A spatiotemporal epidemiological investigation of the impact of environmental change on the transmission dynamics of Echinococcus spp. in Ningxia Hui Autonomous Region, China

Background: Human echinococcoses are zoonotic parasitic diseases of major public health importance globally. According to recent estimates, the geographical distribution of echinococcosis is expanding and becoming an emerging and re-emerging problem in several regions of the world. Echinococcosis endemicity is geographically heterogeneous and might be affected by global environmental change over time. The aims of my research were: 1) to assess and quantify the spatiotemporal variation in land cover and climate change in Ningxia Hui Autonomous Region (NHAR); 2) to identify highly endemic areas for human echinococcoses in NHAR, and to determine the environmental covariates that have shaped the local geographical distribution of the disease; 3) to develop spatial statistical models that explain and predict the spatiotemporal variation of human exposure to Echinococcus spp. in a highly endemic county of NHAR; and 4) to analyse associations between the environment and the spatiotemporal variation of human exposure to the parasites and dog infections with Echinococcus granulosus and Echinococcus multilocularis in four echinococcosis-endemic counties of NHAR. Methods: Data on echinococcosis infections and human exposure to E. granulosus and E. multilocularis were obtained from different sources: 1) A hospital-based retrospective survey of human echinococcosis cases in NHAR between 1992 and 2013; 2) three cross-sectional surveys of school children conducted in Xiji County in 2002–2003, 2006–2007 and 2012–2013; and 3) A cross-sectional survey of human exposure and dog infections with E. granulosus and E. multilocularis conducted in Xiji, Haiyuan, Guyuan and Tongxin Counties. Environmental data were derived from high-resolution (30 m) imagery from Landsat 4/5-TM and 8-OLI and meteorological reports provided by the Chinese Academy of Sciences. Image analysis techniques and a Bayesian statistical framework were used to conduct a land cover change detection analyses and to develop regression models that described and quantified climate trends and the environmental factors associated with echinococcosis risk at different spatial scales. Results: The land cover changes observed in NHAR from 1991 to 2015 concurred with the main goals of a national policy on payments for ecosystem services, implemented in the Autonomous Region, in increasing forest and herbaceous vegetation coverages and in regenerating bareland. Statistically significant positive trends were observed in annual, summer and winter temperatures in most of the region, and a small magnitude change was found in annual precipitation, in the same 25-year period. The south of NHAR was identified as a highly endemic area for cystic echinococcosis (CE; caused by E. granulosus) and alveolar echinococcosis (AE; caused by E. multilocularis). Selected environmental covariates explained most of the spatial variation in AE risk, while the risk of CE appeared to be less spatially variable at the township level. The risk of exposure to E. granulosus expanded across Xiji County from 2002–2013, while the risk of exposure to E. multilocularis became more confined in communities located in the south of this highly endemic area. In 2012–2013, the predicted seroprevalences of human exposure to E. granulosus and dog infection with this parasite were characterised by similar geographical patterns across Xiji, Haiyuan, Guyuan and Tongxin Counties. By contrast, the predicted high seroprevalence areas for human exposure and dog infection with E. multilocularis did not coincide spatially. Climate, land cover and landscape fragmentation played a key role in explaining some of the observed spatial variation in the risk of infection with Echinococcus spp. among schoolchildren and dogs in the south of NHAR at the village level. Conclusions: The findings of this research defined populations at a high risk of human exposure to E. granulosus and E. multilocularis in NHAR. The research provides evidence on the potential effects of landscape regeneration projects on the incidence of human echinococcoses due to the associations found between the infections and regenerated land. This information will be essential to track future requirements for scaling up and targeting the control strategies proposed by the National Action Plan for Echinococcosis Control in China and may facilitate the design of future ecosystem management and protection policies and a more effective response to emerging local environmental risks. The predictive models developed as part of this research can also be used to monitor echinococcosis infections and the emergence in Echinococcus spp. transmission in the most affected areas

Effects of anti-beta 2-glycoprotein 1 antibodies and its association with pregnancy-related morbidity in antiphospholipid syndrome

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by venous, arterial, or small-vessel thrombosis and/or pregnancy-related morbidity, associated with persistent positivity of antiphospholipid antibodies (aPL). Pregnancy-related morbidity in APS patients is characterized by unexplained fetal deaths, premature birth of morphologically normal newborns, and/or consecutive pregnancy losses before the 10th week of gestation. Beta 2-glycoprotein 1 (ß2GP1) is the main antigen recognized by aPL and plays an essential role in the pathogenesis of APS. Antibodies against ß2GP1 (aß2GP1) are involved in damage-generating mechanisms in APS due to their interaction with trophoblasts, decidua, and endothelial cells. aß2GP1 might be used as a prognostic tool for obstetric risk stratification and ß2GP1 could be a target for molecular-targeted treatment to prevent pregnancy morbidity in APS. This review describes these aspects of aß2GP1, including effects on different cellular targets, its association with the severity of obstetric manifestations and the potential of ß2GP1-targeted therapies for APS

Cambios de espacios educativos: nexos o rupturas del estudiante universitario

Se presentan los resultados de una investigación cualitativa, cuyo objetivo fue comprender los nexos o rupturas que experimentan algunos estudiantes universitarios en relación con los cambios de espacios educativos, a partir de su visión de realidad con el fin de visibilizar su realidad contextual. Para ello, el método elegido fue el biográfico narrativo, donde a partir de relatos de vida se pudo evidenciar que los nexos o rupturas que experimentan los estudiantes a partir de su visión de realidad, se dan en la dinámica cotidiana en relación con dichos espacios educativos, lo que lleva al rompimiento, a la acomodación y a la construcción de una  nueva visión de la cotidianidad, a medida que los estudiantes hacen el cambio rural-local-urbano. De lo cual se desprende que no hay una real ruptura con lo que arraiga al estudiante, por tanto, es necesario enfocar la educación en el campo, desde los cambios de vida y no de ubicación, donde se atienda a lo específico de cada uno de ellos, lo que incluye fundamentalmente el acompañamiento y entendimiento de la vida en el hogar, el pueblo y la ciudad (y la visión de esta vida) desde el estudiante mismo

Spatial predictive risk mapping of lymphatic filariasis residual hotspots in American Samoa using demographic and environmental factors

Background: American Samoa successfully completed seven rounds of mass drug administration (MDA) for lymphatic filariasis (LF) from 2000–2006. The territory passed the school-based transmission assessment surveys in 2011 and 2015 but failed in 2016. One of the key challenges after the implementation of MDA is the identification of any residual hotspots of transmission. Method: Based on data collected in a 2016 community survey in persons aged ≥8 years, Bayesian geostatistical models were developed for LF antigen (Ag), and Wb123, Bm14, Bm33 antibodies (Abs) to predict spatial variation in infection markers using demographic and environmental factors (including land cover, elevation, rainfall, distance to the coastline and distance to streams). Results: In the Ag model, females had a 26.8% (95% CrI: 11.0–39.8%) lower risk of being Ag-positive than males. There was a 2.4% (95% CrI: 1.8–3.0%) increase in the odds of Ag positivity for every year of age. Also, the odds of Ag-positivity increased by 0.4% (95% CrI: 0.1–0.7%) for each 1% increase in tree cover. The models for Wb123, Bm14 and Bm33 Abs showed simi-lar significant associations as the Ag model for sex, age and tree coverage. After accounting for the effect of covariates, the radii of the clusters were larger for Bm14 and Bm33 Abs compared to Ag and Wb123 Ab. The predictive maps showed that Ab-positivity was more wide-spread across the territory, while Ag-positivity was more confined to villages in the north-west of the main island. Conclusion: The findings may facilitate more specific targeting of post-MDA surveillance activities by prioritising those areas at higher risk of ongoing transmission

Potential use of antibodies to provide an earlier indication of lymphatic filariasis resurgence in post–mass drug ad ministration surveillance in American Samoa

Background: Under the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted 7 rounds of mass drug administration (MDA) between 2000 and 2006. The territory passed transmission assessment surveys (TASs) in 2011 (TAS-1) and 2015 (TAS-2). In 2016, the territory failed TAS-3, indicating resurgence. This study aims to determine if antibodies (Abs) may have provided a timelier indication of LF resurgence in American Samoa. Methods: We examined school-level antigen (Ag) and Ab status (presence/absence of Ag- and Ab-positive children) and prevalence of single and combined Ab responses to Wb123, Bm14, and Bm33 Ags at each TAS. Pearson chi-square test and logistic regression were used to examine associations between school-level Ab prevalence in TAS-1 and TAS-2 and school-level Ag status in TAS-3. Results: Schools with higher prevalence of Wb123 Ab in TAS-2 had higher odds of being Ag-positive in TAS-3 (odds ratio [OR] 24.5, 95% confidence interval [CI] 1.2–512.7). Schools that were Ab-positive for WB123 plus Bm14, Bm33, or both Bm14 and Bm33 in TAS-2 had higher odds of being Ag-positive in TAS-3 (OR 16.0–24.5). Conclusion: Abs could provide earlier signals of resurgence and enable a timelier response. The promising role of Abs in surveillance after MDA and decision making should be further investigated in other settings

Uso de energías renovables para el abastecimiento eléctrico en una comunidad rural

Ilustraciones, fotografíasEn Colombia la calidad de vida de muchas comunidades, especialmente las rurales, se ha visto afectada por la deficiencia en la cobertura de los servicios públicos básicos debido a las difíciles condiciones climáticas, topográficas, y a la falta de acciones institucionales y gubernamentales. A pesar de esta situación, las comunidades rurales colombianas han sido resilientes y han permanecido en sus territorios, logrando, a través de métodos artesanales, el abastecimiento de algunos servicios como es el caso de los acueductos comunitarios, para proveerse de agua potable, y las letrinas y pozos sépticos para sus aguas residuales. Si embargo, con la energía eléctrica es diferente pues es un servicio que difícilmente se puede suplir sin el apoyo técnico adecuado. Afortunadamente, los avances tecnológicos y una mayor consciencia ambiental, han permitido desarrollar alternativas para suplir las necesidades energéticas de las comunidades utilizando fuentes renovables de energía que no contaminan, son funcionales, replicables e independientes de la red energética de las ciudades. Las energías renovables de mayor acceso en los territorios rurales colombianos son la energía solar y la energía hidráulica (del agua). Gracias al aprovechamiento de estas energías renovables, diferentes comunidades han encontrado una alternativa para suplir sus requerimientos básicos de energía. Un ejemplo de este aprovechamiento en el uso de energías renovables es el de la comunidad de la vereda El Arenillo, zona rural de Palmira, municipio del Valle del Cauca. En la zona alta de esta vereda se abastecen de nergía eléctrica a través de un módulo aprovechando la energía solar y de una microturbina hidráulica (“mini” central hidroeléctrica) aprovechando la energía del agua que fluye por el acueducto comunitario. Esta cartilla se constituye en un manual que contiene la información técnica referente a los componentes, la operación y el mantenimiento necesarios, tanto del módulo “El Águila solar”, módulo que es de uso comunitario y libre; como de la microturbina hidráulica “La Elvira”, que provee energía eléctrica a 5 casas de la zona alta de la vereda. Se espera que esta cartilla sea una herramienta que contribuya a que el uso de la energía renovable en la comunidad El Arenillo perdure por muchos años.Introducción, Módulo “El Águila Solar”, Partes del módulo solar, Funcionamiento, Ventajas y desventajas, Mantenimiento, Sugerencias, Microturbina hidráulica “La Elvira”, Partes del sistema, Alimentación del sistema, Microturbina y generador, Salida del sistema, Sistema de distribución eléctrica, Funcionamiento, Mantenimiento, Recomendaciones y precauciones, Anexo, Bibliografía.1° ed

Estimating the prevalence of Echinococcus in domestic dogs in highly endemic for echinococcosis

Background: Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are highly endemic in Xiji County of Ningxia Hui Autonomous Region (NHAR) in China where the control campaign based on dog de-worming with praziquantel has been undertaken over preceding decades. This study is to determine the current prevalence of Echinococcus granulosus and E. multilocularis in domestic dogs and monitor the echinococcosis transmission dynamics. Methods: Study villages were selected using landscape patterns (Geographic Information System, GIS) for Echinococcus transmission "hot spots", combined with hospital records identifying risk areas for AE and CE. A survey of 750 domestic dogs, including copro-sampling and owner questionnaires, from 25 selected villages, was undertaken in 2012. A copro-multiplex PCR assay was used for the specific diagnosis of E. granulosus and E. multilocularis in the dogs. Data analysis, using IBM SPSS Statistics, was undertaken, to compare the prevalence of the two Echinococcus spp. in dogs between four geographical areas of Xiji by the χ 2 test. Univariate analysis of the combinations of outcomes from the questionnaire and copro-PCR assay data was carried out to determine the significant risk factors for dog infection. Results: The highest de-worming rate of 84.0% was found in the northwest area of Xiji County, and significant differences (P 0.05) in the prevalence of E. granulosus in dogs from the northwest, southwest, northeast, and southeast of Xiji, but there were significant differences (P< 0.05) between dogs infected with E. multilocularis from the four areas. None of the other independent variables was statistically significant. Conclusions: The results from this study indicate a high prevalence of both E. granulosus and E. muiltilocularis in dogs in Xiji County, NHAR. Transmission of E. multilocularis was more impacted by geographical risk-factors in Xiji County than that of E. granulosus. Dogs have the potential to maintain the transmission of both species of Echinococcus within local Xiji communities, and the current praziquantel dosing of dogs appears to be ineffective or poorly implemented in this area.This study was funded by the Science Fund for Gansu Provincial Key Science and Technology Projects (No. 1203NKDA039); Special Fund for Agro-scientific Research in the Public Interest (No. 200903036–07; 201303037); West China Top Class Discipline Project in Basic Medical Sciences, Ningxia Medical University; The National Natural Science Foundation of China (No. 30960339; 81460311) and the Australian National Health and Medical Research Council (NHMRC) (project grant No. APP 1009539)

Environmental risk factors and changing spatial patterns of human seropositivity for Echinococcus spp. in Xiji County, Ningxia Hui Autonomous Region, China

Background: Human echinococcoses are parasitic helminth infections that constitute a serious public health concern in several regions across the world. Cystic (CE) and alveolar echinococcosis (AE) in China represent a high proportion of the total global burden of these infections. This study was conducted to predict the spatial distribution of human seropositivity for Echinococcus species in Xiji County, Ningxia Hui Autonomous Region (NHAR), with the aim of identifying communities where targeted prevention and control efforts are required. Methods: Bayesian geostatistical models with environmental and demographic covariates were developed to predict spatial variation in the risk of human seropositivity for Echinococcus granulosus (the cause of CE) and E. multilocularis (the cause of AE). Data were collected from three cross-sectional surveys of school children conducted in Xiji County in 2002-2003, 2006-2007 and 2012-2013. Environmental data were derived from high-resolution satellite images and meteorological data. Results: The overall seroprevalence of E. granulosus and E. multilocularis was 33.4 and 12.2%, respectively, across the three surveys. Seropositivity for E. granulosus was significantly associated with summer and winter precipitation, landscape fragmentation variables and the extent of areas covered by forest, shrubland, water and bareland/artificial surfaces. Seropositivity for E. multilocularis was significantly associated with summer and winter precipitations, landscape fragmentation variables and the extent of shrubland and water bodies. Spatial correlation occurred over greater distances for E. granulosus than for E. multilocularis. The predictive maps showed that the risk of seropositivity for E. granulosus expanded across Xiji during the three surveys, while the risk of seropositivity for E. multilocularis became more confined in communities located in the south. Conclusions: The identification of high-risk areas for seropositivity for these parasites, and a better understanding of the role of the environment in determining the transmission dynamics of Echinococcus spp. may help to guide and monitor improvements in human echinococcosis control strategies by allowing targeted allocation of resources.We acknowledge financial support by the National Health and Medical Research Council (NHMRC) of Australia (APP1009539). AMCR is a PhD Candidate supported by a Postgraduate Award from The Australian National University and ACAC is a NHMRC Senior Research Fellow. DPM is a NHMRC Senior Principal Research Fellow and DJG is a NHMRC Career Development Fello

Spatial prediction of the risk of exposure to Echinococcus spp. among schoolchildren and dogs in Ningxia Hui Autonomous Region, People's Republic of China

The geographical distribution of Echinococcus spp. infections in Ningxia Hui Autonomous Region (NHAR) has been reported to be expanding in response to environmental change. The aim of the present study was to predict and compare the spatial distribution of human seropositivity for Echinococcus granulosus and Echinococcus multilocularis and infections with these parasites in dogs in four counties in the south of NHAR to identify communities where targeted prevention and control efforts are required. Predicted seroprevalence of E. granulosus in schoolchildren and E. granulosus infections in dogs concurred spatially, whereas predicted seroprevalence of E. multilocularis in schoolchildren and E. multilocularis infections in dogs differed spatially. Enhanced vegetation index was significantly associated with E. multilocularis seropositivity among schoolchildren, and infections with E. granulosus and E. multilocularis in dogs. A positive association was also found between dog infection with E. granulosus and cultivated land, and a negative association between human seropositivity for E. granulosus and bare-land/artificial surfaces. The findings of this study support the importance of land cover and climatic variables in determining habitat suitability for Echinococcus spp. infections, and suggest that definitive hosts other than dogs (e.g. foxes) are important in defining the geographical risk of human seropositivity for E. multilocularis in NHAR.the authors acknowledge financial support by the National Health and Medical Research Council (NHMRC) of Australia (APP1009539)