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Meyer JN, Pan WK, Ryde IT, Alexander T, Klein-Adams JC, Ndirangu DS, Falvo MJ. Correction: Bioenergetic function is decreased in peripheral blood mononuclear cells of veterans with Gulf War Illness. PLoS One 2024; 19:e0302501. [PMID: 38635641 PMCID: PMC11025795 DOI: 10.1371/journal.pone.0302501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0287412.].
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Janko MM, Araujo AL, Ascencio EJ, Guedes GR, Vasco LE, Santos RO, Damasceno CP, Medrano PG, Chacón-Uscamaita PR, Gunderson AK, O'Malley S, Kansara PH, Narvaez MB, Coombes C, Pizzitutti F, Salmon-Mulanovich G, Zaitchik BF, Mena CF, Lescano AG, Barbieri AF, Pan WK. Study protocol: improving response to malaria in the Amazon through identification of inter-community networks and human mobility in border regions of Ecuador, Peru and Brazil. BMJ Open 2024; 14:e078911. [PMID: 38626977 PMCID: PMC11029361 DOI: 10.1136/bmjopen-2023-078911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Understanding human mobility's role in malaria transmission is critical to successful control and elimination. However, common approaches to measuring mobility are ill-equipped for remote regions such as the Amazon. This study develops a network survey to quantify the effect of community connectivity and mobility on malaria transmission. METHODS We measure community connectivity across the study area using a respondent driven sampling design among key informants who are at least 18 years of age. 45 initial communities will be selected: 10 in Brazil, 10 in Ecuador and 25 in Peru. Participants will be recruited in each initial node and administered a survey to obtain data on each community's mobility patterns. Survey responses will be ranked and the 2-3 most connected communities will then be selected and surveyed. This process will be repeated for a third round of data collection. Community network matrices will be linked with each country's malaria surveillance system to test the effects of mobility on disease risk. ETHICS AND DISSEMINATION This study protocol has been approved by the institutional review boards of Duke University (USA), Universidad San Francisco de Quito (Ecuador), Universidad Peruana Cayetano Heredia (Peru) and Universidade Federal Minas Gerais (Brazil). Results will be disseminated in communities by the end of the study.
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Affiliation(s)
- Mark M Janko
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Andrea L Araujo
- Instituto de Geografia, Universidad San Francisco de Quito, Quito, Ecuador
| | - Edson J Ascencio
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gilvan R Guedes
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Luis E Vasco
- Instituto de Geografia, Universidad San Francisco de Quito, Quito, Ecuador
| | - Reinaldo O Santos
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Camila P Damasceno
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Pamela R Chacón-Uscamaita
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annika K Gunderson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sara O'Malley
- Duke University Nicholas School of the Environment, Durham, North Carolina, USA
| | - Prakrut H Kansara
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manuel B Narvaez
- Instituto de Geografia, Universidad San Francisco de Quito, Quito, Ecuador
| | - Carolina Coombes
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Benjamin F Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carlos F Mena
- Instituto de Geografia, Universidad San Francisco de Quito, Quito, Ecuador
| | - Andres G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alisson F Barbieri
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - William K Pan
- Duke Global Health Institute, Durham, North Carolina, USA
- Duke University Nicholas School of the Environment, Durham, North Carolina, USA
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Gunderson AK, Recalde-Coronel C, Zaitchik BF, Yori PP, Rengifo Pinedo S, Paredes Olortegui M, Kosek M, Vinetz JM, Pan WK. A prospective cohort study linking migration, climate, and malaria risk in the Peruvian Amazon - CORRIGENDUM. Epidemiol Infect 2024; 152:e5. [PMID: 38214060 PMCID: PMC10789972 DOI: 10.1017/s0950268824000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
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Gunderson AK, Recalde-Coronel C, Zaitchick BF, Yori PP, Rengifo Pinedo S, Paredes Olortegui M, Kosek M, Vinetz JM, Pan WK. A prospective cohort study linking migration, climate, and malaria risk in the Peruvian Amazon. Epidemiol Infect 2023; 151:e202. [PMID: 38031496 PMCID: PMC10753477 DOI: 10.1017/s0950268823001838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Migration is an important risk factor for malaria transmission for malaria transmission, creating networks that connect Plasmodium between communities. This study aims to understand the timing of why people in the Peruvian Amazon migrated and how characteristics of these migrants are associated with malaria risk. A cohort of 2,202 participants was followed for three years (July 2006 - October 2009), with thrice-weekly active surveillance to record infection and recent travel, which included travel destination(s) and duration away. Migration occurred more frequently in the dry season, but the 7-day rolling mean (7DRM) streamflow was positively correlated with migration events (OR 1.25 (95% CI: 1.138, 1.368)). High-frequency and low-frequency migrant populations reported 9.7 (IRR 7.59 (95% CI:.381, 13.160)) and 4.1 (IRR 2.89 (95% CI: 1.636, 5.099)) times more P. vivax cases than those considered non-migrants and 30.7 (IRR 32.42 (95% CI: 7.977, 131.765)) and 7.4 (IRR 7.44 (95% CI: 1.783, 31.066)) times more P. falciparum cases, respectively. High-frequency migrants employed in manual labour within their community were at 2.45 (95% CI: 1.113, 5.416) times higher risk than non-employed low-frequency migrants. This study confirms the importance of migration for malaria risk as well as factors increasing risk among the migratory community, including, sex, occupation, and educational status.
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Affiliation(s)
- Annika K. Gunderson
- Department of Epidemiology, Gilling School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Cristina Recalde-Coronel
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Benjamin F. Zaitchick
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Pablo Peñataro Yori
- Asociación Benéfica Prisma, Iquitos, Peru
- Division of Infectious Diseases, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Margaret Kosek
- Asociación Benéfica Prisma, Iquitos, Peru
- Division of Infectious Diseases, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph M. Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, USA
- International Centers of Excellence for Malaria Research – Amazonia, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- VA Connecticut Healthcare System, West Haven, CT, USA
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - William K. Pan
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Nicholas School of the Environment, Duke University, Durham, NC, USA
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Janko MM, Araujo AL, Ascencio EJ, Guedes GR, Vasco LE, Santos RA, Damasceno CP, Medrano PG, Chacón-Uscamaita PR, Gunderson AK, O’Malley S, Kansara PH, Narvaez MB, Coombes CS, Pizzitutti F, Salmon-Mulanovich G, Zaitchik BF, Mena CF, Lescano AG, Barbieri AF, Pan WK. Network Profile: Improving Response to Malaria in the Amazon through Identification of Inter-Community Networks and Human Mobility in Border Regions of Ecuador, Peru, and Brazil. medRxiv 2023:2023.11.29.23299202. [PMID: 38076857 PMCID: PMC10705622 DOI: 10.1101/2023.11.29.23299202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objectives Understanding human mobility's role on malaria transmission is critical to successful control and elimination. However, common approaches to measuring mobility are ill-equipped for remote regions such as the Amazon. This study develops a network survey to quantify the effect of community connectivity and mobility on malaria transmission. Design A community-level network survey. Setting We collect data on community connectivity along three river systems in the Amazon basin: the Pastaza river corridor spanning the Ecuador-Peru border; and the Amazon and Javari river corridors spanning the Brazil-Peru border. Participants We interviewed key informants in Brazil, Ecuador, and Peru, including from indigenous communities: Shuar, Achuar, Shiwiar, Kichwa, Ticuna, and Yagua. Key informants are at least 18 years of age and are considered community leaders. Primary outcome Weekly, community-level malaria incidence during the study period. Methods We measure community connectivity across the study area using a respondent driven sampling design. Forty-five communities were initially selected: 10 in Brazil, 10 in Ecuador, and 25 in Peru. Participants were recruited in each initial node and administered a survey to obtain data on each community's mobility patterns. Survey responses were ranked and the 2-3 most connected communities were then selected and surveyed. This process was repeated for a third round of data collection. Community network matrices will be linked with eadch country's malaria surveillance system to test the effects of mobility on disease risk. Findings To date, 586 key informants were surveyed from 126 communities along the Pastaza river corridor. Data collection along the Amazon and Javari river corridors is ongoing. Initial results indicate that network sampling is a superior method to delineate migration flows between communities. Conclusions Our study provides measures of mobility and connectivity in rural settings where traditional approaches are insufficient, and will allow us to understand mobility's effect on malaria transmission.
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Affiliation(s)
- Mark M. Janko
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Andrea L. Araujo
- Instituto de Geografía, Universidad San Francisco de Quito, Quito, Ecuador
| | - Edson J. Ascencio
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gilvan R. Guedes
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Luis E. Vasco
- Instituto de Geografía, Universidad San Francisco de Quito, Quito, Ecuador
| | - Reinaldo A. Santos
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Camila P. Damasceno
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Perla G. Medrano
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Pamela R. Chacón-Uscamaita
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annika K. Gunderson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sara O’Malley
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Prakrut H. Kansara
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manuel B. Narvaez
- Instituto de Geografía, Universidad San Francisco de Quito, Quito, Ecuador
| | - Carolina S. Coombes
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Benjamin F. Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carlos F. Mena
- Instituto de Geografía, Universidad San Francisco de Quito, Quito, Ecuador
| | - Andres G. Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alisson F. Barbieri
- Center for Regional Development and Planning (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - William K. Pan
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
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Pizzitutti F, Bonnet G, Gonzales-Gustavson E, Gabriël S, Pan WK, Gonzalez AE, Garcia HH, O'Neal SE. Spatial transferability of an agent-based model to simulate Taenia solium control interventions. Parasit Vectors 2023; 16:410. [PMID: 37941062 PMCID: PMC10634186 DOI: 10.1186/s13071-023-06003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Models can be used to study and predict the impact of interventions aimed at controlling the spread of infectious agents, such as Taenia solium, a zoonotic parasite whose larval stage causes epilepsy and economic loss in many rural areas of the developing nations. To enhance the credibility of model estimates, calibration against observed data is necessary. However, this process may lead to a paradoxical dependence of model parameters on location-specific data, thus limiting the model's geographic transferability. METHODS In this study, we adopted a non-local model calibration approach to assess whether it can improve the spatial transferability of CystiAgent, our agent-based model of local-scale T. solium transmission. The calibration dataset for CystiAgent consisted of cross-sectional data on human taeniasis, pig cysticercosis and pig serology collected in eight villages in Northwest Peru. After calibration, the model was transferred to a second group of 21 destination villages in the same area without recalibrating its parameters. Model outputs were compared to pig serology data collected over a period of 2 years in the destination villages during a trial of T. solium control interventions, based on mass and spatially targeted human and pig treatments. RESULTS Considering the uncertainties associated with empirical data, the model produced simulated pre-intervention pig seroprevalences that were successfully validated against data collected in 81% of destination villages. Furthermore, the model outputs were able to reproduce validated pig seroincidence values in 76% of destination villages when compared to the data obtained after the interventions. The results demonstrate that the CystiAgent model, when calibrated using a non-local approach, can be successfully transferred without requiring additional calibration. CONCLUSIONS This feature allows the model to simulate both baseline pre-intervention transmission conditions and the outcomes of control interventions across villages that form geographically homogeneous regions, providing a basis for developing large-scale models representing T. solium transmission at a regional level.
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Affiliation(s)
| | - Gabrielle Bonnet
- Centre for Mathematical Modelling of Infectious Disease (CMMID), Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eloy Gonzales-Gustavson
- Tropical and Highlands Veterinary Research Institute, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Ghent, Belgium
| | - William K Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, USA
| | - Armando E Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Seth E O'Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, USA
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Meyer JN, Pan WK, Ryde IT, Alexander T, Klein-Adams JC, Ndirangu DS, Falvo MJ. Bioenergetic function is decreased in peripheral blood mononuclear cells of veterans with Gulf War Illness. PLoS One 2023; 18:e0287412. [PMID: 37910447 PMCID: PMC10619881 DOI: 10.1371/journal.pone.0287412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Gulf War Illness (GWI) is a major health problem for approximately 250,000 Gulf War (GW) veterans, but the etiology of GWI is unclear. We hypothesized that mitochondrial dysfunction is an important contributor to GWI, based on the similarity of some GWI symptoms to those occurring in some mitochondrial diseases; the plausibility that certain pollutants to which GW veterans were exposed affect mitochondria; mitochondrial effects observed in studies in laboratory models of GWI; and previous evidence of mitochondrial outcomes in studies in GW veterans. A primary role of mitochondria is generation of energy via oxidative phosphorylation. However, direct assessment of mitochondrial respiration, reflecting oxidative phosphorylation, has not been carried out in veterans with GWI. In this case-control observational study, we tested multiple measures of mitochondrial function and integrity in a cohort of 114 GW veterans, 80 with and 34 without GWI as assessed by the Kansas definition. In circulating white blood cells, we analyzed multiple measures of mitochondrial respiration and extracellular acidification, a proxy for non-aerobic energy generation; mitochondrial DNA (mtDNA) copy number; mtDNA damage; and nuclear DNA damage. We also collected detailed survey data on demographics; deployment; self-reported exposure to pesticides, pyridostigmine bromide, and chemical and biological warfare agents; and current biometrics, health and activity levels. We observed a 9% increase in mtDNA content in blood in veterans with GWI, but did not detect differences in DNA damage. Basal and ATP-linked oxygen consumption were respectively 42% and 47% higher in veterans without GWI, after adjustment for mtDNA amount. We did not find evidence for a compensatory increase in anaerobic energy generation: extracellular acidification was also lower in GWI (12% lower at baseline). A subset of 27 and 26 veterans returned for second and third visits, allowing us to measure stability of mitochondrial parameters over time. mtDNA CN, mtDNA damage, ATP-linked OCR, and spare respiratory capacity were moderately replicable over time, with intraclass correlation coefficients of 0.43, 0.44, 0.50, and 0.57, respectively. Other measures showed higher visit-to-visit variability. Many measurements showed lower replicability over time among veterans with GWI compared to veterans without GWI. Finally, we found a strong association between recalled exposure to pesticides, pyridostigmine bromide, and chemical and biological warfare agents and GWI (p < 0.01, p < 0.01, and p < 0.0001, respectively). Our results demonstrate decreased mitochondrial respiratory function as well as decreased glycolytic activity, both of which are consistent with decreased energy availability, in peripheral blood mononuclear cells in veterans with GWI.
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Affiliation(s)
- Joel N. Meyer
- Nicholas School of the Environment, Duke University, Durham, NC, United States of America
| | - William K. Pan
- Nicholas School of the Environment, Duke University, Durham, NC, United States of America
| | - Ian T. Ryde
- Nicholas School of the Environment, Duke University, Durham, NC, United States of America
| | - Thomas Alexander
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Jacquelyn C. Klein-Adams
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Duncan S. Ndirangu
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Michael J. Falvo
- Department of Veterans Affairs, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ, United States of America
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Berky AJ, Weinhouse C, Vissoci J, Rivera N, Ortiz EJ, Navio S, Miranda JJ, Mallipudi A, Fixen E, Hsu-Kim H, Pan WK. In Utero Exposure to Metals and Birth Outcomes in an Artisanal and Small-Scale Gold Mining Birth Cohort in Madre de Dios, Peru. Environ Health Perspect 2023; 131:97008. [PMID: 37747404 PMCID: PMC10519195 DOI: 10.1289/ehp10557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Few birth cohorts in South America evaluate the joint effect of minerals and toxic metals on neonatal health. In Madre de Dios, Peru, mercury exposure is prevalent owing to artisanal gold mining, yet its effect on neonatal health is unknown. OBJECTIVES We aimed to determine whether toxic metals are associated with lower birth weight and shorter gestational age independently of antenatal care and other maternal well-being factors. METHODS Data are from the COhorte de NAcimiento de MAdre de Dios (CONAMAD) birth cohort, which enrolled pregnant women in Madre de Dios prior to their third trimester and obtained maternal and cord blood samples at birth. We use structural equation models (SEMs) to construct latent variables for the maternal metals environment (ME) and the fetal environment (FE) using concentrations of calcium, iron, selenium, zinc, magnesium, mercury, lead, and arsenic measured in maternal and cord blood, respectively. We then assessed the relationship between the latent variables ME and FE, toxic metals, prenatal visits, hypertension, and their effect on gestational age and birth weight. RESULTS Among 198 mothers successfully enrolled and followed at birth, 29% had blood mercury levels that exceeded the U.S. Centers for Disease Control and Prevention threshold of 5.8 μ g / L and 2 mothers surpassed the former 5 - μ g / dL threshold for blood lead. The current threshold value is 3.5 μ g / dL . Minerals and toxic metals loaded onto ME and FE latent variables. ME was associated with FE (β = 0.24; 95% CI: 0.05, 0.45). FE was associated with longer gestational age (β = 2.31; 95% CI: - 0.3 , 4.51) and heavier birth weight. Mercury exposure was not directly associated with health outcomes. A 1% increase in maternal blood lead shortened gestational age by 0.05 d (β = - 0.75 ; 95% CI: - 1.51 , - 0.13 ), which at the 5 - μ g / dL threshold resulted in a loss of 3.6 gestational days and 76.5 g in birth weight for newborns. Prenatal care visits were associated with improved birth outcomes, with a doubling of visits from 6 to 12 associated with 5.5 more gestational days (95% CI: 1.6, 9.4) and 319 g of birth weight (95% CI: 287.6, 350.7). DISCUSSION Maternal lead, even at low exposures, was associated with shorter gestation and lower birth weight. Studies that focus only on harmful exposures or nutrition may mischaracterize the dynamic maternal ME and FE. SEMs provide a framework to evaluate these complex relationships during pregnancy and reduce overcontrolling that can occur with linear regression. https://doi.org/10.1289/EHP10557.
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Affiliation(s)
- Axel J Berky
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Caren Weinhouse
- Oregon Institute of Occupational Health Sciences, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Joao Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nelson Rivera
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Ernesto J Ortiz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Susy Navio
- Dirección Regional de Salud, Ministerio de Salud del Perú, Madre de Dios, Perú
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andres Mallipudi
- Bellevue Hospital Center/Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Emma Fixen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heileen Hsu-Kim
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - William K Pan
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Janko MM, Recalde-Coronel GC, Damasceno CP, Salmón-Mulanovich G, Barbieri AF, Lescano AG, Zaitchik BF, Pan WK. The impact of sustained malaria control in the Loreto region of Peru: a retrospective, observational, spatially-varying interrupted time series analysis of the PAMAFRO program. Lancet Reg Health Am 2023; 20:100477. [PMID: 36970494 PMCID: PMC10036736 DOI: 10.1016/j.lana.2023.100477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/23/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
Background Although malaria control investments worldwide have resulted in dramatic declines in transmission since 2000, progress has stalled. In the Amazon, malaria resurgence has followed withdrawal of Global Fund support of the Project for Malaria Control in Andean Border Areas (PAMAFRO). We estimate intervention-specific and spatially-explicit effects of the PAMAFRO program on malaria incidence across the Loreto region of Peru, and consider the influence of the environmental risk factors in the presence of interventions. Methods We conducted a retrospective, observational, spatial interrupted time series analysis of malaria incidence rates among people reporting to health posts across Loreto, Peru between the first epidemiological week of January 2001 and the last epidemiological week of December 2016. Model inference is at the smallest administrative unit (district), where the weekly number of diagnosed cases of Plasmodium vivax and Plasmodium falciparum were determined by microscopy. Census data provided population at risk. We include as covariates weekly estimates of minimum temperature and cumulative precipitation in each district, as well as spatially- and temporally-lagged malaria incidence rates. Environmental data were derived from a hydrometeorological model designed for the Amazon. We used Bayesian spatiotemporal modeling techniques to estimate the impact of the PAMAFRO program, variability in environmental effects, and the role of climate anomalies on transmission after PAMAFRO withdrawal. Findings During the PAMAFRO program, incidence of P. vivax declined from 42.8 to 10.1 cases/1000 people/year. Incidence for P. falciparum declined from 14.3 to 2.5 cases/1000 people/year over this same period. The effects of PAMAFRO-supported interventions varied both by geography and species of malaria. Interventions were only effective in districts where interventions were also deployed in surrounding districts. Further, interventions diminished the effects of other prevailing demographic and environmental risk factors. Withdrawal of the program led to a resurgence in transmission. Increasing minimum temperatures and variability and intensity of rainfall events from 2011 onward and accompanying population displacements contributed to this resurgence. Interpretation Malaria control programs must consider the climate and environmental scope of interventions to maximize effectiveness. They must also ensure financial sustainability to maintain local progress and commitment to malaria prevention and elimination efforts, as well as to offset the effects of environmental change that increase transmission risk. Funding National Aeronautics and Space Administration, National Institutes of Health, Bill and Melinda Gates Foundation.
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Affiliation(s)
- Mark M. Janko
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - G. Cristina Recalde-Coronel
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | | | | | | | - Andrés G. Lescano
- Clima, Latin American Center of Excellence for Climate Change and Health, and Emerge, Emerging Diseases and Climate Change Research Unit, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Benjamin F. Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - William K. Pan
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Nicholas School of the Environment, Duke University, Durham, NC, USA
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10
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Fernández D, Giné-Vázquez I, Morena M, Koyanagi AI, Janko MM, Haro JM, Panagiotakos D, Molassiotis A, Pan WK, Tyrovolas S. Government interventions and control policies to contain the first COVID-19 outbreak: An analysis of evidence. Scand J Public Health 2023:14034948231156969. [PMID: 36883722 PMCID: PMC9996153 DOI: 10.1177/14034948231156969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND The overarching aim of this study was to evaluate the effectiveness over time of government interventions and policy restrictions and the impact of determinants on spread and mortality during the first-wave of the COVID-19 pandemic, globally, regionally and by country-income level, up to 18 May 2020. METHODS We created a global database merging World Health Organization daily case reports (from 218 countries/territories) with other socio-demographic and population health measures from 21 January to 18 May 2020. A four-level government policy interventions score (low to very high) was created based on the Oxford Stringency Index. RESULTS Our results support the use of very high government interventions to suppress both COVID-19 spread and mortality effectively during wave one globally compared to other policy levels of control. Similar trends in virus propagation and mortality were observed in all country-income levels and specific regions. CONCLUSIONS
Rapid implementation of government interventions was needed to contain the first wave of the COVID-19 outbreak and to reduce COVID-19-related mortality.
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Affiliation(s)
- Daniel Fernández
- Serra Húnter fellow. Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Spain.,Institute of Mathematics of UPC-BarcelonaTech (IMTech), Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
| | - Iago Giné-Vázquez
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain.,Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Marianthi Morena
- Nutrition and Dietetics Department, Harokopio University, Greece
| | - A I Koyanagi
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain.,Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain.,ICREA, Spain
| | | | - Josep Maria Haro
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain.,Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Alex Molassiotis
- College of Arts, Humanities and Education, University of Derby, UK
| | - William K Pan
- Global Health Institute, Duke University, USA.,Nicholas School of the Environment, Duke University, USA
| | - Stefanos Tyrovolas
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain.,Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain.,WHO Collaborating Centre for Community Health Services (WHOCC), School of Nursing, The Hong Kong Polytechnic University, China
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11
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Pizzitutti F, Bonnet G, Gonzales-Gustavson E, Gabriël S, Pan WK, Pray IW, Gonzalez AE, Garcia HH, O’Neal SE. Non-local validated parametrization of an agent-based model of local-scale Taenia solium transmission in North-West Peru. PLoS One 2022; 17:e0275247. [PMID: 36166462 PMCID: PMC9514638 DOI: 10.1371/journal.pone.0275247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/13/2022] [Indexed: 12/01/2022] Open
Abstract
The pork tapeworm, Taenia solium, is the cause of a preventable zoonotic disease, cysticercosis, affecting both pigs and humans. Continued endemic transmission of T. solium is a major contributor of epilepsy and other neurologic morbidity, and the source of important economic losses, in many rural areas of developing countries. Simulation modelling can play an important role in aiding the design and evaluation of strategies to control or even eliminate transmission of the parasite. In this paper, we present a new agent based model of local-scale T. solium transmission and a new, non-local, approach to the model calibration to fit model outputs to observed human taeniasis and pig cysticercosis prevalence simultaneously for several endemic villages. The model fully describes all relevant aspects of T. solium transmission, including the processes of pig and human infection, the spatial distribution of human and pig populations, the production of pork for human consumption, and the movement of humans and pigs in and out in several endemic villages of the northwest of Peru. Despite the high level of uncertainty associated with the empirical measurements of epidemiological data associated with T. solium, the non-local calibrated model parametrization reproduces the observed prevalences with an acceptable precision. It does so not only for the villages used to calibrate the model, but also for villages not included in the calibration process. This important finding demonstrates that the model, including its calibrated parametrization, can be successfully transferred within an endemic region. This will enable future studies to inform the design and optimization of T. solium control interventions in villages where the calibration may be prevented by the limited amount of empirical data, expanding the possible applications to a wider range of settings compared to previous models.
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Affiliation(s)
| | - Gabrielle Bonnet
- Centre for the Mathematical Modelling of Infectious Diseases (CMMID), London School of Hygiene & Tropical Diseases, London, United Kingdom
| | - Eloy Gonzales-Gustavson
- Tropical and Highlands Veterinary Research Institute, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Ghent, Belgium
| | - William K. Pan
- Nicholas School of Environment Durham, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, Duke University, Durham, NC, United States of America
| | - Ian W. Pray
- School of Public Health, Oregon Health and Science University Portland State University, Portland, OR, United States of America
| | - Armando E. Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Seth E. O’Neal
- School of Public Health, Oregon Health and Science University Portland State University, Portland, OR, United States of America
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima Peru
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12
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Berky AJ, Robie E, Chipa SN, Ortiz EJ, Palmer EJ, Rivera NA, Avalos AMM, Meyer JN, Hsu-Kim H, Pan WK. Risk of lead exposure from wild game consumption from cross-sectional studies in Madre de Dios, Peru. The Lancet Regional Health - Americas 2022; 12. [PMID: 36237535 PMCID: PMC9555248 DOI: 10.1016/j.lana.2022.100266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Methods Findings Interpretation
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Affiliation(s)
- Axel J. Berky
- Nicholas School of the Environment, Duke University, Grainger Hall, 9 Circuit Drive, Box 90328, Durham, NC 27708, USA
- Corresponding author.
| | - Emily Robie
- Duke Global Health Institute, Duke University, NC 27080, USA
| | | | - Ernesto J. Ortiz
- Duke Global Health Innovations Centre, Duke University, NC 27080, USA
| | - Emma J. Palmer
- Civil Architectural and Environmental Engineering, University of Texas at Austin, TX 78712, USA
| | - Nelson A. Rivera
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708, USA
| | - Ana Maria Morales Avalos
- Dirección Ejecutiva de Medicina Alternativa y Complementaria, Instituto Nacional de Salud, Lima, Peru
| | - Joel N. Meyer
- Nicholas School of the Environment, Duke University, Grainger Hall, 9 Circuit Drive, Box 90328, Durham, NC 27708, USA
| | - Heileen Hsu-Kim
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708, USA
| | - William K. Pan
- Nicholas School of the Environment, Duke University, Grainger Hall, 9 Circuit Drive, Box 90328, Durham, NC 27708, USA
- Duke Global Health Institute, Duke University, NC 27080, USA
- Corresponding author at: Dirección Regional de Salud, Madre de Dios, Peru.
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13
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Bonnet G, Pizzitutti F, Gonzales-Gustavson EA, Gabriël S, Pan WK, Garcia HH, Bustos JA, Vilchez P, O’Neal SE. CystiHuman: A model of human neurocysticercosis. PLoS Comput Biol 2022; 18:e1010118. [PMID: 35587497 PMCID: PMC9159625 DOI: 10.1371/journal.pcbi.1010118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 06/01/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Taenia solium tapeworm is responsible for cysticercosis, a neglected tropical disease presenting as larvae in the body of a host following taenia egg ingestion. Neurocysticercosis (NCC), the name of the disease when it affects the human central nervous system, is a major cause of epilepsy in developing countries, and can also cause intracranial hypertension, hydrocephalus and death. Simulation models can help identify the most cost-effective interventions before their implementation. Modelling NCC should enable the comparison of a broad range of interventions, from treatment of human taeniasis (presence of an adult taenia worm in the human intestine) to NCC mitigation. It also allows a focus on the actual impact of the disease, rather than using proxies as is the case for other models. METHODS This agent-based model is the first model that simulates human NCC and associated pathologies. It uses the output of another model, CystiAgent, which simulates the evolution of pig cysticercosis and human taeniasis, adding human and cyst agents, including a model of cyst location and stage, human symptoms, and treatment. CystiHuman also accounts for delays in the appearance of NCC-related symptoms. It comprises three modules detailing cyst development, seizure probability and timing, and intracranial hypertension/hydrocephalus, respectively. It has been implemented in Java MASON and calibrated in three endemic villages in Peru, then applied to another village (Rica Playa) to compare simulation results with field data in that village. RESULTS AND DISCUSSION Despite limitations in available field data, parameter values found through calibration are plausible and simulated outcomes in Rica Playa are close to actual values for NCC prevalence and the way it increases with age and cases with single lesions. Initial simulations further suggest that short-term interventions followed by a rapid increase in taeniasis prevalence back to original levels may have limited impacts on NCC prevalence.
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Affiliation(s)
- Gabrielle Bonnet
- Independent Consultant for the School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Francesco Pizzitutti
- Independent Consultant for the School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | | | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Gent, Belgium
| | - William K. Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Javier A. Bustos
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Percy Vilchez
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Seth E. O’Neal
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
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14
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Gerson JR, Szponar N, Zambrano AA, Bergquist B, Broadbent E, Driscoll CT, Erkenswick G, Evers DC, Fernandez LE, Hsu-Kim H, Inga G, Lansdale KN, Marchese MJ, Martinez A, Moore C, Pan WK, Purizaca RP, Sánchez V, Silman M, Ury EA, Vega C, Watsa M, Bernhardt ES. Amazon forests capture high levels of atmospheric mercury pollution from artisanal gold mining. Nat Commun 2022; 13:559. [PMID: 35091543 PMCID: PMC8799693 DOI: 10.1038/s41467-022-27997-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Mercury emissions from artisanal and small-scale gold mining throughout the Global South exceed coal combustion as the largest global source of mercury. We examined mercury deposition and storage in an area of the Peruvian Amazon heavily impacted by artisanal gold mining. Intact forests in the Peruvian Amazon near gold mining receive extremely high inputs of mercury and experience elevated total mercury and methylmercury in the atmosphere, canopy foliage, and soils. Here we show for the first time that an intact forest canopy near artisanal gold mining intercepts large amounts of particulate and gaseous mercury, at a rate proportional with total leaf area. We document substantial mercury accumulation in soils, biomass, and resident songbirds in some of the Amazon's most protected and biodiverse areas, raising important questions about how mercury pollution may constrain modern and future conservation efforts in these tropical ecosystems.
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Affiliation(s)
- Jacqueline R Gerson
- Department of Biology, Duke University, Durham, NC, 27708, USA.
- Duke Global Health Institute, Duke University, Durham, NC, 27708, USA.
| | - Natalie Szponar
- Department of Earth Sciences, University of Toronto, Toronto, ON, M5S 3B1, Canada
| | | | - Bridget Bergquist
- Department of Earth Sciences, University of Toronto, Toronto, ON, M5S 3B1, Canada
| | - Eben Broadbent
- School of Forest Resources and Conservation, University of Florida, Gainesville, FL, 32611, USA
| | - Charles T Driscoll
- Department of Civil and Environmental Engineering, Syracuse University, Syracuse, NY, 13244, USA
| | - Gideon Erkenswick
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Field Projects International, Escondido, CA, 92029, USA
| | - David C Evers
- Biodiversity Research Institute, Portland, ME, 04103, USA
| | - Luis E Fernandez
- Centro de Innovación Científica Amazónica (CINCIA), Puerto Maldonado, Peru
- Center for Energy, Environment, and Sustainability (CEES), Wake Forest University, Winston-Salem, NC, 27109, USA
- Department of Biology, Wake Forest University, Winston-Salem, NC, 27109, USA
| | - Heileen Hsu-Kim
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, 27708, USA
| | - Giancarlo Inga
- San Diego Zoo Wildlife Alliance, San Diego, CA, 92101, USA
| | - Kelsey N Lansdale
- Environmental Science Program, Duke University, Durham, NC, 27708, USA
| | - Melissa J Marchese
- Duke Global Health Institute, Duke University, Durham, NC, 27708, USA
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
| | - Ari Martinez
- Department of Biological Sciences, California State University, Long Beach, CA, 90840, USA
| | - Caroline Moore
- San Diego Zoo Wildlife Alliance, San Diego, CA, 92101, USA
| | - William K Pan
- Duke Global Health Institute, Duke University, Durham, NC, 27708, USA
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
| | | | - Victor Sánchez
- Instituto de Investigación en Ecología y Conservación (IIECOO), La Libertad, Peru
| | - Miles Silman
- Centro de Innovación Científica Amazónica (CINCIA), Puerto Maldonado, Peru
- Center for Energy, Environment, and Sustainability (CEES), Wake Forest University, Winston-Salem, NC, 27109, USA
- Department of Biology, Wake Forest University, Winston-Salem, NC, 27109, USA
| | - Emily A Ury
- Department of Biology, Duke University, Durham, NC, 27708, USA
| | - Claudia Vega
- Centro de Innovación Científica Amazónica (CINCIA), Puerto Maldonado, Peru
- Center for Energy, Environment, and Sustainability (CEES), Wake Forest University, Winston-Salem, NC, 27109, USA
- Department of Biology, Wake Forest University, Winston-Salem, NC, 27109, USA
| | - Mrinalini Watsa
- Field Projects International, Escondido, CA, 92029, USA
- San Diego Zoo Wildlife Alliance, San Diego, CA, 92101, USA
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15
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Koenigsmark F, Weinhouse C, Berky AJ, Morales AM, Ortiz EJ, Pierce EM, Pan WK, Hsu-Kim H. Efficacy of Hair Total Mercury Content as a Biomarker of Methylmercury Exposure to Communities in the Area of Artisanal and Small-Scale Gold Mining in Madre de Dios, Peru. Int J Environ Res Public Health 2021; 18:13350. [PMID: 34948962 PMCID: PMC8707462 DOI: 10.3390/ijerph182413350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/05/2022]
Abstract
Total mercury content (THg) in hair is an accepted biomarker for chronic dietary methylmercury (MeHg) exposure. In artisanal and small-scale gold mining (ASGM) communities, the validity of this biomarker is questioned because of the potential for contamination from inorganic mercury. As mining communities may have both inorganic and organic mercury exposures, the efficacy of the hair-THg biomarker needs to be evaluated, particularly as nations begin population exposure assessments under their commitments to the Minamata Convention. We sought to validate the efficacy of hair THg for public health monitoring of MeHg exposures for populations living in ASGM communities. We quantified both THg and MeHg contents in hair from a representative subset of participants (N = 287) in a large, population-level mercury exposure assessment in the ASGM region in Madre de Dios (MDD), Peru. We compared population MeHg-THg correlations and %MeHg values with demographic variables including community location, sex, occupation, and nativity. We observed that hair MeHg-THg correlations were high (r > 0.7) for all communities, regardless of location or nativity. Specifically, for individuals within ASGM communities, 81% (121 of 150 total) had hair THg predominantly in the form of MeHg (i.e., >66% of THg) and reflective of dietary exposure to mercury. Furthermore, for individuals with hair THg exceeding the U.S. EPA threshold (1.0 μg/g), 88 out of 106 (83%) had MeHg as the predominant form. As a result, had urine THg solely been used for mercury exposure monitoring, approximately 59% of the ASGM population would have been misclassified as having low mercury exposure. Our results support the use of hair THg for monitoring of MeHg exposure of populations in ASGM settings where alternative biomarkers of MeHg exposure are not feasible.
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Affiliation(s)
- Faye Koenigsmark
- Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA;
| | - Caren Weinhouse
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA;
| | - Axel J. Berky
- Nicholas School of the Environment, Duke University, 9 Circuit Drive, Durham, NC 27710, USA;
| | - Ana Maria Morales
- Centro Nacional de Salud Intercultural, Instituto Nacional de Salud, Ministerio de Salud, Cápac Yupanqui 1400-Jesus María, Lima 15027, Peru;
| | - Ernesto J. Ortiz
- Duke Global Health Innovation Center, Duke University, 310 Blackwell Street, Durham, NC 27701, USA;
| | - Eric M. Pierce
- Environmental Sciences Division, Oak Ridge National Laboratory, 1 Bethel Valley, Oak Ridge, TN 37831, USA;
| | - William K. Pan
- Nicholas School of the Environment, Duke University, 9 Circuit Drive, Durham, NC 27710, USA;
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA
| | - Heileen Hsu-Kim
- Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA;
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16
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Pan WK, Fernández D, Tyrovolas S, Iago GV, Dasgupta RR, Zaitchik BF, Lantos PM, Woods CW. Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States. Front Public Health 2021; 9:754696. [PMID: 34912768 PMCID: PMC8666663 DOI: 10.3389/fpubh.2021.754696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Attempts to quantify effect sizes of non-pharmaceutical interventions (NPI) to control COVID-19 in the US have not accounted for heterogeneity in social or environmental factors that may influence NPI effectiveness. This study quantifies national and sub-national effect sizes of NPIs during the early months of the pandemic in the US. Methods: Daily county-level COVID-19 cases and deaths during the first wave (January 2020 through phased removal of interventions) were obtained. County-level cases, doubling times, and death rates were compared to four increasingly restrictive NPI levels. Socio-demographic, climate and mobility factors were analyzed to explain and evaluate NPI heterogeneity, with mobility used to approximate NPI compliance. Analyses were conducted separately for the US and for each Census regions (Pacific, Mountain, east/West North Central, East/West South Central, South Atlantic, Middle Atlantic and New England). A stepped-wedge cluster-randomized trial analysis was used, leveraging the phased implementation of policies. Results: Aggressive (level 4) NPIs were associated with slower COVID-19 propagation, particularly in high compliance counties. Longer duration of level 4 NPIs was associated with lower case rates (log beta −0.028, 95% CI −0.04 to −0.02) and longer doubling times (log beta 0.02, 95% CI 0.01–0.03). Effects varied by Census region, for example, level 4 effects on doubling time in Pacific states were opposite to those in Middle Atlantic and New England states. NPI heterogeneity can be explained by differential timing of policy initiation and by variable socio-demographic county characteristics that predict compliance, particularly poverty and racial/ethnic population. Climate exhibits relatively consistent relationships across Census regions, for example, higher minimum temperature and specific humidity were associated with lower doubling times and higher death rates for this period of analysis in South Central, South Atlantic, Middle Atlantic, and New England states. Conclusion and Relevance: Heterogeneity exists in both the effectiveness of NPIs across US Census regions and policy compliance. This county-level variability indicates that control strategies are best designed at community-levels where policies can be tuned based on knowledge of local disparities and compliance with public health ordinances.
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Affiliation(s)
- William K Pan
- Nicholas School of Environment, Duke University, Durham, NC, United States.,Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Daniel Fernández
- Serra Húnter Fellow, Department of Statistics and Operations Research, Polytechnic Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain.,Institute of Mathematics of UPC - BarcelonaTech (IMTech), Barcelona, Spain
| | - Stefanos Tyrovolas
- WHO Collaborating Centre for Community Health Services (WHOCC), School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Giné-Vázquez Iago
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Benjamin F Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M Lantos
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Duke School of Medicine, Duke University, Durham, NC, United States
| | - Christopher W Woods
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Duke School of Medicine, Duke University, Durham, NC, United States
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Pray IW, Pizzitutti F, Bonnet G, Gonzales-Gustavson E, Wakeland W, Pan WK, Lambert WE, Gonzalez AE, Garcia HH, O’Neal SE. Validation of a spatial agent-based model for Taenia solium transmission ("CystiAgent") against a large prospective trial of control strategies in northern Peru. PLoS Negl Trop Dis 2021; 15:e0009885. [PMID: 34705827 PMCID: PMC8575314 DOI: 10.1371/journal.pntd.0009885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 11/08/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The pork tapeworm (Taenia solium) is a parasitic helminth that imposes a major health and economic burden on poor rural populations around the world. As recognized by the World Health Organization, a key barrier for achieving control of T. solium is the lack of an accurate and validated simulation model with which to study transmission and evaluate available control and elimination strategies. CystiAgent is a spatially-explicit agent based model for T. solium that is unique among T. solium models in its ability to represent key spatial and environmental features of transmission and simulate spatially targeted interventions, such as ring strategy. METHODS/PRINCIPAL FINDINGS We validated CystiAgent against results from the Ring Strategy Trial (RST)-a large cluster-randomized trial conducted in northern Peru that evaluated six unique interventions for T. solium control in 23 villages. For the validation, each intervention strategy was replicated in CystiAgent, and the simulated prevalences of human taeniasis, porcine cysticercosis, and porcine seroincidence were compared against prevalence estimates from the trial. Results showed that CystiAgent produced declines in transmission in response to each of the six intervention strategies, but overestimated the effect of interventions in the majority of villages; simulated prevalences for human taenasis and porcine cysticercosis at the end of the trial were a median of 0.53 and 5.0 percentages points less than prevalence observed at the end of the trial, respectively. CONCLUSIONS/SIGNIFICANCE The validation of CystiAgent represented an important step towards developing an accurate and reliable T. solium transmission model that can be deployed to fill critical gaps in our understanding of T. solium transmission and control. To improve model accuracy, future versions would benefit from improved data on pig immunity and resistance, field effectiveness of anti-helminthic treatment, and factors driving spatial clustering of T. solium infections including dispersion and contact with T. solium eggs in the environment.
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Affiliation(s)
- Ian W. Pray
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Francesco Pizzitutti
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Gabrielle Bonnet
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Eloy Gonzales-Gustavson
- Tropical and Highlands Veterinary Research Institute, School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, EL Mantaro, Peru
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, Oregon, United States of America
| | - William K. Pan
- Duke Global Health Institute & Nicholas School of Environment, Duke University, Durham, North Carolina, United States of America
| | - William E. Lambert
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Armando E. Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Hector H. Garcia
- School of Sciences, Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Seth E. O’Neal
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
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Lana JT, Mallipudi A, Ortiz EJ, Arevalo JH, Llanos-Cuentas A, Pan WK. Risk factors for cutaneous leishmaniasis in a high-altitude forest region of Peru. Trop Med Health 2021; 49:40. [PMID: 34001266 PMCID: PMC8130303 DOI: 10.1186/s41182-021-00332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND American cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and children were infected with CL raising concern among authorities that transmission was shifting towards domestic spaces and population centers. METHODS We describe the characteristics of CL patients from four participating clinics after digitizing up to 10 years of patient data from each clinic's CL registries. We assessed risk factors of CL associated with intradomestic, peridomestic, or non-domestic transmission through a matched case-control study with 63 patients who had visited these same clinics for CL (cases) or other medical reasons (controls) between January 2014 and August 2016. The study consisted of an in-home interview of participants by a trained field worker using a standard questionnaire. Risk factors were identified using bivariable and multivariable conditional logistic regression. RESULTS Between 2007 and 2016, a total of 529 confirmed CL positives were recorded in the available CL registries. Children and working aged women made up 58.6% of the cases. Our final model suggests that the odds of sleeping in or very near an agricultural field were five times greater in cases than controls (p = 0.025). Survey data indicate that women, children, and men have similar propensities to both visit and sleep in or near agricultural fields. CONCLUSIONS Women and children may be underappreciated as CL risk groups in agriculturally dependent regions. Despite the age-sex breakdown of clinical CL patients and high rates of deforestation occurring in the study area, transmission is mostly occurring outside of the largest population centers. Curbing transmission in non-domestic spaces may be limited to decreasing exposure to sandflies during the evening, nighttime, and early morning hours. Our paper serves as a cautionary tale for those relying solely on the demographic information obtained from clinic-based data to understand basic epidemiological trends of vector-borne infections.
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Affiliation(s)
- Justin T Lana
- Nicholas School of the Environment, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Andrés Mallipudi
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ernesto J Ortiz
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jairo H Arevalo
- Facultad de Medicina San Fernando, Universidad Nacional de San Martin Tarapoto, Tarapoto, San Martin, Perú
- Laboratorio Referencial de Salud Publica San Martin, Tarapoto, San Martin, Peru
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Lima, Peru
| | - William K Pan
- Nicholas School of the Environment, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Tyrovolas S, Tyrovola D, Giné-Vázquez I, Koyanagi A, Bernabe-Ortiz A, Rodriguez-Artalejo F, Haro JM, Pan WK, Miranda JJ, Panagiotakos D. Global, regional, and national burden of aortic aneurysm, 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017. Eur J Prev Cardiol 2021; 29:1220-1232. [PMID: 33783496 DOI: 10.1093/eurjpc/zwab015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/02/2020] [Accepted: 02/02/2021] [Indexed: 11/12/2022]
Abstract
AIMS This study aimed at evaluating the age, sex, and country-income patterns in aortic aneurysm disease burden, analysing trends in mortality and years of life lost (YLLs), as well as their causal drivers and risk factors, using the 2017 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2017). METHODS AND RESULTS We described the temporal, global, and regional (195 countries) patterns of aortic aneurysm (thoracic and abdominal) mortality, YLLs, their drivers [sociodemographic index (SDI), healthcare access and quality index (HAQ index)] and risk factors using the GBD 1990-2017. Correlation and mixed multilevel modelling between aortic aneurysm mortality, YLLs, HAQ index and other variables were applied. From 1990 to 2017, a global declining trend in age-standardized aortic aneurysm mortality was found [2.88 deaths/100 000 (95% uncertainty intervals, UI 2.79 to 3.03) in 1990 and 2.19 deaths/100 000 (95% UI 2.09 to 2.28) in 2017]. Among high-income countries (HICs) a consistent declining Spearman's correlation between age-standardised aortic aneurysm mortality, SDI (HICs; 1990 rho: 0.57, P ≤ 0.001; 2017 rho: 0.41, P = 0.001) and HAQ index was observed (HICs; 1990 rho: 0.50, P <0.001; 2016 rho: 0.35, P = 0.006); in comparison with low- and middle-income countries where correlation trends were weak and mixed. At a global level, higher HAQ index was related with lower aortic aneurysm mortality and YLLs [mortality, coef: -0.05, 95% confidence interval (CI): -0.06, -0.04; YLLs, coef: -0.94, 95% CI: -1.17, -0.71]. CONCLUSIONS Age-standardized aortic aneurysm mortality declined globally between 1990 and 2017. Globally, age-standardized aortic aneurysm mortality and YLLs were related to changes in SDI and HAQ index levels, while country-level income-related variations were also observed.
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Affiliation(s)
- Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain.,Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 Eleutheriou Venizelou str, 17671 Athens, Greece.,WHO Collaborating Centre for Community Health Services (WHOCC), School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hong Kong SAR, China
| | - Dimitra Tyrovola
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 Eleutheriou Venizelou str, 17671 Athens, Greece.,State Cardiology Clinic, Hippokration General Hospital, 114 Vasilissis Sofias avenue, 11527 Athens, Greece
| | - Iago Giné-Vázquez
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain.,ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima 15074, Peru
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, calle de Arzobispo Morcillo 4, 28029 Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), IMDEA-Food, calle de Melchor Fernandez Almargo 3, 28029 Madrid, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain.,King Saud University, Riyadh 11451, Saudi Arabia
| | - William K Pan
- Nicholas School of the Environment, Duke University, 9 Circuit Dr., Durham, NC 27708, USA.,Global Health Institute, Duke University, 310 Trent Dr., Durham, NC 27708, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima 15074, Peru.,Department of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 Eleutheriou Venizelou str, 17671 Athens, Greece
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Wimberly MC, de Beurs KM, Loboda TV, Pan WK. Satellite Observations and Malaria: New Opportunities for Research and Applications. Trends Parasitol 2021; 37:525-537. [PMID: 33775559 PMCID: PMC8122067 DOI: 10.1016/j.pt.2021.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
Satellite remote sensing provides a wealth of information about environmental factors that influence malaria transmission cycles and human populations at risk. Long-term observations facilitate analysis of climate–malaria relationships, and high-resolution data can be used to assess the effects of agriculture, urbanization, deforestation, and water management on malaria. New sources of very-high-resolution satellite imagery and synthetic aperture radar data will increase the precision and frequency of observations. Cloud computing platforms for remote sensing data combined with analysis-ready datasets and high-level data products have made satellite remote sensing more accessible to nonspecialists. Further collaboration between the malaria and remote sensing communities is needed to develop and implement useful geospatial data products that will support global efforts toward malaria control, elimination, and eradication.
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Affiliation(s)
- Michael C Wimberly
- Department of Geography and Environmental Sustainability, University of Oklahoma, Norman, OK, USA.
| | - Kirsten M de Beurs
- Department of Geography and Environmental Sustainability, University of Oklahoma, Norman, OK, USA
| | - Tatiana V Loboda
- Department of Geographical Sciences, University of Maryland, College Park, MD, USA
| | - William K Pan
- Duke Global Health Institute, Duke University, Durham, NC, USA
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21
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Weinhouse C, Gallis JA, Ortiz E, Berky AJ, Morales AM, Diringer SE, Harrington J, Bullins P, Rogers L, Hare-Grogg J, Hsu-Kim H, Pan WK. A population-based mercury exposure assessment near an artisanal and small-scale gold mining site in the Peruvian Amazon. J Expo Sci Environ Epidemiol 2021; 31:126-136. [PMID: 32467625 PMCID: PMC8281380 DOI: 10.1038/s41370-020-0234-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 05/04/2023]
Abstract
Human exposure to mercury is a leading public health problem. Artisanal and small-scale gold mining (ASGM) is a major source of global mercury emissions. Although occupational mercury exposure to miners (via mercury vapor inhalation) is known, chronic mercury exposure to nearby residents that are not miners (via mercury-contaminated fish consumption) is poorly characterized. We conducted a population-based mercury exposure assessment in 23 communities (19 rural, 4 urban) around the Amarakaeri Communal Reserve, which is bordered on the east by heavy ASGM activity. We measured total mercury in hair (N = 2083) and blood (N = 476) from March-June 2015 and performed follow-up measurements (N = 723 hair and N = 290 blood) from February-April 2016. Mercury exposure risk was highest in communities classified as indigenous, or native, regardless of proximity to mining activity. Residence in a native community (vs. non-native) was associated with mercury levels 1.9 times higher in hair (median native 3.5 ppm vs. median non-native 1.4 ppm total mercury) and 1.6 times higher in blood (median native 7.4 ng/mL vs median non-native 3.2 ng/mL total mercury). Unexpectedly, proximity to mining was not associated with exposure risk. These findings challenge common assumptions about mercury exposure patterns and emphasize the importance of population-representative studies to identify high risk sub-populations.
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Affiliation(s)
- Caren Weinhouse
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, North Carolina 27710
| | - John A. Gallis
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, North Carolina 27710
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza, Durham, North Carolina 27710
| | - Ernesto Ortiz
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, North Carolina 27710
| | - Axel J. Berky
- Nicholas School of the Environment, Duke University, 9 Circuit Drive, Durham, North Carolina 27710
| | | | - Sarah E. Diringer
- Pacific Institute, 654 13 Street, Preservation Park, Oakland, California 94612
| | - James Harrington
- Research Triangle Institute, 3040 East Cornwallis Road, Research Triangle Park, North Carolina 27709
| | - Paige Bullins
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, North Carolina 27710
| | - Laura Rogers
- Civil and Environmental Engineering, Pratt School of Engineering, Duke University, 121 Hudson Hall, Durham, North Carolina 27708
| | - John Hare-Grogg
- Civil and Environmental Engineering, Pratt School of Engineering, Duke University, 121 Hudson Hall, Durham, North Carolina 27708
| | - Heileen Hsu-Kim
- Nicholas School of the Environment, Duke University, 9 Circuit Drive, Durham, North Carolina 27710
- Civil and Environmental Engineering, Pratt School of Engineering, Duke University, 121 Hudson Hall, Durham, North Carolina 27708
| | - William K. Pan
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, North Carolina 27710
- Nicholas School of the Environment, Duke University, 9 Circuit Drive, Durham, North Carolina 27710
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Reuben A, Frischtak H, Berky A, Ortiz EJ, Morales AM, Hsu‐Kim H, Pendergast LL, Pan WK. Elevated Hair Mercury Levels Are Associated With Neurodevelopmental Deficits in Children Living Near Artisanal and Small-Scale Gold Mining in Peru. Geohealth 2020; 4:e2019GH000222. [PMID: 32490301 PMCID: PMC7240868 DOI: 10.1029/2019gh000222] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/10/2020] [Accepted: 03/11/2020] [Indexed: 05/08/2023]
Abstract
Children living near artisanal and small-scale gold mining (ASGM) are at risk of exposure to mercury, a neurotoxicant. It is not certain whether such exposures are harming development, as they occur in underresourced contexts entwined with other stressors, such as malnutrition and enteric infection. This study sought to investigate the association between hair-mercury levels and visual-motor, cognitive, and physical development among children living near ASGM in the Peruvian Amazon. Total hair-mercury levels were measured in 164 children ages 5-12 living in Madre de Dios, Peru. Primary outcomes included Visual-Motor Integration assessed via the Beery-VMI Developmental Test, General Cognitive Ability assessed via the Batería-III Woodcock-Munoz (Spanish-language Woodcock-Johnson Tests of Cognitive Abilities), and Physical Health assessed via anthropometry/hemoglobin counts. Mean (SD) hair-mercury level was 2.06 (2.43) μg/g. Fifty-four children (32.9%) had hair-mercury levels above the World Health Organization reference level of 2.0 μg/g. After controlling for sex, child age, maternal education, and family socioeconomic status, each one unit increase in log hair-mercury level was associated with a 1.01 unit decrease in Visual-Motor Integration (95%CI: -2.06, 0.05, p = 0.061), a 2.59 unit decrease in General Cognitive Ability (95%CI: -4.52, -0.66, p = 0.012), and a 2.43 unit decrease in Physical Health (95%CI: -5.34, 0.49, p = 0.096). After adjustment for covariates, children with hair-mercury levels exceeding the World Health Organization reference level scored 4.68 IQ points lower in Cognitive Ability than their peers. Mercury exposures related to ASGM may be harming child development in the Peruvian Amazon. Children in this region may benefit from intervention to reach their full developmental potential.
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Affiliation(s)
- Aaron Reuben
- Department of Psychology and NeuroscienceDuke UniversityDurhamNCUSA
| | | | - Axel Berky
- Global Health InstituteDuke UniversityDurhamNCUSA
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - Ernesto J. Ortiz
- Global Health InstituteDuke UniversityDurhamNCUSA
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - Ana Maria Morales
- Centro de Estudios, Investigaciones y Servicios en Salud Publica (CENSAP)Puerto MaldonadoPeru
| | - Heileen Hsu‐Kim
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - Laura L. Pendergast
- Department of Psychological Studies in EducationTemple UniversityPhiladelphiaPAUSA
| | - William K. Pan
- Global Health InstituteDuke UniversityDurhamNCUSA
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
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Feingold BJ, Berky A, Hsu-Kim H, Rojas Jurado E, Pan WK. Population-based dietary exposure to mercury through fish consumption in the Southern Peruvian Amazon. Environ Res 2020; 183:108720. [PMID: 31627842 PMCID: PMC8299663 DOI: 10.1016/j.envres.2019.108720] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Mercury exposure related to artisanal and small-scale gold mining (ASGM) has raised environmental and public health concerns globally. Exposure to mercury, a potent neurotoxin that bioaccumulates in fish, is especially of concern to women of childbearing age (WCBA) and children in high-fish consuming populations. In Madre de Dios (MDD), Peru, an Amazon region with naturally occurring mercury and high ASGM activity, there is significant exposure concern among the mainly riverine, fish-consuming communities. The objective of this study was to conduct the first assessment of mercury exposure in a population-based sample of MDD, identify factors associated with elevated levels and compare the relationship between fish consumption and hair total mercury (H-THg) among persons living in ASGM affected and non-ASGM affected watersheds. METHODS Hair samples and household demographic surveys, including a module on fish consumption, were collected from 723 participants across 46 communities within 10 km of the Interoceanic Highway in MDD, who were previously enrolled in the first population-based study in MDD spanning areas affected and unaffected by ASGM. H-THg concentration (natural log transformed) was evaluated for association with independent demographic variables through multilevel multivariate regression models accounting for clustering among households and communities. Samples from canned fish available at local stores were also tested for total mercury. RESULTS Fish consumption (diversity and total consumed) varied spatially along the highway. 269 participants (37.2%) had elevated H-THg (>2.2 μg/g; median 1.60 μg/g; mean 2.24 μg/g), including 42.7% of WCBA and 20.0% of children under 5. Overall, H-THg was higher among people living in ASGM-affected areas. H-THg concentrations were strongly associated with fish consumption; however, in the multivariate models, household consumption of high trophic level fish was associated with elevated H-THg only in communities located in the ASGM-impacted watersheds. Similarly, the relationship between living in a household engaged in economic activities of fishing or Brazil nut harvesting was associated with higher H-THg, but only among households in the ASGM-affected area. In the non-ASGM affected areas, we observed a positive relationship between household daily fruit consumption and H-THg that was not observed in ASGM-affected areas. CONCLUSION Diet, residential location, and occupation are strong predictors of mercury exposure in Madre de Dios, Peru. Canned fish may represent a previously overlooked source of dietary Hg exposure in the region. In accordance with the Minamata Convention on Mercury, the significant environmental health concern of mercury exposure in ASGM areas demands policy and programmatic attention.
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Affiliation(s)
- Beth J Feingold
- University at Albany School of Public Health, State University of New York, 1 University Place, Rensselaer, NY, USA; Institute for Health and the Environment, University at Albany, State University of New York, 5 University Place, Albany, NY, USA.
| | - Axel Berky
- Nicholas School of the Environment, Duke University, Durham, NC, USA.
| | - Heileen Hsu-Kim
- Civil and Environmental Engineering, Duke University, Durham, NC, USA.
| | | | - William K Pan
- Nicholas School of the Environment, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
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Recalde-Coronel GC, Zaitchik B, Pan WK. Madden-Julian Oscillation influence on sub-seasonal rainfall variability on the west of South America. Clim Dyn 2020; 54:2167-2185. [PMID: 33456207 PMCID: PMC7810149 DOI: 10.1007/s00382-019-05107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/23/2019] [Indexed: 06/12/2023]
Abstract
The Madden-Julian Oscillation (MJO) is the leading driver of intraseasonal rainfall variability in the global tropics. However, the influence of MJO on western tropical South America (WTSA) has not been a focus of research. This is not surprising since the MJO convective core becomes nondescript as it propagates across the eastern Pacific, such that its influence on the Pacific coast of tropical South America is not obvious in global analyses. In this study, we examine MJO impacts on subseasonal rainfall variability in the rainiest season for WTSA (February-April). In order to avoid confusion with El Niño Southern Oscillation (ENSO) signals, only ENSO-neutral years are included in the analysis. We found that the MJO convective core reemerges when it propagates onto land in WTSA, and that it is associated with subseasonal precipitation anomalies of 20-50% relative to climatology. The MJO signal is evident in the Real-Time Multivariate MJO (RMM) index; however, the signal is clearer when a custom subseasonal index for the region based on WTSA outgoing longwave radiation is employed. Dynamically, the MJO influence is consistent with a modulation of the Pacific Ocean Walker Circulation descending branch, which is climatologically located in or near WTSA. Furthermore, MJO drives zonal and vertical motions on moisture and wind fields that influence precipitation in the region. We found that the timing of deep convection on subseasonal timescales captured by the regional index is consistent with a dominant role of the MJO convective core, rather than propagation of equatorial Rossby or Kelvin waves. However, there is evidence that equatorial Rossby waves that emerge over the tropical Atlantic Ocean also influence precipitation in WTSA on MJO timescales.
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Affiliation(s)
- G. Cristina Recalde-Coronel
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Benjamin Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - William K. Pan
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Diringer SE, Berky AJ, Marani M, Ortiz EJ, Karatum O, Plata DL, Pan WK, Hsu-Kim H. Deforestation Due to Artisanal and Small-Scale Gold Mining Exacerbates Soil and Mercury Mobilization in Madre de Dios, Peru. Environ Sci Technol 2020; 54:286-296. [PMID: 31825606 PMCID: PMC7244384 DOI: 10.1021/acs.est.9b06620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Artisanal and small-scale gold mining (ASGM) is a significant contributor of mercury (Hg) contamination and deforestation across the globe. In the Colorado River watershed in Madre de Dios, Peru, mining and deforestation have increased exponentially since the 1980s, resulting in major socioeconomic shifts in the region and two national state of emergency (2016 and 2019) in response to concerns for wide-scale mercury poisoning by these activities. This research employed a watershed-scale soil particle detachment model and environmental field sampling to estimate the role of land cover change and soil erosion on river transport of Hg in a heavily ASGM-impacted watershed. The model estimated that observed decreases in forest cover increased soil mobilization by a factor of two in the Colorado River watershed during the 18 year period and by 4-fold in the Puquiri subwatershed (the area of most concentrated ASGM activity). If deforestation continues to increase at its current exponential rate through 2030, the annual mobilization of soil and Hg may increase by an additional 20-25% relative to 2014 levels. While, the estimated total mass of Hg transported by rivers is substantially less than the estimated tons of Hg used with ASGM in Peru, this research shows that deforestation associated with ASGM is an additional mechanism for mobilizing naturally occurring and anthropogenic Hg from terrestrial landscapes to aquatic environments in the region, potentially leading to bioaccumulation in fish and exposure to communities downstream.
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Affiliation(s)
- Sarah E. Diringer
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, NC 27710, USA
| | - Axel J. Berky
- Nicholas School of the Environment, Duke University, Durham, NC 27710 USA
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - Marco Marani
- Nicholas School of the Environment, Duke University, Durham, NC 27710 USA
- Department of Civil, Environmental, and Architectural Engineering, University of Padova, 35131 Padova, Italy
| | - Ernesto J. Ortiz
- Nicholas School of the Environment, Duke University, Durham, NC 27710 USA
| | - Osman Karatum
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, NC 27710, USA
| | - Desiree L. Plata
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - William K. Pan
- Nicholas School of the Environment, Duke University, Durham, NC 27710 USA
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
- co-corresponding authors: W.K. Pan: , (919) 684-4108; H. Hsu-Kim: , (919) 660-5109
| | - Heileen Hsu-Kim
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, NC 27710, USA
- co-corresponding authors: W.K. Pan: , (919) 684-4108; H. Hsu-Kim: , (919) 660-5109
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Pettigrew SM, Pan WK, Berky A, Harrington J, Bobb JF, Feingold BJ. In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. Sci Total Environ 2019; 687:1046-1054. [PMID: 31412442 DOI: 10.1016/j.scitotenv.2019.05.484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 06/10/2023]
Abstract
Road development has been a major driver of the transition from traditional to calorie-dense processed 'Western' diets in lower and middle-income countries. The paving of the Interoceanic Highway (IOH) facilitated rapid development to the Madre de Dios (MDD) region in the Peruvian Amazon. As traditional foods such as Brazil nuts and fish are known to be rich in the essential micronutrient selenium, people further along the nutrition transition to a Western diet may have lower selenium (Se) intake. To test this hypothesis, in 2014 the Investigacion de Migracion, Ambiente, y Salud (IMAS Study) (Migration, Environment, and Health Study) collected household surveys from 310 households in 46 communities along the IOH and nails for Se analysis from 418 adults. Principal component analysis of 25 commonly consumed food items identified a factor resembling Western diet, which was used to calculate household Western diet weighted sum factor scores (WSFS). WSFS means were interpolated into a 10 km buffer around the IOH using inverse distance weighting. Western diet adoption was higher in urban compared to rural areas (p < 0.0001), and geographic variation was observed between mining and agricultural areas. Mean nail Se was 730 ng/g, SD 198 ng/g (range: 200-1390 ng/g). Generalized estimating equation (GEE) models assessed the association between food consumption and nail Se. Household chicken consumption was positively associated with Se in rural areas only. Urban/rural status modified the effect of western diet adoption on nail Se, and Se was inversely associated with WSFS in urban areas only. Conclusion: In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. As the essential micronutrient selenium is a vital part of antioxidant proteins, lower intake could compound the chronic health effects that may result from transition to a calorie-dense diet.
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Affiliation(s)
- Stacy M Pettigrew
- Department of Environmental Health Sciences, State University of New York at Albany, School of Public Health, 1 University Place, Rensselaer, NY 12144, United States of America
| | - William K Pan
- Global Health Institute, Duke University, Durham, NC 27710, USA; Nicholas School of the Environment, Duke University, Durham, NC 27710, USA
| | - Axel Berky
- Nicholas School of the Environment, Duke University, Durham, NC 27710, USA
| | - James Harrington
- Analytical Sciences Department, Research Triangle Institute, East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194, United States of America
| | - Jennifer F Bobb
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, #1600, Seattle, WA 98101, United States of America
| | - Beth J Feingold
- Department of Environmental Health Sciences, State University of New York at Albany, School of Public Health, 1 University Place, Rensselaer, NY 12144, United States of America.
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Pizzitutti F, Mena CF, Feingold B, Pan WK. Modeling asymptomatic infections and work-related human circulation as drivers of unstable malaria transmission in low-prevalence areas: A study in the Northern Peruvian Amazon. Acta Trop 2019; 197:104909. [PMID: 30703339 DOI: 10.1016/j.actatropica.2019.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite relatively successful control campaigns, malaria remains a relevant public health problem in the Peruvian Amazon. Several studies suggest that malaria persistence in the area can be connected with a high prevalence of asymptomatic infections, which were subsequently shown to be connected with work-related exposure in areas of hyperendemic transmission. In this study, we tested the hypothesis that the infection reservoir represented by asymptomatic carriers in the northern Peruvian Amazon, combined with circular human movement to and from hyperendemic working areas, can capture the observed hypoendemic malaria transmission. METHODS We designed a set of agent-based models that represent local-scale malaria transmission in a typical riverine community in the northern Peruvian Amazon. The models include asymptomatic individuals as well as a full representation of human movements within the community and between the community and external hyperendemic working places. Several theoretical scenarios are explored to verify if and how malaria clinical immunity prevalence and human work-related movements influence the malaria morbidity registered in the community. RESULTS Agent-based simulations suggest that malaria incidence observed through passive case detection can be reproduced as exclusively generated by the asymptomatic infection reservoir. Scenarios analysis also show that, even if asymptomatic infections are completely eliminated, human movements to and from hyperendemic working areas generate a flow of imported cases that is enough to permit the persistence of transmission in the community. Simulation results were verified over a wide range of clinical immunity prevalence values and over a wide range of percentages of people working in remote hyperendemic areas. This context of unstable malaria transmission is observed to be vulnerable to severe outbreaks. CONCLUSIONS Asymptomatic malaria infection and occupational circular human movement to hyperendemic transmission areas are designated by agent-based models as possible exclusive causes of residual hypoendemic malaria transmission observed in the Peruvian Amazon. Control strategies are proposed to decrease asymptomatic infection prevalence and to block transmission from asymptomatic individuals to the malaria susceptible population.
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Berky AJ, Ryde IT, Feingold B, Ortiz EJ, Wyatt LH, Weinhouse C, Hsu-Kim H, Meyer JN, Pan WK. Predictors of mitochondrial DNA copy number and damage in a mercury-exposed rural Peruvian population near artisanal and small-scale gold mining: An exploratory study. Environ Mol Mutagen 2019; 60:197-210. [PMID: 30289587 PMCID: PMC6452630 DOI: 10.1002/em.22244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 05/22/2023]
Abstract
Mitochondrial DNA (mtDNA) copy number (CN) and damage in circulating white blood cells have been proposed as effect biomarkers for pollutant exposures. Studies have shown that mercury accumulates in mitochondria and affects mitochondrial function and integrity; however, these data are derived largely from experiments in model systems, rather than human population studies that evaluate the potential utility of mitochondrial exposure biomarkers. We measured mtDNA CN and damage in white blood cells (WBCs) from 83 residents of nine communities in the Madre de Dios region of the Peruvian Amazon that vary in proximity to artisanal and small-scale gold mining. Prior research from this region reported high levels of mercury in fish and a significant association between food consumption and human total hair mercury level of residents. We observed that mtDNA CN and damage were both associated with consumption of fruit and vegetables, higher diversity of fruit consumed, residential location, and health characteristics, suggesting common environmental drivers. Surprisingly, we observed negative associations of mtDNA damage with both obesity and age. We did not observe any association between total hair mercury or, in contrast to previous results, age, with either mtDNA damage or CN. The results of this exploratory study highlight the importance of combining epidemiological and laboratory research in studying the effects of stressors on mitochondria, suggesting that future work should incorporate nutritional and social characteristics, and caution should be taken when applying conclusions from epidemiological studies conducted in the developed world to other regions, as results may not be easily translated. Environ. Mol. Mutagen. 60: 197-210, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Axel J. Berky
- Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA
| | - Ian T. Ryde
- Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA
| | - Beth Feingold
- University of Albany, School of Public Health, Rensselaer, NY 12144, USA
| | - Ernesto J. Ortiz
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Lauren H. Wyatt
- Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA
| | - Caren Weinhouse
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Heileen Hsu-Kim
- Department of Civil and Engineering, Box 90287, Duke University, Durham, NC 27708, USA
| | - Joel N. Meyer
- Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA
- Corresponding authors: William Pan, Duke Global Health Institute, 310 Trent Drive, Campus Box 90519, Durham, NC 27708, fax 681-7748, , Joel N. Meyer, Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA,
| | - William K. Pan
- Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
- Corresponding authors: William Pan, Duke Global Health Institute, 310 Trent Drive, Campus Box 90519, Durham, NC 27708, fax 681-7748, , Joel N. Meyer, Nicholas School of the Environment, Box 90328, Duke University, Durham, NC 27708, USA,
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Pan WK, Seidman JC, Ali A, Hoest C, Mason C, Mondal D, Knobler SL, Bessong P. Oral polio vaccine response in the MAL-ED birth cohort study: Considerations for polio eradication strategies. Vaccine 2018; 37:352-365. [PMID: 30442479 PMCID: PMC6325791 DOI: 10.1016/j.vaccine.2018.05.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/28/2022]
Abstract
Background Immunization programs have leveraged decades of research to maximize oral polio vaccine (OPV) response. Moving toward global poliovirus eradication, the WHO recommended phased OPV-to-IPV replacement on schedules in 2012. Using the MAL-ED prospective birth cohort data, we evaluated the influence of early life exposures impacting OPV immunization by measuring OPV response for serotypes 1 and 3. Methods Polio neutralizing antibody assays were conducted at 7 and 15 months of age for serotypes 1 and 3. Analyses were conducted on children receiving ≥3 OPV doses (n = 1449). History of vaccination, feeding patterns, physical growth, home environment, diarrhea, enteropathogen detection, and gut inflammation were examined as risk factors for non-response [Log2(titer) < 3] and Log2(titer) by serotype using multivariate regression. Findings Serotype 1 seroconversion was significantly higher than serotype 3 (96.6% vs. 89.6%, 15 months). Model results indicate serotypes 1 and 3 failure was minimized following four and six OPV doses, respectively; however, enteropathogen detection and poor socioeconomic conditions attenuated response in both serotypes. At three months of age, bacterial detection in stool reduced serotype 1 and 3 Log2 titers by 0.34 (95% CI 0.14–0.54) and 0.53 (95% CI 0.29–0.77), respectively, and increased odds of serotype 3 failure by 3.0 (95% CI 1.6–5.8). Our socioeconomic index, consisting of Water, Assets, Maternal education, and Income (WAMI), was associated with a 0.79 (95% CI 0.15–1.43) and 1.23 (95% CI 0.34–2.12) higher serotype 1 and 3 Log2 titer, respectively, and a 0.04 (95% CI 0.002–0.40) lower odds of serotype 3 failure. Introduction of solids, transferrin receptor, and underweight were differentially associated with serotype response. Other factors, including diarrheal frequency and breastfeeding practices, were not associated with OPV response. Interpretation Under real-world conditions, improved vaccination coverage and socio-environmental conditions, and reducing early life bacterial exposures are key to improving OPV response and should inform polio eradication strategies.
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Affiliation(s)
- William K Pan
- Duke Global Health Institute, Duke University, Trent Hall, 310 Trent Drive, Durham, NC 27710, USA.
| | - Jessica C Seidman
- Fogarty International Center/National Institutes of Health, Bethesda, MD, USA
| | - Asad Ali
- Aga Khan University, Karachi, Pakistan
| | - Christel Hoest
- Fogarty International Center/National Institutes of Health, Bethesda, MD, USA
| | - Carl Mason
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Stacey L Knobler
- Fogarty International Center/National Institutes of Health, Bethesda, MD, USA
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30
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Salmón-Mulanovich G, Blazes DL, Guezala V MC, Rios Z, Espinoza A, Guevara C, Lescano AG, Montgomery JM, Bausch DG, Pan WK. Individual and Spatial Risk of Dengue Virus Infection in Puerto Maldonado, Peru. Am J Trop Med Hyg 2018; 99:1440-1450. [PMID: 30298808 DOI: 10.4269/ajtmh.17-1015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dengue virus (DENV) affects more than 100 countries worldwide. Dengue virus infection has been increasing in the southern Peruvian Amazon city of Puerto Maldonado since 2000. We designed this study to describe the prevalence of past DENV infection and to evaluate risk factors. In 2012, we conducted a cross-sectional serosurvey and administered a knowledge, attitudes, and practices (KAP) questionnaire to members of randomly selected households. Sera were screened for antibodies to DENV by enzyme-linked immunosorbent assay and confirmed by plaque reduction neutralization test. We created indices for KAP (KAPi). We used SaTScan (Martin Kulldorff with Information Management Services Inc., Boston, MA) to detect clustering and created a multivariate model introducing the distance of households to potential vector and infection sources. A total of 505 participants from 307 households provided a blood sample and completed a questionnaire. Fifty-four percent of participants (95% confidence interval [CI]: 49.6; 58.5) had neutralizing antibodies to DENV. Higher values of KAPi were positively associated with having DENV antibodies in the multivariate analysis (odds ratio [ORII]: 1.6, 95% CI: 0.6, 2.4; ORIII: 2.7, 95% CI: 1.3, 5.5; and ORIV: 2.4, 95% CI: 1.2, 5.0). Older groups had lower chances of having been exposed to DENV than younger people (OR20-30: 0.5, 95% CI: 0.2, 0.8; OR31-45: 0.5, 95% CI: 0.3, 0.9; and OR>45: 0.6, 95% CI: 0.3, 1.3). Multivariate data analysis from the 270 households with location information showed male gender to have lower risk of past DENV infection (OR: 0.6, 95% CI: 0.4, 0.9). We conclude that risk of DENV infection in Puerto Maldonado is related to gender, age of the population, and location.
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Affiliation(s)
- Gabriela Salmón-Mulanovich
- U.S. Naval Medical Research Unit No. 6, Lima, Peru.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David L Blazes
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington.,U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Zonia Rios
- U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | | | | | - Andrés G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.,U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | - Joel M Montgomery
- U.S. Naval Medical Research Unit No. 6, Lima, Peru.,Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel G Bausch
- U.S. Naval Medical Research Unit No. 6, Lima, Peru.,Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - William K Pan
- Duke Global Health Institute and Nicholas School of Environment, Duke University, Durham, North Carolina
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Khalil IA, Troeger C, Blacker BF, Rao PC, Brown A, Atherly DE, Brewer TG, Engmann CM, Houpt ER, Kang G, Kotloff KL, Levine MM, Luby SP, MacLennan CA, Pan WK, Pavlinac PB, Platts-Mills JA, Qadri F, Riddle MS, Ryan ET, Shoultz DA, Steele AD, Walson JL, Sanders JW, Mokdad AH, Murray CJL, Hay SI, Reiner RC. Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990-2016. Lancet Infect Dis 2018; 18:1229-1240. [PMID: 30266330 PMCID: PMC6202441 DOI: 10.1016/s1473-3099(18)30475-4] [Citation(s) in RCA: 331] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 01/01/2023]
Abstract
Background Shigella and enterotoxigenic Escherichia coli (ETEC) are bacterial pathogens that are frequently associated with diarrhoeal disease, and are a significant cause of mortality and morbidity worldwide. The Global Burden of Diseases, Injuries, and Risk Factors study 2016 (GBD 2016) is a systematic, scientific effort to quantify the morbidity and mortality due to over 300 causes of death and disability. We aimed to analyse the global burden of shigella and ETEC diarrhoea according to age, sex, geography, and year from 1990 to 2016. Methods We modelled shigella and ETEC-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We used a compartmental meta-regression tool to model the incidence of shigella and ETEC, which enforces an association between incidence, prevalence, and remission on the basis of scientific literature, population representative surveys, and health-care data. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings Shigella was the second leading cause of diarrhoeal mortality in 2016 among all ages, accounting for 212 438 deaths (95% UI 136 979–326 913) and about 13·2% (9·2–17·4) of all diarrhoea deaths. Shigella was responsible for 63 713 deaths (41 191–93 611) among children younger than 5 years and was frequently associated with diarrhoea across all adult age groups, increasing in elderly people, with broad geographical distribution. ETEC was the eighth leading cause of diarrhoea mortality in 2016 among all age groups, accounting for 51 186 deaths (26 757–83 064) and about 3·2% (1·8–4·7) of diarrhoea deaths. ETEC was responsible for about 4·2% (2·2–6·8) of diarrhoea deaths in children younger than 5 years. Interpretation The health burden of bacterial diarrhoeal pathogens is difficult to estimate. Despite existing prevention and treatment options, they remain a major cause of morbidity and mortality globally. Additional emphasis by public health officials is needed on a reduction in disease due to shigella and ETEC to reduce disease burden. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | | | - Puja C Rao
- Institute for Health Metrics and Evaluation, Seattle WA, USA
| | | | | | - Thomas G Brewer
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Cyril M Engmann
- Maternal, Newborn, Child Health & Nutrition, PATH, Seattle, WA, USA; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Gagandeep Kang
- Translational Health Science and Technology Institute, Faridabad, India
| | - Karen L Kotloff
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Myron M Levine
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Calman A MacLennan
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - William K Pan
- Institute for Health Metrics and Evaluation, Seattle WA, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Edward T Ryan
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology & Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - David A Shoultz
- Drug Development, PATH, Seattle, WA, USA; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Albers School of Business & Economics, Seattle University, Seattle, WA, USA
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Judd L Walson
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Epidemiology, University of Washington School of Medicine, Seattle, WA, USA
| | - John W Sanders
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle WA, USA
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, Seattle WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, Seattle WA, USA.
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Weinhouse C, Ortiz EJ, Berky AJ, Bullins P, Hare-Grogg J, Rogers L, Morales AM, Hsu-Kim H, Pan WK. Hair Mercury Level is Associated with Anemia and Micronutrient Status in Children Living Near Artisanal and Small-Scale Gold Mining in the Peruvian Amazon. Am J Trop Med Hyg 2017; 97:1886-1897. [PMID: 29016304 DOI: 10.4269/ajtmh.17-0269] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Anemia has been widely studied in global health contexts because of severe nutritional deficiency, and more recently, inflammatory status, but chemical exposures are rarely considered. Until recently, "anemia" was used synonymously with "iron deficiency anemia (IDA)" in global health settings. However, only 50% of anemia cases worldwide are IDA. Environmental toxicology studies of anemia risk have generally focused on populations in developed countries, albeit with high exposure to environmental toxicants, such as lead or cadmium. In the developing world, toxicant exposures commonly coexist with other risk factors for anemia. In particular, artisanal and small-scale gold mining (ASGM) communities are at risk for dietary methylmercury exposure through contaminated fish consumption, and for anemia due to food insecurity and infectious and chronic diseases. Here, we report analysis of total hair mercury content, hemoglobin, and serum micronutrient levels in children < 12 years of age (N = 83) near ASGM in the Peruvian Amazon. Forty-nine percent (N = 29/59) of those aged < 5 years were anemic (< 11 g/dL) and 52% (N = 12/23) of those aged 5-11 years (< 11.5 g/dL). Few children were stunted, wasted, or micronutrient deficient. Median total hair mercury was 1.18 μg/g (range: 0.06-9.70 μg/g). We found an inverse association between total mercury and hemoglobin (β = -0.12 g/dL, P = 0.06) that persisted (β = -0.14 g/dL, P = 0.04) after adjusting for age, sex, anthropometrics, and vitamin B12 in multivariate regression. This study provides preliminary evidence that methylmercury exposure is associated with anemia, which is especially relevant to children living near ASGM.
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Affiliation(s)
- Caren Weinhouse
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Ernesto J Ortiz
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Axel J Berky
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Paige Bullins
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - John Hare-Grogg
- Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - Laura Rogers
- Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - Ana-Maria Morales
- Centro de Estudios, Investigación y Servicios en Salud Publica, Lima, Peru
| | - Heileen Hsu-Kim
- Nicholas School of the Environment, Duke University, Durham, North Carolina.,Civil and Environmental Engineering, Duke University, Durham, North Carolina
| | - William K Pan
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Nicholas School of the Environment, Duke University, Durham, North Carolina
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Abstract
Despite implications for both humans and the environment, a scant body of research examines fertility in forest frontiers. This study examines the fertility-environment association using empirical data from Ecuadorian Amazon between 1980 and 1999. Fertility dramatically declined during this period, and our empirical models suggest that households' relationship to land partially explains this decline. Controlling for known fertility determinants such as age and education, women in households lacking land titles experienced a 27 % higher birth rate than did women in households with land titles. This suggests insecure land tenure was associated with higher fertility. Furthermore, each additional hectare of new pasture was associated with a 16 % higher birth rate, suggesting the potential role of a more stable and lucrative income source in supporting additional births. Findings from this research can help inform strategic policies to address sustainable development in frontier environments.
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Affiliation(s)
- William K. Pan
- Duke Global Health Institute and Nicholas School of Environment, Duke University, 310 Trent Drive, Rm 227, Durham, NC 27708, USA
| | - David López-Carr
- Department of Geography, University of California at Santa Barbara (UCSB), 4836 Ellison Hall, Santa Barbara, CA 93106-4060, USA
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Tudor C, Van der Walt ML, Margot B, Dorman SE, Pan WK, Yenokyan G, Farley JE. Occupational Risk Factors for Tuberculosis Among Healthcare Workers in KwaZulu-Natal, South Africa. Clin Infect Dis 2016; 62 Suppl 3:S255-61. [PMID: 27118855 PMCID: PMC4845891 DOI: 10.1093/cid/ciw046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberculosis is a known occupational hazard for healthcare workers (HCWs), especially in countries with a high burden of tuberculosis. It is estimated that HCWs have a 2- to 3-fold increased risk of developing tuberculosis compared with the general population. The objective of this study was to identify occupational risk factors for tuberculosis among HCWs in 3 district hospitals with specialized multidrug-resistant tuberculosis wards in KwaZulu-Natal, South Africa. METHODS We conducted a case-control study of HCWs diagnosed with tuberculosis between January 2006 and December 2010. Cases and controls were asked to complete a self-administered questionnaire regarding potential risk factors for tuberculosis. RESULTS Of 307 subjects selected, 145 (47%) HCWs responded to the questionnaire; 54 (37%) tuberculosis cases and 91 (63%) controls. Cases occurred more frequently among clinical staff 46% (n = 25) and support staff 35% (n = 19). Thirty-two (26% [32/125]) HCWs were known to be infected with human immunodeficiency virus (HIV), including 45% (21/54) of cases. HCWs living with HIV (odds ratio [OR], 6.35; 95% confidence interval [CI], 3.54-11.37) and those who spent time working in areas with patients (OR, 2.24; 95% CI, 1.40-3.59) had significantly greater odds of developing tuberculosis, controlling for occupation, number of wards worked in, and household crowding. CONCLUSIONS HIV was the major independent risk factor for tuberculosis among HCWs in this sample. These findings support the need for HCWs to know their HIV status, and for HIV-infected HCWs to be offered antiretroviral therapy and isoniazid preventive therapy. Infection prevention and control should also be improved to prevent transmission of tuberculosis in healthcare settings to protect both HCWs and patients.
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Affiliation(s)
- Carrie Tudor
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | | | - Bruce Margot
- Department of Communicable Diseases, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Susan E Dorman
- Division of Infectious Disease, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William K Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jason E Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Wyatt LH, Diringer SE, Rogers LA, Hsu-Kim H, Pan WK, Meyer JN. Antagonistic Growth Effects of Mercury and Selenium in Caenorhabditis elegans Are Chemical-Species-Dependent and Do Not Depend on Internal Hg/Se Ratios. Environ Sci Technol 2016; 50:3256-64. [PMID: 26938845 PMCID: PMC4964607 DOI: 10.1021/acs.est.5b06044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The relationship between mercury (Hg) and selenium (Se) toxicity is complex, with coexposure reported to reduce, increase, and have no effect on toxicity. Different interactions may be related to chemical compound, but this has not been systematically examined. Our goal was to assess the interactive effects between the two elements on growth in the nematode Caenorhabditis elegans, focusing on inorganic and organic Hg (HgCl2 and MeHgCl) and Se (selenomethionine, sodium selenite, and sodium selenate) compounds. We utilized aqueous Hg/Se dosing molar ratios that were either above, below, or equal to 1 and measured the internal nematode total Hg and Se concentrations for the highest concentrations of each Se compound. Observed interactions were complicated, differed between Se and Hg compounds, and included greater-than-additive, additive, and less-than-additive growth impacts. Biologically significant interactions were only observed when the dosing Se solution concentration was 100-25,000 times greater than the dosing Hg concentration. Mitigation of growth impacts was not predictable on the basis of internal Hg/Se molar ratio; improved growth was observed at some internal Hg/Se molar ratios both above and below 1. These findings suggest that future assessments of the Hg and Se relationship should incorporate chemical compound into the evaluation.
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Affiliation(s)
- Lauren H. Wyatt
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Sarah E. Diringer
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Laura A. Rogers
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Heileen Hsu-Kim
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina 27708, United States
| | - William K. Pan
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
- Global Health Institute, Duke University, Durham, North Carolina 27708, United States
| | - Joel N. Meyer
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
- Corresponding Author. Phone: 919-613-8109;
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Lantos PM, Nigrovic LE, Auwaerter PG, Fowler VG, Ruffin F, Brinkerhoff RJ, Reber J, Williams C, Broyhill J, Pan WK, Gaines DN. Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014. Open Forum Infect Dis 2015; 2:ofv143. [PMID: 26550580 PMCID: PMC4629694 DOI: 10.1093/ofid/ofv143] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/24/2015] [Indexed: 11/14/2022] Open
Abstract
Background. The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods. We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results. There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions. The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years.
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Affiliation(s)
- Paul M. Lantos
- Divisions of Pediatric Infectious Diseases
- General Internal Medicine
| | - Lise E. Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Massachusetts
| | - Paul G. Auwaerter
- Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Vance G. Fowler
- Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Felicia Ruffin
- Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - R. Jory Brinkerhoff
- Department of Biology, University of Richmond, Virginia
- University of KwaZulu-Natal, Westville, South Africa
| | - Jodi Reber
- North Carolina Department of Public Health, Raleigh
| | | | | | - William K. Pan
- Duke Global Health Institute
- Nicholas School of the Environment, Duke University, Durham, North Carolina
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Salmon-Mulanovich G, Blazes DL, Lescano AG, Bausch DG, Montgomery JM, Pan WK. Economic Burden of Dengue Virus Infection at the Household Level Among Residents of Puerto Maldonado, Peru. Am J Trop Med Hyg 2015. [PMID: 26217040 DOI: 10.4269/ajtmh.14-0755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dengue virus (DENV) was reintroduced to Peru in the 1990s and has been reported in Puerto Maldonado (population ~65,000) in the Peruvian southern Amazon basin since 2000. This region also has the highest human migration rate in the country, mainly from areas not endemic for DENV. The objective of this study was to assess the proportion of household income that is diverted to costs incurred because of dengue illness and to compare these expenses between recent migrants (RMs) and long-term residents (LTRs). We administered a standardized questionnaire to persons diagnosed with dengue illness at Hospital Santa Rosa in Puerto Maldonado from December 2012 to March 2013. We compared direct and indirect medical costs between RMs and LTRs. A total of 80 participants completed the survey, of whom 28 (35%) were RMs and 52 (65%) were LTRs. Each dengue illness episode cost the household an average of US$105 (standard deviation [SD] = 107), representing 24% of their monthly income. Indirect costs were the greatest expense (US$56, SD = 87), especially lost wages. The proportion of household income diverted to dengue illness did not differ significantly between RM and LTR households. The study highlights the significant financial burden incurred by households when a family member suffers dengue illness.
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Affiliation(s)
- Gabriela Salmon-Mulanovich
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - David L Blazes
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Andres G Lescano
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Daniel G Bausch
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Joel M Montgomery
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - William K Pan
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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Platts-Mills JA, McCormick BJJ, Kosek M, Pan WK, Checkley W, Houpt ER. Methods of analysis of enteropathogen infection in the MAL-ED Cohort Study. Clin Infect Dis 2015; 59 Suppl 4:S233-8. [PMID: 25305292 DOI: 10.1093/cid/ciu408] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Studies of diarrheal etiology in low- and middle-income countries have typically focused on children presenting with severe symptoms to health centers and thus are best equipped to describe the pathogens capable of leading to severe diarrheal disease. The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study was designed to evaluate, via intensive community surveillance, the hypothesis that repeated exposure to enteropathogens has a detrimental effect on growth, vaccine response, and cognitive development, which are the primary outcome measures for this study. In the setting of multiple outcomes of interest, a longitudinal cohort design was chosen. Because many or even the majority of enteric infections are asymptomatic, the collection of asymptomatic surveillance stools was a critical element. However, capturing diarrheal stools additionally allowed for the determination of the principle causes of diarrhea at the community level as well as for a comparison between those enteropathogens associated with diarrhea and those that are associated with poor growth, diminished vaccine response, and impaired cognitive development. Here, we discuss the analytical methods proposed for the MAL-ED study to determine the principal causes of diarrhea at the community level and describe the complex interplay between recurrent exposure to enteropathogens and these critical long-term outcomes.
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Affiliation(s)
- James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | | | - Margaret Kosek
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Biomedical Research, Asociación Benéfica PRISMA, Iquitos, Peru
| | - William K Pan
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - William Checkley
- Fogarty International Center, National Institutes of Health, Bethesda, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
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Lee JGL, Pan WK, Henriksen L, Goldstein AO, Ribisl KM. Is There a Relationship Between the Concentration of Same-Sex Couples and Tobacco Retailer Density? Nicotine Tob Res 2015; 18:147-55. [PMID: 25744959 DOI: 10.1093/ntr/ntv046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Tobacco use is markedly higher among lesbian, gay, and bisexual populations than heterosexuals. Higher density of tobacco retailers is found in neighborhoods with lower income and more racial/ethnic minorities. Same-sex couples tend to live in similar neighborhoods, but the association of this demographic with tobacco retailer density has not been examined. METHODS For a national sample of 97 US counties, we calculated the number of tobacco retailers per 1000 persons and rates of same-sex couples per 1000 households in each census tract (n = 17 941). Using spatial regression, we examined the association of these variables in sex-stratified models, including neighborhood demographics and other environmental characteristics to examine confounding. RESULTS Results from spatial regression show that higher rates of both female and male same-sex couples were associated with a higher density of tobacco retailers. However the magnitude of this association was small. For female couples, the association was not significant after controlling for area-level characteristics, such as percent black, percent Hispanic, median household income, the presence of interstate highways, and urbanicity, which are neighborhood correlates of higher tobacco retailer density. For male couples, the association persisted after control for these characteristics. CONCLUSION Same-sex couples reside in areas with higher tobacco retailer density, and for men, this association was not explained by neighborhood confounders, such as racial/ethnic composition and income. While lesbian, gay, and bisexual disparities in tobacco use may be influenced by neighborhood environment, the magnitude of the association suggests other explanations of these disparities remain important areas of research.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC;
| | - William K Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, NC
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford School of Medicine, Palo Alto, CA
| | - Adam O Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Danysh HE, Gilman RH, Wells JC, Pan WK, Zaitchik B, Gonzálvez G, Alvarez M, Checkley W. El Niño adversely affected childhood stature and lean mass in northern Peru. ACTA ACUST UNITED AC 2014. [DOI: 10.1186/s40665-014-0007-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lee G, Paredes Olortegui M, Peñataro Yori P, Black RE, Caulfield L, Banda Chavez C, Hall E, Pan WK, Meza R, Kosek M. Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth. Pediatr Infect Dis J 2014; 33:1004-9. [PMID: 25361185 DOI: 10.1097/inf.0000000000000351] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies examining the etiology-specific effects of diarrheal disease on growth are limited and variable in their analytic methods, making comparisons difficult and priority setting based on these findings challenging. A study by Black et al (Black RE, Brown KH, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics. 1984;33:1004-1009.) examined the association between Shigella and enterotoxigenic Escherichia coli-related disease and weight gain and linear growth in Bangladeshi children aged 0-5 years. We estimated similar associations in a 2002 cohort of 0- to 6-year-old children in the Peruvian Amazon. METHODS Diarrheal surveillence was conducted using household visits 3 times per week. Anthropometry was collected monthly. Mixed-effect models were used to estimate the association between Shigella, ETEC and Campylobacter diarrhea and weight gain in a 2-month period and linear growth over a 9-month period. Diarrheal disease burdens and growth intervals were quantified so as to be as comparable as possible to the original report. RESULTS Shigella- and ETEC-associated diarrhea were not associated with diminished weight gain, although the association between ETEC diarrhea and weight gain (-4.5 g/percent of days spent with ETEC, P = 0.098) was twice that of other etiologic agents, as well as similar in magnitude to the original report. Shigella-associated diarrhea was associated with decreased linear growth (0.055 cm less growth/percent days, P = 0.008), also similar to the original study. CONCLUSIONS Our findings suggest that associations between enteropathogen-specific diarrheal episodes and growth, particularly Shigella, are comparable across geographic and epidemiological contexts.
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Affiliation(s)
- Gwenyth Lee
- From the *Department of International Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Asociaciόn Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Peru; ‡Naval Medical Research Center, Bethesda, MD; §Duke Global Health Institute and Nicholas School of Environment, Duke University, Durham, NC; and ¶Department of Bacteriology, US Naval Medical Research Unit Six, Lima, Peru
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Tudor C, Van der Walt M, Margot B, Dorman SE, Pan WK, Yenokyan G, Farley JE. Tuberculosis among health care workers in KwaZulu-Natal, South Africa: a retrospective cohort analysis. BMC Public Health 2014; 14:891. [PMID: 25174848 PMCID: PMC4161912 DOI: 10.1186/1471-2458-14-891] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an occupational hazard for health care workers (HCWs) who are at greater risk of developing TB than the general population. The objective of this study was to compare the difference in TB incidence among HCWs with versus without a history of working in TB wards, to estimate the incidence of TB among HCWs, and to identify risk factors for TB disease in HCWs. METHODS A retrospective cohort study (January 2006 to December 2010) was conducted in three district hospitals in KwaZulu-Natal, South Africa. Data were abstracted via chart review from occupational health medical records. Bivariate and multivariate analyses were performed using a Poisson multilevel mixed model. RESULTS Of 1,313 (92%) medical charts reviewed with data on location of work documented, 112 (9%) cases of TB were identified. Among HCWs with TB 14 (13%) had multidrug-resistant TB. Thirty-six (32%) were cured, 33 (29%) completed treatment, and 13 (12%) died. An increased incidence of TB was reported for HCWs with a history of working in TB wards (incidence rate ratio [IRR] 2.03, 95% CI 1.11-3.71), pediatric wards (IRR 1.82 95% CI 1.07-3.10), outpatient departments (IRR 2.08 95% CI 1.23-3.52), and stores/workshop (IRR 2.38 95% CI 1.06-5.34) compared with those without such a history. HCWs living with HIV had a greater incidence of TB (IRR 3.2, 95% CI 1.54-6.66) than HIV-negative HCWs. TB incidence among HCWs was approximately two-fold greater than that of the general population over the study period. CONCLUSIONS HCWs working in a TB ward had an increased incidence of TB. However, a greater incidence of TB was also found in HCWs working in other wards including pediatric wards, outpatient departments and stores. We also identified a greater incidence of TB among HCWs than the general population. These findings further support the need for improved infection control measures not only in TB or drug-resistant TB wards or areas perceived to be at high-risk but also throughout hospitals to protect HCWs. Additionally, it is recommended for occupational health services to routinely screen HCWs for TB and provide HCWs with access to care for TB and HIV.
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Affiliation(s)
- Carrie Tudor
- />Fogarty Global Health Post-doctoral Fellow, University of North Carolina, Chapel Hill, 211 W. Sierra Circle, San Marcos, TX 78666 USA
| | | | - Bruce Margot
- />KwaZulu-Natal Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Susan E Dorman
- />Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - William K Pan
- />Duke University Nicholas School of Environment and Duke Global Health Institute, Durham, NC USA
| | - Gayane Yenokyan
- />Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Jason E Farley
- />Johns Hopkins University School of Nursing, Baltimore, Maryland USA
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Abstract
Land use and land cover (LULC) is now recognized as an important driver of disease. For emerging or re-emerging infectious diseases, LULC offers context and serves as a likely proximate driver of risk particularly when considering vector-borne or zoonotic diseases. Ontological differences embedded within disciplinary structures impede progress limiting the ultimate potential of both LULC data and land change theory within disease research. Geography, space, and time serve as effective complements to traditional health and place organizational and disease-research strategies. Improved systemic clarity is obtained if one orients the disease relationship to particular contexts and if the scales of the relationships are clearly defined.
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Affiliation(s)
- Joseph P Messina
- Department of Geography, Center for Global Change and Earth Observations, and AgBioResearch, Michigan State University, 218 Manly Miles Building, 1405 South Harrison Road, East Lansing, MI 48823, USA
| | - William K Pan
- Duke Global Health Institute and Nicholas School of Environment, Duke University, Durham, NC 27708, USA
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Barbieri AF, Pan WK. People, Land, and Context: Multilevel Determinants of Off-farm Employment in the Ecuadorian Amazon. Popul Space Place 2013; 19:558-579. [PMID: 31031573 PMCID: PMC6483401 DOI: 10.1002/psp.1733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper investigates the factors that motivate decisions of settler colonists to engage in off-farm employment (OFE) in the Northern Ecuadorian Amazon (NEA). Overall, OFE, as a type of population mobility, may increasingly become a dominant demographic factor in rural frontier regions. Although OFE decisions are primarily a matter of individual choice, factors associated with the farm household and the local community also play key roles in this decision-making. This paper applies a multilevel conceptual framework and uses a multinomial, multilevel statistical model to study OFE in the NEA in 1999 as a result of factors at the individual, farm household, and community levels. The results show important differences between OFE participation choices in personal characteristics, human capital, farm household life cycle, land use, land management, farm environmental conditions, transportation accessibility, community size, and structure of local labor markets. The paper also identifies the effects of policy-relevant variables on choices to engage in OFE in local community, other rural, or urban areas of destination.
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Affiliation(s)
- Alisson Flávio Barbieri
- Department of Demography and Center for Regional Development and Planning (CEDEPLAR), Universidade Federal de Minas Gerais (UFMG), Brazil. Address: CEDEPLAR/FACE/UFMG, Av. Antonio Carlos 6627, CEP 31270-901, Belo Horizonte MG, Brazil.
| | - William K Pan
- Duke Global Health Institute and the Nicholas School of Environment, Duke University. Address: Room 227 Trent Hall and A354 LSRC, P.O. Box 90519, Durham, NC 27708 USA.
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Parker BS, Paredes Olortegui M, Peñataro Yori P, Escobedo K, Florin D, Rengifo Pinedo S, Cardenas Greffa R, Capcha Vega L, Rodriguez Ferrucci H, Pan WK, Banda Chavez C, Vinetz JM, Kosek M. Hyperendemic malaria transmission in areas of occupation-related travel in the Peruvian Amazon. Malar J 2013; 12:178. [PMID: 23724869 PMCID: PMC3673823 DOI: 10.1186/1475-2875-12-178] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Plasmodium vivax and Plasmodium falciparum cause a significant illness burden in Peru. Anopheline indices for populated communities in the peri-Iquitos region of Loreto have been reported to be remarkably low, with entomological inoculation rates (EIR) estimated at one to 30 infective bites per year based on a few studies in close proximity to the urban centre of Iquitos and surrounding deforested areas. Local reports suggest that a large number of the reported cases are contracted outside of populated communities in undeveloped riverine areas frequented by loggers and fishermen. Methods To better understand vectorial capacity in suspected high malaria transmission zones in a rural district near Iquitos, Peru, mosquito collections were conducted at different points in the seasonality of malaria transmission in 21 sites frequented by occupational labourers. Prevalence of Plasmodium spp in vectors was determined by circumsporozoite protein ELISA on individual mosquitoes. Slide surveillance was performed for humans encountered in the zone. Results In total, of 8,365 adult female mosquitoes examined, 98.5% were identified as Anopheles darlingi and 117 (1.4%) tested positive for sporozoites (P. falciparum, P. vivax VK210 or P. vivax VK247). Measured human biting rates at these sites ranged from 0.102 to 41.13 bites per person per hour, with EIR values as high as 5.3 infective bites per person per night. Six percent of the 284 blood films were positive for P. vivax or P. falciparum; however, 88% of the individuals found to be positive were asymptomatic at the time of sampling. Conclusions The results of this study provide key missing indices of prominent spatial and temporal heterogeneity of vectorial capacity in the Amazon Basin of Peru. The identification of a target human subpopulation as a principal reservoir and dispersion source of Plasmodium species has important implications for vaccine development and the delivery of effective targeted malaria control strategies.
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Affiliation(s)
- Benjamin S Parker
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Room E5545, Baltimore, Maryland 21205, USA
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Franklin FA, LaVeist TA, Webster DW, Pan WK. Alcohol outlets and violent crime in washington d.C. West J Emerg Med 2010; 11:283-90. [PMID: 20882151 PMCID: PMC2941368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/26/2010] [Accepted: 04/27/2010] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Alcohol is more likely than any other drug to be involved in substance-related violence. In 2000 violence-related and self-directed injuries accounted for an estimated $37 billion and $33 billion in productivity losses and medical treatment, respectively. A review of emergency department data revealed violence and clinically identified trauma-related injuries have the strongest correlation among alcohol-dependent injuries. At the environmental level there is a relationship between alcohol outlet density and violent crime. A limited number of studies have examined the relationship between alcohol outlet type and the components of violent crime. The aim of this study is to examine the relationship between the aggregate components of violent crime and alcohol outlet density by type of outlet. METHODS For this study we used Washington, D.C. census tract data from the 2000 census to examine neighborhood characteristics. Alcohol outlet, violent crime, and population-level data for Washington, D.C. were drawn from various official yetpublicly available sources. We developed an analytic database to examine the relationship between alcohol outlet category and four types of violent crime. After estimating spatial correlation and determining spatial dependence, we used a negative binomial regression analysis to assess the alcohol availability-violent crime association, while controlling for structural correlates of violence. RESULTS Independent of alternative structural correlates of violent crime, including the prevalence of weapons and illicit drugs, community-level alcohol outlet density is significantly associated with assaultive violence. Outlets were significantly related to robbery, assault, and sexual offenses. In addition, the relationship among on-premise and off-premise outlets varied across violent crime categories. CONCLUSION In Washington, D.C., alcohol outlet density is significantly associated with the violent crimes. The science regarding alcohol outlet density and alcohol-related harms has clearly identified the use of limiting outlet density to reduce the associated adverse health consequences. Moreover, the disproportionate burden among poor urban and minority communities underscores the urgency to develop context-appropriate policies to regulate the functioning of current alcohol outlet establishments and to prevent the proliferation of future outlets.
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Affiliation(s)
- F. Abron Franklin
- Satcher Health Leadership Institute, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA,Address for Correspondence: Frank A. Franklin, II, PhD, MPH, Satcher Health Leadership Institute, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, SW, NCPC Suite 238, Atlanta, GA 30310-1495. :
| | - Thomas A. LaVeist
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD
| | - Daniel W. Webster
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD
| | - William K. Pan
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD
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Salmon DA, Sotir MJ, Pan WK, Berg JL, Omer SB, Stokley S, Hopfensperger DJ, Davis JP, Halsey NA. Parental vaccine refusal in Wisconsin: a case-control study. WMJ 2009; 108:17-23. [PMID: 19326630 PMCID: PMC6359894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Successful immunization programs have diminished parental fear of diseases and increased fear of vaccines. Children with nonmedical exemptions to school immunization requirements are at increased risk of acquiring and transmitting disease. We explored differences in vaccine attitudes, beliefs, and information sources among parents of exempt and vaccinated children. METHODS Self-administered surveys were mailed to 780 parents of children with nonmedical exemptions (cases) and 1491 parents of fully-vaccinated children (controls). RESULTS Vaccines most often refused by exempt children were varicella (49%) and hepatitis B (30%). The most common reason for claiming exemptions was vaccine might cause harm (57%). Parents of vaccinated children were less likely than parents of exempt children to report concern about vaccine safety, question the need for immunization, and oppose immunization requirements. Nearly 25% of parents of vaccinated children reported that children get more immunizations than are good for them and 34% expressed concern that children's immune systems could be weakened by too many immunizations. Both groups received information from health care professionals; parents of exempt children were more likely to also consult other sources. CONCLUSIONS Our findings support the need for improved methods to communicate vaccine safety information. Further studies to explore vaccine safety concerns among parents are needed.
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Affiliation(s)
- Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Oswald WE, Hunter GC, Lescano AG, Cabrera L, Leontsini E, Pan WK, Soldan VP, Gilman RH. Direct observation of hygiene in a Peruvian shantytown: not enough handwashing and too little water. Trop Med Int Health 2008; 13:1421-8. [PMID: 19055623 PMCID: PMC4014353 DOI: 10.1111/j.1365-3156.2008.02177.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To document frequency of hygiene practices of mothers and children in a shantytown in Lima, Peru. METHODS Continuous monitoring over three 12-h sessions in households without in-house water connections to measure: (i) water and soap use of 32 mothers; (ii) frequency of interrupting faecal-hand contamination by washing; and (iii) the time until faecal-hand contamination became a possible transmission event. RESULTS During 1008 h of observation, 55% (65/119) of mothers' and 69% (37/54) of children's faecal-hand contamination events were not followed within 15 min by handwashing or bathing. Nearly 40% (67/173) of faecal-hand contamination events became possible faecal-oral transmission events. There was no difference in the time-until-transmission between mothers and children (P = 0.43). Potential transmission of faecal material to food or mouth occurred in 64% of cases within 1 h of hand contamination. Mean water usage (6.5 l) was low compared to international disaster relief standards. CONCLUSIONS We observed low volumes of water usage, inadequate handwashing, and frequent opportunities for faecal contamination and possible transmission in this water-scarce community.
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Affiliation(s)
- William E Oswald
- Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Kosek M, Yori PP, Pan WK, Olortegui MP, Gilman RH, Perez J, Chavez CB, Sanchez GM, Burga R, Hall E. Epidemiology of highly endemic multiply antibiotic-resistant shigellosis in children in the Peruvian Amazon. Pediatrics 2008; 122:e541-9. [PMID: 18710884 PMCID: PMC6204332 DOI: 10.1542/peds.2008-0458] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Our goal was to estimate the impact of a Shigella vaccine in an area where shigellosis is endemic by characterizing the disease burden and antibiotic-resistance profiles of isolates and by determining the prevalence of Shigella flexneri serotypes. PATIENTS AND METHODS We conducted a 43-month-long prospective, community-based diarrheal disease surveillance in 442 children <72 months of age in the Peruvian Amazon between October 1, 2002, and April 15, 2006. RESULTS The incidence of diarrheal disease was 4.38 episodes per child-year. The incidence rate for shigellosis was 0.34 episodes per child-year in children <72 months of age and peaked in children between 12 and 23 months at 0.43 episodes per child-year. Maternal education at or beyond the primary grade level, piped water supply, weight-for-age z score, and improved water-storage practices were the most significant determinants of disease in this community with living conditions comparable to many rural areas in the developing world. CONCLUSIONS Children living in this region had a 20-fold higher rate of disease incidence detected by active surveillance as those recently estimated by passive detection. Most symptomatic disease was caused by S flexneri, although the diversity of serotypes will require a multivalent vaccine to have a significant impact on the burden of disease caused by shigellosis. Several other public health disease-control interventions targeted at water source and improved storage, nutritional interventions, and improved maternal education seem to have a greater impact than a univalent S flexneri 2a vaccine.
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Affiliation(s)
- Margaret Kosek
- Johns Hopkins School of Public Health, Department of International Health, 615 N Wolfe St, W 5515, Baltimore, MD 21205, USA.
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Saito M, Pan WK, Gilman RH, Bautista CT, Bamrah S, Martín CA, Tsiouris SJ, Argüello DF, Martinez-Carrasco G. Comparison of altitude effect on Mycobacterium tuberculosis infection between rural and urban communities in Peru. Am J Trop Med Hyg 2006; 75:49-54. [PMID: 16837708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The mechanism of high altitude effect on tuberculosis (TB) infection has not been fully established. We previously reported a lower positive tuberculin skin test (TST) prevalence in high altitude villages compared with sea level communities in Peru. In this study, four additional communities were tested to assess whether decreased TB transmission was also in urban environments at high altitude. TST results from 3,629 individuals in nine communities were analyzed using generalized estimating equations to account for community clustering. Positive TST prevalence was not significantly different between the urban highland and the urban non-highland communities after adjusting for age, household contacts with a TST-positive person or a TB case, and presence of a Bacillus Calmette-Guérin vaccination scar. The effect of population concentration and increased contact with active TB overwhelmed the protective effect of altitude in urban highlands. Highland cities require the same preventive efforts against TB as non-highland communities.
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Affiliation(s)
- Mayuko Saito
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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