Effectiveness of Take-Home Naloxone Programs in Athletic Training: An Evidence-to-Practice Review

The number of opioid overdoses (ODs) has risen in recent years and has become more complex due to the co-involvement of both prescription and illicit opioid drug use. Provisional programs for take-home naloxone (a medication designed to rapidly reverse opiate OD symptoms) kits have been distributed to combat this potentially fatal epidemic. Although there is strong evidence to support the efficacy of naloxone in the reversal of opiate OD, there is limited evidence to support the efficacy of take-home naloxone (THN) kits. The purpose of this evidence-to-practice review was to summarize a systematic review on the efficacy of THN programs. The authors aimed to include studies of THN programs that both trained opioid users in OD prevention and reported on OD outcomes. The Bradford Hill criteria (strength of association, temporality, consistency, specificity, dose-response relationship, biological plausibility, coherence, experimental evidence, and analogy) and five additional criteria (measure cost-effectiveness, absence of negative consequences, feasibility of implementation/expansion/ coverage, unanticipated benefits, and special populations) was used as dependent variables to determine the impact of public health intervention where randomized control trials (RCTs) are not ethically feasible or operationally practical. All 22 studies included provided empirical support using the Bradford Hill Criteria for community based THN programs. Despite being unable to deduce whether death would have occurred without the administration of THN, the studies combined accounted for an estimated 2316 successful opioid OD reversals. Thus, there is a strong association between THN administration and overdose survival. Additionally, there was a low rate of adverse events: withdrawal symptoms (2.8%), vomiting (2.2%), agitation (2.1%), seizures (0.1%). Consequently, we recommend that athletic trainers include opioid crisis management equipment and procedures in a site-specific policies manual. Clinical relevance is highly dependent on patient population and geographic location, considering 90% of reversed ODs were heroin induced. Application to individuals in organized sport is minimal, but nonetheless, individuals who are prescribed opioids for pain management should be candidates for THN programs. Athletic trainers and guardians of minors prescribed opioid medications should be educated on dispensing medication, best practices for opioid crisis management, and distribution of naloxone/THN.

Importance of Molecular Data to Identify Fungal Plant Pathogens and Guidelines for Pathogenicity Testing Based on Koch’s Postulates

Fungi are an essential component of any ecosystem, but they can also cause mild and severe plant diseases. Plant diseases are caused by a wide array of fungal groups that affect a diverse range of hosts with different tissue specificities. Fungi were previously named based only on morphology and, in many cases, host association, which has led to superfluous species names and synonyms. Morphology-based identification represents an important method for genus level identification and molecular data are important to accurately identify species. Accurate identification of fungal pathogens is vital as the scientific name links the knowledge concerning a species including the biology, host range, distribution, and potential risk of the pathogen, which are vital for effective control measures. Thus, in the modern era, a polyphasic approach is recommended when identifying fungal pathogens. It is also important to determine if the organism is capable of causing host damage, which usually relies on the application of Koch’s postulates for fungal plant pathogens. The importance and the challenges of applying Koch’s postulates are discussed. Bradford Hill criteria, which are generally used in establishing the cause of human disease, are briefly introduced. We provide guidelines for pathogenicity testing based on the implementation of modified Koch’s postulates incorporating biological gradient, consistency, and plausibility criteria from Bradford Hill. We provide a set of protocols for fungal pathogenicity testing along with a severity score guide, which takes into consideration the depth of lesions. The application of a standard protocol for fungal pathogenicity testing and disease assessment in plants will enable inter-studies comparison, thus improving accuracy. When introducing novel plant pathogenic fungal species without proving the taxon is the causal agent using Koch’s postulates, we advise the use of the term associated with the “disease symptoms” of “the host plant”. Where possible, details of disease symptoms should be clearly articulated.

Let’s discuss the Criteria of Bradford Hill (1965)

This letter to Editors discusses the Criteria of Bradford Hill (1965).

The Major Health Implications of Social Connection

The influence of social relationships extends beyond emotional well-being to influence long-term physical-health outcomes, including mortality risk. Despite the varied measurement approaches used to examine social relationships within the health literature, the data can be synthesized using social connection as an organizing framework. This review discusses cumulative scientific evidence of links between various aspects of social connection and mortality, as well as supporting evidence for links with morbidity and plausible mechanisms. This evidence fulfills the criteria outlined in the Bradford Hill guidelines for establishing causality. Despite strong evidence currently available, several gaps remain and will need to be addressed if society is to rise to the challenge of developing effective interventions to reduce risk associated with social disconnection. This evidence has important broader implications for medical practice and public health.

Scoping review on the epidemiology, diagnostics, and clinical significance of porcine astroviruses

Porcine astroviruses (PoAstVs) have been reported globally and are divided into at least five distinct lineages (PoAstV1-PoAsV5). The primary objective of this study was to summarize the scientific literature about the frequency of detection, associated clinical presentations, and type of samples and diagnostic tools used for the detection of porcine astroviruses. The secondary objective was to summarize the body of knowledge about the causal role in disease of PoAstVs using the Bradford Hill framework. A search was conducted using Centre for Biosciences and Agriculture International (CABI), MEDLINE, American Association of Swine Veterinarians (AASV) Swine Information Library (SIL) abstracts, swine conferences including American College of Veterinary Pathologists (ACVP), and American Association of Veterinary Laboratory Diagnosticians (AAVLD). From 168 studies identified by the search, 29 studies were eligible. Results indicated that 69% (20/29) of the literature on PoAstVs has been published between 2011 and 2018. Of 29 papers, 52% were detection studies (15 of 29) and 48% (14 of 29) were case-control studies. Seventy-two percent (21 of 29) reported differential diagnosis and 10% (3 of 29) reported histologic lesions, out of which 67% (2 of 3) associated the detection of PoAstV3 with development of polioencephalomyelitis. PCR-based assays were the most common diagnostic tools. Keywords: Swine, Astrovirus, Scoping review, Bradford Hill, PoAstV detection

Scoping review on the epidemiology, diagnostics, and clinical significance of porcine astroviruses

Porcine astroviruses (PoAstVs) have been reported globally and are divided into at least five distinct lineages (PoAstV1-PoAsV5). The primary objective of this study was to summarize the scientific literature about the frequency of detection, associated clinical presentations, and type of samples and diagnostic tools used for the detection of porcine astroviruses. The secondary objective was to summarize the body of knowledge about the causal role in disease of PoAstVs using the Bradford Hill framework. A search was conducted using Centre for Biosciences and Agriculture International (CABI), MEDLINE, American Association of Swine Veterinarians (AASV) Swine Information Library (SIL) abstracts, swine conferences including American College of Veterinary Pathologists (ACVP), and American Association of Veterinary Laboratory Diagnosticians (AAVLD). From 168 studies identified by the search, 29 studies were eligible. Results indicated that 69% (20/29) of the literature on PoAstVs has been published between 2011 and 2018. Of 29 papers, 52% were detection studies (15 of 29) and 48% (14 of 29) were case-control studies. Seventy-two percent (21 of 29) reported differential diagnosis and 10% (3 of 29) reported histologic lesions, out of which 67% (2 of 3) associated the detection of PoAstV3 with development of polioencephalomyelitis. PCR-based assays were the most common diagnostic tools. Keywords: Swine, Astrovirus, Scoping review, Bradford Hill, PoAstV detection

Onchocerca volvulus and epilepsy: A comprehensive review using the Bradford Hill criteria for causation

Background The possibility that onchocerciasis may cause epilepsy has been suggested for a long time, but thus far, an etiological link has not been universally accepted. The objective of this review is to critically appraise the relationship between Onchocerca volvulus and epilepsy and subsequently apply the Bradford Hill criteria to further evaluate the likelihood of a causal association. Methods PubMed and gray literature published until September 15, 2020, were searched and findings from original research were synthesized. Adherence to the 9 Bradford Hill criteria in the context of onchocerciasis and epilepsy was determined to assess whether the criteria are met to strengthen the evidence base for a causal link between infection with O. volvulus and epilepsy, including the nodding syndrome. Results Onchocerciasis as a risk factor for epilepsy meets the following Bradford Hill criteria for causality: strength of the association, consistency, temporality, and biological gradient. There is weaker evidence supporting causality based on the specificity, plausibility, coherence, and analogy criteria. There is little experimental evidence. Considering the Bradford Hill criteria, available data suggest that under certain conditions (high microfilarial load, timing of infection, and perhaps genetic predisposition), onchocerciasis is likely to cause epilepsy including nodding and Nakalanga syndromes. Conclusion Applying the Bradford Hill criteria suggests consistent epidemiological evidence that O. volvulus infection is a trigger of epilepsy. However, the pathophysiological mechanisms responsible for seizure induction still need to be elucidated.