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PubMed2006

Educating African pastors on mother-to-child transmission of HIV/AIDS.

PURPOSE: To educate pastors of the Assemblies of God in Burkina Faso concerning HIV/AIDS and mother-to-child transmission (MTCT). DESIGN: A pretest-posttest design was used with a convenience sample of 102 pastors attending the educational program on HIV/AIDS and MTCT in January, February, and March of 2005. The educational program was implemented in local Bible colleges in Ouagadougou, Burkina Faso. METHODS: Participants attended an 18-hour program on HIV/AIDS and MTCT. A picture booklet was designed and used to help explain the prevention of MTCT of HIV The pretest-posttest examination and follow-up evaluation were designed for this project. FINDINGS: Results of the pretest showed minimal knowledge of pastors regarding HIV/AIDS. The median composite scores on the knowledge questions increased from 16% on the pretest to 92% on the posttest. Within the 3-month follow-up period, 34 follow-up evaluations were received. Although all the responding pastors had recommended testing for expectant mothers, only 13 had discussed MTCT in their churches or communities. CONCLUSIONS: The educational program was effective in increasing the pastors' knowledge of HIV/AIDS and MTCT. Further research is needed to identify barriers to full utilization of that knowledge.

Adolescent↗

PubMed2003

The TB epidemic from 1992 to 2002.

In 1992, less than 20 countries were implementing a sound TB control strategy. At the same time, TB was being resurrected as a major public health problem world-wide after two decades of neglect. Awareness of upward trends in the industrialized countries and MDR-TB outbreaks in large cities were driving forces behind the re-emergence of TB in the international health agenda. New evidence, and consequent estimates, suggested that the situation in developing countries, especially in sub-Saharan Africa, was deteriorating rapidly. Similarly, major increases were observed in the former USSR. It was estimated that some 7-8 million new cases and 2-3 million deaths were occurring annually in the world. The global targets of reaching 85% cure rates and 70% case detection among infectious cases were established by the World Health Assembly in 1991. Both the WHO declaration of TB as a global emergency in 1993 and the launch of the five-element DOTS strategy in 1994-1995 resulted in countries adopting DOTS in encouraging numbers. In fact, in 2000, 148 countries including all 22 highest burden countries (HBC) responsible for 80% of cases world-wide, had adopted the new DOTS strategy. Nevertheless, progress in case detection remained slow due to incomplete geographical coverage or need to widen detection and notification capacity with innovative schemes. The major constraints to TB control became increasingly clear, and a global Stop TB Partnership was eventually established to address such constraints. A Global DOTS Expansion Plan revealed the needs and the gaps to achieve the global targets in 2005. Today, in 2002, the top priority remains that of expanding DOTS, as rapidly as possible, using a number of new approaches to increase case detection and notification while maintaining high cure rates. These must involve collaboration with the private sector and communities, as well as strengthening of primary care services. Similarly, crucial is the rapid identification of solutions to TB/HIV and MDR-TB.

Developing Countries↗

PubMed1991

Origins of the Human Genome Project.

The Human Genome Project has become a reality. Building on a debate that dates back to 1985, several genome projects are now in full stride around the world, and more are likely to form in the next several years. Italy began its genome program in 1987, and the United Kingdom and U.S.S.R. in 1988. The European communities mounted several genome projects on yeast, bacteria, Drosophila, and Arabidospis thaliana (a rapidly growing plant with a small genome) in 1988, and in 1990 commenced a new 2-year program on the human genome. In the United States, we have completed the first year of operation of the National Center for Human Genome Research at the National Institutes of Health (NIH), now the largest single funding source for genome research in the world. There have been dedicated budgets focused on genome-scale research at NIH, the U.S. Department of Energy, and the Howard Hughes Medical Institute for several years, and results are beginning to accumulate. There were three annual meetings on genome mapping and sequencing at Cold Spring Harbor, New York, in the spring of 1988, 1989, and 1990; the talks have shifted from a discussion about how to approach problems to presenting results from experiments already performed. We have finally begun to work rather than merely talk. The purpose of genome projects is to assemble data on the structure of DNA in human chromosomes and those of other organisms. A second goal is to develop new technologies to perform mapping and sequencing. There have been impressive technical advances in the past 5 years since the debate about the human genome project began. We are on the verge of beginning pilot projects to test several approaches to sequencing long stretches of DNA, using both automation and manual methods. Ordered sets of yeast artificial chromosome and cosmid clones have been assembled to span more than 2 million base pairs of several human chromosomes, and a region of 10 million base pairs has been assembled for Caenorhabditis elegans by a collaboration between Washington University and the Medical Research Council laboratory in Cambridge, U.K. This project is now turning to sequencing C. elegans DNA as a logical extension of this work. These are but the first fruits of the genome project. There is much more to come.

Europe↗

PubMed1995

Developing national health information in Australia.

Two significant developments in the past two years have given impetus to development of health information in Australia. In March 1993, the former National Minimum Data Set was revised and published as the National Health Data Dictionary. Second, establishment of an agreement in June 1993, between the Commonwealth and State/Territory government health authorities, the Australian Bureau of Statistics, and the Australian Institute of Health and Welfare initiated a process of working cooperatively to develop national health information. Australia, like many other countries, suffers from inconsistent health data definitions, lack of timely data, poor data quality, gaps in data coverage, and barriers to accessing the data. The National Health Information Agreement [1] came into effect on June 1, 1993 and seeks to provide a national framework and processes to improve national health information, that is, information on health of the population; determinants of the population's health; provision and utilization of health promotion and disease prevention programs and health services including: outcomes and outputs, resource use and costs, access by and distribution to population groups; relationships between these elements; and the language necessary to facilitate provision of services and collection of national health information. The major implementation mechanism of the Agreement is a rolling three-year National Health Information Work Program of national health information activities. The activities range from development work on standard hospital charts of accounts, on health outcome measures, and on new collections such as outpatients to improved definitions and the enhancement of existing collections such as mental health and vital statistics. The Work Program is published annually. A first priority is to improve the data collections available. This is being achieved through the setting of national data definitions and standards. The Agreement recognizes the National Health Data Dictionary (NHDD) as the authoritative set of national definitions and is a significant initiative aimed at improving Australia's health information. The dictionary is the repository of the agreed common language, use of the definitions facilities the description and comparison of health and health services nationally [2]. The National Health Data Dictionary currently covers institutionally provided health care, the national health labor force, and is expanding to cover other major areas, including outpatient services, community care, and mental health. The NHDD is reviewed and maintained by the National Health Data Committee and the overall coordination of definition development projects and publication is undertaken by the Institute. The placement of an agreed definition in the NHDD does not automatically mean that it has a place in a national data collection. The use of the dictionary definition will allow comparison by and between service providers. In order for a data item to be eligible for inclusion in a national minimum data set, the definition of that item must be contained in the NHDD. During the first three months of 1995, the Australian Institute of Health and Welfare will conduct a national project to develop a model for the health system in Australia. The model will provide a common vocabulary and information architecture in order to facilitate better quality health information, and consequently better health for Australians. It is expected that the development of the model will bring several benefits including facilitating the more rapid and accurate assembly of appropriate clinical information to support improved customer service and outcomes, provide a mechanism for achieving better quality information, reduce the costs of data collection; provide enabling mechanisms for the integration of systems via data standards and reduce the costs of acquiring information systems through reduced development and tailoring costs for suppliers. (abst

Australia↗

PubMed2026

Convergence and global molecular epidemiology of Klebsiella pneumoniae plasmids harbouring the iuc3 virulence locus: a population genomic analysis.

BACKGROUND: Klebsiella pneumoniae is an important pathogen of humans and animals. In the past five years, increasing reports of convergent strains that carry both virulence factors and antimicrobial resistance genes (ARGs) have raised serious public health concerns. The aim of this study is to describe the global diversity of plasmids carrying iuc3 (a key virulence factor in K pneumoniae associated with pigs and clinical isolates) from diverse settings, and their role in the emergence of convergent strains through hybridisation with plasmids carrying ARGs. METHODS: This population genomic analysis study was designed to describe both the global and local diversity of iuc3-carrying plasmids from diverse sources, and the co-occurrence of iuc3 with ARGs. We used all 4148 Klebsiella spp isolates from two large One-Health studies (SpARK, Italy, and OH-DART, Thailand), including 191 Klebsiella isolates from pigs, 635 from clinical isolates, 1040 from hospital and community carriage, and 2282 from other sources. Short-read sequencing of Klebsiella isolates was performed as part of the SpARK study. We sequenced Klebsiella isolates from the OH-DART (MicrobesNG, Birmingham, UK; HiSeq and NovaSeq, Illumina San Diego, CA, USA; GridION, Oxford Nanopore Technologies, Oxford, UK) and SpARK (MinION or GridION, Oxford Nanopore Technologies, Oxford, UK) studies. We also retrieved plasmid sequences carrying iuc3 from the National Centre for Biotechnology Information (NCBI). To ascertain the degree of diversity, evolutionary dynamics, and structuring across ecological and geographical axes, we detected ARGs and virulence loci, analysed clustering patterns and generated approximate maximum-likelihood phylogenetic trees. FINDINGS: We identified 48 K pneumoniae isolates with iuc3 in the SpARK data and 79 in the OH-DART data. Three (2·4%) of these 127 isolates were from clinical sources, 73 (57·5%) were from pig or pork meat. iuc3 isolates corresponded to multiple (n=47) host sequence types (STs), with ST35, ST45, ST881, ST25, and ST967 harbouring iuc3 in both datasets. We generated hybrid assemblies for 44 (SpARK) and 36 (OH-DART) isolates, plus a single iuc3 isolate from Germany. 53 (65·4%) of these isolates were from pigs, three (3·7%) from clinical sources, and 25 (30·9%) from other sources. There were an additional 48 iuc3 positive isolates from our collections for which only short read data was available. A single iuc3-positive Klebsiella oxytoca isolate from a pig farm was detected in the SpARK data, which was also sequenced. We identified 330 iuc3-positive isolates and 58 iuc3-carrying plasmid assemblies from NCBI, of which 83 (21·4%) were from clinical sources, 120 from pigs (30·9%), and 185 (47·7%) from other sources or of unknown provenance. These isolates were from K pneumoniae except two isolates of Klebsiella quasipneumoniae subsp similipneumoniae and one of Enterobacter hormaechei. The combined dataset of 517 iuc3 plasmids ranged in size from 110 375 bp to 365 580 bp and mostly corresponded to multiple IncFIB(K) and IncFII replicon types. We found seven convergent K pneumoniae plasmids in the Thai data: six from fresh markets and one from a neighbouring hospital. These plasmids emerged through the hybridisation of cocirculating iuc3 plasmids and plasmids encoding extended-spectrum β-lactamases (ESBLs), although none of these seven plasmids carried genes encoding carbapenemases. We also identified putative cocirculating parental plasmids carrying iuc3 and ESBL-encoding genes. Clustering and phylogenetic analysis resolved the iuc3 plasmid sequences into three groups, which were consistent using both complete plasmid sequences (n=139) and short-read data (n=517). In the complete plasmid sequence data, 66 strains contained group 1 plasmids, 38 strains contained group 2 plasmids, and 35 strains contained group 3 plasmids. Group 3 plasmids are mostly carried by isolates circulating in hospitals throughout Asia, with occasional examples in Europe and elsewhere, and carry multiple ARGs and potential virulence factors. By contrast, group 1 plasmids are commonly carried by porcine isolates in Europe, and group 2 are a heterogeneous mixture of geographical and ecological sources. INTERPRETATION: Plasmid hybridisation occurs frequently outside of the health-care environment and can lead to the convergence of resistance and virulence traits. Generating complete plasmid sequences from regional population-scale samples facilitates the identification of convergent plasmids and their putative parental plasmids. Three robust groups of iuc3 plasmids were resolved, which show both epidemiological and geographical differences; one of these groups was associated with clinical isolates in Asia and warrants targeted plasmid surveillance. FUNDING: UKRI, JPIAMR, Evolution Education Trust, and a Schlumberger Foundation Fellowship.

Plasmids↗

PubMed2026

Mikania micrantha invasion restructures rhizosphere nitrogen cycling through enzyme activation, microbial recruitment, and allelopathic regulation.

BACKGROUND: Plant invasions profoundly influence terrestrial ecosystems by reshaping nutrient cycling processes. However, the mechanisms through which invasive plants such as Mikania micrantha modulate soil nitrogen (N) cycling and microbial communities remain insufficiently explored. Moreover, comparative studies with indigenous congener are scarce, limiting insights into whether such effects reflect species-specific strategies or genus-wide traits. This study investigates how M. micrantha modulates nitrogen metabolic pathways and rhizosphere microecology using combined metagenomic and metabolomic analyses. RESULTS: Integrated analyses revealed that M. micrantha established a distinctive "high total nitrogen-low mineral nitrogen" profile in the rhizosphere soil. Metagenomic profiling showed consistent enrichment of key ammonium assimilation enzymes, including glutamine synthetase and glutamate dehydrogenase, promoting enhanced incorporation of NH₄⁺ into organic nitrogen pools. In contrast, genes encoding nitrate reductase and nitrate transporters were significantly lower in relative abundance, limiting nitrate assimilation. Mikania micrantha also selectively enriched nitrogen-fixing microbes (notably rhizobia genera) and plant growth-promoting rhizobacteria (PGPR), thereby enhancing biological nitrogen fixation capacity. Metabolomic analysis further identified several allelopathic compounds in invaded soils at higher relative abundance, particularly epicatechin, which exhibited inhibitory effects on nitrifying bacteria. Compared with the congener Mikania cordata, which exerted weaker impacts on soil nitrogen cycling and microbial assembly, M. micrantha deployed a more comprehensive strategy integrating biochemical, microbial, and metabolic regulation. CONCLUSIONS: These findings demonstrate that under greenhouse-controlled conditions, M. micrantha reconfigures rhizosphere nitrogen cycling through a multi-dimensional strategy that couples biochemical regulation, microbial recruitment, and metabolite-mediated interference, thereby suggesting a potential mechanism that may contribute to its ecological advantage in natural settings. Video Abstract.

Rhizosphere↗

PubMed2026

Phage bioinformatics tools: a review of computational approaches for bacteriophage research.

Rising clinical interest in phage therapy and the exponential growth of metagenomic sequence catalogues have driven a rapid expansion of bacteriophage bioinformatics. More than 80 dedicated tools, mostly published since 2020, now span identification, assembly, annotation, taxonomy, lifestyle prediction, defence-system detection, and host prediction. Aimed at experienced practitioners and developers, this review synthesizes the field through the lens of three successive computational paradigms: sequence homology, bounded by database completeness; machine learning, constrained by labelled training data; and foundation models, which now achieve Matthews correlation coefficients above 0.95 in identification tasks and, through structure-informed prediction, raise functional annotation to over half of phage genes. Furthermore, we map the upstream components, namely, gene callers, homology engines, protein language models, and structural search tools, that underpin most downstream pipelines, exposing shared infrastructure and ecosystem-level fragility when dependencies change. To translate this into practice, we propose web-based and command-line reference workflows calibrated to user expertise and sample types. Finally, we set an agenda for the next wave of tool development. Roughly half of phage genes still resist functional annotation despite structural methods; no broadly generalizable strain-level host predictor exists for phage therapy; varying true-positive rates (0%-97%) underscore the absence of standardized community benchmarks analogous to Critical Assessment of Structure Prediction or Critical Assessment of Metagenome Interpretation. As generative genome models begin designing synthetic phages, progress will depend less on producing standalone tools than on rigorous evaluation, interoperable infrastructure, and clinically meaningful prediction targets.

Computational Biology↗

PubMed2025

Discovery of Respiratory Pathogens in People Living With HIV in the African Cohort Study.

INTRODUCTION: Respiratory infection outbreaks pose a threat to the readiness of the United States and allied armed forces. Predicting and preventing such outbreaks requires understanding of the epidemiology of potential respiratory pathogens in communities where service members live and work. We conducted pan-viral surveillance of respiratory specimens from people living with HIV or without HIV but under the risk enrolled in the U.S. Military HIV Research Program's African Cohort Study to determine the prevalence and possible clinical presentation of viruses in this population. METHODS: The African Cohort Study is an open-ended prospective cohort study that enrolls people with and without HIV aged ≥15 years at 12 clinical sites in Kenya, Tanzania, Uganda, and Nigeria. The study follows participants every 6 months and collects social, demographic, clinical, and laboratory data. A total of 131 respiratory samples, collected from March 2022 to February 2023 from participants in South Rift Valley Province, Kenya, who had symptoms of respiratory illness or a positive COVID-19 test, were analyzed using a pan-viral hybridization metagenomic next-generation sequencing approach. Libraries were sequenced on the Illumina Next-generation Sequencing System NovaSeq 6000. Sample data were run through several pathogen discovery pipelines. RESULTS: Full genome and partial genome sequences were assembled for several respiratory viruses including SARS-CoV-2, human coronavirus HKU1, human adenovirus 62, human metapneumovirus, human mastadenovirus B (coinfection with SARS-CoV-2), human mastadenovirus C (coinfection with SARS-CoV-2), and human parechovirus 3 (coinfection with adenovirus 62). The results showed that SARS-CoV-2 lineages correspond with lineages circulating during March 2022 to February 2023 and revealed additional viral respiratory pathogens and viruses known to be associated with HIV. CONCLUSIONS: These preliminary results suggest that continued genomic surveillance efforts are needed for data-driven decisions on force health protection, prevention of emerging respiratory infections, and mitigation of impacts on military readiness caused by infectious diseases.

Humans↗

PubMed2026

Genome-based predictions of metabolic preferences and substrate phenotypes in psychrotrophic bacteria from permafrost environments.

Genomes reveal vast functional potential, but harbor genomic noise that obscures prediction of metabolic and environmental preferences. Genomic databases are skewed towards clinically relevant and easily cultivated bacteria, limiting predictions for diverse and underrepresented environmental taxa. Psychrotrophic bacteria, which can survive and grow in cold, nutrient-limited, dry, and saline environments, are especially underrepresented despite their relevance for understanding microbial responses to changing cold environments and potential biotechnological value given growth at low temperatures. Assembling complete genomes of 48 isolates from Alaskan permafrost, seasonally frozen active layer soils, and terrestrial ice, we used Kyoto Encyclopedia of Genes and Genomes (KEGG) ortholog annotations to evaluate the predictability of metabolic resource-use traits observed using phenotypic tests. Genome-predicted values for glycolytic versus gluconeogenic catabolic preference index, or sugar-acid preference (SAP), explained over 50% of the variance in empirically observed SAP. SAP was inversely correlated to genomic GC content, which follows phylum-level trends, indicating that coarse metabolic preference covaries with phylogeny. Regularized elastic net models offered a more granular view, linking KEGG genes to specific substrate utilization and sensitivity phenotypes and yielding moderate but reproducible accuracy (AUC 0.70-0.79) for 11 substrates, demonstrating that specific substrate responses may be predictable from relatively small subsets of KO genes. These results extend recent advances, such as the SAP metric, and highlight associations among genomic GC content, phylum, and broad metabolic strategy. Linking genomic content to phenotype using isolates is a necessary step toward predictive models of microbial function in environmental communities, and this work can be used for hypothesis generation, with applications towards more expansive data sets.IMPORTANCECold region soils and ice host psychrotrophic bacteria with metabolic traits and adaptations that enable persistence in harsh, resource-limited environments. However, these taxa are underrepresented in genomic reference databases dominated by well-studied, mesophilic organisms. This gap limits inference of ecological strategies and our ability to predict how these microbes may influence the large, thaw-vulnerable carbon reservoirs in permafrost. Here, we show that genomic GC content is associated with the sugar-versus-acid catabolic preference (SAP) of isolates across major phyla, suggesting that broad genomic features may provide a coarse signal of metabolic strategy. We demonstrate that a modified SAP metric, using binary (positive/negative) substrate utilization rather than detailed growth rate measurements, is moderately predictive, thus extending its application to slow-growing or difficult-to-culture taxa. Together, these advances broaden the toolkit for linking genome content to resource-use traits (phenotype) in poorly characterized, cold-adapted bacteria and offer a tractable entry point to broad prediction and hypothesis generation.

Genome, Bacterial↗

PubMed2025

Modeling Alternative Conformational States in CASP16.

The CASP16 Ensemble Prediction experiment assessed advances in methods for modeling proteins, nucleic acids, and their complexes in multiple conformational states. Targets included systems with experimental structures determined in two or three states, evaluated by direct comparison to experimental coordinates, as well as domain-linker-domain (D-L-D) targets assessed against statistical models from NMR and SAXS data. This paper focuses on the former class of multi-state targets. Ten ensembles were released as community challenges, including ligand-induced conformational changes, protein-DNA complexes, a trimeric protein, a stem-loop RNA, and multiple oligomeric states of a single RNA. For five targets, some groups produced reasonably accurate models of both reference states (best TM-score >0.75). However, with the exception of one protein-ligand complex (T1214), where an apo structure was available as a template, predictors generally failed to capture key structural details distinguishing the states. Overall, accuracy was significantly lower than for single-state targets in other CASP experiments. The most successful approaches generated multiple AlphaFold2 models using enhanced multiple sequence alignments and sampling protocols, followed by model quality based selection. While the AlphaFold3 server performed well on several targets, individual groups outperformed it in specific cases. By contrast, predictions for one protein-DNA complex, three RNA targets, and multiple oligomeric RNA states consistently fell short (TM-score <0.75). These results highlight both progress and persistent challenges in multi-state prediction. Despite recent advances, accurate modeling of conformational ensembles, particularly RNA and large multimeric assemblies, remains a critical frontier for structural biology.

AlphaFold2↗

PubMed2002

Coronary disease surveillance in Olmsted County objectives and methodology.

The community surveillance study of coronary heart disease (CHD) in Olmsted County, MN, is designed to estimate trends in myocardial infarction (MI) incidence, case fatality rate, and CHD mortality, while including all ages. A distinctive feature of this study is its ability to capture longitudinal data before and after index events via the medical record linkage system of the Rochester Epidemiology Project. The goal of this report is to describe the methods implemented to measure CHD trends, the implications of including elderly individuals on MI ascertainment and trends in prior CHD among persons with incident MI. The methods are based on standardized criteria involving the review of death certificate information and hospital records to identify CHD deaths, and incident MIs in Olmsted County. The medical record linkage system in place under the auspices of the Rochester Epidemiology Project was used to ascertain antecedent CHD and outcomes. Hospitalized MIs were screened from sampled events coded ICD9 codes 410-414 and classified using enzyme values, cardiac pain, and ECG coding. After screening 5,042 records, a cohort of 1,658 validated incident MIs was assembled 35% (575) among persons aged 75 years or greater. The proportion of MIs validated with cardiac pain and enzymes without Minnesota ECG coding was lower among the elderly than among persons less than 75 years of age (35 vs. 29%, respectively; P <.001). The proportion of events validated without requiring ECG coding decreased over time in both age strata (P for trend.001). Reliability analyses indicated excellent agreement in event classification. More than half of the incident MIs did not have antecedent CHD, and this proportion increased overtime. These data indicate that the elderly contribute approximately one-third of the cases of incident MI, underscoring the importance of including all ages to fully characterize the burden of CHD. Cases among elderly persons more frequently require ECG coding for validation, but standardized ascertainment procedures are feasible and reliable in all age groups. More than half of the incident MIs occurred among persons with no prior CHD, and this proportion increased over time. The combination of standardized methodology and of the longitudinal data via the record linkage system of the Rochester Epidemiology Project will allow reliable measures of CHD trends and help define preventive strategies.

Aged↗

PubMed1986

Effects of ultra high speed floor burnishing on air quality in health care facilities.

Effects of ultra high speed (UHS) floor burnishing upon air quality in health care facilities were evaluated. A 2,000-rpm burnisher can disseminate high-velocity (190 km/hr) dust and microbial particles. A UHS burnisher used with either inadequate or no air restraint produced significant increases (P less than 0.05) in the levels of airborne dust particles and microorganisms. A UHS burnisher equipped with an air restraint assembly specifically designed for use in health care facilities produced no significant increase (P greater than 0.05) in the levels of airborne dust particles or microorganisms when compared to ambient air levels. The types and distribution of airborne microorganisms isolated from microbial air samples were not unusual nor were they directly influenced by the floor burnishing processes. Furthermore, the UHS floor burnishing process produced a significant reduction (P less than 0.05) in microbial floor contaminants (96%). When the use of UHS floor burnishing is contemplated for productivity improvement and esthetic enhancement, the possible adverse effects on air quality should also be considered.

Air Microbiology↗

PubMed1998

The new child health insurance expansions: how will school-based health centers fit in?

In June 1998, the Making the Grade National Program Office and the National Assembly on School-Based Health Care sponsored a workshop on the relationship between the State Child Health Insurance Program (SCHIP) and school-based health centers. Workshop participants used the health centers' experience with Medicaid managed care as a window for understanding their prospects for negotiating contracts with health plans under SCHIP. Speakers representing the federal perspective, state agencies, health plans, and local school-based health centers offered their views on the challenges of developing contracts, incentives, and disincentives that health plans have to contract with school-based health centers, and what has accounted for success where relationships are moving forward. Experiences in Colorado and Connecticut were presented as case studies on these evolving issues.

Child↗

PubMed1995

Mental health services: critical component of integrated primary care and substance abuse treatment.

The documented high incidence of mental health disorders among individuals in substance abuse treatment argues for the importance of studying the provision of mental health services to this population. This survey documents how the Linkage Programs assembled an array of mental health services based on the assessed health care needs of clients. Specialty and nonspecialty personnel addressed the extensive mental health needs of ethnically diverse, multiproblem clients with substance abuse problems. The innovative use of nonconventional providers, however, did not eliminate the shortfall between the number of clients with mental health problems and the number who were referred to and received mental health services; nor did it enable all Linkage Programs to address the mental health needs of the most severely ill clients. There is a continuing need to forge relationships between mental health providers and integrated providers of primary care and substance abuse treatment.

Community Mental Health Services↗

PubMed2000

An integrative review illuminates curricular applications of primary health care.

The International Council of Nurses supported primary health care and advocated its acceptance by other intersectorial stakeholders. Nurse educators involved in curriculum development have respected this direction. To pursue the primary health care vision and influence the adoption of primary health care delivery systems, all principles of primary health care must be implemented simultaneously. An integrative review was conducted to ascertain the interpretation of primary health care held by nurse authors. A content analysis of the nursing literature revealed that 184 of the 254 articles retrieved (72%), applied primary health care in a manner that is consistent with the World Health Organization (WHO) definition. Through curricular applications of different interpretations of the primary health care principles, differences in the created learning environment are discussed. The Declaration of Alma Ata, evolving from beliefs and values shared by 134 member nations present at the Assembly, delineated that primary health care was the accepted infrastructure to guide policies that direct health care delivery systems regardless of the context in the country (WHO, 1978). Even with this overwhelming endorsement, very few countries have made changes in policies and infrastructure for implementing the underlying values and beliefs ascribed in primary health care. Changes that have occurred have not been organized around the vision or the principles of primary health care. This delay has had, and will continue to have, a huge impact on nursing education, practice, and research. Nurses are interested in helping people attain, maintain, or regain health; primary health care has the potential to achieve health for all citizens of the world.

Attitude of Health Personnel↗

PubMed2002

Primary health care approach. Its relevance to oral health in Nigeria.

This article discusses the concept of Primary Health Care--an idea which started with the World Health Assembly agreement in 1977 to work resolutely towards the goal of Health for All. This decision was followed by the historic international conference on Primary Health Care at Alma Ata in 1978. Many countries including Nigeria, adopted the primary health care strategy to achieve health for all by the year 2000 (now 2000 and beyond). Since health needs to be seen and dealt with in a holistic manner, oral health is an integral part of health. Strategies for achieving health for all implicitly and must of necessity involve oral health. This article has tried to show the relevance of the strategy of primary health care to oral health. It concludes that primary health care approach is very relevant to oral health in Nigeria.

Community Dentistry↗

PubMed1999

Human papillomavirus vaccines.

Genital human papillomavirus (HPV) infections are the viral sexually transmitted diseases most frequently diagnosed that include anogenital condylomas and squamous intra-$bepithelial lesions, among which the precursors of invasive carcinomas of the uterine cervix. In animal PV models, vaccination against L1 and/or L2 viral capsid proteins provides an efficient protection against infection, involving virus type-specific neutralizing antibodies. Vaccination against non-structural E1, E2, E6 or E7 viral proteins does not prevent infection, unless administered altogether, but tends to stimulate regression, warranting the design of therapeutic vaccines. Prophylactic vaccines based on the use of virus-like particles (VLPs) obtained by auto-assembly of L1 or L1 and L2 proteins produced by recombinant DNA technology are under phase I/II clinical trials for HPV6/11 associated with condylomas and for HPV16, the most frequent oncogenic genotype. Second generation vaccines are chimeric proteins or VLPs incorporating one of the structural proteins (L1 or L2) fused to a non-structural protein (E6, E7 or E2), which should induce both humoral and cellular immunity. Vaccine valency (number of genotypes), route of administration (humoral versus local immunity), vaccinees (children, young adults, gender) and forms of vaccines (recombinant $LSalmonella typhimurium*I$L, edible plants expressing L1 and L2 proteins, DNA vaccines, synthetic antigenic peptides) are under study. End points to evaluate vaccine efficacy in phase III trials should include viral DNA detection and typing, and screening for low or high grade intraepithelial lesions. Therapeutic vaccines based on recombinant HPV E6 and/or E7 vaccinia virus, L2-E7 fusion proteins or E7 peptides corresponding to cytotoxic T cell epitopes are currently tested (phase I/II trials) in patients with cervical carcinomas of advanced clinical stages or high grade intraepithelial lesions. Animal studies, phase I/II clinical trials and implementation of the community support that HPV vaccines will constitute an efficient means to prevent carcinoma of the uterine cervix.

Animals↗

PubMed2003

Expression of the FAT10 gene is highly upregulated in hepatocellular carcinoma and other gastrointestinal and gynecological cancers.

The ubiquitin-like modifier (UBL) family has recently generated much interest in the scientific community, as it is implicated to play important regulatory roles via novel protein-protein modification. FAT10 (diubiquitin) belongs to this family of proteins, comprising two ubiquitin-like moieties fused in tandem, and has been implicated to be involved in the maintenance of spindle integrity during mitosis. As FAT10 may play a role in the regulation of genomic stability, we examined if there is an association between FAT10 expression and hepatocellular carcinoma (HCC) or other cancers. Northern blot analyses revealed upregulation of FAT10 expression in the tumors of 90% of HCC patients. In situ hybridization as well as immunohistochemistry utilizing anti-FAT10 antibodies localized highest FAT10 expression in the nucleus of HCC hepatocytes rather than the surrounding immune and non-HCC cells. FAT10 expression was also found to be highly upregulated in other cancers of the gastrointestinal tract and female reproductive system. In conclusion, we demonstrated upregulation of FAT10 expression in various gastrointestinal and gynecological cancers. Its overexpression is unrelated to the general increase in protein synthesis or a general immune/inflammatory response to cancer. Rather, FAT10 may modulate tumorigenesis through its reported interaction with the MAD2 spindle-assembly checkpoint protein.

Carcinoma, Hepatocellular↗