Evaluating the impact of individual, social, and environmental factors on bed net use for malaria prevention

The number of malaria cases in the world has been declining over the past decade, in large part due to the use of insecticide treated bed nets. There have been numerous studies evaluating where, when, and why people use nets. Some of the most widely explored factors that influence net use are socio-demographic characteristics including age, gender, and socio-economic status. In response to the implementation of social and behavior change communication about nets, more recent studies have focused on emotional, cognitive, and social predictors of net use. There is also evidence of climatic factors such as rainfall and temperature affecting net use, and qualitative research has reported decreased net use during the dry season due to perceptions of being too hot under a net as well as increased use during the rains due to increases in perceived nuisance biting. One of the most important considerations when evaluating net use behavior is whether an individual had access to a net to use in the first place. The objective of this thesis was to evaluate how individual, household, social, and environmental factors impact bed net use, especially among individuals with access to a net in their household. This was done by defining ideational theory in the context of malaria control and modeling how ideation about bed nets can affect net use, in addition to evaluating the role of ideational factors at individual, household, and community levels. Also important was understanding individuals’ propensity to purchase nets, and how particular beliefs and family settings affect this propensity. Finally, this thesis assessed how bed net use was influenced by different ecological factors among individuals with access to a net

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

CFTR modulator use and risk of nontuberculous mycobacteria positivity in cystic fibrosis, 2011–2018

Background People with cystic fibrosis are at increased risk of pulmonary nontuberculous mycobacteria (NTM) disease. Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are associated with reduced lung infection with pathogens like Pseudomonas aeruginosa and Staphylococcus aureus. This association has not been studied with NTM. Methods Using encounter-level data from the US Cystic Fibrosis Foundation Patient Registry from 2011 to 2018, we identified individuals aged >12 years with one or more NTM-negative sputum culture and information on receipt of ivacaftor therapy. We used a Cox proportional hazards model to assess the relationship between CFTR modulator usage (any and monotherapy versus combination therapy) and NTM sputum culture positivity, controlling for sex, least severe class of CFTR mutation, receipt of chronic macrolides, age, body mass index and percentage predicted forced expiratory volume. Results Out of 25 987 unique individuals, 17 403 individuals met inclusion criteria. During follow-up, 42% of individuals received CFTR modulator therapy, and 23% had incident NTM. The median (interquartile range) time to event was 6.1 (4.0–7.3) years for those ever receiving CFTR modulators compared to 4.0 (1.6–6.5) years in those never receiving CFTR modulators. CFTR modulator use was associated with a significantly reduced hazard of NTM culture positivity (hazard ratio (HR) 0.88, 95% CI 0.79–0.97); there was no significant difference in the hazard between those receiving ivacaftor monotherapy versus combination therapy (combination HR 1.01, 95% CI 0.79–1.23). Conclusions CFTR modulator therapy is associated with a decreased risk of NTM positivity in individuals with cystic fibrosis

COVID-19 risk perception and vaccine acceptance in individuals with self-reported chronic respiratory or autoimmune conditions

Abstract Background COVID-19 disproportionately affects those with preexisting conditions, but little research has determined whether those with chronic diseases view the pandemic itself differently - and whether there are differences between chronic diseases. We theorized that while individuals with respiratory disease or autoimmune disorders would perceive greater threat from COVID-19 and be more supportive of non-pharmaceutical interventions (NPIs), those with autoimmune disorders would be less likely to support vaccination-based interventions. Methods We conducted a two-wave online survey conducted in February and November 2021 asking respondents their beliefs about COVID-19 risk perception, adoption and support of interventions, willingness to be vaccinated against COVID-19, and reasons for vaccination. Regression analysis was conducted to assess the relationship of respondents reporting a chronic disease and COVID-19 behaviors and attitudes, compared to healthy respondents adjusting for demographic and political factors. Results In the initial survey, individuals reporting a chronic disease had both stronger feelings of risk from COVID-19 as well as preferences for NPIs than healthy controls. The only NPI that was still practiced significantly more compared to healthy controls in the resample was limiting trips outside of the home. Support for community-level NPIs was higher among individuals reporting a chronic disease than healthy controls and remained high among those with respiratory diseases in sample 2. Vaccine acceptance produced more divergent results: those reporting chronic respiratory diseases were 6% more willing to be vaccinated than healthy controls, while we found no significant difference between individuals with autoimmune diseases and healthy controls. Respondents with chronic respiratory disease and those with autoimmune diseases were more likely to want to be vaccinated to protect themselves from COVID-19, and those with an autoimmune disease were more likely to report fear of a bad vaccine reaction as the reason for vaccine hesitancy. In the resample, neither those with respiratory diseases nor autoimmune diseases reported being more willing to receive a booster vaccine than healthy controls. Conclusions It is not enough to recognize the importance of health in determining attitudes: nuanced differences between conditions must also be recognized

Hospital-based antibiotic use in patients with Mycobacterium avium complex

Treatment guidelines exist for pulmonary Mycobacterium avium complex (MAC) infection, although studies suggest poor concordance in clinician practice. Using a national database including hospital encounters of laboratory-confirmed MAC patients, we sought to characterise US treatment practices. We assessed patients in the Premier Healthcare Database from 2009 to 2013 with two or more MAC-positive cultures or one MAC-positive culture and the International Classification of Diseases (9th revision) code for pulmonary nontuberculous mycobacteria (PNTM). Treatment was characterised by patient-, provider- and facility-level factors; significant differences were assessed (p<0.05). Multilevel Poisson regression estimated adjusted relative risks (aRR) of receiving guidelines-based or macrolide resistance-promoting regimens. Of 1326 MAC patients, 645 (49%) received treatment: 10% received guidelines-based treatment and 18% resistance-associated therapy. Patients were more likely to receive guidelines-based therapy if they had multiple hospital encounters (aRR 1.5), codes for PNTM (aRR 5.7) or tuberculosis (aRR 4.5) or radiological procedures (aRR 10.9); multiple hospital encounters (aRR 0.8) or a tuberculosis code (aRR 0.1) were less likely to be associated with receiving resistance-promoting regimens. In hospital-based MAC patients, half received antibiotics active against MAC, a low proportion received therapy based on MAC guidelines and many received antibiotics that promote macrolide resistance. Improved implementation of guidelines-based treatment is needed to decrease use of regimens associated with macrolide resistance

Associations between ideational variables and bed net use in Madagascar, Mali, and Nigeria

Abstract Background The use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts. Methods Sampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use. Results In all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative). Conclusion This research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control

Incidence of Nontuberculous Mycobacterial Pulmonary Infection, by Ethnic Group, Hawaii, USA, 2005–2019

To further clarify differences in the risk for nontuberculous mycobacterial pulmonary infection (NTM-PI) among ethnic populations in Hawaii, USA, we conducted a retrospective cohort study among beneficiaries of Kaiser Permanente Hawaii (KPH). We abstracted demographic, socioeconomic, clinical, and microbiological data from KPH electronic health records for 2005–2019. An NTM-PI case-patient was defined as a person from whom >1 NTM pulmonary isolate was obtained. We performed Cox proportional hazards regression to estimate incidence of NTM-PI while controlling for confounders. Across ethnic groups, risk for NTM-PI was higher among persons who were underweight (body mass index [BMI] <18.5 kg/m2). Among beneficiaries who self-identified as any Asian ethnicity, risk for incident NTM-PI was increased by 30%. Low BMI may increase susceptibility to NTM-PI, and risk may be higher for persons who self-identify as Asian, independent of BMI