Screening for tuberculosis at an adult education center: results of a community-based participatory process

Objectives. We used a community-based participatory research (CBPR) approach to plan and implement free TB skin testing at an adult education center to determine the efficacy of CBPR with voluntary tuberculosis (TB) screening and the prevalence of TB infection among immigrant and refugee populations.Methods. We formed a CBPR partnership to address TB screening at an adult education center that serves a large immigrant and refugee population in Rochester, Minnesota. We conducted focus groups involving educators, health providers, and students of the education center, and used this input to implement TB education and TB skin testing among the center''s students.Results. A total of 259 adult learners volunteered to be skin-tested in April 2009; 48 (18.5%) had positive TB skin tests.Conclusions. Our results imply that TB skin testing at adult education centers that serve large foreign-born populations may be effective. Our findings also show that a participatory process may enhance the willingness of foreign-born persons to participate in TB skin-testing efforts.Incidence of tuberculosis (TB) infection in the United States has declined over the past decade, but a disparity has emerged wherein this decline has been much less pronounced among foreign-born Americans. More than half of active TB cases in the United States occur in foreign-born individuals,¹ and the majority of these cases are attributable to reactivation of latent TB infection (LTBI).^2,3 The Centers for Disease Control and Prevention (CDC) has recommended testing for and treating LTBI among foreign-born individuals from countries with a high incidence of TB who have lived in the United States for 5 years or less.⁴ This strategy may be particularly effective for individuals from sub-Saharan Africa and Southeast Asia.⁴ The risk of TB remains elevated even for foreign-born individuals who live in the United States for longer than 5 years.³In spite of the CDC''s recommendation, LTBI screening of foreign-born individuals is not commonly practiced in the community setting because of a lack of funding and limited availability of local resources.⁵ Previous studies have demonstrated that school-based targeted testing of asymptomatic foreign-born children is both effective and cost-effective for identifying and treating LTBI.^6–11 However, concerns have been raised that mandatory testing practices may be stigmatizing to these immigrant groups.^12aCommunity-based participatory research (CBPR) is a way to collaboratively investigate health topics within a community, whereby community members and academics work as partners in an equitable relationship.^12b–14 CBPR has been particularly successful in identifying and addressing health disparities, because it empowers communities and promotes understanding of cultural issues pertinent to health.^15,16 The CDC recommends forging these types of partnerships to address TB in the United States.^17aHawthorne Education Center (HEC), a constituent of the Rochester (MN) Public Schools district, provides education with an emphasis on literacy to Rochester adults. HEC serves a large foreign-born population through classes that teach English as a second language (ESL) and other programs. HEC has evolved into a community center, providing instruction for cultural adjustment, citizenship, and even training for driver''s license exams. More than 70 different languages are spoken within HEC, which supports approximately 2500 students yearly from diverse backgrounds. An estimated 85% of HEC''s students have incomes at or below the federal poverty level, and less than half (40%) have completed high school.The Hawthorne Health Service at HEC emerged as a collaborative free clinic and health-literacy campaign for adult learners and their families. Most Hawthorne learners have some of the strongest indicators of TB risk in the United States, including recent emigration from regions of the world where TB is endemic. The HEC community has experienced several cases of active TB among its students in recent years.In 2006, HEC leadership approached Mayo Clinic faculty who volunteered at HEC to suggest working together to address the problem of TB among the center''s learners. Two years earlier, these 2 agencies had formed a CBPR partnership to broadly address health concerns at HEC. They established operating norms, held monthly meetings, and conducted a health needs assessment. This partnership grew to include 5 more community-based organizations, 2 more academic centers, and many more volunteers to form the Rochester Healthy Community Partnership, whose mission is to promote health and well-being among the Rochester population through CBPR, education, and civic engagement.Members of the Rochester Healthy Community Partnership conducted 10 focus groups with HEC adult learners and staff to elicit their perceptions of TB and their recommended solutions for addressing this issue.^17b In conducting the focus groups, we used principles of CBPR, including community involvement in every aspect of project design and analysis. One theme that emerged from the focus groups was a recommendation for free on-site TB testing. Therefore, to determine the efficacy of a CBPR approach to voluntary TB screening, and to determine the prevalence of LTBI at this adult education center, the partnership used a CBPR approach to plan and implement free TB skin testing at HEC. Every component of subsequent program planning and assessment was initiated and implemented under the supervision of the Rochester Healthy Community Partnership community–academic working group.     

Antiplatelet activity of Phellinus baummii methanol extract is mediated by cyclic AMP elevation and inhibition of collagen-activated integrin-α(IIb) β₃ and MAP kinase

Phellinus baumii is a mushroom that has been used as folk medicine against various diseases and is reported to have antidiabetic, anticancer, antioxidant, antiinflammatory and antihypertensive activities. However, information on the effects of P. baumii extract in platelet function is limited. Therefore, the aim of this study was to examine the impact of a P. baumii methanol extract (PBME) on platelet activation and to investigate the mechanism behind its antiplatelet activity. PBME effects on agonist‐induced platelet aggregation, granule secretion, [Ca²⁺]_i mobilization, α_IIbβ₃ activation, cyclic AMP release and mitogen‐activated protein kinase (MAPK) phosphorylations were studied using rat platelets. PBME dose‐dependently inhibited collagen, thrombin and ADP‐induced platelet aggregation with an IC₅₀ of 51.0 ± 2.4, 54.0 ± 2.1 and 53.0 ± 4.3 μg/mL, respectively. Likewise, thrombin‐induced [Ca²⁺]_i and collagen‐activated ATP secretions were suppressed in PBME treated platelets. Aggregation and ATP secretion were also markedly attenuated by PBME alone or in combination with PP2 (Src inhibitor) and U‐73122 (PLC inhibitor) in collagen‐stimulated platelets. Besides, PBME treatment elevated basal cyclic AMP levels and inhibited collagen‐induced integrin‐α_IIbβ₃ activation. Moreover, PBME attenuated extracellular‐signal‐regulated protein kinase 2 (ERK2) and c‐Jun N‐terminal kinase 1 (JNK1) phosphorylations. Further PD98059 (ERK inhibitor) and SP60025 (JNK inhibitor) reduced collagen‐induced platelet aggregation and ATP secretion. In conclusion, the observed PBME antiplatelet activity may be mediated by activation of cyclic AMP and inhibition of ERK2 and JNK1 phosphorylations. Finally, these data suggest that PBME may have therapeutic potential for the treatment of cardiovascular diseases that involve aberrant platelet function. Copyright © 2011 John Wiley & Sons, Ltd.     

Bacillus cereus G9241 makes anthrax toxin and capsule like highly virulent B. anthracis Ames but behaves like attenuated toxigenic nonencapsulated B. anthracis Sterne in rabbits and mice

Bacillus cereus G9241 was isolated from a welder with a pulmonary anthrax-like illness. The organism contains two megaplasmids, pBCXO1 and pBC218. These plasmids are analogous to the Bacillus anthracis Ames plasmids pXO1 and pXO2 that encode anthrax toxins and capsule, respectively. Here we evaluated the virulence of B. cereus G9241 as well as the contributions of pBCXO1 and pBC218 to virulence. B. cereus G9241 was avirulent in New Zealand rabbits after subcutaneous inoculation and attenuated 100-fold compared to the published 50% lethal dose (LD(50)) values for B. anthracis Ames after aerosol inoculation. A/J and C57BL/6J mice were comparably susceptible to B. cereus G9241 by both subcutaneous and intranasal routes of infection. However, the LD(50)s for B. cereus G9241 in both mouse strains were markedly higher than those reported for B. anthracis Ames and more like those of the toxigenic but nonencapsulated B. anthracis Sterne. Furthermore, B. cereus G9241 spores could germinate and disseminate after intranasal inoculation into A/J mice, as indicated by the presence of vegetative cells in the spleen and blood of animals 48 h after infection. Lastly, B. cereus G9241 derivatives cured of one or both megaplasmids were highly attenuated in A/J mice. We conclude that the presence of the toxin- and capsule-encoding plasmids pBCXO1 and pBC218 in B. cereus G9241 alone is insufficient to render the strain as virulent as B. anthracis Ames. However, like B. anthracis, full virulence of B. cereus G9241 for mice requires the presence of both plasmids.     

Non-compliance with appointments amongst patients attending an Allergology Clinic, after implementation of an improvement plan

BackgroundNon-compliance is a common cause of failed medical action, contributing to absence of regular check-ups. Our group has already published studies that analyse the level of non-compliance with appointments amongst patients attending our Allergology clinic, and we have made proposals for improvement.ObjectiveThis article evaluates the results obtained three years after setting up and launching telephone reminders for patients’ first appointments.MethodsAll patients who were given appointments for first and subsequent visits during 2005 were included. A total of 18215 appointments were studied (3115 first appointments and 15100 subsequent ones). Of these, there were 2479 missed appointments (438 first appointments and 2041 subsequent ones), corresponding to 2215 patients (412 first visits and 1803 subsequent ones), with a mean of 1.12 appointments/patient/year.ResultsThe non-compliance rate was 13.61 %. The most common non-compliers were men (14.11 % missed appointments against 13.24% missed appointments in women) and in the age range 20-29 years and 30-39 years (16.46 % and 15.28 % non-compliance, respectively). The mean age of non-compliers was 34.55 ± 14.73 years. We observed a significant number of patients who missed more than one appointment (5.12 % of all non-compliers and 0.7 % of all patients). Differences were found in the degree of non-compliance depending on the type of appointment (14.06 % non-compliance with first visits and 13.52 % with subsequent visits). We observed a significant increase in missed appointments during the Summer holidays; July and August showed the highest percentage of missed appointments for both the first visit (20.62 % in July and 23.59 % in August) and subsequent visits alike (16.14 % in July and 14.23 % in August).ConclusionsA slight reduction in non-compliance was observed after implementing the proposals made in our previous study. In view of the high costs incurred from missed appointments, the government should finance studies to reduce this problem. The causes of non-compliance may be difficult to control, including present access to the public health service. We must be alert to and/or take preventive measures in young patients and cases of previous non-compliance.The degree of non-compliance is a quality indicator, because it reduces the yield of appointments, and it evidences a lack of cohesion of patients with Primary Health Care Units for first appointments, and with Specialist Care Units for subsequent appointments. Once certain levels of attendance have been attained, it is difficult to achieve an effect on this point in order to improve attendance rates.     

Proposal for relative units of value (RUV) for use in allergy examinations

Health resources are limited and consequently real cost generators must be identified to optimize resources. In the present article, we describe the structure of the Homogeneous Functional Groups (HFG) for Diagnostic Techniques in the Allergy Department of the Virgen de la Arrixaca University Hospital in Murcia (Spain) and the healthcare products generated. Based on the 2005 budget, variable costing was used to calculate the costs of the healthcare products generated (skin tests, investigation of drug allergies, etc.) by one of the three HFG (the HFG for complementary investigations). On the basis of these costs, and taking as the unit the cost of one skin prick test, we assigned relative units of value (RUV) to each of the products in our services portfolio. The following conclusions can be drawn: 1) the current system of variable costing provides information, which should be useful to health professionals; 2) the real cost generators in the microcosm of daily clinical practice should be identified to allow resource reallocation; 3) the costing system used enables modifications to be made that allow decision making on optimal use of the budget; 4) to take the decisions required to optimize resources, clinical management and complementary tests should go hand-in-hand.     

Valorization of β-Chitin Extraction Byproduct from Cuttlefish Bone and Its Application in Food Wastewater Treatment

The nontoxicity, worldwide availability and low production cost of cuttlefish bone products qualify them an excellent biocoagulant to treat food industry wastewater. In this study, cuttlefish bone liquid waste from the deproteinization step was used as a biocoagulant to treat food industry wastewater. This work concerns a waste that has never before been investigated. The objectives of this work were: the recovery of waste resulting from cuttlefish bone deproteinization, the replacementof chemical coagulants with natural ones to preserve the environment, and the enhancement ofthe value of fishery byproducts. A quantitative characterization of the industrial effluents of a Moroccan food processing plant was performed. The physicochemical properties of the raw cuttlefish bone powder and the deproteinization liquid extract were determined using specific analysis techniques: SEM/EDX, FTIR, XRD and ¹H-NMR. The protein content of the deproteinization liquid was determined by OPA fluorescent assay. The zeta potential of the liquid extract was also determined. The obtained analytical results showed that the deproteinization liquid waste contained an adequate amount of soluble chitin fractions that could be used in food wastewater treatment. The effects of the coagulant dose and pH on the food industrial effluents were studied to confirm the effectiveness of the deproteinization liquid extract. Under optimal conditions, the coagulant showed satisfactory results. Process optimization was performed using the Box–Behnken design and response surface methodology. Thus, the optimal removal efficiencies predicted using this model for turbidity (99.68%), BOD₅ (97.76%), and COD (82.92%) were obtained at a dosage of 8 mL biocoagulant in 0.5 L of food processing wastewater at an alkaline pH of 11.     

Inhibition of Venezuelan Equine Encephalitis Virus Using Small Interfering RNAs

Acutely infectious new world alphaviruses such as Venezuelan Equine Encephalitis Virus (VEEV) pose important challenges to the human population due to a lack of effective therapeutic intervention strategies. Small interfering RNAs that can selectively target the viral genome (vsiRNAs) has been observed to offer survival advantages in several in vitro and in vivo models of acute virus infections, including alphaviruses such as Chikungunya virus and filoviruses such as Ebola virus. In this study, novel vsiRNAs that targeted conserved regions in the nonstructural and structural genes of the VEEV genome were designed and evaluated for antiviral activity in mammalian cells in the context of VEEV infection. The data demonstrate that vsiRNAs were able to effectively decrease the infectious virus titer at earlier time points post infection in the context of the attenuated TC-83 strain and the virulent Trinidad Donkey strain, while the inhibition was overcome at later time points. Depletion of Argonaute 2 protein (Ago2), the catalytic component of the RISC complex, negated the inhibitory effect of the vsiRNAs, underscoring the involvement of the siRNA pathway in the inhibition process. Depletion of the RNAi pathway proteins Dicer, MOV10, TRBP2 and Matrin 3 decreased viral load in infected cells, alluding to an impact of the RNAi pathway in the establishment of a productive infection. Additional studies focused on rational combinations of effective vsiRNAs and delivery strategies to confer better in vivo bioavailability and distribution to key target tissues such as the brain can provide effective solutions to treat encephalitic diseases resulting from alphavirus infections.     

Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%–46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%–77%). Women involved in home gardening significantly increased (73%–93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.     

Histologic features of bone regenerated by means of negative pressure in the context of odontogenic keratocyst

Oral and Maxillofacial Surgery - The objective of the present research is to describe the histologic features of the bone regenerated by means of negative pressure (sugosteogenesis) in a group of...