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Article ; Online: Meta-analysis of African ancestry genome-wide association studies identified novel locus and validates multiple loci associated with kidney function.

Kintu, Christopher / Soremekun, Opeyemi / Machipisa, Tafadzwa / Mayanja, Richard / Kalyesubula, Robert / Bagaya, Bernard S / Jjingo, Daudi / Chikowore, Tinashe / Fatumo, Segun

BMC genomics

2023 Volume 24, Issue 1, Page(s) 496

Abstract: Despite recent efforts to increase diversity in genome-wide association studies (GWASs), most loci currently associated with kidney function are still limited to European ancestry due to the underlying sample selection bias in available GWASs. We set out ...

Abstract	Despite recent efforts to increase diversity in genome-wide association studies (GWASs), most loci currently associated with kidney function are still limited to European ancestry due to the underlying sample selection bias in available GWASs. We set out to identify susceptibility loci associated with estimated glomerular filtration rate (eGFRcrea) in 80027 individuals of African-ancestry from the UK Biobank (UKBB), Million Veteran Program (MVP), and Chronic Kidney Disease genetics (CKDGen) consortia.We identified 8 lead SNPs, 7 of which were previously associated with eGFR in other populations. We identified one novel variant, rs77408001 which is an intronic variant mapped to the ELN gene. We validated three previously reported loci at GATM-SPATA5L1, SLC15A5 and AGPAT3. Fine-mapping analysis identified variants rs77121243 and rs201602445 as having a 99.9% posterior probability of being causal. Our results warrant designing bigger studies within individuals of African ancestry to gain new insights into the pathogenesis of Chronic Kidney Disease (CKD), and identify genomic variants unique to this ancestry that may influence renal function and disease.
MeSH term(s)	Humans ; Genome-Wide Association Study ; Black People/genetics ; Mutation ; Renal Insufficiency, Chronic/genetics ; Kidney
Language	English
Publishing date	2023-08-29
Publishing country	England
Document type	Meta-Analysis ; Journal Article
ZDB-ID	2041499-7
ISSN	1471-2164 ; 1471-2164
ISSN (online)	1471-2164
ISSN	1471-2164
DOI	10.1186/s12864-023-09601-0
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Article ; Online: Airway microbiome-immune crosstalk in chronic obstructive pulmonary disease.

Kayongo, Alex / Robertson, Nicole M / Siddharthan, Trishul / Ntayi, Moses Levi / Ndawula, Josephine Caren / Sande, Obondo J / Bagaya, Bernard S / Kirenga, Bruce / Mayanja-Kizza, Harriet / Joloba, Moses L / Forslund, Sofia K

Frontiers in immunology

2023 Volume 13, Page(s) 1085551

Abstract: Chronic Obstructive Pulmonary Disease (COPD) has significantly contributed to global mortality, with three million deaths reported annually. This impact is expected to increase over the next 40 years, with approximately 5 million people predicted to ... ...

Abstract	Chronic Obstructive Pulmonary Disease (COPD) has significantly contributed to global mortality, with three million deaths reported annually. This impact is expected to increase over the next 40 years, with approximately 5 million people predicted to succumb to COPD-related deaths annually. Immune mechanisms driving disease progression have not been fully elucidated. Airway microbiota have been implicated. However, it is still unclear how changes in the airway microbiome drive persistent immune activation and consequent lung damage. Mechanisms mediating microbiome-immune crosstalk in the airways remain unclear. In this review, we examine how dysbiosis mediates airway inflammation in COPD. We give a detailed account of how airway commensal bacteria interact with the mucosal innate and adaptive immune system to regulate immune responses in healthy or diseased airways. Immune-phenotyping airway microbiota could advance COPD immunotherapeutics and identify key open questions that future research must address to further such translation.
MeSH term(s)	Humans ; Pulmonary Disease, Chronic Obstructive ; Lung ; Inflammation ; Disease Progression ; Microbiota
Language	English
Publishing date	2023-01-17
Publishing country	Switzerland
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2022.1085551
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Article ; Online: Divergent neuroimmune signatures in the cerebrospinal fluid predict differential gender-specific survival among patients with HIV-associated cryptococcal meningitis.

Okurut, Samuel / Boulware, David R / Okafor, Elizabeth / Rhein, Joshua / Kajumbula, Henry / Bagaya, Bernard S / Bwanga, Freddie / Olobo, Joseph O / Manabe, Yukari C / Meya, David B / Janoff, Edward N

Frontiers in immunology

2023 Volume 14, Page(s) 1275443

Abstract: Introduction: Survival among people with HIV-associated cryptococcal meningitis (CM) remains low, particularly among women, despite the currently optimal use of antifungal drugs. Cryptococcus dissemination into the central nervous system [brain, spinal ... ...

Abstract	Introduction: Survival among people with HIV-associated cryptococcal meningitis (CM) remains low, particularly among women, despite the currently optimal use of antifungal drugs. Cryptococcus dissemination into the central nervous system [brain, spinal cord, and cerebrospinal fluid (CSF)] elicits the local production of cytokines, chemokines, and other biomarkers. However, no consistent diagnostic or prognostic neuroimmune signature is reported to underpin the risk of death or to identify mechanisms to improve treatment and survival. We hypothesized that distinct neuroimmune signatures in the CSF would distinguish survivors from people who died on antifungal treatment and who may benefit from tailored therapy. Methods: We considered baseline clinical features, CSF cryptococcal fungal burden, and CSF neuroimmune signatures with survival at 18 weeks among 419 consenting adults by "gender" (168 women and 251 men by biological sex defined at birth). Results: Survival at 18 weeks was significantly lower among women than among men {47% vs. 59%, respectively; hazard ratio (HR) = 1.4 [95% confidence interval (CI), 1.0 to 1.9; p = 0.023]}. Unsupervised principal component analysis (PCA) demonstrated divergent neuroimmune signatures by gender, survival, and intragender-specific survival. Overall, women had lower levels of programmed death ligand 1, Interleukin (IL) (IL-11RA/IL-1F30, and IL-15 (IL-15) than men (all p < 0.028). Female survivors compared with those who died expressed significant elevations in levels of CCL11 and CXCL10 chemokines (both p = 0.001), as well as increased T helper 1, regulatory, and T helper 17 cytokines (all p < 0.041). In contrast, male survivors expressed lower levels of IL-15 and IL-8 compared with men who died (p < 0.044). Conclusions: Survivors of both genders demonstrated a significant increase in the levels of immune regulatory IL-10. In conclusion, the lower survival among women with CM was accompanied by distinct differential gender-specific neuroimmune signatures. These female and male intragender-specific survival-associated neuroimmune signatures provide potential targets for interventions to advance therapy to improve the low survival among people with HIV-associated CM.
MeSH term(s)	Adult ; Infant, Newborn ; Humans ; Female ; Male ; Meningitis, Cryptococcal/drug therapy ; Interleukin-15/therapeutic use ; Antifungal Agents/therapeutic use ; Cytokines/therapeutic use ; Chemokines/therapeutic use ; Interleukins/therapeutic use ; HIV Infections/drug therapy ; HIV Infections/complications
Chemical Substances	Interleukin-15 ; Antifungal Agents ; Cytokines ; Chemokines ; Interleukins
Language	English
Publishing date	2023-12-13
Publishing country	Switzerland
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2023.1275443
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Article ; Online: Heme oxygenase-1 and neopterin plasma/serum levels and their role in diagnosing active and latent TB among HIV/TB co-infected patients: a cross sectional study.

Uwimaana, Esther / Bagaya, Bernard S / Castelnuovo, Barbara / Kateete, David P / Godwin, Anguzu / Kiwanuka, Noah / Whalen, Christopher C / Joloba, Moses L

BMC infectious diseases

2021 Volume 21, Issue 1, Page(s) 711

Abstract: Background: Tuberculosis (TB) diagnosis in the context of HIV co-infection remains challenging. Heme oxygenase 1 (HO-1) and neopterin have been validated as potential biomarkers for TB diagnosis. Latent TB infection (LTBI) is diagnosed using tuberculin ... ...

Abstract	Background: Tuberculosis (TB) diagnosis in the context of HIV co-infection remains challenging. Heme oxygenase 1 (HO-1) and neopterin have been validated as potential biomarkers for TB diagnosis. Latent TB infection (LTBI) is diagnosed using tuberculin skin test (TST) and interferon gamma release assays (T-Spot and QuantiFERON TB gold tests, respectively). However, these tests have shown challenges and yet diagnosing LTBI is important for the overall control of TB. This study was conducted to determine the levels of H0-1 and neopterin, and their role in the diagnosis of TB among individuals enrolled in the Community Health and Social Network of Tuberculosis (COHSONET) study and the Kampala TB Drug Resistance Survey (KDRS). Methods: This was a nested cross-sectional study. Plasma and serum samples collected from 140 patients at Mulago National Referral Hospital, Kampala Uganda were used. M.tb culture was performed on sputum to confirm active TB(ATB) and QuantiFERON TB gold test to confirm latent TB infection (LTBI). ELISAs were performed to determine the levels of HO-1 and neopterin. Data analysis was done using t-test and Receiver Operating Characteristic curves to determine the diagnostic accuracy. Results: HO-1 levels among active tuberculosis (ATB)/HIV-infected patients and LTBI/HIV-infected patients were 10.7 ng/ml (IQR: 7.3-12.7 ng/ml) and 7.5 ng/ml (IQR: 5.4-14.1 ng/ml) respectively. Neopterin levels among ATB/HIV-positive patients and LTBI/HIV-positive patients were 11.7 ng/ml (IQR: 5.2.4 ng/ml) and 8.8 ng/ml (IQR: 2.4-19.8 ng/ml), respectively. HO-1 showed a sensitivity of 58.57% and a specificity of 67.14% with area under the curve (AUC) of 0.57 when used to discriminate between ATB and LTB. Neopterin showed an AUC of 0.62 with a sensitivity of 57.14% and a specificity of 60.0% when used to distinguish ATB from LTB. Conclusion: There was no in significant difference in HO-1 concentration levels of ATB individuals compared to LTB individuals. There was a significant difference in neopterin concentrations levels of ATB individuals compared to latently infected individuals. Findings from this study, show that HO-1 and neopterin have poor ability to distinguish between ATB and LTB.
MeSH term(s)	Coinfection/diagnosis ; Cross-Sectional Studies ; HIV Infections/complications ; Heme Oxygenase-1 ; Humans ; Interferon-gamma Release Tests ; Latent Tuberculosis/complications ; Latent Tuberculosis/diagnosis ; Neopterin ; Tuberculin Test ; Tuberculosis/complications ; Tuberculosis/diagnosis ; Uganda
Chemical Substances	Neopterin (670-65-5) ; Heme Oxygenase-1 (EC 1.14.14.18)
Language	English
Publishing date	2021-07-27
Publishing country	England
Document type	Journal Article
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-021-06370-7
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Article: Phylogenetic Networks and Parameters Inferred from HIV Nucleotide Sequences of High-Risk and General Population Groups in Uganda: Implications for Epidemic Control

Bbosa, Nicholas / Ssemwanga, Deogratius / Nsubuga, Rebecca N. / Kiwanuka, Noah / Bagaya, Bernard S. / Kitayimbwa, John M. / Ssekagiri, Alfred / Yebra, Gonzalo / Kaleebu, Pontiano / Leigh-Brown, Andrew

Viruses. 2021 May 24, v. 13, no. 6

2021

Abstract: Phylogenetic inference is useful in characterising HIV transmission networks and assessing where prevention is likely to have the greatest impact. However, estimating parameters that influence the network structure is still scarce, but important in ... ...

Abstract	Phylogenetic inference is useful in characterising HIV transmission networks and assessing where prevention is likely to have the greatest impact. However, estimating parameters that influence the network structure is still scarce, but important in evaluating determinants of HIV spread. We analyzed 2017 HIV pol sequences (728 Lake Victoria fisherfolk communities (FFCs), 592 female sex workers (FSWs) and 697 general population (GP)) to identify transmission networks on Maximum Likelihood (ML) phylogenetic trees and refined them using time-resolved phylogenies. Network generative models were fitted to the observed degree distributions and network parameters, and corrected Akaike Information Criteria and Bayesian Information Criteria values were estimated. 347 (17.2%) HIV sequences were linked on ML trees (maximum genetic distance ≤4.5%, ≥95% bootstrap support) and, of these, 303 (86.7%) that consisted of pure A1 (n = 168) and D (n = 135) subtypes were analyzed in BEAST v1.8.4. The majority of networks (at least 40%) were found at a time depth of ≤5 years. The waring and yule models fitted best networks of FFCs and FSWs respectively while the negative binomial model fitted best networks in the GP. The network structure in the HIV-hyperendemic FFCs is likely to be scale-free and shaped by preferential attachment, in contrast to the GP. The findings support the targeting of interventions for FFCs in a timely manner for effective epidemic control. Interventions ought to be tailored according to the dynamics of the HIV epidemic in the target population and understanding the network structure is critical in ensuring the success of HIV prevention programs.
Keywords	Bayesian theory ; binomial distribution ; females ; genetic distance ; phylogeny ; Lake Victoria ; Uganda
Language	English
Dates of publication	2021-0524
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2516098-9
ISSN	1999-4915
ISSN	1999-4915
DOI	10.3390/v13060970
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Article ; Online: Characterising antibody avidity in individuals of varied Mycobacterium tuberculosis infection status using surface plasmon resonance.

Kimuda, Simon G / Biraro, Irene Andia / Bagaya, Bernard S / Raynes, John G / Cose, Stephen

PloS one

2018 Volume 13, Issue 10, Page(s) e0205102

Abstract: There is increasing evidence supporting a role for antibodies in protection against tuberculosis (TB), with functional antibodies being described in the latent state of TB infection. Antibody avidity is an important determinant of antibody-mediated ... ...

Abstract	There is increasing evidence supporting a role for antibodies in protection against tuberculosis (TB), with functional antibodies being described in the latent state of TB infection. Antibody avidity is an important determinant of antibody-mediated protection. This study characterised the avidity of antibodies against Ag85A, an immunodominant Mycobacterium tuberculosis (M.tb) antigen and constituent of several anti-TB vaccine candidates, in individuals of varied M.tb infection status. Avidity of Ag85A specific antibodies was measured in 30 uninfected controls, 34 individuals with latent TB infection (LTBI) and 75 active pulmonary TB (APTB) cases, employing the more commonly used chaotrope-based dissociation assays, and surface plasmon resonance (SPR). Chaotrope-based assays indicated that APTB was associated with a higher antibody avidity index compared to uninfected controls [adjusted geometric mean ratio (GMR): 1.641, 95% confidence interval (CI): 1.153, 2.337, p = 0.006, q = 0.018] and to individuals with LTBI [adjusted GMR: 1.604, 95% CI: 1.282, 2.006, p < 0.001, q <0.001]. SPR assays showed that APTB was associated with slower dissociation rates, an indication of higher avidity, compared to uninfected controls (adjusted GMR: 0.796, 95% CI: 0.681, 0.932, p = 0.004, q = 0.012) and there was also weak evidence of more avid antibodies in the LTBI compared to the uninfected controls (adjusted GMR: 0.871, 95% CI: 0.763, 0.994, p = 0.041, q = 0.123). We found no statistically significant differences in anti-Ag85A antibody avidity between the APTB and LTBI groups. This study shows that antibodies of increased avidity are generated against a principle vaccine antigen in M.tb infected individuals. It would be important to determine whether TB vaccines are able to elicit a similar response. Additionally, more research is needed to determine whether antibody avidity is important in protection against infection and disease.
MeSH term(s)	Adolescent ; Adult ; Antibodies, Bacterial/metabolism ; Antibody Affinity ; Child ; Child, Preschool ; Coinfection ; Cross-Sectional Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; HIV Infections/complications ; HIV Infections/immunology ; Humans ; Infant ; Latent Tuberculosis/complications ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/immunology ; Male ; Middle Aged ; Mycobacterium tuberculosis/immunology ; Social Class ; Surface Plasmon Resonance/methods ; Tuberculosis, Pulmonary/complications ; Tuberculosis, Pulmonary/diagnosis ; Tuberculosis, Pulmonary/immunology ; Young Adult
Chemical Substances	Antibodies, Bacterial
Language	English
Publishing date	2018-10-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0205102
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Article ; Online: Biobanking: Strengthening Uganda's Rapid Response to COVID-19 and Other Epidemics.

Kamulegeya, Rogers / Kateete, David Patrick / Bagaya, Bernard S / Nasinghe, Emmanuel / Muttamba, Winters / Nsubuga, Gideon / Kigozi, Edgar / Katabazi, Fred Ashaba / Nakwagala, Fred / Kalungi, Sam / Byamugisha, Josaphat / Worodria, William / Magala, Rose / Kirenga, Bruce / Joloba, Moses L

Biopreservation and biobanking

2021 Volume 20, Issue 3, Page(s) 238–243

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Biological Specimen Banks ; COVID-19/epidemiology ; COVID-19 Testing ; Clinical Laboratory Techniques/methods ; Humans ; Pandemics ; SARS-CoV-2 ; Uganda/epidemiology
Language	English
Publishing date	2021-10-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2593993-2
ISSN	1947-5543 ; 1947-5535
ISSN (online)	1947-5543
ISSN	1947-5535
DOI	10.1089/bio.2021.0022
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Article ; Online: Sputum Microbiome and Chronic Obstructive Pulmonary Disease in a Rural Ugandan Cohort of Well-Controlled HIV Infection.

Microbiology spectrum

2023 , Page(s) e0213921

Abstract: Sub-Saharan Africa has increased morbidity and mortality related to chronic obstructive pulmonary disease (COPD). COPD among people living with HIV (PLWH) has not been well studied in this region, where HIV/AIDS is endemic. Increasing evidence suggests ... ...

Abstract	Sub-Saharan Africa has increased morbidity and mortality related to chronic obstructive pulmonary disease (COPD). COPD among people living with HIV (PLWH) has not been well studied in this region, where HIV/AIDS is endemic. Increasing evidence suggests that respiratory microbial composition plays a role in COPD severity. Therefore, we aimed to investigate microbiome patterns and associations among PLWH with COPD in Sub-Saharan Africa. We conducted a cross-sectional study of 200 adults stratified by HIV and COPD in rural Uganda. Induced sputum samples were collected as an easy-to-obtain proxy for the lower respiratory tract microbiota. We performed 16S rRNA gene sequencing and used PICRUSt2 (version 2.2.3) to infer the functional profiles of the microbial community. We used a statistical tool to detect changes in specific taxa that searches and adjusts for confounding factors such as antiretroviral therapy (ART), age, sex, and other participant characteristics. We could cluster the microbial community into three community types whose distribution was shown to be significantly impacted by HIV. Some genera, e.g.,
Language	English
Publishing date	2023-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2807133-5
ISSN	2165-0497 ; 2165-0497
ISSN (online)	2165-0497
ISSN	2165-0497
DOI	10.1128/spectrum.02139-21
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Article ; Online: Phylogenetic Networks and Parameters Inferred from HIV Nucleotide Sequences of High-Risk and General Population Groups in Uganda: Implications for Epidemic Control.

Bbosa, Nicholas / Ssemwanga, Deogratius / Nsubuga, Rebecca N / Kiwanuka, Noah / Bagaya, Bernard S / Kitayimbwa, John M / Ssekagiri, Alfred / Yebra, Gonzalo / Kaleebu, Pontiano / Leigh-Brown, Andrew

Viruses

2021 Volume 13, Issue 6

Abstract	Phylogenetic inference is useful in characterising HIV transmission networks and assessing where prevention is likely to have the greatest impact. However, estimating parameters that influence the network structure is still scarce, but important in evaluating determinants of HIV spread. We analyzed 2017 HIV
MeSH term(s)	Adult ; Base Sequence/genetics ; Bayes Theorem ; Cross-Sectional Studies ; Epidemics/prevention & control ; Female ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Infections/transmission ; HIV-1/classification ; HIV-1/genetics ; Humans ; Male ; Phylogeny ; Population Groups/statistics & numerical data ; Risk Factors ; Sex Workers/statistics & numerical data ; Uganda
Language	English
Publishing date	2021-05-24
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2516098-9
ISSN	1999-4915 ; 1999-4915
ISSN (online)	1999-4915
ISSN	1999-4915
DOI	10.3390/v13060970
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Article ; Online: Hepatitis B prevalence and incidence in the fishing communities of Lake Victoria, Uganda: a retrospective cohort study.

Kitandwe, Paul Kato / Muyanja, Enoch / Nakaweesa, Teddy / Nanvubya, Annet / Ssetaala, Ali / Mpendo, Juliet / Okech, Brenda / Bagaya, Bernard S / Kiwanuka, Noah / Price, Matt A

BMC public health

2021 Volume 21, Issue 1, Page(s) 394

Abstract: Introduction: Hepatitis B is a serious potentially fatal hepatocellular disease caused by the hepatitis B virus. In the fishing communities of Lake Victoria Uganda, the hepatitis B virus infection burden is largely unknown. This study assessed the ... ...

Abstract	Introduction: Hepatitis B is a serious potentially fatal hepatocellular disease caused by the hepatitis B virus. In the fishing communities of Lake Victoria Uganda, the hepatitis B virus infection burden is largely unknown. This study assessed the prevalence and incidence of hepatitis B in these communities. Methods: This was a retrospective cohort study that tested serum samples collected from 13 to 49-year-old study participants that were residing in two Ugandan Lake Victoria fishing communities of Kasenyi (a mainland) and Jaana (an island). The samples were collected between 2013 and 2015 during the conduct of an HIV epidemiological cohort study in these communities. A total of 467 twelve-month follow-up and 50 baseline visit samples of participants lost to follow-up were tested for hepatitis B serological markers to determine prevalence. To determine hepatitis B virus incidence, samples that were hepatitis B positive at the follow-up visit had their baseline samples tested to identify hepatitis B negative samples whose corresponding follow-up samples were thus incident cases. Results: The baseline mean age of the 517 study participants was 31.1 (SD ± 8.4) years, 278 (53.8%) of whom were females. A total of 36 (7%) study participants had hepatitis B virus infection, 22 (61.1%) of whom were male. Jaana had a higher hepatitis B virus prevalence compared to Kasenyi (10.2% vs 4.0%). In total, 210 (40.6%) study participants had evidence of prior hepatitis B virus infection while 48.6% had never been infected or vaccinated against this disease. A total of 20 (3.9%) participants had results suggestive of prior hepatitis B vaccination. Hepatitis B incidence was 10.5 cases/100PY (95% CI: 7.09-15.53). Being above 25 years of age and staying in Jaana were significant risk factors for hepatitis B virus acquisition (AOR 1.6, 95% CI: 1.1-2.2; p < 0.01 and 1.4, 95% CI: 1.1-1.8; p < 0.01 respectively). Conclusion: Hepatitis B virus incidence in Lake Victoria fishing communities of Uganda is very high, particularly in the islands. Interventions to lower hepatitis B virus transmission in these communities are urgently needed.
MeSH term(s)	Adolescent ; Adult ; Cohort Studies ; Female ; HIV Infections ; Hepatitis B/epidemiology ; Humans ; Incidence ; Islands ; Lakes ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Uganda/epidemiology ; Young Adult
Language	English
Publishing date	2021-02-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/s12889-021-10428-1
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