High Diversity of Trypanosoma Cruzi Discrete Typing Units Circulating in Triatoma in Western Mexico

Chagas disease is caused by the protozoan parasite Trypanosoma cruzi, which is transmitted to domestic and sylvatic mammals via the feces of hematophagous hemiptera of the subfamily Triatominae (Reduviidae). Trypanosoma cruzi is found only in the Americas and displays remarkable genetic diversity. Seven discrete typing units (DTUs) are currently recognized (TcI–TcVI and TcBat). In Jalisco, Mexico, where Chagas disease has a high prevalence rate, TcI has historically been the only DTU reported. This study focused on the molecular identification of T. cruzi DTUs circulating in Triatoma near the Estación de Biología Chamela, on the southwest coast of Jalisco, Mexico. I collected DNA from 95 Triatoma bugs. Trypanosoma cruzi infection was detected using PCR primers specific for the minicircle variable region of the parasite’s kinetoplast DNA (kDNA). Trypanosoma cruzi DTUs were identified by amplifying the intergenic region of the mini-exon, and the genes 24Sα, 18S, TcSC5D, and TcMK. Two species of Triatoma were collected, Triatoma longipennis and T. bolivari, with an overall infection rate of 59%. There was high genetic diversity of T. cruzi in my samples, with the DTUs TcI, TcII, TcIV, TcVI, and Tcbat being identified. This is the first report of TcVI and Tcbat in North America. In the Triatoma found to be infected, 96% had TcI, 35% TcII, 2% TcIV, 25% TcVI, and 2% Tcbat. Several vertebrate hosts for Triatoma were also identified from visible blood within Triatominaes’ gut using PCR primers for cytochrome b and cytochrome oxidase subunit I genes. My observations indicate a much higher diversity of T. cruzi DTUs in Triatoma than previously reported in Jalisco. The results have important implications for understanding the geographical distribution of T. cruzi DTUs and epidemiology of Chagas disease in Mexico

New York State Profile of Young Children in Deep Poverty

Young children in families experiencing deep poverty – those with incomes below 50 percent of the federal poverty line -- are likely to experience severe early adversities that contribute to poor health and education outcomes. This brief offers information about young children, age birth to nine, living in deep poverty in New York State, and about policies that could support their healthy development and success. It includes information about the state and county-level prevalence and characteristics of these children and recommendations for strengthening family and work support policies and developing new two-generation policies that could promote better outcomes for young children and families in deep poverty

Learning about Young Children's Challenging Behavior and Impacts on Programs and Families: A State-wide Survey of Virginia's Early Care and Education Teachers

This report presents the efforts of leaders in Virginia to learn more about teachers’ experience with children who demonstrate challenging behavior in center-based and home-based ECE settings. These leaders partnered with the National Center for Children in Poverty (NCCP) to design and implement a survey of Virginia’s ECE teachers that serve infants, toddlers, and preschoolers. The survey and analysis of responses examined the following questions: How common are different types of challenging behavior? How many children with challenging behavior, in different age groups, do teachers have in their classrooms or child care homes in the course of a year? What are the consequences of challenging behavior, and how often does removal from the ECE setting occur? What are the family circumstances of children with challenging behavior? How do teachers address challenging behavior and what barriers do they face? What factors contribute to the incidence of children with challenging behavior and removal from programs? What supports do teachers believe will help them address the needs of children with challenging behavior

How States Use Medicaid to Cover Key Infant and Early Childhood Mental Health Services: Results of a 50-State Survey (2018 Update)

There is now substantial evidence that young children’s mental health plays a critical role in their early learning and school readiness, long-term school success and self-sufficiency, and future health and mental health outcomes. Fortunately, many states are working to strengthen supports for infants’ and young children’s mental health. This brief examines states’ Medicaid coverage for key infant and early childhood mental health (IECMH) services, along with policies that contribute to service access and quality. It presents the results of an updated 50-state survey that gathered information from state administrators about Medicaid coverage and policies related to the following services for children from birth to age 6: Child screening for social-emotional problems; Maternal depression screening in pediatric and family medicine settings; Developmentally appropriate diagnosis using DC:0–5; Family navigators to help families access services; Mental health services in pediatric, child care and early education, and home settings; Dyadic (parent-child) treatment; Parenting programs to address child mental health need

Racial Differences in the Effectiveness of Total Knee Arthroplasty (TKA) on Postoperative Pain and Function

Objective: African Americans are less likely than Caucasians to perceive TKA as an effective treatment option. We examined post-TKA pain and function by race, with and without adjusting for demographic and clinical factors on determining racial differences. Methods: We analyzed data from FORCE-TJR, a national cohort of TJR patients. Patients had primary and unilateral TKA surgeries 07/01/2011-12/31/2014, and completed surveys on demographic and clinical information, including a pre- and 6-month postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS). The KOOS pain and function scores ranged from 0-100 (higher=better). We examined baseline, 6-month, and 6-month change in pain and function by race, and estimated the association between race and outcomes, adjusting for demographic and clinical factors. Results: Analyses included 5028 white (63% female, 65% income\u3e45k; mean age of 67. BMI of 31) and 270 black patients (80% female, 39% income\u3e45k; mean age of 63, BMI of 34). At baseline, black compared with white patients reported worse knee pain (mean: 39vs.48), and poorer function (mean: 46vs.54). While all patients reported significant gains at 6-month post-surgery, black patients had lower postoperative pain (mean: 71vs.82) and function scores (mean: 73vs.84) than white patients. Although not statistically significant, black patients on average had lower 6-month change than white patients in pain -1.9 (95%CI: -4.4, 0.6) and function -1.6 (95%CI: -3.9, 0.7). Adjusting for covariates, racial differences were significantly more pronounced in change in pain -5.5 (95%CI: -8.3, -2.7) and function -5.6 (95%CI: -8.2, -3.0). Conclusions: TKAs were as effective in reducing pain and improving functions in blacks as in whites. Adjusting for certain demographic and clinical factors can impact assessment of racial differences and the effectiveness of TKA on postoperative outcomes, as black patients were very different from white patients on these important factors

Improvement in mental health following total hip arthroplasty: the role of pain and function

BACKGROUND: Mental health has been shown to improve after total hip arthroplasty (THA). Little is known about the role of pain and function in this context. We assessed whether change in mental health was associated with improvement in pain and function 1 year post-surgery. METHODS: This prospective study included patients enrolled in a THA registry from 2010 to 2014. We examined the mental component score (MCS) before and 1 year post-surgery, and 1-year change, in association with Western Ontario McMaster Universities (WOMAC) pain and function scores. All scores were normalized, ranging from 0 to 100 (larger score indicating better outcome). Analyses were adjusted for potential confounders. RESULTS: Our study included 610 participants, of which 53% were women. Descriptive statistics are as follows: the average (SD) for age (years) was 68.5 (11.8), and for BMI was 26.9 (4.9). In addition, the MCS average (SD) at baseline was 44.7 (11.2), and at 1-year after THA was 47.5 (10.5). The average change from baseline to 1-year post-THA in MCS was 2.8 (95% CI: 1.9, 3.6), for an effect size of 0.26. As for the WOMAC pain score, the average change from baseline to 1-year post-THA was 44.2 (95%CI: 42.4, 46.0), for an effect size of 2.5. The equivalent change in WOMAC function was 38.1 (95% CI: 36.2, 40.0), for an effect size of 2.0. Results from multivariable analysis controlling for covariates showed that an improvement of 10 points in the 1-year change in pain score resulted in a 0.78 point (95%: CI 0.40, 1.26) increase in the 1-year change in MCS, whereas a 10-point improvement in the 1-year change in function was associated with a 0.94 point (95% CI: 0.56, 1.32) increase. CONCLUSIONS: Mental health significantly improved from baseline to 1-year post-THA. Greater improvement in pain and function was associated with greater improvement in mental health 1 year post-THA

Reference Ranges for Bone Mineral Density and Prevalence of Osteoporosis in Vietnamese Men and Women

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to examine the effect of different reference ranges in bone mineral density on the diagnosis of osteoporosis.</p> <p>Methods</p> <p>This cross-sectional study involved 357 men and 870 women aged between 18 and 89 years, who were randomly sampled from various districts within Ho Chi Minh City, Vietnam. BMD at the femoral neck, lumbar spine and whole body was measured by DXA (Hologic QDR4500). Polynomial regression models and bootstraps method were used to determine peak BMD and standard deviation (<it>SD</it>). Based on the two parameters, we computed T-scores (denoted by <it>T</it>_VN) for each individual in the study. A similar diagnosis was also done based on T-scores provided by the densitometer (<it>T</it>_DXA), which is based on the US White population (NHANES III). We then compared the concordance between <it>T</it>_VNand <it>T</it>_DXAin the classification of osteoporosis. Osteoporosis was defined according to the World Health Organization criteria.</p> <p>Results</p> <p>In post-menopausal women, the prevalence of osteoporosis based on femoral neck <it>T</it>_VNwas 29%, but when the diagnosis was based on <it>T</it>_DXA, the prevalence was 44%. In men aged 50+ years, the <it>T</it>_VN-based prevalence of osteoporosis was 10%, which was lower than <it>T</it>_DXA-based prevalence (30%). Among 177 women who were diagnosed with osteoporosis by <it>T</it>_DXA, 35% were actually osteopenia by <it>T</it>_VN. The kappa-statistic was 0.54 for women and 0.41 for men.</p> <p>Conclusion</p> <p>These data suggest that the <it>T-</it>scores provided by the Hologic QDR4500 over-diagnosed osteoporosis in Vietnamese men and women. This over-diagnosis could lead to over-treatment and influence the decision of recruitment of participants in clinical trials.</p