Control Program Research Articles

Quality control of the stereotactic radiosurgery procedure with the alanine-EPR dosimetry

The SRS Technique is a procedure that uses ionizing radiation usually in a single dose or in a maximum number of five fractions for the treatment of intracranial lesions. Multiple brain metastases single-isocenter stereotactic radiosurgery (SRS) treatment is increasingly employed in radiotherapy services. In this treatment is required that the prescription dose be restricted to the lesion only and have a pronounced dose decay in the adjacent healthy tissue. An extensive quality control program must be employed to ensure the quality of the entire treatment procedure. The purpose of this study was to investigate the use of alanine-EPR dosimeters as a dosimetric tool for quality control of the stereotactic radiosurgery procedure using the Volume Modulated Arc Technique (VMAT). The results showed that the alanine-EPR response is linear with the radiation dose in the range from 2 to 100 Gy, with a low dose rate and energy dependencies. The results of the doses measured with alanine in relation to the planned value for the four lesions were concordant, with differences smaller than 1.2%. The experiment enabled a comprehensive assessment of the entire SRS procedure, encompassing both the treatment planning and irradiation phases. Consequently, both mechanical and dosimetric parameters can be evaluated concurrently, allowing for a comprehensive assessment of the total inaccuracy of the procedure.

Risk of arboviral transmission and insecticide resistance status of Aedes mosquitoes during a yellow fever outbreak in Ghana

BackgroundIn late 2021, Ghana was hit by a Yellow Fever outbreak that started in two districts in the Savannah region and spread to several other Districts in three regions. Yellow fever is endemic in Ghana. However, there is currently no structured vector control programme for Aedes the arboviral vector in Ghana. Knowledge of Aedes bionomics and insecticide susceptibility status is important to control the vectors. This study therefore sought to determine Aedes vector bionomics and their insecticide resistance status during a yellow fever outbreak.MethodsThe study was performed in two yellow fever outbreak sites (Wenchi, Larabanga) and two non-outbreak sites (Kpalsogu, Pagaza) in Ghana. Immature Aedes mosquitoes were sampled from water-holding containers in and around human habitations. The risk of disease transmission was determined in each site using stegomyia indices. Adult Aedes mosquitoes were sampled using Biogents Sentinel (BG) traps, Human Landing Catch (HLC), and Prokopack (PPK) aspirators. Phenotypic resistance to permethrin, deltamethrin and pirimiphos-methyl was determined with WHO susceptibility tests using Aedes mosquitoes collected as larvae and reared into adults. Knockdown resistance (kdr) mutations were detected using allele-specific multiplex PCR.ResultsAmong the 2,664 immature Aedes sampled, more than 60% were found in car tyres. Larabanga, an outbreak site, was classified as a high-risk zone for the Yellow Fever outbreak (BI: 84%, CI: 26.4%). Out of 1,507 adult Aedes mosquitoes collected, Aedes aegypti was the predominant vector species (92%). A significantly high abundance of Aedes mosquitoes was observed during the dry season (61.2%) and outdoors (60.6%) (P < 0.001). Moderate to high resistance to deltamethrin was observed in all sites (33.75% to 70%). Moderate resistance to pirimiphos-methyl (65%) was observed in Kpalsogu. Aedes mosquitoes from Larabanga were susceptible (98%) to permethrin. The F1534C kdr, V1016I kdr and V410 kdr alleles were present in all the sites with frequencies between (0.05–0.92). The outbreak sites had significantly higher allele frequencies of F1534C and V1016I respectively compared to non-outbreak sites (P < 0.001).ConclusionThis study indicates that Aedes mosquitoes in Ghana pose a significant risk to public health. Hence there is a need to continue monitoring these vectors to develop an effective control strategy.

Geospatial Analysis of Lumpy Skin Disease Outbreaks among Cattle in Uttar Pradesh, India, 2021-2022.

The emergence of lumpy skin disease (LSD) among cattle in India is concerning. District-level data on LSD cases in Uttar Pradesh between 2021 and 2022 were analyzed. A stepwise spatial analytical approach was followed by first constructing yearly and monthly disease maps for LSD incidence rates (IRs), then spatially interpolating the LSD IRs, followed by evaluating the global and local clustering of LSD IRs and finally conducting spatial regression modeling. Overall, 5784 LSD cases from 6 districts and 112,226 cases from 33 districts were detected in 2021 and 2022, respectively. In the incremental spatial autocorrelation analysis, the highest global clustering of LSD IRs for the 2022 outbreak was detected at 196.49 km. For the 2021 LSD outbreak, one district with high-low and nine districts with low-high LSD IRs were identified in the eastern region of the state. For the 2022 LSD outbreak, 13 districts with high-high and 7 districts with low-high LSD IRs were identified in the western part of the state. A geographically weighted regression model identified the impact of climate (temperature and humidity) and land cover (pasture, fallow, and non-agricultural land) on LSD IRs. The study results can aid animal health authorities in developing LSD prevention and control programs.

Tracking the invasive and euryhaline pikeperch Sander lucioperca in the lower River Thames using acoustic telemetry indicates no movements into areas of relatively high salinity.

Native to Central and Eastern Europe, the euryhaline pikeperch Sander lucioperca can acclimatize to elevated salinity levels (e.g., up to 30‰), but it remains unknown whether their invasive populations use this ability to inhabit and/or disperse through brackish waters, such as estuaries and inshore areas. To test whether invasive pikeperch show a propensity to move into areas of relatively high salinity, their spatial use and movement patterns (e.g., home range, distances moved, and movement rates) were assessed using acoustic telemetry in the upper River Thames estuary, southeast England. Analyses revealed that individual pikeperch were capable of moving relatively long distances in a short time (e.g., speeds up to 70 m min-1), with movement patterns associated more with tidal state and elevation at the water surface (both assumed to relate to changes in salinity) than diurnal changes. There were no recorded movements of any pikeperch into the more saline, downstream waters of the estuary where salinity levels were recorded to over 40‰, with the mean salinity in the most downstream area where pikeperch were detected being 1.39‰ (range of logger: 1.22-1.71). The results suggest that these pikeperch did not use high salinity waters when less saline waters were available, and thus the risk that they will use to move through high salinity areas to expand their invasive range appears low. Accordingly, efforts to minimize risks of the further dispersal of invasive pikeperch populations can focus on control and containment programmes within fresh waters.

Review on the impacts of indoor vector control on domiciliary pests: good intentions challenged by harsh realities.

Arthropod vectored diseases have been a major impediment to societal advancements globally. Strategies to mitigate transmission of these diseases include preventative care (e.g. vaccination), primary treatment and most notably, the suppression of vectors in both indoor and outdoor spaces. The outcomes of indoor vector control (IVC) strategies, such as long-lasting insecticide-treated nets (LLINs) and indoor residual sprays (IRSs), are heavily influenced by individual and community-level perceptions and acceptance. These perceptions, and therefore product acceptance, are largely influenced by the successful suppression of non-target nuisance pests such as bed bugs and cockroaches. Adoption and consistent use of LLINs and IRS is responsible for immense reductions in the prevalence and incidence of malaria. However, recent observations suggest that failed control of indoor pests, leading to product distrust and abandonment, may threaten vector control programme success and further derail already slowed progress towards malaria elimination. We review the evidence of the relationship between IVC and nuisance pests and discuss the dearth of research on this relationship. We make the case that the ancillary control of indoor nuisance and public health pests needs to be considered in the development and implementation of new technologies for malaria elimination.

May Measurement Month 2021: an analysis of blood pressure screening results from Kazakhstan.

The May Measurement Month (MMM) screening campaign initiated by the International Society of Hypertension aimed to assess the prevalence of hypertension and associated risk factors to increase and improve population awareness of raised blood pressure (BP) and methods of prevention. The MMM is a cross-sectional survey of adults aged 18 years and over of both sexes who gave informed consent to participate in the survey and to have their BP measured. Kazakhstan participated in the campaign for the first time in 2021. Blood pressure was measured three times on a single occasion, and data on cardiovascular risk factors were collected. A total of 1763 respondents from 4 regions participated in the screening. The mean age was 41 ± 14.4 years; 31.5% of all participants were found to have hypertension, of whom 41.8% were aware, 34.0% on treatment, and only 15.8% controlled (<140/90 mmHg). Significant differences in these rates were found between age and sex groups. The screening campaign confirms low levels of awareness of hypertension and associated risk factors in the population in Kazakhstan and the need for annual screening and implementation of national hypertension control programmes.

Hazard Control Working at Height at PT Wijaya Karya Bangunan Gedung Tbk. Halim High-Speed Train Construction Project

PT Wijaya karya Bangunan Gedung Tbk. Halim High-Speed Train Project is a company engaged in construction, investment, and concessions. Engaged in the construction sector certainly has a high potential for danger and danger factors. One of them was an accident caused by working at a height. Therefore, it is important to control the danger of working at height to prevent and control the danger of height. This study uses field observation methods, literature studies, and interviews to determine how the hazard control program works at height. The hazard control program for working at height at PT Wijaya Karya Bangunan Gedung Tbk, Halim High-Speed Train Project has been by the regulation of the Minister of Manpower No. 9 of 2016, among others. Fit to work, toolbox meeting inspection, Scaffolding and Full Body Harness. At PT Wijaya Karya Bangunan Gedung Tbk, The halim high-speed train project has procedures related to the Control of work hazards at height, namely the height work safety procedure No. WIKA-BG-PDSMM-IK-26. PT Wijaya Karya Bangunan Gedung Tbk. Halim High-Speed Train Project, but there are still problems related to the lack of supervision of work safety equipment and lack of training for workers related to high-altitude work.

Intraguild species presence alters Aphidoletes aphidimyza (Diptera: Cecidomyiidae) and Aphidius gifuensis (Hymenoptera: Braconidae) foraging responses.

The predatory gall midge, Aphidoletes aphidimyza (Rondani), and tobacco aphid cocoon wasp, Aphidius gifuensis Ashmead, are important natural enemies of Myzus persicae (Sulzer) (Hemiptera: Aphididae). Predation by A. aphidimyza and A. gifuensis can regulate M. persicae; however, how interspecific interference competition affects their foraging efficiency is unknown. Here, we investigated the consumption and parasitization abilities of A. aphidimyza 3rd instar larva and A. gifuensis adults under various conditions. Consumption of parasitized aphids by A. aphidimyza 3rd instar larvae was significantly lower than that of nonparasitized controls, with a substantial increase in handling time. The presence of A. gifuensis adults did not significantly affect the predation capacity of A. aphidimyza larvae. Relative to controls, A. aphidimyza larvae predation trace (PT) and imago activity significantly decreased A. gifuensis parasitism rates at different aphid densities. Further, A. aphidimyza larvae PT increased the A. gifuensis handling time of M. persicae, whereas the presence of A. aphidimyza adults had the opposite effect. Coexistence with heterospecific natural enemies reduced the parasitic capacity of A. gifuensis, whereas A. aphidimyza larvae predation capability was influenced to a lesser extent. Our results demonstrate that intraguild interactions strongly influence the predatory and parasitic efficacy of A. aphidimyza and A. gifuensis, although the effect on A. gifuensis was more pronounced. For effective biological control of M. persicae using A. aphidimyza and A. gifuensis, we recommend releasing A. aphidimyza first to mitigate intraguild predation and enhance the overall success of the pest control program.

Malnutrition is a risk factor for tuberculosis disease among household contacts: A case-control study in Uganda

ObjectiveHousehold contacts (HHCs) of persons with tuberculosis (TB) including rifampicin-resistant or multi-drug-resistant TB (RR/MDR-TB) are at risk for TB infection. We investigated whether index patient-level clinical and socio-demographic factors of persons with MDR-TB are associated with TB disease among their HHCs in Uganda. MethodsWe designed an unmatched case-control study. Cases were HHCs of persons with MDR-TB that had TB disease while controls were a random sample of HHCs of persons with MDR-TB that had no TB disease. The case-to-control ratio was 1:3. We identified the factors that significantly differed between the cases and controls in a multivariable binary logistic regression analysis and reported the odds ratio (OR) and 95% confidence interval (CI). ResultsWe found similar demographic and clinical characteristics among the 11 cases and 33 controls. In a multivariable analysis, malnutrition was significantly associated with being a case than a control (adjusted OR 5.01; 95% CI 1.18-24.83). ConclusionTherefore, TB Control Programs should focus on identifying malnutrition among persons with MDR-TB and providing nutritional counseling and support to improve recovery, and potentially reduce household TB transmission and optimize treatment success. Additionally, rapid screening for TB and preventive therapy should be prioritized to reduce transmission.

Factors Influencing Adolescent Resilience and Human Immunodeficiency Virus-acquired Immune Deficiency Syndrome Prevention Behavior: A Cross-sectional Study of Adolescents in DKI Jakarta Province, Indonesia

Background The incidence of human immunodeficiency virus (HIV)-acquired immune deficiency syndrome (AIDS) remains high in Indonesia. Therefore, HIV-AIDS prevention and control programs have been established for adolescents aged 15–24 years based on the United Nations Sustainable Development Goals. Internal risk factors related to risky sexual behavior and external risk factors associated with exposure to pornography through the media are major hurdles that need to be overcome in efforts to prevent HIV-AIDS among adolescents. Meanwhile, individual protective factors through self-control and adolescent resilience strongly impact the enhancement of HIV-AIDS prevention behavior. This study aimed to determine whether internal and external risk factors and individual and sociocultural protective factors exert influences on adolescent resilience and HIV-AIDS prevention behavior among adolescents. Methods This research employed a descriptive quantitative design with a cross-sectional approach. The population consisted of high school students aged 15–19 years in Jakarta, and a sample of 619 students was taken through proportional stratified random sampling. Inferential analysis was conducted using partial least squares structural equation modeling. Results The data analysis revealed that adolescent resilience (β-value = 0.423; t = 12.129), internal risk factors (β-value = 0.292; t = 10.903), and external risk factors (β-value = -0.088; t = 6.127) most significantly influenced HIV-AIDS prevention behavior, with significant negative impacts. The sub-variable that most strongly determined the presence of HIV-AIDS prevention behavior (Y2) was self-control (λ = 0.983), and the one that did so most weakly was negative cognition (λ = 0.875). Conclusion Adolescent resilience is a crucial factor in enhancing HIV-AIDS prevention behavior among adolescents as it influences adolescents’ beliefs, boosts their self-confidence, fosters emotional insight, and develops social skills and empathy toward others. Thus, enhancing it through HIV-AIDS prevention programs is essential.

Challenges for the management of Johne’s disease in the UK: Expectation management, space, ‘free riding’, and vet-farmer communication

Johne’s disease in cattle is a significant global animal health challenge. Johne’s disease is chronic, affecting the gastrointestinal tract of cattle and other ruminants and is caused by the bacteria Mycobacterium avium ssp. Paratuberculosis. Many countries have introduced schemes and programmes to try and control the spread of Johne’s disease, including the UK. Despite efforts to control it, however, Johne’s disease remains consistently ranked by UK producers as the top ranked disease negatively affecting productivity, indicating that schemes are not perceived to have solved the problem fully. Building on a global systematic review of the literature on barriers and solutions for Johne’s disease control on-farm, we conducted an empirical study with over 400 farmers and 150 veterinary professionals across the UK. The study used workshops and semi-structured interviews to understand better the challenges dairy farmers and veterinarians face in implementing on-farm Johne’s disease management schemes with the aim of identifying solutions. The study found that four main challenges are faced in the on-farm control of Johne’s – (1) Management of farmer expectations around Johne’s disease, with eradication near impossible, (2) Issues regarding space for segregation and the related economics of control (3) A ‘free-riding’ problem which can be influenced by the voluntary nature of control plans and (4) Challenges in vet-farmer communication, including levels of knowledge. Our findings have relevance for the control of Johne’s disease in the UK and other countries, including for regions with voluntary and compulsory control programmes.

Willingness and capacity of publicly-funded vector control programs in the USA to engage in tick management

BackgroundThe vast majority of vector-borne diseases in the USA are associated with mosquitoes or ticks. Mosquito control is often conducted as part of community programs run by publicly-funded entities. By contrast, tick control focuses primarily on individual residential properties and is implemented predominantly by homeowners and the private pest control firms they contract. We surveyed publicly-funded vector control programs (VCPs), presumed to focus mainly on mosquitoes, to determine what tick-related services they currently offer, and their interest in and capacity to expand existing services or provide new ones.MethodsWe distributed a survey to VCPs in the Northeast, Upper Midwest and Pacific Coast states of the USA, where humans are at risk for bites by tick vectors (Ixodes scapularis or Ixodes pacificus) of agents causing Lyme disease and other tick-borne diseases. The data we report are based on responses from 118 VCPs engaged in vector control and with at least some activities focused on ticks.ResultsDespite our survey targeting geographic regions where ticks and tick-borne diseases are persistent and increasing public health concerns, only 11% (12/114) of VCPs reported they took direct action to suppress ticks questing in the environment. The most common tick-related activities conducted by the VCPs were tick bite prevention education for the public (70%; 75/107 VCPs) and tick surveillance (48%; 56/116). When asked which services they would most likely include as part of a comprehensive tick management program, tick bite prevention education (90%; 96/107), tick surveillance (89%; 95/107) and tick suppression guidance for the public (74%; 79/107) were the most common services selected. Most VCPs were also willing to consider engaging in activities to suppress ticks on public lands (68%; 73/107), but few were willing to consider suppressing ticks on privately owned land such as residential properties (15%; 16/107). Across all potential tick-related services, funding was reported as the biggest obstacle to program expansion or development, followed by personnel.ConclusionsConsidering the hesitancy of VCPs to provide tick suppression services on private properties and the high risk for tick bites in peridomestic settings, suppression of ticks on residential properties by private pest control operators will likely play an important role in the tick suppression landscape in the USA for the foreseeable future. Nevertheless, VCPs can assist in this effort by providing locally relevant guidelines to homeowners and private pest control firms regarding best practices for residential tick suppression efforts and associated efficacy evaluations. Publicly-funded VCPs are also well positioned to educate the public on personal tick bite prevention measures and to collect tick surveillance data that provide information on the risk of human encounters with ticks within their jurisdictions.Graphical

Impact of ivermectin and vector control on onchocerciasis transmission in Togo: Assessing the empirical evidence on trends in infection and entomological indicators.

The World Health Organization's 2021-2030 Road Map for Neglected Tropical Diseases boosted global commitment towards the elimination of onchocerciasis, but the timeline to elimination will vary strongly between countries in Africa. To assess progress towards elimination in the Republic of Togo, we reviewed the history of control and time trends in infection. We collated all available programmatic, entomological, and epidemiological data since the initiation of the Onchocerciasis Control Programme (OCP) in Togo through different data sources. We then visualised data trends over time, to assess the impact of interventions on infection and transmission levels. Vector control was initiated by OCP from 1977 (northern and central parts of Togo) or 1988 (southern regions) up to 2002 (most areas) or 2007 ("special intervention zones" [SIZ], parts of Northern and Central Togo). Between 1988 and 1991, Togo initiated ivermectin mass drug administration (MDA) in eligible communities. The impact of vector control was high in most river basins, resulting in low annual biting rates and annual transmission potential declining to very low levels; the impact was lower in river basins designated as SIZ. Repeated, longitudinal ivermectin mass treatments have overall strongly reduced onchocerciasis transmission in Togo. Epidemiological surveys performed between 2014 and 2017 showed that the prevalence of skin microfilariae (mf) and anti-OV16 IgG4 antibodies had declined to low levels in several districts of the Centrale, Plateaux, and Maritime region. Yet, relatively high mf prevalences (between 5.0% and 32.7%) were still found in other districts during the same period, particularly along the Kéran, Mô and Ôti river basins (SIZ areas). Trends in infection prevalence and intensity show that onchocerciasis levels have dropped greatly over time in most areas. This demonstrates the large impact of long-term and wide-scale interventions, and suggest that several districts of Togo are approaching elimination.

Analytical performance of publicly dispensed glucometers in primary health care in a southern Brazilian city

AimsThis study aimed to assess the use of glucometers by patients and the analytical performance of glucometers provided by the primary care services. MethodsThe analytical performance of 48 glucometers Accu-Chek® Active, was assessed through quintuplicate analyses of one Roche and one PNCQ (National Quality Control Program) control sample at different concentrations; 31 were also evaluated by a single proficiency testing sample. The evaluation metrics included imprecision, bias, and total error and were measured according to quality specifications based on biological variation (QSBV). Glucometer users answered a questionnaire regarding their experience. ResultsAmong the 48 glucometers evaluated with internal control samples, 17 met precision criteria at both control levels according to QSBV, while 24 met the criteria at only one control level. Of the 31 glucometers further evaluated through proficiency test, 11 met accuracy criteria according to QSBV, and only one device showed an unacceptable result. Out of these 31, only 15 demonstrated a total error within the acceptable maximum limits based on QSBV. ConclusionsOverall, our findings showed that patients had a good understanding of glucometer usage and suggested that some glucometers should be replaced, as they sometimes failed to meet even the manufacturer’s acceptable variation limits, and/or did not meet QSBV.

Kato-Katz slide preservation technique: Extension of viability and the benefits for schistosomiasis control programs

The World Health Organization recommends the use of the Kato-Katz method in the procedures of schistosomiasis control programs. Studies show the importance of a fast reading of the slides due to the decline of their viability, with the appearance of fungi or desiccation of the sample, which hinders diagnosis. It is necessary to establish a procedure to improve the long-term preservation of these Kato-Katz slides in order to accomplish the following: (1) preserve the slides for future quality control procedures and readings; (2) allow for the production of durable materials for training; and (3) train health professionals involved in diagnosing schistosomiasis. Therefore, this study aims to test a slide preservation methodology for these purposes. The results showed that the modifications made to the experimental slides demonstrated that egg loss was within the expected range and the limit accepted by quality control standards, as well as improved the diagnostic durability of the slides during the preservation times tested. We concluded that the application of the preservation technique to the slides promoted stabilization and permanence for long-term storage.

Automated and rapid target position alignment in laser–plasma experiments using deep learning algorithms

In laser proton acceleration, laser pulses are tightly focused onto the solid target to achieve the highest intensity. For high-frequency application-oriented laser accelerators, the need for rapid and precise laser–target coupling technology is especially essential. We propose innovative methods that leverage deep learning algorithms to automate and expedite target positioning in laser–plasma experiments. Our comparative study of various techniques, such as position scanning, image recognition, and object detection, indicates that the YOLO (You Only Look Once) object detection network excels in facilitating swift and highly precise target positioning. It demonstrates an interference time of approximately 50 ms and a positioning accuracy of 8μm. Subsequently, we have successfully integrated this deep learning model into the control program of the Compact Laser Plasma Accelerator at Peking University to optimize the experimental setup process.

Implementation research on registering cancer cases in primary health centres of Puducherry through community health workers.

Background & objectives Hospital-based cancer registry does not represent the true burden of cancer in the community. Initiating a Primary Health Centre (PHC)-based cancer registry may better estimate population-level data for cancer cases in an area. This study aimed to set up a system for facilitating a PHC-based cancer registry and to assess the registration status of cancer cases in various PHCs of Puducherry. The facilitating and limiting factors while setting up this registry were also assessed. Methods A quasi-experimental study with an embedded mixed-method design was conducted in 31 PHCs/Community Health Centres (CHCs) from March 2021 to November 2022. The interventions were implemented in all PHCs/CHCs of Puducherry with the involvement of the State Non-Communicable Diseases (NCD) cell. The line list of cancer cases from the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Hospital-based cancer registry was shared with all PHCs/CHCs. Sensitization sessions for all Community Health Workers (CHWs) were conducted, and feedback on cancer registration status was given to the State NCD cell. Focus group discussion (FGD)/Key informant interview (KII) was undertaken to understand strengths, challenges, and suggestions. The logic model was used to understand the various indicators while setting up this PHC-based cancer registry. Results Over a one-year intervention period, 1270 cancer cases were registered at Puducherry's PHCs/CHCs, 1203 (88%) from the shared list and 67(5%) from other facilities. However, only 53 per cent of the expected living cases were captured in the various PHCs. Major limitations for registration were the COVID-19 pandemic, stigma, inadequate manpower, infrastructure issues, and privacy concerns during screening. Interpretation & conclusions It was feasible to set up a PHC-based cancer registry in all PHCs of Puducherry. However, registration of cancer cases was suboptimal, as population-based screening of cancer cases, as recommended in the National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) programme, was weak due to the COVID-19 pandemic. Once this is strengthened, the PHC-based cancer registry will better represent the population.

Evaluation of the Centers for Disease Control and Prevention's Essentials for Parenting Toddlers and Preschoolers on parent behavioral outcomes

BackgroundThe Centers for Disease Control and Prevention's web-based behavioral parent training (BPT) program, Essentials for Parenting Toddlers and Preschoolers (EfP), uses a psychoeducational approach to promote positive parenting and address common parenting challenges. The purpose of this study was to assess the effects of EfP on parenting behavior and whether implementation format impacted behavioral outcomes. MethodsA sample of 200 parents of 2- to 4-year-old children were recruited via Internet advertising. Using a repeated single subject, multiple baseline design, parents were randomly assigned to guided navigation (GN; n = 100) or unguided navigation (UN; n = 100) study conditions. Parents were provided secure access to the EfP website and completed 18 weekly surveys. Latent growth curve modeling was used to determine intervention effectiveness on behavioral outcomes. ResultsLatent growth curve modeling indicated both GN and UN study conditions significantly increased use of praise (β = 0.19, p = 0.038) and commands and consequences (β = 0.17, p < 0.001), and decreased corporal punishment use (β = −0.01, p = 0.017) and attitudes promoting corporal punishment (β = −0.01, p < 0.001) over the study period. The UN condition exhibited a significant initial decrease in time-out use that increased over time to match the GN condition. ConclusionsThis study provides evidence for the effectiveness of EfP in promoting non-violent parenting behavior and increasing positive parenting techniques. The format of EfP implementation made no difference in parenting behaviors over time. Digital BPT programs like EfP provide access to evidence-informed parenting resources and can enhance positive parenting.

Evolving the Role of Black Race in Hypertension Therapeutics.

Black race has been used to guide antihypertensive drug selection for Black patients based on predominant between race (same drug) and intra-race (different drugs) blood pressure (BP) response patterns. Accordingly, thiazide diuretics and calcium antagonists have been recommended over renin-angiotensin system (RAS) inhibitors (angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors) and beta blockers for Black patients. Current antihypertensive drug prescribing reflects historical guidance as calcium antagonists and thiazide diuretics are prescribed more and RAS blockers less in Black than White patients. Hypertension control rates in Blacks, lag those for Whites despite their greater use of combination drug therapy and lesser use of monotherapy. This is also true across drug regimens containing any of the 4 recommended classes for initial therapy as well as for evidence-based combination drug therapy (calcium antagonist or thiazide diuretic + RAS blocker) regimens for which there is no known racial disparity in BP response. Current recommendations acknowledge the need for combination drug therapy in most, especially in Black patients. One exemplary comprehensive hypertension control program achieved >80% control rates in Black and White patients with minimal racial disparity while utilizing a race-agnostic therapeutic algorithm. Black patients manifest robust, if not outsized, BP responses to diet/lifestyle modifications. Importantly, race neither appears to be a necessary nor sufficient consideration for the selection of effective drug therapy. Accordingly, we urge the initiation of adequately intense race-agnostic drug therapy coupled with greater emphasis on diet/lifestyle modifications for Black patients as the cornerstone of a race-informed approach to hypertension therapeutics.

‘We may need some help; we are just parents who have chosen to engage in football’: a qualitative study on amateur coaches’ experiences of use of and support for injury prevention training in Sweden

IntroductionAchieving sufficient adherence with injury prevention exercise programmes is a challenge. The aim was to explore how amateur football coaches experience the use of and support for injury prevention training...