Challenges and opportunities in digital health

O artigo de Leal Neto et al. tem como foco o crescimento tecnológico exponencial e as consequentes alterações nos atuais paradigmas das ciências da saúde. O texto cita vários casos em concreto, na perspectiva das “inovações disruptivas” e o seu impacto na saúde públic

Controlling malaria using livestock-based interventions: a one health approach.

Where malaria is transmitted by zoophilic vectors, two types of malaria control strategies have been proposed based on animals: using livestock to divert vector biting from people (zooprophylaxis) or as baits to attract vectors to insecticide sources (insecticide-treated livestock). Opposing findings have been obtained on malaria zooprophylaxis, and despite the success of an insecticide-treated livestock trial in Pakistan, where malaria vectors are highly zoophilic, its effectiveness is yet to be formally tested in Africa where vectors are more anthropophilic. This study aims to clarify the different effects of livestock on malaria and to understand under what circumstances livestock-based interventions could play a role in malaria control programmes. This was explored by developing a mathematical model and combining it with data from Pakistan and Ethiopia. Consistent with previous work, a zooprophylactic effect of untreated livestock is predicted in two situations: if vector population density does not increase with livestock introduction, or if livestock numbers and availability to vectors are sufficiently high such that the increase in vector density is counteracted by the diversion of bites from humans to animals. Although, as expected, insecticide-treatment of livestock is predicted to be more beneficial in settings with highly zoophilic vectors, like South Asia, we find that the intervention could also considerably decrease malaria transmission in regions with more anthropophilic vectors, like Anopheles arabiensis in Africa, under specific circumstances: high treatment coverage of the livestock population, using a product with stronger or longer lasting insecticidal effect than in the Pakistan trial, and with small (ideally null) repellency effect, or if increasing the attractiveness of treated livestock to malaria vectors. The results suggest these are the most appropriate conditions for field testing insecticide-treated livestock in an Africa region with moderately zoophilic vectors, where this intervention could contribute to the integrated control of malaria and livestock diseases

Contrasting Phenotypic Variability of Life-History Traits of Two Feral Populations of Macrolophus pygmaeus (Hemiptera: Miridae) under Two Alternative Diets

Tuta absoluta is a major pest attacking tomato crops. This invasive species emerged in Europe (Spain) in 2006, and 3 years later it spread to Portugal. In 2009/2010, it was recorded for the first time in the Azores archipelago. Macrolophus pygmaeus is a predator widely used as biological control agent against the tomato leaf miner. This study contrasted the life-history traits and population growth parameters of two feral populations of M. pygmaeus, one from Portugal mainland and one from the Azores archipelago. The predators were tested on single prey diet, either of Ephestia kuehniella eggs, a factitious prey used for mass rearing of mirids, or T. absoluta eggs. We predicted that populations would express differences in its phenotypic characteristics, with the Azorean population displaying low performance due to likely low genetic diversity, as expected for insular populations. Our results revealed the inexistence of phenotypic differences in several life history traits, such as immature developmental time, female longevity, males’ body weight and sex ratio. Contrary to our predictions, traits with direct impact on fitness, such as lifetime fertility (95.78 ± 14.23 vs. 61.38 ± 13.52 nymphs), explain better performances for the population of the Azores. Azorean M. pygmaeus females were larger, matured earlier and reproduced at a higher rate for longer periods, than mainland females. Therefore, population growth parameters show a positive advantage for the population of the Azores, fed on T. absoluta (time required for doubling the population Azores, Ek: 8.42 ± 0.50, Ta: 5.76 ± 0.31 and mainland, Ek: 10.88 ± 1.94, Ta: 12.07 ± 3.15). Biological performance of M. pygmaeus was similar when fed with T. absoluta or E. kuehniella that could be beneficial both to optimize mass production of the predator and biological control of the pest. Our results are discussed as well in a fundamental perspective, seeking if differences in biological performance can be explained by lower genetic diversity driven by geographic isolation.FUNDING: This study was financed by FEDER in 85% and by Azorean Public funds by 15% through Operational Program Azores 2020, under the project ECO2–TUTA (ACORES-01-0145-FEDER-000081). L.O. was funded by Portuguese national funds FCT under the project UIDP/05292/2020 and UIDB/05292/2020. E.F. was funded by Portuguese national funds FCT Umbert-ECO PTDC/ASPPLA/29110/2017. J.C.F. and E.F. received backing from Forest Research Centre (CEF) and Linking Landscape, Environment, Agriculture and Food (LEAF) research center, respectively, research units funded by Fundação para a Ciência e a Tecnologia (FCT), Portugal (UIDB/00239/2020 and UIDB/04129/2020, respectively), and both researchers from the Laboratory for Sustainable Land Use and Ecosystem Services–TERRA (LA/P/0092/2020).info:eu-repo/semantics/publishedVersio

Predicting the distribution of canine leishmaniasis in western Europe based on environmental variables.

The domestic dog is the reservoir host of Leishmania infantum, the causative agent of zoonotic visceral leishmaniasis endemic in Mediterranean Europe. Targeted control requires predictive risk maps of canine leishmaniasis (CanL), which are now explored. We databased 2187 published and unpublished surveys of CanL in southern Europe. A total of 947 western surveys met inclusion criteria for analysis, including serological identification of infection (504, 369 dogs tested 1971-2006). Seroprevalence was 23 2% overall (median 10%). Logistic regression models within a GIS framework identified the main environmental predictors of CanL seroprevalence in Portugal, Spain, France and Italy, or in France alone. A 10-fold cross-validation approach determined model capacity to predict point-values of seroprevalence and the correct seroprevalence class (20%). Both the four-country and France-only models performed reasonably well for predicting correctly the 20% seroprevalence classes (AUC >0 70). However, the France-only model performed much better for France than the four-country model. The four-country model adequately predicted regions of CanL emergence in northern Italy (<5% seroprevalence). Both models poorly predicted intermediate point seroprevalences (5-20%) within regional foci, because surveys were biased towards known rural foci and Mediterranean bioclimates. Our recommendations for standardizing surveys would permit higher-resolution risk mapping

Cleaning efficiency in packing lines for fresh market tomatoes

On the last years, in Brazil, sorting and classifying fruits and vegetables using packing lines have increased. This work aimed at characterizing the cleaning process for fresh market tomatoes at two packing lines, one imported and one national located at Campinas, São Paulo State. Characterization included data, number, types and brushes velocity, water use, fruit standing time and cleaning efficiency. Standing time was measured correlating to fruit diameter (CEAGESP). For measuring cleaning efficiency an equipment was developed that was mainly composed of a ring involved with white cloth. Samples were taken before and after the cleaning step and evaluated using a colorimeter HUNTER Lab. The results showed a strong difference between the two equipments. The imported equipment showed lower number on brushes and rotation than national one, however a higher water consumption. For imported equipments this relation was not found. Both packing lines showed the same cleaning efficiency. Cleaning efficiency is related to be an interaction among the studies parameters, and it could be necessary a better management than the one used on both equipments.No Brasil, nos últimos anos, tem aumentado o beneficiamento e a classificação de frutas e hortaliças em equipamentos. O objetivo deste trabalho foi caracterizar a etapa de limpeza de dois equipamentos de beneficiamento de tomate de mesa, um nacional e outro importado, instalados na região metropolitana de Campinas - SP. A caracterização foi realizada quanto ao número, tipo e velocidade de rotação das escovas, aplicação de água, tempo de permanência dos frutos e eficiência de limpeza. O tempo de permanência foi mensurado com relação ao tamanho dos frutos, segundo os padrões da CEAGESP. Para mensurar a eficiência, foi desenvolvido um equipamento composto de um anel deslizante envolvido por um pano branco. As amostragens foram realizadas antes e após a etapa de limpeza e avaliadas utilizando colorímetro HUNTER Lab. Por meio dos resultados, observaram-se diferenças entre os dois equipamentos, em que o importado apresentou menor número de escovas, rotações mais baixas e maior consumo de água que o nacional. No equipamento nacional, o tempo de permanência dependeu do tamanho dos frutos, não sendo encontrada essa correlação no equipamento importado, e ambos tiveram a mesma eficiência de limpeza. Conclui-se que a limpeza está relacionada à interação entre os parâmetros estudados, sendo também necessário realizar manutenções nos equipamentos das unidades para a melhoria no funcionamento.782786Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Influenzanet: Citizens Among 10 Countries Collaborating to Monitor Influenza in Europe.

BACKGROUND: The wide availability of the Internet and the growth of digital communication technologies have become an important tool for epidemiological studies and health surveillance. Influenzanet is a participatory surveillance system monitoring the incidence of influenza-like illness (ILI) in Europe since 2003. It is based on data provided by volunteers who self-report their symptoms via the Internet throughout the influenza season and currently involves 10 countries. OBJECTIVE: In this paper, we describe the Influenzanet system and provide an overview of results from several analyses that have been performed with the collected data, which include participant representativeness analyses, data validation (comparing ILI incidence rates between Influenzanet and sentinel medical practice networks), identification of ILI risk factors, and influenza vaccine effectiveness (VE) studies previously published. Additionally, we present new VE analyses for the Netherlands, stratified by age and chronic illness and offer suggestions for further work and considerations on the continuity and sustainability of the participatory system. METHODS: Influenzanet comprises country-specific websites where residents can register to become volunteers to support influenza surveillance and have access to influenza-related information. Participants are recruited through different communication channels. Following registration, volunteers submit an intake questionnaire with their postal code and sociodemographic and medical characteristics, after which they are invited to report their symptoms via a weekly electronic newsletter reminder. Several thousands of participants have been engaged yearly in Influenzanet, with over 36,000 volunteers in the 2015-16 season alone. RESULTS: In summary, for some traits and in some countries (eg, influenza vaccination rates in the Netherlands), Influenzanet participants were representative of the general population. However, for other traits, they were not (eg, participants underrepresent the youngest and oldest age groups in 7 countries). The incidence of ILI in Influenzanet was found to be closely correlated although quantitatively higher than that obtained by the sentinel medical practice networks. Various risk factors for acquiring an ILI infection were identified. The VE studies performed with Influenzanet data suggest that this surveillance system could develop into a complementary tool to measure the effectiveness of the influenza vaccine, eventually in real time. CONCLUSIONS: Results from these analyses illustrate that Influenzanet has developed into a fast and flexible monitoring system that can complement the traditional influenza surveillance performed by sentinel medical practices. The uniformity of Influenzanet allows for direct comparison of ILI rates between countries. It also has the important advantage of yielding individual data, which can be used to identify risk factors. The way in which the Influenzanet system is constructed allows the collection of data that could be extended beyond those of ILI cases to monitor pandemic influenza and other common or emerging diseases

Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala

INTRODUCTION: Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. METHODS: We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml. RESULTS: Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p \u3c 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p \u3c 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p \u3c 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p \u3c 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p \u3c 0.01) were independently associated with VNS on multivariable regression. CONCLUSIONS: We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal

Determinants of follow-up participation in the Internet-based European influenza surveillance platform Influenzanet.

BACKGROUND: "Influenzanet" is a network of Internet-based platforms aimed at collecting real-time data for influenza surveillance in several European countries. More than 30,000 European volunteers participate every year in the study, representing one of the largest existing Internet-based multicenter cohorts. Each week during the influenza season, participants are asked to report their symptoms (if any) along with a set of additional questions. OBJECTIVE: Focusing on the first influenza season of 2011-12, when the Influenzanet system was completely harmonized within a common framework in Sweden, the United Kingdom, the Netherlands, Belgium, France, Italy, and Portugal, we investigated the propensity of users to regularly come back to the platform to provide information about their health status. Our purpose was to investigate demographic and behavioral factors associated with participation in follow-up. METHODS: By means of a multilevel analysis, we evaluated the association between regular participation during the season and sociodemographic and behavioral characteristics as measured by a background questionnaire completed by participants on registration. RESULTS: We found that lower participation in follow-up was associated with lower educational status (odds ratio [OR] 0.80, 95% CI 0.75-0.85), smoking (OR 0.64, 95% CI 0.59-0.70), younger age (OR ranging from 0.30, 95% CI 0.26-0.33 to 0.70, 95% CI 0.64-0.77), not being vaccinated against seasonal influenza (OR 0.77, 95% CI 0.72-0.84), and living in a household with children (OR 0.69, 95% CI 0.65-0.74). Most of these results hold when single countries are analyzed separately. CONCLUSIONS: Given the opportunistic enrollment of self-selected volunteers in the Influenzanet study, we have investigated how sociodemographic and behavioral characteristics may be associated with follow-up participation in the Influenzanet cohort. The study described in this paper shows that, overall, the most important determinants of participation are related to education and lifestyle: smoking, lower education level, younger age, people living with children, and people who have not been vaccinated against seasonal influenza tend to have a lower participation in follow-up. Despite the cross-country variation, the main findings are similar in the different national cohorts, and indeed the results are found to be valid also when performing a single-country analysis. Differences between countries do not seem to play a crucial role in determining the factors associated with participation in follow-up

Interferon-induced protein with tetratricopeptide repeats 5 of black fruit bat (Pteropus alecto) displays a broad inhibition of RNA viruses

Bats are natural host reservoirs and have adapted a unique innate immune system that permits them to host many viruses without exhibiting symptoms. Notably, bat interferon stimulated genes (ISGs) have been shown to play antiviral roles. Interferon induced protein with tetratricopeptide repeats 5 (IFIT5) is a well-characterised ISG in humans with antiviral activities against negative-sense RNA viruses via inhibiting viral transcription. Here, we aim to investigate if Pteropus alecto (pa) IFIT5 (paIFIT5) possess the ability to inhibit negative-sense RNA viruses. Initially, gene syntenic and comparative structural analyses of multiple animals highlighted a high level of similarity between Pteropus alecto and human IFIT5 proteins. Our results showed that paIFIT5 was significantly inducible by viral and dsRNA stimulation. Transient overexpression of paIFIT5 inhibited the replication of vesicular stomatitis virus (VSV). Using minireplicon and transcription reporter assays, we demonstrated the ability of paIFIT5 specifically to inhibit H17N10 polymerase activity. Mechanistically, we noticed that the antiviral potential of paIFIT5 against negative sense RNA viruses was retributed to its interaction with 5’ppp containing RNA. Taken together, these findings highlight the genetic and functional conservation of IFIT5 among mammals