Combining QMRA and Epidemiology to Estimate Campylobacteriosis Incidence

The disease burden of pathogens as estimated by QMRA (quantitative microbial risk assessment) and EA (epidemiological analysis) often differs considerably. This is an unsatisfactory situation for policymakers and scientists. We explored methods to obtain a unified estimate using campylobacteriosis in the Netherlands as an example, where previous work resulted in estimates of 4.9 million (QMRA) and 90,600 (EA) cases per year. Using the maximum likelihood approach and considering EA the gold standard, the QMRA model could produce the original EA estimate by adjusting mainly the dose‐infection relationship. Considering QMRA the gold standard, the EA model could produce the original QMRA estimate by adjusting mainly the probability that a gastroenteritis case is caused by Campylobacter. A joint analysis of QMRA and EA data and models assuming identical outcomes, using a frequentist or Bayesian approach (using vague priors), resulted in estimates of 102,000 or 123,000 campylobacteriosis cases per year, respectively. These were close to the original EA estimate, and this will be related to the dissimilarity in data availability. The Bayesian approach further showed that attenuating the condition of equal outcomes immediately resulted in very different estimates of the number of campylobacteriosis cases per year and that using more informative priors had little effect on the results. In conclusion, EA was dominant in estimating the burden of campylobacteriosis in the Netherlands. However, it must be noted that only statistical uncertainties were taken into account here. Taking all, usually difficult to quantify, uncertainties into account might lead to a different conclusion.     

Healthy Barbs: Activism Confronts Mortality

Barbara Brenner, JD, was the Executive Director of Breast Cancer Action (BCA) from 1995–2010. Before that, she was a longtime activist in the anti-war movement and an attorney who, for most of her career, practiced public policy law. After she was diagnosed with breast cancer in 1993 at the age of 41, she took the helm of BCA. Under her leadership, the organization moved into a position of national advocacy—demanding research on the causes and prevention of breast cancer, including the role of industrial pollutants. Barbara started the “Think Before You Pink” campaign, encouraging people to question whether companies that display pink ribbons actually produce products that harm women's health or generate any funds to fight breast cancer. Her blog, “Healthy Barbs,” challenged readers to critique routine healthcare practices and policies. Barbara received numerous awards, including a Jefferson Award for Public Service in 2007, the Smith College Medal in 2012, and the ACLU-Northern California's Lola Hanzel Courageous Advocacy Award in 2012. Barbara had a recurrence of breast cancer in 1996. She died of complications associated with amyotrophic lateral sclerosis, ALS, on May 10, 2013.     

An Ecological Model for Quantitative Risk Assessment for Schistosomiasis: The Case of a Patchy Environment in the Coastal Tropical Area of Northeastern Brazil

We developed a stochastic model for quantitative risk assessment for the Schistosoma mansoni (SM) parasite, which causes an endemic disease of public concern. The model provides answers in a useful format for public health decisions, uses data and expert opinion, and can be applied to any landscape where the snail Biomphalaria glabrata is the main intermediate host (South and Central America, the Caribbean, and Africa). It incorporates several realistic and case‐specific features: stage‐structured parasite populations, periodic praziquantel (PZQ) drug treatment for humans, density dependence, extreme events (prolonged rainfall), site‐specific sanitation quality, environmental stochasticity, monthly rainfall variation, uncertainty in parameters, and spatial dynamics. We parameterize the model through a real‐world application in the district of Porto de Galinhas (PG), one of the main touristic destinations in Brazil, where previous studies identified four parasite populations within the metapopulation. The results provide a good approximation of the dynamics of the system and are in agreement with our field observations, i.e., the lack of basic infrastructure (sanitation level and health programs) makes PG a suitable habitat for the persistence and growth of a parasite metapopulation. We quantify the risk of SM metapopulation explosion and quasi‐extinction and the time to metapopulation explosion and quasi‐extinction. We evaluate the sensitivity of the results under varying scenarios of future periodic PZQ treatment (based on the Brazilian Ministry of Health's plan) and sanitation quality. We conclude that the plan might be useful to slow SM metapopulation growth but not to control it. Additional investments in better sanitation are necessary.     

Barriers to Managing Coronary Artery Disease Among Older Women

Numerous barriers to managing coronary artery disease (CAD) among older women are reported in the literature; however, few studies adjust for demographic and health status differences. A survey assessing barriers and other factors was distributed to a stratified random sampling of older women with CAD. Factor analysis and multiple logistic regression procedures were used to estimate the impact of these issues on receiving a CAD-related office visit. The most problematic barriers included denial and low health literacy. Efforts to promote patient awareness of heart health and better communication between patients and clinicians may alleviate these barriers.     

Foot-and-Mouth Disease Entrance Assessment Model Through Air Passenger Violations

This article aims to construct a risk model for the prediction of foot-and-mouth disease (FMD) entrance caused by passengers who illegally carry meat products of cloven-hoofed animals through international airports into a country. The risk that meat contaminated with the FMD virus is formulated as the probabilities of FMD factor events (the prevalence of FMD), the commodity factor event (the transportation, storage, and distribution (TSD) factor event), and the passenger event. Data used for analysis were records of illegal meat product carriers from areas A and B intercepted at an international airport in Taiwan. A risk model was proposed to simulate the probability distributions in disease prevalence, probability of FMD virus existing in the meat products after meat processing, and estimation of survival of virus and time period for TSD. The probability of the passenger event was hypothesized with the odds of intercepted passengers and estimated via logistic regression. The results showed that the odds of passengers being intercepted by beagles were higher than those intercepted by Customs. By conducting Monte Carlo simulations, the probability of FMD virus risk caused by FMD factors from area A was 149 times lower than that from area B. The probability of FMD virus risk caused by the passenger event from area A was four times lower than the corresponding probability from area B. The model provides a contribution to FMD prevention and can be a reference for developing models of other diseases.     

宋代江南地区疾疫成因分析

现代医学认为流行病是由各种生物性致病原或称为病原体所引起的一组具有强烈传染性的疾病.而从传统医学角度而言,所谓流行病是指具有温热病性质的急性传染病,属温热病中具有强烈传染性、病情危重凶险并具有大流行特征的一类疾病.在古代文献中,一般称之为疲、疾疲、瘥、札、疠等.宋人也大体承袭了这一提法.通常情况下,疫病与流行病无法确切区分,因此,统称流行病为疾疫或瘟疫.宋代江南地区是流行病的多发区.这大概与江南地区水网密布,气候温湿、人口密集、人员流动频繁、经济较为活跃易于细菌病毒繁殖有关.     

Psychophysiological Reactivity in Child Sexual Abuse

Sexual abuse has physiological and emotional implications. The purpose of this study is to evaluate the neurobiological sequels of childhood sexual trauma by monitoring physiological variables among sexually abused girls and women compared to controls. We assessed posttrauma and traumatic life events of 35 females sexually abused in their childhood (age range 7–51 years) and 25 control females (age range 7–54 years). Electroencephalography, frontalis electromyography, electrodermal activity, and heart rate parameters were recorded while watching sets of pictures representing neutral and trauma-suggestive stimuli. A minority of participants met the Diagnostic and Statistical Manual of Mental Disorders criteria for post-traumatic stress disorder. Abused females displayed significant elevations in heart rate, electromyography, and electroencephalography while viewing allusive stimuli and elevated heart rate while viewing neutral stimuli. The dysfunctional regulation of the physiological stress system associated with child sexual abuse may endanger the victims with various stress and anxiety disorders.     

Could gonadal and adrenal androgen deficiencies contribute to the depressive symptoms in men with systolic heart failure?

Background: Testosterone (TT) and dehydroepiandrosterone sulphate (DHEAS) are neurosteroids and their deficiencies constitute the hormone risk factors promoting the development of depression in elderly otherwise healthy men. We investigated the link between hypogonadism and depression in accordance with age and concomitant diseases in men with systolic HF using the novel scale previously dedicated for elderly population.

Methods: We analysed the prevalence of depression and severity of depressive symptoms in population of 226 men with systolic HF (40–80 years) compared to 379 healthy peers. The severity of depression was assessed using the Polish long version of Geriatric Depression Scale (GDS).

Results: In men aged 40–59 years the severity of depressive symptoms was greater in NYHA classes III–IV compared to NYHA classes I–II and reference group. In men aged 60–80 years depressive symptoms were more severe in NYHA class III-IV compared to controls (all p?≤?0.001). In multivariate logistic regression model in men aged 40–59 years advanced NYHA class was associated with higher prevalence of mild depression (OR?=?2.14, 95%CI: 1.07–4.29) and chronic obstructive pulmonary disease (COPD) with higher prevalence of severe depression (OR?=?69.1, 95%CI: 2.11–2264.3). In men aged 60–80 years advanced NYHA class and TT deficiency were related to higher prevalence of mild depression (respectively: OR?=?2.9, 95%CI: 1.3–6.4; OR?=?3.6, 95%CI: 1.2–10.63).

Conclusion: TT deficiency, COPD and advanced NYHA class were associated with higher prevalence of depression in men with systolic HF.     

"原创性"文化的特征与构成——鲁迅、卡夫卡文学创作比较谈

鲁迅是中国新文化运动的旗手,卡夫卡被称为“欧美现代派文学之父”,他们各以其鲜明的原创性在中西现代文学史上起到了奠基和引路作用。本文通过对两位作家文学观念、创作主题、艺术方法诸问题的比较,探究其原创性文化的成因,为当今文学的发展提供借鉴之处。     

唐代佛教与山水共生的寺院诗

在中国诗史上,唐代是寺院诗创作的转进与勃兴期,作品数量及题材拓展均取得极大突破。在书写模式上,相继形成藉景畅理、触境明心、纪实绘景三种类型,充分体现佛教与山水互彰的共生性,为山水诗开拓出全新境界。唐人寺院诗重写景造境,常以动静相生法状清寂之景,物态生动,意境幽玄。寺院诗在艺术表现上追求警策,字锻句炼,隽语频出,普遍形成以精切之语状绝胜之景的艺术效果。