Efficacy Of Preventive Interventions Research Articles

(Why?) Evidence-Based Treatments for War-Related Posttraumatic Stress Disorder

Any war increases at least twice the prevalence of post-traumatic stress disorder (PTSD) in its victims. Post-traumatic stress disorder (PTSD) affects about 10% of car accident victims, half of the people who have experienced rape or war, and victims of violence. PTSD negatively affects the quality of life. It is associated with direct and indirect health costs. Any effort to treat and prevent PTSD with evidence-based methods is our obligation toward trauma victims and to professionals at an increased risk of job-related traumatization. In the paper, we will focus on three aspects. First – a rationale of decision making – the role of evidence in elaborating the intervention guidelines will be described. Second, an overview of evidence-based guidelines for the psychological help and for the diagnosis and treatment of PTSD will be presented, according to current NICE (National Institute of Care Excellence) and APA (American Psychological Association) and meta-analyses focusing on war-related trauma. The third part of the paper will be devoted to the prevention of PTSD in people who are exposed to professional, duty-related trauma – the data on the efficacy of preventive interventions together with a short description of the programs (on the example of “Effective performance under stress” program designed to prevent PTSD in firefighters and other professions).

Pelvic floor status during pregnancy as a predictor of pelvic dysfunction and birth outcome

This literature review presents an analysis of a number of studies that examined the association between pelvic floor health during pregnancy and the development of pelvic dysfunction and birth outcomes. These studies consistently demonstrated that changes in pelvic floor structure and function during pregnancy are associated with an increased risk of developing pelvic disorders such as urinary incontinence and pelvic organ prolapse. Besides, certain pelvic floor characteristics, such as muscle strength, tone, and stretching ability, have been identified as potential predictors of pelvic floor dysfunction during pregnancy and prolonged second-stage labor. The data collected suggest that pelvic floor assessment during pregnancy may provide valuable prognostic information about birth outcomes. Understanding these relationships may lead to improved prenatal care strategies and interventions to optimize pelvic floor function and reduce the incidence of adverse birth outcomes. Further research is required to clarify the specific parameters for evaluating pelvic floor changes that are most indicative of pelvic organ dysfunction and adverse birth outcomes, as well as to assess the efficacy of preventive interventions.

Burnout Syndrome Among Healthcare Workers: A Systematic Review of Risk Factors and Prevention Strategies

Burnout syndrome is a pervasive and concerning issue among healthcare workers, posing significant challenges to both individual well-being and the overall functioning of healthcare systems. This systematic review aims to comprehensively investigate the risk factors contributing to burnout among healthcare professionals and evaluate the effectiveness of various prevention strategies. Additionally, this review explores the efficacy of preventive interventions designed to mitigate burnout. Strategies examined include organizational interventions, such as workload optimization, fostering a supportive work environment, and implementing effective leadership practices. The achievement of Sustainable Development Goal (SDG) objectives, particularly in the area of health, depends on the availability of a qualified health workforce. Concerns have recently been voiced regarding the behavior of healthcare professionals, which is reflected in the "no bed syndrome" at healthcare institutions. Critical care HCWs had significant BOS. The results of the study show that for critical care HCWs to reduce BOS, reducing intragroup conflict, improving skill utilization, and raising job satisfaction are crucial. This synthesis of evidence aims to inform future research directions and guide the development of targeted interventions to mitigate the growing prevalence of burnout syndrome among healthcare workers.

Concordance between SARS-CoV-2 index individuals and their household contacts on index individual COVID-19 transmission cofactors: a comparison of self-reported and contact-reported information

BackgroundFollowing the outbreak of the COVID-19 pandemic, several clinical trials have evaluated postexposure prophylaxis (PEP) among close contacts of an index individual with a confirmed SARS-CoV-2 infection. Because index individuals do not directly inform the efficacy of prevention interventions, they are seldom enrolled in COVID-19 PEP studies. However, adjusting for prognostic covariates such as an index individual’s COVID-19 illness and risk behaviors can increase precision in PEP efficacy estimates, so approaches to accurately collecting this information about the index individual are needed. This analysis aimed to assess whether surveying household contacts captures the same information as surveying the index individual directly.MethodsREGN 2069/CoVPN 3502, a randomized controlled trial of COVID-19 PEP, enrolled household contacts of SARS-CoV-2 index individuals. CoVPN 3502-01 retrospectively enrolled and surveyed the index individuals. We compared responses to seven similar questions about the index individuals’ transmission cofactors that were asked in both studies. We estimated the percent concordance between index individuals and their household contacts on each question, with 50% concordance considered equivalent to random chance.ResultsConcordance between index individuals and contacts was high on the most objective questions, approximately 97% (95% CI: 90–99%) for index individual age group and 96% (88–98%) for hospitalization. Concordance was moderate for symptoms, approximately 85% (75–91%). Concordance on questions related to the index individual’s behavior was only slightly better or no better than random: approximately 62% (51–72%) for whether they received COVID-19 treatment, 68% (57–77%) for sharing a bedroom, 70% (59–79%) for sharing a common room, and 49% (39–60%) for mask wearing at home. However, while contacts were surveyed within 96 h of the index individual testing positive for SARS-CoV-2, the median time to enrollment in CoVPN 3502-01 was 240 days, which may have caused recall bias in our results.ConclusionsOur results suggest a need to survey index individuals directly in order to accurately capture their transmission cofactors, rather than relying on their household contacts to report on their behavior. The lag in enrolling participants into CoVPN 3502-01 also highlights the importance of timely enrollment to minimize recall bias.

Association of umbilical cord serum TARC/CCL17 with childhood allergies: A birth cohort study

BackgroundEarly identification of infants at high risk of allergies can improve the efficacy of preventive interventions. However, an established quantifiable risk assessment method in the early postnatal period does not exist. TARC (or CCL17) is a Th2 chemokine used as an activity marker for atopic dermatitis (AD). Therefore, we evaluated the association between cord blood TARC (cTARC) and the development of allergic diseases in childhood. MethodsThis is a high-risk birth cohort for allergy, consisting of children with a family history of allergy. We collected 263 pairs of maternal and child cord blood samples perinatally and child blood samples at ages 1, 2, and 5 years. TARC and allergen-specific immunoglobulin E levels were measured, and the relationship between allergic diseases was analyzed. ResultsThe median cTARC was 989 pg/mL (interquartile range [IQR]: 667–1430 pg/mL). The cTARC levels in children who developed AD were higher than those in children who did not develop AD, and the association strengthened with younger age (median [IQR] at 1 year: 1285 [816–1965] vs. 933 [662–1330] pg/mL, p < 0.01; at 2 years: 1114 [787–1753] vs. 950 [660–1373] pg/mL, p = 0.02). In the multivariate analysis, cTARC was associated with AD, egg white sensitization, food allergy, allergic rhinitis, and Japanese cedar pollen sensitization. ConclusionscTARC was associated with the development of allergic diseases and allergen sensitization in early childhood. These results suggest that, infantile AD-mediated atopic march starts during fetal life, and this immune status is reflected in the cTARC at birth.

Preventive Gambling Programs for Adolescents and Young Adults: A Systematic Review

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

Dementia prevention in memory clinics: recommendations from the European task force for brain health services.

Observational population studies indicate that prevention of dementia and cognitive decline is being accomplished, possibly as an unintended result of better vascular prevention and healthier lifestyles. Population aging in the coming decades requires deliberate efforts to further decrease its prevalence and societal burden. Increasing evidence supports the efficacy of preventive interventions on persons with intact cognition and high dementia risk. We report recommendations for the deployment of second-generation memory clinics (Brain Health Services) whose mission is evidence-based and ethical dementia prevention in at-risk individuals. The cornerstone interventions consist of (i)assessment of genetic and potentially modifiable risk factors including brain pathology, and risk stratification, (ii) risk communication with ad-hoc protocols, (iii) risk reduction with multi-domain interventions, and (iv) cognitive enhancement with cognitive and physical training. A roadmap is proposed for concept validation and ensuing clinical deployment.

Nurse Anesthesia Diversion Prevention: A Knowledge and Needs Gap Analysis.

Substance misuse is an occupational health problem for anesthesia providers (APs). More than 10% of nurse anesthetists misuse and divert medications. No standard exists for addressing AP drug diversion. The purpose of this quality improvement project was to evaluate the use of a knowledge and needs assessment to inform the development of a successful drug diversion prevention program for certified registered nurse anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs). A 28-item questionnaire, using the health belief model (HBM) and the risk perception attitude (RPA) framework, was developed to assess knowledge, beliefs, and practices of substance misuse and diversion. RPA groups were determined by level of belief in self-risk and perceived efficacy of prevention strategies. The survey was emailed to 100 CRNAs and over 100 SRNAs. Survey results were organized using the RPA framework. One hundred twelve surveys were completed. The RPA avoidant category (high-risk belief and low perceived efficacy of preventive interventions) comprised 52.5% of CRNAs; SRNAs were divided primarily among the RPA responsive category with high perceived risk and high-efficacy beliefs (38.9%) and the indifferent category of low-risk beliefs and low perceived efficacy (31.9%). Anesthesia providers have varying beliefs regarding drug misuse and diversion risks and perceptions of their ability to be successful with preventive strategies. Failure to address nurse anesthesia needs-based diversion prevention may result in missed opportunities to educate this group. Implementation of RPA-tailored interventions by health care organizations may produce effective, long-term outcomes for drug diversion within the profession.

The efficacy of the “Talk-to-Me” suicide prevention and mental health education program for tertiary students: a crossover randomised control trial

Despite suicide ideation being one of the most frequently reported health issues impacting tertiary students, there is a paucity of research evaluating the efficacy of preventive interventions aimed at improving mental health outcomes for students studying at two tertiary institutes. The current study evaluated the efficacy of the “Talk-to-Me” Mass Open Online Course (MOOC) in improving tertiary students’ abilities to support the mental health of themselves and their peers via a randomised controlled trial design, comparing them to a waitlist control group. Overall, 129 tertiary students (M = 25.22 years, SD = 7.43; 80% female) undertaking a health science or education course at two Western Australian universities were randomly allocated to either “Talk-to-Me” (n = 66) or waitlist control (n = 63) groups. The participants’ responses to suicidal statements (primary outcome), knowledge of mental health, generalised self-efficacy, coping skills, and overall utility of the program (secondary outcomes) were collected at three timepoints (baseline 10-weeks and 24-weeks from baseline). Assessment time and group interaction were explored using a random-effects regression model, examining changes in the primary and secondary outcomes. Intention-to-treat analysis (N = 129) at 10-weeks demonstrated a significant improvement in generalised self-efficacy for “Talk-to-Me” compared to the control group (ES = 0.36, p = .04), with only the “Talk-to-Me” participants reporting increased knowledge in responding to suicidal ideation (primary outcome). This change was sustained for 24 weeks. Findings provide preliminary evidence suggesting that the “Talk-to-Me” MOOC can effectively improve tertiary students’ mental health and knowledge of how to support themselves and others in distress. ACTRN12619000630112, registered 18-03-2019, anzctr.org.au.

Mitochondrial DNA copy number and trimethylamine levels in the blood: New insights on cardiovascular disease biomarkers.

Among cardiovascular disease (CVD) biomarkers, the mitochondrial DNA copy number (mtDNAcn) is a promising candidate. A growing attention has been also dedicated to trimethylamine-N-oxide (TMAO), an oxidative derivative of the gut metabolite trimethylamine (TMA). With the aim to identify biomarkers predictive of CVD, we investigated TMA, TMAO, and mtDNAcn in a population of 389 coronary artery disease (CAD) patients and 151 healthy controls, in association with established risk factors for CVD (sex, age, hypertension, smoking, diabetes, glomerular filtration rate [GFR]) and troponin, an established marker of CAD. MtDNAcn was significantly lower in CAD patients; it correlates with GFR and TMA, but not with TMAO. A biomarker including mtDNAcn, sex, and hypertension (but neither TMA nor TMAO) emerged as a good predictor of CAD. Our findings support the mtDNAcn as a promising plastic biomarker, useful to monitor the exposure to risk factors and the efficacy of preventive interventions for a personalized CAD risk reduction.

Evaluation of multi-component interventions for prevention of nosocomial pneumonia in older adults: a randomized, controlled trial.

To evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in older patients hospitalized in geriatric wards. A randomized, parallel-group, controlled trial was undertaken in patients aged 65 and above who were admitted to a tertiary hospital geriatric unit from January 1, 2016 to June 30, 2018 for an acute non-respiratory illness. Participants were randomized by to receive either a multi-component intervention (consisting of reverse Trendelenburg position, dysphagia screening, oral care and vaccinations), or usual care. The outcome measures were the proportion of patients who developed hospital-acquired pneumonia during hospitalisation, and mean time from randomization to the next hospitalisation due to respiratory infections in 1year. A total of 123 participants (median age, 85; 43.1% male) were randomized, (n = 59) to intervention group and (n = 64) to control group. The multi-component interventions did not significantly reduce the incidence of hospital-acquired pneumonia but did increase the mean time to next hospitalisation due to respiratory infection (11.5months vs. 9.5months; P = 0.049), and reduced the risk of hospitalisation in 1year (18.6% vs. 34.4%; P = 0.049). Implementation of multi-component interventions increased diagnoses of oropharyngeal dysphagia (35.6% vs. 20.3%; P < 0.001) and improved the influenza (54.5% vs 17.2%; P < 0.001) and pneumococcal vaccination rates (52.5% vs. 20.3%; P < 0.001). The nosocomial pneumonia multi-component intervention did not significantly reduce the incidence of hospital-acquired pneumonia during hospitalisation but reduce subsequent hospitalisations for respiratory infections. ClinicalTrial.gov, NCT04347395.

Preventive interventions targeting cannabis use and related harms in people with psychosis: A systematic review.

While most users will not experience severe adverse health outcomes from cannabis, it can be associated with negative outcomes in people with psychosis. People with psychosis who use cannabis have more severe psychiatric symptoms, higher rates of hospitalization, and diminished psychosocial functioning compared to those who do not use cannabis. Most studies of people with psychotic disorders have focused on cannabis use treatments and only a few on preventive interventions for cannabis. This systematic review aims to evaluate the effectiveness of preventive interventions focusing on cannabis use for people with psychosis. We searched CINAHL Plus, EBM reviews, EMBASE, MEDLINE, PsycInfo and PubMed databases for controlled studies assessing the effects of preventive interventions on cannabis use and related harms in people with psychosis. We conducted the search using a combination of the following concepts: cannabis, psychosis, intervention and prevention. Risk of bias was assessed. The search yielded 11 460 unique studies. Of these, five studies met our eligibility criteria. None of the studies demonstrated clear efficacy of prevention interventions in reducing cannabis use, and none measured cannabis-related harms. All studies had high risk of bias. The small number of studies and the considerable risk of bias made it difficult to conclude whether any of the existing interventions were promising. With increased acceptance and accessibility of cannabis due to liberalizing cannabis policies, it is imperative to improve the evidence base for preventive interventions, in particular their effectiveness in decreasing the risk of cannabis-related harms in people with psychosis.

Reduced positive affect on days with stress exposure predicts depression, anxiety disorders, and low trait positive affect 7 years later.

Positive emotions serve important functions for mental health. Susceptibility to reduced positive emotions in the context of stress may increase risk for poor mental health outcomes, including anxiety and depressive disorders and low overall levels of positive emotion. In an 8-day daily diary study within a larger panel study (N = 1,517), we tested whether degree of reduction in time spent experiencing positive affect on days of stress exposure predicted lower levels of positive affect and elevated risk for major depressive and anxiety disorders (generalized anxiety disorder or panic disorder) 7 years later. Bayesian multilevel structural equation modeling controlling for overall levels of affect, stress exposure, leisure time, sex, age, and past year diagnoses of depression and anxiety disorders was conducted. Participants, on average, reported less time experiencing positive affect on days with stressors compared to days without stressors. In addition, participants varied in the extent to which their time spent experiencing positive affect differed across days with and without stressors. Those who reported an especially reduced proportion of the day experiencing positive affect on days with stressors also experienced lower positive affect and greater risk for major depressive disorder and anxiety disorders 7 years later. These prospective associations suggest that between-person differences in the within-person association between stress and positive emotions have implications for mental health years later. The efficacy of preventive interventions could be improved by fostering resilience of positive emotions during common stressful events. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Efficacy of interventions for prevention and correction of overweight and obesity in children 7–8 years old: a meta-analysis

The rapid increase in overweight and obesity in children is a global public health problem. Interventions to reduce the prevalence of obesity before puberty are considered to be the most effective, but the results of trials are not consistent enough. We performed a meta-analysis of the efficacy of interventions to prevent or correct overweight and obesity in pre-pubertal children. Thirty-one Cochrane systematic reviews were analyzed, the results of 10 RCTs and two prospective comparative studies were extracted. All trials had an moderate or high risk of bias. According to the results of meta-analyzes, the prevention of overweight and obesity through recommendations of lifestyle modification is effective, the difference in a BMI decrease is -0.19, 95% CI [-0.35; -0.03], compared with the absence of intervention, in children 78 years old if applied within 24 years, but not within one year or less. The effect of non-drug interventions in children with overweight or obesity was not revealed.

Psychological and social interventions for the prevention of mental disorders in people living in low- and middle-income countries affected by humanitarian crises.

BackgroundPeople living in 'humanitarian settings' in low‐ and middle‐income countries (LMICs) are exposed to a constellation of physical and psychological stressors that make them vulnerable to developing mental disorders. A range of psychological and social interventions have been implemented with the aim to prevent the onset of mental disorders and/or lower psychological distress in populations at risk, and it is not known whether interventions are effective.ObjectivesTo compare the efficacy and acceptability of psychological and social interventions versus control conditions (wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at preventing the onset of non‐psychotic mental disorders in people living in LMICs affected by humanitarian crises.Search methodsWe searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMD‐CTR), the Cochrane Drugs and Alcohol Review Group (CDAG) Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), PsycINFO (OVID), and ProQuest PILOTS database with results incorporated from searches to February 2020. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies. We checked the reference lists of relevant studies and reviews.Selection criteriaAll randomised controlled trials (RCTs) comparing psychological and social interventions versus control conditions to prevent the onset of mental disorders in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut‐off score on a screening measure).Data collection and analysisWe calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random‐effects model. We analysed data at endpoint (zero to four weeks after therapy) and at medium term (one to four months after intervention). No data were available at long term (six months or longer). We used GRADE to assess the quality of evidence.Main resultsIn the present review we included seven RCTs with a total of 2398 participants, coming from both children/adolescents (five RCTs), and adults (two RCTs). Together, the seven RCTs compared six different psychosocial interventions against a control comparator (waiting list in all studies). All the interventions were delivered by paraprofessionals and, with the exception of one study, delivered at a group level.None of the included studies provided data on the efficacy of interventions to prevent the onset of mental disorders (incidence). For the primary outcome of acceptability, there may be no evidence of a difference between psychological and social interventions and control at endpoint for children and adolescents (RR 0.93, 95% CI 0.78 to 1.10; 5 studies, 1372 participants; low‐quality evidence) or adults (RR 0.96, 95% CI 0.61 to 1.50; 2 studies, 767 participants; very low quality evidence). No information on adverse events related to the interventions was available.For children's and adolescents' secondary outcomes of prevention interventions, there may be no evidence of a difference between psychological and social intervention groups and control groups for reducing PTSD symptoms (standardised mean difference (SMD) −0.16, 95% CI −0.50 to 0.18; 3 studies, 590 participants; very low quality evidence), depressive symptoms (SMD −0.01, 95% CI −0.29 to 0.31; 4 RCTs, 746 participants; very low quality evidence) and anxiety symptoms (SMD 0.11, 95% CI −0.09 to 0.31; 3 studies, 632 participants; very low quality evidence) at study endpoint.In adults' secondary outcomes of prevention interventions, psychological counselling may be effective for reducing depressive symptoms (MD −7.50, 95% CI −9.19 to −5.81; 1 study, 258 participants; very low quality evidence) and anxiety symptoms (MD −6.10, 95% CI −7.57 to −4.63; 1 study, 258 participants; very low quality evidence) at endpoint. No data were available for PTSD symptoms in the adult population.Owing to the small number of RCTs included in the present review, it was not possible to carry out neither sensitivity nor subgroup analyses.Authors' conclusionsOf the seven prevention studies included in this review, none assessed whether prevention interventions reduced the incidence of mental disorders and there may be no evidence for any differences in acceptability. Additionally, for both child and adolescent populations and adult populations, a very small number of RCTs with low quality evidence on the review's secondary outcomes (changes in symptomatology at endpoint) did not suggest any beneficial effect for the studied prevention interventions.Confidence in the findings is hampered by the scarcity of prevention studies eligible for inclusion in the review, by risk of bias in the studies, and by substantial levels of heterogeneity. Moreover, it is possible that random error had a role in distorting results, and that a more thorough picture of the efficacy of prevention interventions will be provided by future studies. For this reason, prevention studies are urgently needed to assess the impact of interventions on the incidence of mental disorders in children and adults, with extended periods of follow‐up.

Describing Intimate partner violence against ever-partnered women in Europe and perpetrator’s characteristics. Results from the Violence against women EU-wide survey

Abstract Available data on intimate partner violence (IPV) are derived from asynchronous and heterogeneous studies. Definition of IPV varies, is often partial, and only a limited number of potential determinants are considered. The Violence against women survey collected data consistently and simultaneously on all dimensions of IPV. Women were also asked about the perpetrator's characteristics. The present study aims to describe prevalence of physical, sexual and psychological IPV against European women, and reported perpetrator's characteristics. Face-to-face interviews were conducted with randomly selected women aged between 18 and 74, by the European Union Agency for Fundamental Rights. IPV was defined by a positive answer to at least one question about violence perpetrated by current or ex-partner. Among the 40357 ever-partnered women, lifetime prevalence of overall IPV was 51.7% (95%CI 51.2-52.2). Prevalence of physical, sexual and psychological IPV were respectively 20.0% (19.6-20.4), 8.4% (8.2-8.7) and 48.5% (48.1-49.0). Partners' or ex-partners characteristics associated with IPV perpetration included: lower education level, unemployment or staying at home, earning less than the woman, a relationship lasting between 1 to 10 years, high frequency of drunkenness, and perpetration of other type of violence. Lifetime prevalence of IPV in EU is high and likely to be underestimated. Specific trajectories and profiles of perpetrators should be characterized to ground the interventions. The risk of underreporting violence should be addressed as it jeopardizes the efficacy of interventions for prevention. They may be undifferentiated and differentiated, targeted and time-sensitive, respectively dedicated to general audience and high-risk populations.

Rates and Correlates of HIV Incidence in Namibia's Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study.

BackgroundDirect measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV.ObjectiveThe aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot.MethodsFollowing the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion.ResultsAmong 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment.ConclusionsNearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations.

Efficacy of Intervention for Prevention of Postoperative Delirium after Spine Surgery.

Introduction Delirium after spine surgery is an important complication; identification of risk factors associated with postoperative delirium (PD) is essential for reducing its incidence. Prophylactic intervention for PD has been reported to be effective. This study aimed to identify risk factors for PD and determine the efficacy of a prevention program using a delirium risk scoring system for PD after spine surgery. Methods This study was conducted in two stages. First, 294 patients (167 males, 127 females) who underwent spine surgery from 2013 to 2014 were assessed to examine the incidence and risk factors of PD and to establish a novel PD screening tool (Group A). Second, preoperative intervention was performed on 265 patients who underwent surgery from 2016 to 2017 (Group B) for the purpose of preventing PD using a delirium risk scoring system. Outcomes, including PD incidence and rates of adverse events, were compared between Group A and Group B. Results A logistic regression analysis revealed that psychiatric disorders (odds ratio [OR] = 10.3, P < 0.001), benzodiazepine use (OR = 4.9, P < 0.001), age > 70 years (OR = 4.2, P < 0.001), hearing loss (OR = 3.7, P = 0.001), and admission to intensive care unit (ICU) (OR = 3.7, P = 0.006) were independent risk factors associated with PD. Based on these results, we established a novel delirium screening tool after spine surgery. PD incidence was significantly higher in Group A than in Group B (22% vs. 13%, P = 0.0008). The occurrence of dangerous behavioral symptoms was significantly higher in Group A than in Group B (66% vs. 40%, P = 0.02). The catheter problem tended to be higher in Group A than in Group B (19% vs. 9%, P = 0.245). Conclusions In this study, psychiatric disorders, benzodiazepine use, age > 70 years, hearing loss, and admission to ICU were independent risk factors associated with PD. With the introduction of the delirium risk score, the onset of delirium was delayed, and adverse outcomes of delirium were reduced.

Health-Related Lifestyles, Substance-Related Behaviors, and Sexual Habits Among Italian Young Adult Males: An Epidemiologic Study.

IntroductionYoung adult males are more likely to demonstrate health-risk behaviors than other individuals. The use of specific data about health-risk behaviors within this population might be important to promote effective preventive psychosocial and educational programs and interventions.AimTo provide a detailed description of health-related lifestyles, substance-related behaviors, and sexual habits that can negatively affect fertility, sexual sphere, and health in a large sample of Italian young adult males.MethodsA sample comprising 2,170 males aged 18–21 years, attending the last year of high school, was administered an online questionnaire made up of 39 multiple-choice questions. The questionnaire explored health-related lifestyles, substance-related behaviors, and sexuality and sexual habits. Descriptive analyses were conducted.Main outcome measureThe outcome measures included data about health-related lifestyles, substance-related behaviors, and sexuality and sexual habits reported by Italian young adult males.ResultsHealth-related lifestyles: 92.9% of the sample reported practicing some physical activity during the week. 90.3% declared a Mediterranean diet and 8.1% a hyperproteic diet. Substance-related behaviors: 33.8% of the sample reported having smoked tobacco at least once in their lives; among them, 71% reported current daily smoking. 40.2% declared drinking alcohol from 5 to 7 days in a week. 32.9% of the sample reported currently using a substance. Sexuality and sexual habits: 97.1% of the sample self-defined themselves as heterosexual. 73.3% of participants rated their knowledge about sexuality as “excellent/good,” 58.7% about sexually transmitted infections. Only 4.8% reported having had a seminal liquid examination. Half of the sample (52.2%) declared having had sexual intercourses, in the largest proportion protected sex. 14.7% of the sample reported having at least one sexual dysfunction. 88.6% of participants reported having used pornography, 18.7% every day.ConclusionThe present study highlighted the need to empower the number and efficacy of preventive interventions to promote health-related behaviors among Italian young male population.Flesia L, Cavalieri F, Angelini S, et al. Health-Related Lifestyles, Substance-Related Behaviors, and Sexual Habits Among Italian Young Adult Males: An Epidemiologic Study. Sex Med 2020;8:361–369.

1507-P: Baseline Metabolite Profiles of Incident Type 2 Diabetes and Heterogeneity of Treatment Effect in the Diabetes Prevention Program (DPP)

Novel biomarkers of T2D and preventative treatment response could predict outcomes in high-risk individuals. We used Cox models to assess the association of 334 profiled metabolites in 2,019 baseline plasma samples with incident T2D after 3.2 years in a DPP substudy. We further assessed if associations out of the 334 metabolites differed by treatment (lifestyle (ILS), metformin (MET), and placebo (PLA)) and if, after stratification into concentration quartiles, the metabolite levels modified treatment effect in pair-wise treatment comparisons. We found 69 metabolites associated with incident T2D in the entire cohort (FDR-q&amp;lt;0.05) including the novel association of cytosine, which had the lowest risk (HR of 0.77 per 1 SD, 95% CI 0.67-0.89, FDR-q 0.008). The associations of 35 metabolites differed across the three treatments (p for homogeneity &amp;lt;0.05) and the quartiles of several of these metabolites modified treatment effects in pair-wise comparisons (Table 1). For example, individuals in higher quartiles of specific phospholipids had decreased T2D risk with ILS compared to PLA and MET, but not with MET when compared to PLA. In conclusion, we identified baseline metabolites associated with T2D risk prediction and efficacy of prevention interventions. This motivates further studies to validate interactions between biomarkers and diabetes prevention strategies. Disclosure Z. Chen: None. J. Liu: None. J. Morningstar: None. B.M. Heckman-Stoddard: None. C. Lee: None. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc. J.F. Ferguson: None. R.F. Hamman: None. W.C. Knowler: None. K.J. Mather: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, Merck &amp; Co., Inc., Novo Nordisk A/S, Sanofi. L. Perreault: Advisory Panel; Self; Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Novo Nordisk A/S. J.C. Florez: None. T. Wang: None. C.B. Clish: None. M. Temprosa: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Other Relationship; Self; Merck KGaA. R.E. Gerszten: None. DPP Research Group: None.