Impact of the Ebola Virus Outbreak on Tuberculosis Treatment Adherence and Outcomes in a Military Hospital in Freetown, Sierra Leone.

The impact and disruption of infectious disease outbreaks stretch far beyond their direct death toll, as they often overburden health systems, reduce treatment seeking behaviors, and interrupt treatment regimens. This study examines the impact of the 2014-2016 Ebola virus outbreak on tuberculosis (TB) treatment outcomes at the 34 Military Hospital in Freetown, Sierra Leone. We used retrospective data from 1,085 TB patient outcome data registers to build a multinomial logistic regression model to evaluate the change in TB treatment outcomes before and after the Public Health Emergency of International Concern (PHEIC) declaration in August 2014. These results showed that HIV status, patient age, whether patients had active versus latent TB, and the time since the start of the outbreak were significantly associated with TB treatment outcomes. The model showed an increase in probability of unknown and unsuccessful (died or treatment failed) treatment outcomes with each month after the PHEIC declaration, across age groups, TB status, and HIV status.

Molecular Characteristics of Rickettsia in Ticks Collected along the Southern Border of Mongolia.

Tick-borne infections are a significant threat to public health, particularly in regions where individuals frequently enter tick habitats. Roughly 26% of the population in Mongolia practice nomadic pastoralism and are considered at high risk of exposure to ticks and the diseases they carry. This study tested ticks from Mongolia's southern border for Rickettsia spp. to better understand the epidemiology of tick-borne diseases in the region. Dermacentor nuttalli and Hyalomma asiaticum ticks (n = 4022) were pooled and tested for Rickettsia spp. by real-time PCR. Melt-curve analyses and Sanger sequencing were used to identify Rickettsia species. Approximately 64% of the 786 tick pools tested positive for Rickettsia bacteria. Melt curve analyses identified four different Rickettsia species circulating in these tick pools. Amplicon sequencing of the ompA gene identified Rickettsia spp. that closely resembled R. raoultii and R. sibirica. Dermacentor nuttalli ticks from Govi-Altai had the highest maximum likelihood estimation infection rate 48.4% (95% CI: 41.7-56.5%), while Hyalommaasiaticum collected in Omnogovi had a rate of 7.6% (95% CI: 6.2-9.2%). The high detection of Rickettsia suggests a substantial risk of infection in southern Mongolia. Further studies are necessary to investigate the clinical burden of tick-borne diseases in Mongolia.

Discrepancies between self-reported tick bites and evidence of tick-borne disease exposure among nomadic Mongolian herders.

Twenty-six per cent of Mongolians live pastoral lifestyles, increasing their likelihood of exposure to ticks and placing them at a higher risk for contracting tick-borne diseases (TBDs). Anaplasma spp. and Rickettsia spp. have been identified in ticks, livestock and humans in Mongolia, but no known qualitative research has been conducted investigating the association between nomadic herder characteristics, tick bite history and exposure to TBDs. To better understand the association between self-reported tick bites and symptoms versus actual exposure to TBDs, this study paired serological data with 335 surveys administered to Mongolian herders, ages 12-69, from 2014 to 2015. Logistic regression results identified no significant associations between reported tick bites or symptoms with serological evidence of Anaplasma spp. and Rickettsia spp. controlling for age, gender and aimag. Among the 335 respondents who were seropositive to either Anaplasma spp. or Rickettsia spp., 32.9% self-reported experiencing abnormal symptoms such as redness, inflammation, headache, arthritis or fever after being bitten. Alternatively, 17.3% (58/335) of individuals reported experiencing symptoms following a tick bite in instances where serological results indicated no exposure to Anaplasma spp. or Rickettsia spp. Results also identified inconsistencies in reporting and seroprevalence among different age groups, with children having the highest reporting and treatment seeking rates but low levels of exposure in comparison with other groups. While survey results showed that individuals were aware of peak tick seasons and tick species that inhabit specific areas, 58% of heads of households (49/84) were unaware that ticks can cause disease in livestock or dogs. This study suggests that herders are an at-risk population in Mongolia with gaps in awareness of TBD risk. Increased surveillance paired with focused outreach to prevent TBDs targeted to the herder population is encouraged.

Geographic Range of Lyme Borreliosis in Mongolia.

Introduction: In Asia, Borrelia garinii, B. afzelii, and B. bavariensis are transmitted by Ixodes persulcatus ticks and clinically present with a wide range of neurological and arthritic symptoms. This report aims to provide details on the geographic distribution of suspected cases of Lyme borreliosis (LB), reported to local Mongolian hospitals between 2007 and 2017. Methods: This report examines 150 reported cases of suspected LB from 13 aimags (provinces) in Mongolia from April 2007 to August 2017, including date and location of infection, method of diagnosis (indirect immunofluorescent assay and/or enzyme-linked immunosorbent assay test), frequency of specific symptoms, and case demographics. Information was gathered through collaboration with the National Center of Communicable Disease and the National Center for Zoonotic Diseases. Results: Zavkhan and Selenge, located in northern Mongolia, had the highest percentage of reported suspected cases, with 25% and 20%, respectively. Ages ranged from 1 to 78 years, with a mean age of 26 years, however, 37% of individuals were younger than 10. More than twice as many women sought treatment as men, and the distribution of men who sought treatment was skewed toward children and the elderly. Most frequently reported symptoms include fever, rash, headache, and enlarged lymph glands. Furthermore, peak months of tick bite and treatment seeking occurred between April and June. Conclusions: Based on these preliminary findings, syndromic surveillance should be expanded across northern Mongolia, with LB considered in differential diagnosis for patients reporting a recent tick bite.

Multi-Institutional Survey of Fourth Year Students' Self Assessed Milestone Based Skill Proficiency and Faculty Expectation During an Emergency Medicine Clerk-ship: Implications For Curriculum Development.

This article was migrated. The article was marked as recommended. Introduction: Emergency medicine milestones suggest skill performance expectations for graduating medical students. The objective of this study is to examine differences between student's perceived proficiency and faculty expectations relative to Level 1 EM milestones, identifying opportunities for curriculum development. Methods: Using ACGME milestone language, the authors developed a survey that measures student perceived skill proficiency with 22 skills, which was administered to fourth year medical students at 6 institutions. Similar surveys were sent to faculty to determine their expectations of students' skill proficiency. Differences between student and faculty responses were calculated. Results: There were 608 student and 114 faculty responses. There was a statistically significant difference between mean student and faculty responses for 13 of the 22 skills. For 10 of these skills, students rated their own skill proficiency higher than faculty expectations. For 3 of the skills, faculty rated their expectations higher than students' perceived proficiency. Conclusions: For pharmacology skills, student ratings were low, indicating an area to focus curriculum development. Items where student ratings are higher than faculty may be a result of overconfidence or a lack of understanding by faculty of students' abilities. Formal assessment of skills in these areas would help clarify the reason and direct faculty and curriculum development.

Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors.

BACKGROUND: Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one's own cardiovascular risk. METHODS: A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors. Separately, the personalization of coronary risk factors was determined by having patients list their individual risk factors for having a heart attack. Primary outcome was the evaluation of ethnic disparities in awareness of cardiovascular risk factors and the patient's misperceptions on personal risk factors. Secondary outcome was the assessment of access to information in the same population by gender and ethnicity. RESULTS: Between October 2006 and April 2008, 1584 consecutive patients were screened, and 1051 patients were enrolled. Participants were 57.5% female and 62.8% self-identified White, 22.5% Black, and 11.5% Hispanic. Misperception about personal risk was significantly higher in non-White compared with the White participants for diabetes (in Blacks [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.08-5.57] and Hispanics [OR, 3.50; 95% CI, 1.49-8.20]) and for hyperlipidemia (in Hispanics [OR, 2.21; 95% CI, 1.19-4.10]). Although the majority (85%) had a primary care physician, Blacks and Hispanics were less likely to have access to information (OR, 0.25; 95% CI, 0.10-0.49; and OR, 0.71; 95% CI, 0.37-1.04, respectively). CONCLUSIONS: There are major gaps between awareness and personalization of risk in major modifiable coronary artery disease risk factors in different ethnic groups.

Alcohol and sexual consent scale: development and validation.

OBJECTIVE: To establish a short measure of attitudes toward sexual consent in the context of alcohol consumption. METHODS: Using a multistage and systematic measurement development process, the investigators developed the Alcohol and Sexual Consent Scale using a sample of college students. RESULTS: The resulting 12-item scale, the Alcohol and Sexual Consent Scale, was examined across a variety of validation measures. The measure is related to alcohol consumption, sexual habits, and sexual victimization and/or perpetration. CONCLUSIONS: The Alcohol and Sexual Consent Scale can be used to serve as an outcome measure in sexual assault prevention programming.