Prion forensics: a multidisciplinary approach to investigate CWD at an illegal deer carcass disposal site

Infectious prions are resistant to degradation and remain infectious in the environment for several years. Chronic wasting disease (CWD) has been detected in cervids inhabiting North America, the Nordic countries, and South Korea. CWD-prion spread is partially attributed to carcass transport and disposal. We employed a forensic approach to investigate an illegal carcass dump site connected with a CWD-positive herd. We integrated anatomic, genetic, and prion amplification methods to discover CWD-positive remains from six white-tailed deer (Odocoileus virginianus) and, using microsatellite markers, confirmed a portion originated from the CWD-infected herd. This approach provides a foundation for future studies of carcass prion transmission risk.

The establishment of a collaborative surveillance program with indigenous hunters to characterize primate health in Southern Guyana

The consumption of primates is integral to the traditional subsistence strategies of many Indigenous communities throughout Amazonia. Understanding the overall health of primates harvested for food in the region is critical to Indigenous food security and thus, these communities are highly invested in long-term primate population health. Here, we describe the establishment of a surveillance comanagement program among the Waiwai, an Indigenous community in the Konashen Amerindian Protected Area (KAPA). To assess primate health in the KAPA, hunters performed field necropsies on primates harvested for food and tissues collected from these individuals were analyzed using histopathology. From 2015 to 2019, hunters conducted 127 necropsies across seven species of primates. Of this sample, 82 primates (between 2015 and 2017) were submitted for histopathological screening. Our histopathology data revealed that KAPA primates had little evidence of underlying disease. Of the tissue abnormalities observed, the majority were either due to diet (e.g., hepatocellular pigment), degenerative changes resulting from aging (e.g., interstitial nephritis, myocyte lipofusion), or nonspecific responses to antigenic stimulation (renal and splenic lymphoid hyperplasia). In our sample, 7.32% of individuals had abnormalities that were consistent with a viral etiology, including myocarditis and hepatitis. Internal parasites were observed in 53.66% of individuals and is consistent with what would be expected from a free-ranging primate population. This study represents the importance of baseline data for long-term monitoring of primate populations hunted for food. More broadly, this research begins to close a critical gap in zoonotic disease risk related to primate harvesting in Amazonia, while also demonstrating the benefits of partnering with Indigenous hunters and leveraging hunting practices in disease surveillance and primate population health assessment.

Health of wild fish exposed to contaminants of emerging concern in freshwater ecosystems utilized by a Minnesota Tribal community

Fish serve as indicators of exposure to contaminants of emerging concern (CECs)-chemicals such as pharmaceuticals, hormones, and personal care products-which are often designed to impact vertebrates. To investigate fish health and CECs in situ, we evaluated the health of wild fish exposed to CECs in waterbodies across northeastern Minnesota with varying anthropogenic pressures and CEC exposures: waterbodies with no human development along their shorelines, those with development, and those directly receiving treated wastewater effluent. Then, we compared three approaches to evaluate the health of fish exposed to CECs in their natural environment: a refined fish health assessment index, a histopathological index, and high-throughput (ToxCast) in vitro assays. Lastly, we mapped adverse outcome pathways (AOPs) associated with identified ToxCast assays to determine potential impacts across levels of biological organization within the aquatic system. These approaches were applied to subsistence fish collected from the Grand Portage Indian Reservation and 1854 Ceded Territory in 2017 and 2019. Overall, 24 CECs were detected in fish tissues, with all but one of the sites having at least one detection. The combined implementation of these tools revealed that subsistence fish exposed to CECs had histological and macroscopic tissue and organ abnormalities, although a direct causal link could not be established. The health of fish in undeveloped sites was as poor, or sometimes poorer, than fish in developed and wastewater effluent-impacted sites based on gross and histologic tissue lesions. Adverse outcome pathways revealed potential hazardous pathways of individual CECs to fish. A better understanding of how the health of wild fish harvested for consumption is affected by CECs may help prioritize risk management research efforts and can ultimately be used to guide fishery management and public health decisions. Integr Environ Assess Manag 2024;20:846-863. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

A De Novo Whole Genome Assembly and Annotation of Parelaphostrongylus tenuis

Parelaphostrongylus tenuis causes ungulate morbidity and mortality in eastern and central North America, but no reference genome sequence exists to facilitate research. Here, we present a P. tenuis genome assembly and annotation, generated with PacBio and Illumina technologies. The assembly is 491 Mbp, with 7285 scaffolds and 185 kb N50.

SPECIES IN THE FECES: DNA METABARCODING TO DETECT POTENTIAL GASTROPOD HOSTS OF PARELAPHOSTRONGYLUS TENUIS Consumed By Moose (Alces Alces)

Our understanding of wildlife multihost pathogen transmission systems is often incomplete due to the difficulty of observing contact between hosts. Understanding these interactions can be critical for preventing disease-induced wildlife declines. The proliferation of high-throughput sequencing technologies provides new opportunities to better explore these cryptic interactions. Parelaphostrongylus tenuis, a multihost parasite, is a leading cause of death in some moose (Alces alces) populations threatened by local extinction in the midwestern and northeastern US and southeastern Canada. Moose contract P. tenuis by consuming infected gastropod intermediate hosts, but little is known about which gastropod species moose consume. To gain more insight, we used a genetic metabarcoding approach on 258 georeferenced and temporally stratified moose fecal samples collected May-October 2017-20 from a declining population in the north-central US. We detected moose consumption of three species of gastropods across five positive samples. Two of these (Punctum minutissimum and Helisoma sp.) have been minimally investigated for the ability to host P. tenuis, while one (Zonitoides arboreus) is a well-documented host. Moose consumption of gastropods documented herein occurred in June and September. Our findings prove that moose consume gastropod species known to become infected by P. tenuis and demonstrate that fecal metabarcoding can provide novel insight on interactions between hosts of a multispecies pathogen transmission system. After determining and improving test sensitivity, these methods may also be extended to document important interactions in other multihost disease systems.

Herd-level risk factors associated with chronic wasting disease-positive herd status in Minnesota, Pennsylvania, and Wisconsin cervid herds

The objective of this study was to evaluate risks related to introduction of Chronic Wasting Disease (CWD) to farmed cervid herds in Minnesota (MN), Pennsylvania (PA), and Wisconsin (WI). This was the first study to evaluate risk factors related to multiple pathways of CWD transmission to farmed cervid herds. Participating herds in this case-control study included 22 case and 49 control herds identified through participation in the respective mandatory State CWD herd program. Data was voluntarily collected from white-tailed deer (WTD) study herds using a questionnaire and state animal health agency databases. Univariable analyses identified associations between CWD-positive herds and variables representing different transmission pathways, including direct contact with infected farmed cervids (imported from a herd that later tested positive for CWD) odds ratio (OR):7.16, 95 % confidence intervals (CI):1.64-31.21 and indirect contact with infected wild cervids (access of domestic cats to pens or feed storage area) OR:4.07, 95 % CI:1.35-12.26, observed evidence of mammalian scavengers inside or outside of fenceline in the previous 12 months OR:6.55, 95 % CI:1.37-31.32, ≤ 5 km distance to nearest detected CWD-positive wild cervid OR:3.08, 95 % CI:1.01-9.39, forested area crosses the perimeter fenceline OR:3.54, 95 % CI:1.13-11.11, ≤ 0.3 m distance of water source to fenceline OR:4.71, 95 % CI:1.60-13.83, and water source shared with wild cervids (running or standing water) OR:4.17, 95 % CI:1.34-12.92. Three variables from univariable analyses that represented different biological transmission pathways were placed in a Firth's penalized maximum likelihood multivariable logistic regression to evaluate associations between transmission pathway and CWD herd infection status. For the issue of low sample size and overfitting, 95 % CIs for estimated coefficients for the three variables were computed via bootstrapping of 10,000 independent bootstrap samples. The three biological variables were significantly associated with herd CWD infection status: imported cervids from a herd that later tested positive for CWD (OR:5.63; 95 % CI:1.1-28.2), ≤ 0.3 m distance of cervid water source to perimeter fenceline (OR:4.83; 95 % CI:1.5-16.1), and ≤ 5 km distance to nearest detected CWD-positive wild cervid (OR:4.10; 95 % CI:1.1-15.2). The risk factors associated with CWD herd status identified in this study indicated the importance of transmission through direct contact pathways with infected cervid herds (introduction of cervids from herds later identified as CWD-infected) and indirect contact pathways with infected wild cervids that could be related to other animals through the perimeter fence. Further studies are needed to confirm and clarify understanding of indirect pathways to allow development of improved biosecurity practices to prevent CWD introduction to cervid herds.

Refining the moose serum progesterone threshold to diagnose pregnancy

Pregnancy determination is necessary for sound wildlife management and understanding population dynamics. Pregnancy rates are sensitive to environmental and physiological factors and may indicate the overall trajectory of a population. Pregnancy can be assessed through direct methods (rectal palpation, sonography) or indicated using hormonal assays (serum progesterone or pregnancy-specific protein B, fecal progestogen metabolites). A commonly used threshold of 2 ng/ml of progesterone in serum has been used by moose biologists to indicate pregnancy but has not been rigorously investigated. To refine this threshold, we examined the relationship between progesterone concentrations in serum samples and pregnancy in 87 moose (Alces alces; 64 female, 23 male) captured from 2010 to 2020 in the Grand Portage Indian Reservation in northeastern Minnesota, USA. Pregnancy was confirmed via rectal palpation (n = 25), necropsy (n = 2), calf observation (n = 25) or characteristic pre-calving behavior (n = 6), with a total of 58 females determined pregnant and 6 not pregnant; 23 males were included to increase the non-pregnant sample size. Using receiver operating characteristic analysis, we identified an optimal threshold of 1.115 ng/ml with a specificity of 0.97 (95% confidence interval [CI] = 0.90-1.00) and a sensitivity of 0.98 (95% CI = 0.95-1.00). Progesterone concentrations were significantly higher in cases of pregnant versus non-pregnant cows, but we did not detect a difference between single and twin births. We applied our newly refined threshold to calculate annual pregnancy rates for all female moose (n = 133) captured in Grand Portage from 2010 to 2021. Mean pregnancy rate during this period was 91% and ranged annually from 69.2 to 100%. Developing a reliable method for determining pregnancy status via serum progesterone analyses will allow wildlife managers to assess pregnancy rates of moose without devoting substantial time and resources to palpation and calf monitoring.

Statistical population reconstruction of moose (Alces alces) in northeastern Minnesota using integrated population models

Given recent and abrupt declines in the abundance of moose (Alces alces) throughout parts of Minnesota and elsewhere in North America, accurately estimating statewide population trends and demographic parameters is a high priority for their continued management and conservation. Statistical population reconstruction using integrated population models provides a flexible framework for combining information from multiple studies to produce robust estimates of population abundance, recruitment, and survival. We used this framework to combine aerial survey data and survival data from telemetry studies to recreate trends and demographics of moose in northeastern Minnesota, USA, from 2005 to 2020. Statistical population reconstruction confirmed the sharp decline in abundance from an estimated 7,841 (90% CI = 6,702–8,933) in 2009 to 3,386 (90% CI = 2,681–4,243) animals in 2013, but also indicated that abundance has remained relatively stable since then, except for a slight decline to 3,163 (90% CI = 2,403–3,718) in 2020. Subsequent stochastic projection of the population from 2021 to 2030 suggests that this modest decline will continue for the next 10 years. Both annual adult survival and per-capita recruitment (number of calves that survived to 1 year per adult female alive during the previous year) decreased substantially in years 2005 and 2019, from 0.902 (SE = 0.043) to 0.689 (SE = 0.061) and from 0.386 (SE = 0.030) to 0.303 (SE = 0.051), respectively. Sensitivity analysis revealed that moose abundance was more sensitive to fluctuations in adult survival than recruitment; thus, we conclude that the steep decline in 2013 was driven primarily by decreasing adult survival. Our analysis demonstrates the potential utility of using statistical population reconstruction to monitor moose population trends and to identify population declines more quickly. Future studies should focus on providing better estimates of per-capita recruitment, using pregnancy rates and calf survival, which can then be incorporated into reconstruction models to help improve estimates of population change through time.

Sensitive detection of chronic wasting disease prions recovered from environmentally relevant surfaces

Chronic wasting disease (CWD) has been identified in 30 states in the United States, four provinces in Canada, and recently emerged in Scandinavia. The association of CWD prions with environmental materials such as soil, plants, and surfaces may enhance the persistence of CWD prion infectivity in the environment exacerbating disease transmission. Identifying and quantifying CWD prions in the environment is significant for prion monitoring and disease transmission control. A systematic method for CWD prion quantification from associated environmental materials, however, does not exist. In this study, we developed an innovative method for extracting prions from swabs and recovering CWD prions swabbed from different types of surfaces including glass, stainless steel, and wood. We found that samples dried on swabs were unfavorable for prion extraction, with the greatest prion recovery from wet swabs. Using this swabbing technique, the recovery of CWD prions dried to glass or stainless steel was approximately 30% in most cases, whereas that from wood was undetectable by conventional prion immunodetection techniques. Real-time quake-induced conversion (RT-QuIC) analysis of these same samples resulted in an increase of the detection limit of CWD prions from stainless steel by 4 orders of magnitude. More importantly, the RT-QuIC detection of CWD prions recovered from stainless steel surfaces using this method was similar to the original CWD prion load applied to the surface. This combined surface swabbing and RT-QuIC detection method provides an ultrasensitive means for prion detection across many settings and applications.

A mixed-methods approach to understanding domestic dog health and disease transmission risk in an indigenous reserve in Guyana, South America

Domestic dogs (Canis lupus familiaris) can transmit a variety of pathogens due to their ubiquitousness in urban, rural and natural environments, and their close interactions with wildlife and humans. In this study, we used a mixed-methods approach to assess the role of domestic dogs as potential intermediaries of disease transmission from wildlife to humans among indigenous Waiwai in the Konashen Community Owned Conservation Area, Guyana. To address these objectives we 1) performed physical examinations and collected biological samples to assess Waiwai domestic dog health, and 2) administered questionnaires to characterize the role of dogs in the community and identify potential transmission pathways between wildlife, dogs, and humans. We observed ectoparasites on all dogs (n = 20), including: fleas (100%), ticks (15%), botflies (30%), and jigger flea lesions (Tunga penetrans) (80%). Ten percent of dogs were seropositive for Ehrlichia canis/ewingii, 10% were positive for Dirofilaria immitis, and one dog was seropositive for Leishmania infantum. All dogs (n = 20) were seronegative for: canine distemper virus, Brucella canis, Leptospira serovars, Trypanosoma cruzi, Anaplasma phagocytophilum/platys and Borrelia burgdorferi. Our questionnaire data revealed that the Waiwai remove ectoparasites from their dogs, clean up dog feces, and administer traditional and/or Western medicine to their dogs. White blood cell, strongyle-type ova, and eosinophil counts were lower in dogs that were not frequently used for hunting, dogs that did receive traditional and/or western medicine, and dogs that were frequently kept in elevated dog houses, although differences were not statistically significant. While our results suggest that the Waiwai have developed cultural practices that may promote dog health and/or prevent zoonotic disease transmission, more research is necessary to determine the efficacy of these practices. Our study provides important data on the health of dogs and the potential for disease transmission to humans in a zoonotic hotspot.

Domestic dogs are found throughout the world and interact closely with both wildlife and humans. Dogs can harbor numerous diseases that can be transmitted to other domestic and wildlife species, and human populations. They can serve as bridges, moving diseases between unconnected populations. Additionally, dogs can help in the early detection of wildlife and human diseases. Therefore, understanding what pathogens domestic dogs harbor can inform both wildlife and human health. In this study, we performed physical examinations, collected biological samples, and administered questionnaires to assess dog health and understand the role of dogs as potential bridges of disease transmission from wildlife to humans among indigenous Waiwai in the Konashen Community Owned Conservation Area, Guyana. On physical exam, we observed ectoparasites on all dogs, however, few pathogens were detected with diagnostic screening. Our questionnaire data revealed that the Waiwai engage in husbandry practices that may promote Waiwai dog health.

Great ape health watch: Enhancing surveillance for emerging infectious diseases in great apes

Infectious diseases have the potential to extirpate populations of great apes. As the interface between humans and great apes expands, zoonoses pose an increasingly severe threat to already endangered great ape populations. Despite recognition of the threat posed by human pathogens to great apes, health monitoring is only conducted for a small fraction of the world's wild great apes (and mostly those that are habituated) meaning that outbreaks of disease often go unrecognized and therefore unmitigated. This lack of surveillance (even in sites where capacity to conduct surveillance is present) is the most significant limiting factor in our ability to quickly detect and respond to emerging infectious diseases in great apes when they first appear. Accordingly, we must create a surveillance system that links disease outbreaks in humans and great apes in time and space, and enables veterinarians, clinicians, conservation managers, national decision makers, and the global health community to respond quickly to these events. Here, we review existing great ape health surveillance programs in African range habitats to identify successes, gaps, and challenges. We use these findings to argue that standardization of surveillance across sites and geographic scales, that monitors primate health in real-time and generates early warnings of disease outbreaks, is an efficient, low-cost step to conserve great ape populations. Such a surveillance program, which we call "Great Ape Health Watch" would lead to long-term improvements in outbreak preparedness, prevention, detection, and response, while generating valuable data for epidemiological research and sustainable conservation planning. Standardized monitoring of great apes would also make it easier to integrate with human surveillance activities. This approach would empower local stakeholders to link wildlife and human health, allowing for near real-time, bidirectional surveillance at the great ape-human interface.

Epidemiological Investigation of Meningeal Worm-Induced Mortalities in Small Ruminants and Camelids Over a 19 Year Period

Meningeal worm, or Parelaphostrongylus tenuis (P. tenuis) is a nematode parasite that can invade the nervous system of small ruminant and camelid species such as alpaca, llama, goats and sheep. Limited reports exist on the epidemiology of disease caused by the nematode in susceptible livestock. We examined archived necropsy reports from small ruminant and camelid mortalities that were submitted, post mortem, to the University of Minnesota Veterinary Diagnostic Laboratory (MNVDL) during 2001–2019 for gross necropsy, histopathology, and pathogen screening. We estimated P. tenuis-induced mortality over time and developed temporal models to better understand patterns and drivers of P. tenuis-induced mortalities in these animals. During the period under examination, 5,617 goats, sheep, llamas and alpacas were necropsied, revealing an overall P. tenuis-induced mortality rate of 1.14% in the necropsy submission pool for these species. P. tenuis-induced mortality rates were highest in llamas (9.91%) and alpacas (5.33%) compared to sheep and goats (<1%), with rates in llamas and alpacas significantly higher than in sheep and goats. P. tenuis-induced mortalities exhibited one seasonal peak, around October to December. P. tenuis-induced mortality rates varied greatly between years, and have significantly increased over time. We also observed a positive correlation between summer temperature (range 20.4–22.4°C) and P. tenuis-induced mortality rates (range 0–3.9%), but not precipitation. This study demonstrates seasonal patterns and differences in mortality between alpacas, goats, llamas and sheep and helps us to better understand the epidemiology of P. tenuis mortality.

Can Co-Grazing Waterfowl Reduce Brainworm Risk for Goats Browsing in Natural Areas?

Goats browsing in woodlands, whether for livestock production goals or vegetation management (e.g., targeted grazing to control invasive plants), are at risk of meningeal worm (Parelaphostrongylus tenuis) infection. Indeed, up to 25% incidence has been observed in goats employed in vegetation management. Infection, which occurs via the consumption of an infected gastropod intermediate host, is potentially deadly in goats. We experimentally tested whether co-grazing with waterfowl could reduce goats' exposure via waterfowl consumption of gastropods. Gastropods were sampled in a deciduous woodland before and after the addition of goats alone, goats and waterfowl, or a control with no animal addition. We found that goats browsing on their own increased the abundance of P. tenuis intermediate hosts; however, when goats co-grazed with waterfowl, these increases were not observed. Importantly, waterfowl did not significantly affect overall gastropod abundance, richness, or diversity. Thus, waterfowl co-grazing may effectively reduce goat contact with infectious gastropods without detrimentally affecting the gastropod community. While co-grazing goats with waterfowl may decrease their P. tenuis exposure risk, additional research is needed to confirm whether waterfowl can actually lower P. tenuis incidence.

Spatial compartmentalization: A nonlethal predator mechanism to reduce parasite transmission between prey species

Predators can modulate disease transmission within prey populations by influencing prey demography and behavior. Predator-prey dynamics can involve multiple species in heterogeneous landscapes; however, studies of predation on disease transmission rarely consider the role of landscapes or the transmission among diverse prey species (i.e., spillover). We used high-resolution habitat and movement data to model spillover risk of the brainworm parasite (Parelaphostrongylus tenuis) between two prey species [white-tailed deer (Odocoileus virginianus) and moose (Alces alces)], accounting for predator [gray wolf (Canis lupus)] presence and landscape configuration. Results revealed that spring migratory movements of cervid hosts increased parasite spillover risk from deer to moose, an effect tempered by changes in elevation, land cover, and wolf presence. Wolves induced host-species segregation, a nonlethal mechanism that modulated disease emergence by reducing spatiotemporal overlap between infected and susceptible prey, showing that wildlife disease dynamics may change with landscape disturbance and the loss of large carnivores.

Investigation of Cyprinid Herpesvirus 3 (CyHV-3) Disease Periods and Factors Influencing CyHV-3 Transmission in A Low Stocking Density Infection Trial

Simple Summary

Pathogens are the primary limitation to aquaculture production of fish and a major issue in consideration of the interface between cultured and wild populations of fishes worldwide. While rapid spread of fish pathogens between populations (wild or farmed) is generally anthropogenic and the result of trade, the mechanisms of transmission once a pathogen has been introduced to a fish population are not well understood. The most widespread pathogen impacting both aquaculture and wild populations of common carp (Cyprinus carpio, carp) is Cyprinid herpesvirus 3 (CyHV-3). To understand how CyHV-3 is transmitted in a population we conducted a series of infection trials, designed to determine the kinetics CyHV-3 infections, identify the contributions of direct and indirect forms of CyHV-3 transmission, and to determine the contributions of contact rate, viral load, pathogenicity, and contact type. We found that direct contact between fish was the primary mechanism of CyHV-3 transmission rather than transmission through contaminated water. Additionally, CyHV-3 transmission occurred primarily during the incubation period of CyHV-3, prior to the appearance of disease signs and disease-associated reduction in contact rate.

Abstract

Cyprinid herpesvirus 3 (CyHV-3) is the etiological agent of koi herpesvirus disease (KHVD) and important pathogen of aquaculture and wild populations of common carp worldwide. Understanding the relative contributions of direct and indirect transmission of CyHV-3 as well as the factors that drive CyHV-3 transmission can clarify the importance of environmental disease vectors and is valuable for informing disease modeling efforts. To study the mechanisms and factors driving CyHV-3 transmission we conducted infection trials that determined the kinetics of KHVD and the contributions of direct and indirect forms of CyHV-3 transmission, as well as the contributions of contact rate, viral load, pathogenicity and contact type. The incubation period of KHVD was 5.88 + 1.75 days and the symptomatic period was 5.31 + 0.87 days. Direct transmission was determined to be the primary mechanism of CyHV-3 transmission (OR = 25.08, 95%CI = 10.73–99.99, p = 4.29 × 10⁻¹⁸) and transmission primarily occurred during the incubation period of KHVD. Direct transmission decreased in the symptomatic period of disease. Transmissibility of CyHV-3 and indirect transmission increased during the symptomatic period of disease, correlating with increased viral loads. Additionally, potential virulence-transmission tradeoffs and disease avoidance behaviors relevant to CyHV-3 transmission were identified.

Current Zoology Reconstructing landscapes of ungulate parturition and predation using vegetation phenology

Enhanced vegetation index (EVI) data can be used to identify and define the space in which ungulates practice parturition and encounter predation. This study explores the use of EVI data to identify landscapes linked to ungulate parturition and predation events across space, time, and environmental conditions. As a case study, we used the moose population (Alces alces) of northern Minnesota in the USA. Using remotely sensed EVI data rasters and global positioning system collar data, we quantified how vegetation phenology and moose movement shaped the births and predation of 52 moose calves from 2013 to 2020 on or adjacent to the Grand Portage Indian Reservation. The known sources of predation were American black bears (Ursus americanus, n = 22) and gray wolves (Canis lupus, n = 28). Satellite-derived data summarizing seasonal landscape features at the local level revealed that landscape heterogeneity use by moose can help to quantitatively identify landscapes of parturition and predation in space and time across large areas. Vegetation phenology proved to be differentiable between adult moose ranges, sites of cow parturition, and sites of calf predation. Landscape characteristics of each moose group were consistent and tractable based on environment, suggesting that sites of parturition and predation of moose are predictable in space and time. It is possible that moose selected specific landscapes for parturition despite risk of increased predation of their calves, which could be an example of an "ecological trap." This analytical framework can be employed to identify areas for future ungulate research on the impacts of landscape on parturition and predation dynamics.

The Gombe Ecosystem Health Project: 16 years of program evolution and lessons learned

Infectious disease outbreaks pose a significant threat to the conservation of chimpanzees (Pan troglodytes) and all threatened nonhuman primates. Characterizing and mitigating these threats to support the sustainability and welfare of wild populations is of the highest priority. In an attempt to understand and mitigate the risk of disease for the chimpanzees of Gombe National Park, Tanzania, we initiated a long-term health-monitoring program in 2004. While the initial focus was to expand the ongoing behavioral research on chimpanzees to include standardized data on clinical signs of health, it soon became evident that the scope of the project would ideally include diagnostic surveillance of pathogens for all primates (including people) and domestic animals, both within and surrounding the National Park. Integration of these data, along with in-depth post-mortem examinations, have allowed us to establish baseline health indicators to inform outbreak response. Here, we describe the development and expansion of the Gombe Ecosystem Health project, review major findings from the research and summarize the challenges and lessons learned over the past 16 years. We also highlight future directions and present the opportunities and challenges that remain when implementing studies of ecosystem health in a complex, multispecies environment.

Anthropogenic factors associated with contaminants of emerging concern detected in inland Minnesota lakes (Phase II)

Contaminants of emerging concern (CECs) include a variety of pharmaceuticals, personal care products, and hormones commonly detected in surface waters. Human activities, such as wastewater treatment and discharge, contribute to the distribution of CECs in water, but other sources and pathways are less frequently examined. This study aimed to identify anthropogenic activities and environmental characteristics associated with the presence of CECs, previously determined to be of high priority for further research and mitigation, in rural inland lakes in northeastern Minnesota, United States. The setting for this study consisted of 21 lakes located within both the Grand Portage Indian Reservation and the 1854 Ceded Territory, where subsistence hunting and fishing are important to the cultural heritage of the indigenous community. We used data pertaining to numbers of buildings, healthcare facilities, wastewater treatment plants, impervious surfaces, and wetlands within defined areas surrounding the lakes as potential predictors of the detection of high priority CECs in water, sediment, and fish. Separate models were run for each contaminant detected in each sample media. We used least absolute shrinkage and selection operator (LASSO) models to account for both predictor selection and parameter estimation for CEC detection. Across contaminants and sample media, the percentage of impervious surface was consistently positively associated with CEC detection. Number of buildings in the surrounding area was often negatively associated with CEC detection, though nonsignificant. Surrounding population, presence of wastewater treatment facilities, and percentage of wetlands in surrounding areas were positively, but inconsistently, associated with CECs, while catchment area and healthcare centers were generally not associated. The results of this study highlight human activities and environmental characteristics associated with CEC presence in a rural area, informing future work regarding specific sources and transport pathways. We also demonstrate the utility of LASSO modeling in the identification of these important relationships.

A chemical prioritization process: Applications to contaminants of emerging concern in freshwater ecosystems (Phase I)

Contaminants of emerging concern (CECs), such as pharmaceuticals, personal care products, and hormones, are frequently found in aquatic ecosystems around the world. Information on sublethal effects from exposure to commonly detected concentrations of CECs is lacking and the limited availability of toxicity data makes it difficult to interpret the biological significance of occurrence data. However, the ability to evaluate the effects of CECs on aquatic ecosystems is growing in importance, as detection frequency increases. The goal of this study was to prioritize the chemical hazards of 117 CECs detected in subsistence species and freshwater ecosystems on the Grand Portage Indian Reservation and adjacent 1854 Ceded Territory in Minnesota, USA. To prioritize CECs for management actions, we adapted Minnesota Pollution Control Agency's Aquatic Toxicity Profiles framework, a tool for the rapid assessment of contaminants to cause adverse effects on aquatic life by incorporating chemical-specific information. This study aimed to 1) perform a rapid-screening assessment and prioritization of detected CECs based on their potential environmental hazard; 2) identify waterbodies in the study region that contain high priority CECs; and 3) inform future monitoring, assessment, and potential remediation in the study region. In water samples alone, 50 CECs were deemed high priority. Twenty-one CECs were high priority among sediment samples and seven CECs were high priority in fish samples. Azithromycin, DEET, diphenhydramine, fluoxetine, miconazole, and verapamil were high priority in all three media. Due to the presence of high priority CECs throughout the study region, we recommend future monitoring of particular CECs based on the prioritization method used here. We present an application of a chemical hazard prioritization process and identify areas where the framework may be adapted to meet the objectives of other management-related assessments.

Exploring Risk for Echinococcosis Spillover in Northern Minnesota Tribal Communities

Echinococcus spp. are zoonotic cestode parasites with a worldwide distribution and a complex, two-host life cycle involving carnivore definitive hosts and small mammal or ungulate intermediate hosts. Surveillance for Echinococcus spp. in the Midwestern United States (USA) is rare. Using a mixed-methods approach, we examined Echinococcus infection risks in wildlife and domestic dogs in four Minnesota Tribal Nations. We hypothesized that the spillover of Echinococcus spp. into domestic dogs would vary with the presence or absence of suspected wildlife host species and certain behaviors associated with domestic dog ownership, like feeding wildlife host carcasses or frequency of veterinary care. Among 83 dogs tested, three (3.6%) were positive for Echinococcus spp. Despite low prevalence, pet owner survey and focus group findings indicated that dogs encounter peri-domestic wildlife most often when they roam freely or consume wildlife carcasses. This study demonstrates a need for further research into spillover potential of endemic zoonotic Echinococcus spp. in the Midwest USA.

Gregariousness is associated with parasite species richness in a community of wild chimpanzees

Increased risk of pathogen transmission through proximity and contact is a well-documented cost of sociality. Affiliative social contact, however, is an integral part of primate group life and can benefit health. Despite its importance to the evolution and maintenance of sociality, the tradeoff between costs and benefits of social contact for group-living primate species remains poorly understood. To improve our understanding of this interplay, we used social network analysis to investigate whether contact via association in the same space and/or physical contact measured through grooming were associated with helminth parasite species richness in a community of wild chimpanzees (Pan troglodytes schweinfurthii). We identified parasite taxa in 381 fecal samples from 36 individuals from the Kasekela community of chimpanzees in Gombe National Park, Tanzania, from November 1, 2006 - October 31, 2012. Over the study period, eight environmentally transmitted helminth taxa were identified. We quantified three network metrics for association and grooming contact, including degree strength, betweenness, and closeness. Our findings suggest that more gregarious individuals - those who spent more time with more individuals in the same space - had higher parasite richness, while the connections in the grooming network were not related to parasite richness. The expected parasite richness in individuals increased by 1.13 taxa (CI: 1.04, 1.22; p = 0.02) per one standard deviation increase in degree strength of association contact. The results of this study add to the understanding of the role that different types of social contact plays in the parasite richness of group-living social primates.

An Ethnographic Approach to Characterizing Potential Pathways of Zoonotic Disease Transmission from Wild Meat in Guyana

The hunting, butchery, and consumption of wild meat is an important interface for zoonotic disease transmission. Despite this, few researchers have used ethnography to understand the sociocultural factors that may increase zoonotic disease transmission from hunting, particularly in Amazonia. Here, we use ethnographic methods consisting of structured, semi-structured and unstructured interviews, and participant observation to address questions pertaining to wild meat consumption, pathways of zoonotic disease transmission, food security, and the cultural identity of indigenous Waiwai in the Konashen Community Owned Conservation Area, Guyana. Our data revealed that the majority of Waiwai eat wild meat two to three times/week and 60% of respondents reported butchery-related injuries. However, semi-structured and unstructured interviews, and participant observation data indicate that the Waiwai do not perceive most cuts from butchery as injuries, despite being a potential route of pathogen exposure. Additionally, participant observation revealed that hunting is integral to Waiwai identity and the Waiwai exhibit a cultural aversion to domestic meats. These findings provide valuable insights into the interplay of hunting and wild meat consumption and disease in Amazonia and demonstrate how an ethnographic approach provides the contextual data necessary for identifying potential pathways of zoonotic transmission from wild meat.

Survey of Toxoplasma gondii Exposure in Muskrats in a Relatively Pristine Ecosystem

Waterborne transmission of Toxoplasma gondii is assumed to be enhanced in areas with human-altered landscapes (e.g., urbanization, agriculture) and increased populations of non-native domestic and feral cats (Felis catus). However, little is known concerning T. gondii exposure risks in more natural watersheds (e.g., reduced human footprint, no domestic or feral cats) to establish a baseline for comparisons. In this study, muskrats (Ondatra zibethicus) were used as sentinels to assess baseline T. gondii exposure in a relatively pristine watershed in the Greater Voyageurs Ecosystem, northern Minnesota, during the summers of 2018-2019. Toxoplasma gondii antibodies were assayed in sera of live-trapped muskrats (n = 70) using a modified agglutination test. None of our samples were positive for T. gondii antibodies (P = 0.00, 95% Wald Score Confidence Interval = 0.00-0.05). This study establishes a baseline to compare T. gondii waterborne transmission risks in other human-modified watersheds.

Occurrence of contaminants of emerging concern in aquatic ecosystems utilized by Minnesota tribal communities

Pharmaceuticals, personal care products, hormones, and other chemicals lacking water quality standards are frequently found in surface water. While evidence is growing that these contaminants of emerging concern (CECs) - those previously unknown, unrecognized, or unregulated - can affect the behavior and reproduction of fish and wildlife, little is known about the distribution of these chemicals in rural, tribal areas. Therefore, we surveyed the presence of CECs in water, sediment, and subsistence fish species across various waterbodies, categorized as undeveloped (i.e., no human development along shorelines), developed (i.e., human development along shorelines), and wastewater effluent-impacted (i.e., contain effluence from wastewater treatment plants), within the Grand Portage Indian Reservation and 1854 Ceded Territory in northeastern Minnesota, U.S.A. Overall, in 28 sites across three years (2016-2018), 117 of the 158 compounds tested were detected in at least one form of medium (i.e., water, sediment, or fish). CECs were detected most frequently at wastewater effluent-impacted sites, with up to 83 chemicals detected in one such lake, while as many as 17 were detected in an undeveloped lake. Although there was no statistically significant difference between the number of CECs present in developed versus undeveloped lakes, a range of 3-17 CECs were detected across these locations. Twenty-two CECs were detected in developed and undeveloped sites that were not detected in wastewater effluent-impacted sites. The detection of CECs in remote, undeveloped locations, where subsistence fish are harvested, raises scientific questions about the safety and security of subsistence foods for indigenous communities. Further investigation is warranted so that science-based solutions to reduce chemical risks to aquatic life and people can be developed locally and be informative for indigenous communities elsewhere.

Molecular and Biological Characterization of a Cervidpoxvirus Isolated From Moose with Necrotizing Dermatitis

Cervidpoxvirus is one of the more recently designated genera within the subfamily Chordopoxvirinae, with Deerpox virus (DPV) as the only recognized species to date. In this study, the authors describe spontaneous disease and infection in the North American moose (Alces americanus) by a novel Cervidpoxvirus, here named Moosepox virus (MPV). Three 4-month-old moose calves developed a multifocal subacute-to-chronic, necrotizing, suppurative-to-granulomatous dermatitis that affected the face and the extremities. Ultrastructurally, all stages of MPV morphogenesis-that is, crescents, spherical immature particles, mature particles, and enveloped mature virus-were observed in skin tissue. In vitro infection with MPV confirmed that its morphogenesis was similar to that of the prototype vaccinia virus. The entire coding region, including 170 putative genes of this MPV, was sequenced and annotated. The sequence length was 164,258 bp with 98.5% nucleotide identity with DPV (strain W-1170-84) based on the whole genome. The genome of the study virus was distinct from that of the reference strain (W-1170-84) in certain genes, including the CD30-like protein (83.9% nucleotide, 81.6% amino acid), the endothelin precursor (73.2% nucleotide including some indels, 51.4% amino acid), and major histocompatibility class (MHC) class I-like protein (81.0% nucleotide, 68.2% amino acid). This study provides biological characterization of a new Cervidpoxvirus attained through in vivo and in vitro ultrastructural analyses. It also demonstrates the importance of whole-genome sequencing in the molecular characterization of poxviruses identified in taxonomically related hosts.

Microbial associations and spatial proximity predict North American moose (Alces alces) gastrointestinal community composition

Microbial communities are increasingly recognized as crucial for animal health. However, our understanding of how microbial communities are structured across wildlife populations is poor. Mechanisms such as interspecific associations are important in structuring free-living communities, but we still lack an understanding of how important interspecific associations are in structuring gut microbial communities in comparison with other factors such as host characteristics or spatial proximity of hosts. Here, we ask how gut microbial communities are structured in a population of North American moose Alces alces. We identify key microbial interspecific associations within the moose gut and quantify how important they are relative to key host characteristics, such as body condition, for predicting microbial community composition. We sampled gut microbial communities from 55 moose in a population experiencing decline due to a myriad of factors, including pathogens and malnutrition. We examined microbial community dynamics in this population utilizing novel graphical network models that can explicitly incorporate spatial information. We found that interspecific associations were the most important mechanism structuring gut microbial communities in moose and detected both positive and negative associations. Models only accounting for associations between microbes had higher predictive value compared to models including moose sex, evidence of previous pathogen exposure or body condition. Adding spatial information on moose location further strengthened our model and allowed us to predict microbe occurrences with ~90% accuracy. Collectively, our results suggest that microbial interspecific associations coupled with host spatial proximity are vital in shaping gut microbial communities in a large herbivore. In this case, previous pathogen exposure and moose body condition were not as important in predicting gut microbial community composition. The approach applied here can be used to quantify interspecific associations and gain a more nuanced understanding of the spatial and host factors shaping microbial communities in non-model hosts.

Syndromic Surveillance of Respiratory Disease in Free-Living Chimpanzees

Disease surveillance in wildlife is rapidly expanding in scope and methodology, emphasizing the need for formal evaluations of system performance. We examined a syndromic surveillance system for respiratory disease detection in Gombe National Park, Tanzania, from 2004 to 2012, with respect to data quality, disease trends, and respiratory disease detection. Data quality was assessed by examining community coverage, completeness, and consistency. The data were examined for baseline trends; signs of respiratory disease occurred at a mean frequency of less than 1 case per week, with most weeks containing zero observations of abnormalities. Seasonal and secular (i.e., over a period of years) trends in respiratory disease frequency were not identified. These baselines were used to develop algorithms for outbreak detection using both weekly counts and weekly prevalence thresholds and then compared retrospectively on the detection of 13 respiratory disease clusters from 2005 to 2012. Prospective application of outbreak detection algorithms to real-time syndromic data would be useful in triggering a rapid outbreak response, such as targeted diagnostic sampling, enhanced surveillance, or mitigation.

Optimizing syndromic health surveillance in free ranging great apes: the case of Gombe National Park

1. Syndromic surveillance is an incipient approach to early wildlife disease detection. Consequently, systematic assessments are needed for methodology validation in wildlife populations. 2. We evaluated the sensitivity of a syndromic surveillance protocol for respiratory disease detection among chimpanzees in Gombe National Park, Tanzania. Empirical health, behavioural and demographic data were integrated with an agent-based, network model to simulate disease transmission and surveillance. 3. Surveillance sensitivity was estimated as 66% (95% Confidence Interval: 63.1, 68.8%) and 59.5% (95% Confidence Interval: 56.5%, 62.4%) for two monitoring methods (weekly count and prevalence thresholds, respectively), but differences among calendar quarters in outbreak size and surveillance sensitivity suggest seasonal effects. 4. We determined that a weekly detection threshold of ≥2 chimpanzees with clinical respiratory disease leading to outbreak response protocols (enhanced observation and biological sampling) is an optimal algorithm for outbreak detection in this population. 5. Synthesis and applications. This is the first quantitative assessment of syndromic surveillance in wildlife, providing a model approach to detecting disease emergence. Coupling syndromic surveillance with targeted diagnostic sampling in the midst of suspected outbreaks will provide a powerful system for detecting disease transmission and understanding population impacts.

Factors influencing detection and co-detection of Ranavirus and Batrachochytrium dendrobatidis in Midwestern North American anuran populations

Amphibian populations are in decline worldwide as they face a barrage of challenges, including infectious diseases caused by ranaviruses and the amphibian chytrid fungus Batrachochytrium dendrobatidis (Bd). Here we describe seasonal dynamics of Bd and ranavirus detection in free-ranging post-metamorphic wood frogs Lithobates sylvaticus, boreal chorus frogs Pseudacris maculata/triseriata, and gray treefrogs Hyla versicolor/chrysoscelis, sampled over a 3 season gradient in Minnesota (USA) wetlands. We detected Bd in 36% (n = 259) of individuals sampled in 3 wetlands in 2014, and 33% (n = 255) of individuals sampled in 8 wetlands in 2015. We also detected ranavirus in 60% and 18% of individuals sampled in 2014 and 2015, respectively. Ranavirus and Bd were detected concurrently in 26% and 2% of animals sampled in 2014 and 2015, respectively. We report clinical signs and associated infection status of sampled frogs; of the clinical signs observed, skin discoloration was significantly associated with ranavirus infection. Using generalized estimating equations, we found that species, season, wetland, and a species × season interaction term were significant predictors of Bd detection, whereas test year approached significance as a predictor of ranavirus detection. The odds of detecting both pathogens concurrently was significantly influenced by species, season, a species × season interaction term, year, and environmental ammonia. We propose an amphibian health monitoring scheme that couples population size surveys with seasonal molecular surveys of pathogen presence. This information is crucial to monitoring the health of remaining strongholds of healthy amphibian populations, as they face an uncertain future of further anthropogenic change.

Summarizing US Wildlife Trade with an Eye Toward Assessing the Risk of Infectious Disease Introduction

The aim of this study was to characterize the role of the USA in the global exchange of wildlife and describe high volume trade with an eye toward prioritizing health risk assessment questions for further analysis. Here we summarize nearly 14 years (2000-2013) of the most comprehensive data available (USFWS LEMIS system), involving 11 billion individual specimens and an additional 977 million kilograms of wildlife. The majority of shipments contained mammals (27%), while the majority of specimens imported were shells (57%) and tropical fish (25%). Most imports were facilitated by the aquatic and pet industry, resulting in one-third of all shipments containing live animals. The importer reported origin of wildlife was 77.7% wild-caught and 17.7% captive-reared. Indonesia was the leading exporter of legal shipments, while Mexico was the leading source reported for illegal shipments. At the specimen level, China was the leading exporter of legal and illegal wildlife imports. The number of annual declared shipments doubled during the period examined, illustrating continually increasing demand, which reinforces the need to scale up capacity for border inspections, risk management protocols and disease surveillance. Most regulatory oversight of wildlife trade is aimed at conservation, rather than prevention of disease introduction.

Noninvasive Tuberculosis Screening in Free-Living Primate Populations in Gombe National Park, Tanzania

Recent advances in noninvasive detection methods for mycobacterial infection in primates create new opportunities for exploring the epidemiology of tuberculosis in free-living species. Chimpanzees (Pan troglodytes schweinfurthii) and baboons (Papio anubis) in Gombe National Park, Tanzania, were screened for infection with pathogens of the Mycobacterium tuberculosis Complex using Fecal IS6110 PCR; none was positive. This study demonstrates the feasibility of large-scale mycobacterial screening in wild primates.

Noninvasive test for tuberculosis detection among primates

Traditional testing methods have limited epidemiologic studies of tuberculosis among free-living primates. PCR amplification of insertion element IS6110 of Mycobacterium tuberculosis from fecal samples was evaluated as a noninvasive screening test for tuberculosis in primates. Active tuberculosis was detected among inoculated macaques and naturally exposed chimpanzees, demonstrating the utility of this test.

A Four-year Study of Anxiety, Depression, Loneliness, Social Support, and Perceived Mistreatment in Medical Students

The goal of this study was to examine anxiety, depression, loneliness, social support, and perceived mistreatment at 4 time points over the course of the 4 years of undergraduate medical education, beginning in 1991. Representative samples of medical students completed a battery of questionnaires at freshman orientation (111 of 189 students = 59 percent), end of the first year (114 of 182 students = 63 percent), end of the second year (96 of 189 students = 51 percent), and end of the fourth year (85 of 192 students = 44 percent). Depression and anxiety were highest at the end of the first year and lowest at the end of the fourth year. Perceived mistreatment, particularly of a psychological nature, was pervasive over the course of 4 years of medical education. Perceived mistreatment was significantly positively correlated with depression and anxiety at freshman orientation and at the end of the first year. The implications of these findings are discussed with a view to making reforms in medical education designed to enhance the professional and personal development of each student.

Factor Analytic Study of the Piers-Harris Children's Self-Concept Scale

A factor analysis of the Piers-Harris Self-Concept Scale was conducted with a biracial u sample of children over a wide age range. The Scale was completed by 348 10-17 year old students in a rural community. Seven factors of 10 had sufficient item loadings to be interpretable. Six matched those found in the manual and an additional factor was found relating to Aggression. Race, sex, and age relationships are also reported for these seven factors.

SERIAL CHEMICAL RESTRAINT FOR TREATMENT OF DECUBITUS ULCERS IN TWO NEONATAL WHITE RHINOCEROSES (CERATOTHERIUM SIMUM)

Two neonatal white rhinoceroses (Ceratotherium simum) at two zoological institutions were medically managed for wounds characterized by extensive multifocal necrosis of the skin and subcutaneous tissue, associated with decubitus ulcers throughout the body. Wounds resulted from prolonged recumbency due to inability to stand in one case and causes unconfirmed in the other. Both calves were born in cement stalls during winter. Using either butorphanol (i.v. or i.m.) alone or in combination with detomidine (i.m.), serial chemical restraint was conducted over a 6-wk period to facilitate wound care. Anesthesia was well tolerated in both calves, and lesions responded well to medical treatment.

Trends in the number and administrative characteristics of medical school health promotion programmes

Over the course of almost 10 years, 1988-97, there has been a significant decline in the number of United States and Canadian medical schools offering health promotion programmes for students. All efforts should be made to enhance the overall health and well-being of medical students and to increase the number of health promotion programmes for them.

Contribution of aerosols generated during mixing and loading of pesticides to operator inhalation exposure

The occupational exposure resulting from the application of crop protection agents continues to be of great interest for the purposes of identifying hazards or determining safer chemical handling methods. The purpose of the present study was to identify the potential respirator exposure of a mixer/loader to chlorothalonil, with the mixing and loading operation as the only source of aerosols (particles <13 microm diameter). Three worst-case mixing/loading scenarios were simulated in the lab: (1) a spill of undiluted chlorothalonil formulation onto a dry, horizontal metal surface; (2) a spill of undiluted chlorothalonil formulation onto a rapidly rotating shaft; and (3) pouring undiluted chlorothalonil formulation into a container of water. Aerosol generation from these scenarios was compared to that resulting from atomizing dilute chlorothalonil through hydraulic nozzles. Aerosols were captured with a cascade impactor, and quantified by gas chromatography. Results indicated that simulated spill scenarios generated aerosol concentrations between 2.1 and 5.3 ng/l, which were in the same order of magnitude as, and only marginally higher than, the detection threshold (1.7 ng/l) and background levels (2.2 ng/l). In comparison, atomization of dilute chlorothalonil through a hollow cone and flat fan nozzles resulted in airborne concentrations of 354 and 96 ng/l, respectively, related to the atomization characteristics of these nozzles. Measurement of the dimensions of the aerosol cloud indicated that aerosols resulting from a spill amounted to approximately 10(-5)% of the spilled chlorothalonil. It was estimated that a male worker respiring 29 l/min would inhale approximately 0.32-0.78 ng of chlorothalonil during a typical 30 s spill, assuming a 1% transfer efficiency between the spill site and the mixer/loader. These estimates were between 10000 and 480000 times less than literature data for respiratory exposure of chlorothalonil by applicators and harvesters, suggesting that inhalation of aerosols from mixing and loading represents a minor component of overall exposure.

Flexor carpi ulnaris tendon transfers in cerebral palsy

Flexor carpi ulnaris tendon transfer to either the extensor carpi radialis longus or extensor carpi radialis brevis has become a standard procedure to improve function in patients with cerebral palsy. In this retrospective study of the procedure, we have compared preoperative and postoperative wrist position, analysed potential outcome predictors and assessed function by objective and subjective measures. Sixteen children, with flexor carpi ulnaris transfer to extensor carpi radialis longus or brevis or extensor digitorum, were tested at an average follow-up of 4 years (range, 1-9). General resting position improved and the centre of the arc of motion averaged 6 degrees pronation and 9 degrees extension. Subjectively, 14 of 16 parents felt there was an improvement in function, 16 of 16 felt that cosmesis was improved, 14 of 16 would recommend the procedure to others, and 15 of 16 were satisfied overall.

A survey of health promotion programs in U.S. and Canadian medical schools

The results of the survey indicate that 55 of 142 schools currently offer a health promotion/well-being program for their students. A total of 11 programs have been added since a similar survey was conducted in 1988. A diversity of program components that could be individualized to the needs of each student were offered, as can be seen in Table 1. Eight different components were offered in more than 50% of the schools, with support groups and substance abuse services being offered in 74.5% of the schools. It is noteworthy that health promotion/well-being programs are only offered at about 20% of medical schools for interns/residents and faculty/staff, although it is possible that they might participate in other programs. It should be pointed out that in more than 95% of the schools, physical/medical and psychologic services were offered; however, specific programs designed to prevent substance and alcohol abuse were only offered in about 54% of the programs.

The process of coping with a gross anatomy exam during the first year of medical school

A total of 42 freshman medical students were evaluated before a major exam, after the exam and before grades were announced and after grades were announced. They completed measures relating to mood, emotions, coping, social support and stakes. Significant time and academic performance differences were found in many domains.

Age and sex modulate effects of stress on the immune system: a multivariate analysis

Multivariate analyses indicate that both age and sex can modulate examination stress effects on immune factors. Stress lowered eosinophil counts in females but raised them in males. Age modulated stress effects on CD4 and CD8 cells, hemoglobin, and erythrocytes. CD4 decreased more in older subjects; CD8 increased in older and decreased in younger subjects; hemoglobin decreased in younger but not older subjects; erythrocytes increased in older and decreased in younger subjects. Initial age and/or sex differences in levels of neutrophils and lymphocytes were not statistically altered by stress. Stress effects not modulated by age or sex increased serum IgA and IgM, CD19, and stimulated phagocytic activity but decreased serum IgG, CD3, basophils, and unstimulated phagocytic activity. The immunological effects of stress are multiple and are influenced by variations in age and sex of the person.

Needs assessment for a health-promotion program in a medical center

232 students surveyed responded more favorably to health-promotion components involving the “body” than those that concern the “mind.”

Stress, coping and health: enhancing well-being during medical school

Medical education can be a health hazard for many students, and far-reaching reforms are needed to improve it. This article reviews the literature on stress, coping and health during undergraduate medical education. The conclusions drawn from this review are used as a basis for advancing recommendations to improve medical education. It is essential to incorporate the principles of health promotion and disease prevention throughout medical education in order to minimize and prevent later burn-out and impairment. Healthy medical students are likely to become healthy doctors who can then model and promote healthy lifestyles with their patients. This preventive approach to health care can lead to an improvement in our health care delivery system.