Periplaneta americana (Blattodea: Blattidae) fungal pathogens in hospital sewer systems: molecular and phylogenetic approaches.

Cockroaches are known as mechanical vectors of some pathogens that can infect humans. The present study aims to rapidly identify Periplaneta americana fungal pathogens from sewer systems of public hospitals in Esfahan using the polymerase chain reaction (PCR) technique. A total of 55 P. americana cockroaches were randomly collected by direct trapping from sewer systems of seven hospitals and screened for fungal infectious agents using standard morphological methods and the PCR sequencing. From the American cockroach, we isolated 62 yeasts and 31 molds from the surface, hemocoel, and digestive tract of P. americana. Based on DNA sequence comparisons and other taxonomic characteristics, they were identified as more than four species of yeast and four species of mold. Yeast species including Pichia kudriavzevii, Candida glabrata, Pichia kluyveri, and Candida viswanathii, and molds such as Aspergillus niger, Penicillium italicum, Mucor plumbeus, and Rhizopus oryzae were isolated repeatedly from the surface, hemocoel, and digestive tract of P. americana. Our results show that the use of a combination of morphological, molecular techniques, and phylogenetic analysis can lead to the identification of pathogenic fungal agents in American cockroaches and also knowledge of fungal pathogens-arthropod host relationships.

Study on Periplaneta americana (Blattodea: Blattidae) Fungal Infections in Hospital Sewer System, Esfahan City, Iran, 2017.

BACKGROUND: American cockroaches contaminated with pathogens inside hospital manholes can be one of the major problems that health care systems face. OBJECTIVES: The aim of this study was to investigate the fungal infections of American cockroaches in the Esfahan hospital sewage network. The principle goal of the study was about the roaches as a vector of fungi and other pathogens. METHOD: The type of study was descriptive-analytical. A total of 55 American cockroach specimens from the manhole walls of the sewerage system of 7 large hospitals were captured. Samples were taken from the surface of the body, digestive tract, and haemocoel of cockroaches. The specimens were then cultured on Sabouraud dextrose agar separately, and fungi were identified according to the macroscopic and microscopic characteristics. RESULTS: All cockroaches collected from hospitals were infected with fungi. Among the 24 (13 infected and 11 noninfected) (44%) female cockroaches and 31 (18 infected and 13 noninfected) (56%) male cockroaches, it was identified that 40.00% was infected with Aspergillus niger, 3.64% with Rhizopus, 7.27% with Penicillium, and 5.45% with Mucor. 6 cockroaches had no yeast contamination. 17 (30.91%) cockroaches were contaminated with Candida glabrata, 23 (41.82%) cockroaches were contaminated with Candida krusei, and 22 (40%) cockroaches were contaminated with other yeast species. The results of this study showed that Candida krusei had the highest prevalence among the isolated fungi with 35.37% of the digestive system and Aspergillus niger with 70.97% of the surface of the cockroach body. CONCLUSION: The results emphasized the role played by cockroaches as potential pathogenic vectors in hospital environments. Therefore, suitable management is needed for controlling this insect to prevent disease transmission in hospitals.

Health Education Serious Games Targeting Health Care Providers, Patients, and Public Health Users: Scoping Review.

BACKGROUND: Serious educational games have shown effectiveness in improving various health outcomes. Previous reviews of health education games have focused on specific diseases, certain medical subjects, fixed target groups, or limited outcomes of interest. Given the recent surge in health game studies, a scoping review of health education games is needed to provide an updated overview of various aspects of such serious games. OBJECTIVE: This study aimed to conduct a scoping review of the design and evaluation of serious educational games for health targeting health care providers, patients, and public (health) users. METHODS: We identified 2313 studies using a unique combination of keywords in the PubMed and ScienceDirect databases. A total of 161 studies were included in this review after removing duplicates (n=55) and excluding studies not meeting our inclusion criteria (1917 based on title and abstract and 180 after reviewing the full text). The results were stratified based on games targeting health care providers, patients, and public users. RESULTS: Most health education games were developed and evaluated in America (82/161, 50.9%) and Europe (64/161, 39.8%), with a considerable number of studies published after 2012. We discovered 58.4% (94/161) of studies aiming to improve knowledge learning and 41.6% (67/161) to enhance skill development. The studies targeted various categories of end users: health care providers (42/161, 26.1%), patients (38/161, 23.6%), public users (75/161, 46.6%), and a mix of users (6/161, 3.7%). Among games targeting patients, only 13% (6/44) targeted a specific disease, whereas a growing majority targeted lifestyle behaviors, social interactions, cognition, and generic health issues (eg, safety and nutrition). Among 101 studies reporting gameplay specifications, the most common gameplay duration was 30 to 45 min. Of the 61 studies reporting game repetition, only 14% (9/61) of the games allowed the users to play the game with unlimited repetitions. From 32 studies that measured follow-up duration after the game intervention, only 1 study reported a 2-year postintervention follow-up. More than 57.7% (93/161) of the games did not have a multidisciplinary team to design, develop, or assess the game. CONCLUSIONS: Serious games are increasingly used for health education targeting a variety of end users. This study offers an updated scoping review of the studies assessing the value of serious games in improving health education. The results showed a promising trend in diversifying the application of health education games that go beyond a specific medical condition. However, our findings indicate the need for health education game development and adoption in developing countries and the need to focus on multidisciplinary teamwork in designing effective health education games. Furthermore, future health games should expand the duration and repetition of games and increase the length of the follow-up assessments to provide evidence on long-term effectiveness.