Important Preventive Intervention Research Articles

Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation: A Danish Nationwide Cohort Study.

Oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) is a highly important preventive intervention, perhaps especially in those with comorbid depression, who have a worse prognosis. However, OAT may pose particular challenges in depressed patients. To assess whether AF patients with depression have lower OAT uptake. This nationwide register-based 2005-2016 cohort study of all Danes with AF and OAT indication (CHA2DS2VASc stroke risk score ≥2) assessed OAT initiation within 90 days in those with incident AF (N=147,162) and OAT prevalence in those with prevalent AF (N=192,656). The associations of depression with both outcomes were estimated in regression analyses with successive adjustment for socioeconomic characteristics and somatic and psychiatric comorbidity. Comorbid depression was significantly associated with lower frequency of OAT initiation in incident AF patients {adjusted proportion differences (aPDs): -6.6% [95% confidence interval (CI), -7.4 to -5.9]} and lower prevalence of OAT [aPD: -4.2% (95% CI, -4.7 to -3.8)] in prevalent AF patients. Yet, the OAT uptake increased substantially during the period, particularly in depressed patients [aPD for OAT prevalence in 2016: -0.8% (95% CI, -1.6 to -0.0)]. Comorbid depression was associated with a significantly lower OAT uptake in patients with AF, which questions whether depressed patients receive sufficient support to manage this consequential cardiac condition. However, a substantial increase in the overall OAT uptake and a decrease of the depression-associated deficit in OAT were seen over the period during which OAT was developed through the introduction of new oral anticoagulation therapy.

Observation on nursing effect of nebulization inhalation in patients with vocal cord polypectomy under tracheal intubation and general anesthesia

Objective To observe the nursing effect of 2% lidocaine and dexamethasone mixture in patients with vocal polyp extirpation under tracheal intubation. Methods From September 2017 to March 2018, 68 patients who were selected to perform vocal cord polyp resection under supportive laryngoscope in the hospital were randomly divided into 4 ml of 2% lidocaine before surgery and 2 ml of 0.5% dexamethasone after atomization inhalation with tracheal intubation under general anesthesia (observation group) and conventional tracheal intubation with general anesthesia (control group), 34 cases of each group.The hemodynamic indexes of endotracheal intubation and operation , the Self-rating Anxiety Scale (SAS) of Ricker at trachea extubation, BCS comfort score and wake time 15 minutes after endotracheal tube extubation were observed. Results The hemodynamics of the observation group was more stable than that of the control group, and the difference was statistically significant(P 0.05). Conclusions The atomization inhalation of 2% lidocaine 4ml and 0.5% dexamethasone mixture before operation as an important preventive nursing intervention can reduce the hemodynamic fluctuation and improve the postoperative comfort. Key words: Atomization inhalation; Nursing effect; Vocal cord polyp extirpation; Lidocaine; Dexamethasone

Modeling the joint effects of adolescent and adult PrEP for sexual minority males in the United States

BackgroundPre-exposure prophylaxis (PrEP) is an effective and safe intervention approved for use to prevent HIV transmission. PrEP scale-up strategies and clinical practice are currently being informed by modeling studies, which have estimated the impact of PrEP in adult and adolescent MSM populations separately. This partitioning may miss important effects or yield biased estimates by excluding dependencies between populations.MethodsWe combined two published models of HIV transmission among adults and adolescent MSM. We simulated an HIV epidemic among MSM aged 13–39 without PrEP, with PrEP for adult MSM ages (19–39) and with the addition of PrEP for adolescents ages (16–18), comparing percent of incident infections averted (impact), the number of person-years on PrEP per infection averted (efficiency), and changes in prevalence.ResultsPrEP use among eligible 19–39 year old MSM averted 29.0% of infections and reduced HIV prevalence from 23.2% to 17.0% over ten years in the population as a whole. Despite being ineligible for PrEP in this scenario, prevalence among sexually active 18 year-olds declined from 6.0% to 4.3% due to reduced transmissions across age cohorts. The addition of PrEP for adolescents ages 16–18 had a small impact on the overall epidemic, further reducing overall prevalence from 17.0% to 16.8%; however prevalence among the sexually active 18 year-olds further declined from 4.3% to 3.8%.ConclusionsPrEP use among adults may significantly reduce HIV prevalence among MSM and may also have significant downstream effects on HIV incidence among adolescents; PrEP targeting adolescents remains an important intervention for HIV prevention.

WIC Recipients in the Retail Environment: A Qualitative Study Assessing Customer Experience and Satisfaction

BackgroundThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction. ObjectiveThis article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved. DesignThe authors designed and conducted semistructured interviews and focus groups with WIC participants. Participants/settingA convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews). Statistical analysis conductedResponses were analyzed qualitatively using principles of content analysis. ResultsChallenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand. ConclusionsDissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma.

Bathing adaptations in the homes of older adults (BATH-OUT): results of a feasibility randomised controlled trial (RCT)

BackgroundHousing adaptations have been identified as an important environmental and prevention intervention for older adults, which may improve health and quality of life. The onset of disability in bathing can act as a warning for further disability in other activities and may therefore be a judicious time-point for intervention. The aim of this study was to determine the feasibility of conducting a Randomised Controlled Trial (RCT) of bathing adaptations, to evaluate whether they improve older adults’ perceived health status and quality of life, prevent further functional deterioration, and reduce the use of other health and social care resources. This study was conducted in preparation for a powered RCT.MethodEligibility criteria were aged > 65 and referred to local authority housing adaptations service for an accessible flush-floor shower. Participants were randomised to either usual adaptations (3–4 month wait) or immediate adaptations (no wait). Outcomes were assessed at 3, 6 and 9 months and included perceived physical and mental health status, health and social care related quality of life, independence in activities of daily living (ADL) and bathing, and falls. Data on costs and the use of health and social care resources were collected during follow-up in order to inform a definitive health economic evaluation.ResultsSixty participants were recruited and randomised, 31 to immediate adaptations and 29 to waiting list control. Mean age was 77(SD8), 58% women and 58% living alone. Follow-ups were completed with 90, 85 and 72% at 3, 6 and 9 months respectively. Adaptations were delivered to 65% of participants within the requisite timescales as there were delays with some privately owned properties. There were improvements from baseline in both groups on all outcome measures following the completion of the adaptations.ConclusionsThis is the first RCT of housing adaptations in the UK. We demonstrated the feasibility of using a waiting list control, subject to minor alterations to the timescales for privately owned properties. A powered trial would evaluate the impact on older adults’ quality of life and investigate the impact of waiting times on functional outcomes and health and care resource use.Trial registrationISRCTN14876332 Registered 12 July 2016.

Association between patient-reported HIV status and provider recommendation for screening in an opportunistic cervical Cancer screening setting in Jos, Nigeria

BackgroundCervical cancer screening (CCS) is an important health service intervention for prevention of morbidity and mortality from invasive cervical cancer. The role of provider recommendation and referral is critical in utilization of this services particularly in settings where screening is largely opportunistic. We sought to understand how patient-reported human immunodeficiency virus (HIV) infection status is associated with provider referral in an opportunistic screening setting.MethodsWe performed a cross-sectional analysis of data on a sample of women who had received a CCS at the “Operation Stop” cervical cancer (OSCC) screening service in Jos, Nigeria over a 10-year time period (2006–2016). We used the de-identified records of women who had their first CCS to analyze the association between patient-reported HIV and likelihood of provider-referral at first CCS. We performed descriptive statistics with relevant test of association using Student t-test (t-test) for continuous variables and Pearson chi square or Fisher exact test where applicable for categorical variables. We also used a bivariable and multivariable logistic regression models to estimate the independent association of patient-reported HIV on provider referral. All statistical tests were performed using STATA version 14.1, College Station, Texas, USA. Level of statistical significance was set at 0.05.ResultsDuring the 10-year period, 14,088 women had their first CCS. The reported HIV prevalence in the population was 5.0%; 95% CI: 4.6, 5.4 (703/14,088). The median age of women who were screened was 37 years (IQR; 30–45). Women who were HIV infected received more referrals from providers compared to women who were HIV uninfected (68.7% versus 49.2%), p-value < 0.001. Similarly, we found an independent effect of patient-reported HIV infection on the likelihood for provider-referral in the screened sample (aOR = 2.35; 95% CI: 1.95, 2.82).ConclusionOur analysis supports the design of health systems that facilitates providers’ engagement and provision of necessary counseling for CCS in the course of routine clinical care. The practice of offering recommendation and referrals for CCS to women at high risk of cervical cancer, such as HIV infected women should be supported.

The Pediatrician’s Role in Oral Health Practice: Perceptions of Oral Health Promotion in Primary Pediatric Settings among Pediatric Residents

Purpose: The American Academy of Pediatrics (AAP) has highlighted the significance of the pediatrician's role in oral health care. However, it is unclear whether pediatricians in training recognize the critical role that they are expected to play in advocating for oral health promotion and providing oral health services when they begin their own practices. A lack of pediatrician involvement in oral health may limit patient access to important preventive measures and interventions, and widen disparities in oral health care …

Cardiac rehabilitation after STEMI.

Cardiac rehabilitation is the most important evidence-based intervention for secondary prevention after STEMI, nevertheless, only a minority of patients may access to a cardiac rehabilitation program. In this review the priority criteria for admission to cardiac rehabilitation and the main barriers that limit a larger involvement of the patients are discussed. Among the components of cardiac rehabilitation exercise is crucial and a tailored exercise training program and a tight monitoring of adherence to lifestyle recommendations are mandatory. Finally, the development of light cardiac rehabilitation pathways and home programs may allow a larger diffusion of outpatient programs. In conclusion, the participation to a cardiac rehabilitation program following STEMI is about 25-35% in western countries, and only 15% in Italy. Stressing the importance of cardiac rehabilitation participation is crucial for all post-myocardial infarction patients, particularly for the vulnerable socioeconomic populations.

Oral Anticoagulants to Prevent Stroke in Nonvalvular Atrial Fibrillation in Patients With CKD Stage 5D: An NKF-KDOQI Controversies Report

Stroke risk may be more than 3-fold higher among patients with chronic kidney disease stage 5D (CKD-5D) compared to the general population, with the highest stroke rates noted among those 85 years and older. Atrial fibrillation (AF), a strong risk factor for stroke, is the most common arrhythmia and affects >7% of the population with CKD-5D. Warfarin use is widely acknowledged as an important intervention for stroke prevention with nonvalvular AF in the general population. However, use of oral anticoagulants for stroke prevention in patients with CKD-5D and nonvalvular AF continues to be debated by the nephrology community. In this National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) controversies report, we discuss the existing observational studies that examine warfarin use and associated stroke and bleeding risks in adults with CKD-5D and AF. Non-vitamin K-dependent oral anticoagulants and their potential use for stroke prevention in patients with CKD-5D and nonvalvular AF are also discussed. Data from randomized clinical trials are urgently needed to determine the benefits and risks of oral anticoagulant use for stroke prevention in the setting of AF among patients with CKD-5D.

Effect of Yoga on Adolescents’ Beliefs about Aggression and Alternatives

International Journal of Medicine and Public Health,2017,7,3,166-171.DOI:10.5530/ijmedph.2017.3.34Published:Aug 2017Type:Original ArticleEffect of Yoga on Adolescents’ Beliefs about Aggression and AlternativesGovindaraja Setty A.G, Pailoor Subramanya, and B.Mahadevan Govindaraja Setty A.G.1*, Pailoor Subramanya2, B.Mahadevan3 1PhD Scholar Swami Vivekananda Yoga University (SVYASA)#19, Eknath Bhavan, Gavipuram Circle, K.G.Nagar, Bangalore-560 019, Karnataka ,INDIA. 2Associate Professor Swami Vivekananda Yoga University (SVYASA) #19, Eknath Bhavan, Gavipuram Circle, K.G.Nagar, Bangalore-560 019, Karnataka, INDIA. 3Professor Indian Institute of Management Bangalore Bangalore – 560076, Karnataka, INDIA.Abstract:Introduction: While the adolescents are trying to adapt to changing life styles and emerging challenges, they are also becoming increasingly aggressive/violent. This is largely attributable to increased competition, stress, and anxiety, besides poor parenting methods. Several studies seek to understand the causes for this delinquency and search for preventive interventions. Indian traditional texts claim that yoga is one of the important preventive interventions. The objective of this paper is to demonstrate the potential of yoga in addressing the non-clinical adolescents’ beliefs about aggression and alternatives compared to physical exercises (PE). Materials and Methods: One hundred and fifty eight normal healthy adolescents participated in this ‘Randomized Control Trial’ design study (Yoga: 76, aged 14.03±1.00 years; PE: 82, aged 14.06 +/- 1.03 years). Yoga/PE intervention was for one hour a day, five days a week, for four weeks. Adolescents’ ‘beliefs about aggression and alternatives’ were measured using ‘beliefs about aggression and alternatives scale’ developed by Multisite violence prevention project (2004). Data analysis was done using SPSS 21.0. Results: Yoga practitioners significantly decreased their overall beliefs supporting aggression (p<.05) and significantly increased their beliefs favoring alternatives to aggression (p<.05), compared to PE practitioners. Conclusion: Four weeks yoga practice significantly reduces the adolescents’ beliefs supporting aggression and increases their beliefs supporting alternatives to aggression compared to PE. Keywords:Aggression, Alternatives, Beliefs about Aggression, Physical Exercises, YogaView:PDF (238.45 KB)

Evaluation of primary immunization coverage among children in a rural block of district Rohtak, Haryana, India

Background: Vaccination is the most important preventive and cost-effective intervention to decrease morbidity and mortality rates in children. Every year, vaccination averts an estimated 2-3 million deaths from diphtheria, tetanus, pertussis and measles. These are all life threatening diseases that disproportionately affect children. An estimated 1.5 million children die annually from diseases that can be prevented by immunization. In the past 50 years, vaccination has saved more lives worldwide than any other medical products or procedures. The objectives of the study were to evaluate primary immunization coverage along with 1st dose of Vitamin-A supplementation coverage, age-appropriate immunization and also to know the reasons for partial or non-immunization among children.Methods: Community-based cross sectional study was conducted among 540 children in the rural area of Rohtak, Haryana during June 2015-May 2016. Information was collected from the mothers regarding immunization status of their children aged 12-23 months old and socio-demographic variables using a semi-structured interview schedule.Results: 395 (73.15%) of 12-23 months old children were fully immunized and the rest 145 (26.85%) were partially immunized. The major reason for drop-out rate was found to be unawareness regarding need for immunization. Immunization coverage was found to be significantly associated with the presence of immunization card and literacy level of mothers.Conclusions: Though the immunization coverage showed improvement through intensive immunization campaigns in recent years, still a lot needs to be done to increase awareness regarding importance of full immunization at the right time as mentioned in the National Immunization schedule (NIS).

Probiotics for prevention of suspected sepsis in low birthweight infants.

Commentary on: Sinha A, Gupta SS, Chellani H, Maliye C, Kumari V, Arya S, Garg BS, Gaur SD, Gaind R, Deotale V, Taywade M, Prasad MS, Thavraj V, Mukherjee A, Roy M. Role of probiotics VSL#3 in prevention of suspected sepsis in low birthweight infants in India: a randomised controlled trial. BMJ Open 2015; 5: e006564. Low birthweight (LBW) is an important indirect cause of neonatal mortality and infections. Considering nearly 30% prevalence of LBW in India and nearly one-third of these neonates dying due to sepsis, even a modest decline in the incidence of sepsis due to a preventive intervention could potentially avert thousands of neonatal deaths 1. Amongst the immunotherapeutic agents for sepsis prevention, probiotics have attracted both interest and debate in the past decade 2, 3 with many institutions using probiotics routinely 4. A review of the level of evidence for probiotics in preterm infants suggests no side effects and long-term outcomes are reassuring 5. The concept of probiotics being helpful in prevention of sepsis seems interesting and novel because few interventions have been proven to be effective in preventing sepsis in LBW infants, apart from exclusive breastfeeding and hand hygiene 6, 7. This study aimed to estimate reduction in incidence of suspected sepsis in zero- to two-month-old LBW infants with a daily supplementation of probiotic VSL#3 (10 billion colony-forming units over a period of 30 days). This intervention, if proven to be efficacious, could be an important public health intervention for prevention of neonatal infections. The study showed no significant reduction in the risk of suspected sepsis (PSBI) diagnosed by the fieldworker. In the un-pre-specified subgroup (weighing 1500–1999 g), the reduction in risk of PSBI was statistically significant. This study was a community-based randomised trial from with high rates of follow-up and good adherence to treatment in both groups. There are, however, a few important limitations which need to be considered before presuming a possible beneficial role of probiotic administration in LBW infants for prevention of sepsis. First, the findings of statistically significant reduction in PSBI in the subgroup weighing 1500–1999 g might be a chance finding because of the small numbers involved. Second, suspected sepsis in itself is not an objective outcome. The significant difference in the subgroup analysis makes it imperative to interpret the results with caution. Third, there was no statistical difference in the colony counts in the two groups on days 1, 21 and 60. The authors mention the absence of an interaction effect between the treatment and the birthweight group which is not clear. Fourth, the intervention initiated on days 3–7 cannot address the risk of early-onset sepsis (EOS), an important cause of morbidity and mortality in LBW neonates. Hence, it may be incorrect to interpret this modest decline in the incidence of sepsis being attributed to due to preventive intervention with probiotics. To conclude, this study suggests possible modest beneficial effect in the subgroup of infants weighing 1500–1999 g. The results underscore the need of a larger study with sufficient power to conclusively evaluate the role of probiotics amongst LBW infants in a population at high risk of mortality from sepsis. Assuming the overall mortality in low birthweight infants to be 20% and the addition of probiotics shall decrease this rate by an absolute value 5% (to 15%); nearly 945 infants will be required in each group (assuming study power to be 80%). https://ebneo.org/2017/01/probiotics-for-prevention-of-suspected-sepsis-in-low-birthweight-infants None. None.

HAND HYGIENE PRACTICES IN MEDICAL STAFF OF TERTIARY CARE HOSPITALS OF LAHORE

With increasing resistance to antibiotics it has become important to prevent the nosocomial infection. Hence as hand hygiene being the most important prevention intervention, this study aimed at exploring hand hygiene practices in junior doctors and nurses of tertiary care hospital of Lahore to further the need of improvement if established.&#x0D; Methodology: 40 nurses and 60 house officers were interviewed in this cross sectional survey and were asked about their hand hygiene practices the difficulty in performing hand hygiene and ways to improve it. Results: It was found that 50(50% )respondents used some form of hand hygiene after touching every patients while 13(13%) after touching 2-3 patients and 26(26%) after on an average of 10 patents. 11 (11%) said that if the hands were soiled from patients’ secretions only than they practiced hand hygiene. Vast majority 76 (76%) used alcohol hand rub for hand hygiene predominantly.31 (31%) graded hand hygiene as time consuming, 27 (27 % ) as inconvenient, 22 (22%) as useless, 20 (20% ) said it caused skin dryness/irritation, When asked what are reasons behind poor hand hygiene practice 96 (96%) responded answered high patient load, 74 out of 100( 74%) soap/water/alocohol rub inaccessible. Only 28% of doctors and 17% of nurses correctly identified 5 moments of hand hygiene according to WHO. When inquired what actions can be done to maximize hand hygiene 77 (77%) said regular advocacy seminar, 46 (46%) said vigilant audit from quality control, 64 (64% ) said optimizing patient load/doctor per duty and 74 out of 100 (74%) said that easy access of soap and water and provision of alcohol rub by hospital administration.&#x0D; Conclusion and Recommendation: Hand hygiene practices were sub optimal and can be improved through regular advocacy seminars, audit, decreasing patient load and providing easy access to soap/water/alcohol rub.

Who to Vax: A free online tool to identify adults for pneumococcal vaccination

We live in an exciting but sometimes overwhelming time to be practicing medicine. The evidence base for population-based decision making is rapidly advancing and continually changing. At the same time, individual patient details and their clinical relevance may fall through the cracks in our complex integrated medical system, requiring vigilance on our part for capturing those details and for improving systems of care.1 Integrating a personal, patient-centered history and examination with evidence-based guidelines is the new art of medicine. Deciding which version of pneumococcal vaccine to give an adult patient epitomizes the complexity of this integration of personalized care and guidelines. It is now recommended that healthy adults without medical comorbidities receive any form of pneumococcal vaccination until the age of 65 years. At the same time, vaccination against disease-causing serotypes of pneumococcus is known to be an important intervention for prevention of invasive pneumococcal disease in a variety of preexisting comorbid conditions and age groups,2,3 and for these groups, there are both age- and disease-specific recommendations on which version of the vaccine to give. The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts who develop recommendations on use of vaccines in the civilian population of the United States, recommends pneumococcal vaccination as beneficial for patients with immunosuppressed states, cigarette smokers, patients with asthma, patients with chronic obstructive pulmonary disease, and other patients who cross our doors routinely.4 For example, patients with asthma are in a higher risk category for invasive pulmonary disease caused by pneumococcus,5–8 and remembering to vaccinate them may yield higher prevention dividends per vaccine than other groups.9

Human papillomavirus infection and vaccination: Knowledge and attitudes among young males in Italy

ABSTRACTThis study assessed knowledge and attitudes about Human papillomavirus (HPV) and the relative vaccination and their determinants in a sample of young males. The survey was conducted between January and April 2015 among a sample of 1000 males aged between 14–24 y in the geographic area of Naples and Caserta, Italy. The 54.9% of the participants reported of having heard about the HPV infection. Those who were aware about the availability of the vaccine, who reported the first vaginal sexual encounter before the 18 y and at least at 18 y compared to those who had not had a complete sexual intercourse, who had undergone a health checkup in the last year, and who had received information about the HPV vaccine by physicians had a significant higher knowledge about the HPV infection. The 58.2% reported that they would be willing to receive the HPV vaccine. Those younger, who reported the first vaginal sexual encounter at least at 18 y, who agreed that male should receive the vaccine, who knew that both males and females can acquire the infection, and who agreed that the vaccine is an important preventive intervention, expressed more positive attitude toward willingness to receive the vaccine. More information about the HPV vaccine were required by those who agreed that the vaccine is an important preventive intervention, who reported the first vaginal sexual encounter at least at 18 y, who have had only one partner in the last year compared to students who had no partner, and who had received information about the vaccine by physicians. This study highlights a need for improved education of young males of the HPV infection and the associated diseases and about the benefit of the vaccination.

Hand Hygiene in Haemodialysis Units

Healthcare-associated infections are a major risk to patient safety. Infection is the first cause of hospitalisation and the second most common cause of mortality among haemodialysis (HD) patients. HD patients, as well as the dialysis staff, are vulnerable to contracting healthcare-associated infections due to frequent and prolonged exposures to many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the associated common environmental conditions, and the immune compromised status of HD patients are major predisposing factors. HD patients are exposed to different types of infections which include bloodstream infections and localized infections of the vascular access, blood-borne infections with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus, and airborne infections. Sources of infections include contaminated water, equipment, environmental surfaces, and infected patients. The evident increased potential for transmission of infections in the HD settings led to the creation and implementation of specific and stricter infection prevention and control measures in addition to the usual standard precautions. Contaminated hands of healthcare workers are among the most common modes of transmission of healthcare-associated infections. Hand hygiene is singled out as the most important infection prevention intervention. Hand hygiene compliance can be improved by continuous education and monitoring, providing a sufficient number of sinks with soap dispensers, paper towels, hand lotions and alcohol-based hand rub placed at each patient station, and regular feedback of surveillance results. Education and training and full awareness of infection control policies and procedures should be provided to all Healthcare workers and to be repeated regularly. The patient and/or caregiver should also be educated on hand hygiene and the care of new vascular access.

The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): the use of direct-acting antivirals as treatment for prevention.

The burden of hepatitis C virus (HCV) is high among people who inject drugs (PWID) and prisoners, and increasing among HIV-infected MSM, who are key populations for HCV transmission in high-income countries and may also play a role in many in low- and middle-income countries. There is an increasing interest in the use of HCV antiviral treatment for prevention in these populations. Numerous theoretical modelling studies have explored the potential impact of HCV treatment for prevention among PWID in a range of global settings, generally finding that modest and achievable levels of HCV treatment, especially with interferon-free direct-acting antiviral therapy (IFN-free DAAs), could substantially reduce HCV chronic prevalence among PWID within the next 10-20 years. In addition, modelling studies have shown HCV testing and treatment in prison (including prevention benefits) could be cost-effective if continuity of care is ensured, or HCV treatments are shortened with DAAs. Modelling work among HIV-infected MSM has shown that further HCV treatment scale-up is likely required despite high treatment rates in this population. However, no empirical studies have explored whether HCV treatment can reduce HCV prevalence and prevent onwards transmission among those at risk of transmission. HCV treatment for key populations such as PWID, prisoners and MSM could become an important HCV prevention intervention, especially in the IFN-free DAA era. However, there is an urgent need to test these hypotheses through empirical studies.

Perceptions about medical male circumcision and sexual behaviours of adults in rural Uganda: a cross sectional study.

IntroductionMedical male circumcision is currently recognized as an additional important HIV preventive intervention to reduce the risk of heterosexually acquired HIV infection in men. However, sexual behaviours after medical circumcision can potentially reduce the expected benefits of the practice. This study explored the perceptions about medical male circumcision and sexual behaviours of adults in Kayunga district, Uganda.MethodsA cross-sectional study was carried out among 393 respondents using a semi structured questionnaire. In addition, four focus group discussions were conducted. Quantitative data was analysed using STATA 12. Univariate, bivariate and multivariate analyses were carried out. Qualitative data was analysed thematically.ResultsThe study established various perceptions about medical male circumcision and sexual behaviours. Majority 247 (64.5%) did not perceive circumcision as a practice that can lead men to have multiple sexual partners. Males were 3 times more likely to think that circumcision would lead to having multiple sexual partners than females (AOR=2.99, CI: 1.93-4.61). Only 89 (23.2%) believed that circumcision would lead to complacency and compromise the use of condoms to prevent against infection with HIV. Respondents who had education above primary were less likely to think that circumcision would compromise the use of condoms (AOR=0.49, CI: 0.31- 0.79). The perception that circumcised youths were less likely to abstain from sexual intercourse was less held among those with education above primary (AOR=0.58, CI: 0.37-0.91) and those older than 30 years (AOR=0.59, CI: 0.38-0.92).ConclusionThere were gaps in knowledge and negative perceptions about MMC in the study community. Measures are needed to avert the negative perceptions by equipping communities with sufficient, accurate and consistent information about medical male circumcision and sexual behaviour.

RACIAL DIFFERENCES POTENTIALLY INFLUENCING SELF-IDENTIFICATION OF MILD COGNITIVE IMPAIRMENT

per se, particularly oily fish rich in omega 3 fatty acids, further limits the potential protective effect on dementia(3-4). Given the role of diet modification in dementia prevention, understanding the link between diet and dementia in Lebanon can be an important dementia prevention intervention for Lebanon and for the Middle East.Methods: 510 participants 65 years old residing in Beirut and Mount Lebanon governorates were included in a cross-sectional survey. Data collection by trained interviewers took place in randomly selected clusters from the capital Beirut andMount Lebanon area. The 10/66 Dementia Research Group diagnostic assessment for dementia and risk factor questionnaires were administered to the participants and their caregivers. Results: Preliminary analysis was carried on 303 participants, 174 females (57.4%) and 129 males (42.6%). The mean age was 72.28 years (SD 7.03). 24 participants were diagnosed with dementia (8%). There was a high prevalence of overweight (54.4%) and obesity (27.7%) among the study population. Neither fish nor meat consumption in this sample was related to dementia prevalence (OR: 0.83; 95%CI: 0.30, 2.33; and OR: 1.48; CI: 0.33,6.56, respectively). Conclusions: Preliminary findings do not support the protective effect of fish consumption, but more definitive conclusions can be made once the entire sample of 510 randomly selected individuals are analyzed. Still, the trends of a lower odds of dementia among older people who consumed fish, and a higher odds of dementia amongmeat consumers is consistent with the results of the large 10/66 study carried out in five LMIC. The latter finding, combined with the nutritional transitions observed in Lebanon and the Arab region and the mounting evidence of the role of diet on dementia, warrants further investigation on a larger national and regional scale.

Factors shaping initial decision-making to self-test amongst cohabiting couples in urban Blantyre, Malawi.

In sub-Saharan Africa, most new HIV infections occur in stable relationships, making couples testing an important intervention for HIV prevention. We explored factors shaping the decision-making of cohabiting couples who opted to self-test in Blantyre, Malawi. Thirty-four self-tested participants (17 couples) were interviewed. Motivators for HIV self-testing (HIVST) emerged at three main levels. Individual motivations included perceived benefits of access to treatment, and self-checking of serostatus in the hope of having been cured by prolonged treatment or faith-healing. HIVST was considered convenient, confidential, reassuring and an enabling new way to test with one’s partner. Partnership motivations included both positive (mutual encouragement) and negative (suspected infidelity) aspects. For women, long-term health and togetherness were important goals that reinforced motivations for couples testing, whereas men often needed persuasion despite finding HIVST more flexible and less onerous than facility-based testing. Internal conflict prompted some partners to use HIVST as a way of disclosing their previously concealed HIV positive serostatus. Thus, the implementation of community-based HIVST should acknowledge and appropriately respond to decision-making processes within couples, which are shaped by gender roles and relationship dynamics.