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Despite the considerable advances in the last years, the health information systems for health surveillance still need to overcome some critical issues so that epidemic detection can be performed in real time. For instance, despite the efforts of the Brazilian Ministry of Health (MoH) to make COVID-19 data available during the pandemic, delays due to data entry and data availability posed an additional threat to disease monitoring. Here, we propose a complementary approach by using electronic medical records (EMRs) data collected in real time to generate a system to enable insights from the local health surveillance system personnel. As a proof of concept, we assessed data from São Caetano do Sul City (SCS), São Paulo, Brazil. We used the “fever” term as a sentinel event. Regular expression techniques were applied to detect febrile diseases. Other specific terms such as “malaria,” “dengue,” “Zika,” or any infectious disease were included in the dictionary and mapped to “fever.” Additionally, after “tokenizing,” we assessed the frequencies of most mentioned terms when fever was also mentioned in the patient complaint. The findings allowed us to detect the overlapping outbreaks of both COVID-19 Omicron BA.1 subvariant and Influenza A virus, which were confirmed by our team by analyzing data from private laboratories and another COVID-19 public monitoring system. Timely information generated from EMRs will be a very important tool to the decision-making process as well as research in epidemiology. Quality and security on the data produced is of paramount importance to allow the use by health surveillance systems.
The COVID-19 pandemic has affected perinatal mental health. Reliable tools are needed to assess perinatal stress during pandemic situations.
To assess the psychometric properties of the Greek versions of the Pandemic-Related Pregnancy Stress Scale (PREPS) and the Pandemic-Related Postpartum Stress Scale (PREPS-PP) and to explore the associations between women's characteristics and perinatal stress during the second pandemic wave.
The PREPS and PREPS-PP were completed by 264 pregnant and 188 postpartum women, respectively, who also completed the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS).
The internal consistency was similar for PREPS and PREPS-PP. It was good for preparedness stress (a = 0.77 and α = 0.71, respectively) and infection stress (α = 0.83 for both scales) but low for positive appraisal (α = 0.46 and α = 0.41, respectively). Of the pregnant women, 55.33% and 55.27%, respectively, reported scores of ≥40 on STAI-S and STAI-T, and the respective percentages for the postpartum women were 47.34% and 46.80%. In addition, 14.39% of the pregnant women and 20.74% of the postpartum women scored ≥13 on the EPDS. Higher preparedness stress on PREPS and PREPS-PP was associated with primiparity (P = 0.022 and P = 0.021, respectively) and disrupted perinatal care (P = 0.069 and P = 0.007, respectively). In postpartum women, higher infection stress was associated with chronic disease (P = 0.037), primiparity (P = 0.02) and perceived risk of infection (P = 0.065). Higher score on infection stress was associated with disrupted perinatal care in both groups (P = 0.107 and P = 0.010, respectively).
The Greek versions of PREPS and PREPS-PP are valid tools for the assessment of women at risk of perinatal stress during a health crisis.
This article is based on an EAA session in Kiel in 2021, in which thirteen contributors provide their response to Robb and Harris's (2018) overview of studies of gender in the European Neolithic and Bronze Age, with a reply by Robb and Harris. The central premise of their 2018 article was the opposition of ‘contextual Neolithic gender’ to ‘cross-contextual Bronze Age gender’, which created uneasiness among the four co-organizers of the Kiel meeting. Reading Robb and Harris's original article leaves the impression that there is an essentialist ‘Neolithic’ and ‘Bronze Age’ gender, the former being under-theorized, unclear, and unstable, the latter binary, unchangeable, and ideological. While Robb and Harris have clearly advanced the discussion on gender, the perspectives and case studies presented here, while critical of their views, take the debate further, painting a more complex and diverse picture that strives to avoid essentialism.
OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.
OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) are commonly seen in primary care, with recurrence rates that range from 16% to 43%, and present significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to develop and evaluate a home-based intervention implemented by Community Health Workers (CHWs) or “promotoras” to prevent recurrence of CA-MRSA in patients presenting to primary care with SSTIs and transmission within their households. This presentation will examine associations between wound microbiology, clinical presentation, and housing characteristics, including housing density and household surfaces contamination. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 3 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants will be randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention (based on the REDUCE MRSA trial) or usual care. The highly engaged stakeholder team finalized the intervention protocol, developed and implemented CHW and clinician training, and developed an online health portal application for data management and exchange. RESULTS/ANTICIPATED RESULTS: We have collected 923 isolates from 237 individuals, including 240 wound culture isolates and 683 surveillance culture isolates (nares, axilla, groin). MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively; 59.5% with MRSA+ wound culture had 1 or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had 1 or more MSSA+ surveillance culture. Of those with MRSA or MSSA infections, 70% of subjects were male, with an average age of 37.9 (SD=15.9 y). The most frequent sites of infection were the leg (20%), axilla (18%), buttock (17%), and abdomen/torso (12%). There was no association between the location and type of infection (MRSA/MSSA) (p-value=0.09). The kitchen floor (14.05%) and bedroom floor (14%) were the most common surfaces contaminated with MRSA. These were also the most common surfaces contaminated with MSSA, which was recovered from 10.2% and 9.1% of kitchen floors and bedroom floors, respectively. For individuals with an MRSA or MSSA wound infection, there was an average number of 3.2 (SD=1.6) co-residents per household, and 36.5% of household members were colonized with either MRSA or MSSA. There is no association between household density (number of co-residents) and type of infection (MRSA/MSSA) (Fisher’s p-values=0.171 and 0.371, respectively). In households of participants with MSSA wound infections, the number of colonized sites is positively associated with the level of household MSSA contamination (p=0.027). Further analyses will examine the associations between molecular subtypes, wound location, household surface contamination and household member colonization and infection. DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the patient-level and environmental-level factors associated with SSTI recurrence, surface contamination and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators to implementation of home visits by CHWs in underserved populations, and aims to strengthen the evidence base for implementation of strategies to identify and reduce household reservoirs and then control SSTI recurrence and household transmission.
DNA methylation is an epigenetic marker that has been shown to vary significantly across different tissues. Taking advantage of the methylation differences between placenta-derived cell-free DNA and maternal blood, several groups employed different approaches for the discovery of fetal-specific biomarkers. The aim of this study was to analyse whole-genome fetal and maternal methylomes in order to identify and confirm the presence of differentially methylated regions (DMRs). We have initially utilized methylated DNA immunoprecipitation (MeDIP) and next-generation sequencing (NGS) to identify genome-wide DMRs between chorionic villus sampling (CVS) and female non-pregnant plasma (PL) and peripheral blood (WBF) samples. Next, using specific criteria, 331 fetal-specific DMRs were selected and confirmed in eight CVS, eight WBF and eight PL samples by combining MeDIP and in-solution targeted enrichment followed by NGS. Results showed higher enrichment in CVS samples as compared to both WBF and PL samples, confirming the distinct methylation levels between fetal and maternal DNA for the selected DMRs. We have successfully implemented a novel approach for the discovery and confirmation of a significant number of fetal-specific DMRs by combining for the first time MeDIP and in-solution targeted enrichment followed by NGS. The implementation of this double-enrichment approach is highly efficient and enables the detailed analysis of multiple DMRs by targeted NGS. Also, this is, to our knowledge, the first reported application of MeDIP on plasma samples, which leverages the implementation of our enrichment methodology in the detection of fetal abnormalities in maternal plasma.
A 3-year (2011–2013) field trial was carried out in a mature vineyard (Vitis vinifera L., cv. Sangiovese), planted in 2003, to assess physiological responses of grapevines to biodynamic management. Starting in 2007, the vineyard was managed with organic production protocols in accordance with EC Regulations (834/2007). In 2008, the vineyard (2 ha) was divided in two large plots, with each plot having similar soil physico-chemical properties. One of the plots was managed with organic protocols per EC Regulations and the other with biodynamic practices, consisting of spray application of preparations 500, 500 K, fladen and 501. During the 2011–2013 season, the biodynamic preparations were used at least twice per year, with the exception of 501 that was applied only once in 2013. Concentration of hormones and mineral elements in biodynamic preparations were determined. Biodynamically managed vines showed lower stomatal conductance in all years and lower leaf water potential in 2012. Leaf photosynthetic activity was not influenced by cultivation method. Biodynamic management led to an increase in leaf enzymatic activities of endochitinase (EC 220.127.116.11), exochitinase (β-N-acetylhexosaminidase, EC 18.104.22.168 and chitin 1,4-β-chitobiosidase) and β-1,3-glucanase (EC 22.214.171.124), which are typically correlated with plant biotic and abiotic stresses and associated with induced plant resistance. Year effects were observed with 1,3-β-glucanase, whose activity in 2012 was 4.1-fold higher than in 2013. Disease incidence and grape yields were not different between organic and biodynamic treatments. This study provided a strong indication of a stimulation of natural defense compounds in grapes grown under biodynamic cultivation, but subsequent effects on plant protection and productivity require further evaluation.
Maternal smoking during pregnancy may increase the risk of nicotine dependence, especially in girls, but data are conflicting and confounding by other familial factors cannot be ruled out.
To clarify the relationship between prenatal tobacco exposure and adolescent tobacco uptake and dependence in boys and girls respectively, while taking confounding factors into close consideration.
We conducted a prospective longitudinal study, comprising 3020 Swedish youths followed from 11 to 18 years of age. Exposure and outcome information was elicited via self-administered parental and repeated youth questionnaires. Hazard ratios (HRs), odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated as measures of associations.
Girls prenatally exposed to maternal tobacco use had a two-to threefold increased odds of experiencing a high number of withdrawal symptoms (OR = 2.83, 95% CI 1.68–4.87), craving for tobacco (OR = 2.04, 95% CI 1.28–3.32) and heavy tobacco use (five or more cigarettes or snus dips per day) (OR = 1.93, 95% CI 1.30–2.86). These associations were weaker among boys, and did not reach formal statistical significance. Associations between prenatal tobacco exposure and onset of regular tobacco use in both genders appeared to be mostly explained by parents' social position and postnatal smoking behaviour.
Prenatal exposure to tobacco is linked to an increased risk of nicotine dependence among adolescent girls.
Citrus clementine cv. ‘Nules’ is a seedless mandarin with excellent quality for consumption as fresh fruit; however, its poor fruit set leads to an excess of small-sized fruits. Currently, the only available practice to increase fruit set is the use of the growth regulator gibberellic acid (GA3) as a foliar spray. A trial was conducted to compare an environmentally friendly new bioregulator (MX), containing methyl-xanthine, to GA3 in terms of increasing fruit set and yield of clementine cv. Nules mandarin trees. Fruit yield was significantly increased in treated trees from 17.4 to 25.7% for GA3 and MX treatments, respectively, compared to untreated control trees, without any significant differences between the growth regulators. At the tested doses, MX performed similarly to GA3 in terms of fruit quality and nutrient content, while colour index was not affected significantly by this new bioregulator. A single foliar application of MX was enough to increase fruit set. Spray application of MX on clementine mandarins at the end of the flowering period, when all petals have fallen showed a similar response to GA3 treatments.
The objective was to investigate the changes occurring in the activities of the enzymes lactate dehydrogenase (LDH), alkaline phosphatase (ALP) and aspartate aminotransferase (AST) in sheep and goat milk as a result of subclinical intramammary infections (IMI) and to evaluate the use of these enzymes for the diagnosis of subclinical IMI in dairy sheep and goats. A total of 206 samples of sheep milk and 162 samples of goat milk, obtained from equal udder halves, were used in the study. For each species they were divided into two groups: a no-infection group and a subclinical infection group. Activities of LDH, ALP and AST were significantly higher in the subclinical infection group than in the no-infection group (P<0·05) in both sheep (LDH: 350·42±11·25 v. 120·91±4·41; ALP: 2773·43±105·18 v. 2189±94·24; AST: 29·57±0·74 v. 17·32±0·46) and goats (LDH: 354·07±13·33 v. 103·79±3·75; ALP: 311·13±25·74 v. 137·24±19·62; AST: 27·59±6·42 v. 15·87±0·45). The activity of LDH was identified as indicator for subclinical IMI in both sheep and goats. The optimum cut-off values for LDH activity, offering the highest diagnostic sensitivity (DSn) and diagnostic specificity (DSp), determined by receiver operating characteristic (ROC) analysis, were at 197 U/l, 185 U/l and 197 U/l for sheep, goats and both species, respectively. DSn for sheep, goats and both species at these cut-off values was 92·8%, 98·2% and 94·0%, whereas DSp was 95·4%, 96·3% and 96·3%, respectively. It was concluded that the determination of LDH activity in milk serum is a sensitive and reliable method for the detection of subclinical IMI in dairy sheep and goats.
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