Exploring the Distribution of  Coccidioides immitis  in  South Central Washington State

ObjectiveOur objective is to describe the environmental conditions associatedwith confirmedCoccidioides immitisgrowth and accumulation sitesin south central Washington in an effort to understand the ecology andidentify additional potential sites across this emerging endemic zone.IntroductionCoccidioidomycosis, commonly referred to as Valley Fever, iscaused by the soil-borne saprophytic fungusC. immitisandposadasii.These species have historically been found in the desert southwest andMexico; however, in 2010 there were three coccidioidomycosis casesidentified in central Washington. Colonization of soils byC. immitishas been confirmed at exposure sites associated with these cases1.Multiple studies have identified a relationship between environmentalconditions andC. immitisgrowth areas2,3,4, but these relationshipshave not been evaluated in Washington. The Washington StateDepartment of Health has been conducting environmental surveillancein an effort to understand the geographic distribution ofC. immitisincentral Washington and the associated risk to humans and animals.Here we describe our environmental surveillance efforts and presentpreliminary findings related to environmental conditions ofC. immitisgrowth areas in central Washington.MethodsWe collected soil samples at potential human exposure sites incentral Washington, as identified through clinical surveillance andpatient interviews. Soil samples were also collected from areasnot associated with human cases by looking for similar soils inareas of interest Soil samples are analyzed by the U.S. Centers forDisease Control and Prevention using real-time PCR that detectsCoccidioides-specific targets. We employed data from the USDA SoilSurvey Geographic (SSURGO) database to describe environmentalconditions associated with positive samples. We used our findingsto identify un-sampled regions of central Washington that couldpotentially supportC. immitisgrowth.ResultsWe detectedCoccidioidesin 13 soil sampling sites at fivelocations withing the region. These detections included locations notpreviously described in central Washington. We identified a bandstretching across central Yakima and Benton counties with similarsoil characteristics to our positive sample sites, which suggests theseregions could potentially support the growth ofC. immitis.ConclusionsCoccidioidomycosis is emerging in south central Washington, andthe ecology and geographic distribution of the pathogen are poorlyunderstood. We found thatC. immitispresents a risk to humans andanimals across a larger region of central Washington than previouslydescribed and highlights a need for continued environmentalsurveillance. The potential growth sites we identified also providea valuable tool for human and veterinary health care providers andpublic health practitioners to understand and mitigate disease risk.

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Climbing Back Up the Mountain

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909115600857 ◽

2016 ◽

Vol 33 (10) ◽

pp. 972-976 ◽

Cited By ~ 3

Author(s):

Sadie P. Hutson

Keyword(s):

Health Care Providers ◽

Care Providers ◽

Care Needs ◽

Subjective Data ◽

South Central ◽

Persons Living With Hiv ◽

Advanced Planning ◽

Qualitative Descriptive ◽

Eol Care ◽

Hiv Aids

Little is known about the health access and end-of-life (EOL) concerns of persons living with HIV/AIDS (PLWHA) in Appalachia, where religious and cultural values are largely traditional. A qualitative, descriptive study with 9 participants was undertaken to assess EOL care needs among those from South Central Appalachian PLWHA. The focus of the study was to examine subjective data regarding EOL needs assessment related to advanced care planning. Five men and 4 women self-acknowledged a diagnosis of HIV/AIDS and completed a 2-hour face-to-face interview with the nurse researcher. Data were analyzed using qualitative descriptive content analysis methods, including data coding for emergent themes and metaphors. A common metaphor tied content to both struggle and triumph as well as the beauty and ruggedness of the Appalachian region: “Climbing Back up the Mountain.” Rich descriptions of the significance of the metaphor match with stigma as the greatest hurdle to overcome in planning and interacting with others, including health care providers and significant others, about EOL care needs and advanced planning preferences. Further, the metaphor was derived directly from quotes offered by participants. Sources of stigma were often intersecting: the disease itself, associations with “promiscuity,” sexual minority status, illicit drug use, and so on. Strong spiritual images were contrasted with a common avoidance and disdain of organized religion. Findings were used in refining plans for a larger study of EOL care needs and concerns on the population of PLWHA in 2 Southern Appalachian states. Comparison with other research and insights for providers is included.

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Evaluation of the Risk of Therapy-Associated Complications in Survivors of Hodgkin Lymphoma

Hematology ◽

10.1182/asheducation-2007.1.192 ◽

2007 ◽

Vol 2007 (1) ◽

pp. 192-196 ◽

Cited By ~ 4

Author(s):

Lois B. Travis

Keyword(s):

Hodgkin Lymphoma ◽

Health Care Providers ◽

Late Effects ◽

Disease Risk ◽

Risk Measures ◽

Epidemiologic Study ◽

Incidence Rates ◽

Care Providers ◽

Large Numbers ◽

Study Designs

Abstract Given the improvements in survival of patients with Hodgkin lymphoma (HL) in the last three decades, quantification of the late effects of successful treatment has become critical. Since the highest incidence rates of HL occur at ages 20 to 34 years, large numbers of patients remain at lifelong risk for the late effects of treatment. Deaths due to second cancers are now the most common cause of mortality among long-term survivors of HL, followed by cardiac disease. Risk measures of these and other late sequelae, however, can vary markedly between investigations, depending on the types of treatment, the rigor with which epidemiologic study designs are applied, ascertainment of events of interest, the duration and completeness of follow-up, and consideration of competing risks. Further, numerous influences apart from therapy can affect late effects, including patient age, sex, race, lifestyle factors (tobacco, alcohol, diet), comorbidities, and the underlying cancer process. In the future, it will become increasingly important for health-care providers to be able to critically evaluate the risk of late effects in HL survivors, which will include a working knowledge of various epidemiologic study designs and risk measures and an ability to judiciously review the medical literature. In this article, the methods, significance and caveats in calculating and reporting risks of complications of treatment for HL are reviewed.

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Assessing utility of a lifestyle-based tool in the clinical setting as a primordial prevention strategy: The Healthy Heart Score

Chronic Illness ◽

10.1177/1742395319899431 ◽

2020 ◽

pp. 174239531989943

Author(s):

Samantha Buls ◽

Elizabeth A Beverly ◽

Darlene E Berryman ◽

Mercedes Sotos-Prieto

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

Health Care Providers ◽

Clinical Setting ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Impact Behavior ◽

Care Providers ◽

Primordial Prevention ◽

Heart Score

Objective To evaluate the opinions of primary health-care providers and patients regarding the use of the Healthy Heart Score 20-year cardiovascular disease risk assessment tool in the clinical setting. Methods Semi-structured in person or phone interviews among 20 patients with no self-reported cardiovascular disease diagnoses and 20 health-care providers in Central (Columbus) and Southeastern (Athens) regions of Ohio. The researchers independently coded transcribed interviews, discussed codes to resolve discrepancies, and agreed on common themes. Results Participants suggested ways to best utilize and improve the tool, including adding graphics for visual reference of serving size. Patients showed interest in cardiovascular disease primordial prevention and expressed willingness to take the assessment prior to seeing a health-care provider. Health-care providers said that they would recommend the assessment to their patients and would be willing to use the tool in their practice. Health-care providers stated few barriers to using the tool, yet discussed numerous challenges to successful primordial prevention. Conclusions Our findings support the utilization of the Healthy Heart Score as a cardiovascular disease primordial prevention tool in the clinical setting. Additional research implementing the tool into the clinical setting will provide deeper insight into how the tool can impact behavior change and cardiovascular disease prevention.

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TickPhone App: A Smartphone Application for Rapid Tick Identification Using Deep Learning

Applied Sciences ◽

10.3390/app11167355 ◽

2021 ◽

Vol 11 (16) ◽

pp. 7355

Author(s):

Zhiheng Xu ◽

Xiong Ding ◽

Kun Yin ◽

Ziyue Li ◽

Joan A. Smyth ◽

...

Keyword(s):

Deep Learning ◽

Lyme Disease ◽

Health Care Providers ◽

Tick Species ◽

Disease Risk ◽

Learning Algorithm ◽

Learning Model ◽

Care Providers ◽

Accurate Identification ◽

Deep Learning Model

Tick species are considered the second leading vector of human diseases. Different ticks can transmit a variety of pathogens that cause various tick-borne diseases (TBD), such as Lyme disease. Currently, it remains a challenge to diagnose Lyme disease because of its non-specific symptoms. Rapid and accurate identification of tick species plays an important role in predicting potential disease risk for tick-bitten patients, and ensuring timely and effective treatment. Here, we developed, optimized, and tested a smartphone-based deep learning algorithm (termed “TickPhone app”) for tick identification. The deep learning model was trained by more than 2000 tick images and optimized by different parameters, including normal sizes of images, deep learning architectures, image styles, and training–testing dataset distributions. The optimized deep learning model achieved a training accuracy of ~90% and a validation accuracy of ~85%. The TickPhone app was used to identify 31 independent tick species and achieved an accuracy of 95.69%. Such a simple and easy-to-use TickPhone app showed great potential to estimate epidemiology and risk of tick-borne disease, help health care providers better predict potential disease risk for tick-bitten patients, and ultimately enable timely and effective medical treatment for patients.

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Trends in Elevated Blood Lead Levels Using 5 and 10 µg/dL Levels of Concern Among Refugee Children Resettled in Massachusetts, 1998-2015

Public Health Reports ◽

10.1177/0033354919874078 ◽

2019 ◽

Vol 134 (6) ◽

pp. 608-616

Author(s):

Paul L. Geltman ◽

Laura Smock ◽

Jennifer Cochran

Keyword(s):

Health Care Providers ◽

Intestinal Parasites ◽

Blood Lead ◽

Refugee Children ◽

Blood Lead Levels ◽

Elevated Blood ◽

Care Providers ◽

South Central ◽

Lead Levels ◽

Elevated Blood Lead Levels

Objectives: Refugee children are known to have a high prevalence of elevated blood lead levels (EBLLs). We sought to determine trends in EBLLs among refugee children during an 18-year period and examine relationships between descriptive characteristics and EBLLs by using 10 µg/dL and 5 µg/dL levels of concern. Methods: We retrospectively evaluated refugee health screening data from Massachusetts for 1998 through 2015 for refugee children aged <7 years. We performed bivariate and multivariate analyses of variables including sex, age, region of origin, anemia, intestinal parasites, tuberculosis test results, and anthropometric measurements and used both 5 µg/dL and 10 µg/dL levels of concern for EBLLs. Results: Of 3421 eligible refugee children, 3054 (88.2%) were tested. Using 5 µg/dL and 10 µg/dL levels of concern, 1279 (41.9%) and 241 (7.9%) children, respectively, had EBLLs. Mean BLLs declined steadily from 7.58 µg/dL in 2004 to 4.03 µg/dL in 2015. African (adjusted odds ratio [aOR] = 2.49; 95% confidence interval [CI], 1.81-3.43), East Asian and Pacific (aOR = 1.98; 95% CI, 1.35-2.91), and South-Central Asian (aOR = 2.47; 95% CI, 1.53-4.01) regions of origin and anemia (aOR = 1.50; 95% CI, 1.14 -1.97) were significantly associated with BLLs ≥5 µg/dL. Conclusions: The prevalence of EBLLs among refugees compared with US-born children is high. Because EBBLs increase the risk for neurocognitive impairment in children, public health professionals, policy makers, researchers, refugee resettlement staff members, and health care providers must remain vigilant in screening for lead poisoning and educating refugees about the hazards posed to young children by lead.

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An evaluation of tick and Lyme disease information on health unit websites in Ontario

Environmental Health Review ◽

10.5864/d2019-006 ◽

2019 ◽

Vol 62 (1) ◽

pp. 20-27 ◽

Cited By ~ 1

Author(s):

Kaitlyn Irving ◽

Lindsay Galway

Keyword(s):

Lyme Disease ◽

Health Care Providers ◽

Visual Information ◽

Disease Risk ◽

Care Providers ◽

Visual Content ◽

The Public ◽

Disease Information ◽

Incorrect Information

Climate change has allowed for the expansion and intensification of blacklegged ticks; the vector of Lyme disease. Projections estimate that by the year 2049 all health units in Ontario will have suitable environmental conditions for the establishment of this vector. A review of website content from health units in Ontario was performed to assess the quality of tick and Lyme disease information provided to the public and health care providers. Websites were evaluated based on criteria such as the provision of Lyme disease information (i.e., transmission, symptoms, treatment, etc.), the inclusion of misleading or incorrect information, and visuals provided. The quality of textual and visual information varied substantially across the 35 health units analyzed. Eleven health units were found to provide misleading or incorrect information. Disparities were found between areas with current Lyme disease risk and those without. The majority of health units did not include satisfactory visual content pertaining to ticks. Given the expected expansion and intensification of blacklegged tick populations across the province, all health units must ensure the information communicated to the public about ticks and Lyme disease is of high-quality and consistent. We conclude with specific recommendations to improve the textual and visual content of websites.

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Health Beliefs Regarding Cardiovascular Disease Risk and Risk Reduction in South Asian Immigrants: An Integrative Review

Journal of Transcultural Nursing ◽

10.1177/1043659619839114 ◽

2019 ◽

Vol 31 (1) ◽

pp. 76-86 ◽

Cited By ~ 1

Author(s):

Padmavathy Ramaswamy ◽

Nitha Mathew Joseph ◽

Jing Wang

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

Risk Reduction ◽

Health Beliefs ◽

Health Care Providers ◽

Disease Risk ◽

Healthy Diet ◽

Integrative Review ◽

Care Providers ◽

Cvd Risk

Introduction: The risk for cardiovascular disease (CVD) is higher in South Asians (SAs) than in other ethnic groups. The purpose of this review is to explore SAs’ health beliefs regarding CVD risk and risk reduction behaviors including physical activity and healthy diet. Methodology: An integrative review was conducted to examine the peer-reviewed literature published before May 2017. Searches from PubMed, Scopus, and CINAHL yielded 1 mixed-method, 4 quantitative, and 14 qualitative studies. Results: Stress, lack of exercise, and high-fat diet were perceived as causes of CVD in most studies. Lack of time, sociocultural norms, and insufficient guidance from health care providers were perceived barriers to CVD risk reduction. Exercise and healthy diet were perceived to be beneficial in a few studies. Cues to action included information from community leaders and health care providers. Discussion: Understanding the unique health beliefs of SAs regarding CVD is important in planning and delivering culturally competent preventive and educational services.

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Advising Obese Adults about Diet and Physical Activity in Sousse, Tunisia

ISRN Obesity ◽

10.1155/2013/498527 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Jihene Maatoug ◽

Imed Harrabi ◽

Sonia Hmad ◽

Mylene Belkacem ◽

Asma Nouira ◽

...

Keyword(s):

Physical Activity ◽

Health Care ◽

Health Care Providers ◽

Disease Risk ◽

Care Providers ◽

Cross Sectional Survey ◽

Obese Adults ◽

Cross Sectional ◽

Diet And Physical Activity ◽

Measure Evaluation

Background. To our knowledge no study has been conducted in Tunisia to describe practice of health care providers towards chronic disease risk factors, particularly among obese adults. Aim. This study is aimed at assessing the level of giving advice on diet and physical activity by health care providers for obese adults comparing to nonobese adults in Tunisia. Methods. A cross-sectional survey was carried out in 2010 for adults aged from18 to 65 years living in the region of Sousse. The questionnaires were administered by an interview made by trained data collectors to standardize the administration of the questionnaire. Anthropometric measurements of height and weight were obtained using a standardized protocol from each participant. Results. The findings from this study indicate that obesity is frequent among adults essentially among women and aged categories. It also shows that obese adults are not adequately diagnosed with few proportion of anthropometric measure evaluation among all the participants. Even if obese participants were significantly more advised than nonobese participants with, respectively, 28.5% to lose weight and 23.8% to increase physical activity, this proportion remains low.

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The impact of biological invasion and genomic local adaptation on the geographical distribution of Aedes aegypti in Panama

10.1101/744607 ◽

2019 ◽

Author(s):

Kelly L. Bennett ◽

W. Owen McMillan ◽

Jose R. Loaiza.

Keyword(s):

Local Adaptation ◽

Geographic Distribution ◽

Environmental Conditions ◽

Disease Risk ◽

Population Persistence ◽

Relative Fitness ◽

Bocas Del Toro ◽

Tropical Environments ◽

The Pacific ◽

The Caribbean

AbstractLocal adaptation is an important consideration when predicting arthropod-borne disease risk because it can impact on vector population fitness and persistence. However, the extent that vector populations are adapted to local environmental conditions and whether this can impact on species distributions generally remains unknown. Here we find that the geographic distribution of Ae. aegypti across Panama is rapidly changing as a consequence of the recent invasion by its ecological competitor, Aedes albopictus. Although Ae. albopictus has displaced Ae. aegypti in some areas, species coexist across many areas, raising the question: What biological and environmental factors permit population persistence?. Despite low population structure and high gene flow in Ae. aegypti across Panama, excepting the province of Bocas del Toro, we identify 128 candidate SNPs, clustered within 17 genes, which show a strong genetic signal of local adaptation. This putatively adaptive variation occurs across relatively fine geographic scales with the composition and frequency of candidate adaptive loci differing between populations in wet tropical environments along the Caribbean coast and the dry tropical conditions typical of the Pacific coast of Panama. Temperature and vegetation were important predictors of adaptive genomic variation in Ae. aegypti with potential areas of local adaptation occurring within the Caribbean region of Bocas del Toro, the Pacific coastal areas of Herrera and Panama City and the eastern Azuero Peninsula. Interestingly, several of these locations coincide with areas where Ae. aegypti and Ae. albopictus co-exist, suggesting that Ae. aegypti could have an adaptive edge under local environmental conditions that impacts on inter-specific competition with Ae. albopictus. Our results guide future experimental work by suggesting that locally adapted Ae. aegypti are able to persist on invasion by Ae. albopictus and, as a consequence, may fundamentally alter future arborviral disease risk and efforts to control mosquito populations.Author SummaryLocal environmental adaptation of mosquito vectors can alter the landscape of arthropod-borne disease by impacting on life history traits that increase their relative fitness thus promoting population persistence. We have identified a number of genomic loci in Ae. aegypti from Panama that exhibit a signal of natural selection associated with variation in the environment. Loci with a signal of local adaptation are predominately partitioned between wet and dry tropical environments with variation largely impacted by temperature and vegetation indices. Local adaptation in tandem with changes in the geographic distribution of Ae. aegypti due to the recent invasion of its ecological competitor, Ae. albopictus, has the potential to alter the landscape of arborviral disease.

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Spirituality in the Last Days of Life in Persons Born in Japan

The Qualitative Report ◽

10.46743/2160-3715/2013.1446 ◽

2015 ◽

Author(s):

Gloria Duke

Keyword(s):

Quality Of Life ◽

Health Care ◽

Data Analysis ◽

Health Care Providers ◽

End Of Life Care ◽

Life Care ◽

Care Providers ◽

South Central ◽

Central Texas

End - of - life care is encumbered with many complex issues that can impede quality of life, especially in populations for which little is known. This study addresses spirituality and preferences for last days of life in persons born in Japan and living in eastern and south central Texas. Descriptive, qualitative methods were used for data collection and data analysis. Two major themes emerged for spirituality: Spirituality as Culture and Universality of Spirituality, and three major themes reflected preferences for the last days of life: Environmental Peace and Comfort, Interconnectedness, and Communication is Key. Nurses and health care providers can use this evidence to facilitate quality of life for these persons and their loved ones to achieve a peaceful an d dignified death. K.

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