Promoting Appropriate Antibiotic Use: Teaching Doctors, Teaching Patients

Antibiotic resistance is a major public health threat that requires an organized, comprehensive approach to overcome. Many studies have shown that integrating education programs for clinicians, medical office staff, patients, and targeted audiences such as day care providers make the biggest difference in community-wide antibiotic use. We describe such an integrated approach between our state’s public health programs and our developing curriculum for primary care residents based at the academic health center. Patients receive education directly from both the state programs and their clinicians during office visits for upper respiratory infections. Physicians learn principles of appropriate antibiotic use, how best to educate patients about this important health topic, and how to address patients’ concerns about their illnesses

Blocking the evolution of insecticide-resistant malaria vectors with a microsporidian

Finding a way to block the evolution insecticide resistance would be a major breakthrough for the control of malaria. We suggest that this may be possible by introducing a stress into mosquito populations that restores the sensitivity of genetically resistant mosquitoes and that decreases their longevity when they are not exposed to insecticide. We use a mathematical model to show that, despite the intense selection pressure imposed by insecticides, moderate levels of stress might tip the evolutionary balance between costs and benefits of resistance toward maintaining sensitivity. Our experimental work with the microsporidian parasite Vavraia culicis infecting two lines of resistant mosquitoes and a sensitive line suggests that it may indeed be possible to stress the mosquitoes in the required way. The mortality of resistant mosquitoes 24 h after exposure to the insecticide was up to 8.8 times higher in infected than in uninfected ones; if mosquitoes were not exposed to the insecticide, resistant mosquitoes infected by the microsporidian lived about half as long as uninfected ones and insecticide-sensitive mosquitoes (with or without the parasite). Our results suggest that biopesticides or other insecticides that interfere with the expression of resistance may help to manage insecticide resistance in programs of malaria control

Innovative Environments: The Equity Culture Audit: An Essential Tool for Improving Schools in Kentucky

In the last twenty years, the state of Kentucky has passed legislative initiatives to address the education needs of its children. Even with the implementation of the progressive laws that were passed, many formidable challenges still confront education delivery in the State. This article introduces and describes the utilization of the Equity-Culture audit as an invaluable tool for data collection and school culture assessment. The authors examine the significance of the role played by leadership in the creation and maintenance of a school\u27s culture. In addition, there is a discussion of how systemic change in districts and schools can be achieved by assessing and transforming their cultures and climates. Organizational change in schools requires active involvement and direction from the instructional leadership. The article also provides a brief account of Equity-Culture audits conducted in the state. Attention is devoted to the informative revelations of the findings and the data-rich value of these audits. Descriptions of how Equity-Culture audits serve as powerful data collection instruments for indentifying problematic issues and developing viable solutions for challenged schools are examined

Temperature during larval development and adult maintenance influences the survival of Anopheles gambiae s.s.

BACKGROUND: Malaria transmission depends on vector life-history parameters and population dynamics, and particularly on the survival of adult Anopheles mosquitoes. These dynamics are sensitive to climatic and environmental factors, and temperature is a particularly important driver. Data currently exist on the influence of constant and fluctuating adult environmental temperature on adult Anopheles gambiae s.s. survival and on the effect of larval environmental temperature on larval survival, but none on how larval temperature affects adult life-history parameters. METHODS: Mosquito larvae and pupae were reared individually at different temperatures (23 ± 1°C, 27 ± 1°C, 31 ± 1°C, and 35 ± 1°C), 75 ± 5% relative humidity. Upon emergence into imagoes, individual adult females were either left at their larval temperature or placed at a different temperature within the range above. Survival was monitored every 24 hours and data were analysed using non-parametric and parametric methods. The Gompertz distribution fitted the survivorship data better than the gamma, Weibull, and exponential distributions overall and was adopted to describe mosquito mortality rates. RESULTS: Increasing environmental temperature during the larval stages decreased larval survival (p < 0.001). Increases of 4°C (from 23°C to 27°C, 27°C to 31°C, and 31°C to 35°C), 8°C (27°C to 35°C) and 12°C (23°C to 35°C) statistically significantly increased larval mortality (p < 0.001). Higher environmental temperature during the adult stages significantly lowered adult survival overall (p < 0.001), with increases of 4°C and 8°C significantly influencing survival (p < 0.001). Increasing the larval environment temperature also significantly increased adult mortality overall (p < 0.001): a 4°C increase (23°C to 27°C) did not significantly affect adult survival (p > 0.05), but an 8°C increase did (p < 0.05). The effect of a 4°C increase in larval temperature from 27°C to 31°C depended on the adult environmental temperature. The data also suggest that differences between the temperatures of the larval and adult environments affects adult mosquito survival. CONCLUSIONS: Environmental temperature affects Anopheles survival directly during the juvenile and adult stages, and indirectly, since temperature during larval development significantly influences adult survival. These results will help to parameterise more reliable mathematical models investigating the potential impact of temperature and global warming on malaria transmission. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13071-014-0489-3) contains supplementary material, which is available to authorized users

Predicting the impact of outdoor vector control interventions on malaria transmission intensity from semi-field studies

BACKGROUND: Semi-field experiments with human landing catch (HLC) measure as the outcome are an important step in the development of novel vector control interventions against outdoor transmission of malaria since they provide good estimates of personal protection. However, it is often infeasible to determine whether the reduction in HLC counts is due to mosquito mortality or repellency, especially considering that spatial repellents based on volatile pyrethroids might induce both. Due to the vastly different impact of repellency and mortality on transmission, the community-level impact of spatial repellents can not be estimated from such semi-field experiments. METHODS: We present a new stochastic model that is able to estimate for any product inhibiting outdoor biting, its repelling effect versus its killing and disarming (preventing host-seeking until the next night) effects, based only on time-stratified HLC data from controlled semi-field experiments. For parameter inference, a Bayesian hierarchical model is used to account for nightly variation of semi-field experimental conditions. We estimate the impact of the products on the vectorial capacity of the given Anopheles species using an existing mathematical model. With this methodology, we analysed data from recent semi-field studies in Kenya and Tanzania on the impact of transfluthrin-treated eave ribbons, the odour-baited Suna trap and their combination (push-pull system) on HLC of Anopheles arabiensis in the peridomestic area. RESULTS: Complementing previous analyses of personal protection, we found that the transfluthrin-treated eave ribbons act mainly by killing or disarming mosquitoes. Depending on the actual ratio of disarming versus killing, the vectorial capacity of An. arabiensis is reduced by 41 to 96% at 70% coverage with the transfluthrin-treated eave ribbons and by 38 to 82% at the same coverage with the push-pull system, under the assumption of a similar impact on biting indoors compared to outdoors. CONCLUSIONS: The results of this analysis of semi-field data suggest that transfluthrin-treated eave ribbons are a promising tool against malaria transmission by An. arabiensis in the peridomestic area, since they provide both personal and community protection. Our modelling framework can estimate the community-level impact of any tool intervening during the mosquito host-seeking state using data from only semi-field experiments with time-stratified HLC

New Perspectives on Transforming States' Health and Human Services: Practical Commentaries on the First Year of the Work Support Strategies Initiative

Millions of low-income working families in America today are struggling to make ends meet. While working hard, often in low-wage jobs, many of these families are living close to the edge of hardship and have little or no resources to fall back on in case of emergencies. Public benefit programs can make a huge difference in the well-being of these working families, providing help with food, child care, and health insurance expenses. These programs help families address immediate needs and weather short-term crises, such as repairing a car needed to get to work or dealing with an unexpected health problem. They can make it possible for families to hold onto their jobs in these emergencies, stabilizing employment and keeping families from falling further into poverty. Yet many families that are eligible for public benefit programs do not participate. Although the recession and its aftermath led to unprecedented increases in receipt of nutrition assistance through the federal Supplemental Nutrition Assistance Program (SNAP), the latest data (from 2010) show that only 65 percent of the eligible working poor are participating. Similarly, of all children eligible for public health insurance coverage through Medicaid or the Children's Health Insurance Program, only 86 percent are participating. The participation rate for public health insurance for parents is only 66 percent. And, these participation rates vary widely across states.The Work Support Strategies, or WSS, Initiative is motivated by the value public benefit programs can provide to working families and the belief that the states and localities administering these programs can improve how eligible families access and retain these benefits. In the first year of the demonstration, nine states took on the challenge of streamlining, integrating, and improving the provision of work support benefits through their SNAP, Medicaid, and child care programs (and, in some states, additional programs such as heating assistance and cash welfare). While most states hope their efforts will also reduce burden on caseworkers and administrative costs in these systems, all are motivated to improve the lives of the families they serve

Developing a Wellbeing Framework for Aboriginal and Torres Strait Islander Peoples Living with Chronic Disease (Wellbeing Study)

Addressing a need identified by Aboriginal and Torres Strait Islander peoples and their primary healthcare providers, this study developed a Wellbeing Framework for managing chronic disease in a manner that also supports wellbeing. Chronic care models that are currently in use usually focus upon the systems, resources and policies that are required to deliver care. The important roles of culture, spirituality, Country and family in maintaining health and wellbeing are notably absent from such models. Re-defining the way in which care is delivered to reflect Aboriginal and Torres Strait Islander peoples’ needs and values is essential for improving the accessibility and acceptability of primary healthcare services.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy