Prevention In People Research Articles

Glimpse of Contemporary Clinical Perspective on “Mindfulness Based Cognitive Behavioral Therapy” in Various Health Dimensions

Mindfulness-based cognitive therapy (MBCT) is a modified form of cognitive behavioral therapy that associates with mindfulness practices such as meditation and breathing exercises. Initially emerged as an intervention for relapse prevention in people with recurrent depression, it has since been connected to various psychiatric conditions and also has also shown marked effectiveness in various physical conditions. This paper aims to briefly describe the perspectives of MBCT and its presumed mechanism of action, and to review its effectiveness on different mental and physical wellbeing. The main therapeutic goal of MBCT is to interrupt automatic processes and teach the participants to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment due to which they can ended up more mindful of their contemplations and dispositions and not get caught within the circle of cynicism by utilizing mindfulness and CBT techniques. This new strategy enables to gain more control of thoughts and emotions. There are different confirmations on the viability of mindfulness based cognitive behavioural intervention in individual’s mental and physical heath dimension. Keywords: Mindfulness-based cognitive therapy, Mindfulness, Cognitive Behavioral Therapy.

Focusing on suicide prevention in people with HIV.

Compared with the general population, people with HIV have an elevated risk of dying by suicide.1 Although previous research has studied and investigated suicide mortality in people with HIV, there are insufficient relevant data focusing on the trend of suicide mortality in a large, representative sample on a national scale. In The Lancet HIV, Fangfang Chen and colleagues2 assessed a large, nationwide cohort of people with HIV in China during 2012–18, calculated the suicide mortality, and identified the risk factors and trends in suicide unique to this group of people.

A Scoping Review of Foot Screening in Adults With Diabetes Mellitus Across Canada

ObjectivesRegular foot screening by a knowledgeable health-care provider is the cornerstone of ulcer and amputation prevention in people with diabetes. However, information on foot screening practices among Canadians with diabetes remains sparse. Therefore, we sought to synthesize available data on the frequency and approach to diabetic foot screening across Canada. MethodsWe conducted a scoping review by searching MEDLINE and Embase databases, alongside a grey literature search, for both English- and French-language reports. Data on patients’ demographics, setting as well as the frequency of and approach to foot screening were abstracted. Title and abstract screening, full-text review and data abstraction were conducted in duplicate, with discrepancies resolved by a third reviewer. ResultsThe search yielded 21 reports including information on diabetic foot screening practices in Canada. In a consolidated study sample of 13,388 Canadians with diabetes, 7,277 (53%) reported receiving a foot examination by a health-care provider at least once in the past year. The majority of reports did not provide information on the demographics of patients being screened or details on the approach to foot screening. No report mentioned the use of a triage algorithm applied to the results of foot screening. ConclusionsIn this work, we identified the limited frequency and uncertain quality of diabetic foot screening across Canada. Further research should focus on better understanding disparities and barriers to regular diabetic foot screening.

An introduction to the special issue: From ideas to efficacy in health psychology.

The impetus for the special issue, "From Ideas to Efficacy" was the perceived need to stimulate and support a more vibrant research base that translates basic behavioral and social science research (bBSSR) discoveries to clinical and public health interventions. This special issue presents novel research that advances translational behavioral science, focusing primarily on the early phases of behavioral translation that are not as well recognized as later-phase translational science (e.g., dissemination and implementation research). The special issue includes a series of empirical, conceptual, and methodological papers, and a shining example of translational research that has had important clinical implications for the treatment of obesity and prevention of people with prediabetes from transitioning to Type II diabetes. In this introduction we will first set the context of the special issue and briefly comment on the papers. We end with several ideas in the areas of funding, training and publication of early phase translational behavioral science that can accelerate the process through which new ideas from our deepening understanding of human behavior can be more rapidly and fully brought to bear on the pressing health problems facing our nation and our world. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Antiepileptic drugs for seizure control in people with neurocysticercosis.

Neurocysticercosis is the most common parasitic infection of the brain. Epilepsy is the most common clinical presentation, though people may also present with headache, symptoms of raised intracranial pressure, hydrocephalus, and ocular symptoms depending upon the localisation of the parasitic cysts. Anthelmintic drugs, antiepileptic drugs (AEDs), and anti-oedema drugs, such as steroids, form the mainstay of treatment. This is an updated version of the Cochrane Review previously published in 2019. To assess the effects (benefits and harms) of AEDs for the primary and secondary prevention of seizures in people with neurocysticercosis. For the question of primary prevention, we examined whether AEDs reduce the likelihood of seizures in people who had neurocysticercosis but had not had a seizure. For the question of secondary prevention, we examined whether AEDs reduce the likelihood of further seizures in people who had had at least one seizure due to neurocysticercosis. As part of primary prevention studies, we also aimed to examine which AED was beneficial in people with neurocysticercosis in terms of duration, dose, and side-effect profile. For the 2021 update of this review, we searched the Cochrane Register of Studies (CRS Web), MEDLINE, and LILACS to January 2021. CRS Web includes randomised or quasi-randomised, controlled trials from CENTRAL, the Specialised Registers of Cochrane Review Groups, including Epilepsy, PubMed, Embase, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform. We also checked the reference lists of identified studies, and contacted experts and colleagues in the field to search for additional and ongoing studies. Randomised and quasi-randomised controlled trials. Single-blind, double-blind, or unblinded studies were eligible for inclusion. We followed standard methodological procedures expected by Cochrane. Two review authors independently selected trials for inclusion and extracted the relevant data. The primary outcomes of interest were: proportion of individuals experiencing seizures, and time to first seizure post randomisation. Secondary outcomes included: seizure freedom, number of withdrawals, side effects, number of people seizure free with short or long durations of treatment, quality of life, therapy costs, hospitalisations, and mortality. We used an intention-to-treat analysis for the primary analysis. We calculated odds ratio (OR) for dichotomous data (proportion of individuals who experienced seizures, were seizure free for a specific time period (12 or 24 months), withdrew from treatment, developed drug-related side effects or complications, were seizure-free with each treatment policy, mortality), and planned to use mean difference (MD) for continuous data, if any continuous data were identified (quality of life, cost of treatment). We intended to evaluate time to first seizure after randomisation by calculating hazard ratios (HRs). We assessed precision using 95% confidence intervals (CIs). We stratified the analysis by treatment comparison. We also considered the duration of drug usage, co-medications, and the length of follow-up. We did not find any trials that investigated the role of AEDs in preventing seizures among people with neurocysticercosis, presenting with symptoms other than seizures. We did not find any trials that directly compared individual AEDs for primary prevention in people with neurocysticercosis. We included four trials that evaluated the efficacy of short-term versus longer-term AED treatment for people with solitary neurocysticercosis (identified on computed tomography (CT) scan) who presented with seizures. In total, 466 people were enrolled. These studies compared AED treatment durations of 6, 12, and 24 months. The risk of seizure recurrence with six months of treatment compared with 12 to 24 months of treatment was inconclusive (odds ratio (OR) 1.34, 95% confidence interval (CI) 0.73 to 2.47; three studies, 360 participants; low-certainty evidence). The risk of seizure recurrence with six to 12 months of treatment compared with 24 months of treatment was inconclusive (OR 1.36, 95% CI 0.72 to 2.57; three studies, 385 participants; very low-certainty evidence). Two studies compared seizure recurrence with CT findings, and suggested that persistent and calcified lesions had a higher recurrence risk, and suggest longer duration of treatment with AEDs. One study reported no side effects, while the rest did not comment on side effects of the drugs. None of the studies addressed the quality of life of the participants. These studies had methodological deficiencies, such as small sample sizes, and a possibility of bias due to lack of blinding, which affect the results of the review. Despite neurocysticercosis being the most common cause of epilepsy worldwide, there is currently no evidence available regarding the use of AEDs as seizure prophylaxis among people presenting with symptoms other than seizures. For those presenting with seizures, there is no reliable evidence regarding the duration of treatment required. Therefore, there is a need for large scale randomised controlled trials to address these questions.

A Scoping Review of Foot Screening in People With Diabetes Mellitus Across Canada

Regular foot screening by a knowledgeable health provider is the cornerstone of ulcer and amputation prevention in people with diabetes. However, information on foot screening practices among Canadians with diabetes remains sparse. We therefore sought to synthesize available data on the frequency and approach to diabetic foot screening across Canada.

Awareness of cardiovascular diseases risk factors, attitude towards their health and sleep disorders among the 25–64 years old population in Russia/Siberia (WHO International «MONICA-psychosocial» program)

Objective: to establish associations of awareness and attitude towards cardiovascular diseases (CVDs) prevention in people with sleep disorders in an open population of Novosibirsk aged 25–64 years.Patients and methods. We carried out screening surveys of representative samples of the 25–64 years old population: in 2013–2016 – V screening (427 men, mean age– 34±0.4 years, response rate – 71%; 548 women, mean age– 35±0.4 years, response rate – 72%); in 2015–2018 – VI screening (275 men, mean age – 49±0.4 years, response rate – 72%; 390 women, mean age – 45±0.4 years, response rate – 75%) using the protocol of the WHO international program «MONICA-psychosocial». Jenkins sleep evaluation questionnaire was used to evaluate sleep disorders in the study population.Results and discussion. Participants with sleep disorders believed that they were «not entirely healthy» (men – 65.5%, χ2 =57.825, df=8, p<0.001 and women – 69.6%, χ2 =96.883, df=4, p<0.001); had health related complaints (men – 78.2%, χ2 =24.179, df=2, p<0.001 and women – 85.2%, χ2 =55.144, df=2, p<0.001), and clearly did not care enough about their health (men – 32.7%, χ2 =29.31, df=4, p<0.001 and women – 34.1%, χ2 =28.116, df=4, p<0.001). Men with sleep disorders more often assumed that they were more likely to get a serious illness within the next 5–10 years (χ2 =12.976, df=4, p<0.01). Participants with sleep disorders were confident that modern medicine can prevent (men – 10.9%, χ2 =19.079, df=2, p<0.001 and women – 13.3%, χ2 =21.944, df=2, p<0.01) and successfully treat (men – 3.6%, χ2 =24.142, df=8, p<0.01 and women – 3.7%, χ2 =15.538, df=8, p<0.05) only some heart diseases. Men and women with sleep disorders are more likely to seek medical attention in case of severe pain or discomfort in the heart area, but do not seek medical advice if this pain or unpleasant sensation is mild (men – 63.6%, χ2 =14.867, df=6, p<0.05 and women – 60%, χ2 =17.872, df=6, p<0.01). Among the participants with sleep disorders men more often believe that the doctor «knows more than me» (36.4%), and women (48.1%) chose an answer: «I will not necessarily agree with the opinion of the doctor after a general examination, until a thorough evaluation has been carried out by specialists» (χ2 =5.917, df=2, p<0.05). Women with sleep disorders were more likely to continue to work if they did not feel very well (54.1%, χ2 =12.455, df=4, p<0.05) or their body temperature rose (37.8%, χ2 =12.937, df=4, p<0.05).Conclusion. People with sleep disorders generally have a more negative attitude towards their health and are skeptical about the possibilities of modern medicine to prevent and treat CVDs, which is reflected in their attitude to work and preventive check-ups.

Reactive balance responses to a trip and slip during gait in people with multiple sclerosis

BackgroundTo examine reactive balance responses to a trip and slip during gait in people with multiple sclerosis (MS). MethodsThis cross-sectional laboratory study involved 29 participants with MS (50.6 ± 13.4 years) and 29 gender-and-aged-matched healthy controls (50.9 ± 19.2 years). Falls following an induced trip and slip along a 10 m walkway, approach (e.g. gait speed, step length, foot contact angle) and recovery strategies (e.g. response time, extrapolated centre of mass position, margin of stability) were compared between the two groups. FindingsThe rate of falls was significantly higher in the participants with MS relative to healthy controls (rate ratio=2.82, 95% confidence interval [CI]=1.42, 5.61). Participants with MS also experienced more trip falls (odds ratio [OR]=3.90, 95% CI=1.16, 13.08) and more slip falls (OR=6.27, 95% CI=1.95, 20.22) than the heathy controls. Participants with MS had significantly slower gait speed, step length, cadence, and foot contact angle during approach (P < 0.05). Following slips, participants with MS had significantly greater stance limb knee flexion (P < 0.05), suggesting inadequate lower limb support to recover balance post-slip. Following trips, participants with MS had significantly delayed response initiation, lower toe clearance, shorter step length, and greater trunk sway (P < 0.05). Fewer participants with MS showed a hopping response to clear the obstacle (P < 0.05). InterpretationMultiple sclerosis impairs reactive balance responses to a trip and slip associated with reduced lower limb function and delayed postural responses. Neurorehabilitation targeting reactive balance may facilitate fall prevention in people with multiple sclerosis.

Effectiveness of self-care interventions for integrated morbidity management of skin neglected tropical diseases in Anambra State, Nigeria

BackgroundLymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria. Not enough is known about the effectiveness of integrated morbidity management and disability prevention in people with these conditions. An integrated self-care intervention was carried out for people with these skin NTDs in two endemic communities of Anambra state, Nigeria. The objective of the study was to assess the effectiveness of self-care practices on costs of care, disability status and health-related quality of life.MethodsThis study utilised a quasi-experimental pre-test/post-test design to assess the effectiveness of the self-care interventions for people affected by NTDs to care for these impairments at home. Data were collected using questionnaires administered at the beginning and at the end of the intervention on monthly cost of morbidity care, and on participants’ disability status and their quality of life (QoL). Focus group discussions (FGDs) were held with both the participants and healthcare workers at follow-up.ResultsForty-eight participants were recruited. Thirty participants (62.5%) continued the self-care interventions until the end of the project. Of those, 25 (83%) demonstrated improvement from their baseline impairment status. The mean household costs of morbidity care per participant decreased by 66% after the intervention, falling from US$157.50 at baseline to US$53.24 after 6 months of self-care (p = 0.004). The mean disability score at baseline was 22.3; this decreased to 12.5 after 6 months of self-care (p < 0.001). Among the 30 participants who continued the interventions until the end of the project, 26 (86.7%) had severe disability score (i.e. a score of 10–46) at baseline, and the number with severe disability fell to 18 (60%) of the 30 after the intervention. The mean QoL score increased from 45.7 at baseline to 57.5 at the end of the intervention (p = 0.004).ConclusionsThe 6-month self-care intervention for participants affected by BU, leprosy, or LF led to lower costs of care (including out-of-pocket costs and lost earnings due to morbidity), improved QoL scores, and reduced disability status.Trial registrationISRCTN Registry: ISRCTN20317241; 27/08/2021, Retrospectively registered.

Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: a scoping review protocol

Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: a scoping review protocol

Foot Screening dan Pengaruh Edukasi terhadap Pengetahuan dan Perilaku Pencegahan Diabetic Foot Ulcer pada Individu dengan Diabetes Mellitus

Diabetic foot ulcer (DFU) is a complication of diabetes mellitus (DM) that is important to get attention especially by people with DM. Approximately 25% of DM cases develop DFU. In addition, 85% of amputations in DM cases are caused by DFU. However, amputation of the lower limb due to DFU could be minimized by giving education about its prevention. Therefore, this study was conducted to determine the risk level of DFU and evaluated the effect of education related to DFU prevention in people with DM. This research was an observational descriptive study with a cohort study approach. This research had 15 participants. Each participant underwent foot screening to determine the risk level of DFU. Afterward, they were given a pretest to evaluate the level of knowledge and behavior of DFU prevention by using questionnaires. Directly after the pretest, they were also given education about DFU prevention. After 6-8 weeks, a post-test was carried out using the same questionnaires. The results showed that all participants had a risk of developing DFU. Giving education has significantly improved the knowledge and behavior of participants in practicing foot care to prevent DFU. It is important to perform foot screening to prevent the complications of DFU. In addition, education is significantly influential in improving the knowledge and behavior related to DFU prevention in people with DM.

268-OR: Cost-Effectiveness and Cost Utility of At-Home Foot Skin Temperature Monitoring for Ulcer Prevention in People with Diabetes: A Multicenter Randomized Controlled Trial (diatemp)

Introduction: The skin of people with diabetic foot disease is thought to heat up from ambulatory activity before it breaks down into ulceration. We assessed cost-effectiveness and cost-utility of at-home foot skin temperature monitoring for ulcer prevention in people with diabetes. Methods: In this outcome-assessor-blinded multicenter RCT, we randomly assigned people with diabetes, neuropathy, foot ulcer history or Charcot’s neuro-arthropathy to usual care (i.e., podiatric treatment, education, and therapeutic footwear) or usual care plus measuring skin temperatures at 6-8 plantar sites per foot each day (enhanced therapy). Foot care costs from a societal perspective were obtained via institute for Medical Technology Assessment questionnaires and from health records. Utilities were calculated based on health-related quality of life as assessed with the EQ-5D-3L. Primary clinical outcome for effectiveness was foot ulcer recurrence. Group differences were assessed by calculating 95% confidence intervals after correction for bias and using accelerated non-parametric bootstrapping. Results: Total foot care costs per participant during 18-months follow-up were significantly lower in the intervention group (n=151; €4007 (SD: €6349)) compared to usual care (n=153; €6872 (SD: 15251); p=0.033). The intervention had 99.3% probability of being cost-effective at a willingness-to-pay of €50,000. Quality-adjusted life years were lower in the intervention group (1.09 (SD: 0.35)) than in usual care (1.12 (SD: 0.34); p=0.397). The intervention had 69.0% probability of achieving cost-utility at a willingness-to-pay of €50,000. Conclusion: In this first-ever societal-perspective cost-effectiveness RCT in the field of diabetic foot disease, we found at-home foot skin temperature monitoring a cost-effective intervention in foot ulcer prevention, at the expense of lower quality of life. Disclosure J. Van netten: None. W. B. Aan de stegge: None. M. Dijkgraaf: None. S. A. Bus: None. Funding Netherlands Organization for Health Research and Development (837002508); Dutch Society for Podiatrists; Dutch Branch Organization for Pedicures

Diabetes mellitus, platelet function and acetylsalicylic acid

Diabetes mellitus is an independent risk factor for cardiovascular disease (CVD). Accelerated development of atherosclerosis in patients with diabetes is a consequence of endothelial dysfunction, low-grade inflammation, oxidative stress, dyslipidemia, and platelet dysfunction. The results of studies have shown that among diabetic patients there is a high percentage of no effect when using both acetylsalicylic acid (ASA) and clopidogrel. It is necessary to distinguish between patients with a weak response and people with no effect— resistant to aspirin. The frequency of the so-called aspirin resistance, according to modern research, is different and depends on the methods used to study platelet function. In diabetic patients, it ranges from 5 to 45% when taking ASA and from 4 to 30% when taking clopidogrel. Recent studies show an even higher proportion of such individuals among people with diabetes. The appropriateness of lifelong ASA for secondary prevention in people diagnosed with CVD is indisputable (level of evidence A). At the same time, approaches to primary prevention vary in different countries. It is emphasized that the primary prevention with ASA in modern conditions maintains a favorable balance of benefits/risks. The new guidelines state that the calculated 10-year risk of cardiovascular events should not be considered when deciding whether to prescribe ASA to patients without CVD. Instead, all risk factors present in each patient should be considered, including burdensome family history, inability to achieve lipid and glycemic levels, and coronary calcification. The conclusion that ASA has evidence-based efficacy in secondary prophylaxis in patients with CVD has been confirmed. Regarding the primary prevention of cardiovascular events, including healthy individuals, the appropriateness, duration of administration, and choice of ASA should be determined taking into account the 10-year development of serious events, the presence of comorbidities, and the risk of bleeding.

The study of efficacy of soy-pumpkin products in the diet of healthy people for prevention of acute respiratory infections

Introduction. Hypoalimentation with the formation of protein-energy malnutrition can reduce the body’s resistance to acute respiratory infections (ARI). Soy and pumpkin can be a promising source of normalization of the diet.Aim. To study the effectiveness of the use of soybean-pumpkin products in the diet of healthy people to increase the resistance of the human body to ARI.Materials and methods. An open, randomized, parallel group study was conducted. Group 1 included 18 people who took a soy-pumpkin drink and dessert for 10 weeks in addition to their usual diet. Group 2 included 17 people on a regular diet. The concentration of vitamin E, cholesterol, α- and β-lipoproteins was determined in blood serum. Diene conjugates and unoxidized lipids were determined in the expired air condensate (EAC) by means of spectrophotometry. Lung function was assessed using spirometry.Results. According to the questionnaire survey, 50% of the participants in group 1 registered a positive dynamics from the regular use of soybean-pumpkin products. Only one participant underwent ARI. In the 2nd group, 7 people (41%) applied for medical help (χ2=4.43; p˂0.05), of which 6 (35%) had ARIs. At the end of the observation, an increase in vitamin E (from 34.1±0.68 to 36.4±0.55 μg/mL, p=0.0036), a decrease in total cholesterol (from 4.85±0.23 to 4.32±0.14 mmol/L, p=0.0013) and β-lipoproteins (from 2.92±0.24 to 2.31±0.18 mmol/L, p=0.0003). At the beginning of the study, in individuals of group 1, there was a relationship between age and the concentration of total cholesterol (r=0.50; p=0.036) and β-lipoproteins (r=0.47; p=0.048), as well as the weight and level of α-lipoproteins (r=-0.49; p=0.041), the concentration of unoxidized lipids (r=0.55; p=0.02), diene conjugates (r=0.48; p=0.043) in EAC. After regular use of soybean-pumpkin products, this correlation dependence was lost.Conclusion. Regular use of soy-pumpkin products for 10 weeks has a beneficial effect on the lipid profile of the blood, increases antioxidant defence, and reduces the susceptibility of a healthy person to ARI.

Could social prescribing contribute to type 2 diabetes prevention in people at high risk? Protocol for a realist, multilevel, mixed methods review and evaluation

IntroductionSocial prescribing is an innovation being widely adopted within the UK National Health Service policy as a way of improving the management of people with long-term conditions, such as type...

A retrospective study on the seasonal occurrence of Japanese Encephalitis cases in Uttar Pradesh

Background: Japanese encephalitis (JE) is a dreaded mosquito-borne viral disease, especially in Asian, Western Pacific, and Northern Australia region and a major public health problem in India. In India, State of Uttar Pradesh contributed a large portion of JE cases to the country. Because of its high morbidity and mortality, JE is of particular interest. With the help of specific intervention, we can prevent the morbidity and mortality of JE cases. The objective of the study was to know the seasonal occurrence of JE cases in Uttar Pradesh.Methods: This was a retrospective study based on secondary data, shared by Communicable Disease wing of Swasthya Bhawan, Lucknow, Uttar Pradesh (U.P) for the analysis. We used data for the study during the past 7 years (2010–2016). Analysis has been done using Microsoft Excel.Results: In Uttar Pradesh, there were 1322 cases of JE during the year 2010-2016. Peak incidence of JE cases were seen in months of September. An overall decreasing trend with some fluctuation was seen in the occurrence of cases from 2010 to 2016. It was also observed that maximum cases were occurred in monsoon season. Majority of the cases were seen in Gorakhpur district which is located in eastern part of Uttar Pradesh.Conclusions: Majority of the cases of JE were seen in rainy months. Gorakhpur district of Uttar Pradesh has the highest load of JE cases. IEC activities should be carried out to disseminate the information regarding JE among the people for prevention.

126 A Student Pilot for A Feasibility Study of the Theoretical 3S Trial (SPFT3S): GP and Ethics Committee Members Questionnaire

Abstract Introduction Emerging research suggests that statin use for primary prevention in people without diabetes aged 75 and older has no benefit. This study aims to determine the feasibility of the theoretical Stop Statin Study (3S), a double-blind randomised controlled trial carried out in general practice, which would test this hypothesis. 50% of trial patients would stop taking statins for 5 years in an event driven study. The questionnaires aim to identify the attitudes of general practitioners (GPs) and ethics committee members (ECMs) regarding stopping statins for 5 years in patients aged 75 and older without diabetes or history of cardiovascular disease and their willingness to allow patients to participate in the 3S study. Method Questionnaires comprised of 6 questions were designed. 4 students distributed the questionnaire and it was completed by 19 GPs based at 8 practices in the North-East of England. 31 ECMs (12 expert and 19 lay) responded by email. Results 95% of GPs who completed the survey would agree to their patients participating in the theoretical study with 47% of GPs indicating that their willingness to participate in the study is patient dependent. 95% of GPs would also consider stopping statins in this population group if sufficient research had been carried out or if the guidelines were changed. 42% of GPs have a negative attitude to prescribing statins in this population group. All the ECMs would approve the study, citing over-prescribing and polypharmacy as their reason. Conclusions The majority of GPs will participate in the theoretical 3S study, if their patients are willing to participate. There is already a negative perception amongst GPs towards the use of statins in elderly people without disease. The 3S study appears to be feasible from the GP and ethics perspective but would require a larger feasibility study.

The TOPAZ study: a home-based trial of zoledronic acid to prevent fractures in neurodegenerative parkinsonism

The Trial of Parkinson’s And Zoledronic acid (TOPAZ, https://clinicaltrials.gov/ct2/show/NCT03924414) is a unique collaboration between experts in movement disorders and osteoporosis to test the efficacy of zoledronic acid, an FDA-approved parenteral treatment for osteoporosis, for fracture prevention in people with neurodegenerative parkinsonism. Aiming to enroll 3,500 participants age 65 years or older, TOPAZ is one of the largest randomized, placebo-controlled clinical trials ever attempted in parkinsonism. The feasibility of TOPAZ is enhanced by its design as a U.S.- wide home-based trial without geographical limits. Participants receive information from multiple sources, including specialty practices, support groups and websites. Conducting TOPAZ in participants’ homes takes advantage of online consent technology, the capacity to confirm diagnosis using telemedicine and the availability of research nursing to provide screening and parenteral therapy in homes. Home-based clinical research may provide an efficient, convenient, less expensive method that opens participation in clinical trials to almost anyone with parkinsonism.

ОГЛЯД ПРОГРАМИ ЗАМІСНОЇ ПІДТРИМУВАЛЬНОЇ ТЕРАПІЇ ЯК ЗАСІБ СОЦІАЛЬНОЇ ПРОФІЛАКТИКИ ВІЛ ДЛЯ ЛЮДЕЙ, ЯКІ ВЖИВАЮТЬ ІН'ЄКЦІЙНІ НАРКОТИКИ В УКРАЇНІ

Currently, the prevalence of HIV in people who inject drugs in Ukraine is over 22 %. Medication-assisted treatment (MAT) is an effective evidence-based means of HIV prevention in people who inject drugs (PWID). The objective of this article was to present the overview of medication-assisted program in Ukraine. Descriptive statistics were used to summarize the open-access official data as well as the results of most recent studies in the field of research to analyze and describe the current state of MAT program for PWID. Presented results summarize demographic, clinical data and access to psycho-social support of PWID on MAT in Ukraine as well as present effective approaches for program scale up for prevention of HIV transmission in people who inject drugs in Ukraine.

Co-Conspirator for Justice: The Revolutionary Life of Dr. Alan Berkman by Susan M. Reverby

Reviewed by: Co-Conspirator for Justice: The Revolutionary Life of Dr. Alan Berkman by Susan M. Reverby Emily K. Hobson Co-Conspirator for Justice: The Revolutionary Life of Dr. Alan Berkman. By Susan M. Reverby. Justice, Power, and Politics. (Chapel Hill: University of North Carolina Press, 2020. Pp. xii, 393. $30.00, ISBN 978-1-4696-5625-0.) In Co-Conspirator for Justice: The Revolutionary Life of Dr. Alan Berkman, Susan M. Reverby offers an absorbing and deeply researched biography of Alan Berkman, a doctor, political prisoner, and global AIDS activist. Reverby, who is a well-known historian of public health, grew up with Berkman in Middletown, New York, attending college with him at Cornell University and remaining "distant friends" until his death (p. 2). Critical of Berkman's involvement in the armed underground yet empathetically drawn to her subject, Reverby engagingly animates the movements at the center of Berkman's life. Born on September 4, 1945, and raised in a Jewish family that moved from the working class into the middle class, Berkman was radicalized while in medical school at Columbia University, which, through the influence of the 1968 student strike, Black Panther Party health clinics, and efforts to democratize Lincoln Hospital, became a kind of laboratory for the health Left. Berkman's commitment to do no harm drew him toward supporting selfdefense against state violence. He provided care to prisoners injured at the Attica prison uprising and to Native activists in the Wounded Knee occupation and, starting in the mid-1970s, became a leader in three interrelated organizations of white anti-imperialists—the Prairie Fire Organizing Committee, the May 19th Communist Organization (May 19th), and the John Brown Anti-Klan Committee. [End Page 367] In 1981 Berkman provided emergency medical care to activists in the aftermath of the attempted robbery of a Brink's armored truck, a disastrous action that was intended to fund the Black Liberation Army and that resulted in the deaths of a Brink's guard and two police officers. The robbery became the focal point of an array of grand jury investigations and conspiracy charges; Berkman was jailed for refusing to provide information and then indicted with others as an accessory after the fact. In 1983 he went underground with fellow members of May 19th, and for two years he helped carry out several bombings of government and industry buildings, all without harm to individuals. Long interested in prison health care, Berkman experienced its inadequacy firsthand after his capture in 1985. Diagnosed with Hodgkin's lymphoma, he found his life at risk as a result of medical negligence in prison, and he survived due largely to his own knowledge and connections. During the time he was held in the Marion Control Unit, a severe isolation facility that later closed due to international protest, he was the only licensed doctor in the prison. Berkman was convicted and sentenced to ten years on charges related to the Brink's robbery, and in 1988 he was indicted with six others for conspiracy bombing. The group, known as the Resistance Conspiracy codefendants, argued double jeopardy and termed their case a "testing ground" for government surveillance and the criminalization of dissent (p. 194). When Berkman's cancer returned, however, his codefendants agreed to guilty pleas and lengthy sentences in exchange for his charges being dismissed and the provision of cancer care. From his release in 1992 until his death in 2009, Berkman devoted himself to fighting HIV/AIDS. He became the medical director of an HIV/AIDS residential program, and after obtaining a fellowship and later a tenured professorship at Columbia, he researched HIV risk and prevention for people who were homeless, used drugs, were mentally ill, or had been imprisoned. Most significantly, he cofounded Health GAP, which won greater global access to HIV drugs through tactics ranging from insider advocacy to direct-action protest at the United Nations. In tracing Berkman's life, Reverby examines a white man's investments in anti-imperialism and feminism, a doctor's relationship to violence, and the centrality of health and medicine to the Left from the 1960s through the 1990s. Reverby draws skillfully on Berkman's unpublished papers, her own interviews...