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Food Safety Knowledge, Attitudes, and Practices among Vegetable Handlers in Bangladesh.
Get PDFThis study delves into the Knowledge, Attitudes, and Practices of vegetable handlers in Jashore Sadar, Bangladesh, specifically focusing on the crucial significance of food safety across the entire farm-to-fork process. Integrating quantitative and qualitative data provides a multifaceted depiction of this pivotal component within the food supply chain. Ten focus group discussions were conducted, and in total, 50 vegetable handlers were interviewed separately. In the survey, there were 17 questions on food safety knowledge, 16 on food safety attitudes, and 17 on food safety-related practices followed by vegetable handlers. We found that while approximately 60% of handlers had good knowledge about food safety, only about one-quarter of the interviewed vegetable handlers had good attitudes and practices toward food safety. The attitudes and practices of individuals involved in handling vegetables demonstrate a complex range of variations shaped by factors such as educational background, prior experience, and availability of food safety training. Concerns regarding the rising expenses linked to adherence to food safety regulations and a perceived lack of accountability among those involved were also noted. The interviewed wholesaler group reported that approximately BDT 100-150 (USD 0.91-1.371)/maund1 was incurred in maintaining proper safety practices, while the interviewed retailer group said costs would increase by BDT 20-40 (USD 0.18-0.36)/maund if they followed proper handling practices. It is important to note that vegetable handlers recognize the favorable economic consequences of implementing appropriate food safety measures. This study highlights the significance of implementing focused educational and policy interventions to address knowledge disparities and encourage the adoption of food safety procedures among individuals involved in handling vegetables
Quantifying the impact of pre-vaccination titre and vaccination history on influenza vaccine immunogenicity.
Get PDFEpidemiological studies suggest that heterogeneity in influenza vaccine antibody response can be associated with specific host factors, including pre-vaccination immune status, age, gender, and vaccination history. However, the pattern of reported associations varies between studies. To better understand the underlying influences on antibody responses, we combined host factors and vaccine-induced in-host antibody kinetics from a cohort study conducted across multiple seasons with a unified analysis framework. We developed a flexible individual-level Bayesian model to estimate associations and interactions between host factors, including pre-vaccine HAI titre, age, sex, vaccination history and study setting, and vaccine-induced HAI titre antibody boosting and waning. We applied the model to derive population-level and individual effects of post-vaccine antibody kinetics for A(H1N1) and A(H3N2) influenza subtypes. We found that post-vaccine HAI titre dynamics were significantly influenced by pre-vaccination HAI titre and vaccination history and that lower pre-vaccination HAI titre results in longer durations of seroprotection (HAI titre equal to 1:40 or higher). We also observed that the effect of vaccination history on antibody boosting was stronger for egg-grown A(H1N1) vaccinating strains in individuals with higher pre-vaccination HAI titres, whereas this effect diminished for egg-grown A(H3N2) vaccinating strains. Consequently, for cell-grown A(H1N1), our inference finds that the expected duration of seroprotection post-vaccination was 171 (95 % Posterior Predictive Interval[PPI] 128-220) and 159 (95 % PPI 120-200) days longer for those who are infrequently vaccinated (<2 vaccines in last five years) compared to those who are frequently vaccinated (2 or more vaccines in the last five years) at pre-vaccination HAI titre values of 1:10 and 1:20 respectively. In addition, we found significant differences in the empirical distributions that describe the individual-level duration of seroprotection for A(H1N1) cell-grown strains. In future, studies that rely on serological endpoints should include the impact of pre-vaccine HAI titre and prior vaccination status on seropositivity and seroconversion estimates, as these can significantly influence an individual's post-vaccination antibody kinetics
Incidence of diabetes mellitus following hospitalisation for COVID-19 in the United Kingdom: A prospective observational study.
Get PDFBACKGROUND: People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness.
METHODS: We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible.
RESULTS: Incidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data.
CONCLUSION: Diabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels
Availability and the quality of key newborn data within routine health facility data: findings of the IMPULSE observational study in the Central African Republic, Ethiopia, Tanzania, and Uganda.
Get PDFBACKGROUND: With declining funding for population-based household surveys, routine health facility data offer a promising alternative for tracking newborn health and service quality. However, their utility depends on data quality. We assessed the quality of ten data elements within routine health information systems in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda, seven of which align with the Every Newborn Action Plan core newborn indicators. METHODS: We conducted a cross-sectional study in 97 emergency obstetric and newborn care facilities across 4 countries between November 2022 and July 2024. We extracted three months of routine register and summary report data on ten maternal and newborn elements (two denominators, three outcome numerators, five newborn care interventions) and one tracer maternal indicator. We evaluated data quality on four dimensions (availability, completeness, accuracy, and internal consistency) and measured internal consistency using the ratio of (total births - live births)/stillbirths, with a value of 1 suggesting ideal internal consistency. RESULTS: Denominator completeness exceeded 90% in Uganda and Tanzania, but was lower in the CAR (87%) and Ethiopia (82%). Impact numerator completeness averaged 79% for neonatal mortality and 81% for low birth weight, with Ethiopia performing worst, with scores of 45% and 32%, respectively). Completeness for newborn interventions (early breastfeeding, kangaroo mother care, bag-mask ventilation, sepsis management) remained below 90%, with the CAR lacking neonatal sepsis data and Ethiopia lacking early breastfeeding data. Accuracy was poor: concordance between register recounts and summary reports ranged from 9% to 40%. Internal consistency checks revealed mismatches in 80% of facilities, including negative ratios in Uganda and ratios >1 in the CAR. CONCLUSIONS: Significant gaps in completeness, accuracy, and internal consistency undermine the reliability of newborn and stillbirth data in routine health information systems, highlighting a need for their strengthening, the integration of standardised newborn indicators, and institutionalized quality verification processes to ensure timely, reliable, and actionable data for improving newborn care
Mental health, water, and food: Relationships between water and food insecurity and probable depression amongst adults in Mexico.
Get PDFBACKGROUND: Water and food insecurity often co-occur, and have independently been identified as potential risk factors for poor mental health. Their interlinkages are only just beginning to be explored; even less is known about how the relationships vary by gender. Understanding the independent associations of water and food insecurity with mental health, as well as their joint effects, can help identify which interventions might be most appropriate for improving health.
METHODS: We explored how probable depression covaried with water and food insecurity using nationally representative data from the Mexican National Health and Nutrition Survey 2021 (ENSANUT 2021, n = 13,126). Cross-sectional data were collected on household water, food insecurity, and probable depression amongst adults. We used multivariable logistic regression models to examine the association of water insecurity and food insecurity with moderate-to-severe probable depression, and we stratified the models by sex.
RESULTS: Household water insecurity was associated with higher odds of probable depression amongst women (1.37 OR, CI: 1.13-1.66) and men (1.30 OR, CI: 0.92-1.83). When controlling for household food insecurity, the association between probable depression and water insecurity was no longer important, however, household food insecurity was associated with higher odds of probable depression. Those experiencing joint water and food insecurity had the highest odds of probable depression (2.70 OR, CI: 2.13-3.40). The associations between water insecurity, food insecurity and mental health did not differ by sex.
CONCLUSION: Concurrent water and food insecurity increase the likelihood of probable depression amongst both men and women. Strategies to mitigate both resource insecurities could improve mental health
Mortality Risk Following a Household Suicide.
Get PDFIMPORTANCE: The broader mortality risks faced by household members following a suicide remain poorly understood, particularly in low- and middle-income countries.
OBJECTIVES: To estimate the risk of all-cause and cause-specific mortality among surviving household members after a suicide within the household and to identify individual and contextual factors associated with mortality risk using data from a national population-based cohort in Brazil.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study used data from the 100 Million Brazilian Cohort linked to the Mortality Information System (SIM) (2001-2018). All individuals who lived in a household with a suicide index case were considered exposed. Data were analyzed from March 2023 to September 2025.
MAIN OUTCOMES AND MEASURES: All-cause mortality, cause-specific mortality, and suicide. Outcomes were derived from the national mortality tracking system. The adjusted hazard ratio of all-cause and specific-cause mortality was calculated using a multivariate, time-varying Cox regression. The risk factors associated with increased mortality, including characteristics of the index case, surviving household members, household conditions, and the timing since the suicide event were also analyzed. RESULTS: The cohort included 101 million individuals, of which there were 47 982 suicide index cases identified. Household members exposed to a suicide (11 070 [7%] Black, 82 407 [53%] Parda, and 57 726 [37%] White) had a 32% higher risk of all-cause mortality (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.28-1.36). The risk of suicide among exposed individuals was more than 4 times higher (aHR, 4.42; 95% CI, 3.86-5.07), with 101 of these deaths (44%) occurring within 2 years of the index suicide case. The population attributable fraction for suicide was 77%. Elevated risks were also observed for other external causes (eg, assault and falls) and nonexternal causes (eg, neoplasms and circulatory and respiratory diseases). Mortality risk was highest when the index case was female and younger, among male survivors, and individuals aged 25 to 59 years. Better household conditions were associated with lower risks of both suicide and all-cause mortality.
CONCLUSIONS AND RELEVANCE: Exposure to suicide within the household was associated with a substantial increase in both suicide-specific and all-cause mortality among surviving household members, particularly in the immediate aftermath. These findings underscore the urgent need to incorporate targeted postvention strategies into comprehensive suicide prevention efforts
Genomic insights into persistent infections, reinfections, and subspecies diversity of Mycobacteroides abscessus: A whole-genome sequencing study of Thai and global isolates.
Get PDFMycobacteroides abscessus is a highly resistant pathogen with significant genetic diversity and complicating clinical management. This study used whole-genome sequencing to analyze genomic variations in seven serially collected isolates from three Thai patients, distinguishing between persistent infections and reinfections. Comparative analysis with 43 global isolates revealed subspecies-specific genetic diversity and distribution patterns. Among Thai isolates, two paired samples (P7.1-P7.2 and P15.1-P15.2) were persistent infections (same clone), while two (P8.1-P8.2 and P15.2-P15.3) were reinfections (different clones). Genome-wide comparisons revealed depth distribution patterns and gene cluster variations among different clones, whereas minimal divergence was observed within persistent infections. Although initial pan-genome analysis identified unique genes in same-clone pairs (P7.1 vs. P7.2 and P15.1 vs. P15.2), further validation using raw read mapping confirmed these genes were not truly unique. Analysis of global isolates showed subspecies-specific genetic variations. M. abscessus subsp. abscessus (MAB) and M. abscessus subsp. massiliense (MMAS) exhibited distinct genotypically drug resistance profiles, with unique core genes linked to adaptation and resistance mechanisms. STRING analysis identified 42 unique core genes in MAB, with 11 gene interactions-truB, prmC_2, and aguA_2 showing the highest interaction scores. In contrast, MMAS had 11 unique core genes with a single interaction between lgrD_4 and rnc. Subsequent validation using NCBI BLAST showed only fmt_2 and aguA_2 were truly unique to MAB. This study provides new insights into the genomic evolution of M. abscessus during persistent and reinfections and genetic variation among subspecies. The findings enhance understanding of M. abscessus epidemiology and may inform therapeutic and infection control
Insect-borne non-enveloped bluetongue virus utilizes discrete small vesicles for non-lytic release and cell-to-cell transmission.
Get PDFBluetongue virus (BTV) is one of the most economically relevant orbiviruses and is the only example of a large complex, but non-enveloped arbovirus. In addition to cell lysis, BTV is known to employ a 'budding' process analogous to that used by enveloped viruses for cell exit, in which the viral glycosylated NS3 protein plays a key role. Recent reports have demonstrated that BTV can also induce non-lytic release via extracellular vesicles (EVs), however, details of the type and origin of the EV used and the role of NS3 in the process remain incompletely understood. In this study we undertook biochemical studies on the non-lytic release of BTV particles in different forms of EVs from several types of host cells and complemented this by comprehensive microscopic analyses using fluorescence microscopy, transmission electron microscopy and electron cryo-tomography. We discovered that BTV particles use both large EVs (LEVs) and smaller size EVs (SEVs) for non-lytic release and that, in each cell type studied, SEV fractions were particularly enriched with NS3. Non-enveloped BTV particles initially released in SEVs were highly infectious and promote efficient cell-to-cell transmission. This discovery highlights the complex mechanisms utilized by a non-enveloped arbovirus for egress and the significance of different EV types in this process
Tackling vaccine hyporesponsiveness through global collaboration, diverse population studies, and data integration.
Get PDFVaccines have improved global health substantially, preventing millions of deaths worldwide. However, striking variations in the immunogenicity and efficacy of some vaccines persist across populations. Notably, suboptimal responses to some vaccines, also known as vaccine hyporesponsiveness, have been observed in low-income and middle-income countries (LMICs) compared with high-income countries or in rural areas within LMICs compared with urban areas within LMICs. Environmental factors, host genetics, lifestyle, and nutrition contribute to immunological variations influencing vaccine responses, highlighting the need to identify key immune signatures that can be manipulated to overcome vaccine hyporesponsiveness. The integration of diverse datasets, accelerated by artificial intelligence, is essential to achieve this goal, which is currently hampered by the under-representation of data from LMICs. The HypoVax Global knowledge hub aims to address this gap by fostering international collaboration and compiling globally representative immunological data from population studies and vaccine trials. The hub offers a platform for high-dimensional data analyses, promotes equitable partnerships, and strives to ensure that all contributions lead to context-specific insights that can inform immunisation strategies to ultimately overcome vaccine hyporesponsiveness
Towards TB elimination in Malawi: a 5-year analysis of key indicators for TB control using surveillance data.
Get PDFBACKGROUND: Malawi's TB Control Programme emphasises data-driven approaches for monitoring TB control efforts, but programmatic indicators have never been systematically evaluated. This study evaluates the performance of Malawi's TB Control Programme, providing insights into national trends, geographical distributions, and programmatic gaps in TB care.
METHODS: Aggregate TB data collected through Malawi's District Health Information System from 2018 to 2022 were analysed cross-sectionally. We analysed trends in TB incidence and case notification rates (CNRs), calculated performance indicators, and assessed district-level variations using time-series plots and statistical comparisons. Population estimates were derived from the 2018 census and adjusted for annual growth.
FINDINGS: Malawi reported 18,025 new persons with TB in 2022. From 2005 to 2018, TB incidence and CNRs declined by 68.6% and 54.5%, respectively. The highest CNRs were recorded among men aged 35-64 years. Treatment success rates improved overall, reaching 89.2% in 2022, though disparities persisted for HIV-positive patients and those treated at tertiary facilities.
CONCLUSION: Challenges remain in Malawi's TB control efforts, particularly in addressing case detection gaps in high-burden districts and improving outcomes for vulnerable populations. Strengthening active case finding, enhancing diagnostic capacity, and addressing socio-economic determinants of health are essential for sustaining progress and achieving END-TB Strategy goals