Reliability Testing of the Star Rating for Schools (SR4S) Mobile Application: Results from a pilot study

Globally, approximately 3500 individuals are killed due to a road traffic injury each day, equating to nearly 1.3 million deaths each year and more than a million children are either killed by, or sustain serious injury, from road traffic incidents. School zones are locations where there may be high concentrations of children at certain hours of the day, thereby increasing their exposure to road and pedestrian injuries. The International Road Assessment Programme (iRAP), an NGO established in 2006, developed the Star Ratings measurement system, which is used globally to provide simple, comparable and objective measurements of the built-in safety of road segments for road users. These ratings are given to governments and other users to inform infrastructure and other road safety programs. Recently, the Star Rating methodology has been adapted for the Star Rating for Schools (SR4S) mobile application (an app), which is designed to measure and communicate road and pedestrian safety risks that children and adolescents are exposed to on their journey to and from school. iRAP has brought together several organizations, including Safe Kids Worldwide (SKW), from around the globe to pilot test the SR4S app. This project, in collaboration with SKW, aims to test the reliability of the SR4S app to answer the following questions: 1) Does the SR4S app produce consistent Star Ratings for the same road segments across multiple users? 2) Does training app users increase the reliability of the SR4S app to assess road and pedestrian safety in local school zones? Data collection took place during a two-day workshop in Washington, D.C., where 9 child injury experts with experience working in pedestrian safety advocacy (i.e. Safe Kids Coordinators) conducted multiple safety assessments using the SR4S app at a local elementary school at 10 road segments and received training on how to use the app. Data was collected once before training, and twice post-training. This data is currently being analyzed for inter-rater reliability and test-retest reliability. Preliminary results: only 5 of 9 users fully collected the required data and this greatly reduced the reliability of the app. The results of the reliability analysis will be presented to iRAP and the SR4S app developers to inform the development of improved versions of the app which will eventually be rolled out for worldwide use

Justification of Intimate Partner Violence in Egypt

Background: Intimate Partner Violence (IPV) is an important problem in developing countries and associated with poor reproductive health outcomes. Objectives: To describe trends and justification of IPV in Egypt. Methods: We used the 2008 Egypt Demographic Health Surveys (EDHS). Information on IPV was drawn from 16,527 women in 2008. We performed bivariate analyses to examine trends in and risk factors for justification of IPV. Results: 39.5% of respondents reported that IPV is justifiable. Logistic regression suggests that age, education, wealth and female autonomy are associated with respondents not justifying IPV. In contrast respondents who supported the continuation of female circumcision and who were related to their husband reported that IPV is justifiable. Conclusions: Justification of IPV continues to be prevalent in Egypt. Further research is needed to identify points of intervention to reduce the support for IPV in Egypt

Occupational Health Risk Factors for Schistosomiasis: Systematic Review and Analysis

Schistosomiasis is a neglected tropical disease caused by a parasitic flatworm which afflicts over 200 million people in the poorest regions of Africa. Carried by snails living in fresh, stagnant water, the parasite penetrates human skin upon contact, causing the victim to suffer a range of symptoms including diarrhea, blood in the urine, and eventual death. Despite its prevalence, schistosomiasis is preventable, treatable, and curable once a control program is implemented. Substantial reduction of schistosomiasis would relieve suffering and produce many socio-economic benefits, including higher productivity and higher school attendance rates. Disease transmission is directly tied to the environment, and those in certain occupations are at particularly high risk, including agricultural workers and fishermen due to direct contact with unsafe water. The objective of this study was to examine which occupations yield risk factors for acquiring schistosomiasis in Africa. Conducting a systematic review and analysis, 36 peer-reviewed studies were selected from Scopus, Web of Science, and Medline based on inclusion criteria. All relevant evidence from the systematic review concluded that certain occupations result in an increase in risk of schistosomiasis, and that a comprehensive approach to prevention is integral in community health in rural areas. Prevention programming for schistosomiasis should focus on at-risk occupations, including targeting water-resource management, irrigation systems management, and agricultural management, in order to stop the occupation-specific transmission of the disease, which leads to higher schistosomiasis rates in endemic communities

Interrelationship between Climatic, Ecologic, Social, and Cultural Determinants Affecting Dengue Emergence and Transmission in Puerto Rico and Their Implications for Zika Response

Objective. The global resurgence of dengue has been attributed to rapid population growth, urban expansion, increased air travel, globalization, and climate change. Dengue is now endemic in Puerto Rico. Puerto Rico is at risk for Zika, another emerging arbovirus. The interrelationship between climatic, ecological, social, and cultural factors that affect dengue and other arboviruses’ transmission is understudied. Design. The objective of this systematic review is to examine the interrelationship between climatic, ecological, social, and cultural factors on dengue transmission in Puerto Rico and to draw lessons for Zika response. Results. A comprehensive search of peer-reviewed journal articles was performed, producing 562 articles; 26 were selected for this review. Findings indicate that human activities and behaviors (urbanization, migration, and consumption) as well as climate have a significant impact on the abundance and the transmission potential of Ae. aegypti, the vector for dengue, Zika, and other viruses. Conclusion. Despite the public health burden of dengue limited investments have been made in research and surveillance. Future research is needed to develop models that integrate the multivariate effects of climatic, ecological, social, and cultural factors, which for Puerto Rico have mostly been examined independently. Such models have the potential to inform response to dengue, Zika, and other arboviruses

Assessing seasonality of travel distance to harm reduction service providers among persons who inject drugs.

BACKGROUND: Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC). FINDINGS: A geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated the walking distance (via sidewalks) from the centroid point of zip code of home residence to the exchange site where PWID presented for services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by season. Differences in mean walking distance measures were statistically significant between winter and spring with PWID traveling approximately 2.88 and 2.77 miles, respectively, to access the SEP during these seasons. CONCLUSIONS: The results of this study suggest that seasonal differences in SEP accessibility may exist between winter and spring. PWID may benefit from harm reduction providers adapting their SEP operations to provide a greater diversity of exchange locations during seasons in which inclement weather may negatively influence engagement with SEPs. Increasing the number of exchange locations based on season may help resolve unmet needs among injectors

Cross-Sectional Comparison of Behavioral Risk Factors for HIV/HCV in People Who Inject Drugs (PWID) in Egypt

Background Egypt has the greatest HCV prevalence worldwide at 15% and a concentrated HIV epidemic in male people who inject drugs (PWID) at 6.8%, who are at a high risk for HCV infection as well. Injection drug use is criminalized in Egypt, and there is limited availability of harm reduction programs. Drug-use and sexual risk behaviors between PWID and the general population have not been studied there. Methods To address this gap, a cross-sectional HIV/HCV epidemiological study of 632 consenting injection drug users in Cairo and Alexandria was conducted. Bivariate logistic regression analysis was done to evaluate the associations between HIV/HCV and needle sharing or sexual practices using SAS 9.4. Results 10.6% (63/ 604) of the study population tested positive for HIV and 61.5% (384/624) tested positive for HCV. Sharing needles with more than 10 people was associated with HIV and HCV infection (OR=3.65, p-val=0.001; OR=2.05, p-val=0.02, respectably). Age was associated with both HIV and HCV (p-val=0.03 and Conclusions The results indicate that the growing epidemic among PWID in Egypt may place the general population at risk for HIV and HCV primarily through sexual contact. In Russia, repressive policies toward PWID allowed HIV to spread to the general population at the start of the epidemic in 2000. Now, 48% of HIV is heterosexually transmitted in Russia and the country contributes \u3e80% of the HIV cases in Eastern Europe and Central Asia. In response to the epidemic, even more punitive laws and regulations were introduced in Russia, and their HIV prevalence has seen a 49% increase between 2005 and 2015. A similar trajectory can be expected for Egypt if preventative measures are not taken. Common-sense harm reduction programs like clean needle exchanges and decriminalization of injection drug use should be part of a comprehensive plan to control the spread of HIV and HCV in Egypt

An assessment of cultural perceptions and recognition of Ebola virus disease, and its correlation with traditional burial practice in rural Guinea

Background: In the midst of the unprecedented Ebola outbreak in West Africa during 2014-2016, the humanitarian response to control the disease was hampered in part because there was a limited understanding of local traditional rituals or indigenous medicine (ethnomedicine) on the part of the responders. The Ebola outbreak claimed 11,310 lives, more than all other outbreaks combined. West African burial funeral ceremonies and surrounding rituals may have hindered interventions that included the forceful removal of the sick or dead from the community. Objective: Our objective was to understand transmission associated with traditional burial practices in rural Guinea. Through the lens of cultural and medical anthropology, this study aims to examine how knowledge of transmission might influence views on traditional burial practices, and how ethnomedical beliefs might block (or mediate) the effect of this knowledge. Method: A survey of 385 household members was administered in 2015 throughout Guinea to capture knowledge and behaviors related to Ebola. Discrete and marginal change in probability models were used to examine disease transmission knowledge on the outcome of whether respondents practice traditional burial rituals. The independent variables were knowledge about person-to-person (PTP) transmission and personal protective equipment (PPE), and the dependent binary variable was the use of traditional burial practice. Within the context of burial behavior, this study controlled for three confounders: 1. demographics (age, sex, years lived in community, ethnicity, occupation, education), 2. knowledge of Ebola etiology & symptoms, and 3. access to medical care. STATA14/MP was used. Results: Once controlling for three potential confounders (demographics, knowledge of Ebola etiology & symptoms, and access to medical care), there was no significant association between the outcome, practicing traditional burial ritual, and knowledge about PTP (person-to-person infection: 12.2 percentage points, p \u3c 0.1 by one-tail test) & PPE (5.8 percentage points, p \u3e 0.1). Conclusion: The result implies that knowledge about PTP & PPE will not necessarily lead respondents to stop traditional burial rituals. To prevent another Ebola outbreak in the future, it is essential to design a social and behavioral intervention that is specially tailored to the culture of the traditional burial ritual

Evaluation of Recruitment Strategies on Inclusiveness of Populations at Risk for Health Disparities in the Statewide Remote Online COVIDsmart Registry

Background The COVID-19 pandemic affected health research practices. The large-scale impacts of COVID-19 and restrictions on face-to-face interaction led to increased use of remote online data collection methods. However, it is unclear if such efforts led to the representation of populations at risk for health disparities. We evaluated whether multiple recruitment strategies would capture a representative sample of individuals at risk for health disparities. Methods The COVIDsmart registry collected clinical, social, economic, and behavioral data in the state of Virginia from March to November, 2021. Seven hundred eighty-two adult participants were enrolled. We compared the representation of COVIDsmart participants at risk for health disparities against state data with two-tailed Z tests. Monte-Carlo estimates evaluated the association between recruitment strategies utilized and health disparity risk status. Results The majority of participants were non-Hispanic White (81.5%), female (78.6%), non-rural (98%), had a Masters’ degree or higher (62.6%), and an income of $100,000 or higher (51%). The recruitment strategy that brought participants into the study did not differ significantly based on racial/ethnic minority status (p\u3e.05), but did differ for low SES versus high SES groups, p=.03. Low SES and ethnic/racial minority representation proportions were significantly lower for COVIDsmart participants than state data, (p\u3e.05). Conclusions Participants at risk for health disparities were not well represented in this registry despite multiple recruitment strategies. The use of targeted emails, social media, and community collaboration may improve the participation of populations at risk for health disparities in remote online research studies

National surveillance for human and pet contact with oral rabies vaccine baits, 2001–2009

Objective—To determine the rate and absolute number of human and pet exposures to oral rabies vaccine (ORV) bait containing liquid vaccinia rabies glycoprotein recombinant vaccine and to evaluate factors that might affect human contact with bait to modify the program and reduce human exposure to the vaccine. Design—Retrospective analysis of surveillance data (2001 to 2009). Sample—Reports on human and pet contact with ORV baits in states with ORV surveillance programs. Procedures—Data were collected from passive, multistate ORV surveillance systems in Alabama, Arizona, Florida, Georgia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Vermont, Virginia, and West Virginia. Data collected included the nature of human or pet contact with bait and vaccine, the caller’s knowledge of the ORV bait program, local human population density, and other relevant demographic data. Results—All 18 states participated in the surveillance program for at least 1 year, for a combined 68 years of observation. One thousand four hundred thirty-six calls were reported, representing 3,076 found baits (6.89/100,000 baits dropped); 296 (20%) calls were related to human contact with ruptured bait, and 550 (38%) involved pet contact with the bait. Six adverse events in humans were reported, one of which required hospitalization. Fifty-nine adverse events in pets were noted, all of which were nonserious. Conclusions and Clinical Relevance—Findings from surveillance activities have been used to improve baiting strategies and minimize human and pet contact with ORV baits. Overall, human and pet contact with ORV baits was infrequent. Surveillance has led to early identification of persons exposed to ORV and rapid intervention

Responding to Emerging Diseases Requires Multi-disciplinary and One Health Training, Egypt

Background: In Egypt, several infectious diseases of zoonotic origin have emerged in recent years like H1N1, MERSCoV and H5N1, the latter now endemic. Responding to these diseases requires a workforce trained in multi-disciplinary approaches to zoonotic disease research and control. It is difficult to deliver multidisciplinary and one health training globally because of the limited number of higher education programs that support such training. In low and middle-income countries where the impacts of emerging zoonotic diseases are felt more directly there is enthusiasm for such training and the use of e-technology can foster international, long-term collaborations. Objectives: To provide health training for infectious diseases research and to foster multidisciplinary collaboration. Methods: We designed and simultaneously held two training workshops, one focused on pediatric infectious diseases and another on emerging infectious diseases to meet the objective. Both workshops had pre- and post-workshop activities for multi-disciplinary methods with an emphasis on the use of mobile technologies to enhance emerging infectious diseases surveillance and research for public health professionals in Egypt. Faculty and scientists from all universities in Egypt and from the National Research Center were invited to participate. Results: 85 participants attended, 31 abstracts were submitted, and over a 3 year period 3 international grant applications were submitted, and 4 abstracts were presented at international conferences. An online forum was developed to continue building collaboration. Conclusions: Interactive on-site workshops are suitable for providing multi-disciplinary training for disease surveillance, research and disease control. Participants shared the opinion that grant proposal and scientific manuscript writing were important skills that they felt they did not have. Long term investments in workshops of this nature are needed to build upon the excitement generated by these activities