Nevin Manimala

Clin Infect Dis. 2021 Apr 27:ciab190. doi: 10.1093/cid/ciab190. Online ahead of print.

ABSTRACT

BACKGROUND: The gambiense human African trypanosomiasis (gHAT) elimination programme in the Democratic Republic of Congo (DRC) routinely collects case data through passive surveillance and active screening, with several regions reporting no cases for several years, despite being endemic in the early 2000s.

METHODS: We use mathematical models fitted to longitudinal data to estimate the probability that selected administrative regions have already achieved elimination of transmission (EOT) of gHAT. We examine the impact of active screening coverage on the certainty of model estimates for transmission and therefore the role of screening in the measurement of EOT.

RESULTS: In three example health zones of Sud-Ubangi province we find there is a moderate (>40%) probability that EOT has been achieved by 2018, based on 2000-2016 data. Budjala and Mbaya reported zero cases during 2017-18 and this further increases our respective estimates to 99.9% and 99.6% (Model S); and to 87.3% and 92.1% (Model W). Bominenge had recent case reporting, however if zero cases were found in 2021 it would substantially raise our certainty that EOT has been met there (99.0% for Model S and 88.5% for Model W), and this could be higher with 50% coverage screening that year (99.1% for Model S and 94.0% for Model W).

CONCLUSIONS: We demonstrate how routine surveillance data coupled with mechanistic modelling can estimate the likelihood that EOT has already been achieved. Such quantitative assessment will become increasingly important for measuring local achievement of EOT as 2030 approaches.

PMID:33905480 | DOI:10.1093/cid/ciab190

Clin Infect Dis. 2021 Apr 27:ciab192. doi: 10.1093/cid/ciab192. Online ahead of print.

ABSTRACT

Maps of the geographical variation in prevalence play an important role in large-scale programmes for the control of Neglected Tropical Diseases. Pre-control mapping is needed to establish the appropriate control intervention in each area of the country in question. Mapping is also needed post-intervention to measure the success of control efforts. In the absence of comprehensive disease registries, mapping efforts can be informed by two kinds of data: empirical estimates of local prevalence obtained by testing individuals from a sample of communities within the geographical region of interest; digital images of environmental factors that are predictive of local prevalence. In this paper, we focus on the design and analysis of impact surveys, i.e. prevalence surveys that are conducted post-intervention with the aim of informing decisions on what further intervention, if any, is needed to achieve elimination of the disease as a public health problem. We show that geospatial statistical methods enable prevalence surveys to be designed and analysed as efficiently as possible so as to make best use of hard-won field data. We use three case-studies based on data from soil-transmitted helminth impact surveys in Kenya, Sierra Leone and Zimbabwe to compare the predictive performance of model-based geostatistics with methods described in current World Health Organisation guidelines. In all three cases, we find that model-based geostatistics substantially outperforms the current WHO guidelines, delivering improved precision for reduced field-sampling effort. We argue from experience that similar improvements will hold for prevalence mapping of other Neglected Tropical Diseases.

PMID:33905476 | DOI:10.1093/cid/ciab192

PLoS Pathog. 2021 Apr 27;17(4):e1009536. doi: 10.1371/journal.ppat.1009536. Online ahead of print.

ABSTRACT

Skin mononuclear phagocytes (MNPs) provide the first interactions of invading viruses with the immune system. In addition to Langerhans cells (LCs), we recently described a second epidermal MNP population, Epi-cDC2s, in human anogenital epidermis that is closely related to dermal conventional dendritic cells type 2 (cDC2) and can be preferentially infected by HIV. Here we show that in epidermal explants topically infected with herpes simplex virus (HSV-1), both LCs and Epi-cDC2s interact with HSV-1 particles and infected keratinocytes. Isolated Epi-cDC2s support higher levels of infection than LCs in vitro, inhibited by acyclovir, but both MNP subtypes express similar levels of the HSV entry receptors nectin-1 and HVEM, and show similar levels of initial uptake. Using inhibitors of endosomal acidification, actin and cholesterol, we found that HSV-1 utilises different entry pathways in each cell type. HSV-1 predominantly infects LCs, and monocyte-derived DCs, via a pH-dependent pathway. In contrast, Epi-cDC2s are mainly infected via a pH-independent pathway which may contribute to the enhanced infection of Epi-cDC2s. Both cells underwent apoptosis suggesting that Epi-cDC2s may follow the same dermal migration and uptake by dermal DCs that we have previously shown for LCs. Thus, we hypothesize that the uptake of HSV and infection of Epi-cDC2s will stimulate immune responses via a different pathway to LCs, which in future may help guide HSV vaccine development and adjuvant targeting.

PMID:33905459 | DOI:10.1371/journal.ppat.1009536

PLoS One. 2021 Apr 27;16(4):e0250637. doi: 10.1371/journal.pone.0250637. eCollection 2021.

ABSTRACT

INTRODUCTION: Pregnant women who disclose their HIV-positive status to their sexual partners have played an important role in reducing the risk of HIV/AIDS transmission to the baby during the antepartum, intrapartum, and postnatal periods. Studies are limited in the current study area in a similar arena. Therefore, this study aimed to assess the proportion of HIV-positive status disclosure and its associated factors among pregnant women.

METHODS: A facility-based cross-sectional study was conducted among 156 HIV-positive pregnant women in Dire Dawa administrative from March 12th to May 10th, 2020. Data were generated using a pretested structured questionnaire through face-to-face interviews. Binary logistic regression analysis was employed to identify the predictor variables associated with the disclosure of HIV-positive status among pregnant women to their sexual partners. Finally, the adjusted odds ratio with 95% confidence intervals at P-value< 0.05 was considered statistically significant.

RESULTS: Of the total, 135 (86.5%) of HIV-positive pregnant women disclosed their HIV status to their sexual partner. Christian followers (both Orthodox and Protestant) [AOR = 8.8, 95% CI: 2.3. 34] more likely to disclose HIV status to their sexual partner than those Muslims. Those participants who started practicing safer sex [AOR = 17.6, 95% CI: 4-77] and those women who had a smooth relationship before the HIV disclosure were [AOR = 14.7, 95% CI: 3-68.6] more likely to disclose HIV status to their sexual partner than their counterparts, respectively.

CONCLUSIONS: The proportion of HIV serostatus disclosure by HIV-positive pregnant women attending antenatal care services to their sexual partners was encouraging. However, this does not mean that there is no need for further awareness and intervention. Hence, interventions to boost and support women in safely disclosing their HIV-positive status are needed.

PMID:33905432 | DOI:10.1371/journal.pone.0250637

PLoS One. 2021 Apr 27;16(4):e0250693. doi: 10.1371/journal.pone.0250693. eCollection 2021.

ABSTRACT

OBJECTIVES: Using the person-environment (PE) fit theory, this study aims to explore factors affecting medical professionals’ job satisfaction, turnover intention, and professional efficacy, and to examine individual characters associated with PE fit.

DESIGN AND METHODS: This study used data from the sixth National Health Service Survey conducted in 2018, with a focus on job outcomes among medical professionals in Shanghai. The reliability and validity of the tools for measuring PE and job outcomes were calculated. A structural equation model was used to examine the relationship among person-job (PJ) fit and person-group (PG) fit, job satisfaction, turnover intention, and professional efficacy. Finally, a hierarchical regression model was used to analyze the association between demographic variables and the PJ and PG fit.

RESULTS: PG fit was directly and positively associated with job satisfaction and professional efficacy. PJ fit had a direct and positive association with job satisfaction but had a direct and negative association with turnover intention. The indirect association of PJ fit with turnover intention was statistically significant. The results from the hierarchical regression analysis showed that younger physicians generally had a lower level of PJ fit and older physicians with higher education tended to have a lower level of PG fit.

CONCLUSIONS: Medical professionals with higher PJ or PG fit have higher job satisfaction, and those with higher PG fit have higher professional efficacy. The impact of PJ fit on turnover intention was mediated by job satisfaction. Healthcare managers should take actions to effectively promote medical professionals’ PJ and PG fit to improve their retention and efficiency.

PMID:33905430 | DOI:10.1371/journal.pone.0250693

PLoS One. 2021 Apr 27;16(4):e0249992. doi: 10.1371/journal.pone.0249992. eCollection 2021.

ABSTRACT

BACKGROUND: Viruses are responsible for a large proportion of acute respiratory tract infections (ARTIs). Human influenza, parainfluenza, respiratory-syncytial-virus, and adenoviruses are among the leading cause of ARTIs. Epidemiological evidence of those respiratory viruses is limited in the East Africa Community (EAC) region. This review sought to identify the prevalence of respiratory syncytial virus, parainfluenza, and adenoviruses among cases of ARTI in the EAC from 2007 to 2020.

METHODS: A literature search was conducted in Medline, Global Index Medicus, and the grey literature from public health institutions and programs in the EAC. Two independent reviewers performed data extraction. We used a random effects model to pool the prevalence estimate across studies. We assessed heterogeneity with the I2 statistic, and Cochran’s Q test, and further we did subgroup analysis. This review was registered with PROSPERO under registration number CRD42018110186.

RESULTS: A total of 12 studies met the eligibility criteria for the studies documented from 2007 to 2020. The overall pooled prevalence of adenoviruses was 13% (95% confidence interval [CI]: 6-21, N = 28829), respiratory syncytial virus 11% (95% CI: 7-15, N = 22627), and parainfluenza was 9% (95% CI: 7-11, N = 28363). Pooled prevalence of reported ARTIs, all ages, and locality varied in the included studies. Studies among participants with severe acute respiratory disease had a higher pooled prevalence of all the three viruses. Considerable heterogeneity was noted overall and in subgroup analysis.

CONCLUSION: Our findings indicate that human adenoviruses, respiratory syncytial virus and parainfluenza virus are prevalent in Kenya, Tanzania, and Uganda. These three respiratory viruses contribute substantially to ARTIs in the EAC, particularly among those with severe disease and those aged five and above.

PMID:33905425 | DOI:10.1371/journal.pone.0249992

PLoS Med. 2021 Apr 27;18(4):e1003611. doi: 10.1371/journal.pmed.1003611. Online ahead of print.

ABSTRACT

BACKGROUND: Gestational hypertensive and acute hypotensive disorders are associated with maternal morbidity and mortality worldwide. However, physiological blood pressure changes in pregnancy are insufficiently defined. We describe blood pressure changes across healthy pregnancies from the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Fetal Growth Longitudinal Study (FGLS) to produce international, gestational age-specific, smoothed centiles (third, 10th, 50th, 90th, and 97th) for blood pressure.

METHODS AND FINDINGS: Secondary analysis of a prospective, longitudinal, observational cohort study (2009 to 2016) was conducted across 8 diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States of America. We enrolled healthy women at low risk of pregnancy complications. We measured blood pressure using standardised methodology and validated equipment at enrolment at <14 weeks, then every 5 ± 1 weeks until delivery. We enrolled 4,607 (35%) women of 13,108 screened. The mean maternal age was 28·4 (standard deviation [SD] 3.9) years; 97% (4,204/4,321) of women were married or living with a partner, and 68% (2,955/4,321) were nulliparous. Their mean body mass index (BMI) was 23.3 (SD 3.0) kg/m2. Systolic blood pressure was lowest at 12 weeks: Median was 111.5 (95% CI 111.3 to 111.8) mmHg, rising to a median maximum of 119.6 (95% CI 118.9 to 120.3) mmHg at 40 weeks’ gestation, a difference of 8.1 (95% CI 7.4 to 8.8) mmHg. Median diastolic blood pressure decreased from 12 weeks: 69.1 (95% CI 68.9 to 69.3) mmHg to a minimum of 68.5 (95% CI 68.3 to 68.7) mmHg at 19+5 weeks’ gestation, a change of -0·6 (95% CI -0.8 to -0.4) mmHg. Diastolic blood pressure subsequently increased to a maximum of 76.3 (95% CI 75.9 to 76.8) mmHg at 40 weeks’ gestation. Systolic blood pressure fell by >14 mmHg or diastolic blood pressure by >11 mmHg in fewer than 10% of women at any gestational age. Fewer than 10% of women increased their systolic blood pressure by >24 mmHg or diastolic blood pressure by >18 mmHg at any gestational age. The study’s main limitations were the unavailability of prepregnancy blood pressure values and inability to explore circadian effects because time of day was not recorded for the blood pressure measurements.

CONCLUSIONS: Our findings provide international, gestational age-specific centiles and limits of acceptable change to facilitate earlier recognition of deteriorating health in pregnant women. These centiles challenge the idea of a clinically significant midpregnancy drop in blood pressure.

PMID:33905424 | DOI:10.1371/journal.pmed.1003611

PLoS One. 2021 Apr 27;16(4):e0249664. doi: 10.1371/journal.pone.0249664. eCollection 2021.

ABSTRACT

BACKGROUND: Birth weight, birth length, and gestational age are major indicators of newborn health. Several prenatal exposure factors influence the fetal environment. The aim of the study was to investigate the effect of prenatal exposure factors, including socio-demographic, behavioural, dietary, physical activity, clinical and environmental on birth outcomes through the mediation of Favourable Fetal Growth Conditions (FFGC).

METHODS: Data was obtained from six hundred and fifty-six Mother and Child in the Environment birth cohort study in Durban, South Africa from 2013 to 2017. We adopted structural equation models which evaluate the direct and indirect effects by allowing multiple simultaneous equations to incorporate confounding and mediation.

RESULTS: A significant direct and indirect effect of FFGC on newborn weight, length, and gestational age was seen. Gestational weight gain and maternal body mass index in the first trimester exerted a mediation effect between maternal behavioural risk factors and FFGC. Similarly, the level of physical activity during pregnancy was associated with decreased gestational weight gain. The effects of maternal characteristics on newborn weight, length, and gestational age were largely indirect, operating through FFGC as a latent variable.

CONCLUSIONS: Gestational weight gain and maternal pre-gestational BMI were observed to mediate the association between prenatal behavioural risk factors and favourable fetal growth conditions.

TRIAL REGISTRATION: Retrospectively registered from 01 March 2013.

PMID:33905420 | DOI:10.1371/journal.pone.0249664

JMIR Serious Games. 2021 Apr 27;9(2):e27290. doi: 10.2196/27290.

ABSTRACT

BACKGROUND: The proportion of smokers making quit attempts and the proportion of smokers successfully quitting have been decreasing over the past few years. Previous studies have shown that smokers with high self-efficacy and motivation to quit have an increased likelihood of quitting and staying quit. Consequently, further research on strategies that can improve the self-efficacy and motivation of smokers seeking to quit could lead to substantially higher cessation rates. Some studies have found that gamification can positively impact the cognitive components of behavioral change, including self-efficacy and motivation. However, the impact of gamification in the context of smoking cessation and mobile health has been sparsely investigated.

OBJECTIVE: This study aims to examine the association between perceived usefulness, perceived ease of use, and frequency of use of gamification features embedded in smoking cessation apps on self-efficacy and motivation to quit smoking.

METHODS: Participants were assigned to use 1 of the 2 mobile apps for a duration of 4 weeks. App-based questionnaires were provided to participants before app use and 2 weeks and 4 weeks after they started using the app. Gamification was quantitatively operationalized based on the Cugelman gamification framework and concepts from the technology acceptance model. The mean values of perceived frequency, ease of use, and usefulness of gamification features were calculated at midstudy and end-study. Two linear regression models were used to investigate the impact of gamification on self-efficacy and motivation to quit.

RESULTS: A total of 116 participants completed the study. The mean self-efficacy increased from 37.38 (SD 13.3) to 42.47 (SD 11.5) points and motivation to quit increased from 5.94 (SD 1.4) to 6.32 (SD 1.7) points after app use. Goal setting was perceived to be the most useful gamification feature, whereas sharing was perceived to be the least useful. Participants self-reported that they used the progress dashboards the most often, whereas they used the sharing feature the least often. The average perceived frequency of gamification features was statistically significantly associated with change in self-efficacy (β=3.35; 95% CI 0.31-6.40) and change in motivation to quit (β=.54; 95% CI 0.15-0.94) between baseline and end-study.

CONCLUSIONS: Gamification embedded in mobile apps can have positive effects on self-efficacy and motivation to quit smoking. The findings of this study can provide important insights for tobacco control policy makers, mobile app developers, and smokers seeking to quit.

PMID:33904824 | DOI:10.2196/27290

JMIR Form Res. 2021 Apr 27;5(4):e25462. doi: 10.2196/25462.

ABSTRACT

BACKGROUND: Cognitive training can improve cognition in healthy older adults.

OBJECTIVE: The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults.

METHODS: A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]).

RESULTS: A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=-0.57, P=.01, 95% CI [-1.00 to -0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=-13.5, P=.01, 95% CI [-23.95 to -3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [-0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=-0.36, P=.08, 95% CI [-0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [-0.05 to 0.96]) that were not statistically significant.

CONCLUSIONS: CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591.

PMID:33904819 | DOI:10.2196/25462