PO 8239 BASELINE ASSESSMENT OF LYMPHATIC FILARIASIS IN 18 COMMUNITIES IN WESTERN GHANA BEFORE THE IMPLEMENTATION OF TWICE-YEARLY TREATMENT

BackgroundLymphatic filariasis (LF) is a neglected tropical disease targeted for elimination as a public health problem by 2020, with the main strategy being treatment of entire endemic communities. Since the inception of the Global Programme for the Elimination of LF in 2000, tremendous progress has been made in many endemic countries. However, current observations point to the need for improved treatment regimen, frequency of treatment or drug delivery strategies in order to achieve the elimination goals in certain endemic areas. In this randomised trial, we evaluate the use of twice-yearly treatment with ivermectin and albendazole in 18 LF-endemic communities in Ghana, where despite 15 years of yearly treatment the disease is still above the elimination thresholds.MethodsFollowing demographic data collection, Wuchereria bancrofti antigen, microfilaria and antibody prevalence were assessed in study participants using the Alere FTS kit, nucleopore filtration and Wb123 ELISA, respectively. The study assessed the perspectives of the communities’on persistent transmission of LF in view of implementing effective treatment uptake strategies.ResultsThe baseline assessments revealed antigen prevalence of 8.2% (95% CI=6.8–9.8), with overall microfilaria prevalence of 1.2%. Infections were higher in males and in individuals who spend significant amount of time outdoors for commercial activities. Barriers related to medication, personal, health system, disease and social structure were observed to affect mass drug administration compliance. Community members perceived that they were not susceptible to infection and this together with drug adverse effects strongly affect the ingestion of the drugs.ConclusionWhile this trial is still in an early phase, the baseline assessments reveal programmatic challenges to the implementation of a twice-yearly treatment strategy for the control of LF which must be addressed to enhance implementation success.

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Intensity profile of lymphatic filariasis among community members of Yewa South Local Government Area, Ogun State, Nigeria

Nigerian Journal of Parasitology ◽

10.4314/njpar.v42i1.13 ◽

2021 ◽

Vol 42 (1) ◽

pp. 94-98

Author(s):

F.F. Adekola ◽

S. O Sam-Wobo ◽

U.F. Ekpo ◽

F. Oluwafemi ◽

O.A. Surakat ◽

...

Keyword(s):

Local Government ◽

Lymphatic Filariasis ◽

Age Groups ◽

Local Government Area ◽

Community Members ◽

Chi Square ◽

Blood Samples ◽

Ogun State ◽

Consistent Treatment ◽

Study Participants

An epidemiological study was conducted in four communities of Yewa-South Local Government Area of Ogun State to determine the prevalence of lymphatic filariasis. Also investigated was the intensity among the study participants. Three hundred and sixty-two participants of both sexes and age ranging from 5 to 85 years were examined. Blood samples for parasitological examination were obtained from consenting participants between 21.00 and 02.00 a.m. The samples were prepared using thick blood smear technique. The data obtained were collected and analyzed using descriptive statistics and chi-square. The result showed that, from the 362 blood samples examined, 186 were positive with an overall of 51.4%. Microfilaraemic prevalence was not significantly related (p>0.05) by sex category with male having 78 (21.5%) and female 108 (29.3%). However, there was significant (p<0.05) relationship in the prevalence by age groups as Community members within the age group =50 had the highest prevalence of 52(14.4%) while the 20-29 years recorded the least prevalence of 18(5.0%). In terms of microfilaraemic load, all females and males who tested positive for lymphatic filariasis with 50.8% having light intensity of < 50mf/ml. There was no significant relationship between prevalence of lymphatic filariasis and communities studied (P>0.05). The high prevalence observed in these communities could be due to bushy vegetation. There is the important need for increased and consistent treatment with Albendazole and health education in all affected communitiesto reduce prevalence and possible elimination of the parasite. Keywords: Intensity, Lymphatic filariasis, prevalence, Ogun State, Nigeria

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Filariasis Limfatik di Kelurahan Pabean Kota Pekalongan

Kesmas National Public Health Journal ◽

10.21109/kesmas.v3i2.229 ◽

2008 ◽

Vol 3 (2) ◽

pp. 51

Author(s):

Tri Ramadhani

Keyword(s):

Public Health ◽

Chronic Disease ◽

Lymphatic Filariasis ◽

Public Health Problem ◽

Wuchereria Bancrofti ◽

Disease Rate ◽

Cross Sectional ◽

Community Behavior ◽

Clinical Survey ◽

Cross Sectional Design

Filariasis limfatik masih merupakan masalah kesehatan masyarakat di Indonesia, khususnya di Kota Pekalongan. Hal ini ditandai dengan semakin meningkatnya angka mikrofilaria dan perluasan daerah dengan kasus filariasis limfatik.Tujuan penelitian adalah untuk mengetahui situasi filariasis limfatik diKelurahan Pabean Kota Pekalongan. Penelitian ini meliputi penduduk dan agent, dalam periode sekitar enam bulan (Juli-Desember 2007) dengan disain studi cross sectional. Pada penelitian ini dilakukan pemeriksaan klinis, survei darah jari dan identifikasi parasit penyebab filariasis limfatik. Hasil penelitian menunjukkan angka mikrofilaria (3,4) angka kesakitan akut filaria (0,4 %) yang tinggi, tetapi angka kesakitan kronis filaria rendah (0,00 %). Parasit penyebabfilariasis di Kelurahan Pabean adalah jenis Wuchereria bancrofti dengan kepadatan rerata mikrofilaria yang tinggi. Pengendalian filariasis limfatik di Kelurahan Pabean perlu dilakukan dengan pengobatan massal dan perubahan perilaku masyarakat.Kata kunci : Filariasis limfatik, kelurahan pabean, mikrofilaria.AbstractLymphatic filariasis is still being a public health problem in Indonesia, especially in Pekalongan district. This problem marked by the increasing rate of microfilaria and areas with lymphatic filariasis. The aim of this study is to know the epidemiologic situation of lymphatic filariasis in Pabean village Pekalongan district. The research was a cross-sectional design and covered host and agent within the period of July-Desember 2007. Data were collected through clinical survey of acute and chronic filariasis symptoms, blood survey and identification of lymphatic filariasis parasite. The result showed that microfilaremia rate was 3,4%, acute disease rate (ADR) 0,4 % and the chronic disease rate (CDR) 0,00 %. The average of microfilaria density in 1 ml blood was 465,63. Based onmicrofilaremia identification in the blood, the lymphatic filariasis agent in Pabean village is Wuchereria bancrofti type. Lymphatic filariasis control in Pabean village need to focused on Mass Drug Administration (MDA) and community behavior for healthy life.Key words : Lymphatic filariasis, pabean village, microfilaria.

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Assessment of the usefulness of anti-Wb123 antibody for post-elimination surveillance of lymphatic filariasis

Parasites & Vectors ◽

10.1186/s13071-020-04535-y ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Ameyo Monique Dorkenoo ◽

Adjaho Koba ◽

Wemboo A. Halatoko ◽

Minongblon Teko ◽

Komlan Kossi ◽

...

Keyword(s):

Lymphatic Filariasis ◽

Specific Antigen ◽

Public Health Problem ◽

Wuchereria Bancrofti ◽

World Health ◽

School Age Children ◽

Enzyme Linked Immunosorbent Assay ◽

Cross Sectional ◽

Apparent Lack ◽

Endemic District

Abstract Background The World Health Organization has targeted lymphatic filariasis (LF) for elimination as a public health problem and recommends, among other measures, post-elimination surveillance of LF. The identification of sensitive and specific surveillance tools is therefore a research priority. The Wuchereria bancrofti-specific antigen Wb123-based enzyme-linked immunosorbent assay (Wb123 ELISA) detects antibodies to the recombinant Wb123 antigen of W. bancrofti and may be useful as a surveillance tool for LF. Six years after stopping mass drug administration to eliminate LF and recording successful results on two post-treatment transmission assessment surveys, a study was conducted in Togo aimed at helping to identify the role of the Wb123 ELISA in post-validation surveillance of LF. Methods This was a cross-sectional study in eight previously LF-endemic districts and one non-endemic district in Togo. In each sub-district of these nine districts, two schools were selected and 15 children aged 6 to 9 years old at each school provided finger-stick blood for testing for antibodies to Wb123 using the Filaria Detect™ IgG4 ELISA kit® (InBios, International, Inc., Seattle, WA, USA). Results A total of 2654 children aged 6 to 9 years old were tested in 134 schools in the nine districts. Overall, 4.7% (126/2654) children tested positive for antibodies to the Wb123 antigen of W. bancrofti. The prevalence of Wb123 antibodies varied across the eight previously endemic LF districts, from 1.56 to 6.62%. The highest prevalence, 6.99%, was found in the non-endemic district, but this was not significantly different from the average of all the LF districts (4.49%, P = 0.062). Conclusions The Wb123 ELISA was positive in 4.7% of Togolese school-age children who were almost certainly unexposed to LF. This apparent lack of specificity in the Togo context makes it difficult to establish a seroprevalence threshold that could serve to signal LF resurgence in the country, precluding the use of this test for post-validation surveillance in Togo. There remains a need to develop a useful and reliable test for post-elimination surveillance for LF in humans.

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Low Microfilaremia Levels in Three Districts in Coastal Ghana with at Least 16 Years of Mass Drug Administration and Persistent Transmission of Lymphatic Filariasis

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed3040105 ◽

2018 ◽

Vol 3 (4) ◽

pp. 105 ◽

Cited By ~ 3

Author(s):

Dziedzom de Souza ◽

Joseph Otchere ◽

Collins Ahorlu ◽

Susan Adu-Amankwah ◽

Irene Larbi ◽

...

Keyword(s):

Lymphatic Filariasis ◽

Drug Administration ◽

Mass Drug Administration ◽

Successful Implementation ◽

Targeted Interventions ◽

Commercial Activities ◽

Infectivity Rate ◽

One Year ◽

Study Participants ◽

Year 2000

Ghana has been implementing mass drug administration (MDA) of ivermectin and albendazole for the elimination of lymphatic filariasis (LF) since the year 2000, as part of the Global Programme to Eliminate Lymphatic Filariasis (GPELF). It was estimated that 5–6 years of treatment would be sufficient to eliminate the disease. Tremendous progress has been made over the years, and treatment has stopped in many disease endemic districts. However, despite the successful implementation of MDA, there are districts with persistent transmission. In this study we assessed the epidemiology of LF in three adjoining districts that have received at least 16 years of MDA. The assessments were undertaken one year after the last MDA. 1234 adults and 182 children below the age of 10 years were assessed. The overall prevalence of circulating filarial antigen in the study participants was 8.3% (95% CI: 6.9–9.9), with an estimated microfilaria prevalence of 1.2%. The microfilarial intensity in positive individuals ranged from 1 to 57 microfilariae/mL of blood. Higher antigen prevalence was detected in males (13.0%; 95% CI: 10.3–16.2) compared to females (5.5%; 95% CI: 4.1–7.2). The presence of infection was also highest in individuals involved in outdoor commercial activities, with the risks of infection being four- to five-fold higher among farmers, fishermen, drivers and artisans, compared to all other occupations. Using bednets or participating in MDA did not significantly influence the risk of infection. No children below the age of 10 years were found with infection. Detection of Wb123 antibodies for current infections indicated a prevalence of 14.4% (95% CI: 8.1–23.0) in antigen-positive individuals above 10 years of age. No antibodies were detected in children 10 years or below. Assessment of infection within the An. gambiae vectors of LF indicated an infection rate of 0.9% (95% CI: 0.3–2.1) and infectivity rate of 0.5% (95% CI: 0.1–1.6). These results indicate low-level transmission within the districts, and suggest that it will require targeted interventions in order to eliminate the infection.

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A study to assess mass drug administration of DEC for filaria control in district Satna, Madhya Pradesh: a mid term assessment

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180785 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1201

Author(s):

Vivek Sharma ◽

Vikrant Kabirpanthi

Keyword(s):

Lymphatic Filariasis ◽

Drug Administration ◽

Mass Drug Administration ◽

Public Health Problem ◽

Wuchereria Bancrofti ◽

Cross Sectional Study ◽

Urban Site ◽

Major Public Health Problem ◽

Sectional Study ◽

Cross Sectional

Background: Lymphatic filariasis is a major public health problem which is caused by Wuchereria Bancrofti and Brugia Malai. The disease is endemic in 250 districts in 20 states and UTs. In India national health policy 2002 envisages elimination of lymphatic filariasis by 2015. Important strategy for elimination of lymphatic filariasis is through annual mass drug administration of single dose of DEC for 5 year or more to the eligible population. Present cross sectional study was carried out to assess drug compliance after mass drug administration of DEC and the factors responsible for poor compliance among the population of Satna district of MP.Methods: The present study was a cross-sectional study which was carried out in filarial endemic Satna district. In this district 120 houses from 3 CHC & one urban ward was randomly selected. 30 households each from 3 rural and one urban site were interviewed related to MDA for DEC.Results: Coverage of tablet distribution in Satna was 90.9%. Consumption of drug among the people who received the drug was 87.97%, while the total effective consumption was 79.9%. Drug distributors ensured consumption of drug in only 16.9%.Conclusions: Focus of MDA is primarily to mere distribution of drug. There is need to give emphasis on consumption of drug, health education, common side effects and its management in order to increase effective coverage rate.

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Keeping communities at the centre of efforts to eliminate lymphatic filariasis: learning from the past to reach a future free of lymphatic filariasis

International Health ◽

10.1093/inthealth/ihaa086 ◽

2020 ◽

Vol 13 (Supplement_1) ◽

pp. S55-S59

Author(s):

Alison Krentel ◽

Margaret Gyapong ◽

Deborah A McFarland ◽

Olumide Ogundahunsi ◽

Christiana R Titaley ◽

...

Keyword(s):

Lymphatic Filariasis ◽

Public Health Problem ◽

Community Partnership ◽

Community Members ◽

Preventive Chemotherapy ◽

Community Ownership ◽

The Past ◽

Community Access ◽

Risk Communities ◽

Community Drug Distributors

Abstract Since the launch of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000, more than 910 million people have received preventive chemotherapy for lymphatic filariasis (LF) and many thousands have received care for chronic manifestations of the disease. To achieve this, millions of community drug distributors (CDDs), community members and health personnel have worked together each year to ensure that at-risk communities receive preventive chemotherapy through mass drug administration (MDA). The successes of 20 y of partnership with communities is celebrated, including the application of community-directed treatment, the use of CDDs and integration with other platforms to improve community access to healthcare. Important challenges facing the GPELF moving forward towards 2030 relate to global demographic, financing and programmatic changes. New innovations in research and practice present opportunities to encourage further community partnership to achieve the elimination of LF as a public health problem. We stress the critical need for community ownership in the current Covid-19 pandemic, to counter concerns in relaunching MDA programmes for LF.

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Monitoring migrant groups as a post-validation surveillance approach to contain the potential reemergence of lymphatic filariasis in Togo

Parasites & Vectors ◽

10.1186/s13071-021-04644-2 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Monique Ameyo Dorkenoo ◽

Martin Kouame Tchankoni ◽

Degninou Yehadji ◽

Kossi Yakpa ◽

Mawèké Tchalim ◽

...

Keyword(s):

Lymphatic Filariasis ◽

Significant Risk ◽

Public Health Problem ◽

Test Strip ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Positive Case ◽

Cross Sectional ◽

Case Investigation ◽

Migrant Groups

Abstract Background In March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo’s case investigation algorithm to prevent resurgence of LF and sustain Togo’s elimination success. Method A cross-sectional study was conducted in 2018 in the northernmost region of the country. Three migrant populations were identified: (i) nomadic Peuhls, (ii) Togolese members of local communities who migrate annually to neighboring countries for seasonal labor, and (iii) refugees from Ghana who came to Togo because of a communal conflict in Ghana. A questionnaire was designed to collect data on demographics and history of LF and MDA; all participants were tested for circulating filariasis antigen (CFA) using the filariasis test strip (FTS). Any CFA-positive case was confirmed with nocturnal microfilaremia. Results Refugees, seasonal economic migrants and nomadic Peuhls represented 42.1%, 31.4% and 26.5% of the study participants, respectively. The overall prevalence of CFA was 4.2% (58/1391) with the highest prevalence in the nomadic Peuhl group (11.9%), but only one of them (0.07%) was confirmed positive with nocturnal microfilaremia. Using the case investigation algorithm, no other positive case was identified in the positive case’s surroundings. Conclusion This study demonstrates that nomadic Peuhls, with a CFA prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk. Periodic monitoring of migrants, especially the nomadic Peuhl population, is a potential post-validation surveillance approach that could be used to promptly detect any LF cluster that may arise.

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Progress towards elimination of lymphatic filariasis in the Americas region

International Health ◽

10.1093/inthealth/ihaa048 ◽

2020 ◽

Vol 13 (Supplement_1) ◽

pp. S33-S38

Author(s):

Gilberto Fontes ◽

Eliana Maria Mauricio da Rocha ◽

Ronaldo Guilherme Carvalho Scholte ◽

Rubén Santiago Nicholls

Keyword(s):

Dominican Republic ◽

Lymphatic Filariasis ◽

Wuchereria Bancrofti ◽

World Health ◽

Vector Species ◽

Effective Coverage ◽

The Third ◽

Assessment Survey ◽

Health Organization ◽

Important Progress

Abstract In South and Central America, lymphatic filariasis (LF) is caused by Wuchereria bancrofti, which is transmitted by Culex quinquefasciatus, the only vector species in this region. Of the seven countries considered endemic for LF in the Americas in the last decade, Costa Rica, Suriname and Trinidad and Tobago were removed from the World Health Organization list in 2011. The remaining countries, Brazil, Dominican Republic, Guyana and Haiti, have achieved important progress in recent years. Brazil was the first country in the Americas to stop mass drug administration (MDA) and to establish post-MDA surveillance. Dominican Republic stopped MDA in all LF-endemic foci: La Ciénaga and Southwest passed the third Transmission Assessment Survey (TAS) and the Eastern focus passed TAS-1 in 2018. Haiti passed the TAS and interrupted transmission in >80% of endemic communes, achieving effective drug coverage. Guyana implemented effective coverage in MDAs in 2017 and 2018 and in 2019 scaled up the treatment for 100% of the geographical region, introducing ivermectin in the MDA in order to achieve LF elimination by the year 2026. The Americas region is on its way to eliminating LF transmission. However, efforts should be made to improve morbidity management to prevent disability of the already affected populations.

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Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6–59 Months

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa111 ◽

2020 ◽

Author(s):

Gomathi Ramaswamy ◽

Kashish Vohra ◽

Kapil Yadav ◽

Ravneet Kaur ◽

Tripti Rai ◽

...

Keyword(s):

Point Of Care ◽

Venous Blood ◽

Public Health Problem ◽

Outpatient Department ◽

Point Of Care Testing ◽

Adequate Treatment ◽

Non Invasive ◽

Hematology Analyzer ◽

The Mean ◽

Study Participants

Abstract Introduction Globally around 47.4% of children and in India, 58% of children aged 6–59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. Objectives To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6–59 months compared with hematology analyzer. Methods The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli’s hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. Results A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli’s hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli’s hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli’s hemoglobinometer (70%). Invasive DH took the least time (2–3 min) for estimation of hemoglobin per participant, followed by Sahli’s (4–5 min) and non-invasive DH (5–7 min). Conclusion All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli’s can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summary In India, anemia is a serious public health problem, where 58% of the children aged 6–59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices—invasive DH, non-invasive DH and Sahli’s hemoglobinometer among 6–59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6–59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli’s (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli’s hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli’s (70%).

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Emotion regulation across the psychosis continuum

Development and Psychopathology ◽

10.1017/s0954579418001682 ◽

2019 ◽

Vol 32 (1) ◽

pp. 219-227 ◽

Cited By ~ 2

Author(s):

Hannah C. Chapman ◽

Katherine F. Visser ◽

Vijay A. Mittal ◽

Brandon E. Gibb ◽

Meredith E. Coles ◽

...

Keyword(s):

Emotion Regulation ◽

Psychotic Disorders ◽

Psychiatric Symptoms ◽

Healthy Controls ◽

Community Members ◽

Targeted Treatments ◽

Regulation Strategies ◽

Dose Dependent Decrease ◽

Study Participants ◽

Prodromal Syndrome

AbstractEmotion regulation dysfunction is characteristic of psychotic disorders, but little is known about how the use of specific types of emotion regulation strategies differs across phases of psychotic illness. This information is vital for understanding factors contributing to psychosis vulnerability states and developing targeted treatments. Three studies were conducted to examine emotion regulation across phases of psychosis, which included (a) adolescent community members with psychotic-like experiences (PLEs; n = 262) and adolescents without PLEs (n = 1,226); (b) adolescents who met clinical high-risk criteria for a prodromal syndrome (n = 29) and healthy controls (n = 29); and (c) outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ; n = 61) and healthy controls (n = 67). In each study, participants completed the Emotion Regulation Questionnaire and measures of psychiatric symptoms and functional outcome. The three psychosis groups did not differ from each other in reported use of suppression; however, there was evidence for a vulnerability-related, dose-dependent decrease in reappraisal. Across each sample, a lower use of reappraisal was associated with poorer clinical outcomes. Findings indicate that emotion regulation abnormalities occur across a continuum of psychosis vulnerability and represent important targets for intervention.

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