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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Manuel Cardona; Cecilia E. Garcia Cena; Fernando E. Serrano; Roque Saltaren;

    Objective: In this article, we present the conceptual development of a robotics platform, called ALICE (Assistive Lower Limb Controlled Exoskeleton), for kinetic and kinematic gait characterization. The ALICE platform includes a robotics wearable exoskeleton and an on-board muscle driven simulator to estimate the user’s kinetic parameters. Background: Even when the kinematics patterns of the human gait are well studied and reported in the literature, there exists a considerable intra-subject variability in the kinetics of the movements. ALICE aims to be an advanced mechanical sensor that allows us to compute real-time information of both kinetic and kinematic data, opening up a new personalized rehabilitation concept. Methodology: We developed a full muscle driven simulator in an open source environment and validated it with real gait data obtained from patients diagnosed with multiple sclerosis. After that, we designed, modeled, and controlled a 6 DoF lower limb exoskeleton with inertial measurement units and a position/velocity sensor in each actuator. Significance: This novel concept aims to become a tool for improving the diagnosis of pathological gait and to design personalized robotics rehabilitation therapies. Conclusion: ALICE is the first robotics platform automatically adapted to the kinetic and kinematic gait parameters of each patient. Peer reviewed

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    Other literature type . Article . 2020 . Peer-reviewed
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      Other literature type . Article . 2020 . Peer-reviewed
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    Authors: Catharina Wesseling; Jason Glaser; Julieta Rodríguez-Guzmán; Ilana Weiss; +8 Authors

    The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.La mortalidad por la epidemia de enfermedad renal crónica de origen no tradicional (ERCnt) en Mesoamérica asciende a decenas de miles de personas, principalmente hombres jóvenes. No existe consenso sobre su etiología. En la década de 1990, informes anecdóticos apuntaban como factor de riesgo al trabajo en plantaciones de caña de azúcar; se consideró como posibles causantes a los plaguicidas y el estrés térmico. Estudios de prevalencia de base poblacional subsiguientes apoyaron un origen ocupacional, con una proporción elevada de hombres respecto de las mujeres en las tierras bajas donde el riesgo era elevado, pero con pequeñas diferencias de sexo dentro de las categorías ocupacionales y baja prevalencia en el ámbito no laboral. Se reportó ERCnt en los trabajadores de la caña de azúcar y otros cultivos con alta exigencia física y en ocupaciones no agrícolas que implican trabajo manual intenso en ambientes calurosos, pero no entre los agricultores de subsistencia. Estudios recientes con diseños más sólidos han demostrado cambios en la función renal y en los biomarcadores de hidratación en el curso de los turnos laborales, y disminución de la función renal relacionada con el calor y la carga de trabajo en el curso de la cosecha. La implementación de una intervención basada en la provisión de agua, descanso y sombra a mitad de la cosecha en El Salvador detuvo la disminución de la función renal en los cortadores de caña. En Nicaragua, un programa de provisión de agua, descanso y sombra evitó la lesión renal en los trabajadores de la caña con una carga de trabajo baja y moderada, pero no entre los cortadores, quienes tienen la mayor carga de trabajo. Los estudios sobre plaguicidas y factores de riesgo infecciosos han sido en gran medida negativos. Los factores de riesgo no ocupacionales no explican los patrones epidemiológicos observados. En conclusión, el trabajo es el principal desencadenante de la epidemia de ERCnt en Mesoamérica, y el estrés térmico ocupacional es el único factor que consistentemente conduce a la disfunción renal en las poblaciones afectadas. Los cortadores que trabajan en los ingenios azucareros y están expuestos a un estrés térmico extremo podrían ser considerados una población ocupacional centinela. La prevención del estrés térmico ocupacional es crítica, más aún si se consideran los efectos del cambio climático.A mortalidade devida à epidemia de doença renal crônica de origem não tradicional (DRCnt) na Mesoamérica atinge dezenas de milhares de pessoas, principalmente homens jovens. Não há consenso sobre a sua etiologia. Na década de 1990, informações empíricas apontavam o trabalho em plantações de cana de açúcar como um fator de risco; pesticidas e estresse térmico também eram considerados causas possíveis. As pesquisas populacionais subsequentes sustentam uma origem ocupacional da doença, com uma elevada proporção de homens quando comparados à de mulheres, em areas de baixa altitude, onde o risco da doença é mais elevado, mas com pequenas diferenças de gênero quando se consideram as categorias ocupacionais e baixa prevalência no ambiente não-ocupacional. A DRCnt foi identificada em trabalhadores agrícolas da cana de açúcar e de outras culturas que exigem trabalho físico de alta intensidade e em ocupações não agrícolas envolvendo um trabalho manual intenso em ambientes quentes, mas não entre os agricultores de subsistência. Estudos recentes com desenhos mais robustos demonstraram mudanças na função renal e nos biomarcadores de hidratação ao longo dos turnos de trabalho, e diminuição da função renal relacionada à exposição ao calor e à carga de trabalho ao longo da colheita. A implementação de uma intervenção de água-descanso-sombra durante a colheita em El Salvador interrompeu o declínio da função renal em cortadores de cana. Na Nicarágua, intervenções água-descanso-sombra parecem ter sido suficientes para evitar lesões renais em trabalhadores canavieiros com cargas de trabalho baixa e moderada, mas não entre os cortadores de cana que têm carga de trabalho mais pesada. Estudos sobre exposição a pesticidas e a fatores de risco de origem infecciosa têm sido largamente negativos. Os fatores de risco não-ocupacionais não explicam os padrões epidemiológicos observados. Em conclusão, ocupação é o principal desencadeador da epidemia de DRCnt na Mesoamérica, e o estresse térmico ocupacional é o único fator comprovado que leva à disfunção renal nas populações afetadas. Os cortadores de cana que trabalham em engenhos de açúcar e expostos a um estresse térmico extremo podem ser considerados uma população ocupacional sentinela. A prevenção do estresse térmico ocupacional é crítica, especialmente considerando os efeitos das mudanças climáticas.

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    Revista Panamericana de Salud Pública
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    Authors: Hoang-Long Vo; Le-Thai-Bao Huynh; Hao Nguyen Si Anh; Dang-An Do; +3 Authors

    There has been no report on the situation of socioeconomic inequalities in the full vaccination coverage among Vietnamese children. This study aims to assess the trends and changes in the socioeconomic inequalities in the full vaccination coverage among Vietnamese children aged 12–23 months from 2000 to 2014. Data were drawn from Multiple Indicator Cluster Surveys (2000, 2006, 2011, and 2014). Concentration index (CCI) and concentration curve (CC) were applied to quantify the degree of the socioeconomic inequalities in full immunization coverage. The prevalence of children fully receiving recommended vaccines was significantly improved during 2000–2014, yet, was still not being covered. The total CCI of full vaccination coverage gradually decreased from 2000 to 2014 (CCI: from 0.241 to 0.009). The CC increasingly became close to the equality line through the survey period, indicating the increasingly narrow gap in child full immunization amongst the poor and the rich. Vietnam witnessed a sharp decrease in socioeconomic inequality in the full vaccination coverage for over a decade. The next policies towards children from vulnerable populations (ethnic minority groups, living in rural areas, and having a mother with low education) belonging to lower socioeconomic groups may mitigate socioeconomic inequalities in full vaccination coverage.

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    Vaccines
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      Vaccines
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    Authors: Ouédraogo, Korotimi; Dimobe, Kangbéni; Zerbo, Issouf; Etongo, Daniel; +2 Authors

    Abstract Background Traditional knowledge (TK) on the different uses of under-valued fruit tree species including Gardenia erubescens Stapf & Hutch.—a plant species of least concern (LC) based on International Union for Conservation of Nature (IUCN) classification yet considered threatened due to overharvesting by a National Assessment in addition to 59 other species in Burkina Faso. This study aimed to collect and synthesize information on traditional knowledge and cultural importance of G. erubescens. This information will contribute to document traditional knowledge systems that are fast eroding due to the lack of transmission of the knowledge and will also highlight G. erubescens as a priority species for conservation given that this species is widely used among householders in rural areas in Burkina Faso. Methods This study assesses TK on the uses and cultural importance (CI) of G. erubescens, among 514 randomly selected respondents across 15 villages bordering three community forest areas located in Eastern and Centre-Western Regions of Burkina Faso through face-to-face semi-structured interviews. Additionally, the uses and CI of G. erubescens were evaluated in relation to informant’s gender, ethnicity, generation, and location. Ethnobotanical indices (relative frequency of citation, relative use value, and CI) were computed using generalized linear models, Kruskal-Wallis, and Mann-Whitney tests. Results Results indicated 30 specific uses of G. erubescens of which food values recorded the highest uses as reported by 58.97% respondents followed by medicine (17.22%) with a very low 0.23% for magical uses. Food and medicinal uses were the most important for women while men valued more the species for constructions, cultural, and magical uses. The fruit is the most preferred and marketable part of the plant while the leaves, fruits, roots, leafy twigs, and bark are mainly harvested for pharmacopeia and psycho-magical problems. Conclusions Traditional knowledge on the uses of G. erubescens varied significantly in relation to gender, ethnicity, generations, and case study locations. Despite the importance of G. erubescens for food and other livelihood values, this specie is of LC to the IUCN; yet, a National Assessment considers it as threatened. The multiple uses of this specie based on TK systems for uses such as food, income, medicine, etc. is an indication that G. erubescens if sustainable managed could form an important safety net especially for rural households in Burkina Faso that are highly dependent on trees and forest resources.

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    Journal of Ethnobiology and Ethnomedicine
    Article . 2019 . Peer-reviewed
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      Journal of Ethnobiology and Ethnomedicine
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    Authors: Martin Banong-le; Samuel Kwabena Ofosu; Francis Anto;

    Background Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease affects all ages and both sexes but more prevalent among the sexually active age group of 15–49 years. The purpose of the current study was to determine the prevalence and factors associated with syphilis infection among outpatients 15–49 years in the Asikuma Odoben Brakwa District of Ghana where high levels of infection were earlier reported among antenatal women. Methods A descriptive cross-sectional study was carried out in 13 randomly selected health facilities. Blood samples were collected and tested for syphilis infection and a questionnaire administered to determine factors associated with the disease. Results A total 277 patients aged 15–49 years participated in the study. The overall prevalence of syphilis infection was 3.2% (9/277), with 5.7% (6/105) and 1.7% (3/172) among males and females respectively. Significant factors associated with syphilis infection included sub-district of residence, (χ2 (4) = 31.20, p < 0.001) and history of coerced sexual intercourse (χ2 (1) =7.49, p = 0.006). Conclusions The prevalence of syphilis infection was high among male patients who lived in rural areas. Having a history of coerced sexual intercourse was a strong predictor for syphilis infection. Access to sexually transmitted infection control interventions in rural communities including health education may help control the disease. Electronic supplementary material The online version of this article (10.1186/s12879-019-3967-6) contains supplementary material, which is available to authorized users.

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    BMC Infectious Diseases
    Article . 2019
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    BMC Infectious Diseases
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    BMC Infectious Diseases
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      BMC Infectious Diseases
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      BMC Infectious Diseases
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    Authors: Abu Hassan, Muhammad Radzi; Aziz, Norasmidar; Ismail, Noraini; Shafie, Zainab; +4 Authors

    Background Melioidosis, a fatal infectious disease caused by Burkholderia pseudomallei, is increasingly diagnosed in tropical regions. However, data on risk factors and the geographic epidemiology of the disease are still limited. Previous studies have also largely been based on the analysis of case series data. Here, we undertook a more definitive hospital-based matched case-control study coupled with spatial analysis to identify demographic, socioeconomic and landscape risk factors for bacteremic melioidosis in the Kedah region of northern Malaysia. Methodology/Principal findings We obtained patient demographic and residential information and clinical presentation and medical history data from 254 confirmed melioidosis cases and 384 matched controls attending Hospital Sultanah Bahiyah (HSB), the main tertiary hospital of Alor Setar, the capital city of Kedah, during the period between 2005 and 2011. Crude and adjusted odds ratios employing conditional logistic regression analysis were used to assess if melioidosis in this region is related to risk factors connected with socio-demographics, various behavioural characteristics, and co-occurring diseases. Spatial clusters of cases were determined using a continuous Poisson model as deployed in SaTScan. A land cover map in conjunction with mapped case data was used to determine disease-land type associations using the Fisher’s exact test deploying simulated p-values. Crude and adjusted odds ratios indicate that melioidosis in this region is related to gender (males), race, occupation (farming) and co-occurring chronic diseases, particularly diabetes. Spatial analyses of disease incidence, however, showed that disease risk and geographic clustering of cases are related strongly to land cover types, with risk of disease increasing non-linearly with the degree of human modification of the natural ecosystem. Conclusions/Significance These findings indicate that melioidosis represents a complex socio-ecological public health problem in Kedah, and that its control requires an understanding and modification of the coupled human and natural variables that govern disease transmission in endemic communities. Author summary Although the public health significance of melioidosis as a particularly highly fatal emerging infectious disease threat in the tropics is being recognized, data on the risk factors and the geographic distribution of the disease is still limited. Previous studies have also largely been based on the investigation of case series data. Here, we extend these studies by employing a hospital-based matched case-control study to carry out a more robust examination of the demographic, socioeconomic, and landscape risk factors that may govern melioidosis incidence in the Alor Setar area of Kedah, State, a key disease endemic region of Malaysia. Our results indicate that melioidosis in northern Malaysia is significantly associated with gender, race, occupation, co-occurring chronic disease as well as living in risky landscapes, with disease risk increasing and declining non-linearly with the degree of ecosystem modification. These findings denote that the disease represents a complex socio-ecological public health problem in Kedah, and that its control requires an understanding and modification of both the human and natural variables that underlie disease transmission in this setting.

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    PLoS Neglected Tropical Diseases
    Article . 2019 . Peer-reviewed
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    PLoS Neglected Tropical Diseases
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      PLoS Neglected Tropical Diseases
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    Authors: Jones, Harriet; Wringe, Alison; Todd, Jim; Songo, John; +8 Authors

    To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania.We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013-2016. Two survey rounds were conducted (2013-2015 and 2015-2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round.In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds.Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals.Évaluer la transposition des recommandations de l'Organisation mondiale de la Santé (OMS) dans les politiques nationales de prévention de la transmission mère-enfant (PTME) du virus de l'immunodéficience humaine (VIH) et contrôler l'application de ces politiques dans les centres de santé de zones rurales d'Afrique du Sud, du Malawi et de République-Unie de Tanzanie.Nous avons répertorié les politiques nationales de PTME et les recommandations de l'OMS pour 15 indicateurs, sur toute la chaîne de soins de santé de la mère et du nourrisson, sur la période comprise entre 2013 et 2016. Deux séries d'enquêtes ont été réalisées (2013-2015 et 2015-2016) dans 46 centres de santé au service des populations de cinq systèmes de surveillance démographique et de santé. Nous avons interrogé les responsables de ces centres à l'aide de questionnaires directifs afin d'obtenir une description de la prestation des soins. Nous avons calculé la proportion de centres ayant appliqué chaque indicateur ainsi que la fréquence et la durée des ruptures de stock de fournitures, pour chaque zone étudiée et chaque série d'enquêtes.En 2016, dans tous les pays étudiés, les lignes directrices de l'OMS avaient été prises en compte dans les politiques nationales relatives à la chaîne des soins de PTME du VIH; la plupart des différences constatées entre les politiques de ces différents pays concernaient la liaison avec les soins de routine contre le VIH. La proportion des centres offrant des conseils après dépistage, proposant de débuter une thérapie antirétrovirale (TAR) le jour même, fournissant dans un même endroit des soins prénataux et des TAR et appliquant l'Option B+ a augmenté ou est restée à 100% dans toutes les zones étudiées. Les progrès dans l'application des politiques en matière de diagnostic et de traitement du nourrisson ont été variables d'une zone à une autre. Les ruptures de stock de kits de dépistage du VIH ou de médicaments antirétroviraux au cours de l'année précédente ont généralement diminué, mais dans chaque zone, sur les deux périodes étudiées, au moins une structure a été confrontée à ce problème.Des progrès ont été faits dans l'application des politiques de PTME dans ces régions. Néanmoins, des manquements persistants dans la chaîne de soins de santé du nourrisson et les problèmes des chaînes d'approvisionnement risquent de compromettre l'atteinte des objectifs d'élimination du VIH chez le nourrisson.Evaluar la adopción de las directrices de la Organización Mundial de la Salud (OMS) en las políticas nacionales de prevención de la transmisión del virus de la inmunodeficiencia humana (VIH) de madre a hijo y supervisar la aplicación de las directrices a nivel de las instalaciones sanitarias en las zonas rurales de Malawi, la República Unida de Tanzanía y Sudáfrica.Resumimos las políticas nacionales de PTMI y las directrices de la OMS para 15 indicadores en toda la serie de servicios de atención maternoinfantil durante el período 2013-2016. Se realizaron dos rondas de encuestas (2013-2015 y 2015-2016) en 46 instalaciones sanitarias que atienden a cinco poblaciones del sistema de vigilancia sanitaria y demográfica. Se administraron cuestionarios estructurados a los gestores de las instalaciones para describir la prestación de servicios. Informamos las proporciones de las instalaciones que aplican cada indicador y la frecuencia y duración de la falta de existencias de suministros, por emplazamiento y ronda de encuestas.En todos los países, las políticas nacionales que influyen en la serie de servicios de atención maternoinfantil de la PTMI se ajustaron a las directrices de la OMS para 2016; la mayoría de las variaciones de las políticas entre países se referían a la vinculación con la atención habitual de la infección por el VIH. La proporción de instalaciones que ofrecen asesoramiento posterior a la prueba, iniciación de la terapia antirretrovírica en el mismo día, atención prenatal y suministro de terapia antirretrovírica en el mismo edificio, y la Opción B+ aumentaron o se mantuvieron en el 100 % en todos los emplazamientos. El progreso en la aplicación de las políticas de diagnóstico y tratamiento del lactante varió de un emplazamiento a otro. Las existencias de kits de pruebas del VIH o de medicamentos antirretrovirales se redujeron en general en el último año, pero en ambas rondas se informó de la existencia de al menos una instalación por emplazamiento.Se ha progresado en la aplicación de la política de PTMI en estos ámbitos. Sin embargo, las persistentes brechas en la serie de servicios de atención infantil y los desafíos de la cadena de suministro pueden socavar los objetivos de eliminación del VIH infantil.تقييم اعتماد منظمة الصحة العالمية (WHO) في السياسات الوطنية للوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) لفيروس نقص المناعة البشرية (HIV) ومراقبة تنفيذ المبادئ التوجيهية على مستوى المرافق في المناطق الريفية في جنوب أفريقيا وجمهورية تنزانيا المتحدة وملاوي.لقد قمنا بتلخيص السياسات الوطنية للوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) وتوجيهات منظمة الصحة العالمية من أجل 15 مؤشر عبر سلسلة أجهزة رعاية الأمومة والطفولة خلال الفترة ما بين 2013 و2016. أُجريت جولتا مسح (2013-2015 و2015-2016) في 46 مرفقاً صحياً يخدم خمسة مجتمعات نظام مراقبة صحية وديموغرافية. قمنا بإدارة استبيانات منظمة لمديري المرافق لوصف تقديم الخدمة. وقمنا بالإبلاغ عن نسب التسهيلات المطبقة لكل مؤشر وتكرار ومدد مخزون اللوازم حسب الموقع وجولة المسح.في جميع البلدان، اهتمت السياسات الوطنية التي تؤثر على سلسلة الرعاية للأمهات والرضع للوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) والمتوافقة مع المبادئ التوجيهية لمنظمة الصحة العالمية بحلول عام 2016؛ ومعظم التغيرات في السياسات بين البلدان أيضًا بالارتباط بالرعاية الروتينية لفيروس نقص المناعة البشرية (HIV). وارتفعت نسبة المرافق التي تقدم المشورة بعد الاختبار، والبدء في العلاج بمضادات الفيروسات الرجعية (ART) في نفس اليوم، والرعاية السابقة للولادة، وتوفير العلاج بمضادات الفيروسات الرجعية في نفس المبنى، والخيار ب + الذي زاد أو بقى بنسبة 100٪ في جميع المواقع. وقد تفاوت التقدم في تنفيذ السياسات المتعلقة بتشخيص الرضع وعلاجهم بين المواقع. كما انخفض مخزون مجموعات اختبار فيروس نقص المناعة البشرية (HIV) أو العقاقير المضادة للفيروسات الرجعية في العام الماضي بشكل عام، ولكن تم الإبلاغ عن ذلك من قبل مرفق واحد على الأقل لكل موقع في كلتا الجولتين.تم إحراز تقدم في تنفيذ سياسة الوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) في هذه الظروف. ومع ذلك، فإن الثغرات المستمرة عبر سلسلة رعاية الرضع وتحدّيات سلسلة التوريد تقوّض أهداف القضاء على فيروس نقص المناعة البشرية لدى الرضع.旨在评估将世界卫生组织 (WHO) 的指导方针纳入艾滋病毒 (HIV) 母婴传播预防 (PMTCT) 政策,并监测马拉维、南非和坦桑尼亚联合共和国的农村地区医疗机构层面指导方针的实施情况。.我们总结了国家艾滋病毒母婴传播预防政策和世界卫生组织指南自 2013-2016 年为孕产妇和婴儿护理联动提供的 15 项指标。在 2013 年至 2015 年和 2015 年至 2016 期间分别对 46 个医疗机构、服务于五大医疗和人口监控系统的人群进行了两轮调查。我们对机构管理者进行了结构式问卷调查,以描述服务的提供情况。我们根据地点和调查轮次,报告实施各项指标的机构比例以及缺货的频率和持续时间。.所有国家中,影响产妇和预防艾滋病毒母婴传播的国家政策应符合截至 2016 年的世界卫生组织的指导方针;大多数国家间政策的变化都与常规艾滋病毒护理有关。在同一栋楼内提供检测后咨询、当日启动抗逆转录病毒疗法 (ART)、产前护理并提供抗逆转录病毒疗法,以及在所有站点增加“Option B+”计划或保持 100% 覆盖。各站点在实施婴儿诊断和治疗政策方面的进展各不相同。过去一年,艾滋病毒检测试剂盒或抗逆转录病毒药物的缺货量整体下降,但在这两轮调查中,每个站点至少有一个机构存在缺货现象。.此类情况下,实施艾滋病毒母婴传播预防政策取得进展。然而,婴儿联动护理和供应链挑战之间的持续差距有可能破坏消除婴儿感染艾滋病毒的目标。.Оценка включения рекомендаций Всемирной организации здравоохранения (ВОЗ) в национальные стратегии профилактики передачи вируса иммунодефицита человека (ВИЧ) от матери ребенку (РМТСТ) и отслеживание внедрения таких рекомендаций на уровне объектов здравоохранения в сельских районах Малави, Объединенной Республики Танзания и Южной Африки.Авторы суммировали национальные стратегии в отношении PMTCT и рекомендации ВОЗ по 15 индикаторам в цепочке мероприятий по оказанию помощи матери и ребенку на протяжении 2013–2016 гг. Исследование проводилось в виде двух раундов опросов (2013–2015 гг. и 2015–2016 гг.) в 46 учреждениях здравоохранения, которые обслуживали пять популяций систем надзора за здоровьем и демографической ситуацией. Руководителям учреждения здравоохранения были выданы структурированные анкеты для описания оказания услуг. В статье приведены сведения о доле учреждений, внедривших каждый из индикаторов, а также о частоте и продолжительности случаев нехватки ресурсов с разбивкой по зонам оказания услуг и раунду опросов.Во всех странах национальные стратегии, влияющие на цепочку предоставления услуг в отношении материнского и детского РМТСТ, были приведены в соответствие с рекомендациями ВОЗ к 2016 г. Большинство вариантов стратегий в разных странах касались привязки к плановому лечению ВИЧ-инфицированных. Доля медицинских учреждений, предоставляющих возможность консультации после тестирования, начала антиретровирусной терапии (АРТ) в тот же день, дородового лечения и АРТ в том же здании, а также предоставляющих вариант В+, выросла или осталась на уровне 100% во всех обследованных зонах. Прогресс во внедрении стратегий диагностики и лечения младенцев различался в зависимости от зоны исследования. Дефицит тест-систем для выявления антител к ВИЧ или антиретровирусных препаратов за последний год в целом уменьшился, но сообщения о нехватке поступали по меньшей мере из одного учреждения в каждой зоне в течение обоих опросов.Наблюдается прогресс во внедрении стратегий PMTCT в указанных условиях. Однако постоянные недочеты в цепочке предоставления услуг младенцам и проблемы с поставками могут поставить под угрозу цели по устранению ВИЧ у младенцев.

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    Europe PubMed Central
    Other literature type . 2019
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    Bulletin of the World Health Organization
    Article . 2019 . Peer-reviewed
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      Europe PubMed Central
      Other literature type . 2019
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      Bulletin of the World Health Organization
      Article . 2019 . Peer-reviewed
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    Authors: Rabearisoa, Njaratiana; Sabarros, Philippe S.; Romanov, Evgeny V.; Lucas, Vincent; +1 Authors

    Depredation in marine ecosystems is defined as the damage or removal of fish or bait from fishing gear by predators. Depredation raises concerns about the conservation of species involved, fisheries yield and profitability, and reference points based on stock assessment of depredated species. Therefore, the development of accurate indicators to assess the impact of depredation is needed. Both the Reunion Island and the Seychelles archipelago pelagic longline fisheries targeting swordfish (Xiphias gladius) and tuna (Thunnus spp.) are affected by depredation from toothed whales and pelagic sharks. In this study, we used fishery data collected between 2004 and 2015 to propose depredation indicators and to assess depredation levels in both fisheries. For both fisheries, the interaction rate (depredation occurrence) was significantly higher for shark compared to toothed whale depredation. However, when depredation occurred, toothed whale depredation impact was significantly higher than shark depredation impact, with higher depredation per unit effort (number of fish depredated per 1000 hooks) and damage rate (proportion of fish depredated per depredated set). The gross depredation rate in the Seychelles was 18.3%. A slight increase of the gross depredation rate was observed for the Reunion Island longline fleet from 2011 (4.1% in 2007-2010 and 4.4% in 2011-2015). Economic losses due to depredation were estimated by using these indicators and published official statistics. A loss of 0.09 EUR/hook due to depredation was estimated for the Reunion Island longline fleet, and 0.86 EUR/hook for the Seychelles. These results suggest a southward decreasing toothed whale and shark depredation gradient in the southwest Indian Ocean. Seychelles depredation levels are among the highest observed in the world revealing this area as a "hotspot" of interaction between pelagic longline fisheries and toothed whales. This study also highlights the need for a set of depredation indicators to allow for a global comparison of depredation rates among various fishing grounds worldwide.

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    Horizon / Pleins textes
    Other literature type . 2018
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    PLoS ONE
    Article . 2018
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    DOAJ
    Article . 2018
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      Horizon / Pleins textes
      Other literature type . 2018
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      PLoS ONE
      Article . 2018
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    Authors: Mahmood, Mohammad Afzal; Halliday, Dale; Cumming, Robert; Thwin, Khin-Thida; +10 Authors

    Introduction The global incidence of snakebite is estimated at more than 2.5 million cases annually, with greater than 100,000 deaths. Historically, Myanmar has one of the highest incidences of venomous snakebites. In order to improve the health outcomes of snakebite patients in Myanmar, access to accurate snakebite incidence data is crucial. The last population-based study in Myanmar was conducted more than a decade ago. In 2014, the Ministry of Health and Sports data from health facilities indicated an incidence of about 29.5 bites/ 100,000 population/year (a total of 15,079 bites). Since data from health facilities lack information about those who do not seek health care from government health services, a new population-based survey was conducted in 2 rural areas of Mandalay region. The survey data were compared to those obtained from healthcare services. Method 4,276 rural respondents in Kyaukse and Madaya townships in Mandalay Division were recruited using cluster sampling that involved random selection of 150 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire. Results One respondent from each of 4,276 households represented 19,877 residents from 144 villages. 24 people in these households had suffered snakebite during the last one year giving an annual incidence of 116/100,000. During the last ten years, 252 people suffered snakebites. 44.1% of the victims were women. 14% of the villages reported 4 or more bites during the last ten years, whereas 27% villages reported no snakebites. 92.4% of the victims recovered fully, 5.4% died, and 2% suffered long term health issues. One victim was reported to have died from causes unrelated to the snakebite. While there was no statistically significant difference between outcomes for children and adults, 4 of 38 of those under 18 years of age died compared to 7 of 133 adults between 19 to 40 years of age. Conclusion This incidence reported by the community members points to substantially more snakebites than the number of snakebite patients attending health facilities. This higher incidence points to the need for a nation-wide population-based survey, community education about gaining access to care where antivenom is available, and to the potential need for a larger supply of antivenom and expansion of medical care in rural areas. Author summary Snakebite is a major health issue affecting large numbers of people, particularly in tropical developing countries. Myanmar has one of the highest incidences of venomous snakebite in the world. Considering changes in demography, development, agricultural practices, knowledge about prevention and preventive practices, regular and accurate assessment of incidence is needed in order to improve public health programs and health services provision to improve health outcomes for snakebite patients. For that purpose, we conducted a large population based survey in Mandalay, which is one of the seven high incidence regions in Myanmar. The survey indicated a substantially higher incidence of snakebites than that suggested by the number of snakebite victims attending health care centres and hospitals. This higher incidence of snakebite has implications for community health service planning, scale of production of antivenom, and the need to improve access to health care centres or hospitals where antivenom is available, and suggests a need for community health education regarding appropriate 1st aid.

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    PLoS Neglected Tropical Diseases
    Article . 2018 . Peer-reviewed
    License: CC BY
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    PLoS Neglected Tropical Diseases
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    Authors: Radfar, Amir; Asgharzadeh, Seyed Ahmad Ahmadi; Quesada, Fernando; Filip, Irina;

    Child labor is one of the oldest problems in our society and still an ongoing issue. During the time, child labor evolved from working in agriculture or small handicraft workshops to being forced into work in factories in the urban setting as a result of the industrial revolution. Children were very profitable assets since their pay was very low, were less likely to strike, and were easy to be manipulated. Socioeconomic disparities and lack of access to education are among others contributing to the child labor. Religious and cultural beliefs can be misguiding and concealing in delineating the limits of child labor. Child labor prevents physical, intellectual, and emotional development of children. To date, there is no international agreement to fully enforced child labor. This public health issue demands a multidisciplinary approach from the education of children and their families to development of comprehensive child labor laws and regulations.

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    Industrial Psychiatry Journal
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    Authors: Manuel Cardona; Cecilia E. Garcia Cena; Fernando E. Serrano; Roque Saltaren;

    Objective: In this article, we present the conceptual development of a robotics platform, called ALICE (Assistive Lower Limb Controlled Exoskeleton), for kinetic and kinematic gait characterization. The ALICE platform includes a robotics wearable exoskeleton and an on-board muscle driven simulator to estimate the user’s kinetic parameters. Background: Even when the kinematics patterns of the human gait are well studied and reported in the literature, there exists a considerable intra-subject variability in the kinetics of the movements. ALICE aims to be an advanced mechanical sensor that allows us to compute real-time information of both kinetic and kinematic data, opening up a new personalized rehabilitation concept. Methodology: We developed a full muscle driven simulator in an open source environment and validated it with real gait data obtained from patients diagnosed with multiple sclerosis. After that, we designed, modeled, and controlled a 6 DoF lower limb exoskeleton with inertial measurement units and a position/velocity sensor in each actuator. Significance: This novel concept aims to become a tool for improving the diagnosis of pathological gait and to design personalized robotics rehabilitation therapies. Conclusion: ALICE is the first robotics platform automatically adapted to the kinetic and kinematic gait parameters of each patient. Peer reviewed

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    Authors: Catharina Wesseling; Jason Glaser; Julieta Rodríguez-Guzmán; Ilana Weiss; +8 Authors

    The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.La mortalidad por la epidemia de enfermedad renal crónica de origen no tradicional (ERCnt) en Mesoamérica asciende a decenas de miles de personas, principalmente hombres jóvenes. No existe consenso sobre su etiología. En la década de 1990, informes anecdóticos apuntaban como factor de riesgo al trabajo en plantaciones de caña de azúcar; se consideró como posibles causantes a los plaguicidas y el estrés térmico. Estudios de prevalencia de base poblacional subsiguientes apoyaron un origen ocupacional, con una proporción elevada de hombres respecto de las mujeres en las tierras bajas donde el riesgo era elevado, pero con pequeñas diferencias de sexo dentro de las categorías ocupacionales y baja prevalencia en el ámbito no laboral. Se reportó ERCnt en los trabajadores de la caña de azúcar y otros cultivos con alta exigencia física y en ocupaciones no agrícolas que implican trabajo manual intenso en ambientes calurosos, pero no entre los agricultores de subsistencia. Estudios recientes con diseños más sólidos han demostrado cambios en la función renal y en los biomarcadores de hidratación en el curso de los turnos laborales, y disminución de la función renal relacionada con el calor y la carga de trabajo en el curso de la cosecha. La implementación de una intervención basada en la provisión de agua, descanso y sombra a mitad de la cosecha en El Salvador detuvo la disminución de la función renal en los cortadores de caña. En Nicaragua, un programa de provisión de agua, descanso y sombra evitó la lesión renal en los trabajadores de la caña con una carga de trabajo baja y moderada, pero no entre los cortadores, quienes tienen la mayor carga de trabajo. Los estudios sobre plaguicidas y factores de riesgo infecciosos han sido en gran medida negativos. Los factores de riesgo no ocupacionales no explican los patrones epidemiológicos observados. En conclusión, el trabajo es el principal desencadenante de la epidemia de ERCnt en Mesoamérica, y el estrés térmico ocupacional es el único factor que consistentemente conduce a la disfunción renal en las poblaciones afectadas. Los cortadores que trabajan en los ingenios azucareros y están expuestos a un estrés térmico extremo podrían ser considerados una población ocupacional centinela. La prevención del estrés térmico ocupacional es crítica, más aún si se consideran los efectos del cambio climático.A mortalidade devida à epidemia de doença renal crônica de origem não tradicional (DRCnt) na Mesoamérica atinge dezenas de milhares de pessoas, principalmente homens jovens. Não há consenso sobre a sua etiologia. Na década de 1990, informações empíricas apontavam o trabalho em plantações de cana de açúcar como um fator de risco; pesticidas e estresse térmico também eram considerados causas possíveis. As pesquisas populacionais subsequentes sustentam uma origem ocupacional da doença, com uma elevada proporção de homens quando comparados à de mulheres, em areas de baixa altitude, onde o risco da doença é mais elevado, mas com pequenas diferenças de gênero quando se consideram as categorias ocupacionais e baixa prevalência no ambiente não-ocupacional. A DRCnt foi identificada em trabalhadores agrícolas da cana de açúcar e de outras culturas que exigem trabalho físico de alta intensidade e em ocupações não agrícolas envolvendo um trabalho manual intenso em ambientes quentes, mas não entre os agricultores de subsistência. Estudos recentes com desenhos mais robustos demonstraram mudanças na função renal e nos biomarcadores de hidratação ao longo dos turnos de trabalho, e diminuição da função renal relacionada à exposição ao calor e à carga de trabalho ao longo da colheita. A implementação de uma intervenção de água-descanso-sombra durante a colheita em El Salvador interrompeu o declínio da função renal em cortadores de cana. Na Nicarágua, intervenções água-descanso-sombra parecem ter sido suficientes para evitar lesões renais em trabalhadores canavieiros com cargas de trabalho baixa e moderada, mas não entre os cortadores de cana que têm carga de trabalho mais pesada. Estudos sobre exposição a pesticidas e a fatores de risco de origem infecciosa têm sido largamente negativos. Os fatores de risco não-ocupacionais não explicam os padrões epidemiológicos observados. Em conclusão, ocupação é o principal desencadeador da epidemia de DRCnt na Mesoamérica, e o estresse térmico ocupacional é o único fator comprovado que leva à disfunção renal nas populações afetadas. Os cortadores de cana que trabalham em engenhos de açúcar e expostos a um estresse térmico extremo podem ser considerados uma população ocupacional sentinela. A prevenção do estresse térmico ocupacional é crítica, especialmente considerando os efeitos das mudanças climáticas.

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    Authors: Hoang-Long Vo; Le-Thai-Bao Huynh; Hao Nguyen Si Anh; Dang-An Do; +3 Authors

    There has been no report on the situation of socioeconomic inequalities in the full vaccination coverage among Vietnamese children. This study aims to assess the trends and changes in the socioeconomic inequalities in the full vaccination coverage among Vietnamese children aged 12–23 months from 2000 to 2014. Data were drawn from Multiple Indicator Cluster Surveys (2000, 2006, 2011, and 2014). Concentration index (CCI) and concentration curve (CC) were applied to quantify the degree of the socioeconomic inequalities in full immunization coverage. The prevalence of children fully receiving recommended vaccines was significantly improved during 2000–2014, yet, was still not being covered. The total CCI of full vaccination coverage gradually decreased from 2000 to 2014 (CCI: from 0.241 to 0.009). The CC increasingly became close to the equality line through the survey period, indicating the increasingly narrow gap in child full immunization amongst the poor and the rich. Vietnam witnessed a sharp decrease in socioeconomic inequality in the full vaccination coverage for over a decade. The next policies towards children from vulnerable populations (ethnic minority groups, living in rural areas, and having a mother with low education) belonging to lower socioeconomic groups may mitigate socioeconomic inequalities in full vaccination coverage.

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    Vaccines
    Other literature type . Article . 2019 . Peer-reviewed
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    Vaccines
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      Vaccines
      Other literature type . Article . 2019 . Peer-reviewed
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      Vaccines
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    Authors: Ouédraogo, Korotimi; Dimobe, Kangbéni; Zerbo, Issouf; Etongo, Daniel; +2 Authors

    Abstract Background Traditional knowledge (TK) on the different uses of under-valued fruit tree species including Gardenia erubescens Stapf & Hutch.—a plant species of least concern (LC) based on International Union for Conservation of Nature (IUCN) classification yet considered threatened due to overharvesting by a National Assessment in addition to 59 other species in Burkina Faso. This study aimed to collect and synthesize information on traditional knowledge and cultural importance of G. erubescens. This information will contribute to document traditional knowledge systems that are fast eroding due to the lack of transmission of the knowledge and will also highlight G. erubescens as a priority species for conservation given that this species is widely used among householders in rural areas in Burkina Faso. Methods This study assesses TK on the uses and cultural importance (CI) of G. erubescens, among 514 randomly selected respondents across 15 villages bordering three community forest areas located in Eastern and Centre-Western Regions of Burkina Faso through face-to-face semi-structured interviews. Additionally, the uses and CI of G. erubescens were evaluated in relation to informant’s gender, ethnicity, generation, and location. Ethnobotanical indices (relative frequency of citation, relative use value, and CI) were computed using generalized linear models, Kruskal-Wallis, and Mann-Whitney tests. Results Results indicated 30 specific uses of G. erubescens of which food values recorded the highest uses as reported by 58.97% respondents followed by medicine (17.22%) with a very low 0.23% for magical uses. Food and medicinal uses were the most important for women while men valued more the species for constructions, cultural, and magical uses. The fruit is the most preferred and marketable part of the plant while the leaves, fruits, roots, leafy twigs, and bark are mainly harvested for pharmacopeia and psycho-magical problems. Conclusions Traditional knowledge on the uses of G. erubescens varied significantly in relation to gender, ethnicity, generations, and case study locations. Despite the importance of G. erubescens for food and other livelihood values, this specie is of LC to the IUCN; yet, a National Assessment considers it as threatened. The multiple uses of this specie based on TK systems for uses such as food, income, medicine, etc. is an indication that G. erubescens if sustainable managed could form an important safety net especially for rural households in Burkina Faso that are highly dependent on trees and forest resources.

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    Journal of Ethnobiology and Ethnomedicine
    Article . 2019 . Peer-reviewed
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      Journal of Ethnobiology and Ethnomedicine
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    Authors: Martin Banong-le; Samuel Kwabena Ofosu; Francis Anto;

    Background Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. The disease affects all ages and both sexes but more prevalent among the sexually active age group of 15–49 years. The purpose of the current study was to determine the prevalence and factors associated with syphilis infection among outpatients 15–49 years in the Asikuma Odoben Brakwa District of Ghana where high levels of infection were earlier reported among antenatal women. Methods A descriptive cross-sectional study was carried out in 13 randomly selected health facilities. Blood samples were collected and tested for syphilis infection and a questionnaire administered to determine factors associated with the disease. Results A total 277 patients aged 15–49 years participated in the study. The overall prevalence of syphilis infection was 3.2% (9/277), with 5.7% (6/105) and 1.7% (3/172) among males and females respectively. Significant factors associated with syphilis infection included sub-district of residence, (χ2 (4) = 31.20, p < 0.001) and history of coerced sexual intercourse (χ2 (1) =7.49, p = 0.006). Conclusions The prevalence of syphilis infection was high among male patients who lived in rural areas. Having a history of coerced sexual intercourse was a strong predictor for syphilis infection. Access to sexually transmitted infection control interventions in rural communities including health education may help control the disease. Electronic supplementary material The online version of this article (10.1186/s12879-019-3967-6) contains supplementary material, which is available to authorized users.

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    BMC Infectious Diseases
    Article . 2019
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    BMC Infectious Diseases
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    BMC Infectious Diseases
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      BMC Infectious Diseases
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      BMC Infectious Diseases
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    Authors: Abu Hassan, Muhammad Radzi; Aziz, Norasmidar; Ismail, Noraini; Shafie, Zainab; +4 Authors

    Background Melioidosis, a fatal infectious disease caused by Burkholderia pseudomallei, is increasingly diagnosed in tropical regions. However, data on risk factors and the geographic epidemiology of the disease are still limited. Previous studies have also largely been based on the analysis of case series data. Here, we undertook a more definitive hospital-based matched case-control study coupled with spatial analysis to identify demographic, socioeconomic and landscape risk factors for bacteremic melioidosis in the Kedah region of northern Malaysia. Methodology/Principal findings We obtained patient demographic and residential information and clinical presentation and medical history data from 254 confirmed melioidosis cases and 384 matched controls attending Hospital Sultanah Bahiyah (HSB), the main tertiary hospital of Alor Setar, the capital city of Kedah, during the period between 2005 and 2011. Crude and adjusted odds ratios employing conditional logistic regression analysis were used to assess if melioidosis in this region is related to risk factors connected with socio-demographics, various behavioural characteristics, and co-occurring diseases. Spatial clusters of cases were determined using a continuous Poisson model as deployed in SaTScan. A land cover map in conjunction with mapped case data was used to determine disease-land type associations using the Fisher’s exact test deploying simulated p-values. Crude and adjusted odds ratios indicate that melioidosis in this region is related to gender (males), race, occupation (farming) and co-occurring chronic diseases, particularly diabetes. Spatial analyses of disease incidence, however, showed that disease risk and geographic clustering of cases are related strongly to land cover types, with risk of disease increasing non-linearly with the degree of human modification of the natural ecosystem. Conclusions/Significance These findings indicate that melioidosis represents a complex socio-ecological public health problem in Kedah, and that its control requires an understanding and modification of the coupled human and natural variables that govern disease transmission in endemic communities. Author summary Although the public health significance of melioidosis as a particularly highly fatal emerging infectious disease threat in the tropics is being recognized, data on the risk factors and the geographic distribution of the disease is still limited. Previous studies have also largely been based on the investigation of case series data. Here, we extend these studies by employing a hospital-based matched case-control study to carry out a more robust examination of the demographic, socioeconomic, and landscape risk factors that may govern melioidosis incidence in the Alor Setar area of Kedah, State, a key disease endemic region of Malaysia. Our results indicate that melioidosis in northern Malaysia is significantly associated with gender, race, occupation, co-occurring chronic disease as well as living in risky landscapes, with disease risk increasing and declining non-linearly with the degree of ecosystem modification. These findings denote that the disease represents a complex socio-ecological public health problem in Kedah, and that its control requires an understanding and modification of both the human and natural variables that underlie disease transmission in this setting.

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    PLoS Neglected Tropical Diseases
    Article . 2019 . Peer-reviewed
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      PLoS Neglected Tropical Diseases
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      PLoS Neglected Tropical Diseases
      Article
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      Article . 2019
      Data sources: DOAJ
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    Authors: Jones, Harriet; Wringe, Alison; Todd, Jim; Songo, John; +8 Authors

    To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania.We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013-2016. Two survey rounds were conducted (2013-2015 and 2015-2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round.In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds.Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals.Évaluer la transposition des recommandations de l'Organisation mondiale de la Santé (OMS) dans les politiques nationales de prévention de la transmission mère-enfant (PTME) du virus de l'immunodéficience humaine (VIH) et contrôler l'application de ces politiques dans les centres de santé de zones rurales d'Afrique du Sud, du Malawi et de République-Unie de Tanzanie.Nous avons répertorié les politiques nationales de PTME et les recommandations de l'OMS pour 15 indicateurs, sur toute la chaîne de soins de santé de la mère et du nourrisson, sur la période comprise entre 2013 et 2016. Deux séries d'enquêtes ont été réalisées (2013-2015 et 2015-2016) dans 46 centres de santé au service des populations de cinq systèmes de surveillance démographique et de santé. Nous avons interrogé les responsables de ces centres à l'aide de questionnaires directifs afin d'obtenir une description de la prestation des soins. Nous avons calculé la proportion de centres ayant appliqué chaque indicateur ainsi que la fréquence et la durée des ruptures de stock de fournitures, pour chaque zone étudiée et chaque série d'enquêtes.En 2016, dans tous les pays étudiés, les lignes directrices de l'OMS avaient été prises en compte dans les politiques nationales relatives à la chaîne des soins de PTME du VIH; la plupart des différences constatées entre les politiques de ces différents pays concernaient la liaison avec les soins de routine contre le VIH. La proportion des centres offrant des conseils après dépistage, proposant de débuter une thérapie antirétrovirale (TAR) le jour même, fournissant dans un même endroit des soins prénataux et des TAR et appliquant l'Option B+ a augmenté ou est restée à 100% dans toutes les zones étudiées. Les progrès dans l'application des politiques en matière de diagnostic et de traitement du nourrisson ont été variables d'une zone à une autre. Les ruptures de stock de kits de dépistage du VIH ou de médicaments antirétroviraux au cours de l'année précédente ont généralement diminué, mais dans chaque zone, sur les deux périodes étudiées, au moins une structure a été confrontée à ce problème.Des progrès ont été faits dans l'application des politiques de PTME dans ces régions. Néanmoins, des manquements persistants dans la chaîne de soins de santé du nourrisson et les problèmes des chaînes d'approvisionnement risquent de compromettre l'atteinte des objectifs d'élimination du VIH chez le nourrisson.Evaluar la adopción de las directrices de la Organización Mundial de la Salud (OMS) en las políticas nacionales de prevención de la transmisión del virus de la inmunodeficiencia humana (VIH) de madre a hijo y supervisar la aplicación de las directrices a nivel de las instalaciones sanitarias en las zonas rurales de Malawi, la República Unida de Tanzanía y Sudáfrica.Resumimos las políticas nacionales de PTMI y las directrices de la OMS para 15 indicadores en toda la serie de servicios de atención maternoinfantil durante el período 2013-2016. Se realizaron dos rondas de encuestas (2013-2015 y 2015-2016) en 46 instalaciones sanitarias que atienden a cinco poblaciones del sistema de vigilancia sanitaria y demográfica. Se administraron cuestionarios estructurados a los gestores de las instalaciones para describir la prestación de servicios. Informamos las proporciones de las instalaciones que aplican cada indicador y la frecuencia y duración de la falta de existencias de suministros, por emplazamiento y ronda de encuestas.En todos los países, las políticas nacionales que influyen en la serie de servicios de atención maternoinfantil de la PTMI se ajustaron a las directrices de la OMS para 2016; la mayoría de las variaciones de las políticas entre países se referían a la vinculación con la atención habitual de la infección por el VIH. La proporción de instalaciones que ofrecen asesoramiento posterior a la prueba, iniciación de la terapia antirretrovírica en el mismo día, atención prenatal y suministro de terapia antirretrovírica en el mismo edificio, y la Opción B+ aumentaron o se mantuvieron en el 100 % en todos los emplazamientos. El progreso en la aplicación de las políticas de diagnóstico y tratamiento del lactante varió de un emplazamiento a otro. Las existencias de kits de pruebas del VIH o de medicamentos antirretrovirales se redujeron en general en el último año, pero en ambas rondas se informó de la existencia de al menos una instalación por emplazamiento.Se ha progresado en la aplicación de la política de PTMI en estos ámbitos. Sin embargo, las persistentes brechas en la serie de servicios de atención infantil y los desafíos de la cadena de suministro pueden socavar los objetivos de eliminación del VIH infantil.تقييم اعتماد منظمة الصحة العالمية (WHO) في السياسات الوطنية للوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) لفيروس نقص المناعة البشرية (HIV) ومراقبة تنفيذ المبادئ التوجيهية على مستوى المرافق في المناطق الريفية في جنوب أفريقيا وجمهورية تنزانيا المتحدة وملاوي.لقد قمنا بتلخيص السياسات الوطنية للوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) وتوجيهات منظمة الصحة العالمية من أجل 15 مؤشر عبر سلسلة أجهزة رعاية الأمومة والطفولة خلال الفترة ما بين 2013 و2016. أُجريت جولتا مسح (2013-2015 و2015-2016) في 46 مرفقاً صحياً يخدم خمسة مجتمعات نظام مراقبة صحية وديموغرافية. قمنا بإدارة استبيانات منظمة لمديري المرافق لوصف تقديم الخدمة. وقمنا بالإبلاغ عن نسب التسهيلات المطبقة لكل مؤشر وتكرار ومدد مخزون اللوازم حسب الموقع وجولة المسح.في جميع البلدان، اهتمت السياسات الوطنية التي تؤثر على سلسلة الرعاية للأمهات والرضع للوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) والمتوافقة مع المبادئ التوجيهية لمنظمة الصحة العالمية بحلول عام 2016؛ ومعظم التغيرات في السياسات بين البلدان أيضًا بالارتباط بالرعاية الروتينية لفيروس نقص المناعة البشرية (HIV). وارتفعت نسبة المرافق التي تقدم المشورة بعد الاختبار، والبدء في العلاج بمضادات الفيروسات الرجعية (ART) في نفس اليوم، والرعاية السابقة للولادة، وتوفير العلاج بمضادات الفيروسات الرجعية في نفس المبنى، والخيار ب + الذي زاد أو بقى بنسبة 100٪ في جميع المواقع. وقد تفاوت التقدم في تنفيذ السياسات المتعلقة بتشخيص الرضع وعلاجهم بين المواقع. كما انخفض مخزون مجموعات اختبار فيروس نقص المناعة البشرية (HIV) أو العقاقير المضادة للفيروسات الرجعية في العام الماضي بشكل عام، ولكن تم الإبلاغ عن ذلك من قبل مرفق واحد على الأقل لكل موقع في كلتا الجولتين.تم إحراز تقدم في تنفيذ سياسة الوقاية من انتقال العدوى من الأم إلى الطفل (PMTCT) في هذه الظروف. ومع ذلك، فإن الثغرات المستمرة عبر سلسلة رعاية الرضع وتحدّيات سلسلة التوريد تقوّض أهداف القضاء على فيروس نقص المناعة البشرية لدى الرضع.旨在评估将世界卫生组织 (WHO) 的指导方针纳入艾滋病毒 (HIV) 母婴传播预防 (PMTCT) 政策,并监测马拉维、南非和坦桑尼亚联合共和国的农村地区医疗机构层面指导方针的实施情况。.我们总结了国家艾滋病毒母婴传播预防政策和世界卫生组织指南自 2013-2016 年为孕产妇和婴儿护理联动提供的 15 项指标。在 2013 年至 2015 年和 2015 年至 2016 期间分别对 46 个医疗机构、服务于五大医疗和人口监控系统的人群进行了两轮调查。我们对机构管理者进行了结构式问卷调查,以描述服务的提供情况。我们根据地点和调查轮次,报告实施各项指标的机构比例以及缺货的频率和持续时间。.所有国家中,影响产妇和预防艾滋病毒母婴传播的国家政策应符合截至 2016 年的世界卫生组织的指导方针;大多数国家间政策的变化都与常规艾滋病毒护理有关。在同一栋楼内提供检测后咨询、当日启动抗逆转录病毒疗法 (ART)、产前护理并提供抗逆转录病毒疗法,以及在所有站点增加“Option B+”计划或保持 100% 覆盖。各站点在实施婴儿诊断和治疗政策方面的进展各不相同。过去一年,艾滋病毒检测试剂盒或抗逆转录病毒药物的缺货量整体下降,但在这两轮调查中,每个站点至少有一个机构存在缺货现象。.此类情况下,实施艾滋病毒母婴传播预防政策取得进展。然而,婴儿联动护理和供应链挑战之间的持续差距有可能破坏消除婴儿感染艾滋病毒的目标。.Оценка включения рекомендаций Всемирной организации здравоохранения (ВОЗ) в национальные стратегии профилактики передачи вируса иммунодефицита человека (ВИЧ) от матери ребенку (РМТСТ) и отслеживание внедрения таких рекомендаций на уровне объектов здравоохранения в сельских районах Малави, Объединенной Республики Танзания и Южной Африки.Авторы суммировали национальные стратегии в отношении PMTCT и рекомендации ВОЗ по 15 индикаторам в цепочке мероприятий по оказанию помощи матери и ребенку на протяжении 2013–2016 гг. Исследование проводилось в виде двух раундов опросов (2013–2015 гг. и 2015–2016 гг.) в 46 учреждениях здравоохранения, которые обслуживали пять популяций систем надзора за здоровьем и демографической ситуацией. Руководителям учреждения здравоохранения были выданы структурированные анкеты для описания оказания услуг. В статье приведены сведения о доле учреждений, внедривших каждый из индикаторов, а также о частоте и продолжительности случаев нехватки ресурсов с разбивкой по зонам оказания услуг и раунду опросов.Во всех странах национальные стратегии, влияющие на цепочку предоставления услуг в отношении материнского и детского РМТСТ, были приведены в соответствие с рекомендациями ВОЗ к 2016 г. Большинство вариантов стратегий в разных странах касались привязки к плановому лечению ВИЧ-инфицированных. Доля медицинских учреждений, предоставляющих возможность консультации после тестирования, начала антиретровирусной терапии (АРТ) в тот же день, дородового лечения и АРТ в том же здании, а также предоставляющих вариант В+, выросла или осталась на уровне 100% во всех обследованных зонах. Прогресс во внедрении стратегий диагностики и лечения младенцев различался в зависимости от зоны исследования. Дефицит тест-систем для выявления антител к ВИЧ или антиретровирусных препаратов за последний год в целом уменьшился, но сообщения о нехватке поступали по меньшей мере из одного учреждения в каждой зоне в течение обоих опросов.Наблюдается прогресс во внедрении стратегий PMTCT в указанных условиях. Однако постоянные недочеты в цепочке предоставления услуг младенцам и проблемы с поставками могут поставить под угрозу цели по устранению ВИЧ у младенцев.

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    Europe PubMed Central
    Other literature type . 2019
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    Bulletin of the World Health Organization
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      Bulletin of the World Health Organization
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    Authors: Rabearisoa, Njaratiana; Sabarros, Philippe S.; Romanov, Evgeny V.; Lucas, Vincent; +1 Authors

    Depredation in marine ecosystems is defined as the damage or removal of fish or bait from fishing gear by predators. Depredation raises concerns about the conservation of species involved, fisheries yield and profitability, and reference points based on stock assessment of depredated species. Therefore, the development of accurate indicators to assess the impact of depredation is needed. Both the Reunion Island and the Seychelles archipelago pelagic longline fisheries targeting swordfish (Xiphias gladius) and tuna (Thunnus spp.) are affected by depredation from toothed whales and pelagic sharks. In this study, we used fishery data collected between 2004 and 2015 to propose depredation indicators and to assess depredation levels in both fisheries. For both fisheries, the interaction rate (depredation occurrence) was significantly higher for shark compared to toothed whale depredation. However, when depredation occurred, toothed whale depredation impact was significantly higher than shark depredation impact, with higher depredation per unit effort (number of fish depredated per 1000 hooks) and damage rate (proportion of fish depredated per depredated set). The gross depredation rate in the Seychelles was 18.3%. A slight increase of the gross depredation rate was observed for the Reunion Island longline fleet from 2011 (4.1% in 2007-2010 and 4.4% in 2011-2015). Economic losses due to depredation were estimated by using these indicators and published official statistics. A loss of 0.09 EUR/hook due to depredation was estimated for the Reunion Island longline fleet, and 0.86 EUR/hook for the Seychelles. These results suggest a southward decreasing toothed whale and shark depredation gradient in the southwest Indian Ocean. Seychelles depredation levels are among the highest observed in the world revealing this area as a "hotspot" of interaction between pelagic longline fisheries and toothed whales. This study also highlights the need for a set of depredation indicators to allow for a global comparison of depredation rates among various fishing grounds worldwide.

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    Horizon / Pleins textes
    Other literature type . 2018
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    PLoS ONE
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      Horizon / Pleins textes
      Other literature type . 2018
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      PLoS ONE
      Article . 2018
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    Authors: Mahmood, Mohammad Afzal; Halliday, Dale; Cumming, Robert; Thwin, Khin-Thida; +10 Authors

    Introduction The global incidence of snakebite is estimated at more than 2.5 million cases annually, with greater than 100,000 deaths. Historically, Myanmar has one of the highest incidences of venomous snakebites. In order to improve the health outcomes of snakebite patients in Myanmar, access to accurate snakebite incidence data is crucial. The last population-based study in Myanmar was conducted more than a decade ago. In 2014, the Ministry of Health and Sports data from health facilities indicated an incidence of about 29.5 bites/ 100,000 population/year (a total of 15,079 bites). Since data from health facilities lack information about those who do not seek health care from government health services, a new population-based survey was conducted in 2 rural areas of Mandalay region. The survey data were compared to those obtained from healthcare services. Method 4,276 rural respondents in Kyaukse and Madaya townships in Mandalay Division were recruited using cluster sampling that involved random selection of 150 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire. Results One respondent from each of 4,276 households represented 19,877 residents from 144 villages. 24 people in these households had suffered snakebite during the last one year giving an annual incidence of 116/100,000. During the last ten years, 252 people suffered snakebites. 44.1% of the victims were women. 14% of the villages reported 4 or more bites during the last ten years, whereas 27% villages reported no snakebites. 92.4% of the victims recovered fully, 5.4% died, and 2% suffered long term health issues. One victim was reported to have died from causes unrelated to the snakebite. While there was no statistically significant difference between outcomes for children and adults, 4 of 38 of those under 18 years of age died compared to 7 of 133 adults between 19 to 40 years of age. Conclusion This incidence reported by the community members points to substantially more snakebites than the number of snakebite patients attending health facilities. This higher incidence points to the need for a nation-wide population-based survey, community education about gaining access to care where antivenom is available, and to the potential need for a larger supply of antivenom and expansion of medical care in rural areas. Author summary Snakebite is a major health issue affecting large numbers of people, particularly in tropical developing countries. Myanmar has one of the highest incidences of venomous snakebite in the world. Considering changes in demography, development, agricultural practices, knowledge about prevention and preventive practices, regular and accurate assessment of incidence is needed in order to improve public health programs and health services provision to improve health outcomes for snakebite patients. For that purpose, we conducted a large population based survey in Mandalay, which is one of the seven high incidence regions in Myanmar. The survey indicated a substantially higher incidence of snakebites than that suggested by the number of snakebite victims attending health care centres and hospitals. This higher incidence of snakebite has implications for community health service planning, scale of production of antivenom, and the need to improve access to health care centres or hospitals where antivenom is available, and suggests a need for community health education regarding appropriate 1st aid.

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    PLoS Neglected Tropical Diseases
    Article . 2018 . Peer-reviewed
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    PLoS Neglected Tropical Diseases
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    Article . 2018
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      PLoS Neglected Tropical Diseases
      Article . 2018 . Peer-reviewed
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      PLoS Neglected Tropical Diseases
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    Authors: Radfar, Amir; Asgharzadeh, Seyed Ahmad Ahmadi; Quesada, Fernando; Filip, Irina;

    Child labor is one of the oldest problems in our society and still an ongoing issue. During the time, child labor evolved from working in agriculture or small handicraft workshops to being forced into work in factories in the urban setting as a result of the industrial revolution. Children were very profitable assets since their pay was very low, were less likely to strike, and were easy to be manipulated. Socioeconomic disparities and lack of access to education are among others contributing to the child labor. Religious and cultural beliefs can be misguiding and concealing in delineating the limits of child labor. Child labor prevents physical, intellectual, and emotional development of children. To date, there is no international agreement to fully enforced child labor. This public health issue demands a multidisciplinary approach from the education of children and their families to development of comprehensive child labor laws and regulations.

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    Industrial Psychiatry Journal
    Article . 2018 . Peer-reviewed
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      Industrial Psychiatry Journal
      Article . 2018 . Peer-reviewed
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