The protozoan parasite Trypanosoma cruzi was first described by Carlos Chagas after isolation of the organism from the blood of a Brazilian patient in 1909 (Garcia et al., 2015). An estimated 7.5 to 10 million persons are infected with Chagas disease worldwide (Hotez et al., 2008; Hotez et al., 2014). In the United States, the disease is anecdotally referred to as a “silent killer” with a 30% chance of those infected to develop a potentially fatal cardiac disease. According to Cantey et al. (2012), Chagas disease is emerging as a significant public health concern in the United States. Given the proximity of Texas to Latin America, cases imported from highly endemic areas in Latin America would likely occur in Texas. Recent communication from the Centers for Disease Control and Prevention that the bite of blood-sucking triatomine bugs in the subfamily Triatominae also termed “kissing bugs” that transfers the parasites to humans have now been found in 28 states, including California and Pennsylvania. Garcia et al. (2015) argued that despite the numerous publications related to Chagas disease in the southern US and northern regions of Mexico, very little is known about the disease burden from imported and locally acquired T. cruzi infection.There is concern that Chagas disease might be undiagnosed in the US as a result of documented low physician awareness (Stimpert & Montgomery, 2010). While the zoonotic nature of Chagas’ life cycle implies unfeasible eradication; entomological surveillance is and will remain crucial to containing Chagas disease transmission (Tarleton et al., 2007).
While it is considered safe to breastfeed even if the mother has Chagas disease (Centers for disease control and prevention, 2013); people can also become infected through blood transfusion, congenital transmission (from a pregnant woman to her baby), organ transplantation, accidental laboratory exposure and consumption of uncooked food contaminated with feces from infected bugs. If the mother has cracked nipples or blood in the breast milk, it is warranted to pump and discard the milk until the bleeding resolves and the nipples heal (Centers for disease control and prevention, 2013). The enduring challenge of household reinfestation by locally native vectors as stated by Abad-Franch et al. (2011), horizontal strategies works better when the community takes on a protagonist role. Encouraging vector notification by residents and other simple forms of participation can substantially enhance the effectiveness of surveillance (Abad-Franch et al., 2011). Therefore, control programs in concert with community-based approaches as a strategic asset from inception that requires a timely, professional response to every notification, benefiting from a strengthened focus on community empowerment. According to Schofield (1978), when bug population density is low, vector detection failures are unavoidable. Decision-making will be dependent upon the accurate estimation of infestation rates (World Health Organization, 2002), and imperfect detection can seriously misguide Chagas disease control management program. Continued attentiveness from governmental and health organizations are warranted, as this disease continue to be a globalized public health issue. Improved diagnostic tools, expanded surveillance and increased research funding will be required in maintaining existing effective public health strategies and in preventing the spread of the disease to new areas and populations (Bonney, 2014). To improve outbreak control, and improve Chagas disease response, it is essential to discuss the gaps in the scientific knowledge of the disease. Moreover, crucial in improving the morbidity in the state of Texas and neighboring states is the recommendation of the needed steps to enhance the understanding of T. cruzi.
Abad-Franch, F., Vega, M. C., Rolón, M. S., Santos, W. S., & de Arias, A. R. (2011). Community participation in Chagas disease vector surveillance: systematic review. PLoS Negl Trop Dis, 5(6), e1207.
Bonney, K. M. (2014). Chagas disease in the 21st century: a public health success or an emerging threat?. Parasite, 21, 11.
Cantey, P. T., Stramer, S. L., Townsend, R. L., Kamel, H., Ofafa, K., Todd, C. W., … & Hall, C. (2012). The United States Trypanosoma cruzi Infection Study: evidence for vector‐borne transmission of the parasite that causes Chagas disease among United States blood donors. Transfusion, 52(9), 1922-1930.
Centers for disease control and prevention. (2013). Parasites-American Trypanosomiasis (also known as Chagas Disease). Retrieved 21 July, 2016, from http://www.cdc.gov/parasites/chagas/gen_info/detailed.html
Garcia, M. N., Woc-Colburn, L., Aguilar, D., Hotez, P. J., & Murray, K. O. (2015). Historical perspectives on the epidemiology of human chagas disease in Texas and recommendations for enhanced understanding of clinical chagas disease in the Southern United States. PLOS Negl Trop Dis, 9(11), e0003981.
Hotez, P. J., Bottazzi, M. E., Franco-Paredes, C., Ault, S. K., & Periago, M. R. (2008). The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis, 2(9), e300.
Hotez, P. J., Alvarado, M., Basáñez, M. G., Bolliger, I., Bourne, R., Boussinesq, M., … & Carabin, H. (2014). The global burden of disease study 2010: interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis, 8(7), e2865.
Schofield, C. J. (1978). A comparison of sampling techniques for domestic populations of Triatominae. Transactions of the Royal Society of Tropical Medicine and Hygiene, 72(5), 449-455.
Stimpert, K. K., & Montgomery, S. P. (2010). Physician awareness of Chagas disease, USA. Emerging infectious diseases, 16(5), 871.
Tarleton, R. L., Reithinger, R., Urbina, J. A., Kitron, U., & Gürtler, R. E. (2007). The challenges of Chagas disease—Grim outlook or glimmer of hope?. PLoS Med, 4(12), e332.
World Health Organization. (2002). Control of Chagas disease: second report of the WHO expert committee.
In most countries, public health approaches to address violent radicalization are already applied in street violence and bioterrorism; but leaders and stakeholders need to embrace the significance of public health interventions and research on violent radicalization (Bhui et al., 2012). While past studies (Bakker, 2006; Loza, 2007) found that overwhelming majority of people who become radicalized to violence in the West are young and male, generally aged between mid-teens and mid-20s; scarcity of research findings on the extent and nature of women’s roles in group and community radicalization (Carter, 2013). The recent acts of terrorism around the world, especially the event in San Bernardino California, it is important to note the urgent need to look at the significance of a public health approach to understanding violent radicalization. Recognizing this sense of urgency introduce the possible role of collective responsibility of leaders in epidemiology, sociology, psychology and other behavioral sciences in developing novel epidemiologic measures towards prevention strategies (Bhui, Hicks, Lashley, & Jones, 2012). While most nation’s counterterrorism approaches are grounded in inter-governmental intelligence data exchange and criminal justice systems, embracing the perceived belief that existing legal system can deal with violent radicalization effectively; it is paramount to argue that new players be included in the collection of relevant data needed in the development of public health approach to address violence such as the World Health Organization’s Violence Prevention Alliance, and the Centers for Disease Control and Prevention (CDC). The goal of CDC’s “Public Health Approach to Violence Prevention” is to decrease risk factors and increase protective factors. The logical argument for this proposed study is the need for public health research, and establish a new approach to guard against violent radicalization.
Given the current integrated surveillance system that monitors death and injuries as a direct effect of terrorism events, it is critical to recognize the risk and protective factors for violent radicalization. Bhui et al. (2102) noted “the perceived discrimination in the population as a whole or amongst distinct segments of the population; trust in authorities and their counterterrorism approaches; perceived or real economic inequalities patterned by ethnicity or religious groups; and international conflict in which the authorities appear to be biased or unfair towards a specific migrant, religious or ethnic group.” For future research, it is paramount to identify the possible independent variables that are associated with the increased probability of radicalization in certain communities such as marginalized communities, diaspora communities, and ideology. The perceived feeling of inclusion or integration in a larger, popular community was theorized to amplify the extent of susceptibility to radicalization. Baumeister and Leary (1995) asserted on the importance of adapting psychological theories on stable interpersonal relationships. It is critical to examine the perceived instability in diaspora communities that could increase the risk of marginalization. Indicators related specifically to diaspora communities are language, the size of the community, the arrival age of immigrant(s) to the community, the age structure of the population, and the spatial concentration of the community. Marret et al. (2013) asserted the importance of understanding the core of radicalization process that demands the necessity to question and debate the concept of violent radicalization at the theoretical level and the empirical level. The motivation for an individual or group to commit extremist violence or terrorism is not grounded in a single ideology, but selectively demonstrate their commitment from different clusters of belief systems. Behavioral indicators as stated by Fishman (2010) could be generated from social media, chat rooms, and involvement in public ideologically motivated legal activities might provide insights into community-based ideological sentiments.
Bakker, E. (2006). Jihadi terrorists in Europe, their characteristics and the circumstances in which they joined the jihad: an exploratory study.
Baumeister, R. F., & Leary, M. R. (1995). The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological bulletin, 117(3), 497.
Bhui, K. S., Hicks, M. H., Lashley, M., & Jones, E. (2012). A public health approach to understanding and preventing violent radicalization. BMC medicine, 10(1), 16.
Carter, B. (2013). Women and violent extremism. GSDRC Helpdesk Research Report.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2008). The public health approach to violence prevention. Atlanta, GA: CDC.
Fishman, Shira. (2010). “Community-Level Indicators of Radicalization: A Data and Methods Task Force.” Report to Human Factors / Behavioral Sciences Division, Science and Technology Directorate, U.S. Department of Homeland Security. Retrieved from http://www.start.umd.edu/pubs/START_HFD_CommRadReport.pdf
King, G., & Zeng, L. (2001). Logistic regression in rare events data. Political analysis, 9(2), 137-163.
Labilles, U. (2016). The significance of Public Health Approach on Violent Radicalization (Unpublished, Advanced Epidemiology Methods, PUBH-8520-1, 2016 Winter Qtr. Wk9Proj) Walden University, Minneapolis.
Loza, W. (2007). The psychology of extremism and terrorism: A Middle-Eastern perspective. Aggression and Violent Behavior, 12(2), 141-155.
Marret, J. L., Feddes, A. R., Mann, L., Doosje, B., & Griffioen-Young, H. (2013). An Overview of the SAFIRE Project: A Scientific Approach to Finding Indicators and Responses to Radicalization. Journal Exit-Deutschland. Zeitschrift für Deradikalisierung und demokratische Kultur, 2, 123-148.
Last Christmas Eve, I received a wonderful and encouraging letter from the President. My daughter Abby opened it with excitement, and after reading his letter, she asked if she could keep it. We may all have something to say regarding what are happening around us, and we may all have our default someone to blame, but in the eyes of a growing citizen of this great country of ours, what is paramount is learning respect and love for our country. In the eyes of a child, a leader is someone who will make her/his place in this world a better place to live. They do not know about political parties, politicians at each other’s throat, but just a very simple concept “Peace.” After watching the movie “Unbroken” last night, she told me that she need to write the President a thank you letter. I told her that I already did via e-mail. Then she said, I need to thank him too since like Louis in the movie, he does not give up to something what is right. Enjoy what is left with the Holiday Season everyone.