Disparities in Capreomycin Resistance Levels Associated with the rrs A1401G Mutation in Clinical Isolates of Mycobacterium tuberculosis

As the prevalence of multidrug-resistant and extensively drug-resistant tuberculosis strains continues to rise, so does the need to develop accurate and rapid molecular tests to complement time-consuming growth-based drug susceptibility testing. Performance of molecular methods relies on the association of specific mutations with phenotypic drug resistance and while considerable progress has been made for resistance detection of first-line antituberculosis drugs, rapid detection of resistance for second-line drugs lags behind. The rrs A1401G allele is considered a strong predictor of cross-resistance between the three second-line injectable drugs, capreomycin (CAP), kanamycin, and amikacin. However, discordance is often observed between the rrs A1401G mutation and CAP resistance, with up to 40% of rrs A1401G mutants being classified as CAP susceptible. We measured the MICs to CAP in 53 clinical isolates harboring the rrs A1401G mutation and found that the CAP MICs ranged from 8 μg/ml to 40 μg/ml. These results were drastically different from engineered A1401G mutants generated in isogenic Mycobacterium tuberculosis, which exclusively exhibited high-level CAP MICs of 40 μg/ml. These data support the results of prior studies, which suggest that the critical concentration of CAP (10 μg/ml) used to determine resistance by indirect agar proportion may be too high to detect all CAP-resistant strains and suggest that a larger percentage of resistant isolates could be identified by lowering the critical concentration. These data also suggest that differences in resistance levels among clinical isolates are possibly due to second site or compensatory mutations located elsewhere in the genome.     

Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability

BackgroundChildren with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors.Objective/Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone.MethodsParent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform.ResultsFifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions.ConclusionsE-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.     

Technology and social media use by adult patients with intellectual and/or developmental disabilities

BackgroundTechnology and social media offer individuals with intellectual and/or developmental disabilities (I/DD) unique and innovative ways to facilitate active participation in their own healthcare process. What remains unclear is the extent to which devices are currently used by this growing patient population.ObjectiveTo explore the prevalence of technology and social media use, as well as the possible barriers, among adult patients with I/DD.MethodsA cross-sectional study utilizing an anonymous, accessible survey was used to obtain data from all adult patients (18 + years of age) with I/DD presenting for primary care services at a healthcare facility in New York between September and December of 2016.ResultsA total of 370 individuals completed the survey (529 approached, 69.9% response rate). Less than half (44.6%) of respondents used devices such as a tablet, smartphone or desktop; most (86.8%) did not use social media. Only 21.6% of respondents indicated that they use some type of assistive technology. While some respondents (46.0%) were identified by their caregivers as having a disability that would prevent them from learning/using technology, other respondents reported having no challenges (18.0%), needing training and/or ongoing support (7.4%), or being uncertain as to whether they would experience any challenges (15.5%).ConclusionsMany adult patients with I/DD do not use technology and social media that could promote self-determination and participation in their healthcare. Continued efforts must be made to promote technology use among adults with I/DD and to ensure that appropriate training is available for both the individual and his/her caregivers to achieve adoption and utilization.     

Declines in Pregnancies among U.S. Adolescents from 2007 to 2017: Behavioral Contributors to the Trend

Study ObjectivesAdolescent pregnancies and births in the United States have undergone dramatic declines in recent decades. We aimed to estimate the contribution of changes in 3 proximal behaviors to these declines among 14- to 18-year-olds for 2007-2017: 1) delays in age at first sexual intercourse, 2) declines in number of sexual partners, and 3) changes in contraceptive use, particularly uptake of long-acting reversible contraception (LARC).DesignWe adapted an existing iterative dynamic population model and parameterized it using 6 waves of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We compared pregnancies from observed behavioral trends with counterfactual scenarios that assumed constant behaviors over the decade. We calculated outcomes by cause, year, and age.ResultsWe found that changes in these behaviors could explain pregnancy reductions of 496,200, 78,500, and 40,700 over the decade, respectively, with total medical and societal cost savings of $9.71 billion, $1.54 billion, and $796 million. LARC adoption, particularly among 18-year-olds, could explain much of the improvement from contraception use. The 3 factors together did not fully explain observed birth declines; adding a 50% decline in sex acts per partner did.ConclusionsDelays in first sexual intercourse contributed the most to declining births over this decade, although all behaviors considered had major effects. Differences from earlier models could result from differences in years and ages covered. Evidence-based teen pregnancy prevention programs, including comprehensive sex education, youth-friendly reproductive health services, and parental and community support, can continue to address these drivers and reduce teen pregnancy.     

Disability advocacy messaging and conceptual links to underlying disability identity development among college students with learning disabilities and attention disorders

BackgroundLearning disabilities and attention disorders (LD/AD) are highly prevalent neurodevelopmental conditions that influence developmental trajectories and whose impacts exist throughout the life course. Self-advocacy skills are critical for college students with LD/AD, which are underpinned by understanding of self and one's disability.ObjectiveThis study examined disability advocacy messaging included in projects created by college students with LD/AD, compared patterns in disability messaging to existing disability identity models, and explored changes in disability messaging during receipt of holistic campus-based LD/AD supports.MethodsParticipants were 52 undergraduates with LD/AD enrolled in a larger study. This one-group analysis involved qualitative exploration of the projects’ topical content, use of grounded theory procedures for conceptualizing the data, and quantitative analysis to explore changes over time in disability advocacy messaging.ResultsParticipants messaged a broad range of disability-related topics. A five-level theoretical model of disability messaging was created from the textual data. The model evinces parallels to existing disability identity development models. A significant (p < .01) positive shift in disability messaging was observed in a comparison of messages from participants’ first and last projects submitted over the four-semester period of study involvement.ConclusionStudy findings support conceptual linkages among disability messaging and disability identity development. The resultant continuum model suggests a potential extension of existing disability identity development paradigms. Shifts in disability messaging provide preliminary evidence for potential personal and institutional benefits of engaging college students with LD/AD in disability-focused project creation.     

Spousal support and self-determined physical activity in individuals with multiple sclerosis: A theory-informed qualitative exploration

BackgroundIndividuals with multiple sclerosis (MS) tend to exhibit high levels of sedentary behavior which contributes to increased disability and comorbidity. Understanding what factors underlie the motivation to be physically active in this group is therefore important.ObjectiveThis theory-informed qualitative study explored spousal support and behavior in fostering self-determined physical activity engagement of adults with MS.MethodsEight couples were interviewed using a semi-structured interview guide derived from Self-Determination Theory.ResultsAnalysis of transcribed audio recordings revealed that supportive and empathetic spousal communication, encouragement and expectations regarding physical activity, and bonding through co-participation increased feelings of relatedness. In addition, co-planning and problem-solving around physical activity and serving as a behavioral model facilitated perceptions of competency, while spouses who valued their partners’ independence and offered choice enhanced autonomous motivation for physical activity.ConclusionsInsight into the marital context that supports self-determined physical activity decisions of individuals with MS may better inform family-oriented health promotion approaches in this group.     

Gritty,hardy, resilient,and socially supported: A replication study

BackgroundThe present study adds to the knowledge base in positive psychology and disability sport psychology by replicating and extending the research of Martin, Byrd, Watts, and Dent (2015).ObjectivesIn the current study we replicated previous findings by predicting life quality and sport engagement using measures of grit, hardiness, and resilience. We also extended the work of Martin et al. (2015) by examining athlete social support.MethodsEighty-seven adult (80 men, 7 women) wheelchair rugby athletes with various disabilities (e.g., amputee) participated in the current study. They completed questionnaires at rugby tournaments or on-line assessing grit, hardiness, resilience, social support and life satisfaction and sport engagement.ResultsOverall, the regression equation predicting life satisfaction was significant, F (4, 81) = 9.67, p < .00, accounting for thirty-two percent of the variance. One variable, resilience, contributed unique meaningful variance as indicated by its significant beta weight (β = 0.46, p < .001). The regression analyses predicting sport engagement was also significant, F (4, 81) = 12.08, p < .001, and predicted 37% of the variance. Grit (β = 0.21, p < .05), social support (β = 0.25, p < .01), resilience (β = 0.23, p < .05), and hardiness (β = 0.27, p < .05) were all significant predictors.ConclusionAthletes reporting high levels of resilience reported the highest quality of life. Athletes reporting high levels of grit, resilience, hardiness, and social support were the most engaged in their sport. We also partially replicated the work of Martin et al. (2015).     

黑龙江省新型冠状病毒肺炎本土相关疫情流行特征

目的 描述黑龙江省新型冠状病毒肺炎（新冠肺炎）本土相关疫情的流行状况及特点,为黑龙江省新冠肺炎防控策略提供参考依据。方法 新冠肺炎个案调查、聚集性疫情调查资料来源于中国CDC全国传染病报告信息管理系统和突发公共卫生事件报告管理信息系统。采用Excel 2010和SPSS 23.0软件整理数据与统计学分析,描述人群、时间及地区分布特征。结果 2020年1月22日黑龙江省报告首例新冠肺炎确诊病例,截至2020年3月11日,13个城市累计报告境内病例482例,发病率为1.28/10万,病死率为2.70%（13/482）。其中聚集性疫情81起,确诊病例数占总确诊病例的79.25%（382/482）,死亡12例;家庭聚集70起（86.42%,70/81）。与散发病例相比,聚集性疫情尤其是家庭聚集性病例中,病死率、≥60岁老年人与重/危重型的比例均较高,差异均无统计学意义（均P>0.05）。涉及病例≥5例的聚集性疫情占41.98%（34/81）,涉及病例数占聚集性病例的68.31%（261/382）,涉及6~9例病例数的聚集性疫情中,年龄≥65岁者的比例较多（26.53%,39/147）。结论 黑龙江省新冠肺炎的发病率较高,前期疫情较为严重;聚集性疫情尤其是家庭聚集涉及病例数较多。     

新型毒品滥用对男男性行为人群高危性行为的影响

目的 了解新型毒品滥用对MSM高危性行为及HIV感染的影响,为制订有针对性的艾滋病防治对策和干预措施提供依据。方法 2019年4-7月在山东省3个MSM监测哨点,收集当地MSM人口学特征、相关行为信息,采集血样做HIV和梅毒检测。结果 共调查MSM 1 203人,年龄（30.2±8.9）岁,未婚815人（67.7%）,大专及以上文化程度805人（66.9%）;曾经使用过新型毒品的比例为54.2%（652/1 203）;最近6个月发生过无保护肛交和群交行为的比例分别为62.2%（721/1 160）和16.3%（189/1 160）;HIV和梅毒抗体阳性率分别为3.1%（37/1 203）和4.7%（56/1 203）。多因素logistic回归分析结果显示,MSM最近6个月发生无保护性肛交的影响因素中,来自青岛市是济南市的1.59倍（95% CI：1.13～2.23）、高中及以下文化程度是大专及以上文化程度的1.61倍（95% CI：1.20～2.16）、从酒吧/歌舞厅等场所寻找男性性伴的是互联网/交友软件的1.69倍（95% CI：1.06～2.69）、艾滋病知识得分<6分是≥6分的1.55倍（95% CI：1.01～2.37）、最近1周同性性伴数≥2人是<2人的1.48倍（95% CI：1.12～1.95）、最近6个月发生群交行为是无群交行为的2.43倍（95% CI：1.61～3.67）,曾使用新型毒品是未使用毒品的1.46倍（95% CI：1.11～1.91）。MSM最近6个月发生群交行为的影响因素中,来自青岛市是济南市的2.21倍（95% CI：1.45～3.38）、外省户籍是本省户籍的2.13倍（95% CI：1.28～3.55）、艾滋病知识得分≥6分是<6分的3.11倍（95% CI：1.55～6.25）、最近6个月肛交未坚持使用安全套是坚持使用安全套的2.60倍（95% CI：1.71～3.96）、最近6个月有同性商业性行为是无同性商业性行为的3.38倍（95% CI：1.92～5.95）、曾经使用过新型毒品是未使用毒品的2.71倍（95% CI：1.82～4.04）、最近1年未检测HIV是检测HIV的2.66倍（95% CI：1.59～4.43）。结论 山东省MSM人群中使用新型毒品现象普遍,新型毒品滥用促进该人群无保护性行为和群交行为的发生,应重点加强对吸毒MSM监测和干预力度。