Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition

Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Shared common variants in prostate cancer and blood lipids

Background Epidemiological and clinical studies suggest comorbidity between prostate cancer (PCA) and cardiovascular disease (CVD) risk factors. However, the relationship between these two phenotypes is still not well understood. Here we sought to identify shared genetic loci between PCA and CVD risk factors. Methods We applied a genetic epidemiology method based on conjunction false discovery rate (FDR) that combines summary statistics from different genome-wide association studies (GWAS), and allows identification of genetic overlap between two phenotypes. We evaluated summary statistics from large, multi-centre GWA studies of PCA (n = 50 000) and CVD risk factors (n = 200 000) [triglycerides (TG), low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol, systolic blood pressure, body mass index, waist-hip ratio and type 2 diabetes (T2D)]. Enrichment of single nucleotide polymorphisms (SNPs) associated with PCA and CVD risk factors was assessed with conditional quantile-quantile plots and the Anderson-Darling test. Moreover, we pinpointed shared loci using conjunction FDR. Results We found the strongest enrichment of P-values in PCA was conditional on LDL and conditional on TG. In contrast, we found only weak enrichment conditional on HDL or conditional on the other traits investigated. Conjunction FDR identified altogether 17 loci; 10 loci were associated with PCA and LDL, 3 loci were associated with PCA and TG and additionally 4 loci were associated with PCA, LDL and TG jointly (conjunction FDR < 0.01). For T2D, we detected one locus adjacent to HNF1B. Conclusions We found polygenic overlap between PCA predisposition and blood lipids, in particular LDL and TG, and identified 17 pleiotropic gene loci between PCA and LDL, and PCA and TG, respectively. These findings provide novel pathobiological insights and may have implications for trials using targeting lipid-lowering agents in a prevention or cancer setting.

Non-invasive assessment of pineapple and mango fruit quality using near infra-red spectroscopy

The potential of near infra-red (NIR) spectroscopy for non-invasive measurement of fruit quality of pineapple (Ananas comosus var. Smooth Cayenne) and mango (Magnifera indica var. Kensington) fruit was assessed. A remote reflectance fibre optic probe, placed in contact with the fruit skin surface in a light-proof box, was used to deliver monochromatic light to the fruit, and to collect NIR reflectance spectra (760–2500 nm). The probe illuminated and collected reflected radiation from an area of about 16 cm2. The NIR spectral attributes were correlated with pineapple juice Brix and with mango flesh dry matter (DM) measured from fruit flesh directly underlying the scanned area. The highest correlations for both fruit were found using the second derivative of the spectra (d2 log 1/R) and an additive calibration equation. Multiple linear regression (MLR) on pineapple fruit spectra (n = 85) gave a calibration equation using d2 log 1/R at wavelengths of 866, 760, 1232 and 832 nm with a multiple coefficient of determination (R2) of 0.75, and a standard error of calibration (SEC) of 1.21 °Brix. Modified partial least squares (MPLS) regression analysis yielded a calibration equation with R2 = 0.91, SEC = 0.69, and a standard error of cross validation (SECV) of 1.09 oBrix. For mango, MLR gave a calibration equation using d2 log 1/R at 904, 872, 1660 and 1516 nm with R2 = 0.90, and SEC = 0.85% DM and a bias of 0.39. Using MPLS analysis, a calibration equation with R2 = 0.98, SEC = 0.54 and SECV = 1.19 was obtained. We conclude that NIR technology offers the potential to assess fruit sweetness in intact whole pineapple and DM in mango fruit, respectively, to within 1° Brix and 1% DM, and could be used for the grading of fruit in fruit packing sheds.

Jacopo Bassano freskomaalarina : Cartiglianon ja Enegon kirkkojen freskot: konteksti, rekonstruktio ja tulkinta

The object of this study is Jacopo Bassano (c. 1510 1592) as a fresco painter and the significance of frescoes in his late production. The research focuses on the only surviving cycle of frescoes of his later years in the Cartigliano parish church, bearing the date 1575. The other cycle studied here was painted for the 16th century parish church of Enego. It contained one of the most extensive fresco decorations executed by Jacopo Bassano together with his eldest son Francesco. However, nothing has survived of the fresco cycle and the ceiling paintings of the church, nor is any visual documentation of them left. Only the small altarpiece attributed to Jacopo Bassano and depicting Saints Justine, Sebastian, Anthony Abbott, and Roch (dated to c. 1555/1560) has been preserved. I have suggested that the frescoes of the Cartigliano parish church should be examined in the interpretational context of the spirituality of the post-Tridentine period. This period frames the historical context for the frescoes and functions as a basis for the iconographical interpretation that I have proposed. I have shown that the iconographic programme of the frescoes in the choir of the Cartigliano parish church has obvious points of contact with the Catholic doctrines reconfirmed by the Council of Trent (1545 1563). I also argue that the fresco cycle and the ceiling paintings of the Enego church should be placed in the same interpretational context as the frescoes of Cartigliano. I present a reconstruction of the frescoes in the choir attributed to Jacopo Bassano and of those on the walls of the nave attributed to his son Francesco Bassano. According to my reconstruction, the frescoes in the choir and nave walls formed a coherent cycle with a unitary iconographic programme which included the 28 paintings with Old Testament subjects in the nave ceiling. The reconstruction includes the dating and the iconography of the fresco programme and its interpretative basis. The reconstruction is based on visitation records and inventories from the 16th and 17th centuries as well as on the oldest relevant literature, namely the descriptions offered by Carlo Ridolfi (1648) and G. B. Verci (1775). I also consider the relationship of the large compositional sketches attributed to Jacopo Bassano and depicting Christological subjects to the lost frescoes in Enego. These studies have been executed with coloured chalks, and many of them are also dated 1568 or 1569 by the painter. I suggest in this study that these large studies in coloured chalks were preparatory drawings for the fresco cycle in Enego, depicting scenes from the life and suffering of Christ. All the subjects of the aforesaid drawings were included in the Enego cycle.

Serum immunoreactive pancreatic lipase and cationic trypsinogen for the assessment of exocrine pancreatic function in older patients with cystic fibrosis

Indirect and qualitative tests of pancreatic function are commonly used to screen patients with cystic fibrosis for pancreatic insufficiency. In an attempt to develop a more quantitative assessment, we compared the usefulness of measuring serum pancreatic lipase using a newly developed enzyme-linked immunosorbent immunoassay with that of cationic trypsinogen using a radioimmunoassay in the assessment of exocrine pancreatic function in patients with cystic fibrosis. Previously, we have shown neither lipase nor trypsinogen to be of use in assessing pancreatic function prior to 5 years of age because the majority of patients with cystic fibrosis in early infancy have elevated serum levels regardless of pancreatic function. Therefore, we studied 77 patients with cystic fibrosis older than 5 years of age, 41 with steatorrhea and 36 without steatorrhea. In addition, 28 of 77 patients consented to undergo a quantitative pancreatic stimulation test. There was a significant difference between the steatorrheic and nonsteatorrheic patients with the steatorrheic group having lower lipase and trypsinogen values than the nonsteatorrheic group (P < .001). Sensitivities and specificities in detecting steatorrhea were 95% and 86%, respectively, for lipase and 93% and 92%, respectively, for trypsinogen. No correlations were found between the serum levels of lipase and trypsinogen and their respective duodenal concentrations because of abnormally high serum levels of both enzymes found in some nonsteatorrheic patients. We conclude from this study that both serum lipase and trypsinogen levels accurately detect steatorrhea in patients with cystic fibrosis who are older than 5 years but are imprecise indicators of specific pancreatic exocrine function above the level needed for normal fat absorption.

Age-related alterations in immunoreactive pancreatic lipase and cationic trypsinogen in young children with cystic fibrosis

Serum immunoreactive pancreatic lipase and cationic trypsinogen are elevated in young infants with cystic fibrosis (CF) and may be useful neonatal screening tests for CF. We compared lipase measured by a recently developed ELISA immunoassay with trypsinogen measured by radioimmunoassay in 70 children (ages 0.1 to 9.9 years) with CF who had various degrees of pancreatic dysfunction and in 79 similarly aged children without CF (controls). In the control children, lipase activity increased with advancing age, whereas trypsinogen showed no age-related trend. Lipase and trypsinogen were significantly elevated in the infants with CF who were younger than 1 year, irrespective of pancreatic function (trypsinogen, P<0.001; lipase, P<0.05). Sensitivities in detecting CF were 76% and 90% for lipase and trypsinogen, respectively. After the first year of life, lipase and trypsinogen values declined toward normal, the rate of decline of lipase being greater than that of trypsinogen; 67% of lipase values were within or below the normal range by 3 years, whereas 67% of trypsinogen values continued to be elevated. We conclude that trypsinogen is an excellent screening test for CF in young infants regardless of pancreatic function, and that the addition of a serum pancreatic lipase determination does not improve the accuracy of trypsinogen as a screening test for cystic fibrosis.

Fernando Pessoan ortonyymi ja heteronyymit modernistis-romanttisena myyttinä

Tutkimuksessani selvitän portugalilaisrunoilija Fernando Pessoan (1888-1935) heteronyymejä ja ortonyymiä modernistis-romanttisena myyttinä. Myytin piirteet paljastuivat Pessoan omia kirjoituksia ja runoja tutkimalla ja käyttämällä apuna Pessoa-tutkimusta. Tutkimusaineistonani ovat Pessoa-ortonyymin Mensagem-runoelma ja ”Autopsykografia”-runo, Álvaro de Campoksen vuonna 1917 Portugal Futurista –lehdessä julkaistu ”Ultimatum”-runomanifesti, Alberto Caeiron ”Guardador de Rebanhos”-runosikermä sekä Ricardo Reisin ”Oodit”-kokonaisuuteen kuuluvat runot: n:ro 59 ”Acima da verdade estão os deuses” (”Totuuden yläpuolella ovat jumalat”, 1914), n:ro 66 ”Olho os campos, Neera” (”Katson peltoja, Neera”, 1917), n:ro 181 ”Amo o que vejo” (”Rakastan sitä mitä näen”, 1934), n:ro 175 ”Estas só. Ninguem o sabe.” (”Olet yksin. Kukaan ei tiedä sitä”, 1933). Tutkimuksessani romanttisen runouden keskeisinä piirteinä pidetään uskoa taiteilijaneroon (geniukseen), mimeettiseen illuusioon (taide tavoittelee ulkoisen todellisuuden toisintamista mahdollisimman autenttisena) ja tekijän ja kokijan eli subjektin ja objektin erottamiseen toisistaan. Käsitänkin modernin runon tutkimuksessani hylänneen monia entisiä käsityksiä ja vastakkainasetteluja muun muassa tekijän ja ulkopuolisen maailman, mielen ja kielen välillä. Näitä moderneja ”rikkomuksia” identifioin ja määrittelen Pessoan heteronyymien runoudessa. Tutkimukseni apukäsitteitä ovat vilpittömyys ja autenttisuus, jotka kuvaavat runoilijan suhdetta itseensä ja muihin ja joita on pohtinut mm. Lionel Trilling teoksessaan Sincerity and authencity. Romanttisessa runoudessa suhde yhteisöön muodostui ensisijaisesti suhteessa omaan itseen, yhtenäiseen minuuteen nojaavan vilpittömyyden kautta, modernissa runoudessa hajanaisuutta ja yksilön suhdetta myös yhteisöön korostavan autenttisuuden avulla. Tutkimuksessani havaitsin, että Pessoa on jo tuotantonsa alusta lähtien kehittänyt tietoisesti modernistis-romanttista myyttiä – päätelmää tukivat niin Pessoan omat kirjoitukset kuin runoanalyysini. Pessoa ennusti ensimmäisen kerran romanttiseen nerotaiteilijaan vertautuvaa ”supra-Camõesia” ”A nova poesia Portuguesa Sociologicamente considerada” –esseessään vuonna 1912. Campoksen ”Ultimatum”-manifestissa puhuja uskoi muutaman useita kymmeniä persoonallisuuksia hallitsevan ”Synteesi-Ihmisen” tai ”supra-Camõesin” ilmestymiseen. ”Synteesi-Ihmisen” oli määrä palauttaa kukoistukseensa lamaantuneessa tilassa ollut Portugalin kirjallisuus uuteen kukoistukseensa. Eräänlaisen perustan koko myytille loi vuotta ennen Pessoan kuolemaa julkaistu Mensagem (suom. Viesti), jossa runoilija esittää saudosistisen ja sebastianistisen perustan. Teixeira de Pascoaesin kehittämä saudosismi näkyy Mensagemissa uskona Portugalin valtion perustajien ja laajentajien – löytöretkeilijöiden – edustamaan voittoisaan lusofoniseen mentaliteettiin, jonka Pessoa asettaa niin kansakunnan, runoilijan kuin ihmisen ihanteeksi. Toinen Mensagemissa esiintyvä myytin rakennusaine on sebastianismi eli usko kuningas Sebastianin (1554-1578) paluuseen. ”Synteesi-Ihminen”/”supra-Camões” oli reinkarnoitunut Sebastian, jonka piti palauttaa kansa ja kulttuuri kukoistukseensa lusofonisen valloittajamentaliteetin avulla. ”Autopsykografia”-runossaan Pessoa esittää puolestaan runoilijaa koskevan modernin poetiikan ongelmineen: esittävyyteen perustuva taide etäännyttää kokijan – taiteilijan – aina väistämättä ensimmäisestä, spontaanista ja luonnollisesta kokemuksesta ja tekee hänestä teeskentelijän ja simulakrumien (Baudrillard), toisen tason merkityksen tuottajan. ”Autopsykografian” moderni poetiikka koskee myös lukijaa, joka ei tavoita runoilijan välittämää merkitystä vaan kolmannen tason merkityksen. ”Autopsykografian” runous- ja ihmiskäsitys on moderni: runoilija on ammattimainen teeskentelijä, lähtökohtaisesti vilpillinen ja epäautenttinen. Pessoa ja Campos edustavat Pessoan objektiivisia heteronyymejä ja myytin modernia puolta. Pessoan subjektiiviset heteronyymit Reis ja Caeiro täydentävät objektiviisia, modernin ihmisen ahdistusta ja levottomuutta ilmaisseita Pessoaa ja Camposta ollen luonteeltaan romanttisia vilpittömyyden kannattajia. Caeiro arvosti näköaistia yli muiden aistien. Hänen tavoitteenaan oli katsoa aina kuin ensimmäistä kertaa, spontaanisti ja välittömästi kuin lapsi. Reis puolestaan korosti harmoniaa jumalten, ihmisten ja luonnon välillä ja uskoi kohtuullisiin aistinautintoihin. Molemmat muodostivat Pessoan myytin romanttisen puolen yhteisessä halussaan hylätä sosiaaliset roolit ja opetukset ja palata kohti yksilöllistä minää. Vilpittömyys ja autenttisuus ovat Caeiron ja Reisin ohjeita runoilijalle ja ihmiselle. Objektiiviset ja subjektiiviset heteronyymit yhdessä muodostavat modernistis-romanttisen myytin, joka kokonaisuudessaan on looginen: objektiiviset heteronyymit esittivät teeskentelyn, vilpillisyyden ja moderniuden ongelmat; subjektiiviset tarjosivat ratkaisua niihin, poisopettelua sosiaalisista rooleista ja rohkeutta mennä kohti omaa yksilöllistä minuutta.

Use of CLIMEX modelling to identify prospective areas for exploration to find new biological control agents for prickly acacia

Selection of biocontrol agents that are adapted to the climates in areas of intended release demands a thorough analysis of the climates of the source and release sites. We present a case study that demonstrates how use of the CLIMEX software can improve decision making in relation to the identification of prospective areas for exploration for agents to control the woody weed, prickly acacia Acacia nilotica ssp. indica in the arid areas of north Queensland.

Lettuce Information Kit. Agrilink, your growing guide to better farming guide

Each Agrilink kit has been designed to be both comprehensive and practical. As the kits are arranged to answer questions of increasing complexity, they are useful references for both new and experienced producers of specific crops. Agrilink integrates the technology of horticultural production with the management of horticultural enterprises. REPRINT INFORMATION - PLEASE READ! For updated information please call 13 25 23 or visit the website www.deedi.qld.gov.au (Select: Queensland Industries – Agriculture link) This publication has been reprinted as a digital book without any changes to the content published in 1997. We advise readers to take particular note of the areas most likely to be out-of-date and so requiring further research: see detailed information on first page of the kit. Even with these limitations we believe this information kit provides important and valuable information for intending and existing growers. This publication was last revised in 1997. The information is not current and the accuracy of the information cannot be guaranteed by the State of Queensland. This information has been made available to assist users to identify issues involved in the production of lettuce. This information is not to be used or relied upon by users for any purpose which may expose the user or any other person to loss or damage. Users should conduct their own inquiries and rely on their own independent professional advice. While every care has been taken in preparing this publication, the State of Queensland accepts no responsibility for decisions or actions taken as a result of any data, information, statement or advice, expressed or implied, contained in this publication.

Studio portrait of Cora Berliner with her mother and sister; Hannover Portraits Family

Digital Image

Human papillomavirus infection and vaccination: Awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of teenage daughters in Weihai, Shandong, China

In preparation for the introduction of human papillomavirus (HPV) vaccine, we investigated awareness and knowledge of HPV/HPV vaccine and potential acceptability to HPV vaccine among mothers with a teenage daughter in Weihai, Shandong, China. A cross-sectional survey was conducted in 2013 with a sample of 1850 mothers who had a daughter (aged 9–17 years) attending primary, junior and senior high schools. In the final sample (N = 1578, response rate 85.30%), awareness of HPV was reported by 305 (19.32%) mothers. Awareness varied significantly by daughter’s age (P<0.01), mother’s education level (P<0.01), mother’s occupation (P<0.01), household income (P<0.01) and residence type (P<0.01). Knowledge about HPV/HPV vaccine was poor with a mean total score of 3.56 (SD = 2.40) out of a possible score of 13. Mothers with a higher education level reported higher levels of knowledge (P = 0.02). Slightly more than one-fourth (26.49%) of mothers expressed their potential acceptability of HPV vaccine for their daughters. Acceptability increased along with increased daughters’ age (P<0.01), household income (P<0.01) and knowledge level (P<0.01). House wives and unemployed mothers had the highest acceptability (P<0.01). The most common reasons for not accepting HPV vaccination were “My daughter is too young to have risk of cervical cancer (30.95%)”, “The vaccine has not been widely used, and the decision will be made after it is widely used (24.91%)”, “Worry about the safety of the vaccine (22.85%)”. Awareness and knowledge of HPV/HPV vaccines are poor and HPV vaccine acceptability is low among these Chinese mothers. These results may help inform appropriate health education programs in this population.

Bacterial Community Structure in the Hindgut of Wild and Captive Dugongs (Dugong dugon)

Dugongs (Dugong dugon) are marine mammals that obtain nutrients through hindgut fermentation of seagrass, however, the microbes responsible have not been identified. This study used denaturing gradient gel electrophoresis (DGGE) and 454-pyrosequencing to profile hindgut bacterial communities in wild dugongs. Faecal samples obtained from 32 wild dugongs representing four size/maturity classes, and two captive dugongs fed on cos lettuce were screened using DGGE. Partial 16S rRNA gene profiles of hindgut bacteria from wild dugong calves and juveniles were grouped together and were different to those in subadults and adults. Marked differences between hindgut bacterial communities of wild and captive dugongs were also observed, except for a single captive whose profile resembled wild adults following an unsuccessful reintroduction to the wild. Pyrosequencing of hindgut communities in two wild dugongs confirmed the stability of bacterial populations, and Firmicutes (average 75.6% of Operational Taxonomic Units [OTUs]) and Bacteroidetes (19.9% of OTUs) dominated. Dominant genera were Roseburia, Clostridium, and Bacteroides. Hindgut microbial composition and diversity in wild dugongs is affected by ontogeny and probably diet. In captive dugongs, the absence of the dominant bacterial DNA bands identified in wild dugongs is probably dependent upon prevailing diet and other captive conditions such as the use of antibiotics. This study represents a first step in the characterisation of a novel microbial ecosystem-the marine hindgut of Sirenia.

First Report of a Toxic Nodularia spumigena (Nostocales/Cyanobacteria) Bloom in Sub-Tropical Australia. II. Bioaccumulation of Nodularin in Isolated Populations of Mullet (Mugilidae)

Fish collected after a mass mortality at an artificial lake in south-east Queensland, Australia, were examined for the presence of nodularin as the lake had earlier been affected by a Nodularia bloom. Methanol extracts of muscle, liver, peritoneal and stomach contents were analysed by HPLC and tandem mass spectrometry; histological examination was conducted on livers from captured mullet. Livers of sea mullet (Mugil cephalus) involved in the fish kill contained high concentrations of nodularin (median 43.6 mg/kg, range 40.8-47.8 mg/kg dry weight; n = 3) and the toxin was also present in muscle tissue (median 44.0 mu g/kg, range 32.3-56.8 mu g/kg dry weight). Livers of fish occupying higher trophic levels accumulated much lower concentrations. Mullet captured from the lake 10 months later were also found to have high hepatic nodularin levels. DNA sequencing of mullet specimens revealed two species inhabiting the study lake: M. cephalus and an unidentified mugilid. The two mullet species appear to differ in their exposure and/or uptake of nodularin, with M. cephalus demonstrating higher tissue concentrations. The feeding ecology of mullet would appear to explain the unusual capacity of these fish to concentrate nodularin in their livers; these findings may have public health implications for mullet fisheries and aquaculture production where toxic cyanobacteria blooms affect source waters. This report incorporates a systematic review of the literature on nodularin measured in edible fish, shellfish and crustaceans.