Impact Of Prevention Interventions Research Articles

Preventive strategies in paediatric cardiovascular surgery: impact on surgical site infections and beyond

BackgroundSurgical management of congenital heart disease (CHD) has increased worldwide, but healthcare-associated infections (HAI) can impede these efforts. This study analysed the incidence of HAI, the impact of preventive interventions, and microbiological profiles in a paediatric cardiovascular surgery program. MethodsCohort study including children under 12 years of age with CHD who underwent cardiovascular surgery between 2010-2021 in Medellín, Colombia (a middle-income setting). Data were collected from medical and laboratory records and infection control program databases. Impact of various preventive interventions was assessed using a Poisson model. A p-value less than 0.05 was considered statistically significant. Results2512 surgeries were analysed. Incidence of surgical site infection (SSI) was 5.9%, followed by central line-associated bloodstream infection (CLABSI; 4.7%), catheter-associated urinary tract infection (CAUTI; 2.2%) and ventilator-associated pneumonia (VAP; 1.4%). Most of the strategies focused on preventing SSI, resulting in a reduction from 9.5% in 2010 to 3.0% in 2021 (p=0.030). Antibiotic prophylaxis based on patient weight and continuous infusion had an impact on reducing SSI (RR:0.56; 95%CI:0.32-0.99). Vacuum-assisted closure (VAC) in clean wounds reduced 100% infections. No significant risk reduction was observed for other HAI with the implemented interventions. ConclusionPreventive strategies effectively reduced SSI but no other infections, emphasizing the need for targeted approaches to address a broader spectrum of HAI successfully.

Burden of malaria, impact of interventions and climate variability in Western Ethiopia: an area with large irrigation based farming

BackgroundLand use change has increasingly been expanding throughout the world in the past decades. It can have profound effects on the spatial and temporal distribution of vector borne diseases like malaria through ecological and habitat change. Understanding malaria disease occurrence and the impact of prevention interventions under this intense environmental modification is important for effective and efficient malaria control strategy.MethodsA descriptive ecological study was conducted by reviewing health service records at Abobo district health office. The records were reviewed to extract data on malaria morbidity, mortality, and prevention and control methods. Moreover, Meteorological data were obtained from Gambella region Meteorology Service Center and National Meteorology Authority head office. Univariate, bivariate and multivariate analysis techniques were used to analyze the data.ResultsFor the twelve-year time period, the mean annual total malaria case count in the district was 7369.58. The peak monthly malaria incidence was about 57 cases per 1000 people. Only in 2009 and 2015 that zero death due to malaria was recorded over the past 12 years. Fluctuating pattern of impatient malaria cases occurrence was seen over the past twelve years with an average number of 225.5 inpatient cases. The data showed that there is a high burden of malaria in the district. Plasmodium falciparum (Pf) was a predominant parasite species in the district with the maximum percentage of about 90. There was no statistically significant association between season and total malaria case number (F3,8: 1.982, P:0.195). However, the inter-annual total case count difference was statistically significant (F11,132: 36.305, p < 0001). Total malaria case count had shown two months lagged carry on effect. Moreover, 3 months lagged humidity had significant positive effect on total malaria cases. Malaria prevention interventions and meteorological factors showed statistically significant association with total malaria cases.ConclusionMalaria was and will remain to be a major public health problem in the area. The social and economic impact of the disease on the local community is clearly pronounced as it is the leading cause of health facility visit and admission including the mortality associated with it. Scale up of effective interventions is quite important. Continuous monitoring of the performance of the vector control tools needs to be done.

The Impact of Preventive Interventions on Intimate Partner Violence among Pregnant Women Resident in Hamadan City Slum Areas Using the PEN-3 Model: Control Randomized Trial Study.

BackgroundIntimate partner violence is a severe life-threatening criminal and public health problem affecting the well-being of individuals, families, and society. Planning interventions to reduce the burden of this persistent and criminal violence should be relevant culturally and socially.MethodsIn this randomized control trial, 150 pregnant women residing in slum areas of Hamadan were randomly assigned to two groups (intervention group: n=50 and control group: n=100). Interventional strategies included educating the victims based on local cultural norms, culturally sensitive individual and group counseling, and educating health care providers. Data were collected via face-to-face interviews at baseline and again at 3 months after the intervention. We used a paired t-test to evaluate the effect of the intervention by comparing changes in the outcomes measured.ResultsThere were no statistically significant differences between the two groups at baseline in terms of sociodemographic characteristics. Post-test scores of knowledge (7.50±2.65 vs. 5.14±3.51, P=0.001), communication skills (18.38±4.25 vs. 16.2±3.83, P=0.04), and family support and social expectation of obedience (15.79±4.45 vs. 13.40±4.57, P=0.005) of the victims were statistically significantly higher in the experimental group compared to the control group. Moreover, physical (0.74±2.28 vs. 1.20±2.60, P=0.06), psychological (2.80±4.10 vs. 4.52±5.43, P=0.06), and sexual (0.11±0.58 vs. 0.61±1.22, P=0.04) violence reduced in the experimental group compared to the control group.ConclusionCulturally relevant interventions can reduce intimate partner violence.

The Use of Population Attributable Risk to Estimate The Impact of Preventive Interventions of Smoking Cessation in Chronic Obstructive Pulmonary Disease(COPD)

This article is a Letter to Editor and does not include an Abstract.

Evaluation of variability in individual response to treatments in the clinical high-risk state for psychosis: A meta-analysis

BackgroundIndividuals at Clinical High Risk for Psychosis (CHR-P) may differ considerably in their response to indicated preventive interventions. No studies have tested this. MethodPRISMA-compliant systematic review of the Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/gray literature up to 1 September 2019. RCTs in CHR-P individuals, reporting on attenuated positive psychotic symptoms were included. The primary outcome was the variability ratio between the variance of the severity of attenuated positive psychotic symptoms in the indicated intervention condition vs the control condition (needs-based interventions, NBI) at 6 and 12 months. Random effect models, C statistics, meta-regressions/sensitivity analyses and Cochrane Risk of Bias assessment were performed. ResultsOverall, 1707 individuals from 14 RCTs (57% male, mean age = 20) reporting on the impact of preventive interventions on attenuated positive psychotic symptoms were included. At 6 months, the variability ratio was 1 (95% CI 0.89–1.12). At 12 months, the variability ratio was higher in the indicated intervention compared to the NBI condition but not statistically different: 1.09 (95% CI 0.94–1.25). Between-study heterogeneity was serious (I2 = 51% and 68%, respectively), but sensitivity analysis suggested it may be related to two outlying studies or larger variability in the response to treatment in small studies. ConclusionsThere is no evidence for individual differences in CHR-P response to preventive treatments. Although the study cannot exclude that subsets of CHR-P individuals may respond differently to preventive treatments, it indicates that the average effect of preventive interventions is a reasonable estimate for the CHR-P individual.

HBV vaccination and PMTCT as elimination tools in the presence of HIV: insights from a clinical cohort and dynamic model

BackgroundSustainable Development Goals set a challenge for the elimination of hepatitis B virus (HBV) infection as a public health concern by the year 2030. Deployment of a robust prophylactic vaccine and enhanced interventions for prevention of mother to child transmission (PMTCT) are cornerstones of elimination strategy. However, in light of the estimated global burden of 290 million cases, enhanced efforts are required to underpin optimisation of public health strategy. Robust analysis of population epidemiology is particularly crucial for populations in Africa made vulnerable by HIV co-infection, poverty, stigma and poor access to prevention, diagnosis and treatment.MethodsWe here set out to evaluate the current and future role of HBV vaccination and PMTCT as tools for elimination. We first investigated the current impact of paediatric vaccination in a cohort of children with and without HIV infection in Kimberley, South Africa. Second, we used these data to inform a new parsimonious model to simulate the ongoing impact of preventive interventions. By applying these two approaches in parallel, we are able to determine both the current impact of interventions, and the future projected outcome of ongoing preventive strategies over time.ResultsExisting efforts have been successful in reducing paediatric prevalence of HBV infection in this setting to < 1%, demonstrating the success of the existing vaccine campaign. Our model predicts that, if consistently deployed, combination efforts of vaccination and PMTCT can significantly reduce population prevalence (HBsAg) by 2030, such that a major public health impact is possible even without achieving elimination. However, the prevalence of HBV e-antigen (HBeAg)-positive carriers will decline more slowly, representing a persistent population reservoir. We show that HIV co-infection significantly reduces titres of vaccine-mediated antibody, but has a relatively minor role in influencing the projected time to elimination. Our model can also be applied to other settings in order to predict impact and time to elimination based on specific interventions.ConclusionsThrough extensive deployment of preventive strategies for HBV, significant positive public health impact is possible, although time to HBV elimination as a public health concern is likely to be substantially longer than that proposed by current goals.

Incidence and admission rates for severe malaria and their impact on mortality in Africa

BackgroundAppropriate treatment of life-threatening Plasmodium falciparum malaria requires in-patient care. Although the proportion of severe cases accessing in-patient care in endemic settings strongly affects overall case fatality rates and thus disease burden, this proportion is generally unknown. At present, estimates of malaria mortality are driven by prevalence or overall clinical incidence data, ignoring differences in case fatality resulting from variations in access. Consequently, the overall impact of preventive interventions on disease burden have not been validly compared with those of improvements in access to case management or its quality.MethodsUsing a simulation-based approach, severe malaria admission rates and the subsequent severe malaria disease and mortality rates for 41 malaria endemic countries of sub-Saharan Africa were estimated. Country differences in transmission and health care settings were captured by use of high spatial resolution data on demographics and falciparum malaria prevalence, as well as national level estimates of effective coverage of treatment for uncomplicated malaria. Reported and modelled estimates of cases, admissions and malaria deaths from the World Malaria Report, along with predicted burden from simulations, were combined to provide revised estimates of access to in-patient care and case fatality rates.ResultsThere is substantial variation between countries’ in-patient admission rates and estimated levels of case fatality rates. It was found that for many African countries, most patients admitted for in-patient treatment would not meet strict criteria for severe disease and that for some countries only a small proportion of the total severe cases are admitted. Estimates are highly sensitive to the assumed community case fatality rates. Re-estimation of national level malaria mortality rates suggests that there is substantial burden attributable to inefficient in-patient access and treatment of severe disease.ConclusionsThe model-based methods proposed here offer a standardized approach to estimate the numbers of severe malaria cases and deaths based on national level reporting, allowing for coverage of both curative and preventive interventions. This makes possible direct comparisons of the potential benefits of scaling-up either category of interventions. The profound uncertainties around these estimates highlight the need for better data.

Viral Genetic Linkage Analysis in the Presence of Missing Data.

Analyses of viral genetic linkage can provide insight into HIV transmission dynamics and the impact of prevention interventions. For example, such analyses have the potential to determine whether recently-infected individuals have acquired viruses circulating within or outside a given community. In addition, they have the potential to identify characteristics of chronically infected individuals that make their viruses likely to cluster with others circulating within a community. Such clustering can be related to the potential of such individuals to contribute to the spread of the virus, either directly through transmission to their partners or indirectly through further spread of HIV from those partners. Assessment of the extent to which individual (incident or prevalent) viruses are clustered within a community will be biased if only a subset of subjects are observed, especially if that subset is not representative of the entire HIV infected population. To address this concern, we develop a multiple imputation framework in which missing sequences are imputed based on a model for the diversification of viral genomes. The imputation method decreases the bias in clustering that arises from informative missingness. Data from a household survey conducted in a village in Botswana are used to illustrate these methods. We demonstrate that the multiple imputation approach reduces bias in the overall proportion of clustering due to the presence of missing observations.

Attempting to prevent postnatal depression by targeting the mother-infant relationship: a randomised controlled trial.

The purpose of the study was to investigate whether an intervention which focused on enhancing the quality of the mother-infant relationship would prevent the development of postnatal depression (PND) and the associated impairments in parenting and adverse effects on child development. Recent meta-analyses indicate modest preventive effects of psychological treatments for women vulnerable to the development of PND. However, given the strong evidence for an impact of PND on the quality of the mother-infant relationship and child development, it is notable that there are limited data on the impact of preventive interventions on these outcomes. This is clearly a question that requires research attention. Accordingly, a randomised controlled trial (RCT) was conducted of such a preventive intervention. A large sample of pregnant women was screened to identify those at risk of PND. In an RCT 91 were randomly assigned to receive the index intervention from research health visitors, and 99 were assigned to a control group who received normal care. In an adjacent area 76 women at risk of PND received the index intervention from trained National Health Service (NHS) health visitors. The index intervention involved 11 home visits, two antenatally and nine postnatally. They were supportive in nature, with specific measures to enhance maternal sensitivity to infant communicative signals, including items from the Neonatal Behavioral Assessment Scale. Independent assessments were made at 8 weeks, 18 weeks, and 12 and 18 months postpartum. Assessments were made of maternal mood, maternal sensitivity in mother-infant engagement, and infant behaviour problems, attachment and cognition. The RCT revealed that the index intervention had no impact on maternal mood, the quality of the maternal parenting behaviours, or infant outcome, although there were suggestions, on some self-report measures, that those with a lower level of antenatal risk experienced benefit. This was also the case for the intervention delivered by trained NHS health visitors. The findings indicate that the approach investigated to preventing PND and its associated problems cannot be recommended.

Identifying recently acquired HIV infections among newly diagnosed men who have sex with men attending STI clinics in The Netherlands

ObjectivesThe current surveillance system in The Netherlands cannot differentiate recent HIV infections from established infections, which is crucial for estimating the HIV incidence; this information is needed for assessing trends...

Book Review: Chronic Medical Disease &amp; Cognitive Aging: Toward a Healthy Body and Brain, edited by Kristine Yaffe (New York Oxford University Press, 2013)

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Violence Prevention and Students with Disabilities: Perspectives from the Field of Youth Violence Prevention

* Though violent crime rates have decreased generally over the past two decades, youth violence remains a significant public health problem. Each year in the United States there are over 5,000 homicide victims between the ages of 1 0 and 24 years and more than 700,000 youths are treated in emergency departments for violence-related injuries (Centers for Disease Control & Prevention [CDC], 2012). In a recent national survey, over 60% of children reported that they were exposed to violence within the past year, and 46% were assaulted within the past year (Finkelhor, Turner, Ormrod, & Hamby, 2009). The short- and long-term consequences of youth violence are significant. Exposure to youth violence contributes to a range of other poor physical and mental health outcomes for youth, including substance use, high risk sexual behavior, depression, academic problems, and suicide (Arseneault, Walsh, Trzeniewski, Newcombe, & Caspi, 2006; Finkelhor, Turner, & Ormrod, 2006; Menard, 2002; Swahn & Bossarte, 2006).Developmental studies have provided increasing clarity about the types of risk factors to target in order to reduce youth violence (CDC, 2012; U.S. Department of Health and Human Services, 2001; World Federation of Mental Health, 2002). The key risk factors associated with youth violence are generally divided into four broad domains: individual, family, peer, and community or neighborhood (Hawkins et al., 1998; Herrenkohl et al., 2000). As a result, a growing list of preventive interventions aimed at children and youth and targeting risk factors identified in basic developmental studies have been shown to be effective (Catalano, Arthur, Hawkins, Berglund, & Olson, 1 998). Thus, we know that programs can be designed to affect developmental trajectories and risk.Much of the work in youth violence prevention has been based in a public heath model and guided by a developmental-ecological perspective on risk and prevention (Bronfenbrenner, 1979, 1988). A central tenet of developmental-ecological theory is that individual development is influenced by the ongoing qualities of the social settings in which the child lives or participates and the extent and nature of the interaction between these settings. Child development and behavior is influenced by family functioning, peer relationships, schools, communities, and larger societal influences (e.g., norms; media). This model also emphasizes development as an important consideration, recognizing children's capacity for change over time. The same factor may have a different impact depending on the age of the child. Thus, the developmental stage must be considered when identifying and attempting to intervene on risk and protective factors.The key implication of the developmentalecological model for violence prevention is that the impact of preventive interventions is likely dependent on the social ecology in which development occurs and the intervention that is provided (Gorman-Smith, Tolan, & Henry, 2000; Tolan, Gorman-Smith, & Henry, 2003). Just as the social-ecological model of development emphasizes that individual development depends in part on social context, so the developmental-ecological prevention model emphasizes that prevention efforts always take place within some social context, so their impact may depend in part on features of that context.In addition to the substantive findings of each, the papers in this special issue contribute to the field of youth violence by advancing understanding of the nature and importance of context in risk and prevention for a population often left out of the youth violence prevention discussion - students with disabilities. Given the risk for both peer victimization and sometimes perpetration of violence found among this population, these papers highlight the need for further research to better inform the development of effective preventive interventions for these vulnerable youth.The paper by Farmer, Lane, Lee, Hamm, and Lambert (2012 [this issue]) highlights the important contextual influence of school social dynamics in supporting or suppressing aggressive behavior. …

Transmission ofChlamydia trachomatisthrough sexual partnerships: a comparison between three individual-based models and empirical data

Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in many developed countries. The highest prevalence rates are found among young adults who have frequent partner change rates. Three published individual-based models have incorporated a detailed description of age-specific sexual behaviour in order to quantify the transmission of C. trachomatis in the population and to assess the impact of screening interventions. Owing to varying assumptions about sexual partnership formation and dissolution and the great uncertainty about critical parameters, such models show conflicting results about the impact of preventive interventions. Here, we perform a detailed evaluation of these models by comparing the partnership formation and dissolution dynamics with data from Natsal 2000, a population-based probability sample survey of sexual attitudes and lifestyles in Britain. The data also allow us to describe the dispersion of C. trachomatis infections as a function of sexual behaviour, using the Gini coefficient. We suggest that the Gini coefficient is a useful measure for calibrating infectious disease models that include risk structure and highlight the need to estimate this measure for other STIs.

Recent HIV infection among newly diagnosed with HIV cases in Turin, Italy

Background Knowledge of the proportion of recent HIV infections (RHI) is important for epidemiologic purposes to assess HIV transmission patterns and evaluate the impact of prevention interventions. The aim of this study was to analyze the characteristics of persons with RHI and to monitor the trend of RHI over time. Methods In the period 2003-2004 and in 2007-2008, serum samples from individuals newly diagnosed with HIV infection were collected in the Infectious Diseases Hospital in Turin. All serum samples were tested for the HIV antibody avidity index (AI); samples with an AI ≤ 0.80 were defined as RHI (≤ 6 months from seroconversion). Results In the study period, 432 serum samples were collected from newly diagnosed HIV individuals. The number of persons with RHI was 113 (26.2%), and the proportion of RHI significantly increased from 22.1% in 2003-2004 to 30.8% in 2007-2008 (p-value < 0.05). The proportion of RHI was higher among MSM compared to heterosexual individuals (33.0% vs. 21.0%, p-value = 0.06). The median age of persons with RHI was similar between MSM (35 years) and heterosexual persons (34 years), as well as between 2003-2004 and 2007-2008 (35 years). A significantly higher proportion of persons who underwent a previous HIV test was observed among RHI (51.3%) compared to those with an established infection (28.5%) (p < 0.001). The proportion of RHI among MSM increased from 25.5% in 2003-2004 to 40.7% in 2007-2008, whereas remained almost stable among heterosexual persons and injecting drug users. Disaggregating by reasons of HIV testing, different proportions of RHI were found: 34.8% among those exposed to unprotected sexual intercourse, 24.5% among injecting drug users, and 11.5% among those screened during pregnancy or blood donation. Discussion RHI have increased over time in Turin, especially among MSM. However, no changes were observed in the age of HIV acquisition by sexual orientation and time period. The identification of RHI can be affected by the frequency of HIV testing and this bias should be considered in estimating HIV incidence.

School-based cognitive-behavioural interventions: A systematic review of effects and inequalities

Little is known about the impact of preventive interventions on inequalities in young people’s mental health. We conducted a systematic review of mental health promotion interventions based on cognitive behavioural therapy (CBT) delivered in schools to young people aged 11–19. Meta-analysis of 17 high quality randomised controlled trials (RCTs) showed a reduction in symptoms of depression, which was generally short term. Interventions for people with clinical risk factors or existing symptoms were more effective, with benefits lasting up to six months. We also found that CBT may be more effective for young people from families with middle to high socioeconomic status (SES) than for those from low SES backgrounds. However, this finding was based on a metaregression with only six studies. A lack of long-term follow-up data and a failure to report subgroup analyses prevented further conclusions being drawn about the effect of these types of interventions on mental health inequalities.

Prevention and health promotion in school and community settings: a commentary on the international perspective

Although somehow different in scale and scope the main public health problems adolescents currently face around the world are quite similar in nature. Therefore international comparisons in the field of health and preventive interventions are quite important. This article outlines some basic concepts used in the international field of adolescent health prevention and promotion with emphases on youth participation process evaluation and analyses of trends of behavior as means to assess both the impact of preventive activities and the influence of the norms and values of the surrounding society. Using examples in the areas of school health substance use and adolescent sexuality this article highlights the usefulness of research and intervention approaches that go beyond the traditional quantitative measures of efficiency and effectiveness. (excerpt)