Prevalence of hepatitis C virus exposure and infection among Indigenous and tribal populations: a global systematic review and meta-analysis

OBJECTIVES

The objective of this study was to estimate prevalence of hepatitis C virus (HCV) exposure and infection among Indigenous and tribal populations globally.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

We systematically searched bibliographic databases and grey literature (1/01/2000-16/06/2022). Prevalence estimates were synthesised overall, by World Health Organization region and HCV-risk group. For studies with comparator populations, prevalence ratios were estimated and pooled.

RESULTS

Ninety-two studies were included. Globally, among general Indigenous and tribal populations, the median prevalence of HCV antibody (HCV Ab) was 1.3% (interquartile range [IQR]: 0.3-3.8%, I2 = 98.5%) and HCV RNA was 0.4% (IQR: 0-1.3%, I2 = 96.1%). The Western Pacific Region had the highest prevalence (HCV Ab: median: 3.0% [IQR: 0.4-11.9%], HCV RNA: median 5.6% [IQR: 2.0-8.8%]). Prevalence was highest in people who injected drugs (HCV Ab: median: 59.5%, IQR: 51.5-67.6%, I2 = 96.6%; and HCV RNA: median: 29.4%, IQR: 21.8-35.2%, I2 = 97.2%). There was no association between HCV Ab prevalence and Indigenous/tribal status for general populations (prevalence ratio = 0.91; 95% CI: 0.56, 1.49) or key risk groups.

CONCLUSIONS

Indigenous and tribal peoples from the Western Pacific Region and recognised at-risk sub-populations had higher HCV prevalence. HCV prevalence showed no association with Indigenous/tribal status. However, this review was limited by heterogeneity and poor quality of constituent studies, varying definitions of Indigenous/tribal status, regional data gaps, and limited studies on chronic infection (HCV RNA). Comprehensive quality evidence on HCV epidemiology in Indigenous and tribal peoples is needed to tailor preventive and treatment interventions so these populations are not left behind in elimination efforts.

The effect of dietary supplementation of organic trace minerals on performance, mineral retention, lymphoid organs and antibody titres of broilers

Complete replacement of inorganic trace minerals (ITM) with proteinated organic trace minerals (PTM) at equal or lower inclusion rates was evaluated. One thousand and eight, one-d-old male chicks were divided into 24 pens containing 42 chicks, and randomly allocated to one of the following: T1: control group with ITM supplied at the standard commercial level in Ecuador; T2: PTM at 100% T1; T3: PTM at 66% TI; and T4: PTM at 33% T1. The 42-d experiment employed a three-phase feeding programme (1-14, 15-28 and 29-42 d). Restricted feeding was used to prevent the development of ascites associated with high altitude. At 21 and 42 d of age, Cu, Mn and Zn retention were measured in tibial bone, and Fe in whole blood. Lymphoid organ weights were at 21 and 42 d of age. Antibody titres were measured by ELISA at 42 d of age. Weight gain, feed consumption, feed conversion and mortality were similar among treatments, although were below breed expectations due to feed restriction practices. Blood Fe was not affected by treatment (P<0.05). At both 21 and 42 d of age, minerals in tibia differed (P<0.01), with Mn and Zn concentrations being significantly higher in all PTM groups, compared to ITM control at 42 d. However, at 21 d, Zn was higher for the ITM-fed birds. No differences in lymphoid organ (bursa, thymus, and spleen) weights were observed, or for Gumboro (infectious bursal disease), infections bronchitis virus and reovirus antibody titres. For Newcastle disease virus, T4 birds had significantly lower antibody titres compared to other treatment groups. In conclusion, replacement of inorganic minerals with a proteinated form organic minerals at lower inclusion rates had no negative impact on performance, lymphoid organ weight or antibody titres in broilers raised under commercial conditions of high altitude and restricted feeding.

The impact of COVID-19 restrictions on perceived health and wellbeing of adult Australian sport and physical activity participants

Individuals’ access to sport and physical activity has been hampered due to COVID-19 lockdown restrictions. In Australia participation in community sport was cancelled during lockdowns. There is limited research on the impact of sport participation restrictions on the health and wellbeing of adults.

Aim

The aim of this study was to investigate the perceived health and wellbeing of a sample of predominantly active Australian adults, both during COVID-19 and in comparison with one year earlier (pre COVID-19).

Methods

A survey was conducted during the first COVID-19 restrictions and lockdowns in Australia in May–June 2020. It was distributed by national and state sporting organisations and through researchers’ social media accounts. This particular paper focuses on adults aged 18–59 years. The survey collected information on participant demographics, the sport and physical activity patterns pre- COVID-19, and health and wellbeing outcomes during COVID-19 lockdown and compared to one year earlier. The health measures were cross-tabulated against the demographic and sport and physical activity variables, and group profiles compared with chi-square tests. Scales were derived from three wellbeing questions, and group differences were analysed by t-tests and F-tests.

Results

The survey sample included 1279 men and 868 women aged 18–59 years. Most (67%) resided in metropolitan cities. The great majority (83%) were sport participants. During COVID-19 lockdown men were significantly more likely than women to report worse or much worse general (p = 0.014), physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction (p = 0.016). The inactive adults were significantly more likely to report poorer general health (p = 0.001) and physical health (p = 0.001) compared to active adults. The younger age cohort (18–29 years) were significantly more likely to report poorer general wellbeing (p < 0.001), and lower life satisfaction (p < 0.001) compared to the older age groups.

Conclusion

It seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted males and younger adults in particular. Sports clubs provide an important setting for individuals’ health and wellbeing which is why clubs require the capacity to deliver sport and individuals may need to regain the motivation to return.

Validation of the ALONE Scale: A Clinical Measure of Loneliness

OBJECTIVES

This study aimed to examine the validity and reliability of a rapid, clinically administrable loneliness screening tool for older adults called the ALONE scale.

DESIGN

This was a cross-sectional study.

SETTING

Participants were recruited from either ambulatory clinics or a nursing home.

PARTICIPANTS

Participants were 65 years of age or older and had SLUMS scores of 14 or greater.

MEASUREMENTS

Construct validity of the 5-item ALONE scale was examined through correlation with the previously validated UCLA-20 Loneliness Questionnaire. Divergent validity for discriminating between loneliness and depression was examined through correlation with the PHQ-8 items. Test-retest reliability was assessed by correlation between baseline ALONE scores and those from re-administration in 2-3 weeks.

RESULTS

Among ambulatory clinic participants (n=199), the ALONE scale showed strong correlation with the UCLA-20 (r=0.81, p < 0.001). Similar correlation coefficients were seen among demographic subgroups: White Americans (n=123) (r=0.81, p < 0.001), Black Americans (n=66) (r=0.79, p < 0.001), adults ≥ 75 years (n=74) (r=0.86, p < 0.001). Among nursing home patients (n=22), the ALONE scale showed fair correlation with the UCLA-20 (r=0.74, p < 0.001). Test-retest of the ALONE scale showed a strong correlation (r=0.89, p < 0.001). ROC curve analysis determined ALONE scale scores of 8 and greater as optimal for severe loneliness screening.

CONCLUSION

This study shows that the ALONE scale has strong validity in assessing older adults for severe loneliness. The brief, comprehensible nature of the ALONE scale reduces adoption burden making it optimal for use in clinical settings.

Nosocomial or not? A combined epidemiological and genomic investigation to understand hospital-acquired COVID-19 infection on an elderly care ward

Background

COVID-19 has the potential to cause outbreaks in hospitals. Given the comorbid and elderly cohort of patients hospitalized, hospital-acquired COVID-19 infection is often fatal. Pathogen genome sequencing is becoming increasingly important in infection prevention and control (IPC).

Aim

To inform the understanding of in-hospital SARS-CoV-2 transmission in order to improve IPC practices and to inform the future development of virological testing for IPC.

Methods

Patients detected COVID-19 positive by polymerase chain reaction on Ward A in April and May 2020 were included with contact tracing to identify other potential cases. Genome sequencing was undertaken for a subgroup of cases. Epidemiological, genomic, and cluster analyses were performed to describe the epidemiology and to identify factors contributing to the outbreak.

Findings

Fourteen cases were identified on Ward A. Contact tracing identified 16 further patient cases; in addition, eight healthcare workers (HCWs) were identified as being COVID-19 positive through a round of asymptomatic testing. Genome sequencing of 16 of these cases identified viral genomes differing by two single nucleotide polymorphisms or fewer, with further cluster analysis identifying two groups of infection (a five-person group and a six-person group).

Conclusion

Despite the temporal relationship of cases, genome sequencing identified that not all cases shared transmission events. However, 11 samples were found to be closely related and these likely represented in-hospital transmission. This included three HCWs, thereby confirming transmission between patients and HCWs.

An online Sexual Health and Rehabilitation eClinic (TrueNTH SHAReClinic) for prostate cancer patients: a feasibility study

Purpose

The primary objective was to determine the feasibility of implementing the TrueNTH SHAReClinic as a pan-Canadian sexual health and rehabilitation intervention for patients treated for localized prostate cancer.

Methods

The feasibility study was designed to evaluate the accessibility and acceptability of the intervention. Participants from five institutions across Canada were enrolled to attend one pre-treatment and five follow-up online clinic visits over 1 year following their prostate cancer (PC) treatment.

Results

Sixty-five patients were enrolled in the intervention. Website analytics revealed that 71% completed the intervention in its entirety, including the educational modules, with an additional 10% completing more than half of the intervention. Five thousand eighty-three views of the educational modules were made along with 654 views of the health library items. Over 1500 messages were exchanged between participants and their sexual health coaches. At 12 months, the intervention received an overall average participant rating of 4.1 out of 5 on a single item satisfaction measure.

Conclusion

Results support the TrueNTH SHAReClinic as highly acceptable to participants as defined by intervention adherence and engagement. The TrueNTH SHAReClinic demonstrated promise for being a feasible and potentially resource-efficient approach to effectively improving the sexual well-being of patients after PC treatment.

The use of separate-level neuraxial anaesthesia for caesarean delivery in a patient with a history of spinal tuberculosis

We present the case of a 33-year-old parturient who required caesarean delivery at 31 weeks' gestation. She had a history of degenerative disease of the lumbar spine secondary to tuberculosis, acquired as a child in India. Her complex medical history also included ischaemic heart disease and obstructive sleep apnoea, and due to this general anaesthesia was considered to be of high risk. However, regional anaesthesia also posed significant challenges because magnetic resonance imaging of the spine showed a partial collapse with subsequent fusion of second and third lumbar vertebral bodies with thoracolumbar kyphosis. Neuraxial anaesthesia was performed with ultrasound guidance for determining levels and depth of epidural space. An epidural was inserted at the T12-L1 interspace and a spinal anaesthetic block was placed at L4-L5. Delivery and recovery were uneventful. This case highlights the safe and effective use of neuraxial anaesthesia in an asymptomatic patient with treated spinal tuberculosis as well as the usefulness of high-quality imaging of the spine in the decision to perform neuraxial anaesthesia.

Feeding low dietary levels of organic trace minerals improves broiler performance and reduces excretion of minerals in litter

1. This experiment was conducted to evaluate the effect of organic and inorganic trace minerals in diets fed to 1872, one-day-old male Ross 708 broiler chicks. Two sources of supplemental trace minerals (inorganic or organic) and four trace minerals levels (12.5%, 25.0%, 37.5% or 50.0%) plus a positive control containing inorganic minerals at 100% of recommended levels according to Brazilian industry standards, were used in the diets. 2. When analysed with mineral source as the main factor, broilers fed diets containing organic minerals had better feed conversion (FCR) throughout the trial, until 48 d of age (1.754 organic vs. 1.783 inorganic; P < 0.05), improved liveability at 48 d (95.8% organic vs. 93.6% inorganic; P < 0.05) and higher weight gain at 48 d (3.941 kg organic vs. 3.881 kg inorganic; P < 0.05) compared to the inorganic trace mineral diets. At lower dietary inclusion levels (12.5% and 25%) the organic mineral-fed birds had a four-point improvement in FCR (P < 0.05). 3. Feeding organic minerals improved tibial ash at 48 d from 49.5% to 51.25% (P < 0.05). The P and Ca in the tibia at 48 d were significantly (P < 0.05) higher for the birds fed organic minerals (Ca: 17.4% vs. 18.7%; P: 8.8% vs. 9.4%, respectively). The lower levels of trace minerals in feed reduced the mineral concentration of Zn, Cu and Mn in the faeces and, hence, in the litter (P < 0.05). 4. Feeding organic minerals promoted a small, but statistically significant, drop in pH of breast meat compared to inorganic minerals at 48 d (5.83 vs. 5.86, respectively; P < 0.05). The organic mineral diets reduced drip loss in breast meat compared to inorganic trace mineral supplementation at 32 d of age, but not in older birds (2.46% vs. 3.77%, respectively; P < 0.05). 5. Oxidation status, measured by superoxide dismutase activity in breast muscle at 48 d of age, significantly increased with mineral inclusion levels (P < 0.001), irrespective of source. 6. It was concluded that the use of organic minerals, even at low levels in the diet, is beneficial for broiler performance and reduces the excretion of minerals in litter.

Evaluation of the performance of DiaSorin molecular Pneumocystis jirovecii-CMV multiplex real-time PCR assay from bronchoalveolar lavage samples

The aim of this study was to evaluate the performance of the DiaSorin Molecular PJ-CMV multiplex real-time PCR (PJ-CMV PCR) assay (DiaSorin Molecular LLC, USA) in bronchoalveolar lavage (BAL) samples compared to direct immunofluorescence assay (IFA) for the detection of Pneumocystis jirovecii and assess CMV and P. jirovecii co-infection rate in immunosuppressed patients with suspected pneumonia. A total of 125 BAL samples from immunosuppressed patients submitted for PJP-IFA were tested. Surplus samples were saved and further tested by using the PJ-CMV PCR assay. Among the 125 samples, P. jirovecii was detected in 31.2% (39/125) and in 40% (50/125) of the specimens using IFA and PJ-CMV PCR respectively. Eleven of the PJ-CMV PCR positive samples were negative by direct IFA for P. jirovecii. All samples positive by direct IFA were also positive by PJ-CMV PCR. Using the direct IFA as a gold standard, the PJ-CMV PCR sensitivity, specificity, positive predictive value and negative predictive value for detection of P. jirovecii were 100%, 87.2%, 78% and 100%, respectively. However, after reviewing the clinical diagnosis, the specificity and PPV increased to 100%. Of the 50 P. jirovecii samples positive by PJ-CMV PCR, 18 (36%) were also positive for CMV by the PJ-CMV PCR. The co-infection rate was found to be 37.5% (6/16) and 35.2% (12/34) in HIV infected and non-HIV infected patients. This study indicated that the DiaSorin Molecular PJ-CMV multiplex real-time PCR assay has higher sensitivity than direct IFA for detection of P. jirovecii and provides rapid detection of PJ and CMV infection in BAL samples.

First Measurement of the Total Neutron Cross Section on Argon between 100 and 800 MeV

We report the first measurement of the neutron cross section on argon in the energy range of 100-800 MeV. The measurement was obtained with a 4.3-h exposure of the Mini-CAPTAIN detector to the WNR/LANSCE beam at LANL. The total cross section is measured from the attenuation coefficient of the neutron flux as it traverses the liquid argon volume. A set of 2631 candidate interactions is divided in bins of the neutron kinetic energy calculated from time-of-flight measurements. These interactions are reconstructed with custom-made algorithms specifically designed for the data in a time projection chamber the size of the Mini-CAPTAIN detector. The energy averaged cross section is 0.91±0.10(stat)±0.09(syst)  b. A comparison of the measured cross section is made to the GEANT4 and FLUKA event generator packages, where the energy averaged cross sections in this range are 0.60 and 0.68 b, respectively.

Utility of state-level influenza disease burden and severity estimates to investigate an apparent increase in reported severe cases of influenza A(H1N1) pdm09 - Arizona, 2015-2016

The Arizona Department of Health Services identified unusually high levels of influenza activity and severe complications during the 2015-2016 influenza season leading to concerns about potential increased disease severity compared with prior seasons. We estimated state-level burden and severity to compare across three seasons using multiple data sources for community-level illness, hospitalisation and death. Severity ratios were calculated as the number of hospitalisations or deaths per community case. Community influenza-like illness rates, hospitalisation rates and mortality rates in 2015-2016 were higher than the previous two seasons. However, ratios of severe disease to community illness were similar. Arizona experienced overall increased disease burden in 2015-2016, but not increased severity compared with prior seasons. Timely estimates of state-specific burden and severity are potentially feasible and may provide important information during seemingly unusual influenza seasons or pandemic situations.