Building Local Capacity in a Low-Resource Setting to Increase Access to Health Care: An Evaluation of Blood Pressure Monitoring Training.

Cardiovascular risk factors such as hypertension are common and largely uncontrolled in Malawi. In this low-resource setting, Community Health Workers (CHWs) can increase access to home-based blood pressure (BP) monitoring. The purpose of this study is to evaluate the effectiveness of a CHW training focused on BP monitoring and referral criteria, as well as the accuracy of referral decision-making and documentation. The participants were a purposive sample of all active home-based palliative care CHWs at St. Gabriel's Hospital (n = 60) located in Namitete, Malawi, serving over 250,000 people within a 50 km radius. This was a retrospective cross-sectional study conducted in December 2020 using both quantitative (descriptive, paired t-test) and qualitative (thematic) analysis. Participants showed significantly greater knowledge on the post-test (M = 8.98, SD = 1.213) compared to the pretest (M = 7.96, SD = 1.231), t (54)-5.0557.475, p < .001. All participants who attended both days of training demonstrated competency on a skills checklist in 100% of the rehabilitation and BP monitoring skills taught. Through document analysis of record books, referral decisions for patients with hypertension were 87.57% accurate and 81.07% of entries (n = 713) were complete. Participants reported the lack of both transportation and equipment as barriers to their work. They reported trainings, supplies, and support from the hospital as facilitators to their work. This study shows that BP can be monitored in remote villages, accurate referrals can be made, and stroke prevention education can be provided. These interventions increase the chances of more equitable care for this vulnerable population in a resource-limited setting.

Local Salmonella Enteritidis restaurant outbreak investigation in England provides further evidence for eggs as source in widespread international cluster, March to April 2023.

We report a 5-single nucleotide polymorphism cluster of Salmonella Enteriditis in England, part of a global cluster of S. Enteritidis ST11. Forty-seven confirmed cases have been investigated of whom 25 were linked to a restaurant. In addition, there were 18 probable cases with restaurant exposure. Epidemiological investigations suggested eggs or chicken as the most likely cause of the outbreak but were unable to distinguish between those two food vehicles. Ongoing food chain investigations indicated links to imported eggs from Poland.

Multilocus variable-number tandem-repeat genotyping of Renibacterium salmoninarum, a bacterium causing bacterial kidney disease in salmonid fish.

BACKGROUND: Bacterial kidney disease (BKD), caused by Renibacterium salmoninarum, is a bacterial disease of fish, which is both geographically widespread and difficult to control. Previously, application of various molecular typing methods has failed to reliably discriminate between R. salmoninarum isolates originating from different host species and geographic areas. The current study aimed to utilize multilocus variable number tandem repeats (VNTR) to investigate inter-strain variation of R. salmoninarum to establish whether host-specific populations exist in Atlantic salmon and rainbow trout respectively. Such information would be valuable in risk assessment of transmission of R. salmoninarum in a multispecies aquaculture environment. RESULTS: The present analysis utilizing sixteen VNTRs distinguished 17 different haplotypes amongst 41 R. salmoninarum isolates originating from Atlantic salmon and rainbow trout in Scotland, Norway and the US. The VNTR typing system revealed two well supported groups of R. salmoninarum haplotypes. The first group included R. salmoninarum isolates originating from both Atlantic salmon and rainbow trout circulating in Scottish and Norwegian aquaculture, in addition to the type strain ATCC33209T originating from Chinook salmon in North America. The second group comprised isolates found exclusively in Atlantic salmon, of mainly wild origin, including isolates NCIB1114 and NCIB1116 associated with the original Dee disease in Scotland. CONCLUSIONS: The present study confirmed that VNTR analysis can be successfully applied to discriminate R. salmoninarum strains. There was no clear distinction between isolates originating from Atlantic salmon and rainbow trout as several haplotypes in group 1 clustered together R. salmoninarum isolates from both species. These findings indicate a potential exchange of pathogens between Atlantic salmon and rainbow trout in Scottish and Norwegian aquaculture during the last 20 years. In a scenario of expansion of rainbow trout farming into the marine environment, appropriate biosecurity measures to minimize disease occurrence are advised. The present results also suggest that R. salmoninarum isolates circulating in European aquaculture over the last 20 years are genetically distant to the wild strains originally causing BKD in the rivers Dee and Spey.

Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs.

BACKGROUND: Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members. METHODS: A cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members. RESULTS: Members of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted 'happy hour' promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes. CONCLUSIONS: The findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.

The making of a (dog) movie star: The effect of the portrayal of dogs in movies on breed registrations in the United States.

The media is a powerful force that can affect the welfare of the domiciled dog population. Dogs have long been in human stories and their depictions can create demand for the breeds shown. While previous research has found that this effect can last for up to ten years after the release of a movie, how this phenomenon occurs is unknown. This paper examines if how a dog is portrayed in a movie is associated with a subsequent change in American Kennel Club breed registrations for that breed. Following a systematic literature review, four key themes were identified in how dogs are portrayed in the media; dogs portrayed as heroes, as anthropomorphised, as embodying the ideals of Western societies (Whiteness and heteronormativity) and as boundaries between wilderness and human society. Forty movies from between 1930 to 2004 were analysed, resulting in 95 dog characters scored, and hierarchical multiple linear regression was run. Movies with dogs portrayed as heroes were followed by significant increases in the number of American Kennel Club breed registrations for the breed shown, while anthropomorphised dogs were followed by significant decreases in the number of dogs registered for up to five years after a movie's release. These results indicate that how dogs are portrayed may be an important driver of demand for breeds. Future work should investigate whether these portrayals may have negative welfare implications for real dogs by leading to owners having unrealistic expectations for dogs or increasing demand for dogs with in-breeding related disorders.