Mass behaviour change amid COVID-19: How public health information and social norms explain the transformation

COVID-19 is a severe and ongoing threat globally, with the spread disrupting lives and society. Despite the developments of vaccines, the key measure to reduce the transmission of variants has stemmed from mass changes to personal behaviours. COVID-19 pandemic offers a unique context, where the protection behaviours enacted by an individual are necessary to keep the community safe. A social psychological perspective can be used to understand the reasons for adherence to policies and determine what other factors can shape preventive behaviours. To resolve this, in partnership with health consumers we use an online survey, with the findings substantiating preventive behaviours are positively related to COVID-19 information access and descriptive norms. Additionally, findings demonstrate the mediating role of injunctive norms on preventive behaviour suggesting that policy makers can influence decision-making by promoting health information that provides guidance on acceptable behaviours, but also demonstrates subsequent success. The integrity of the model is substantiated by partial least squares (PLS) testing.

Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities

BACKGROUND

Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination.

METHODS

Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4.

RESULTS

Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61).

DISCUSSION

Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.

Global Burden of Animal Diseases: a novel approach to understanding and managing disease in livestock and aquaculture

Investments in animal health and Veterinary Services can have a measurable impact on the health of people and the environment. These investments require a baseline metric that describes the burden of animal health and welfare in order to justify and prioritise resource allocation and from which to measure the impact of interventions. This paper is part of a process of scientific enquiry in which problems are identified and solutions sought in an inclusive way. It poses the broad question: what should a system to measure the animal disease burden on society look like and what value would it add? Moreover, it aims to do this in such a way as to be accessible by a wide audience, who are encouraged to engage in this debate. Given that farmed animals, including those raised by poor smallholders, are an economic entity, this system should be based on economic principles. These poor farmers are negatively impacted by disparities in animal health technology, which can be addressed through a mixture of supply-led and demand-driven interventions, reinforcing the relevance of targeted financial support from government and non-governmental organisations. The Global Burden of Animal Diseases (GBADs) Programme will glean existing data to measure animal health losses within carefully characterised production systems. Consistent and transparent attribution of animal health losses will enable meaningful comparisons of the animal disease burden to be made between diseases, production systems and countries, and will show how it is apportioned by people's socio-economic status and gender. The GBADs Programme will produce a cloud-based knowledge engine and data portal, through which users will access burden metrics and associated visualisations, support for decisionmaking in the form of future animal health scenarios, and the outputs of wider economic modelling. The vision of GBADs, strengthening the food system for the benefit of society and the environment, is an example of One Health thinking in action.

The importance of animal welfare and Veterinary Services in a changing world

Animal welfare is an essential component of the future of sustainable agriculture and the United Nations Sustainable Development Goals. There is growing global recognition of the importance of animal welfare, which must always be considered as part of the decision-making around food and nutrition security. Veterinary Services, encompassing public and private veterinarians and para-veterinarians, are custodians of animal welfare and key players in future actions to improve it. The welfare of animals is everyone's responsibility, from the individual farmer and practitioner to policymakers at the national and intergovernmental level. In this paper, after providing background information about current animal welfare issues and identifying animal welfare risks, the authors make a number of recommendations for action at the institutional and individual level. They do so because while the former is essential to generate change at scale and effective resourcing, the latter can create immediate action at a local level and drive change from the ground up. Without coordinated action from Veterinary Services, opportunities to improve animal welfare, alongside human and environmental health and well-being, may very well be lost, and animal welfare may fail to improve or even be at risk of decline.

Foresight methodologies useful to Veterinary Services

The world is facing a broad range of challenges related to agriculture, and particularly the livestock sector, including threats to productivity, the natural environment and human health. While much research has been conducted into potential risks and their drivers, the 2020 COVID-19 pandemic demonstrated how governments can be affected by shocks that are to some extent predictable but for which they are often ill prepared. Policy seeks to anticipate and also influence the future and, as policy-makers, national Veterinary Services have an important role in both anticipating and influencing the future of their countries and the world. In the first part of this paper, the author summarises a wide range of Foresight methodologies and tools relevant to, or used by, Veterinary Services or veterinary researchers. This discussion is followed by an example of the adaptation and application of a Foresight framework tailored specifically to Veterinary Services. Finally, the author draws conclusions on Foresight methodologies useful to Veterinary Services.

Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019

INTRODUCTION

In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization.

METHODS

Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator.

RESULTS

Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance.

CONCLUSIONS

Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.

MILK Symposium review: Foodborne diseases from milk and milk products in developing countries-Review of causes and health and economic implications

Dairy production is rapidly increasing in developing countries and making significant contributions to health, nutrition, environments, and livelihoods, with the potential for still greater contributions. However, dairy products can also contribute to human disease in many ways, with dairyborne disease likely being the most important. Health risks may be from biological, chemical, physical, or allergenic hazards present in milk and other dairy products. Lacking rigorous evidence on the full burden of foodborne and dairyborne disease in developing countries, we compiled information from different sources to improve our estimates. The most credible evidence on dairyborne disease comes from the World Health Organization initiative on the Global Burden of Foodborne Disease. This suggests that dairy products may has been responsible for 20 disability-adjusted life years per 100,000 people in 2010. This corresponds to around 4% of the global foodborne disease burden and 12% of the animal source food disease burden. Most of this burden falls on low- and middle-income countries (LMIC). However, the estimate is conservative. Weaker evidence from historical burden in high-income countries, outbreak reports from LMIC and high-income countries, and quantitative microbial risk assessment suggest that the real burden may be higher. The economic burden in terms of lost human capital is at least US$4 billion/yr in LMIC. Among the most important hazards are Mycobacterium bovis, Campylobacter spp., and non-typhoidal Salmonella enterica. The known burden of chemical hazards is lower but also more uncertain. Important chemical hazards are mycotoxins, dioxins, and heavy metals. Some interventions have been shown to have unintended and unwanted consequences, so formative research and rigorous evaluation should accompany interventions. For example, there are many documented cases in which women's control over livestock is diminished with increasing commercialization. Dairy co-operatives have had mixed success, often incurring governance and institutional challenges. More recently, there has been interest in working with the informal sector. New technologies offer new opportunities for sustainable dairy development.

Trust in trade: a global perspective on health certification

Trade in livestock and livestock products can bring about great benefits, but also substantial risk to animal and human health with high economic, social and environmental impacts. Livestock products are also especially vulnerable to food fraud. In order to mitigate risk and prevent fraud, most animal trade requires health certification by a competent authority, backed by systems and processes that create trust and confidence in importers. Among Veterinary Services which have undergone a structured assessment of performance, most find the need to improve their authority and/or capability for health certificates and for transparent disease reporting. Health certification is trusted when it is legal, carried out by an adequately performing authority, implemented by competent persons, supported by technical evidence, and validated by third parties and when the process is transparent, predictable and free from conflict of interest. The large and growing trade in animals and their products is a testimony to the effectiveness of the current process and the trust of importers. Nonetheless, there is considerable scope for further improvement especially by improving the legal framework, building capacity of Veterinary Services, increasing trust in signing authorities, validating the certification process, and making the process of certification more efficient and predictable.

Exploring the relationship between Australian university websites and international student enrolments

Purpose

This paper focuses on exploring the relationship between Australian university websites and international student enrolments. Few studies have investigated this relationship and, as such, this research addresses some of the existing knowledge gaps.

Design/methodology/approach

A mono-method qualitative methodology was adopted for this study. Primary data collection was through the website content of selected Australian universities. Six Australian universities were selected; three universities with positive international student enrolments and three universities with negative international student enrolments. The website content of the selected six universities was analysed using the dimensions of the ICTRT framework (Li and Wang, 2011) to evaluate website effectiveness. The study results were based on two analysis levels, an overall thematic analysis (level 1) and an ICTRT framework-based analysis (level 2). The thematic analysis, based on the major themes and concepts, was conducted using Leximancer 4.5.

Findings

Two major findings emerged. First, the websites of universities with positive international student enrolments tend to be more people focused whereas websites from universities with negative international student enrolments tend to be technology or system focused. Second, websites from universities with positive international student enrolments tend to be more visionary or forward focused whereas websites from universities with negative international student enrolments tend to be more backward focused. Additionally, the study findings indicate some important website marketing strategies for Australian universities with negative international student enrolments.

Research limitations/implications

This study used ICTRT framework to evaluate the websites of Australian universities. Li and Wang (2011) proposed this framework for evaluating websites. Hotel, travel agency and destination marketing organisation websites have been assessed using the ICTRT framework (Li and Wang, 2011; Pai et al., 2014; Sun et al., 2017). This model has not previously been used, however, to evaluate tertiary education websites. This study is among the first to examine the university websites using a theoretical framework employed in destination marketing organisations which is a major theoretical contribution.

Practical implications

The major findings indicate that the website attributes, which are future focused and people oriented, are necessary for university websites with negative international student enrolments. Similar to university websites with positive international student enrolments, university websites with negative international student enrolments should also provide more contact details of staff members, should be more people oriented and should provide information focused on future students rather than past and current students. These practical implications are useful for administrative bodies in Australian universities for increasing international student enrolments.

Originality/value

This study is among the first to examine the university websites using a theoretical framework used in destination marketing organizations which is a major theoretical contribution. For example, this study has provided an illustrative example of how a research model of destination marketing organizations will be used in the universities or higher education context.

Aflatoxin M1 levels in different marketed milk products in Nairobi, Kenya

Milk is an important source of energy and nutrients, especially for children, and in Kenya, milk consumption is higher than other countries in the region. One major concern with milk is the risks of chemical contaminants, and reports of high levels of aflatoxin M1 (AFM1) in milk in Kenya has been causing public health concerns. This study collected marketed milk products every month during 1 year, just as a consumer would purchase them from retailers and traders in a low-income area, and a major supermarket in a middle/high-income area. In total, 291 sampled milk products (raw, pasteurised, UHT milk, yoghurt and lala) were collected and analysed for AFM1 using a commercial ELISA kit. More than 50% of the samples exceeded 50 ng/kg (the level allowed in the EU), but only three samples exceeded 500 ng/kg (the level allowed in the USA). Geometric mean AFM1 level was 61.9 ng/kg in the 135 samples from the low-income area while it was 36.1 ng/kg in the 156 from the higher income area (p < 0.001). The levels varied significantly depending on the time of year, with lowest levels of milk in January. There were also differences between manufacturers and products, with UHT milk having lower levels. There was no difference depending on the price for all dairy products, but when only including milk, higher price was associated with lower levels of AFM1. In conclusion, this study shows that milk purchased by a consumer is likely to contain AFM1 above 50 ng/kg, and that further research is needed to find ways to mitigate AFM1 contamination through working with farmers and milk processors both in the formal and informal sectors.

Sensitivity and Specificity Estimation for the Clinical Diagnosis of Highly Pathogenic Avian Influenza in the Egyptian Participatory Disease Surveillance Program

Many developing countries lack sufficient resources to conduct animal disease surveillance. In recent years, participatory epidemiology has been used to increase the cover and decrease the costs of surveillance. However, few diagnostic performance assessments have been carried out on participatory methods. The objective of the present study was to estimate the diagnostic performance of practitioners working for the Community-Based Animal Health and Outreach (CAHO) program, which is a participatory disease surveillance system for the detection of highly pathogenic avian influenza outbreaks in Egypt. CAHO practitioners' diagnostic assessment of inspected birds was compared with real-time reverse-transcriptase polymerase chain reaction (RRT-PCR) test results at the household level. Diagnostic performance was estimated directly from two-by-two tables using RRT-PCR as a reference test in two different scenarios. In the first scenario, only results from chickens were considered. In the second scenario, results for all poultry species were analyzed. Poultry flocks in 916 households located in 717 villages were inspected by CAHO practitioners, who collected 3458 bird samples. In the first scenario, CAHO practitioners presented sensitivity (Se) and specificity (Sp) estimates of 40% (95% confidence interval [CI]: 21%-59%) and 92% (95% CI: 91%-94%), respectively. In the second scenario, diagnostic performance estimates were Se = 47% (95% CI: 29%-65%) and Sp = 88% (95% CI: 86%-90%). A significant difference was observed only between Sp estimates (P < 0.01). Practitioners' diagnostics and RRT-PCR results were in very poor agreement with kappa values of 0.16 and 0.14 for scenarios 1 and 2, respectively. However, the use of a broad case definition, the possible presence of immunity against the virus in replacement birds, and the low prevalence observed during the survey would negatively affect the practitioners' performance.

Inter-epidemic Rift Valley fever virus seroconversions in an irrigation scheme in Bura, south-east Kenya

Rift Valley fever (RVF) is an acute mosquito-borne viral zoonosis whose outbreaks are often associated with prolonged rainfall and flooding, during which large numbers of vectors emerge. Recent studies into the inter-epidemic maintenance of RVF virus (RVFV) suggest that both vertical transmission in vectors and direct transmission between hosts act in combination with predisposing factors for persistence of the virus. A comparative longitudinal survey was carried out in Tana River County, Kenya, in irrigated, riverine and pastoral ecosystems from September 2014-June 2015. The objectives were to investigate the possibility of low-level RVFV transmission in these ecosystems during an inter-epidemic period (IEP), examine variations in RVFV seroprevalence in sheep and goats and determine the risk factors for transmission. Three hundred and sixteen small ruminants were selected and tested for immunoglobulin G antibodies against RVFV nucleoprotein using a competitive ELISA during six visits. Data on potential risk factors were also captured. Inter-epidemic RVFV transmission was evidenced by 15 seroconversions within the irrigated and riverine villages. The number of seroconversions was not significantly different (OR = 0.66, CI = 0.19-2.17, p = .59) between irrigated and riverine areas. No seroconversions were detected in the pastoral ecosystem. This study highlights the increased risk of inter-epidemic RVFV transmission posed by irrigation, through provision of necessary environmental conditions that enable vectors access to more breeding grounds, resting places and shade, which favour their breeding and survival.

A survey of aflatoxin B1 in maize and awareness of aflatoxins in Vietnam

Vietnam is a tropical country with high temperature and precipitation, which may provide good conditions for fungal growth. A few limited studies have been conducted to evaluate the level of aflatoxin B1 in maize in Vietnam. In addition, no studies have been conducted to evaluate the perception and knowledge of aflatoxins in Vietnam. Therefore, the main objective of this study was to determine the levels of aflatoxin B1 for human and animal consumption in maize and evaluate perceptions and knowledge of aflatoxins among people across the country. A total of 2,370 samples were collected from six provinces and analysed using ELISA. Among collected samples, 799 samples (33.71%, 95% confidence interval (CI): 31.81-35.66%) and 687 samples (28.98%, 95%CI: 27.17-30.86%) had levels above 2 µg/kg and 5 µg/kg, respectively [range from below limit of detection (LOD) to 34.8 µg/kg; of the samples above LOD, the mean was 13.1 µg/kg and median was 11.2 µg/kg]. A total of 551 people were interviewed from 6 provinces. The survey showed that awareness of aflatoxins (question: Have you heard about aflatoxins?) in southern Vietnam [An Giang (25%), Dak Lak (23.23%) and Dong Nai (6%)] was relatively higher than in provinces in northern Vietnam. We believe that this analysed information can be useful to better understand the epidemiology of aflatoxins in different provinces. This study also produces evidence on potential risk to humans and animals in Vietnam as well as demographic factors (such as gender and level of education) significantly influencing knowledge of aflatoxins. In conclusion, this paper points to the importance of raising the awareness of the risks with aflatoxins, bearing in mind the gender aspect during capacity development.

Effects of Irrigation and Rainfall on the Population Dynamics of Rift Valley Fever and Other Arbovirus Mosquito Vectors in the Epidemic-Prone Tana River County, Kenya

Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that is found in most regions of sub-Saharan Africa, and it affects humans, livestock, and some wild ungulates. Outbreaks are precipitated by an abundance of mosquito vectors associated with heavy persistent rainfall with flooding. We determined the impact of flood-irrigation farming and the effect of environmental parameters on the ecology and densities of primary and secondary vectors of the RVF virus (RVFV) in an RVF-epidemic hotspot in the Tana River Basin, Kenya. Mosquito sampling was conducted in farms and villages (settlements) in an irrigated and a neighboring nonirrigated site (Murukani). Overall, a significantly higher number of mosquitoes were collected in farms in the irrigation scheme compared with villages in the same area (P < 0.001), or farms (P < 0.001), and villages (P = 0.03) in Murukani. In particular, key primary vectors of RVFV, Aedes mcintoshi Marks and Aedes ochraceous Theobald, were more prevalent in the farms compared with villages in the irrigation scheme (P = 0.001) both during the dry and the wet seasons. Similarly, there was a greater abundance of secondary vectors, particularly Culex univittatus Theobald and Culex pipiens (L.) in the irrigation scheme than in the Murukani area. Rainfall and humidity were positively correlated with mosquito densities, particularly the primary vectors. Adult floodwater mosquitoes and Mansonia spp. were collected indoors; immatures of Ae. mcintoshi and secondary vectors were collected in the irrigation drainage canals, whereas those of Ae. ochraceous and Aedes sudanensis Theobald were missing from these water bodies. In conclusion, irrigation in RVF endemic areas provides conducive resting and breeding conditions for vectors of RVFV and other endemic arboviruses.

Effects of climate change on the occurrence and distribution of livestock diseases

The planet's mean air and ocean temperatures have been rising over the last century because of increasing greenhouse gas (GHG) emissions. These changes have substantial effects on the epidemiology of infectious diseases. We describe direct and indirect processes linking climate change and infectious diseases in livestock with reference to specific case studies. Some of the studies are used to show a positive association between temperature and expansion of the geographical ranges of arthropod vectors (e.g. Culicoides imicola, which transmits bluetongue virus) while others are used to illustrate an opposite trend (e.g. tsetse flies that transmit a range of trypanosome parasites in sub-Saharan Africa). We further describe a positive association between extreme events: droughts and El Niño/southern oscillation (ENSO) weather patterns and Rift Valley fever outbreaks in East Africa and some adaptation practices used to mitigate the impacts of climate change that may increase risk of exposure to infectious pathogens. We conclude by outlining mitigation and adaptation measures that can be used specifically in the livestock sector to minimize the impacts of climate change-associated livestock diseases.

Physicochemical characterisation of mangafodipir trisodium

Purpose: To determine the structure and various physicochemical properties of man-gafodipir (MnDPDP) trisodium, the active ingredient of Teslascan, a new organ-specific contrast medium for MR imaging.

Material and Methods: The structure of MnDPDP trisodium crystals was determined by X-ray crystallography. The possible existence of polymorphism in MnDPDP trisodium was evaluated by powder X-ray diffraction, optical microscopy, thermal analysis and IR spectroscopy. In addition, various spectroscopic techniques and physicochemical measurements were used for characterisation of MnDPDP trisodium.

Results: The crystallographic data obtained for MnDPDP trisodium show that the general core structure of the MnDPDP anion is similar to that seen in related substances. The metal coordination geometry is a distorted octahedron defined by 2 phenolate oxygens, 2 carboxylate oxygens and 2 amine nitrogens. The unit cell contains 2 MnDPDP anions, 6 sodium ions and 50 water molecules. The various spectroscopic data are consistent with the structure determined by X-ray crystallography. The product (Teslascan) has low viscosity, is isotonic with blood and has a physiological pH.

Conclusion: MnDPDP trisodium is a crystalline, hygroscopic solid which is readily soluble in water. No evidence of polymorphism was seen in the samples studied.

Assessing the Potential Role of Pigs in the Epidemiology of Ebola Virus in Uganda

Uganda has experienced 4 Ebola outbreaks since the discovery of the virus. Recent epidemiological work has shown pigs are hosts for Ebola viruses. Due to their high reproduction rates, rapid weight gain, potential to provide quick financial returns and rising demand for pork, pig production in Uganda has undergone massive expansion. The combination of pork sector growth supported by development programmes and Ebola virus risk prompted a foresight exercise using desk, interview and spatial methods. The study found that the lack of serological evidence for specific reservoir species, the number of human index cases unable to account for their source of infection, domestic pig habitat overlap with potential Ebola virus zoonotic host environments, reported interactions at the human-pig-wildlife interface that could support transmission, fever in pigs as a commonly reported problem by pig farmers and temporal correlation of outbreaks with peak pork consumption periods warrants further research into potential zoonotic transmission in Uganda from pigs.

Blood donation: comparing individual characteristics, attitudes, and feelings of donors and nondonors

The shortage of blood donors and increased demand for blood is an important health issue. Finding ways to increase donor recruitment and retention is a priority and, thus, an important area for research. This article aims to better understand donors and nondonors on the basis of their social responsibility, susceptibility to interpersonal influence, involvement in and attitude towards the blood donation issue, and their aroused feelings. The data from 345 completed surveys were collected via a web-based, self-administered method. Mean differences were examined and the conceptual model was tested via structural equation modeling. The findings provide important clarification of donation and nondonation behavior.

On dogs, people, and a rabies epidemic: results from a sociocultural study in Bali, Indonesia

Background

Previously free of rabies, Bali experienced an outbreak in 2008, which has since caused a large number of human fatalities. In response, both mass dog culling and vaccination have been implemented. In order to assess potential community-driven interventions for optimizing rabies control, we conducted a study exploring the relationship between dogs, rabies, and the Balinese community. The objectives of this study were to: i) understand the human-dog relationship in Bali; ii) explore local knowledge, attitudes, and practices (KAPs) relating to rabies; and iii) assess potential community-driven activities to optimize rabies control and surveillance.

Methods

Conducted between February and June 2011, the study combined a questionnaire (n = 300; CI = 95 %; error margin = 5 %) and focus group discussions (FGDs) in 10 villages in the Denpasar, Gianyar, and Karangasem regencies. The questionnaire included a Likert scale to assess community knowledge and attitudes. For the knowledge assessment, three points were given for a correct answer, while wrong answers and uncertain answers were given zero points. For the attitudes assessment, three points were given for a positive answer, two points for a neutral answer, and one point for a negative answer. Respondent knowledge was categorized as good (score >40), fair (score 20–40), or poor (score <20), based on a maximum total score 60. Respondent attitudes were categorized as positive (score >26), neutral (score 13–26), or negative (score <13), based on a maximum total score of 39. Mixed-gender FGDs in each sub-village (banjar) were conducted, each involving 7–15 participants to complement the questionnaire results. On a follow-up research trip in mid-2013, the data analysis was triangulated and validated using semi-structured interviews. Questionnaire data were analyzed descriptively using SPSS 17.0, while qualitative data from interviews and FGDs were analyzed manually according to accepted methods of coding and memo writing. The chi-square test was then used to analyze the statistical relationships between knowledge and attitudes of the respondents.

Results

Out of the total 300 respondents, most were predominantly male (82 %), Hindu (99 %), married (96 %), older than 30 years of age (92 %), and owned dogs (72 %). Dog ownership was motivated by culture, personal taste, and function, with dogs was being used as guards (85 %) and companion animals (27 %), and was sometimes related to religious or traditional obligations (2 %). Relating to their culture and local beliefs, and eventually becoming their way of life, 79 % of respondents kept free-roaming dogs. With the rabies outbreak in Bali and Western breeds becoming more popular, more responsible dog ownership (leashing, confining, regular feeding) became more acceptable and changed community perceptions on keeping dogs, even though the sustainability of this practice cannot be gauged. In addition, the economic situation posed major problems in rural areas. The level of community knowledge about rabies and its associated control programs were generally fair and community attitudes were positive. However, community KAPs still need to be improved. A total of 74 % respondents reported to have vaccinated their dogs in 2011, but only few were found to report rabid animals to livestock officers (12 %) and a significant number believed that washing a bite wound was not important (62 %). Moreover, free-roaming dog practices and discarding of unwanted female puppies still continue and possibly create difficulties for rabies elimination as these practices potentially increase the stray dog population. We identified three major sociocultural aspects with potential for community-driven interventions to optimize current rabies elimination efforts: integrating local notions of ahimsa (non-violence) into education campaigns, engaging communities through the local banjar sociopolitical system, and working with traditional legal structures to increase local compliance with rabies control.

Conclusion

The human-dog relationship in Bali is multifaceted. Due to the uniqueness of the culture and the local beliefs, and encouraged by a socioeconomic aspect, a number of local practices were found to be constituting risk factors for continued rabies spread. Community knowledge and attitudes, which can consequently result in behavioral changes, needs to be improved across different genders, ages, educational backgrounds, and roles in the community, regardless of the individual village’s experiences with rabies. Furthermore, community-driven activities based on sociocultural conditioning and community capacity at the banjar and village levels, such as public awareness activities, vaccination, dog registration, dog population management, and rapid response to dog bites, were identified as being able to complement the rabies control program in Bali. The program also needs recognition or acknowledgement from governments, especially local government as well as regular mentoring to improve and sustain community participation.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-015-0061-1) contains supplementary material, which is available to authorized users.

Slum Livestock Agriculture

Slums are unplanned squatter human settlements in peri-urban and urban areas where more than 800 million people live. These densely populated areas lack basic public services. Livestock raised in these conditions compete with humans for space and water, and pose a risk to human and animal health. Notwithstanding the risk of disease transmission, slum livestock agriculture plays an essential role in the livelihoods of people and deserves consideration in urban planning and policy making.

Economics of brucellosis impact and control in low-income countries

Most data and evidence on the economic burden of brucellosis and the benefits of its control are from high-income and middle-income countries. However, the burden of brucellosis is greatest in low-income countries. This paper focuses on estimating the economic burdens of brucellosis in low-income countries in tropical Asia and Africa. The prospects for national, technically feasible, and economically viable, national brucellosis control programmes in most low-income countries are limited. However, some targeted control programmes will be beneficial and can probably be feasibly managed and provide good economic returns. More ambitious control will require a more general strengthening of Veterinary Services and livestock-sector capacity, using risk-management-based approaches.

Identification of potential risk factors associated with highly pathogenic avian influenza subtype H5N1 outbreak occurrence in Lagos and Kano States, Nigeria, during the 2006-2007 epidemics

Highly pathogenic avian influenza HPAI H5N1 was first reported in Africa in 2006, in Nigeria. The country experienced severe outbreaks in 2006 and 2007, strongly affecting the poultry population. Current knowledge on potential risk factors for HPAI H5N1 occurrence in poultry farms in Nigeria is limited. Therefore, we conducted a case-control study to identify potential farm-level risk factors for HPAI H5N1 occurrence in two areas of the country that were affected by the disease in 2006 and 2007, namely the States of Lagos and Kano. A case-control study was conducted at the farm level. A convenience sample of 110 farms was surveyed. Data on farm characteristics, farm management and trade practices were collected. Logistic regression was used to identify factors associated with farms that confirmed positive for HPAI. Having a neighbouring poultry farm was identified as a potential risk factor for disease occurrence [OR, 5.23; 95% CI, (0.88-30.97); P-value = 0.048]. Farm staff washing their hands before handling birds was a protective factor [OR, 0.14; 95% CI, (0.05-0.37); P-value <0.001], as well as not allowing traders to enter the farm [OR, 0.23; 95% CI, (0.08-0.70); P-value = 0.008]. Our study highlighted the importance of trade and proximity between poultry farms in the epidemiology of HPAI H5N1 and the role of biosecurity in disease prevention in Kano and Lagos States. Despite the limitations owing to the sampling strategy, these results are consistent with other risk factor studies previously conducted on HPAI H5N1 in both Africa and other regions, suggesting similar risk factor patterns for HPAI H5N1 virus spread and substantiating current knowledge regarding the epidemiology of the disease. Finally, this study generated information from areas where data are difficult to obtain.

Field trial of a synthetic tsetse-repellent technology developed for the control of bovine trypanosomosis in Kenya

We conducted a field trial among Maasai cattle-keepers in Nkuruman and Nkineji areas of Kenya to evaluate the effectiveness of a synthetic tsetse-repellent technology developed for the control of trypanosomosis in cattle. The technology was a repellent (2-methoxy 4-methylphenol) emitted from dispensers attached to collars worn by cattle. Treatment was allocated at the herd level to ensure adequate protection of all the animals in a herd, with measurements of effectiveness conducted at the individual-animal level. The trial began in April 2005 and ran for 16 months including a baseline phase of 4 months. We recruited 12 herds in each area using a restricted random-sampling technique and distributed them equally into intervention (repellent) and control groups. Sample size was determined using a formal power calculation. Effectiveness or minimal worthwhile difference was defined as a 50% reduction in the incidence of trypanosome infection in the treated versus control group (effectiveness below which the technology was considered by experts as not viable compared to existing control techniques). All the animals in the recruited herds were screened monthly (buffy-coat technique) for trypanosome infections. The analysis followed the principle of intention-to-treat by which subjects are analysed according to their initial treatment assignment, regardless of the mechanical performance of the device. Crude and adjusted effects of the technology were 23% (p<0.001) and 18% (p=0.08) reduction in the infection incidence in the treatment compared to the control groups, respectively. The impact of the technology estimated in this study did not achieve the threshold of 50% reduction in the trypanosome infection incidence set a priori to indicate effectiveness (p<0.001). We therefore concluded that the prototype repellent technology package was not sufficiently effective in reducing trypanosome infection incidence under natural tsetse challenge to merit commercial development.

Factors limiting the health of semi-scavenging ducks in Bangladesh

Duck rearing is well suited to coastal and lowland areas in Bangladesh. It is an important component of sustainable livelihood strategies for poor rural communities as an additional source of household income. An epidemiological study was conducted during January 2005-June 2006 on 379 households in Chatkhil of the Noakhali District, Bangladesh which were using the recently devised "Bangladesh duck model". The overall objective of the study was to identify factors that significantly contributed to mortality and constrained productivity and to generate sufficient knowledge to enable establishment of a disease surveillance system for household ducks. The overall mortality was 15.0% in Chatkhil, with predation causing a significantly higher mortality compared with diseases (p < 0.001). Common diseases were duck plague and duck cholera. Morbid ducks frequently displayed signs associated with diseases affecting the nervous and digestive systems. Haemorrhagic lesions in various organs and white multiple foci on the liver were frequently observed in dead ducks. Epidemiological analysis with a shared frailty model that accounted for clustering of data by farm was used to estimate the association between survival time and risk factors. The overall mortality rate due to disease was significantly lower in vaccinated than in non-vaccinated ducks in all zones except zone 2 (p < 0.001). Only vaccinated ducks survived in zone 1. In conclusion, duck mortality and untimely sale of ducks appeared to be important constraints for household duck production in Chatkhil. Vaccination against duck plague appears to be an effective preventive strategy in reducing the level of associated duck mortality. A successful network was established amongst farmers and the surveillance team through which dead ducks, with accompanying information, were readily obtained for analysis. Therefore, there is an opportunity for establishing a long-term disease surveillance programme for rural ducks in Chatkhil of the Noakhali District of Bangladesh.

Mitral valve-tricuspid valve distance as a sonographic marker of trisomy 21

OBJECTIVE

Pathologic studies suggest that a decreased mitral valve-tricuspid valve distance (MTD) is found in trisomy 21 fetuses without cardiac defects. We assessed the feasibility of using the MTD as a second-trimester sonographic marker for trisomy 21.

METHODS

We performed a retrospective case-control study of all cases of trisomy 21 at our institution from 1998 to 2008. Cases without a prenatally identified cardiac defect and with adequate images from 15 to 26 weeks' gestation were assessed. The distance between the medial insertions of the mitral and tricuspid valves (i.e. the MTD) onto the ventricular septum was obtained. We also obtained the MTD from normal controls during the study period. Multiple linear regression analysis was used to assess the effects of gestational age and trisomy 21 on MTD. Gestational age-specific percentiles and multiples of the median were calculated, and curves were fitted using linear regression analysis.

RESULTS

We identified 57 trisomy 21 fetuses with a measurable MTD and compared these with 634 control fetuses. Multiple linear regression analysis revealed a positive correlation between MTD and gestational age and a negative correlation between trisomy 21 and MTD. Using a cut-off of the 5(th) percentile, the MTD detected 70% of trisomy 21 cases with a 3.8% false-positive rate in the controls.

CONCLUSIONS

The MTD increases with gestational age and is lower in fetuses with trisomy 21. Twenty (35%) of the 57 cases had no sonographic marker of trisomy 21 except an MTD below the 5(th) percentile for gestational age. The MTD was a useful independent marker for trisomy 21 in the second trimester.

Fetal nuchal translucency thickness evaluation in the overweight and obese gravida

OBJECTIVE

To evaluate the time required and failure rate for completion of nuchal translucency thickness (NT) measurements with increased maternal body mass index (BMI).

METHODS

This was a retrospective review of ultrasound examinations for NT measurement in 11-14-week singleton pregnancies performed at a single site from 2004 to 2007. Women were stratified by prepregnancy BMI into normal weight (BMI, 18.5-24.9 kg/m(2)), overweight (BMI, 25.0-29.9 kg/m(2)) and obese Class I (BMI, 30.0-34.9 kg/m(2)), Class II (BMI, 35.0-39.9 kg/m(2)) and Class III (BMI >or= 40.0 kg/m(2)) groups. The failure rate, the time required for measurement, and the total study time in min were evaluated by BMI class for the first attempt and for all attempts at NT measurement.

RESULTS

A total of 2508 women underwent attempted NT screening with complete data available on 1678 women (1707 examinations). The failure rate for NT screening varied significantly according to BMI (P < 0.001). At the first attempt, the median time for NT measurement varied significantly according to BMI (normal weight group, 9.7 (interquartile range (IQR) 4.4, 19.0) min; overweight group, 8.8 (4.0, 19.8) min; obese Class I, 9.6 (4.8, 20.4) min; Class II, 14.1 (5.0, 28.2) min; Class III, 12.3 (4.6, 22.7) min; P < 0.01), as did the total study time (normal group, 16.4 (10.1, 26.6) min; overweight group, 15.7 (9.8, 25.0) min, Class I, 17.3 (10.3, 29.2) min; Class II, 23.0 (12.2, 36.1) min; Class III, 18.7 (11.0, 30.8) min; P = 0.002). For all attempts also, the median time for NT measurement varied significantly according to BMI (normal weight group, 9.7 (IQR 4.4, 19.0) min; overweight group, 8.8 (4.0, 19.9) min; obese Class I, 9.6 (4.8, 21.0) min; Class II, 14.1 (5.0, 28.7) min; Class III, 12.3 (4.6, 22.5) min; P < 0.01), as did the total study time (normal weight group, 16.4 (10.2, 26.7) min; overweight group, 15.7 (9.8, 25.1) min; Class I, 17.6 (10.4, 29.9) min; Class II, 23.2 (12.0, 37.5) min; Class III, 18.7 (11.9, 31.9) min; P < 0.001).

CONCLUSION

As maternal BMI increases, the time required to obtain NT measurements and the failure rate increase. Before the ultrasound examination, patients with a BMI over 30 should be counseled regarding the need for additional time and failure rates for first-trimester screening.

Overview on urban and peri-urban agriculture: definition, impact on human health, constraints and policy issues

OBJECTIVES

To collate and synthesize current knowledge of components of urban agriculture (UA) with a thematic emphasis on human health impact and a geographic emphasis on East Africa.

DATA SOURCES

Data management followed a structured approach in which key issues were first identified and then studies selected through literature search and personal communication.

DATA EXTRACTION

Evidence-based principles.

DATA SYNTHESIS

Urban agriculture is an important source of food security for urban dwellers in East Africa. Descriptors of UA are location, areas, activities, scale, products, destinations, stakeholders and motivation. Many zoonotic and food-borne diseases have been associated with UA but evidence on human health impact and management is lacking. Major constraints to UA are illegality and lack of access to input and market; policy options have been developed for overcoming these.

CONCLUSION

Urban agriculture is an important activity and likely to remain so. Both positive and negative human health impacts are potentially important but more research is needed to understand these and set appropriate policy and support levels.

Risk assessment for Escherichia coli O157:H7 in marketed unpasteurized milk in selected East African countries

We carried out a study to assess the risk associated with the presence of Shiga toxigenic Escherichia coli (STEC) in informally marketed unpasteurized milk in urban East Africa. Data for the risk models were obtained from on-going and recently completed studies in Kenya and Uganda. Inputs for the model were complemented with data from published literature in similar populations. A fault-tree scenario pathway and modular process risk model approach were used for exposure assessment. Hazard characterization was based on a socioeconomic study with dose-responses derived from the literature. We used a probabilistic approach with Monte Carlo simulation and inputs from farm and household surveys. The qualitative analysis suggested a low to moderate risk of infection from consuming milk and that the widespread consumer practice of boiling milk before consumption was an important risk mitigator. Quantitative analysis revealed that two to three symptomatic STEC infections could be expected for every 10,000 unpasteurized milk portions consumed, with a possible range of 0 to 22 symptomatic cases. Sensitivity analyses to assess the uncertainty and variability associated with the model revealed that the factor with the greatest influence on disease incidence was the prevalence of STEC in dairy cattle. Risk assessment is a potentially useful method for managing food safety in informal markets.

Invited review: Role of livestock in human nutrition and health for poverty reduction in developing countries

Livestock keeping is critical for many of the poor in the developing world, often contributing to multiple livelihood objectives and offering pathways out of poverty. Livestock keeping also affects an indispensable asset of the poor, their human capital, through its impact on their own nutrition and health. This paper outlines the linkages between livestock keeping and the physical well-being of the poor, and examines a number of commonly held beliefs that misrepresent livestock development issues related to these linkages. These beliefs limit the scope of intervention programs to promote livestock and limit their potential contribution to poverty reduction. Recognition of the complexity of the role livestock play in household decision-making and of the opportunities foregone due to these misconceptions can enhance the ability of livestock to contribute to human well-being in the developing world.

Comparing FAMACHA eye color chart and Hemoglobin Color Scale tests for detecting anemia and improving treatment of bovine trypanosomosis in West Africa

African animal trypanosomosis (AAT) is considered the most important cattle disease in sub-Saharan Africa but its diagnosis in the field is difficult, resulting in inappropriate treatments, excessive delay in treatments and under-treatment. A field study in West Africa investigated the usefulness of anemia in the diagnosis of trypanosomosis. A total of 20,772 cattle blood samples were taken from 121 villages in 3 countries. The average packed cell volume (PCV) of trypanosomosis positive cattle was 23%, versus 28% for negative cattle. In a sub-set of animals, other causes of anemia were investigated showing most of the anemia burden was attributable to trypanosomosis. Anemia was a reasonably accurate indicator of trypanosomosis in the study area, with a sensitivity of 56% and a specificity of 80% and a diagnostic odds ratio of 4.2, the highest of all the signs evaluated (anemia, emaciation, staring coat, lymphadenopathy, fever, lacrimation and salivary or nasal discharge). Having confirmed the usefulness of anemia as a predictor of trypanosomosis, two potential pen-side tests for anemia were evaluated (the first reported trial of their use in cattle), firstly a color chart developed for anemia detection in sheep through visual inspection of conjunctival membranes (FAMACHA) and secondly the Hemoglobin Color Scale (HbCS) developed for assessing hemoglobin levels in human patients by comparing blood drops on filter paper with color standards. In a population of cattle suspected by their owners to be sick with trypanosomosis (n=898) the sensitivity of the HbCS test was 56% and the specificity was 77%, while the sensitivity of the FAMACHA test was 95% and the specificity was 22%. The higher sensitivity but lower specificity suggests the FAMACHA may be useful as a screening test and the HbCS as a confirmatory test. The two tests were also evaluated in cattle randomly selected from the village herd. Using cut-off points to optimize test performance, the HbCS test had a sensitivity of 81% and a specificity of 62% (n=505 cattle), while the FAMACHA had a sensitivity of 92% and a specificity of 30% (n=298 cattle). Recommendations are made for the appropriate use of these tests in the West African region.

An FPGA-Based Vision Prosthesis Prototype: Implementing an Efficient Multiplexing Method for Addressing Electrodes

A prototype of an epi-retinal vision prosthesis based upon an efficient electrode addressing schema has been developed. This system has the ability to stimulate multiple electrode regions simultaneously, hence greatly improving the maximum rate of stimulation compared to many currently available neural stimulation devices based on serial stimulation protocols. To minimize the problem of cross talk between stimulating electrodes, a hexagon layout of electrodes was implemented. Basic tests were completed using a field programmable gate array logic system driving analogue circuitry to inject current into physiological saline via electrodes in hexagon arrangements and in a simple paired arrangement. The hexagon layout of electrodes was shown to clearly reduce the interaction between multiple current sources and hence cross talk.

Cardiovascular changes with the laryngeal mask airway in cardiac anaesthesia

BACKGROUND

The laryngeal mask airway (LMA) causes fewer haemodynamic changes, particularly in mean arterial pressure (MAP) and heart rate (HR), than tracheal intubation using either laryngoscopy or the intubating LMA. There are no data for patients with coronary artery disease.

METHOD

We studied 27 patients having coronary artery bypass grafting, prospectively randomized to be managed with either the LMA or tracheal intubation using either laryngoscopy or the ILMA. We used invasive monitoring to compare the haemodynamic effects in each group during induction and emergence from anaesthesia.

RESULTS

Both methods of intubation caused an increase in MAP compared with the LMA (P<0.05). Mixed venous oxygen saturation increased in the intubated patients but not with the LMA (P<0.05). HR did not change at induction in the LMA group. Changes at extubation were similar in all groups but cardiac index was lower in the LMA group (P<0.05).

CONCLUSION

The LMA allows airway management without hypertension and tachycardia and should be considered when anaesthetizing patients with coronary disease.

Topical diclofenac versus placebo: a double blind, randomized clinical trial in patients with osteoarthritis of the knee

OBJECTIVE

To assess the efficacy and safety of a topical formulation of 2% diclofenac in lecithin organogel in the treatment of pain associated with mild to moderate osteoarthritis (OA) of the knee.

METHODS

Seventy patients completed a double blind, randomized, placebo controlled, parallel group design 2 week clinical trial. Patient responses to disease-specific (WOMAC VA3.0) and quality of life (Medical Outcome Survey SF-36) health status measures were assessed. Global assessments were also made at baseline and post-treatment. The physician conducted a global assessment and range of motion of the knee at baseline and post-treatment.

RESULTS

T tests on the aggregated WOMAC total score and aggregated subscale scores revealed significant improvement (p<0.05) on the aggregated total score and the pain, stiffness, and physical function subscales from baseline to post-treatment for the active treatment group versus the placebo group. Analysis of gain scores from the aggregated WOMAC total score and aggregated subscale scores also revealed that this improvement was significantly greater than the improvement recorded by the placebo treatment group on the aggregated total and the pain and physical function subscale scores. Other efficacy measures exhibited no significant differences between or within treatment groups.

CONCLUSION

A topical formulation of 2% diclofenac in a lecithin organogel appears to have therapeutic value in patients with mild to moderate OA of the knee as determined by responses from the WOMAC (VA3.0) osteoarthritis health status measure.

Modified lapidus arthrodesis for adolescent hallux abducto valgus

The Lapidus arthrodesis was originally described for the surgical correction of hallux valgus associated with metatasus primus adductus. It was popularized on the adult patient with moderate to severe hallux valgus deformity. However, the authors present a retrospective review of 23 adolescents between the ages of 13 and 20 who underwent the procedures. Characteristics of adolescent hallux valgus include a smaller dorsal medial eminence, less valgus rotation of the hallux, and certain mechanical influences. These influences may include a generalized increase in motion at the first metatarsocuneiform joint. The modified Lapidus arthrodesis eliminates motion at the first metatarsocuneiform joint and therefore directly addresses an etiology of the deformity. Both preoperative and postoperative radiographs were evaluated for reduction in the 1-2 intermetatarsal angle. Patients were evaluated through either chart review or telephone interview for present activity level, comfortable footgear, and overall satisfaction of the procedure. Twenty-seven out of 30 feet (90%) had either a good or excellent result with only three complications and two recurrences over a mean follow-up of 61 months.

A comparison of intrathecal morphine-6-glucuronide and intrathecal morphine sulfate as analgesics for total hip replacement

Postoperative analgesia was assessed after intrathecal administration of morphine-6-glucuronide (M6G) 100 micrograms and 125 micrograms in 75 patients undergoing total hip replacement. Analgesia was excellent and was similar to that obtained after intrathecal administration of morphine sulfate 500 micrograms. Visual analog pain scores recorded postoperatively were low (median = 0) and were similar in all three groups. However, at 6 and 10 h after operation significantly more patients in the M6G 125 group recorded pain as 0 compared with patients in the morphine group (P < 0.04, P < 0.01) and significantly more patients in the M6G 100 group recorded pain as 0 at 24 h after operation compared with patients in the morphine group (P < 0.04). Postoperative meperidine consumption using a patient-controlled system was also similar in each of the three treatment groups. Nausea and emesis occurred frequently in all groups; morphine (nausea 88%, vomiting 76%), M6G 100 micrograms (nausea 76%, vomiting 64%), and M6G 125 micrograms (nausea 88%, vomiting 60%). Respiratory depression occurred in two and three patients, respectively, in the M6G 100-microgram and 125-microgram groups but did not occur in any patient who received morphine sulfate. The lack of statistical significance in the difference in incidence of respiratory depression between the groups may represent a type II error. However, the risk of late respiratory depression developing after administration of any intrathecal opioid necessitates careful postoperative observation of patients. As M6G is a potent intrathecal analgesic further investigation of this drug using small doses may be useful.