scholarly journals Enteric Pathogen Diversity in Infant Foods in Low-Income Neighborhoods of Kisumu, Kenya

2019 ◽  
Vol 16 (3) ◽  
pp. 506 ◽  
Author(s):  
Kevin Tsai ◽  
Sheillah Simiyu ◽  
Jane Mumma ◽  
Rose Aseyo ◽  
Oliver Cumming ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Ratio ◽  
Low Income ◽  
Pathogen Transmission ◽  
Enteric Pathogen ◽  
Infant Food ◽  
Food Hygiene ◽  
Adjusted Risk ◽  
Household Food ◽  
Adjusted Risk Ratio

Pediatric diarrheal disease remains the second most common cause of preventable illness and death among children under the age of five, especially in low and middle-income countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission in LMICs. For this study, we examined the frequency of enteric pathogen occurrence and co-occurrence in 127 infant weaning foods in Kisumu, Kenya, using a multi-pathogen PCR diagnostic tool, and assessed household food hygiene risk factors for contamination. Bacterial, viral, and protozoan enteric pathogen DNA and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods containing more than one pathogen type. Multivariable generalized linear mixed model analysis indicated type of infant food best explained the presence and diversity of enteric pathogens in infant food, while most household food hygiene risk factors considered in this study were not significantly associated with pathogen contamination. Specifically, cow’s milk was significantly more likely to contain a pathogen (adjusted risk ratio = 14.4; 95% confidence interval (CI) 1.78–116.1) and more likely to have higher number of enteric pathogen species (adjusted risk ratio = 2.35; 95% CI 1.67–3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are needed to prevent foodborne transmission of pathogens to infants.

scholarly journals Enteric Pathogen Diversity in Infant Foods in Low-income Neighborhoods Of Kisumu, Kenya

2018 ◽  
Author(s):  
Kevin Tsai ◽  
Sheillah Simiyu ◽  
Jane Mumma ◽  
Rose Evalyne Aseyo ◽  
Oliver Cumming ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Ratio ◽  
Low Income ◽  
Enteric Pathogen ◽  
Infant Food ◽  
Food Hygiene ◽  
Adjusted Risk ◽  
Infant Foods ◽  
Household Food ◽  
Adjusted Risk Ratio

Pediatric diarrheal disease remains the 2nd most common cause of preventable illness and death among children under the age of five, especially in Low and Middle-Income Countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission due to measuring infant food contaminations in LMICs. For this study, we examined the frequency of enteric pathogen occurrence and co-occurrence in 127 weaning infant foods in Kisumu, Kenya using a multi-pathogen rt-PCR diagnostic tool, and assessed household food hygiene risk factors for contamination. Bacterial, viral, and protozoa enteric pathogen DNA and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods containing more than one pathogen type. Multivariable generalized linear mixed model analysis indicated type of infant food best explained the presence and diversity of enteric pathogens in infant food, while most household food hygiene risk factors considered in this study were not significantly associated with pathogen contamination. Specifically, cow's milk was significantly more likely to contain a pathogen (adjusted Risk Ratio=14.4; 95% Confidence Interval (CI) 1.78-116.1) and contained 2.35 more types of pathogens (adjusted Risk Ratio=2.35; 95% CI 1.67-3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are needed to prevent foodborne transmission of pathogens to infants.

scholarly journals Risk factors for losing hepatitis B virus surface antibody in patients with HBV surface antigen negative/surface antibody positive serostatus receiving biologic disease-modifying anti-rheumatic drugs: a nested case-control study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Ming-Hui Hung ◽  
Ya-Chih Tien ◽  
Ying-Ming Chiu
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Surface Antigen ◽  
Risk Ratio ◽  
Hbv Reactivation ◽  
Biologic Dmards ◽  
Adjusted Risk ◽  
Lower Baseline ◽  
Adjusted Risk Ratio

Abstract Background Hepatitis B virus (HBV) reactivation consequent to immunosuppressive therapy is an increasingly prevalent problem with serious clinical implications. Treatment with biologic agents conduces to the loss of protective antibody to HBV surface antigen (anti-HBs), which significantly increases the risk of HBV reactivation. Hence, we investigated the risk factors for losing anti-HBs in patients with rheumatic diseases and HBV surface antigen negative/anti-HBs positive (HBsAg−/anti-HBs+) serostatus during treatment with biologic disease-modifying anti-rheumatic drugs (DMARDs). Methods Using a nested case-control design, we prospectively enrolled patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis/psoriasis, or juvenile idiopathic arthritis, who were treated with biologic DMARDs at Changhua Christian Hospital, Taiwan, from January 2013 to June 2019 and had HBsAg−/anti-HBs+ serostatus; the analytic sample excluded all patients with HBsAg+ or anti-HBs− serostatus. Anti-HBs titers were monitored 6-monthly and cases were defined as anti-HBs < 10 mIU/ml during follow-up. Cases were matched one-to-all with controls with anti-HBs ≥ 10 mIU/ml on the same ascertainment date and equivalent durations of biologic DMARDs treatment (control patients could be resampled and could also become cases during follow-up). Between-group characteristics were compared and risk factors for anti-HBs loss were investigated by conditional logistic regression analyses. Results Among 294 eligible patients, 23 cases were matched with 311 controls. The incidence of anti-HBs loss was ~ 2.7%/person-year during biologic DMARDs treatment. Besides lower baseline anti-HBs titer (risk ratio 0.93, 95% CI 0.89–0.97), cases were significantly more likely than controls to have diabetes mellitus (risk ratio 4.76, 95% CI 1.48–15.30) and chronic kidney disease (risk ratio 14.00, 95% CI 2.22–88.23) in univariate analysis. Risk factors remaining significantly associated with anti-HBs loss in multivariate analysis were lower baseline anti-HBs titer (adjusted risk ratio 0.93, 95% CI 0.88–0.97) and chronic kidney disease (adjusted risk ratio 45.68, 95% CI 2.39–871.5). Conclusions Besides lower baseline anti-HBs titer, chronic kidney disease also strongly predicts future anti-HBs negativity in patients with HBsAg−/anti-HBs+ serostatus who receive biologic DMARDs to treat rheumatic diseases. Patients with low anti-HBs titer (≤ 100 mIU/ml) and/or chronic kidney disease should be monitored during biologic DMARDs therapy, to enable timely prophylaxis to preempt potential HBV reactivation.

scholarly journals A Food Insecurity Systematic Review: Experience from Malaysia

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 945
Author(s):  
Norhasmah Sulaiman ◽  
Heather Yeatman ◽  
Joanna Russell ◽  
Leh Shii Law
Keyword(s):  
Risk Factors ◽  
Food Insecurity ◽  
Coping Strategies ◽  
Low Income ◽  
Meta Analysis ◽  
Welfare Recipient ◽  
Vulnerable Groups ◽  
Household Food Security ◽  
Household Food Insecurity ◽  
Household Food

Living free from hunger is a basic human right. However, some communities still experience household food insecurity. This systematic literature review explored different aspects of household food insecurity in Malaysia including vulnerable groups, prevalence, risk factors, coping strategies, and the consequences of food insecurity. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Thirty-three relevant articles were selected from scientific databases such as CINAHL, Pubmed and Google Scholar, scrutiny of reference lists, and personal communication with experts in the field. The prevalence of household food insecurity in Malaysia was unexpectedly reported as high, with affected groups including Orang Asli, low-income household/welfare-recipient households, university students, and the elderly. Demographic risk factors and socioeconomic characteristics included larger household, living in poverty, and low education. Coping strategies were practices to increase the accessibility of food in their households. Consequences of household food insecurity included psychological, dietary (macro- and micronutrient intakes), nutritional status, and health impacts. In conclusion, this review confirmed that household food insecurity in Malaysia continues to exist. Nevertheless, extensive and active investigations are encouraged to obtain a more holistic and comprehensive picture pertaining to household food security in Malaysia.

Birth outcomes are superior after transfer of fresh versus frozen embryos for donor oocyte recipients

2020 ◽  
Vol 35 (12) ◽  
pp. 2850-2859
Author(s):  
Cassandra Roeca ◽  
Rachel L Johnson ◽  
Tracy Truong ◽  
Nichole E Carlson ◽  
Alex J Polotsky
Keyword(s):  
Birth Weight ◽  
Birth Outcomes ◽  
Live Birth ◽  
Risk Ratio ◽  
Gestational Age ◽  
Embryo Cryopreservation ◽  
Adjusted Risk ◽  
Donor Oocyte ◽  
Adjusted Risk Ratio ◽  
Frozen Embryos

Abstract STUDY QUESTION For donor oocyte recipients, are birth outcomes superior for fresh versus frozen embryos? SUMMARY ANSWER Among fresh donor oocyte recipients, fresh embryos are associated with better birth outcomes when compared with frozen embryos. WHAT IS KNOWN ALREADY Frozen embryo transfer (ET) with vitrification has been associated with improved pregnancy rates, but also increased rates of large for gestational age infants. Donor oocyte recipients represent an attractive biological model to attempt to isolate the impact of embryo cryopreservation on IVF outcomes, yet there is a paucity of studies in this population. STUDY DESIGN, SIZE, DURATION A retrospective cohort of the US national registry, the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, of IVF cycles of women using fresh donor oocytes resulting in ET between 2013 and 2015. Thawed oocytes were excluded. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Good obstetric outcome (GBO), defined as a singleton, term, live birth with appropriate for gestational age birth weight, was the primary outcome measure. Secondary outcomes included live birth, clinical pregnancy, spontaneous abortion, preterm birth, multiple births and gestational age-adjusted weight. Outcomes were modeled using the generalized estimating equation approach. MAIN RESULTS AND THE ROLE OF CHANCE Data are from 25 387 donor oocyte cycles, in which 14 289 were fresh and 11 098 were frozen ETs. A GBO was 27% more likely in fresh ETs (26.3%) compared to frozen (20.9%) (adjusted risk ratio 1.27; 95% confidence interval (CI) 1.21–1.35; P &lt; 0.001). Overall, fresh transfer was more likely to result in a live birth (55.7% versus 39.5%; adjusted risk ratio 1.21; 95% CI 1.18–1.26; P &lt; 0.001). Among singleton births, there was no difference in gestational age-adjusted birth weight between groups. LIMITATION, REASONS FOR CAUTION Our cohort findings contrast with data from autologous oocytes. Prospective studies with this population are warranted. WIDER IMPLICATIONS OF THE FINDINGS Among donor oocyte recipients, fresh ETs may be associated with better birth outcomes. Reassuringly, given its prevalent use, modern embryo cryopreservation does not appear to result in phenotypically larger infants. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.

scholarly journals 2377. Social Determinants Impact Readmission Following Clostridioides difficile-Related Index Hospital Stay in Medicare Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S820-S820
Author(s):  
Elizabeth Scaria ◽  
Ryan Powell ◽  
Jen Birstler ◽  
Oguzhan Alagoz ◽  
Daniel Shirley ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Risk Ratio ◽  
Disadvantaged Neighborhood ◽  
Adjusted Risk ◽  
Clostridioides Difficile ◽  
Disadvantaged Neighborhoods ◽  
Adjusted Risk Ratio ◽  
Index Hospital ◽  
The Relationship ◽  
Readmission Risk

Abstract Background Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea and recurs in up to 30% of patients, often requiring readmission. Socioeconomic factors, such as living in a disadvantaged neighborhood may impact readmission but have not been studied. Methods We examined the relationship between neighborhood disadvantage, as measured by the Singh validated area deprivation index (ADI), and 30-day all-cause readmission risk in patients with an index hospital stay with CDI. We analyzed a random 20% sample of national Medicare claims for patients’ initial index hospitalization with a CDI diagnosis in 2014 (n = 19,528) that included each patient’s neighborhood ADI national percentile. The most disadvantaged neighborhoods were categorized as those in the upper 35 percentile, while the least disadvantaged was defined as those in the bottom 65% of national ADI rankings. We evaluated the relationship between ADI percentile and 30-day readmission risk using multivariate logistic regression, controlling for key patient demographics, comorbidities, and hospital/stay characteristics. Results A total of 19,528 patients had an index stay with CDI, 4,899 were readmitted within 30 days. Patients from the most disadvantaged neighborhoods had a higher average rate of readmission compared with those living in the least disadvantaged neighborhoods (28% vs. 24% rate; unadjusted risk ratio = 1.16 [1.10, 1.21]). This relationship held after controlling for confounders. After adjustment, being a resident in the most disadvantaged neighborhoods was associated with a 10% increased risk of readmission (adjusted risk ratio = 1.10 [1.05, 1.16]), which was similar to the effect sizes associated with dual Medicaid-Medicare enrollment status (adjusted risk ratio = 1.09 [1.03, 1.15]) and renal failure (adjusted risk ratio = 1.14 [1.08, 1.21]). Conclusion Living in a disadvantaged neighborhood is associated with an increased 30-day readmission risk similar in magnitude to Medicaid status and renal failure in patients with index hospitalizations of CDI. Future studies should examine whether interventions such as post discharge support and care coordination for patients in disadvantaged neighborhoods may reduce readmissions in this patient population. Disclosures All authors: No reported disclosures.

scholarly journals Comparative Analysis of Outcome Measures Used in Examining Neurodevelopmental Effects of Early Childhood Anesthesia Exposure

2014 ◽  
Vol 120 (6) ◽  
pp. 1319-1332 ◽  
Author(s):  
Caleb H. Ing ◽  
Charles J. DiMaggio ◽  
Eva Malacova ◽  
Andrew J. Whitehouse ◽  
Mary K. Hegarty ◽  
...  
Keyword(s):  
Academic Achievement ◽  
Outcome Measures ◽  
Clinical Evaluation ◽  
Risk Ratio ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Classification Of Diseases

Abstract Introduction: Immature animals exposed to anesthesia display apoptotic neurodegeneration and neurobehavioral deficits. The safety of anesthetic agents in children has been evaluated using a variety of neurodevelopmental outcome measures with varied results. Methods: The authors used data from the Western Australian Pregnancy Cohort (Raine) Study to examine the association between exposure to anesthesia in children younger than 3 yr of age and three types of outcomes at age of 10 yr: neuropsychological testing, International Classification of Diseases, 9th Revision, Clinical Modification–coded clinical disorders, and academic achievement. The authors’ primary analysis was restricted to children with data for all outcomes and covariates from the total cohort of 2,868 children born from 1989 to 1992. The authors used a modified multivariable Poisson regression model to determine the adjusted association of anesthesia exposure with outcomes. Results: Of 781 children studied, 112 had anesthesia exposure. The incidence of deficit ranged from 5.1 to 7.8% in neuropsychological tests, 14.6 to 29.5% in International Classification of Diseases, 9th Revision, Clinical Modification–coded outcomes, and 4.2 to 11.8% in academic achievement tests. Compared with unexposed peers, exposed children had an increased risk of deficit in neuropsychological language assessments (Clinical Evaluation of Language Fundamentals Total Score: adjusted risk ratio, 2.47; 95% CI, 1.41 to 4.33, Clinical Evaluation of Language Fundamentals Receptive Language Score: adjusted risk ratio, 2.23; 95% CI, 1.19 to 4.18, and Clinical Evaluation of Language Fundamentals Expressive Language Score: adjusted risk ratio, 2.00; 95% CI, 1.08 to 3.68) and International Classification of Diseases, 9th Revision, Clinical Modification–coded language and cognitive disorders (adjusted risk ratio, 1.57; 95% CI, 1.18 to 2.10), but not academic achievement scores. Conclusions: When assessing cognition in children with early exposure to anesthesia, the results may depend on the outcome measure used. Neuropsychological and International Classification of Diseases, 9th Revision, Clinical Modification–coded clinical outcomes showed an increased risk of deficit in exposed children compared with that in unexposed children, whereas academic achievement scores did not. This may explain some of the variation in the literature and underscores the importance of the outcome measures when interpreting studies of cognitive function.

scholarly journals Risk Factors for SARS-CoV-2 Infection and Presence of Anti-SARS-CoV-2 Antibodies among University Student Dormitory Residents, September–November 2020

2021 ◽  
Author(s):  
Hannah E Segaloff ◽  
Devlin Cole ◽  
Hannah G Rosenblum ◽  
Christine C Lee ◽  
Clint N Morgan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Test Results ◽  
Rt Pcr ◽  
Adjusted Risk ◽  
Social Events ◽  
Adjusted Risk Ratio ◽  
Infection Risk Factors ◽  
Polymerase Chain ◽  
Survey Responses ◽  
The Relationship

Abstract Background Multiple SARS-CoV-2 outbreaks occurred at universities during Fall 2020, but little is known about risk factors for campus-associated infections immunity provided by anti-SARS-CoV-2 antibodies in young adults. Methods We conducted surveys and serology tests among students living in dormitories in September and November to examine infection risk factors and antibody presence. Using campus weekly reverse transcription polymerase chain reaction (RT-PCR) test results, the relationship between survey responses, SARS-CoV-2 antibodies and infections was assessed. Results Of 6136 students, 1197 completed the survey and 572 also completed serologic testing in September compared with 517 and 414 in November, respectively. Participation in fraternity or sorority events (adjusted Risk Ratio (aRR): 1·9 [95% CI: 1·4–2·5]) and frequent alcohol consumption (aRR: 1·6 [1·2–2·2]) were associated with SARS-CoV-2 infection. Mask wearing during social events (aRR: 0·6 [0·6–1·0]) was associated with decreased risk. None of the 20 students with antibodies in September tested postive for SARS-CoV-2 during the semester, while 27·8% of students who tested RT-PCR positive tested negative for antibodies in November. Conclusion Frequent drinking and attending social events were associated with SARS-CoV-2 infection. Antibody presence in September appeared to be protective from re-infection, but this finding was not statistically significant.

scholarly journals The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study

2020 ◽  
Vol 14 (5) ◽  
pp. 155798832095999
Author(s):  
Shu-Kay Ng ◽  
Sean A. Martin ◽  
Robert J. Adams ◽  
Peter O’Loughlin ◽  
Gary A. Wittert
Keyword(s):  
Health Service ◽  
Risk Ratio ◽  
Medical Decision ◽  
Anxiety And Depression ◽  
Comorbid Conditions ◽  
Adjusted Risk ◽  
Comorbid Anxiety ◽  
Primary Health ◽  
Adjusted Risk Ratio ◽  
Gp Visits

This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men ( n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.

scholarly journals The Safe Start trial to assess the effect of an infant hygiene intervention on enteric infections and diarrhoea in low-income informal neighbourhoods of Kisumu, Kenya: a study protocol for a cluster randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jane Mumma ◽  
Sheillah Simiyu ◽  
Evalyne Aseyo ◽  
John Anderson ◽  
Alexandra Czerniewska ◽  
...  
Keyword(s):  
Low Income ◽  
Controlled Trial ◽  
Infant Food ◽  
Food Hygiene ◽  
Randomized Controlled ◽  
Hygiene Intervention ◽  
Enteric Infections ◽  
Cluster Randomized ◽  
Start Trial ◽  
The Impact

Abstract Background Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, and no studies in low income urban settings where risks are plausibly very high. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya. Methods This is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targeted four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding, including when reheating or reserving; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean. Results The primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria (Enterococcus) isolated and enumerated to assess the impact of the intervention on infant food contamination. Conclusion To our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The Safe Start trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the local health extension system can improve the health of young children. Trial registration The trial was registered at clinicaltrial.gov on March 16th 2018 before enrolment of any participants (https://clinicaltrials.gov/ct2/show/NCT03468114).

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