variables in coping with cancer threat in the receipt of digital rectal examinations among men from 7 ethnic subpopulations composing 3 major ethnic groups. METHODS: Three hundred eight men were assessed on how often they obtained digital rectal exams and their likelihood of coping with a hypothetical cancer diagnosis. RESULTS: There were ethnic disparities in screening frequency that were not accounted for by demographic/background variables. Coping styles that reflect problem solving, use of social support, and avoidance provided unique and additional variance in understanding these disparities. CONCLUSIONS: Cancer researchers and educators must account for heterogeneity within typical major ethnic groups, as well as consider the role of personality variables, as they differentially predict outcomes in ethnic subpopulations.

On the importance of being ethnic: coping with the threat of prostate cancer in relation to prostate cancer screening.

The relation between coping with a possible prostate cancer diagnosis and screening behavior was examined in men from seven precise ethnic groups. Five coping styles differed in their likelihood of use across ethnic groups and had somewhat different associations with frequency of prostate-specific antigen (PSA) testing. As expected, PSA test frequency differed among men from different ethnic groups and was differentially predicted by coping styles. Analyzing the results using typical groups of White, Black, and Hispanic, rather than precise ethnic groups, obscured these results. Researchers investigating psychological variables in preventive health behaviors must analyze diversity within the framework provided by ethnic specificity. Such an approach will guide the development and provision of interventions that are more sensitive to the characteristics of specific ethnic groups of at risk men.

Stress versus discrete negative emotions in the prediction of physical complaints: does predictive utility vary across ethnic groups?

Reports of stress and negative emotion are important predictors of health. However, whether discrete emotions or stress measures are more useful, whether they contribute independently to outcome, and whether they relate to health equally across ethnic groups remain unclear. In the current study, 207 US-born European American, US-born African American, Black English-speaking Caribbean, and Dominican men aged 40 years and older completed measures of somatic symptoms, trait emotions, and stress. Sadness and stress independently predicted symptom reports, even when examined concurrently, and with demographics controlled; trait anger did not predict symptoms. Moreover, the relations between trait emotions and symptoms varied across groups. Levels of sadness were associated with greater symptoms among US-born European American and Dominican men, but negatively associated among Black English-speaking Caribbean men, and the relations for anger also differed marginally across groups. The results underscore the importance of differentiating among discrete emotions and stress and considering ethnic interactions when examining reports of somatic symptomology. We suggest that the impact of psychological characteristics on health must be considered within cultural and ethnic contexts to be fully understood.

Emotion experience and expression across the adult life span: insights from a multimodal assessment study.

This investigation represents a multimodal study of age-related differences in experienced and expressed affect and in emotion regulatory skills in a sample of young, middle-aged, and older adults (N=96), testing formulations derived from differential emotions theory. The experimental session consisted of a 10-min anger induction and a 10-min sadness induction using a relived emotion task; participants were also randomly assigned to an inhibition or noninhibition condition. In addition to subjective ratings of emotional experience provided by participants, their facial behavior was coded using an objective facial affect coding system; a content analysis also was applied to the emotion narratives. Separate repeated measures analyses of variance applied to each emotion domain indicated age differences in the co-occurrence of negative emotions and co-occurrence of positive and negative emotions across domains, thus extending the finding of emotion heterogeneity or complexity in emotion experience to facial behavior and verbal narratives. The authors also found that the inhibition condition resulted in a different pattern of results in the older versus middle-aged and younger adults. The intensity and frequency of discrete emotions were similar across age groups, with a few exceptions. Overall, the findings were generally consistent with differential emotions theory.

Prostate cancer screening behavior in men from seven ethnic groups: the fear factor.

Rates of prostate cancer screening are known to vary among the major ethnic groups. However, likely variations in screening behavior among ethnic subpopulations and the likely role of psychological characteristics remain understudied. We examined differences in prostate cancer screening among samples of 44 men from each of seven ethnic groups (N = 308; U.S.-born European Americans, U.S.-born African Americans, men from the English-speaking Caribbean, Haitians, Dominicans, Puerto Ricans, and Eastern Europeans) and the associations among trait fear, emotion regulatory characteristics, and screening. As expected, there were differences in the frequency of both digital rectal exam (DRE) and prostate-specific antigen (PSA) tests among the groups, even when demographic factors and access were controlled. Haitian men reported fewer DRE and PSA tests than either U.S.-born European American or Dominican men, and immigrant Eastern European men reported fewer tests than U.S.-born European Americans; consistent with prior research, U.S.-born African Americans differed from U.S.-born European Americans for DRE but not PSA frequency. Second, the addition of trait fear significantly improved model fit, as did the inclusion of a quadratic, inverted U, trait fear term, even where demographics, access, and ethnicity were controlled. Trait fear did not interact with ethnicity, suggesting its effect may operate equally across groups, and adding patterns of information processing and emotion regulation to the model did not improve model fit. Overall, our data suggest that fear is among the key psychological determinants of male screening behavior and would be usefully considered in models designed to increase male screening frequency.

Breast self-examination practices among women from six ethnic groups and the influence of cancer worry.

Diverse samples of women (N = 1364) from Brooklyn, New York, were interviewed regarding their breast cancer screening practices. Of interest here is the relation between cancer worry and adherence to breast self-examination (BSE) guidelines among the six ethnic groups identified--European American, African American, Haitian, Dominican and English-speaking Caribbean women. There was a significant difference in cancer worry by ethnicity. Logistic regression analysis indicated that education, cancer worry, and perceived efficacy of BSE significantly predicted adherence. Furthermore, there were significant differences among women of African descent in BSE adherence and cancer worry. These differences reflect the emerging need for researchers to empirically and methodically investigate ethnic and cultural factors, as well as emotions and affect in preventive health behaviors.

Effects of random outcomes on choice behavior.

Decision-making researchers have shown that making optimal decisions is aided by the detection of information salient to the task. When the task involves random events, humans tend to perceive these events as contingent. In this study, outcomes were grouped together with choices to identify some of the conditions under which random events are correctly perceived. Of the two groups (ns=40) only one was provided information regarding the relationship between choice and outcome. This provision did not improve the detection of the relationship between random events any more than direct contact with the underlying contingencies. Findings are discussed in terms of experiential contact with and sensitivity to underlying contingency.

Rule-governed versus contingency-governed behavior in a self-control task: effects of changes in contingencies.

Rule-governed behavior is typically acquired faster than contingency-governed behavior but is less sensitive than contingency-governed behavior to unverbalized contingency changes. The present study investigated these relationships in a computer task frequently used to study human self-control. Instructions for one group of participants contained a hint about how to maximize long-term reinforcement; the other group performed the task without the hint. Participants given the hint came closer to maximizing reinforcement in the long term, but their behavior was less sensitive to an unsignaled contingency change than that of those not given the hint. The study shows that, like other complex behaviors, self-control may be contingency-governed or rule-governed.