Goal Of Prevention Research Articles

Acceptability of six-monthly PrEP dispensing supported with interim HIV self-testing to simplify PrEP delivery in Kenya: findings from qualitative research

BackgroundIn Africa, dispensing oral HIV pre-exposure prophylaxis (PrEP) within already strained public health facilities has led to prolonged waiting periods and suboptimal experiences for clients. We sought to explore the acceptability of dispensing PrEP semiannually with interim HIV self-testing (HIVST) versus quarterly PrEP dispensing with clinic-based HIV testing to optimize clinic-delivered PrEP services.MethodsWe conducted a qualitative study within a non-inferiority individual-level randomized controlled trial testing the effect of six-monthly PrEP dispensing with HIVST compared to the standard-of-care three-monthly PrEP dispensing on PrEP clinical outcomes in Kenya (ClinicalTrials.gov: NCT03593629). Eligible participants were ≥ 18 years, refilling PrEP for the first time, and either in an HIV serodifferent relationship (men and women) or singly enrolled (women only). A subset of participants in the intervention group completed serial in-depth interviews (IDIs) at enrollment, six months, and 12 months. We utilized stratified purposive sampling to ensure representation across participant groups. We analyzed our qualitative data thematically using a combination of inductive and deductive approaches, the latter guided by the Theoretical Framework of Acceptability (TFA).ResultsBetween May 2018 and June 2021, we conducted 120 serial IDIs with 55 participants; 64% (35/55) were in a serodifferent relationship, 64% (35/55) were women, and the median age was 32 years (IQR 27–40). Overall, participants found this novel PrEP delivery model highly acceptable; it was well-liked, private (TFA construct: affective attitude), and less burdensome (TFA construct: burden) compared to standard PrEP delivery. Additionally, participants were confident in their ability to participate in the intervention (TFA construct: self-efficacy). Some participants, however, highlighted model disadvantages, including fewer opportunities for in-person counseling and potentially less accurate HIV testing (TFA construct: opportunity costs). Ultimately, most participants reported that the intervention allowed them to achieve their HIV prevention goals (TFA construct: perceived effectiveness) and that their confidence in at-home HIVST and PrEP continuation increased following each semiannual clinic visit.ConclusionsSemiannual PrEP clinic visits supported with six-monthly drug dispensing and interim HIVST was acceptable among PrEP users who experienced the intervention in Kenya. More comprehensive pre-intervention counseling and training on HIVST may help alleviate the client concerns presented, which were often resolved over time with intervention experience.

Sociodemographic inequalities in the uptake of prenatal HIV testing in Ethiopia: Systematic review and meta-analysis.

In order to attain the ambitious 95-95-95 UNAIDS goals, HIV testing serves as the pivotal starting point and plays a crucial role in preventing, treating, and managing HIV. Equal access to HIV testing is crucial to stop the spread of the virus. Measuring healthcare disparities is vital for promoting fairness in health services and achieving global goals for HIV prevention and treatment. Ethiopia is actively engaged in efforts to achieve these goals and is dedicated to combating HIV/AIDS. To the best of our knowledge, no previous systematic review or meta-analysis has been conducted on sociodemographic inequalities in prenatal HIV testing in Ethiopia. Hence, this study aims to assess sociodemographic inequalities in prenatal HIV testing in Ethiopia. We conducted an extensive search across various databases, such as PubMed, Scopus, Google Scholar, and Embase, to collect articles and reports. The data we gathered was then exported to R software for further analysis. Our analysis involved performing a meta-analysis of proportions using a random effect model. To assess the variability among the included studies, we used statistical measures such as I2 statistics and the Cochran's Q test. The results of the pooled prenatal HIV testing, along with its corresponding 95% confidence interval, were presented using a forest plot. A comprehensive analysis of 20 research papers on prenatal HIV testing in Ethiopia revealed that the overall pooled prevalence of testing was 69% (95% CI [60.0-80.0]). Factors such as higher education, urban residence, income, a positive attitude towards testing, marriage, and discussions about testing during antenatal care (ANC) were found to positively influence testing rates. The prevalence of prenatal HIV testing among antenatal care attendees in Ethiopia falls short of the UNAIDS target. In order to enhance the testing rates, it is advised to implement targeted initiatives within Ethiopia's public health programs. To ensure effectiveness, these initiatives should adopt a sustainable and customized approach that takes into account the specific needs and circumstances of women, particularly those who are economically disadvantaged. Ethiopia can make significant strides in enhancing the prenatal HIV testing landscape by effectively implementing policies and programs that prioritize the welfare of the less privileged. As limitation this systematic review did not include longitudinal and qualitative studies that might have provided different results. Trial registration in PROSPERO with ID: CRD42024550564.

7540 Recognition of Need for Optimization of Diabetes Education for Children with Type 1 diabetes: Long term Provider Experience

Abstract Disclosure: J. Begum-Hasan: None. Title: Recognition of need for optimization of diabetes education for children with Type 1 diabetes: long term “On call provider experience “Janhanara Begum – Hasan, MD, PhD. Jacob school medicine. UBMD Pediatrics Context: Pediatric endocrinologist does provide on call service 24/7 to support patient care as needed for the family with children with diabetes. Complication of diabetes including DKA is preventable However, based on interaction with the family with children diabetes, the trend shows sub optimal education in this regard. Aim/Objective: To review case scenario and provide recommendation to optimize diabetes management with a goal of prevention of complications. Case discussion: 3 case scenarios are selected to review. Case 1: The father called at 2 am as his daughter’s (12 year F) Insulin pump is broken and BGs are elevated in upper 300s. Her urine is +ve for moderate ketone and she has nausea. He does not have any short acting pen or syringe to provide correction Insulin. He reports that he is not aware of her Insulin settings in the pump. Parents are separated and mother is more involved in her care. Short /long acting Insulin pen were prescribed with recommendations including correction dose as per weight with a plan for follow up. Case 2: The mother called at 9 pm and reported that by mistake, she did administer “Admelog” at 18 units instead of Basaglar, for her son, 11 year old with Type 1 diabetes. He was on Lantus and Humalog before. She gets confused with short and long acting Insulin particularly with changes. The mother was advised on close monitoring of BGs with recommendation of treatment of Hypoglycemia including Glucagon therapy. He was followed closely with stabilization of BGs with extra carbohydrate overnight. Case 3: The father calls to inform that his son, 14 year, with recent onset Typ1 diabetes, has been vomiting with high BG in 400s with large ketone. His Insulin dose was decreased recently as he was told to be in “Honeymoon phase” and planned for close follow up. However, the family missed endocrine FU >12 months now. His BGs have been high in upper 200s to 300s for last 2-3 months. The parents are in the process of divorce. He was sent to local ED with clinical impression of DKA. He was treated for his severe DKA as found after metabolic labs. He did well after 2 days hospitalization for management of his DKA. Conclusion: -Complications of Type 1 diabetes are preventable. The family needs further education on diabetes management including review of Insulin therapy when Insulin pump does malfunction, with a copy of written instruction of Insulin doses, differences in long and short acting Insulin along with psychosocial support to optimize care of children with Type 1 diabetes. Presentation: 6/2/2024

Longitudinal correlates of learning burnout among Chinese adolescents during the COVID-19 pandemic: A cross-lagged panel network analysis

BackgroundLearning burnout as a serious psychological distress problem among adolescents during the COVID-19 pandemic was investigated using the cross-lagged panel network models. MethodsA three-wave study using a sample of 11 to 18-year-olds in China was conducted, with baseline data collected in June 2020 (n = 4156) and follow-ups in December 2020 (n = 3209) and August 2021 (n = 2324). Two temporal cross-lagged panel network models were computed to analyze adolescent learning burnout over time. ResultsThe predictive pathway of adolescent learning burnout demonstrates significant temporal specificity. In the early outbreak period, Positive thinking, Appreciation of life and Depression are the most influential predictive symptoms. In the normalized epidemic prevention period, Goal planning, Affect control and Positive thinking are the most influential predictive symptoms. However, during this period, the extent to which adolescent learning burnout is predicted by other symptoms in the networks is significantly reduced. LimitationsThe samples used in this study are not expected to be nationally representative, and therefore the generalizability of the results may be limited. ConclusionsThese findings highlight the predictive roles of Positive thinking, Appreciation of life, and Depression in adolescent learning burnout and the importance of timely intervention on these symptoms in the early outbreak period of public health emergency similar to the COVID-19 pandemic. Findings also illustrate the essentiality of eliminate unstable factors in the school environment during the normalized epidemic prevention period.

Abstract B099: Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program

Abstract Purpose The Scaling What Works (SWW) program aimed to build the capacity of National Comprehensive Cancer Control Program (NCCCP) recipients to scale three CDC-identified cancer control projects through training, mentorship, and technical assistance (TA). The SWW program held a Symposium to provide in-person training on adapting, implementing, evaluating, sustaining, and scaling the three projects. We recruited 100% of US-Affiliated Pacific Island (USAPI) NCCCP programs (n=6), who made up approximately 26% of all programs that attended the Symposium (n=23). The USAPI jurisdictions face high cancer burden due, in part, to the United States nuclear legacy, the effects of climate change, limited medical infrastructure, and lack of culturally competent, centralized care across the almost 4,000 miles that the USAPI spans. Through the SWW program, USAPI recipients are supported in their ongoing efforts to mitigate cancer disparities affecting their communities. MethodsWe applied community-based participatory research methods and health equity principles to ensure the SWW program was relevant and responsive to the USAPI recipients’ contexts and needs. We created a SWW subcommittee to learn about and advocate for the specific needs of the USAPI. The committee spoke with ten clinicians and researchers with experience working in the USAPI, across four informal meetings, to understand the unique cancer prevention and control context of each USAPI jurisdiction. The committee reviewed USAPI cancer plans and extracted data related to SWW activities, including cancer prevention priorities, community partners, demographic characteristics, and healthcare infrastructure. Data were added to a matrix, coded, and summarized by subcommittee team members to develop a USAPI fact sheet. We shared the fact sheet with SWW Symposium facilitators and mentors to provide them with the necessary information to support the USAPI programs. Findings We identified components critical to providing effective training and TA that will support USAPI-led work to address disparities in cancer prevention and control. These components include 1) acknowledging the current and historical power dynamics that establish the USAPI cancer prevention and control program space, 2) adjusting generalized training content to each jurisdiction’s unique context and cancer prevention goals, 3) adapting communication strategies to USAPI programs’ preferences and time zones, 4) facilitating networking opportunities both between NCCCP USAPI jurisdictions and across all NCCCP recipients to build a SWW community of practice, and 5) establishing a sustained, bidirectional partnership between USAPI program leaders and the SWW team to collaborate on future cancer prevention and control projects and to provide training and TA, as needed. ConclusionsThe lessons learned from SWW regarding health equity and capacity-building can inform the efforts of researchers, evaluators, and training and TA providers working with USAPI jurisdictions, states, and territories engaged in cancer prevention and control work. Citation Format: Amy L. Tran, Mary Wangen, Renée M. Ferrari, Jingle Xu, Alison T. Brenner, Stephanie B. Wheeler, Rebecca J. Lee, Elizabeth A. Rohan, Angela R. Moore, Shixiu Wang, Alyssa LaMonica, Mary Puckett, Amy L. Thompson, CK Smith, Katie Jones, Malesa Pereira, Rogelio Robles-Morales, Lori A. Crane, Courtney N. Petagna, Thuy T. Vu, Betsy C Risendal, Rachel Hirschey. Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B099.

Intravitreal steroid implants in the management of noninfectious intermediate and posterior uveitis

Abstract The management of intermediate and posterior uveitis poses a significant challenge of achieving adequate drug concentrations in the posterior segment over the chronic nature of the disease. Systemic agents seldom reach effective drug levels, and even with low maintenance or tapering doses, it is hard to avoid systemic toxicity. The use of intravitreal and periocular injections is often unable to prevent recurrences due to their short half-life. Since the emergence of intravitreal implants (Vitrasert, Retisert), it has become possible to circumvent these therapeutic challenges. A detailed review in the PubMed index yielded 155 articles, of which 22 were analyzed based on exclusion criteria. A recent shift from surgically sutured to minimally invasive injectable implants mainly indicated for noninfectious uveitis is evident from the literature. This review article also provides insights into dexamethasone (Ozurdex) and recent fluocinolone acetonide (Yutiq, Iluvien) implants with particular emphasis on their improved safety and efficacy. Dexamethasone implants favor the therapeutic goal of prevention of recurrences, whereas the use of fluocinolone implants helps to attain better visual outcomes due to their longer duration of action. Thus, the review provides recent literature supporting the role and indication of sustained release intravitreal implants in the management of noninfectious intermediate and posterior uveitis.

Evaluation of a digital patient education programme in patients with coronary artery disease, a survey-based study

IntroductionPatient education programmes focusing on risk factor modification and lifestyle changes are well established as part of cardiac rehabilitation in patients with coronary artery disease (CAD). As participation rates are low, digital patient education programmes (DPE) are interesting alternatives to increase access. Understanding patients’ perceptions of DPE are important in terms of successful implementation in clinical practice but are not well known. Therefore, the aim of this study was to assess patients’ perceptions of using a DPE in terms of end-user acceptance and usability, perceived significance for lifestyle changes and secondary preventive goal fulfilment in patients with CAD.MethodsThis was a cross-sectional survey-based study. The survey was distributed to all 1625 patients with acute coronary syndrome or chronic CAD with revascularisation, who were registered users of the DPE between 2020 and 2022 as part of cardiac rehabilitation. The survey contained 64 questions about e.g., acceptance and usability, perceived significance for making lifestyle changes and secondary preventive goal fulfilment. Patients who had never logged in to the DPE received questions about their reasons for not logging in. Data were analysed descriptively.ResultsA total of 366 patients (mean age: 69.1 ± 11.3 years, 20% female) completed the survey and among those 207 patients (57%) had used the DPE. Patients reported that the DPE was simple to use (80%) and improved access to healthcare (67–75%). A total of 69% of the patients were generally satisfied with the DPE, > 60% reported that the DPE increased their knowledge about secondary preventive treatment goals and approximately 60% reported having a healthy lifestyle today. On the other hand, 35% of the patients would have preferred a hospital-based education programme. Among the 159 patients (43%) who had never used the DPE, the most reported reason was a perceived need for more information about how to use the DPE (52%).ConclusionsThis study shows an overall high level of patient acceptance and usability of the DPE, which supports its continued development and long-term role in cardiac rehabilitation in patients with CAD. Future studies should assess associations between participation in the DPE and clinical outcomes, such as secondary preventive goal fulfilment and hospitalisation.

Current concept of osteoporosis diagnosis and treatment in children

Osteoporosis (OP) is a disease characterized by a decrease in bone strength, leading to an increased risk of fractures. Bone fragility in children may be due to genetic disorders, chronic underlying conditions or taking medications that negatively affect bone metabolism. The article considers the modern classification of OP in children, approaches to its diagnosis, the role of dual-energy X-ray absorptiometry for diagnosis.The main goal of OP prevention and treatment is to achieve a higher peak of bone mass, improve bone microarchitectonics, and, as in adults, reduce the risk of fractures, prevent skeletal deformities, improve mobility, independence and quality of life. Recommendations for lifestyle changes are presented, including adequate calcium intake and vitamin D, taking antiresorptive drugs, as well as prospective management of children with OP.

Sex specific analysis of patients with and without reported statin intolerance referred to a specialized outpatient lipid clinic

BackgroundLowering LDL-cholesterol is a fundamental goal for both primary and secondary prevention of atherosclerotic cardiovascular diseases. Our study aims to analyse potential sex disparities regarding the tolerability and effectiveness of lipid-lowering therapy in patients with and without reported statin intolerance who are being treated at a lipid-outpatient clinic.MethodsFrom 2017 to 2022, n = 1062 patients (n = 612 men, n = 450 women) at high-risk were referred to our lipid-outpatient clinic because of difficulties in lipid control by primary healthcare providers. The main therapeutic objective was to optimize lipid-lowering therapy according to current treatment guidelines.ResultsPatients presented with high LDL-C baseline levels (4.97 ± 1.81 mmol/l (192 ± 70 mg/dL) in men and 5.46 ± 2.04 mmol/l (211 ± 79 mg/dL) in women). Intolerance towards statins was reported more frequently by women (48.2%) than by men (38.9%, p = 0.004). LDL-C continuously decreased with individual treatment adjustments across follow-up visits. In total, treatment goals (LDL < 1.4 mmol/l (< 55 mg/dl) or < 1.8 mmol/l (< 70 mg/dl)) were accomplished in 75.8% of men and 55.5% of women after the last follow-up visit (p < 0.0001). In men, these data are almost identical in subjects with statin intolerance. In contrast, treatment goals were reached less frequently in women with statin intolerance compared to women tolerant to statin therapy.ConclusionEven if treated in a specialized lipid clinic, women are less likely to reach their target LDL-C than men, particularly when statin intolerant. Nevertheless, many patients with statin intolerance can be successfully treated using oral combination and PCSK9 inhibitor therapy. However, ongoing follow-up care to monitor progress and to adjust treatment plans is necessary to reach this goal.

Individualized regimen of Posaconazole oral suspension in Chinese HSCT patients based on population pharmacokinetic model

To establish a population pharmacokinetic (PopPK) model of posaconazole suspension in Chinese hematopoietic stem cell transplantation (HSCT) patients and to recommend an optimal dosing regimen. A single-center, retrospective, model-based study was conducted in 62 Chinese patients, including 103 with posaconazole plasma concentrations. PopPK analysis using NONMEM software. A one-compartment model of first-order elimination and absorption was in good agreement with the experimental data. Analysis of covariance showed that body weight (WT), creatinine clearance (CCR), and proton pump inhibitor (PPI) had a significant effect on the pharmacokinetics of posaconazole. The dose simulation results show that patients with CCR ≥ 90 mL/min require at least 3 mg/kg TID and 7 mg/kg BID dosing regimens for prevention and treatment, respectively. However, when combined with PPI, at least 5 mg/kg BID and 5 mg/kg TID dosing regimens are required for prevention and treatment, respectively. Regardless of whether it is used in combination with PPI or not, patients with a CCR of 60–90 mL/min can achieve PTA goals by using a 4 mg/kg BID and 4 mg/kg TID regimen for prevention and treatment, respectively. A dosing regimen of 3 mg/kg BID in patients with a CCR of 30–60 mL/min is sufficient to meet the PTA goal of prophylaxis, and the dose needs to be elevated to 4 mg/kg BID for the treatment of fungal infections, and there is no need to change the dose according to the coadministration of PPI. When the patient's CCR is less than 30 mL/min, whether or not combined with PPI, the administration regimen of 2 mg/kg BID and 3 mg/kg BID can meet the PTA goals for prevention and treatment, respectively.

Comprehensive Sexuality Education (CSE) and HIV/AIDS Prevention among Youth in East Africa

Comprehensive Sexuality Education (CSE) is a pivotal strategy for reducing HIV/AIDS prevalence among youth in East Africa, where the growing young population presents significant challenges for effective prevention. This review examines the role of CSE in equipping young people with essential knowledge, skills, and attitudes to make informed decisions about their sexual health. We explore the importance of culturally relevant and evidence-based curricula, the impact of teacher training programmes, and the integration of CSE into both school and community settings. We highlight the crucial role of youth-friendly health services in providing accessible and confidential care and identify peer education and youth-led initiatives as key strategies for engaging and empowering young people in HIV prevention. We examine the role of economic empowerment strategies, such as microfinance and vocational training, in reducing HIV vulnerability. We discuss gender-sensitive approaches to address the unique needs of different genders, including LGBTQ+ youth. The review also explores the potential of innovative technologies and digital solutions, such as mobile health applications and social media campaigns, to enhance HIV prevention efforts. The review emphasises community engagement and support systems, policy advocacy, and research as essential components for a comprehensive response. By integrating these diverse strategies, the review underscores the need for a multi-faceted approach to effectively address HIV/AIDS among youth in East Africa, ultimately aiming to improve health outcomes and achieve sustainable prevention goals. Keywords: Comprehensive Sexuality Education (CSE), HIV/AIDS, Youth, East Africa

The Impact of The Application of The Death Penalty on Reducing Crime Rates: Legal and Criminological Perspectives

The application of the death penalty as a punishment for severe crimes has long been a controversial topic in legal and criminological discourse. This article explores the impact of the death penalty's application on reducing crime rates from two main perspectives: law and criminology. This study uses a qualitative approach with in-depth literature analysis of death penalty policies in various countries, as well as empirical data on crime trends before and after the implementation of the death penalty. From a legal perspective, this article examines how the death penalty is justified as the most extreme tool of law enforcement and how it is integrated within the existing legal framework in several jurisdictions. From a criminological point of view, this article examines theories and research that evaluate the effectiveness of the death penalty as a determinant against crime. The analysis includes a study of the psychological effects of the death penalty on potential offenders, as well as a statistical evaluation of the correlation between the death penalty and a decrease in crime rates. The results of the analysis show that although there is some evidence to support the effectiveness of the death penalty as a crime deterrent, this evidence is often inconclusive and influenced by many contextual factors. In addition, we found that the application of the death penalty usually carries significant ethical and social implications, which can limit its effectiveness and acceptance in society. This article concludes with a discussion of the policy implications of these findings. It provides recommendations for law enforcement and policymakers in balancing crime prevention goals with the principles of justice and human rights. We also call for the need for more holistic research to fully understand the impact of the death penalty on crime levels.

Patient-Centered Care in Action: How Clinicians Respond to Patient Dissatisfaction with Contraceptive Side Effects.

Patient-centered care is widely cited as a component of quality contraceptive health care, but its operationalization in clinical interaction is contested. This article examines patient-centered care as an interactional phenomenon using the case of patient dissatisfaction with side effects of hormonal contraceptive medications. Drawing on transcript data from 109 tape-recorded reproductive health visits, I find that provider responses to treatment dissatisfaction range from patient-centered to relatively authoritarian. Providers typically offer patient-centered responses that validate patient experiences and integrate them into contraceptive counseling and method selection. At the same time, explicit communication about patients' contraceptive priorities is rare. In its absence, providers use patient-centered communication to smooth the interactional path toward uptake of highly effective hormonal methods, mostly ignoring the possibility that some patients may prefer less effective methods. Patient-centered contraceptive care was circumscribed by the clinical goal of pregnancy prevention.

Cardiovascular risk evaluation using lipid profile and blood pressure among obese and non-obese individuals in India.

Cardiovascular diseases (CVDs) are a group of disorders that affect the heart and blood vessels. Identifying high-risk individuals is a primary goal of cardiovascular disease prevention. The aim is to examine risk factor on assessing lipid profiles and blood pressure, both in obese and non-obese individuals. This study took place over a year at a Tertiary Care Hospital, were investigated the lipid profile and blood pressure of obese and non-obese participants aged 30-60 years. The obese group had an average age of 43.2±6.3 years compared to 45.1±5.8 years in the non-obese group, indicating a slightly older population in the obese group. The non-obese group had an average total cholesterol level of 193.7 mg/dL, with a total cholesterol (TC) level of 209.3 mg/dL. When it came to LDL cholesterol, the obese group had a higher level of 137.4 mg/dL compared to the non-obese group with 121.3 mg/dL. Conversely, HDL cholesterol levels were lower in the obese group at 44.1 mg/dL than in the non-obese group at 49.1 mg/dL. Obesity is associated with lipid metabolism and hypertension disturbances, especially with effect on HDL-C reduction and TC, TG, LDL cholesterol to high level. Thus, lipid profile and blood pressure among obese and non-obese individuals help in cardiovascular risk evaluation.

Quantitative evaluation of water, sanitation, and hygiene measures on COVID-19 pandemic peak reduction in the Philippines

New cases of coronavirus disease 2019 (COVID-19) are continually being recorded worldwide, despite global efforts in implementing non-pharmaceutical interventions and establishing vaccination programs. This trend highlights the need to identify the factors associated with the continued spread of COVID-19. The World Health Organization recommends hand washing as a cost-effective intervention for preventing COVID-19, indicating that water, sanitation, and hygiene (WaSH) are central to the prevention of the disease. However, low- and middle-income countries lack adequate access to WaSH, which increases the risk of contracting COVID-19. The aim of this study was to identify the WaSH factors associated with the incidence of COVID-19 and quantitatively estimate the effects of improvements in WaSH on reducing the incidence of COVID-19 during the peak of the pandemic. Lasso regression and extreme gradient boosting models were used to identify the WaSH factors. Distinct estimation models were developed to assess the effect of WaSH in rural regions under two assumptions: increasing regional basic sanitation coverage up to 25 % and 50%. The reduction in the incidence of COVID-19 during the peak of the pandemic was calculated for each rural region. The results of the analyses indicated that basic sanitation is important for reducing the incidence of COVID-19 in rural regions compared to urban regions in the Philippines. In addition, the results suggested that increasing basic sanitation coverage could reduce the incidence of COVID-19 by 2–66 %, alleviating the burden on healthcare facilities. This study indicates that improved basic sanitation infrastructure are needed in rural Philippines. The results of this study emphasise the significance of WaSH as an indicator of COVID-19 incidence, highlighting the need for its enhancement to enable the achievement of sustainable disease prevention and pandemic preparedness goals.

The co-assembly of spike silica nanoparticles with high affinity to nucleic acid for airborne virus detection

The global pandemic of coronavirus disease 2019 (COVID-19) highlights the shortcomings of the current testing paradigm for viral disease diagnostics. Though the Polymerase Chain Reaction (PCR) technique is currently used for nucleic acid detection in liquid samples, its application in airborne virus has not yet been developed, due to low viral load in the air, lack of efficient capture probe and supporting equipment. Herein, we developed an ultrasensitive biosensing nanoplatform for airborne virus detection. The extraction and concentration of nucleic acid from test samples has been accomplished by novel spike silica nanoparticles (SSNPs)-based nucleic acid capture probe with high spike length to nanoparticle diameter ratio and appropriate surface potential. When integrated with air sampler and Quantitative Real-Time PCR (qPCR) equipment, nucleic acid enrichment can be achieved significantly. Our results demonstrated a successful detection of the virus in the air with the limit of detection (LoD) of 500 copies/L, which greatly surpasses the LoD of 1 × 106 copies/L. This detection method effectively addresses the obstacle posed by the low abundance of pathogens in the environment and could be applied for the detection of pathogens in air or water, aiming to achieve the goal of disease prevention and control prior to its onset.

How education policy actors interpret, portray and contest risk in children’s physically active play in schools: a framing analysis

ABSTRACT Children’s physical activity is low and play outdoors has been declining, coinciding with a greater preoccupation with risk in many countries. This study examines how policy actors frame the issue of risk in children’s active physical play in schools. Using a theory-informed, multi-method, qualitative case-study design, 30 participants from a range of sectors involved in policy relevant to children’s physical activity and play in schools participated in interviews and photo-elicitation. Data were analysed using reflexive thematic analysis. Four frames of active physical play in schools were identified. Two ‘risk averse’ frames (protection and productivity) dominated and were primarily expressed by policy actors inside the school system. These frames were characterised by a negative construction of risk, and concerns for adverse outcomes for children and schools. In contrast, two frames were ‘risk tolerant’ (development and flourishing), within which risk was constructed as ‘uncertainty’, which could lead to positive or negative outcomes in play, and supported a child’s holistic learning, development, and wellbeing. While there were some ‘real world’ examples of risk tolerant frames, more commonly they were expressed in the context of how things should or could be in schools. Findings indicate school policies that prioritise injury prevention and productivity goals, may involve a risk-benefit trade-off over other fundamental objectives, elevating some risks above less visible ones, such as the consequences of play and physical activity restriction. Implications for education policy are discussed. Future work should seek to improve understanding of forces contributing to risk averse frames of physically active play in schools and contribute evidence for the benefits of risk-taking for children.

Challenging the Boundaries Between Treatment, Prevention, and Enhancement in Human Genome Editing.

Traditional distinctions between treatment and enhancement goals for human genome editing (HGE) have animated oversight considerations, yet these categories have been complicated by the addition of prevention as a possible target for HGE applications. To assess the role these three categories might play in continued HGE governance efforts, we report on interviews with genome editing scientists and governance group members. While some accepted traditional distinctions between treatment and enhancement and rejected the latter as unacceptable, others argued that the concept of enhancement is largely irrelevant or not as morally problematic as suggested. Others described how preventive goals for HGE create gray zones where prevention and enhancement may be difficult to distinguish, which may stymie uses of HGE. We conclude by discussing the governance implications of these various understandings of treatment, prevention, and enhancement as HGE research moves beyond the treatment of serious disease to embrace longer range preventive goals.

Dietary Adequacy of Individuals with Cardiovascular Disease According to Clinical Guidelines in the Brazilian Cardioprotective Nutritional (BALANCE).

Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved. To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC). Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant. 647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%). Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

Contemporary comprehension of root canal biofilms and future perspectives: Part 2

ABSTRACT In Part 1 of this commissioned review, we discussed the basic biology of biofilms, its assembly, biogeography, and physicomechanical properties. In the second part of this review, we critically discuss the literature pertaining to microbiology of endodontic diseases, types of root canal infections, microbial dynamics, and host evasion strategies and highlight the concept of functional redundancy. Then, we review the role of fungi in endodontic diseases and provide an important narrative on the role of biofilms in weakening dentin. Finally, we briefly review the goals of prevention and treatment of apical periodontitis and provide futuristic perspectives to reinforce critical points that will aid future research and discovery.