National Prevention Research Articles

HIV Infection Among Adolescent Girls and Young Women in Sub-Saharan Africa: Philosophical Perspectives of Sociostructural Risk Factors

Background and Objective Sociostructural risk factors influence human immunodeficiency virus (HIV) infection outcomes among adolescent girls and young women (AGYW) aged 15–24 in Sub-Saharan Africa. The philosophical perspectives on sociostructural risk factors can be helpful in reducing new HIV infections in this age group. This review aims to describe these perspectives to guide the development and implementation of targeted interventions at preventing new HIV infection among AGYW, while addressing age-gender inequalities in HIV infection risk reduction. Methods This literature review examined philosophical perspectives on sociostructural risk factors of HIV infection from June 1981 when improvements in HIV knowledge regarding clinical course and epidemiology began to November 2023. We utilized literature from peer-reviewed papers and books on HIV risk factors and infection outcomes among AGYW, gathered from search engines like PubMed, Google Scholar, and Medline. Results The philosophy of sexuality is linked to sociostructural tenets like seduction, early marriage, adultery, and prostitution. Ubuntu’s philosophy is influenced by Western culture, such as pornography and adolescent marriages. Realism is linked to sexual violence, HIV stigma, and unfavorable health policy decisions. The philosophy of health integrates natural and holistic phenomena to address HIV infection. Conclusion and Implications for Translation The literature reviews suggest that addressing philosophical issues like seduction, early marriages, adultery, prostitution, pornography exposure, sexual violence, and unfavorable policies are crucial for reducing new HIV infection among AGYW and recommend the Ministries of Health to review and adopt these considerations in their respective national HIV prevention guidelines.

Impact of a national dementia research consortium: The Canadian Consortium on Neurodegeneration in Aging (CCNA).

The Canadian Consortium on Neurodegeneration in Aging (CCNA) was created by the Canadian federal government through its health research funding agency, the Canadian Institutes for Health Research (CIHR), in 2014, as a response to the G7 initiative to fight dementia. Two five-year funding cycles (2014-2019; 2019-2024) have occurred following peer review, and a third cycle (Phase 3) has just begun. A unique construct was mandated, consisting of 20 national teams in Phase I and 19 teams in Phase II (with research topics spanning from basic to clinical science to health resource systems) along with cross-cutting programs to support them. Responding to the needs of researchers within the CCNA teams, a unique sample of 1173 deeply phenotyped patients with various forms of dementia was accrued and studied over eight years (COMPASS-ND). In the second phase of funding (2019-2024), a national dementia prevention program (CAN-THUMBS UP) was set up. In a short time, this prevention program became a member of the World Wide FINGERS prevention consortium. In this article, the challenges, successes, and impacts of CCNA in Canada and internationally are discussed. Short-term deliverables have occurred, along with considerable promise of impacts in the longer term. The creation of synergy, networking, capacity building, engagement of people with lived experience, and economies of scale have contributed to the considerable success of CCNA by all measures. CCNA is evidence that an organized "centrally-organized" approach to dementia research can catalyze important progress nationally and yield significant and measurable results.

The problem of suicidality, personality disorder, and treatment: an alternative psycho-social perspective.

Suicidal behaviour, including both attempted and completed suicides, has been increasing globally, particularly in industrialized nations, making suicidality a significant public health concern. Despite the allocation of increasing resources by US, EU, and UK governmental and mental health bodies, the effectiveness of current strategies for the treatment, management, and prevention of suicide remains in question. This paper reviews evidence from epidemiological studies and national prevention policies, alongside research data from a London-based specialist personality disorder treatment centre and clinical case studies from private psychiatric/psychotherapy practice, to explore an alternative psychosocial approach to addressing suicidality. The dominant psychiatric model, which relies heavily on medication, hospitalization, and often coercive methods of control, may have iatrogenic effects, potentially exacerbating the risk of suicide. In contrast, a psychodynamic and psychosocial approach, focused on understanding the underlying psychological dimensions of suicidality, fostering a trusting therapeutic alliance, addressing both internal and external factors contributing to suicidal behaviour, and promoting open dialogue around suicidal thoughts, has shown promise in reducing suicide risk. The findings presented in this paper argue for a rethinking of traditional psychiatric approaches, advocating for a shift toward more personalized, collaborative, and psychologically informed interventions that can more effectively reduce the risk of suicide.

Prevalence and risk factors of gastroesophageal reflux disease among adults attending primary healthcare in Bahrain

ABSTRACT Background: Gastroesophageal reflux disease (GERD) is one of the most diagnosed digestive disorders, with much-conducted research assessing its prevalence and risk factors associated with it worldwide. However, there are no published previous studies to determine such disease and its burden in Bahrain. Hence, this study aims to estimate the prevalence and evaluate the risk factors associated with GERD among adults attending primary care in Bahrain. Material and Methodology: A total of 385 adults aged 18 years and above participated in this descriptive cross-sectional study in the period from 1st to 27th of April 2023. The sample was collected randomly through an interview-based validated questionnaire from 10 health centers selected randomly. The questionnaire consisted of three sections: Demographic characteristics, risk factors that are associated with GERD and (GERD-Q) questionnaire with a scoring rate for the diagnosis of GERD, in which a score of 8 or more gives us the diagnosis of GERD. Results: A response rate of 93.6% was accomplished. Most of the participants were female (53.2%), Bahraini (88.6%), university-educated (50.9%) and married (71.2%). The mean age of the participants was 41.5 (SD = ±14.4 years). The prevalence of GERD was 41.5% which was statistically significant associated with family history of GERD, history of hypertension, sleeping within less than 1 hour after dinner, bariatric surgery and use of NSAIDs or Aspirin regularly (P < 0.05). Conclusions: The prevalence of GERD was 41.5%, which is higher than in the Middle East, East Asia and Western countries. Many modifiable risk factors where associate with it which deserves the conduction of national prevention programs and educational campaigns to prevent this disease and its complications. Further studies are needed to assess other risk factors and the effect of GERD on the overall health status and quality of life.

Advancing Rheumatic Heart Disease Management in Indonesia: Strengthening Early Detection, Targeted Screening, and Prevention Strategies

Background: Indonesia ranks fourth globally in rheumatic heart disease (RHD) prevalence, with a mortality rate of 4.8 per 100,000—higher than malaria. Despite global progress in RHD management, Indonesia lacks a comprehensive national prevention program. Secondary prevention strategies could significantly improve outcomes in high-risk populations by targeting disease progression. Method: This systematic review and meta-analysis examined the impact of secondary prevention on echocardiographic outcomes in Indonesian RHD patients. The review included randomized controlled trials, observational studies, quasi-experimental designs, and case-control studies, emphasizing the role of secondary prevention in mitigating disease progression. Results: Six studies meeting inclusion criteria underwent full-text analysis, with four eligible for meta-analysis. These studies revealed that secondary prevention improved echocardiographic markers, demonstrating its potential to alter disease trajectories in resource-limited settings. Conclusion: Indonesia faces challenges in RHD management due to geographical and healthcare constraints. Echocardiographic screening, a sensitive and specific diagnostic tool, is vital for early detection and monitoring. With technological advancements, cost-effective screening is increasingly feasible, even in remote areas. Strengthening early detection, targeted screening, and secondary prevention strategies is critical for reducing the RHD burden in Indonesia.

Pharmacist homicides in the United States: A retrospective review of NVDRS data from 2003 to 2020.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Workplace and work-related violence are growing concerns in the healthcare community and among healthcare professionals. A gap exists in our understanding of the most extreme form of violence, homicide, against pharmacists and the contributing factors leading to their tragic deaths. The objective of this study was to identify homicides of pharmacists and characterize potential patterns, including, but not limited to, the connection to pharmacists' work. Data from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) were analyzed to explore the number and characteristics of homicides of pharmacists that occurred between 2003 and 2020. Between 2003 and 2020, 33 homicides of pharmacists were reported to the NVDRS. A slight majority (n = 17, 52%) of victims were female. Six (18%) were determined to be workplace or work-related homicides; only 2 homicides were related to the work of a pharmacist. Nearly two-thirds (n = 21, 64%) were perpetrated with a firearm. The suspects for most of these homicides were male (n = 28, 85%), and many were either a current or former partner of the decedent (n = 14, 42%). In the US, homicides of pharmacists occur infrequently relative to the general population. Homicides in pharmacists' workplaces are uncommon, and homicides of pharmacists appear to be tied most often to domestic violence and firearms.

Increases in suicidal thoughts disclosure among adults in France from 2000 to 2021

BackgroundThe objective of the study was to investigate the prevalence of suicidal ideation disclosure over the past two decades in nationally representative samples of the general population, and to identify factors associated with disclosure. MethodsData were drawn from consecutive nationally representative cross-sectional Health Barometer surveys. The 2000, 2005, 2010, 2014, 2017, and 2021 waves were pooled to examine disclosure among those who reported 12-month suicidal ideation. Logistic regressions were performed to identify factors associated with the odds of disclosure. ResultsAcross all waves (n = 124,124), 6014 of adults (4.7 %) reported 12-month suicidal ideation, and among them, 49.7 % talked to someone about it. Disclosure was 39 % in 2000, 44.6 % in 2005, 49.9 % in 2010, 52.8 % in 2014, 47.2 % in 2017, and 64.8 % in 2021. Female gender, a prior suicide attempt, higher education, inactive status, and younger age were associated with significantly greater odds of disclosure. Each survey wave was also associated with a greater likelihood of disclosure when compared to 2000, 1.31 (95 % CI, 1.08–1.59) in 2005, 1.69 (95 % CI, 1.38–2.07) in 2010, 1.89 (95 % CI, 1.52–2.34) in 2014, 1.47 (95 % CI, 1.21–1.79) in 2017, and 2.99 (95 % CI, 2.43–3.68) in 2021. LimitationsCross-sectional surveys. ConclusionsIn the general population of France, adults with suicidal ideation were increasingly more likely to disclose their ideation to someone in recent years. Factors associated with odds of disclosure should inform national suicide prevention strategies to identify subgroups who remain less likely than others to disclose their ideation.

Unintentional drowning fatalities in Sweden between 2002 and 2021

BackgroundDespite declining over the past three decades, unintentional drownings still account for an estimated 236 000 annual deaths worldwide. Susceptibility persists amongst demographic groups and is influenced by sex, age, and socio-economic status, emphasizing the need for targeted interventions. Due to rapidly evolving population dynamics, particularly within Europe, there is a further responsibility to understand the impact of ethnicity on the risks of drowning to guide prevention.MethodsWe conducted a national population-based retrospective study using data from the Swedish National Board of Forensic Medicine and Statistics Sweden for the years 2002 to 2021. The analysis includes variables such as age, sex, presence of alcohol and narcotics as well as activity undertaken at the time of drowning and type of water body. Furthermore, we considered ethnicity to identify subpopulations at greater risks.ResultsResults revealed a plateau in unintentional drowning rates in Sweden since 2012, despite an overall decrease from 2002 to 2021. Findings confirm the trend that males are overrepresented within drowning statistics across all age groups, and that individuals aged > 50 constitute over half of all unintentional drownings. Men aged between 40-69 years boating, and individuals of non-Swedish origin, particularly those < 20 years of age, face a notably greater risk of drowning, underscoring the need for subpopulation-targeted prevention strategies.ConclusionThe ten-year plateau in unintentional drowning signals the need for an official national prevention strategy with annual evaluations. Suggestions also include improved parental supervision of children, further avoidance of alcohol while swimming and boating, as well as targeted swimming lessons and water competency training for individuals of non-Swedish origin.

Prevalence and correlates of severe problematic cannabis use: analysis of a population-based survey in Jamaica.

There is an increasing demand for the treatment of problematic cannabis use (PCU) in low-income and middle-income countries. Jamaica's historical inclination towards cannabis use underscores the need for research in addressing this issue. To determine the prevalence and patterns of cannabis use and assess the sociodemographic factors, psychosocial correlates, knowledge and perceptions associated with severe PCU among Jamaicans using nationally representative data. This study involved a secondary data analysis of the last Jamaica National Drug Prevalence Survey. It included 786 participants who used cannabis in the past year and completed the Cannabis Abuse Screening Test (CAST). The CAST has been validated against the Diagnostic and Statistical Manual of Mental Disorders (DSM), with a score ≥ 7 meeting the criteria for severe PCU. CAST scores were dichotomized utilizing these thresholds, and data generated were analyzed with SPSS version 25 using Pearson's χ2 test and logistic regression. In the past year, 53.3% of Jamaicans who smoked cannabis had a score of 7 or higher on the CAST and smoked an average of 62.21 joints per month. Male respondents were twice as likely to have severe PCU as females. Additionally, young, middle, and older adults were respectively 3, 5 and 3 times more likely to report severe PCU compared to adolescent respondents. Participants who started cannabis use at 11 years and under, 12-17 years, and 18-25 years were respectively 5, 7 and 7 times more likely to report severe PCU than those at 26 years and older. Moreover, easy access to cannabis, a high perceived need for treatment, belief in increased national drug use prevalence, and awareness of the National Drug Control and Prevention Agency were associated with increased odds of reporting severe PCU. One out of every two Jamaicans who used cannabis in the past year reported severe PCU and smoked an average of two cannabis joints per day. Early initiation increases the risk of severe PCU. Accordingly, a public health approach involving multiple sectors is needed to provide treatment options.

Trends in the use of thyroid diagnostics and treatments between 2008 and 2019 in Germany

Following implementation of a national prevention program against iodine deficiency-related disorders in 1993 in Germany, the prevalence of thyroid disorders declined, but aggregated drug dispensation data suggested a recent increase in thyroid hormone use. We aimed to systematically investigate trends in the use of thyroid diagnostic and treatment measures between 2008 and 2019 in Germany. Using the GePaRD database (claims data from ~ 20% of the German population), we determined the annual age-specific and age-standardized prevalence of the use of thyroid diagnostics (thyroid-stimulating hormone (TSH) measurement, thyroid ultrasound, scintiscan, biopsy) and treatment (medication, surgery, radioiodine therapy) from 2008 to 2019 stratified by sex. Between 2008 and 2019, the age-standardized prevalence of TSH measurement increased by 44% in males (from 165 to 238 per 1,000 persons) and by 31% in females (from 134 to 176 per 1,000). The prevalence of thyroid ultrasound use showed no clear time trend, while there was a decrease in the prevalence of scintiscan use (males/females: decrease by 42/43%) and biopsy (males/females: decrease by 42/34%). The prevalence of levothyroxine use increased by ~ 31% both in males (from 36 to 47 per 1,000) and females (from 134 to 175 per 1,000), while the prevalence of thionamide use, iodine use, thyroidectomy, and radioiodine therapy decreased. Our study suggests a continued decline in the prevalence of clinically significant thyroid disorders between 2008 and 2019. The substantial increase in the prevalence of TSH measurement and levothyroxine use during this time period might indicate overuse of diagnostics and overtreatment, warranting further investigation.

Exploring the Dimensions and Correlates of Teen Economic Abuse Through a Cross-Sectional Survey

PurposeTeen economic abuse (TEA) is an understudied form of adolescent relationship abuse with limited measures available to assess prevalence. The purpose of this article is to assess the underlying dimensions of survey items (developed with youth) to refine measurement of and validate the structures comprising TEA and examine differences in prevalence of TEA perpetration (Prp) and victimization (Vct) by demographic characteristics. MethodsThis cross-sectional, online survey was conducted between July and September 2021. Youth ages 13–19 who read English and reside in the United States were eligible to complete this study. Recruitment occurred through a national violence prevention listserv with an emphasis on reaching organizations serving youth who are unhoused, juvenile justice and child welfare-system involved, identifying as sexual or gender minorities, or from communities of color. Based on exploratory and confirmatory factor analysis, negative binomial regression models were run to assess associations of demographic characteristics, with levels of TEA Vct and Prp. ResultsAdolescents who identify as White reported significantly more types of TEA exposures than their American Indian or Alaskan Native (adjusted incident rate ratios = 1.3; 95% CI = [1.1, 1.4]), Hispanic Latino (1.2 [1.1, 1.4]), and Multiracial peers (2.4 [1.8, 3.1]). Gender diverse adolescents (1.14 [1, 1.3]) and cisgender females (1.08 [1, 1.2]) had significantly more types of TEA exposures than cisgender males. Those with past-year physical or sexual violence in dating relationships reported more types of TEA exposures (4.1 [3.8, 4.4]) than those who had not experienced such violence. Adolescents with exposure to foster care or homelessness had more types of TEA (1.3 [1.2, 1.4]) than those without such experiences. DiscussionHealthcare providers serving youth should be aware of how economic abuse manifests in adolescent relationships when providing support and resources for youth, especially those who are system-involved or experiencing housing instability. Findings also highlight the need for education about TEA and economic justice in violence prevention programs.

Prevalence and antibiotics susceptibility of thermotolerant &lt;i&gt;Campylobacter&lt;/i&gt; spp. isolated from humans and chickens in the Republic of Guinea

Background.The issue of diarrheal diseases remains relevant for modern health care in all countries. Campylobacteriosis is the most common infectious disease with foodborne transmission and poultry meat is a transmission factor.Materials and methods.724 items of faeces sampled from patients with diarrheal syndrome and 283 samples of faeces of chickens raised on private farms and five poultry farms in the province were studied. For bacteriological method were used selective media. Traditional routine tests (cell morphology, cytochrome oxidase, catalase, hydrolysis of sodium hippurate and indoxyl acetate) and MALDI-ToF mass spectrometry was performed for identification. The susceptibility of strains to antibiotics was analysed using the disc-diffusion method. Results were interpreted according to the EUCAST criteria, versions 2019–2022.Results.Campylobacterspp. was cultured in 65 out of 724 faecal samples from patients with acute diarrhoea, of them 83.08% were identified asC. jejuni, and 16.92% asC. coli. Of the 237Campylobacterstrains from chicken were identified asC. jejuni(54.0%), asC. coli(46.0%).Campylobacterspp. strains from humans were resistant to tetracycline (40.0%), to erythromycin (6.15%), to ciprofloxacin (12.31%). The strains from chickens kept on farms, were resistant to tetracycline in 42.55%, to ciprofloxacin — in 22.70% and to erythromycin — in 11.35%. The strains from chickens kept on private farms were resistant to tetracycline in 4.17%, to ciprofloxacin — in 1.04%, all strains were sensitive to erythromycin.Conclusion.Thus, due to the widespread prevalence ofCampylobacterspp., infectious diseases they cause remain a topical issue. Studying the resistance to antibiotics inCampylobacterspp. among poultry could allow to develop new approaches to confirming the significance of their foodborne nature and to improve the national disease prevention system.

Temporal trends, regional and socio-economic disparities of colorectal cancer burden in Cyprus

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide and it is the third most common cancer in Cyprus. Previous studies have documented variations in CRC burden over time, across regions and area-based socio-economic deprivation. The aim of this study was to analyse the burden of CRC over time, across regions and area-based socio-economic deprivation in Cyprus for the time period 2000 to 2015. Methods A small area ecological study was performed, with census tracts as units of spatial analysis. The incidence and death date, sex and age of CRC were obtained from the population-based cancer registry of Cyprus. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed estimates of SIRs and SMRs were derived from the Spatiotemporal Bayesian Poisson log-linear model. To investigate temporal trends in the association between area-based socioeconomic deprivation and CRC burden, we have used the national socio-economic index. Results The burden of CRC was rising over time. The CRC cumulative incidence increase from 243.7 in the time period 2000-2007 to 347.3 per 100,000 persons in the time period 2008-2015.There was also a more pronounced geographical variation in SIR and SMR in the time period 2008-2015. Four areas out of 369 had smoothed SIR&amp;gt;1.15 while twenty-six areas had smoothed SMR&amp;gt;1.15, with most of those areas located at the east coast of the island and around the capital city. There was a temporal trend in the socio-economic inequalities of CRC burden. The areas in the third and fourth quartile of the socio-economic index had 23% and 45% lower rates of CRC incidence, and 33% and 47% lower rates of CRC mortality in the period 2008-2015. Conclusions These findings could shape national prevention policies, such as the national screening program of CRC starting in 2025 and protection strategies for CRC mortality. Key messages • Colorectal cancer screening should be geographically targeted for efficient resource allocation. • Public health interventions to improve colorectal-specific mortality risk should be geographically targeted.

The Molecular detection of blaVIM in carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex infections in Indonesia

Background: Bacteria of carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (CRABC) is a significant pathogen causes illnesses acquired via healthcare around the world, however little is known regarding the molecular resistant gene of A. baumannii-calcoaceticus complex bacteria resistant to carbapenem in Indonesian healthcare facilities. This study is aimed to identify the carbapenemase resistant gene of CRABC in two referral care hospitals in the islands of North Sulawesiand East Java, Indonesia. Methods: The Vitek2® system was used to identify the CRABC pathogen that were obtained from standard medical cultures, which included blood, lower respiratory tract, wound and urine samples from patients treated in the medical wards, intensive care unit (ICU), surgical wards, neonatal intensive care unit (NICU), and cardiovascular intensive care unit (CVICU) in two referral care hospitals in Manado, North Sulawesi, and Malang, East Java. Using PCR, we identified the presence of the carbapenemase resistance genes blaGES, blaVIM, blaIMP1, and blaOXA-48 carbapenemase resistance genes. Results: Seventy threeA. baumannii-calcoaceticus complex carbapenem resistance bacteria were collected. The specimens from the lower respiratory tract specimens, the isolates of the carbapenem-resistant A. baumannii-calcoaceticus complex were frequently found.In this study, we detected the blaVIM carbapenemase resistance genes from blood and sputum samples in tertiary care hospital in Malang. Conclusions: We identified the blaVIM carbapenemase resistance genes were found in the referral care hospitals in Malang, East Java, Indonesia. Awareness of the national prevention and surveillance system is isolated by the prevention and reduction of CRABC transmission.

Prevalence and Molecular Characterization of β-Thalassemia in Kirkuk Province of Northern Iraq

To determine the prevalence and molecular basis of β-thalassemia in the Northeastern Iraqi province of Kirkuk, a total of 3954 individuals attending the provincial premarital screening center were recruited. The prevalence of β-thalassemia minor among the screened individuals was found to be 3.0%, while those of Hemoglobin E, and δβ-thalassemia carrier states were 0.05%, and 0.03% respectively. Molecular characterization of the β-thalassemia mutations was achieved by multiplex PCR and reverse hybridization, followed by next generation sequencing for those left uncharacterized by the former technique. Among 19 β-thalassemia mutations identified, seven were the most frequent, namely: IVS-II-1 (G > A), codon 8/9 (+G), IVS-I-6 (T > C), IVS-I-110 (G > A), IVS-I-I (G > A), IVS-I-5 (G > C) and codon 44 (-C) accounting for 78.5% of the mutations. This study further illustrates the heterogeneity of the spectrum of β-thalassemia in different parts of Iraq, and provides an essential step to facilitate prenatal diagnosis in the setting of a future national thalassemia prevention program.

Exploring Place of Death among Individuals with Huntington's Disease in the United States

ObjectivesTo describe trends and identify factors associated with place of death among individuals with Huntington's disease (HD). DesignRetrospective cohort of deceased individuals with HD from the Centers for Disease Control and Prevention's National Center for Health Statistics. Setting and ParticipantsA total of 13,350 individuals with HD who died in the United States between 2009 and 2019. MethodsWe analyzed place of death, categorized as long-term care (LTC) facility, home, hospital, hospice facility, and other locations. Trends in the places of death from 2009 to 2019 were assessed using linear regression models. Multivariate logistic regression models were used to identify sociodemographic factors associated with place of death. ResultsFrom 2009 to 2019, the greatest proportion of deaths occurred in LTC facilities (48.4%). There was a significantly decreasing trend in the proportion of deaths occurring in LTC facilities (53.5%–43.9%, P < .001). A greater proportion of deaths in rural areas occurred in LTC facilities compared with all other locations (P < .001 for all comparisons). In the multivariate model, aged younger than 44 years, Black race, Hispanic ethnicity, some college education or greater, and being married were associated with significantly lower odds of dying in a LTC facility compared with home. Conclusions and ImplicationsDespite a decreasing trend, LTC facilities remain a cornerstone of support for individuals with HD, particularly in rural areas. These results suggest multiple avenues for research to improve accessibility and quality of care for individuals with late stages of HD. Future studies are needed to further understand the impact of rurality and lack of support in the home on the accessibility and quality of LTC and hospice care for individuals with HD. These results may also help inform interventions focused on training and staff education within LTC and hospice facilities to better manage HD progression and symptoms.

Epidemiology of Ciguatoxin Poisoning Outbreaks in the United States Between 2001 and 2021.

This study examined data from the Centers for Disease Control and Prevention's National Outbreak Reporting System between 2001 and 2021 for confirmed outbreaks of foodborne illness due to Ciguatoxin in the United States. Previous research into Ciguatoxin illness in the United States has focused on specific states or territories-namely Hawaii, Florida, Puerto Rico, and the Virgin Islands-meaning the national distribution of outbreaks remains unclear. In addition, while specific categories of seafood (e.g., reef fish) are known to carry elevated risk of illness due to Ciguatoxin poisoning, it remains unclear the extent to which specific seafood items are associated with the odds of being hospitalized in an outbreak. This study calculated descriptive statistics for the distribution of outbreaks by state, season, site of exposure, and implicated seafood item. Then, binomial regression was used to assess the relationship between the implicated seafood item in an outbreak and hospitalization. Results provided evidence that knowing the implicated seafood item in an outbreak is associated with the odds of hospitalization (χ25 = 33.023, p < 0.0001). Even when a seafood item was found to be associated with elevated odds of hospitalization, not all cases involved hospitalization. This finding aligns with Ciguatoxin poisoning case reports, noting that key epidemiological factors include not just the seafood item consumed but also the quantity and the part consumed (e.g., the head). In conclusion, public health officials should consider Ciguatoxin poisoning outbreaks as multidimensional and utilize information about the seafood consumed as well as the quantity and parts of the seafood consumed.

Trends in Melanoma Incidence, Prevalence, Stage at Diagnosis, and Survival: An Analysis of the United States Cancer Statistics (USCS) Database.

Background and objectives Melanoma, a major skin cancer, has seen varying trends in incidence, prevalence, stage atdiagnosis, and survival. This study examines these trends using the United States CancerStatistics (USCS) database, covering the period from 1999 to 2021. Methods We extracted data from the USCS database, which integrates the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program and the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR). The analysis included new melanoma cases, prevalence estimates (using a 20-year limited duration), stage at diagnosis, and five-year relative survival rates. Incidence rates were adjusted for age using the 2000 United States standard population. Descriptive and trend analyses were performed using IBM SPSS Statistics software, version 29 (IBM Corp., Armonk, NY). Results The analysis of melanoma trends from 1999 to 2021 reveals a significant increase in the annual age-adjusted incidence rate, rising from 15.1 per 100,000 (95% CI: 14.9- 15.2) in 1999 to 23.0 per 100,000 (95% CI: 22.8- 23.1) in 2021. This upward trend is consistent across gender and racial/ethnic groups. The prevalence of melanoma over a 20-year period was 0.279 (95% CI: 0.276-0.282), with males showing a higher prevalence (0.302, 95% CI: 0.298-0.306) compared to females (0.256, 95% CI: 0.252-0.260). The distribution of melanoma stage at diagnosis indicated that 77% of cases were localized (95% CI: 76.5-77.5%), 9.5% regional (95% CI: 9.2-9.8%), 4.7% distant (95% CI: 4.4-5.0%), and 8.8% unstaged (95% CI: 8.5-9.1%). Survival analysis showed a five-year relative survival rate of 99.4% (95% CI: 99.2-99.6%) for localized melanoma and 35.6% (95% CI: 33.7-37.6%) for distant melanoma, highlighting significant disparities in survival based on stage at diagnosis. Conclusions The study highlights a rising incidence of melanoma and emphasizes the critical role of early detection in improving survival outcomes. The findings underscore the effectiveness of early diagnosis and the necessity for ongoing efforts to improve melanoma outcomes across diverse populations.

What is known about suicide prevention gatekeeper training and directions for future research.

Suicide prevention training that teaches skills to support a person experiencing thoughts of suicide and create community support networks, often termed, "gatekeeper" training (GKT), has been a longstanding pillar of international, national, and local suicide prevention efforts. GKT aims to improve knowledge, attitudes, and self-efficacy in identifying individuals at risk for suicide, hopefully enhancing one's willingness and ability to intervene with a person experiencing a crisis. However, little is known about GKT's effectiveness in creating the essential behavior change (e.g., increase in intervening behaviors) it sets out to accomplish. This paper explores the history and theoretical background of GKT, reviews the current state of research on GKT, and provides framing and recommendations for next steps to advance research and practice around GKT. Through positioning GKT appropriately within the field of suicide prevention, we argue that the field of suicide prevention needs more rigorous research around GKT that includes long-term follow-up data on usage of skills learned during training, data on outcomes of those who have received an intervention from a trained gatekeeper, and the integration of implementation science to further our understanding of which trainings are appropriate for which helpers.

Evaluating national infection prevention and control minimum requirements: evidence from global cross-sectional surveys, 2017–22

WHO infection prevention and control (IPC) minimum requirements provide standards to reduce the risk of infection during health-care delivery. We aimed to investigate the global implementation of these requirements at national levels and the progress of doing so across 2021-22 compared with 2017-18 to identify future directions for interventions. National IPC focal points were invited to complete an online survey measuring IPC minimum requirements from July 19, 2021, to Jan 31, 2022. The primary outcome was the proportion of countries meeting IPC minimum requirements. Country characteristics associated with this outcome were assessed with beta regression. Subset analyses were conducted to compare the 2021-22 indicators with a WHO IPC survey conducted in 2017-18 and to assess the correlation of the proportion of IPC minimum requirements met with the results of other WHO metrics. 106 countries (ie, 13 low income, 27 lower-middle income, 33 upper-middle income, and 33 high income) participated in the survey (56% response rate). Four (4%) of 106 met all IPC minimum requirements. The highest scoring IPC core component was multimodal improvement strategies and the lowest was IPC education and training. The odds of meeting IPC minimum requirements was higher among high-income countries compared with low-income countries (adjusted odds ratio 2·7, 95% CI 1·3-5·8; p=0·020). Compared with the 2017-18 survey, there was a significant increase in the proportion of countries reporting an active national IPC programme (65% to 82%, p=0·037) and a dedicated budget (26% to 44%, p=0·037). Evaluation of the IPC minimum requirements compared with other survey instruments revealed a low positive correlation. To build resilient health systems capable of withstanding future health threats, urgently scaling up adherence to WHO IPC minimum requirements is essential. WHO. For the French and Spanish translations of the abstract see Supplementary Materials section.