Hasil untuk "Arctic medicine. Tropical medicine"

Yuelin Xiong, Huatang Luo, Hao Wang et al.

<h4>Background</h4>Schistosomiasis, a neglected tropical disease (NTD), remains a public health concern in China. Health education is a fundamental intervention for its control. Even in transmission-interrupted areas like Wuhan, sustained awareness is crucial. However, recent literature on school-based interventions evaluating knowledge, attitudes and practices (KAP) among children in such areas is limited.<h4>Objective</h4>This study aimed to evaluate and compare the effectiveness of peer-led education versus routine health education in improving schistosomiasis-related KAP among elementary students in an urban area where schistosomiasis transmission has been interrupted.<h4>Methods</h4>A quasi-experimental school-level trial was conducted from October 2021 to January 2022 among 1013 fourth- and fifth-grade students of Yucai Hankou and Dijiao primary schools in Jiang'an district, Wuhan, China. Students were randomly assigned to two groups. Group I (n = 524) received peer-led education, while Group II (n = 489) received routine health education. Schistosomiasis-related KAP were assessed via standardized questionnaires at baseline and one month post-intervention. Statistical analyses followed the intention-to-treat principle, using multiple imputation for missing baseline data. Intervention effects were evaluated via analysis of covariance (ANCOVA) and multivariable logistic regression, adjusting for baseline scores and demographic covariates.<h4>Results</h4>Following the intervention, both peer-led and routine health education interventions significantly improved schistosomiasis-related KAP scores among schoolchildren. For knowledge scores, both groups showed significant improvement from baseline to follow-up (within-group change: 2.93 for Group I vs. 0.98 for Group II, both P < 0.001). After adjusting for baseline scores, age, sex, and grade, Group I demonstrated a significantly higher adjusted mean score of 8.73 (95% CI: 8.63, 8.84) compared to Group II, which had an adjusted mean of 7.21 (95% CI: 7.10, 7.32). The adjusted mean difference (AMD) was 1.52 (95% CI: 1.37, 1.68), which was statistically significant (P < 0.001). For attitude scores, both groups exhibited small but statistically significant increases from baseline (within-group change: 0.20 for Group I vs. 0.21 for Group II, both P < 0.001). However, the between-group comparison revealed no significant difference at follow-up. For practice scores, significant within-group improvements were observed in both Group I and Group II (within-group change: 0.30 vs. 0.33, both P < 0.001). The adjusted mean was 3.95 (95% CI: 3.93, 3.97) in Group I and 3.97 (95% CI: 3.95, 4.00) in Group II. The AMD was -0.02 (95% CI: -0.06, 0.01), and this between-group difference was not statistically significant (P = 0.237). In terms of binary outcomes, the odds of achieving good knowledge were 6.04 times higher in Group I compared to Group II (aOR = 6.04, 95% CI: 4.43 to 8.24, P < 0.001), while no significant effects were observed on positive attitude or favorable practices between the two groups.<h4>Conclusion</h4>Peer-led education is more effective than routine health education in improving schistosomiasis-related knowledge among primary school students in a transmission-interrupted area. Although both approaches enhanced KAP, the peer-led model demonstrated superior knowledge gains. These findings support the integration of peer-led strategies into sustainable school-based health education programmes to maintain schistosomiasis awareness and support ongoing control efforts in post-transmission settings.

Eric Nyarko, Iddrisu Abugbil Atubiga, Emmanuel Tetteh Siame et al.

<h4>Background</h4>Snakebite is a severe neglected tropical disease (NTD) that affects 2.5 million people each year, resulting in the deaths of 81,000-138,000 individuals, including rural villagers, agricultural workers, and children. The World Health Organization (WHO) has set strategic objectives to halve the deaths and disabilities caused by snakebite envenoming (SBE) by 2030. This study used innovative research methods, such as the statistical design of experiments and machine learning (ML), to explore healthcare workers' priorities in Ghana regarding the WHO's strategic objectives for controlling and preventing SBE. The goal was to identify their priority needs to guide the development of a research agenda and relevant interventions or policies that prioritize local needs while aligning with the WHO's strategic objectives for SBE control and prevention.<h4>Method</h4>In this cross-sectional study, we employed a MaxDiff statistical design to collect data on the prioritization of the WHO strategic objectives for SBE from 137 healthcare workers in the Kwahu Afram Plains North and South districts of the Eastern Region of Ghana from August to December 2024. We divided the final dataset using a hold-back validation method, maintaining a training-to-validation ratio of 70:30. For data analysis, we utilized a diverse range of five machine learning models: Ridge Regression, Elastic Net, LASSO, a Generalized Regression Model with Pruned Forward Selection, and Forward Selection. To compare the performance of these models, we used several key metrics, including Akaike Information Criterion corrected (AICc), the Bayesian Information Criterion (BIC), the Root Average Squared Error (RASE), negative log-likelihood, and the total time taken to fit each model.<h4>Results</h4>The Ridge regression model appeared as the best candidate among the ML models used in this study. Its superior predictive performance justifies the computational cost it requires, making it the preferred option for applications that prioritize both predictive performance and computational efficiency. This model consistently predicted key WHO strategic objectives for preventing and controlling SBE. Of the objectives, 'Ensuring safe and effective treatment' had the highest priority, followed by 'Strengthening health systems', 'Empowering and engaging communities' and 'Increasing partnerships, coordination, and resources'. This underscores their order of importance for local initiatives. Therefore, these strategies must be prioritized when designing local policies, relevant interventions, and research agendas.<h4>Conclusion</h4>By utilizing a MaxDiff statistical experiment design and five machine learning models, participants prioritized the WHO strategic objectives for preventing and controlling SBE in Ghana. Our findings provide essential insights into local policy-making and intervention strategies and for shaping research agendas in Ghana. A local action plan is urgently needed, prioritizing 'Ensuring safe and effective treatment' at the community level, followed by 'Strengthening health systems', 'Empowering and engaging communities', and 'Increasing partnerships, coordination, and resources'. Prioritizing these strategies in Ghana is crucial for supporting the WHO's goal of reducing the global SBE burden by 50% by 2030. The success of these strategies hinges on the active involvement of the Ministry of Health and the Ghana Health Service in their implementation at the local level and within the health system.

Alberto Rizzo, Silvia Grosso, Ivano Faggion et al.

Ruwan Ratnayake, Francesco Checchi, Christopher I Jarvis et al.

<h4>Background</h4>The evaluation of ring vaccination and other outbreak-containment interventions during severe and rapidly-evolving epidemics presents a challenge for the choice of a feasible study design, and subsequently, for the estimation of statistical power. To support a future evaluation of a case-area targeted intervention against cholera, we have proposed a prospective observational study design to estimate the association between the strength of implementation of this intervention across several small outbreaks (occurring within geographically delineated clusters around primary and secondary cases named 'rings') and its effectiveness (defined as a reduction in cholera incidence). We describe here a strategy combining mathematical modelling and simulation to estimate power for a prospective observational study.<h4>Methodology and principal findings</h4>The strategy combines stochastic modelling of transmission and the direct and indirect effects of the intervention in a set of rings, with a simulation of the study analysis on the model results. We found that targeting 80 to 100 rings was required to achieve power ≥80%, using a basic reproduction number of 2.0 and a dispersion coefficient of 1.0-1.5.<h4>Conclusions</h4>This power estimation strategy is feasible to implement for observational study designs which aim to evaluate outbreak containment for other pathogens in geographically or socially defined rings.

Martha Puello, Gregorio Young, Paola Suárez

Introducción. Las proteasas y las fosfolipasas son factores de virulencia de Candida spp. que cumplen un papel importante en la invasión de los tejidos. Entre los factores relacionados con el huésped, se encuentran algunos asociados con las características ambientales y otros con la colonización. Objetivo. Determinar la actividad de fosfolipasas y proteasas en aislamientos de especies colonizadoras y patógenas de Candida spp., aisladas de mujeres gestantes de Cartagena de Indias. Materiales y métodos. Se determinó la actividad de fosfolipasas y proteasas en 56 aislamientos mediante degradación del sustrato y cálculo del coeficiente de actividad enzimática. Se compararon las actividades de fosfolipasas y proteasas, entre los aislamientos colonizadores y los patógenos. Resultados. La actividad de la fosfolipasa fue “muy alta” (< 0,69) en 34 aislamientos e, igualmente, la de la proteasa en 14. No hubo diferencias significativas al comparar las actividades de las fosfolipasas y de las de las proteasas, entre los aislamientos colonizadores y los patógenos. Conclusiones. La actividad de las fosfolipasas predominó como factor de virulencia en los aislamientos estudiados. No obstante, no se encontró una diferencia significativa entre los grupos de aislamientos colonizadores y los patógenos, en cuanto a las actividades de fosfolipasas y proteasas.

P. Hotez, A. Damania, M. Bottazzi

1 Departments of Pediatrics and Molecular Virology & Microbiology, Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America, 2 Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas, United States of America, 3 Department of Biology, Baylor University, Waco, Texas, United States of America, 4 James A Baker III Institute of Public Policy, Rice University, Houston, Texas, United States of America, 5 Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, Texas, United States of America, 6 Department of Pediatrics, Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America

P. Hotez, M. Bottazzi, Sunit K. Singh et al.

1 Departments of Pediatrics and Molecular Virology & Microbiology, Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America, 2 Department of Biology, Baylor University, Waco, Texas, United States of America, 3 Hagler Institute for Advanced Study at Texas A&M University, Texas, United States of America, 4 James A Baker III Institute of Public Policy, Rice University, Houston, Texas, United States of America, 5 Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, Texas, United States of America, 6 Molecular Biology Unit, Faculty of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, 7 Department of Microbiology, Immunology, and Tropical Medicine, George Washington University School of Medicine, Washington D.C., United States of America, 8 Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America

P. Hotez

1 Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America, 2 James A Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America, 3 Department of Biology, Baylor University, Waco, Texas, United States of America, 4 Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, Texas, United States of America

Jarbas Barbosa da Silva, Marcos Espinal