Modeling the Impact of Tuberculosis Control Strategies in Highly Endemic Overcrowded Prisons

International audienceBACKGROUND: Tuberculosis (TB) in prisons is a major health problem in countries of high and intermediate TB endemicity such as Brazil. For operational reasons, TB control strategies in prisons cannot be compared through population based intervention studies. METHODOLOGY/PRINCIPAL FINDINGS: A mathematical model is proposed to simulate the TB dynamics in prison and evaluate the potential impact on active TB prevalence of several intervention strategies. The TB dynamics with the ongoing program was simulated over a 10 year period in a Rio de Janeiro prison (TB prevalence 4.6 %). Then, a simulation of the DOTS strategy reaching the objective of 70 % of bacteriologically-positive cases detected and 85 % of detected cases cured was performed; this strategy reduced only to 2.8% the average predicted TB prevalence after 5 years. Adding TB detection at entry point to DOTS strategy had no major effect on the predicted active TB prevalence. But, adding further a yearly X-ray mass screening of inmates reduced the predicted active TB prevalence below 1%. Furthermore, according to this model, after applying this strategy during 2 years (three annual screenings), the TB burden would be reduced and the active TB prevalence could be kept at a low level by associating X-ray screening at entry point and DOTS. CONCLUSIONS/SIGNIFICANCE: We have shown that X-ray mass screenings should be considered to control TB in highly endemic prison. Prisons with different levels of TB prevalence could be examined thanks to this model which provides a rational tool for public health deciders

The Impact of Parents' Categorization of Their Own Weight and Their Child's Weight on Healthy Lifestyle Promoting Beliefs and Practices

Objective. To evaluate parents' beliefs and practices related to childhood obesity and determine if these are influenced by parent's perception of their own weight or their child's weight. Methods. Parents of obese ( = 689) or normal weight ( = 1122) children 4-15 years in Georgia, USA, were randomly selected to complete a telephone survey. Frequency of child obesity-related perceptions, beliefs, and practices were assessed, stratified by parent-perceived self-weight and child weight status, and compared using Chisquared tests and multivariate logistic regression. Results. Most parents, regardless of perceived child weight, agreed that child overweight/obesity can cause serious illness (95%) but only one-half believed it was a problem in Georgia. Many (42.4%) failed to recognize obesity in their own children. More parents who perceived their child as overweight versus normal weight reported concern about their child's diet and activity and indicated readiness for lifestyle change. Parents' perception of their own weight had little additional impact. Conclusions. While awareness of child overweight as a modifiable health risk is high, many parents fail to recognize it in their own families and communities, reducing the likelihood of positive lifestyle change. Additional efforts to help parents understand their role in facilitating behavior change and to assist them in identifying at-risk children are required

Understanding the dynamics of Ebola epidemics

Ebola is a highly lethal virus, which has caused at least 14 confirmed outbreaks in Africa between 1976 and 2006. Using data from two epidemics [in Democratic Republic of Congo (DRC) in 1995 and in Uganda in 2000], we built a mathematical model for the spread of Ebola haemorrhagic fever epidemics taking into account transmission in different epidemiological settings. We estimated the basic reproduction number (R0) to be 2·7 (95% CI 1·9–2·8) for the 1995 epidemic in DRC, and 2·7 (95% CI 2·5–4·1) for the 2000 epidemic in Uganda. For each epidemic, we quantified transmission in different settings (illness in the community, hospitalization, and traditional burial) and simulated various epidemic scenarios to explore the impact of control interventions on a potential epidemic. A key parameter was the rapid institution of control measures. For both epidemic profiles identified, increasing hospitalization rate reduced the predicted epidemic size

Domestic Ritual in Ancient Mesoamerica

Although the concepts and patterns of ritual varied through time in relation to general sociopolitical transformations and local historical circumstances in ancient Mesoamerica, most archaeologists would agree that certain underlying themes and structures modeled the ritual phenomena of this complex culture area. By focusing on ritual expression at the household level, this volume seeks to compare the manifestations of domestic ritual across time and space in both the cores and peripheries, in the cities and in the villages. The authors explore the ways in which cosmological principles and concepts of the sacred were used in the construction of ritual space and practice, how local landscapes provided templates for the images and paraphernalia recovered from archaeological contexts, how foreign enclaves relied on ritual for social reproduction, and how domestic ritual was related to, and indeed embedded in, institutionalized state religions