Caring for Children While Working in Agriculture—The Perspectiveof Farmworker Parents

ABSTRACT

Access to safe, off-farm childcare is often a challenge for farmworkers with young children and is likely to become an increasingly salient barrier as more agricultural workers migrate together with families and as the number of women entering the agricultural workforce increases. Agriculture is one of the most hazardous industries, and the presence of young children in the workplace puts them at risk. To better understand the current nature of childcare for farmworker families and the challenges to accessing services, this project facilitated in-person surveys with 132 parents in three communities in Florida. A convenience sample that intentionally targeted parents living and working in areas with limited access to Migrant and Seasonal Head Start facilities was used to recruit participants. Most participants reported childcare access as a challenge. They expressed a desire to work in an area based on childcare availability. These findings offer agribusiness leaders important data to consider. They also suggest that industry support of childcare may be an important workforce investment. Findings indicate that high quality, affordable off-farm childcare services could serve as a means for attracting farmworkers to regions currently experiencing labor shortages. Additional research is warranted to explore this subject in diverse geographic areas.     

How non-functioning pituitary adenomas can affect health-related quality of life: a conceptual model and literature review

After treatment for a non-functioning pituitary adenoma (NFA) health-related quality of life (HR-QoL) improves considerably. However, the literature about the normalization of HR-QoL after treatment is inconclusive. Some researchers described a persistently decreased HR-QoL compared to reference data, while others did not. Considering this variety in observed HR-QoL outcomes, the aim of the present review was to provide a literature overview of health outcomes in patients with a NFA, using a conceptual HR-QoL model. A concrete conceptualization of the health outcomes of patients with a NFA can be helpful to understand the observed variety in HR-QoL outcomes and to improve clinical care and guidance of these patients. For this conceptualization, the Wilson and Cleary model was used. This model has a biopsychosocial character and has been validated in several patient populations. In the present review, health outcomes of patients with a NFA were described at each stage of the model e.g. biological and physiological variables, symptom status, functional status, general health perceptions and overall HR-QoL. The Wilson–Cleary model elucidates that elements at each stage of the model can contribute to the impairment in HR-QoL of patients with a NFA, which explains the reported variety in the literature. Furthermore, by applying the model, potential interventions targeting these elements can be identified. While optimal biomedical treatment has always been the focus, it is clearly not sufficient for good HR-QoL in patients with a NFA. Further improvement of HR-QoL should be supported by a pituitary specific care trajectory, including psychosocial care (e.g. self-management training), to beneficially affect characteristics of the patient and the (healthcare) environment, with the utmost goal to optimize HR-QoL in patients after treatment.     

PA-457: a potent HIV inhibitor that disrupts core condensation by targeting a late step in Gag processing

New HIV therapies are urgently needed to address the growing problem of drug resistance. In this article, we characterize the anti-HIV drug candidate 3-O-(3',3'-dimethylsuccinyl) betulinic acid (PA-457). We show that PA-457 potently inhibits replication of both WT and drug-resistant HIV-1 isolates and demonstrate that the compound acts by disrupting a late step in Gag processing involving conversion of the capsid precursor (p25) to mature capsid protein (p24). We find that virions from PA-457-treated cultures are noninfectious and exhibit an aberrant particle morphology characterized by a spherical, acentric core and a crescent-shaped, electron-dense shell lying just inside the viral membrane. To identify the determinants of compound activity we selected for PA-457-resistant virus in vitro. Consistent with the effect on Gag processing, we found that mutations conferring resistance to PA-457 map to the p25 to p24 cleavage site. PA-457 represents a unique class of anti-HIV compounds termed maturation inhibitors that exploit a previously unidentified viral target, providing additional opportunities for HIV drug discovery.     

Work disability and its determinants in patients with pituitary tumor-related disease

Introduction

Pituitary tumors may have a considerable impact on patients’ functional status, including paid employment, yet research in this area is sparse.

Objective

To describe work disability and its determinants in patients treated for a pituitary tumor.

Methods

Cross-sectional study including patients treated for a pituitary tumor in the working age (18–65 years), who completed five validated questionnaires assessing work disability [Short Form-Health and Labour Questionnaire, Work Role Functioning Questionnaire 2.0 (WRFQ)], health-related quality of life (HRQoL) and utility (Short Form-36, EuroQoL) and disease burden (Leiden Bother and Needs Questionnaire-Pituitary). Additional data were extracted from the medical records (age, gender, tumor type, treatment, date of diagnosis) and self-reports (marital status, education, endocrine status). Associations of disease-specific and sociodemographic characteristics, HRQoL, and disease burden with (not) having a paid job were examined through multivariate logistic regression.

Results

We included 241 patients (61% female, median age 53 years, median time since diagnosis 11 years), of whom 68 (28%) were without a paid job. Patients who had acromegaly, Cushing’s disease, (pan)hypopituitarism, radiotherapy, were single, less educated, lower HRQoL, and increased disease burden were more often without a paid job (p?<?0.05). Among those with paid jobs, 41% reported health-related absenteeism in the previous year. The three work incapacitating problems reported by the largest proportion of patients were within the mental and social domain (WRFQ).

Conclusion

Work disability among patients treated for a pituitary tumor is substantial. As impact on social functioning is high, it is strongly advised to incorporate work disability during clinical guidance of patients.

     

Genetic polymorphisms influencing total and γ′ fibrinogen levels and fibrin clot properties in Africans

Inter‐ethnic variation in fibrinogen levels is hypothesized to be the result of differences in genetic background. No information is available regarding the contribution of genetics to fibrinogen γ′ in Africans. Only limited information is available regarding the interaction between genotypes and total and γ′ fibrinogen concentration in determining fibrin clot properties. Our aim was to investigate the effect of polymorphisms in the fibrinogen and Factor XIII genes on total and γ′ fibrinogen and clot properties (turbidimetry) in 2010 black Africans as well as to determine their interactions. Significant associations were observed between rs1049636 (FGG gene), with total fibrinogen levels and between rs2070011 (FGA promoter area) and fibrinogen γ′ levels. Significant associations were observed between single nucleotide polymorphisms (SNPs) in the FGA (rs2070011), FGB (rs1800787) and FGG (rs1049636) genes and fibre size. Significant interactions were found between total and/or γ′ fibrinogen levels and SNPs in the FGA (rs2070011), FGB (rs2227385, rs1800787, rs1800788, rs4220) and F13A1 genes (rs5985) in determining clot properties. The different SNPs influenced the relationships between total and γ′ fibrinogen levels with clot properties in opposing directions. Genetic influences may be ethnic‐specific and should not only focus on fibrinogen concentration, but also on functionality in determining its role in CVD.     

IgE and IgG4 antibody responses to Aedes saliva in African children

Aedes mosquitoes are the major vectors of (re)-emerging infections including arboviruses (dengue, Chikungunya, yellow fever) in developing countries. Moreover, the emergence of Aedes-borne diseases in the developed world is currently a source of concern. Evaluation of human immune responses to Aedes bites could be a useful immuno-epidemiological tool for evaluating exposure to Aedes-borne diseases and thus predicting the risk of such emerging diseases. Specific IgE and IgG4 antibody (Ab) responses to Aedes aegypti saliva were evaluated in young Senegalese children living in an area of exposure to the Aedes vector. Specific IgE and IgG4 responses increased during rainy season of high exposure to Aedes bites. In addition, the evolution of anti-saliva isotype levels during the rainy season presented spatial heterogeneity between the studied villages. These preliminaries results support the potential approach of using anti-saliva Ab responses for evaluating exposure to Aedes vectors and risks of emerging arbovirus infections.     

DNB: a partial D with anti-D frequent in Central Europe

To improve routine D typing and define transfusion strategy, it is important to establish the frequency of partial D alleles and their susceptibility to anti-D alloimmunization due to transfusion or pregnancy. We identified the partial D DNB that was caused by an RHD(G355S) allele associated with a CDe haplotype and whose phenotype presented a normal D in routine typing. The antigen density was about 6000 D antigens per red blood cell, and the Rhesus index was 0.02. Five anti-D immunization events with allo-anti-D titers up to 128 were observed. Twelve carriers of DNB were whites of Central Europe; the only Danish proband had Austrian ancestry. DNB was the most frequent partial D recognized so far in whites, occurring with frequencies of up to 1:292 in Switzerland. DNB was the underlying partial D phenotype in a relevant fraction of anti-D immunizations occurring in whites.     

Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL

Introduction

Although quality of life (QoL) is recognized as an important indicator of the course of a disease, it has rarely been addressed in studies evaluating the outcome of care for patients with pulmonary embolism (PE). This study primarily aimed to evaluate the QoL of patients with acute PE in comparison to population norms and to patients with other cardiopulmonary diseases, using a generic QoL questionnaire. Secondary, the impact of time period from diagnosis and clinical patient characteristics on QoL was assessed, using a disease-specific questionnaire.

Methods

QoL was assessed in 109 consecutive out-patients with a history of objectively confirmed acute PE (mean age 60.4 ± 15.0 years, 56 females), using the generic Short Form-36 (SF-36) and the disease specific Pulmonary Embolism Quality of Life questionnaire (PEmb-QoL). The score of the SF-36 were compared with scores of the general Dutch population and reference populations with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), a history of acute myocardial infarction (AMI), derived from the literature. Scores on the SF-35 and PEmb-QoL were used to evaluate QoL in the short-term and long-term clinical course of patients with acute PE. In addition, we examined correlations between PEmb-QoL scores and clinical patient characteristics.

Results

Compared to scores of the general Dutch population, scores of PE patients were worse on several subscales of the SF-36 (social functioning, role emotional, general health (P < 0.001), role physical and vitality (P < 0.05)). Compared to patients with COPD and CHF, patients with PE scored higher (= better) on all subscales of the SF-36 (P ≤ 0.004) and had scores comparable with patients with AMI the previous year. Comparing intermediately assessed QoL with QoL assessed in long-term follow-up, PE patients scored worse on SF-36 subscales: physical functioning, social functioning, vitality (P < 0.05), and on the PEmb-QoL subscales: emotional complaints and limitations in ADL (P ≤ 0.03). Clinical characteristics did not correlate with QoL as measured by PEmb-QoL.

Conclusion

Our study demonstrated an impaired QoL in patients after treatment of PE. The results of this study provided more knowledge about QoL in patients treated for PE.     

Diurnal biting of malaria mosquitoes in the Central African Republic indicates residual transmission may be “out of control”

Malaria control interventions target nocturnal feeding of the Anopheles vectors indoors to reduce parasite transmission. Mass deployment of insecticidal bed nets and indoor residual spraying with insecticides, however, may induce mosquitoes to blood-feed at places and at times when humans are not protected. These changes can set a ceiling to the efficacy of these control interventions, resulting in residual malaria transmission. Despite its relevance for disease transmission, the daily rhythmicity of Anopheles biting behavior is poorly documented, most investigations focusing on crepuscular hours and nighttime. By performing mosquito collections 48-h around the clock, both indoors and outdoors, and by modeling biting events using circular statistics, we evaluated the full daily rhythmicity of biting in urban Bangui, Central African Republic. While the bulk of biting by Anopheles gambiae, Anopheles coluzzii, Anopheles funestus, and Anopheles pharoensis occurred from sunset to sunrise outdoors, unexpectedly ∼20 to 30% of indoor biting occurred during daytime. As biting events did not fully conform to any family of circular distributions, we fitted mixtures of von Mises distributions and found that observations were consistent with three compartments, corresponding indoors to populations of early-night, late-night, and daytime-biting events. It is not known whether these populations of biting events correspond to spatiotemporal heterogeneities or also to distinct mosquito genotypes/phenotypes belonging consistently to each compartment. Prevalence of Plasmodium falciparum in nighttime- and daytime-biting mosquitoes was the same. As >50% of biting occurs in Bangui when people are unprotected, malaria control interventions outside the domiciliary environment should be envisaged.

Transmission of parasites of the genus Plasmodium that are the causative agents of human malaria is considered to occur mainly from sunset to sunrise, when their vectors, mosquitoes of the genus Anopheles, feed on human hosts that are at rest or asleep (1, 2). This principle is so firmly established that sampling protocols to measure the strength of transmission usually disregard diurnal Anopheles feeding (3). This has not always been so: sampling routines implemented in the early 20th century by medical entomologists generally covered the whole 24-h biting cycle of different mosquito species (4). It is generally assumed that nighttime blood-feeding evolved because hosts are less active at this time, so that mosquitoes incur a lower risk of being swatted or chased away, enabling higher feeding success (2). Human hosts, however, most often rest indoors; many human-biting anophelines, therefore, penetrate inside households in order to have access to and feed on humans. Current mainstay vector control tactics exploit these behaviors in order to reduce transmission by means of two interventions: protecting humans under long-lasting insecticidal bed nets (LLINs), and spraying houses with residual insecticides (i.e., indoor residual spraying, IRS) (5). Additional benefits of IRS come from the habit of some malaria vectors to rest inside dwellings, using them as refugia either before or after blood-feeding (1).Despite the incontestable success of these control interventions in reducing the burden of malaria (6), a plateau in the incidence rate of malaria cases has been observed in Africa during the last years (7). This could be at least in part explained by the intensive selection pressure put up by insecticides (8). Indeed, mutations conferring insecticide resistance have rapidly emerged (9), and resistance to different classes of insecticides is presently widespread in most malaria vector populations (10, 11). Moreover, there is evidence that some vector populations are changing their behavior in response to control interventions by feeding progressively more at places and at times when humans are less likely to be protected (12, 13). So far, behavioral modifications have resulted in more biting during the evening and early morning and out-of-doors (14–21). Recent studies reporting significant amounts of daytime biting, however, remain somewhat anecdotal, with few exceptions. Overall, these modifications increase the window of opportunity for human–vector contact, producing what is called residual malaria transmission (22, 23): this expression implies that transmission will persist even if LLINs and IRS are fully effective. It is feared, therefore, that the malaria elimination target set upon current control interventions may be compromised in the long term by residual malaria transmission (24). Countering this phenomenon should be based on better knowledge of the biology and behavior of the vectors, with the aim to develop more suitable interventions (12, 23, 25).In the Central African Republic, malaria remains a major public health problem and the main cause of deaths among children <5 y old (26). In 2006, the National Malaria Control Program implemented the first phase of the Global Fund Program for Malaria based on free distribution of LLINs to pregnant women and children <5 y old, with moderate results (26, 27). A new campaign of mass LLIN distribution was deployed in 2015. Yet, malaria incidence was not significantly reduced (28). Several studies reported the presence in the country of populations of the major malaria vectors Anopheles gambiae, Anopheles coluzzii, and Anopheles funestus that are resistant to pyrethroids, the class of insecticides used for impregnation of bed nets (29–31). It is not known, however, the degree to which insecticide resistance is responsible for such moderate reductions in malaria incidence in this country, above and beyond what can be accounted for by a national health system weakened by years of civil war and unrest.In order to appreciate the potential of residual malaria transmission in this epidemiological context, we investigated the biting behavior of the malaria vectors occurring in urban settings of Bangui, Central African Republic. We implemented two significant modifications to the sampling protocol and analytical procedures that are usually applied in this kind of investigation. First, the sampling plan consisted of monthly sessions of 48-h around-the-clock collections of mosquitoes coming to feed on human hosts both indoors and outdoors. Second, the daily rhythmicity of the observed biting events was analyzed quantitatively using a circular statistics framework that models these events on a circumference rather than along the usual linear representation (32–34). Unexpectedly, we found that 20 to 30% of malaria vector biting occurred at full daytime indoors. These results suggest that current vector control interventions may not be enough to achieve sufficient reductions in malaria transmission in Bangui. Perhaps even more significant, these observations suggest that Anopheles mosquitoes may have the potential to achieve fundamental modifications in the temporal organization and circadian control of their feeding behavior, with major impacts on malaria control strategies in Africa. We elaborate these results as follows.