Prior Dengue Virus Infection Is Associated With Increased Viral Load in Patients Infected With Dengue but Not Zika Virus.

Open Forum Infect Dis. 2019 Jul 01;6(7):

Authors: Santiago GA, Sharp TM, Rosenberg E, Sosa Cardona II, Alvarado L, Paz-Bailey G, Muñoz-Jordán JL

Abstract
To evaluate potential enhancement of Zika virus (ZIKV) infection among patients with prior dengue virus (DENV) infection, we compared loads of viral RNA among patients infected with ZIKV (n = 1070), DENV-2 (n = 312), or DENV-3 (n = 260). Compared to patients without prior DENV infection, patients with prior DENV infection had significantly higher mean loads of viral RNA if infected with DENV-2 (10.6 vs 11.6 log10 GCE/mL, respectively; t test, P < .0001) or DENV-3 (10.3 vs 10.9 log10 GCE/mL; P < .0001), but not ZIKV (4.7 vs 4.7 log10 GCE/mL; P = .959). These findings provide evidence against in vivo enhancement of ZIKV by anti-DENV antibodies.

PMID: 31363765 [PubMed]

Characterization of influenza H1N1 Gag virus-like particles and extracellular vesicles co-produced in HEK-293SF.

Vaccine. 2019 Jul 26;:

Authors: Venereo-Sánchez A, Fulton K, Koczka K, Twine S, Chahal P, Ansorge S, Gilbert R, Henry O, Kamen A

Abstract
One of the concerns associated with the use of influenza virus-like particles (VLPs) as vaccine candidate or delivery system is their heterogeneous composition. Enveloped VLPs take up the host cell membrane at the budding site carrying out not only the viral antigenic proteins but also host proteins. In addition, the intrinsic nature of cells to produce membrane derived vesicles or extracellular vesicles (EVs), which have similar size to the VLPs, makes VLP purification process challenging. To further characterize these particles and identify proteins that are unique to each population, comparative proteomic analyses were completed to ultimately provide guidance for rational design of separation protocols. The VLPs were produced in suspension and serum free media by transient transfection of an inducible clone of a Human Embryonic Kidney (HEK-293SF) cells expressing HA and NA (H1N1/A/Puerto Rico/8/34), with a plasmid containing the gag gene of HIV-1 fused to GFP. EVs were produced independently from the non-transformed HEK-293SF cell line as a control for comparative studies. Both preparations were characterized for total nucleic acids and protein concentrations and extensively analyzed by nanoLC-MS/MS for their protein compositions. The proteomic analyses showed that aside from the recombinant VLP proteins, nucleolin was the most abundant host cell protein uniquely identified within VLPs (considering the MASCOT score value) while lactotransferrin and heat shock protein 90 were the most abundant proteins in EVs. Overall, this comparative study identifies potential target proteins as specific markers to guide VLP purification and discusses the biogenesis of enveloped particles released in HEK-293 cell suspension cultures emphasizing on the biological functions of host cell proteins identified.

PMID: 31358407 [PubMed - as supplied by publisher]

Poly-γ-Glutamic Acid Complexed With Alum Induces Cross-Protective Immunity of Pandemic H1N1 Vaccine.

Front Immunol. 2019;10:1604

Authors: Nguyen QT, Kwak C, Lee WS, Kim J, Jeong J, Sung MH, Yang J, Poo H

Abstract
The use of a good vaccine adjuvant may induce a higher immunogenicity profile of vaccine antigens. Here, we developed a new adjuvant by combining poly-γ-glutamic acid (γ-PGA) with alum (PGA/Alum) and investigated its ability to enhance the immunogenicity and the cross-reactive efficacy of pandemic H1N1 (pH1N1) influenza vaccine antigen. PGA/Alum enhanced antigen delivery to draining lymph nodes and antigen-specific immunogenicity in mice using OVA as a model antigen. It also greatly increased OVA-specific antibody production, cytotoxic T lymphocyte (CTL) activity, and antibody-dependent cellular cytotoxicity (ADCC). These abilities of PGA/Alum improved the protective efficacy of pH1N1 vaccine antigen by increasing hemagglutination-inhibition titers, enhancing ADCC and CTL activity, and speeding viral clearance following homologous viral challenge. Importantly, the cross-protective efficacy of pH1N1 vaccine against heterologous viruses [A/Puerto Rico/8/34 (H1N1) and A/Hong Kong/1/1968 (H3N2)] was significantly enhanced by PGA/Alum, and cross-reactive ADCC and CTL activities were observed. Together, our results strongly suggest that PGA/Alum may be a promising vaccine adjuvant for preventing influenza and other infectious diseases.

PMID: 31354739 [PubMed - in process]

Strategies and Tools for Public Health Workforce Training Needs Assessments in Diverse and Changing Population Health Contexts.

J Public Health Manag Pract. 2019 Sep/Oct;25(5):490-497

Authors: Aidala AA, Cavaliere B, Cinnick S

Abstract
CONTEXT: A key component of the improvement of public health infrastructure in the United States revolves around public health workforce development and training. Workforce challenges faced by the public health system have long been recognized, but there are additional challenges facing any region-wide or cross-jurisdictional effort to accurately assess priority workforce training needs and develop training resources to address those needs. These challenges include structural variability of public health organizations; diverse population health contexts; capturing both topic-specific skill sets and foundational competencies among public health workers; and reaching/representing the target population despite suspicion, disinterest, and/or assessment "fatigue" among employees asked to participate in workforce development surveys.
OBJECTIVE: The purpose of this article is to describe the challenges, strategies to meet those challenges, and lessons learned conducting public health workforce training needs assessments by academic and practice partners of the Region 2 Public Health Training Center (R2/PHTC).
SETTING AND PARTICIPANTS: The R2/PHTC is hosted by the Mailman School of Public Health at Columbia University and serves New York, New Jersey, Puerto Rico, and the US Virgin Islands within its jurisdiction.
RESULTS: Strategies for responding to diverse organizational structures and population health contexts across the region; defining training priorities that address both foundational competencies for public health professionals and content-specific training to address local public health needs; reaching/representing target populations of public health workers; and analysis and report writing to encourage rapid response to identified needs and comprehensive workforce development planning are discussed. Lessons learned are likely instructive to other workforce training needs assessments in complex and ever-changing public health environments.

PMID: 31348164 [PubMed - in process]

Invasion origin, rapid population expansion, and the lack of genetic structure of cotton bollworm (Helicoverpa armigera) in the Americas.

Ecol Evol. 2019 Jul;9(13):7378-7401

Authors: Gonçalves RM, Mastrangelo T, Rodrigues JCV, Paulo DF, Omoto C, Corrêa AS, de Azeredo-Espin AML

Abstract
In 2013, Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) was officially declared as present in Brazil and, after two years, the species was detected in the Caribbean and North America. Information on genetic features and accurate distribution of pests is the basis for agricultural protection policies. Furthermore, such knowledge is imperative to develop control strategies, understand the geographical range, and genetic patterns of this species in the Americas. Here, we carried out the widest sampling of H. armigera in the South American continent and Puerto Rico, after we estimated the diversity, demographic parameters, and genetic structure. The Internal Transcribed Spacer 1 (ITS1) nuclear marker was used to investigate the presence of putative hybrids between H. armigera and H. zea, and they were observed at a frequency of 1.5%. An ABC analysis, based in COI gene fragment, suggested Europe as the origin of South America specimens of H. armigeraand following a movement northward through the Caribbean. Three mtDNA genes and three nDNA markers revealed high genetic diversity distributed without the defined population structure of H. armigera in South America. Most of the genetic variation is within populations with a multidirectional expansion of H. armigera among morphoclimatic regions. High genetic diversity, rapid population expansion, and hybridization have implications for pest management since they suggest that adaptive alleles are spread through wide areas in South America that favor rapid local adaptation of H. armigera to new and disturbed environments (e.g., in agricultural areas).

PMID: 31346410 [PubMed]

A Nationwide Snapshot of the Predictors of and Barriers to School Garden Success.

J Nutr Educ Behav. 2019 Jul 23;:

Authors: Burt KG, Lindel N, Wang J, Burgermaster M, Fera J

Abstract
OBJECTIVE: To explore the degree and predictors of and barriers to school garden integration (termed success).
DESIGN: A 30-item online survey consisting of demographic, garden characteristic, and barrier questions, as well as the School Garden Integration Scale, was conducted in 266 school garden organizations (13 national, 8 regional, and 245 state or local).
PARTICIPANTS: A total of 414 school gardeners from 38 states and Puerto Rico.
MAIN OUTCOME MEASURES: School garden success using the GREEN Tool.
ANALYSIS: Descriptive statistics were used to determine the degree of success of school garden programs and explore barriers. Multiple regression analysis was conducted to determine independent predictors of school garden success.
RESULTS: The average score was 37 (range 1-53, of a possible 57 points), indicating moderate success. Operating budget (P < .001), operating time (P < .05), and planting in-ground (P < .01) had a positive significant influence on success score, whereas rural location (P < .01) and lacking community interest (P < .01) had a negative significant influence, controlling for race/ethnicity, region, total garden investment, and Community Need Index score (a proxy for socioeconomic status).
CONCLUSIONS AND IMPLICATIONS: Results indicate that success of school garden programs may be more difficult for the schools located in a rural area or in the absence of school or community-at-large interest. This study found that race/ethnicity of students and socioeconomic status are not related to success score, which is promising as other research indicates that successful school gardens may be especially impactful for low-income people of color. Causal research is needed to identify strategies that increase school garden success, with a focus on engaging key stakeholders (administrators, teachers, parents, the community at large, and garden coordinators).

PMID: 31345673 [PubMed - as supplied by publisher]

Untangling the Hypogeococcus pungens species complex (Hemiptera: Pseudococcidae) for Argentina, Australia, and Puerto Rico based on host plant associations and genetic evidence.

PLoS One. 2019;14(7):e0220366

Authors: Poveda-Martínez D, Aguirre MB, Logarzo G, Calderón L, de la Colina A, Hight S, Triapitsyn S, Diaz-Soltero H, Hasson E

Abstract
Hypogeococcus pungens, a mealybug native of southern South America, is devastating native cacti in Puerto Rico and threatening cactus diversity in the Caribbean, and potentially in Central and North America. The taxonomic status of H. pungens is controversial since it has been reported feeding not only on Cactaceae but also on other plant families throughout its distribution range. However, in Australia, where the species had been exported from Argentina to control weedy American cacti, it was never found on host plants other than Cactaceae. These conflicting pieces of evidence not only cast doubt on the species identity that invaded Puerto Rico, but also have a negative impact on the search for natural enemies to be used in biological control programs against this pest. Here we present reproductive incompatibility and phylogenetic evidences that give support to the hypothesis that H. pungens is a species complex in which divergence appears to be driven by the host plants. The nuclear EF1α and 18S and the mitochondrial COI genes were used as markers to evaluate the phylogenetic relationships among H. pungens populations collected in Argentina, Australia and Puerto Rico feeding on Cactaceae and/or Amaranthaceae. Additionally, we conducted reciprocal crosses between mealybugs from both hosts. Species delimitation analysis revealed two well-supported putative species within H. pungens, one including mealybugs feeding on Amaranthaceae (H. pungens sensu stricto), and a new undescribed species using Cactaceae as hosts. Additionally, we found asymmetric reproductive incompatibility between these putative species suggesting recent reproductive isolation. The Bayesian species delimitation also suggested that the Australian mealybug population may derive from another undescribed species. Overall, the patterns of genetic differentiation may be interpreted as the result of recent speciation events prompted by host plant shifts. Finally, the finding of a single haplotype in the Puerto Rico population suggests only one invasive event. We still need to identify the geographical origin of the pest in order to enable the use of biological control to reduce the threat to cacti diversity in the Caribbean.

PMID: 31344099 [PubMed - in process]

Autocidal gravid ovitraps protect humans from chikungunya virus infection by reducing Aedes aegypti mosquito populations.

PLoS Negl Trop Dis. 2019 Jul;13(7):e0007538

Authors: Sharp TM, Lorenzi O, Torres-Velásquez B, Acevedo V, Pérez-Padilla J, Rivera A, Muñoz-Jordán J, Margolis HS, Waterman SH, Biggerstaff BJ, Paz-Bailey G, Barrera R

Abstract
BACKGROUND: Public health responses to outbreaks of dengue, chikungunya, and Zika virus have been stymied by the inability to control the primary vector, Aedes aegypti mosquitos. Consequently, the need for novel approaches to Aedes vector control is urgent. Placement of three autocidal gravid ovitraps (AGO traps) in ~85% of homes in a community was previously shown to sustainably reduce the density of female Ae. aegypti by >80%. Following the introduction of chikungunya virus (CHIKV) to Puerto Rico, we conducted a seroprevalence survey to estimate the prevalence of CHIKV infection in communities with and without AGO traps and evaluate their effect on reducing CHIKV transmission.
METHODS AND FINDINGS: Multivariate models that calculated adjusted prevalence ratios (aPR) showed that among 175 and 152 residents of communities with and without AGO traps, respectively, an estimated 26.1% and 43.8% had been infected with CHIKV (aPR = 0.50, 95% CI: 0.37-0.91). After stratification by time spent in their community, protection from CHIKV infection was strongest among residents who reported spending many or all weekly daytime hours in their community:10.3% seropositive in communities with AGO traps vs. 48.7% in communities without (PR = 0.21, 95% CI: 0.11-0.41). The age-adjusted rate of fever with arthralgia attributable to CHIKV infection was 58% (95% CI: 46-66%). The monthly number of CHIKV-infected mosquitos and symptomatic residents were diminished in communities with AGO traps compared to those without.
CONCLUSIONS: These findings indicate that AGO traps are an effective tool that protects humans from infection with a virus transmitted by Ae. aegypti mosquitos. Future studies should evaluate their protective effectiveness in large, urban communities.

PMID: 31344040 [PubMed - in process]

Seroprevalence, risk factors, and rodent reservoirs of leptospirosis in an urban community of Puerto Rico, 2015.

J Infect Dis. 2019 Jul 02;:

Authors: Briskin EA, Casanovas-Massana A, Ryff KR, Morales-Estrada S, Hamond C, Perez-Rodriguez NM, Benavidez KM, Weinberger DM, Castro-Arellano I, Wunder EA, Sharp TM, Rivera-Garcia B, Ko AI

Abstract
BACKGROUND: The burden of leptospirosis in Puerto Rico remains unclear due to underreporting.
METHODS: A cross-sectional survey and rodent trapping was performed in a community within San Juan, Puerto Rico to determine the seroprevalence and risk factors for Leptospira infection. The microscopic agglutination test was used to detect anti-Leptospira antibodies as a marker of previous infection. We evaluated Leptospira carriage by qPCR among rodents trapped at the community site.
RESULTS: Of 202 study participants, 55 (27.2%) had Leptospira agglutinating antibodies. Among the 55 seropositive individuals, antibodies were directed most frequently against serogroups Icterohaemorrhagiae (22.0%) and Autumnalis (10.6%). Of 18 captured rodents, 11 (61.1%) carried pathogenic Leptospira (L. borgpetersenii, 7 and L. interrogans, 2). Four participants showed their highest titer against an isolate obtained from a rodent (serogroup Ballum). Increasing household distance to the canal that runs through the community was associated with decreased risk of infection (OR = 0.934 per 10m increase, 95% CI: 0.952-0.992).
CONCLUSION: There are high levels of Leptospira exposure in an urban setting in Puerto Rico, for which rodents may be an important reservoir for transmission. Our findings indicate that prevention should focus on mitigating risk posed by infrastructure deficiencies such as the canal.

PMID: 31342075 [PubMed - as supplied by publisher]

In utero tobacco smoke exposure, DNA methylation, and asthma in Latino children.

Environ Epidemiol. 2019 Jun;3(3):e048

Authors: Neophytou AM, Oh SS, Hu D, Huntsman S, Eng C, Rodríguez-Santana JR, Kumar R, Balmes JR, Eisen EA, Burchard EG

Abstract
Background: Maternal smoking during pregnancy is a risk factor for chronic disease later in life and has been associated with variability of DNA methylation at specific cytosine-phosphate-guanine (CpG) loci. We assessed the role of DNA methylation as a potential mediator of adverse effects of in utero tobacco smoke exposures on asthma outcomes in Latino children from the US mainland and Puerto Rico.
Methods: Relationships between self-reported exposure and DNA methylation at CpG loci previously reported to be associated with maternal smoking were assessed in a subsample consisting of 572 children aged 8-21 years (310 cases with asthma, 262 healthy controls), sampled from a larger asthma case-control study. Subsequently, we assessed associations between top loci and asthma-related outcomes, followed by mediation analysis for loci for which associations with outcomes were observed.
Results: Self-reported maternal smoking was associated with a -1.5% (95% confidence interval (CI) = -2.4%, -0.6%) lower methylation at CpG locus cg05575921 on the AHRR gene; a 1% increase in DNA methylation at the same locus resulted in an odds ratio (OR) of 0.90 (95% CI = 0.83, 0.96) for the odds of asthma. The OR for the indirect effect of maternal smoking on asthma mediated through methylation at the cg05575921 locus was 1.18 (95% CI = 1.07, 1.68), compared to the OR for the total effect of exposure in the parent study of 1.48 (95% CI = 1.03, 2.11).
Conclusions: Our findings suggest potential mediation by DNA methylation in the association between maternal smoking during pregnancy and asthma status.

PMID: 31342008 [PubMed]

Reduced effectiveness of repellents in a pyrethroid-resistant strain of Aedes aegypti (Diptera: culicidae) and its correlation with olfactory sensitivity.

Pest Manag Sci. 2019 Jul 24;:

Authors: Yang L, Norris EJ, Jiang S, Bernier UR, Linthicum KJ, Bloomquist JR

Abstract
BACKGROUND: The mosquito, Aedes aegypti (Diptera: Culicidae), is a vector of dengue fever, zika, chikungunya, and yellow fever viruses, and in many areas possesses significant levels of resistance to pyrethroids. Behavioral performance was assessed in 15, 30, and 60 min exposures in a high throughput vapor phase spatial repellency assay to three contact repellent standards: N, N-diethyl-3-methylbenzamide (DEET), ethyl 3-[acetyl(butyl)amino] propanoate (IR3535), and 2-undecanone, as well as pyrethrum extract, transfluthrin, and metofluthrin in susceptible (Orlando) and a pyrethroid-resistant Puerto Rico strain of Aedes aegypti. Additionally, electroantennographic studies were used to investigate the antennal sensitivities to these compounds in both strains.
RESULTS: Resistance was found to all tested insect repellents in the Puerto Rico strain of Ae. aegypti. Resistance ratios at the different time points were about 2 for DEET, 3 for 2-undecanone, and 12 for IR3535. Resistance was also observed to pyrethrum extract (~9-fold), transfluthrin (~5-fold), and metofluthrin (~48-fold) in repellent behavioral response. Electrophysiological analysis found decreased antennal sensitivity to all repellents tested, consistent with their behavioral effects.
CONCLUSION: The reduced sensitivity to these repellents may represent a fitness cost arising from the kdr mutation present in Puerto Rico Aedes aegypti. This work highlights the need for understanding collateral effects from the evolution of pesticide resistance in mosquitoes, and the importance of finding alternative strategies to control resistance development. This article is protected by copyright. All rights reserved.

PMID: 31338960 [PubMed - as supplied by publisher]

Dietary Intake and Its Determinants Among Adults Living in the Metropolitan Area of Puerto Rico.

Nutrients. 2019 Jul 14;11(7):

Authors: Mattei J, Tamez M, Bigornia SJ, Noel SE, Xiao RS, Ríos-Bedoya CF, Rodríguez-Orengo JF, Tucker KL

Abstract
There is scarce information regarding the dietary intake of adults living in Puerto Rico (PR). We aimed to assess intake of nutrients and foods, adherence to recommended intake of nutrients and diet quality, and sociodemographic and lifestyle factors correlated with diet quality among adults in the San Juan metropolitan area of PR. Data were obtained from participants of the cross-sectional convenience-sample Puerto Rico Assessment of Diet, Lifestyle, and Diseases (n = 248; ages 30-75 years). Diet quality was defined using the Alternate Healthy Eating Index 2010 (AHEI; range 0-110 indicating lower-higher quality). Linear regression models were used to relate AHEI to sociodemographic and lifestyle factors. Most participants met the Estimated Average Requirement (EAR) for iron, folate, and vitamins B12 and B6; 61% met the EAR for magnesium and 56% for calcium. Only 4% met the EAR for vitamin D, and 7% met the adequate intake for potassium. The main contributors to total energy intake were sugary beverages (11.8%), sweets/desserts (10.2%), dairy (8.5%), mixed dishes (7.6%), starches (6.3%), fast foods (5.5%), and rice (4.9%). The mean (SD) AHEI score was 59.8 (11.0). The lowest AHEI components for which recommended servings were met were red/processed meats, fruit, sodium, sugary beverages, and polyunsaturated fats, and the highest were nuts/legumes, omega-3 fats, and whole grains. Significantly higher AHEI scores were noted for older adults, other ethnicities (vs. Puerto Rican), being single, having some college or higher education, and never/formerly smoking. Adults living in PR report healthy and unhealthy dietary intakes, providing an opportunity to improve diet at the population level.

PMID: 31337152 [PubMed - in process]

Pertussis in Latin America: Recent epidemiological data presented at the 2017 Global Pertussis Initiative meeting.

Vaccine. 2019 Jul 19;:

Authors: Hozbor D, Ulloa-Gutierrez R, Marino C, Wirsing von König CH, Tan T, Forsyth K

Abstract
The Global Pertussis Initiative (GPI) is an expert scientific forum that publishes consensus recommendations for pertussis monitoring, prevention, and treatment across many regions of the world. Here, we report on the regional 2017 GPI meeting on the Americas, focusing on Latin America. Information on current pertussis epidemiology, surveillance, vaccine strategies, diagnostic capabilities, disease awareness, and major local obstacles was presented by researchers from Argentina, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela. Pertussis outbreaks have occurred during the last decade in the majority of participant countries and have been followed by improvements in surveillance. In the countries that introduced maternal immunization during pregnancy, a reduction in the infant case fatality rate has been detected. All countries need to maintain and improve pertussis surveillance to reach primary vaccination coverage >90%. Moreover, countries without maternal immunization programs should strongly consider them.

PMID: 31331774 [PubMed - as supplied by publisher]

Generation of a Reassortant Influenza A Subtype H3N2 Virus Expressing Gaussia Luciferase.

Viruses. 2019 Jul 20;11(7):

Authors: Wang L, Cui Q, Zhao X, Li P, Wang Y, Rong L, Du R

Abstract
Reporter influenza A viruses (IAVs) carrying fluorescent or luminescent genes provide a powerful tool for both basic and translational research. Most reporter IAVs are based on the backbone of either subtype H1N1 viruses, A/Puerto Rico/8/1934 (PR8) or A/WSN/1933, but no reporter subtype H3N2 virus is currently available to our knowledge. Since the IAV subtype H3N2 co-circulates with H1N1 among humans causing annual epidemics, a reporter influenza A subtype H3N2 virus would be highly valuable. In this study, the segments of A/Wyoming/3/03 (NY, H3N2) virus encoding hemagglutinin and neuraminidase, respectively, were reassorted with the six internal genes of PR8 where the NS gene was fused with a Gaussia luciferase (Gluc) gene. Using reverse genetics, NY-r19-Gluc, a replication competent reassortant influenza A subtype H3N2 virus expressing reporter Gluc was successfully generated. This reporter virus is stable during replication in Madin-Darby canine kidney (MDCK) cells, and preliminary studies demonstrated it as a useful tool to evaluate antivirals. In addition, NY-r19-Gluc virus will be a powerful tool in other studies including the application of diagnostic and therapeutic antibodies as well as the evaluation of novel vaccines.

PMID: 31330768 [PubMed - in process]

Distinguishing patients with laboratory-confirmed chikungunya from dengue and other acute febrile illnesses, Puerto Rico, 2012-2015.

PLoS Negl Trop Dis. 2019 Jul;13(7):e0007562

Authors: Alvarado LI, Lorenzi OD, Torres-Velásquez BC, Sharp TM, Vargas L, Muñoz-Jordán JL, Hunsperger EA, Pérez-Padilla J, Rivera A, González-Zeno GE, Galloway RL, Glass Elrod M, Mathis DL, Oberste MS, Nix WA, Henderson E, McQuiston J, Singleton J, Kato C, García-Gubern C, Santiago-Rivera W, Muns-Sosa R, Ortiz-Rivera JD, Jiménez G, Rivera-Amill V, Andújar-Pérez DA, Horiuchi K, Tomashek KM

Abstract
Chikungunya, a mosquito-borne viral, acute febrile illness (AFI) is associated with polyarthralgia and polyarthritis. Differentiation from other AFI is difficult due to the non-specific presentation and limited availability of diagnostics. This 3-year study identified independent clinical predictors by day post-illness onset (DPO) at presentation and age-group that distinguish chikungunya cases from two groups: other AFI and dengue. Specimens collected from participants with fever ≤7 days were tested for chikungunya, dengue viruses 1-4, and 20 other pathogens. Of 8,996 participants, 18.2% had chikungunya, and 10.8% had dengue. Chikungunya cases were more likely than other groups to be older, report a chronic condition, and present <3 DPO. Regardless of timing of presentation, significant positive predictors for chikungunya versus other AFI were: joint pain, muscle, bone or back pain, skin rash, and red conjunctiva; with dengue as the comparator, red swollen joints (arthritis), joint pain, skin rash, any bleeding, and irritability were predictors. Chikungunya cases were less likely than AFI and dengue to present with thrombocytopenia, signs of poor circulation, diarrhea, headache, and cough. Among participants presenting <3 DPO, predictors for chikungunya versus other AFI included: joint pain, skin rash, and muscle, bone or back pain, and absence of thrombocytopenia, poor circulation and respiratory or gastrointestinal symptoms; when the comparator was dengue, joint pain and arthritis, and absence of thrombocytopenia, leukopenia, and nausea were early predictors. Among all groups presenting 3-5 DPO, pruritic skin became a predictor for chikungunya, joint, muscle, bone or back pain were no longer predictive, while arthritis became predictive in all age-groups. Absence of thrombocytopenia was a significant predictor regardless of DPO or comparison group. This study identified robust clinical indicators such as joint pain, skin rash and absence of thrombocytopenia that can allow early identification of and accurate differentiation between patients with chikungunya and other common causes of AFI.

PMID: 31329598 [PubMed - in process]

Developmental Trends in Sexual Attraction Among Puerto Rican Early Adolescents in Two Contexts.

Child Dev. 2019 Jul 20;:

Authors: Elkington KS, Wainberg ML, Ramos-Olazagasti M, Chen C, Ortin A, Canino GJ, Bird HR, Duarte CS

Abstract
Sexual attraction (SA), the earliest stage of sexual orientation, is scarcely studied. This prospective study examined, over 3 years, prevalence, changes in SA, and the role of context, among 946 Puerto Rican youth, aged 11-13 years at initial assessment in the South Bronx (SBx), New York City, and Puerto Rico (PR). Overall, 98.1% of boys and 95.3% of girls reported opposite-sex only SA at some point, whereas 13.8% of girls and 12.0% of boys reported any-same SA. Opposite-sex only SA increased over time, whereas other SAs decreased except for any same-sex SA among SBx girls. Girls in the SBx and younger youth in PR reported more any same-sex SA. Context and culture may play a role in the developmental trajectories of adolescents' SA.

PMID: 31325160 [PubMed - as supplied by publisher]

Prevalence of depressive symptoms among older adults who reported medical cost as a barrier to seeking health care: findings from a nationally representative sample.

BMC Geriatr. 2019 Jul 18;19(1):192

Authors: Cheruvu VK, Chiyaka ET

Abstract
BACKGROUND: Older adults aged 65 and over will make up more than 20% of U.S. residents by 2030, and in 2050, this population will reach 83.7 million. Depression among older adults is a major public health concern projected to be the second leading cause of disease burden. Despite having Medicare, and other employer supplements, the burden of out of pocket healthcare expenses may be an important predictor of depression. The current study aims to investigate whether delay in seeing a doctor when needed but could not because of medical cost is significantly associated with symptoms of current depression in older adults.
METHODS: Cross-sectional data from the 2011 Behavioral Risk Factor Surveillance System (BFRSS) from 12 states and Puerto Rico were used for this study (n = 24,018).
RESULTS: The prevalence of symptoms of current depression among older adults who reported medical cost as a barrier to seeking health care was significantly higher (17.8%) when compared to older adults who reported medical cost not being a barrier to seeking health care (5.5%). Older adults who reported medical cost as a barrier to seeking health care were more likely to report current depressive symptoms compared to their counterparts [Adjusted Odds Ratio (AOR): 2.2 [95% CI: 1.5-3.3]).
CONCLUSIONS: Older adults (≥ 65 years of age) who experience the burden of medical cost for health care are significantly more likely to report symptoms of depression. Health care professionals and policymakers should consider effective interventions to improve access to health care among older adults.

PMID: 31319807 [PubMed - in process]

A case of silent invasion: Citizen science confirms the presence of Harmonia axyridis (Coleoptera, Coccinellidae) in Central America.

PLoS One. 2019;14(7):e0220082

Authors: Hiller T, Haelewaters D

Abstract
Harmonia axyridis (Coleoptera, Coccinellidae) is a globally invasive ladybird. It has been intentionally introduced in many countries as a biological control agent, whereas it has been unintentionally released in many others. Climatic factors are important in limiting the spread of H. axyridis. For example, very few records are known from tropical or desert regions. Currently, no published reports are known from Central America. Here, we report H. axyridis from Costa Rica, Guatemala, Honduras, Panama, and Puerto Rico. Specimens were either observed by the authors, discovered in dried insect collections, or retrieved from searching through online photographs available from the citizen science project iNaturalist and the photo-sharing website Flickr. These new records and the wide distribution of H. axyridis in Latin America suggest several invasion events, which have gone unnoticed until now. We stress the need for further, large-scale monitoring and show the advantage of citizen science to assess the presence of invasive alien species.

PMID: 31318960 [PubMed - in process]

State-Specific Prevalence of Quit Attempts Among Adult Cigarette Smokers - United States, 2011-2017.

MMWR Morb Mortal Wkly Rep. 2019 Jul 19;68(28):621-626

Authors: Walton K, Wang TW, Schauer GL, Hu S, McGruder HF, Jamal A, Babb S

Abstract
From 1965 to 2017, the prevalence of cigarette smoking among U.S. adults aged ≥18 years decreased from 42.4% to 14.0%, in part because of increases in smoking cessation (1,2). Increasing smoking cessation can reduce smoking-related disease, death, and health care expenditures (3). Increases in cessation are driven in large part by increases in quit attempts (4). Healthy People 2020 objective 4.1 calls for increasing the proportion of U.S. adult cigarette smokers who made a past-year quit attempt to ≥80% (5). To assess state-specific trends in the prevalence of past-year quit attempts among adult cigarette smokers, CDC analyzed data from the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys for all 50 states, the District of Columbia (DC), Guam, and Puerto Rico. During 2011-2017, quit attempt prevalence increased in four states (Kansas, Louisiana, Virginia, and West Virginia), declined in two states (New York and Tennessee), and did not significantly change in the remaining 44 states, DC, and two territories. In 2017, the prevalence of past-year quit attempts ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4%. In 2017, older smokers were less likely than younger smokers to make a quit attempt in most states. Implementation of comprehensive state tobacco control programs and evidence-based tobacco control interventions, including barrier-free access to cessation treatments, can increase the number of smokers who make quit attempts and succeed in quitting (2,3).

PMID: 31318853 [PubMed - in process]

Traumatic esophageal perforation in Puerto Rico Trauma Hospital: A case-series.

Ann Med Surg (Lond). 2019 Aug;44:62-67

Authors: Vázquez-Rodríguez JC, Pelet Del Toro NM, García-Rodríguez O, Ramos-Meléndez E, López-Maldonado J, Rodríguez F, Mejías JP, Rodríguez-Ortiz P

Abstract
Background: Esophageal injuries are rare, life-threatening, events with an overall reported incidence of less than 3%. In rare cases, trauma due to blunt or penetrating injuries cause esophageal perforations, which account for less than 15% of all esophageal injuries.
Materials and methods: A case-series study was conducted to describe the outcomes and management of all the traumatic esophageal injuries at the Puerto Rico Trauma Hospital (PRTH) from 2000 through 2017. These cases were evaluated in terms of etiology of perforation, mechanism of injury and esophageal level.
Results: Sixteen patients were treated for esophageal injuries at the PRTH between 2000 and 2017. Of these patients, 15 (93.7%) were males with a median age of 24.5 years (16, 49). Regarding the etiology of the esophageal perforation, 2 (12.5%) patients suffered blunt esophageal trauma, and 14 (87.5%) patients had penetrating trauma to the esophagus. The most common mechanism of perforation was gunshot wound 10 (62.4%), followed by stab wound 4 (25.0%), and the least common were motor vehicle collision 1 (6.3%) and pedestrian injured by traffic 1 (6.3%). Regarding esophageal location, 9 (56.3%) patients presented cervical, 6 (37.5%) thoracic, and 1 (6.3%) abdominal injuries. Most patients 13 (81.3%) had a prompt diagnosis of traumatic esophageal perforation, while 3 (18.7%) patients had a delayed diagnosis. Only 2 (12.5%) deaths occurred among our 16 patients, including 1 (6.3%) in delayed diagnosed subjects.
Conclusion: Esophageal perforation is a life-threatening condition and should be treated urgently. An early diagnosis and prompt surgical treatment completed in the first 24-h is fundamental for a good outcome.

PMID: 31316769 [PubMed]