Field evaluation of a recombinant glutathione S-transferase-based pyrethroid quantification assay

A recombinant glutathione S-transferase (GST)-based pyrethroid quantification assay was field-tested in Ifakara, Tanzania. Initial laboratory tests suggested that all reagents used in the assay should be sufficiently stable for field use, provided that domestic refrigeration facilities were available. Insecticide-impregnated bednets were collected from a region where a social marketing programme was in progress. A total of 100 bednets were collected and the assay plus standard HPLC analysis was performed on the residues extracted from four replicate areas of each net. Insecticide residue estimations for assays performed on white and pale green bednet samples were accurate when compared with residue analysis by HPLC. However, for dark green or blue bednets, there was no correlation between the GST-based assay and HPLC pyrethroid quantification results. The assay failure with the dark coloured nets was caused by the extraction of the dyes along with the insecticide, which subsequently interfered with the GST assay. When the same samples were analysed by HPLC, the dyes were separated from the insecticide by reverse phase column chromatography and hence did not affect the result

Past, Present, and Future of Japanese Encephalitis

JE is increasing in some areas (due to population growth and intensified rice irrigation) but declining in others

Cancer Predisposition Cascade Screening for Hereditary Breast/Ovarian Cancer and Lynch Syndromes in Switzerland: Study Protocol

Background : Breast, colorectal, ovarian, and endometrial cancers constitute approximately 30% of newly diagnosed cancer cases in Switzerland, affecting more than 12,000 individuals annually. Hundreds of these patients are likely to carry germline pathogenic variants associated with hereditary breast ovarian cancer (HBOC) or Lynch syndrome (LS). Genetic services (counseling and testing) for hereditary susceptibility to cancer can prevent many cancer diagnoses and deaths through early identification and risk management. Objective : Cascade screening is the systematic identification and testing of relatives of a known mutation carrier. It determines whether asymptomatic relatives also carry the known variant, needing management options to reduce future harmful outcomes. Specific aims of the CASCADE study are to (1) survey index cases with HBOC or LS from clinic-based genetic testing records and determine their current cancer status and surveillance practices, needs for coordination of medical care, psychosocial needs, patient-provider and patient-family communication, quality of life, and willingness to serve as advocates for cancer genetic services to blood relatives, (2) survey first- and second-degree relatives and first-cousins identified from pedigrees or family history records of HBOC and LS index cases and determine their current cancer and mutation status, cancer surveillance practices, needs for coordination of medical care, barriers and facilitators to using cancer genetic services, psychosocial needs, patient-provider and patient-family communication, quality of life, and willingness to participate in a study designed to increase use of cancer genetic services, and (3) explore the influence of patient-provider communication about genetic cancer risk on patient-family communication and the acceptability of a family-based communication, coping, and decision support intervention with focus group(s) of mutation carriers and relatives. Methods: CASCADE is a longitudinal study using surveys (online or paper/pencil) and focus groups, designed to elicit factors that enhance cascade genetic testing for HBOC and LS in Switzerland. Repeated observations are the optimal way for assessing these outcomes. Focus groups will examine barriers in patient-provider and patient-family communication, and the acceptability of a family-based communication, coping, and decision-support intervention. The survey will be developed in English, translated into three languages (German, French, and Italian), and back-translated into English, except for scales with validated versions in these languages. Results: Descriptive analyses will include calculating means, standard deviations, frequencies, and percentages of variables and participant descriptors. Bivariate analyses (Pearson correlations, chi-square test for differences in proportions, and t test for differences in means) will assess associations between demographics and clinical characteristics. Regression analyses will incorporate generalized estimating equations for pairing index cases with their relatives and explore whether predictors are in direct, mediating, or moderating relationship to an outcome. Focus group data will be transcribed verbatim and analyzed for common themes. Conclusions: Robust evidence from basic science and descriptive population-based studies in Switzerland support the necessity of cascade screening for genetic predisposition to HBOC and LS. CASCADE is designed to address translation of this knowledge into public health interventions. Trial Registration: ClinicalTrials.gov NCT03124212; https://clinicaltrials.gov/ct2/show/NCT03124212 (Archived by WebCite at http://www.webcitation.org/6tKZnNDBt

Colombia: Doctoral Excursion, Earth Sciences Department ETH Zurich, August 21 – September 5, 2018

Field guide of Doctoral Excursion to Colombia, co-organized by Luz M. Mejia, R.Ott, L. Echeverria-Pazos, E. Erlanger. Chapter 11: Climate Change Effects on Colombian Biodiversity written by Luz M. Mejia and B. Revels

Impact on health caused by water resources development and management projects and health impact assessment as a tool for mitigation

Since the rise of early civilisations people have adapted and modified water bodies for their use. Water is made available through dams, wells, canals and other infrastructure to provide drinking water for households and livestock and to feed irrigated agriculture. Despite myriad benefits due to water resources development and management there are also adverse effects. Certain components of it can facilitate the transmission of infectious diseases or impact the psychosocial conditions of affected communities and individuals. The framework of this PhD thesis is built around ascertaining the nature and scale of health impacts caused by water resources development and management projects in order to facilitate the prevention and mitigation of these impacts. Part I deals with dams and with health issues in connection with the construction of the Nam Theun 2 hydroelectric project (NT2) in the Lao People’s Democratic Republic. Part II discusses the role of health impact assessment (HIA) as a tool for the systematic appraisal of positive and negative health effects of projects, programmes and policies. Part III focuses on the impact of water resources development and management projects on the transmission of lymphatic filariasis and Japanese encephalitis. In Part IV the effectiveness of different methods for dengue vector control is analysed. Part I: Dams can positively or negatively impact various aspects of health. Dam projects can generate revenue for development and increase the output of agricultural production by feeding irrigation systems. Negative impacts from constructions may include the proliferation of vectors that transmit infectious diseases, mental health problems in resettled communities or increased rates of sexually-transmitted infections around work camps. The analysis of baseline health data of the people in the two areas (the Nakai plateau where the dam will be located and Xe Bang Fai downstream area where the water will be discharged) that are in proximity to the NT2 project revealed that malnutrition is a considerable public health issue. 56% of the children younger than 5 years in Nakai and 36% of the children in Xe Bang Fai were estimated to be underweight. Infection with intestinal nematodes was another significant public health problem. An infection with Ascaris lumbricoides was found in 68% and hookworms in 9.7% of the population surveyed on the Nakai plateau. Malaria was of less importance and due to expected reduction of the vector’s habitat (deforestation), malaria prevalence may further decrease in the future. The NT2 project also has large potential to improve health. Increased incomes through construction and development could improve the nutritional situation and the construction of water and sanitation systems in the resettlement villages may lead to an overall decrease in the prevalence of infectious diseases. Analysis of existing data on health seeking behaviour showed substantial differences between the highland Nakai community and the lowland Xe Bang Fai communities. Self-treatment with anti-malarial drugs (chloroquine and sulfadoxine-pyrimethamine) was practiced by 32% and 7% of the people with malaria symptoms in Xe Bang Fai in Nakai, respectively. The mean amount spent per person for one consultation was US$1.7 in Nakai and US$ 7.2 in Xe Bang Fai. Part II: Health impact assessment of projects, programmes and policies is a methodology that aims at identifying and mitigating negative health effects and enhancing positive ones. Over the past two decades, HIA has been developed, and has become an integral part of public-health policies in industrialised countries. However, in the developing world, the institutionalisation of HIA still has some distance to go. We assessed and quantified the number of HIA related publications in the peer-reviewed literature and discussed the need for conducting HIA in the developing world, which can be clearly seen in petroleum and water resources development projects. A systematic literature search revealed that less than 6% of the publications had a specific focus on developing countries. Hence, there is a pressing need for HIA in the developing world, particularly in view of current predictions of major petroleum and water resources development projects, and China’s increasing investment in the oil and water sectors across Africa. Vector-borne and water-based diseases, for example, are key public-health issues in tropical and sub-tropical environments. Major infrastructural projects can induce environmental change which in turn might spur transmission of those diseases. Since the Chinese government and Chinese enterprises currently lack experience in conducting HIA, we argue that these projects are unlikely to be built and operated in an environmentally and public health friendly manner. We suggest that binding international regulations should be created to insure that projects, programmes and policies undergo HIA, particularly if they are constructed in the developing world. Part III: In this study we investigated the impact of irrigation on the transmission of Japanese encephalitis. Currently, there are approximately 220 million people living in proximity to irrigated agriculture. Over the past 40 years, the land area irrigated for rice cultivation increased by 22% in Japanese encephalitis-endemic countries. This may contribute to the steadily increasing incidence of Japanese encephalitis in those countries. We show that intermittent irrigation could interrupt the life cycle of the vector Culex tritaeniorhynchus, which could lead to an elimination of up to 91% of the immature stages of the vector. In a second study, we calculated that worldwide over 2 billion people are at risk of lymphatic filariasis. Of those, 213 million live in proximity to irrigated agriculture and 394.5 million live in urban areas with inadequate sanitation facilities. In Bangladesh, India, Myanmar and Nepal alone, we find 52% of the burden, 29% of the people at risk, 69% of the size of the population at risk due to proximity to irrigated land and 33% of the population that lacks of improved sanitation. Water resources development and management can lead to a proliferation of the following vectors: Anopheles gambiae, An. funestus, An. barbirostris, Cx. quinquefasciatus, Cx. pipiens pipiens, Cx. antennatus and Aedes polynesiensis. However, it can also curb the breeding of An. pharoensis, An. melas, An. subpictus und Ae. samoanus. We argue that there is a considerable need to investigate the impact of water resources development and management on clinical parameters of lymphatic filariasis. Part IV: Dengue, which is transmitted by Ae. aegypti and Ae. albopictus, is the most prevalent arboviral disease. The global incidence of dengue is 50-100 million cases annually, with up to 500,000 resulting in hemorrhagic fever or dengue shock syndrome. The vectors show breeding preferences for domestic water containers. Vector control remains the cornerstone for the prevention and control of dengue, however, there is a paucity of evidence regarding the effectiveness and applicability of different vector control methods. We conducted a systematic literature search and identified 56 publications. From these, we could extract relevant data about 61 dengue vector control interventions, trials and programmes. By means of a meta-analysis we compared the effectiveness of chemical control, biological control, environmental management and integrated vector management (several methods combined). We found that integrated vector management is the most effective method to reduce the Breteau index (number of containers per 100 houses infected with dengue vectors), the house index (percent of houses with infected containers) and the container index (percent of containers infected), resulting in random combined relative effectiveness of 0.33, 0.17, and 0.12, respectively (0 means complete elimination of breeding comtainers, whereas 1 reflects no change). Environmental control showed a relatively low effectiveness, i.e. 0.71 for the Breteau index, 0.43 for the house index and 0.49 for the container index. Biological control usually targeted a small number of people (median population size: 200; range: 20-2500), whereas integrated vector management focused on larger populations (median: 12,450; range: 210- 9,600,000)

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times

Do fathers care about their own immunisation status? The Child-Parent-Immunisation Survey and a review of the literature

AIMS We recently conducted a large survey amongst parents of young children exploring attitudes concerning immunisation and the general immunisation status of the children and their parents in Switzerland. Since little is known about the immunisation status of fathers of young children, we present our findings here; data on mothers were previously published elsewhere. METHODS We performed standardised interviews with parents of children born on or after 1 January 2013, and hospitalised at the University of Basel Children’s Hospital, Switzerland, between January and June 2017. If participation was declined, partial consent was sought for four questions regarding age, education level, attitudes towards vaccinations in general and availability of vaccination records of the parents. To compare our study results with other studies focusing on the completeness of the immunisation status of fathers, we conducted a literature search using broad search terms for studies published between 1 April 2009 and 1 December 2019. RESULTS Thirty-nine (20%) fathers of 199 enrolled children participated. The great majority had a positive or mostly positive attitude towards vaccinations, but only 2 (15%) of 13 fathers who participated in immunisation counselling were up-to-date with all generally recommended immunisations. Fifty-two percent of participating fathers reported that the last assessment of their immunisation status by a physician was >5 years ago. After the birth of their child, 56% of fathers had received a recommendation for immunisation against pertussis and 65% of them followed the recommendation. We identified three studies matching our review’s inclusion criteria. None of them reported specific findings for fathers. CONCLUSIONS This is the first study to analyse the complete immunisation status of fathers of young children. It is often incomplete with potentially missed opportunities for updating vaccinations during recent physician consultations. The low participation rate of fathers is a limitation which prohibits generalisation of our findings. However, as healthcare personnel have been shown to have the strongest impact on vaccination uptake, we propose that this group be further sensitised and educated with the goal of improving immunisation rates in fathers of young children