Reduction Interventions Research Articles

The timing of local SARS-Cov-2 outbreaks and vaccination coverage during the Delta wave in Melbourne

ObjectiveThis article presents a longitudinal analysis of COVID-19 infection and vaccination coverage in Melbourne metropolitan local government areas (LGAs) during the 2021 Delta wave. MethodsCOVID-19 vaccination and infection data from 12 July to 27 November 2021 were sourced from government websites. Summary statistics and associated 95% confidence intervals (95% CI) were compared by LGA ranked according to socioeconomic status: total “burden” (total infections per thousand), “peak” (highest weekly infection rate), “lag” (interval between peak and 70% double vaccination). ResultsLGAs in the bottom five deciles for social advantage experienced higher infection rates (39.0 per thousand [95% CI: 38.5, 39.5] vs. 14.8 [14.7, 14.9]), and had lower two-dose vaccination coverage (23.8% [23.6, 23.9] vs. 32.7% [32.6, 32.7]) compared with LGAs in the top five deciles. LGAs that achieved 70% coverage two weeks or more after the infection peak experienced nearly twice the total infection burden (27.7 per 1000 [27.3, 28.0] compared with 14.9 [14.7, 15.0]) than LGAs with a shorter lag. ConclusionsExposure and transmission risk factors cluster within disadvantaged LGAs. The potential for large local outbreaks is heightened if vaccination uptake trails in these communities. Implications for Public HealthIn a pandemic, decision-makers must prioritise disease control and harm reduction interventions for at-risk LGAs.

The Student’s Psychological Stress During Covid-19

This study investigates psychological stress among middle school students in Baquba district during the COVID-19 pandemic, focusing on potential gender-based differences. Despite established evidence of heightened stress levels during pandemics, few studies have explored these impacts on school-aged children and potential variances between genders. Utilizing a balanced sample of 100 students (50 male and 50 female) from four schools, this research employed a psychological stress scale with confirmed psychometric properties, including a stability coefficient of 0.80. Statistical analysis revealed significant stress levels among the students, yet no gender differences were identified at the 0.05 significance level. These findings suggest that interventions aimed at reducing student stress during pandemics need not differentiate between male and female students but should instead focus on strategies that address the broader student population. Highlights: Significant psychological stress exists among middle school students during COVID-19. No statistical difference in stress levels between male and female students. Stress reduction interventions should target all students, regardless of gender. Keywords: Psychological Stress, COVID-19, Gender Differences, Middle School, Stress Interventions

Exploring pregnancy-related stigma experiences among adolescents in rural Uganda.

Pregnant adolescents face multiple adverse experiences that vary by context due to pregnancy-related stigma. We explored experiences of pregnancy-related stigma and psychosocial issues among adolescents living in rural eastern Uganda. We conducted in-depth semi-structured interviews with 15 adolescents (15-19 years old) who were pregnant (>3 months) or had recently given birth (<3 months) at Tororo District Hospital in Uganda. All interviews were translated from Dhopadhola to English. Thematic analysis was conducted to identify major themes, which were interpreted using the Health Stigma and Discrimination Framework. Six key themes were identified and were organized under the Health Stigma and Discrimination Framework. Social and gender norms for adolescent women and their lack of autonomy were identified as drivers and facilitators of pregnancy-related stigma. Results show how stigma is experienced by adolescents through the lack of social support, multiple forms of abuse, and negative judgement. Such manifested stigma negatively impacted their psychosocial wellbeing and resulted in limited access to socioeconomic resources and educational opportunities. This study acknowledges the multilevel nature of pregnancy-related stigma among adolescents in the context of existing policy and programming. Recognizing the impact of pregnancy-related stigma on the health and wellbeing of adolescent girls necessitates prioritizing comprehensive stigma reduction interventions that address main drivers and facilitators, and that are rooted in the communities to harness support.

Nudging Householders to Reduce Avoidable Food Waste: The OzHarvest Use It Up Tape

Targeting households with food waste reduction interventions represents a critical opportunity to meet global targets to halve food loss and waste. While the evidence base on the effectiveness of food waste interventions is growing generally, less is known about the outcomes of household-focused interventions. This mixed methods study explores how households experienced a behaviourally orientated nudge (the OzHarvest Use it Up TapeTM) and examines its impact on food waste and behaviour change. The “Tape” served multiple functions for households—including as a visual prompt, a labelling device, a planning tool, and a communication tool—and was more effective for large families and for individuals who were disorganised when shopping and cooking. Significant reductions were also identified in participants’ fresh vegetable and fruit waste and in the total food amounts they wasted. This study demonstrates the effectiveness of behaviourally orientated nudges, like the Tape, in reducing food waste.

A Pilot Study of BRAIN BOOTCAMP, a Low-Intensity Intervention on Diet, Exercise, Cognitive Activity, and Social Interaction to Improve Older Adults’ Dementia Risk Scores

BackgroundLittle is known about the impact of short, low-intensity multidomain dementia risk reduction interventions in older adults.ObjectivesTo examine the effectiveness and feasibility of a low-intensity multidomain lifestyle intervention on dementia risk and dementia literacy in Australian older adults.DesignSingle-group pre-post design.SettingCommunity-dwelling.ParticipantsA total of 853 older Australians (Mean age=73.3 years, SD=6.1) recruited from the community.InterventionA 3-month dementia risk reduction program, BRAIN BOOTCAMP, including education, personalised risk information, physical cues for healthier choices and goal setting and planning to target four modifiable risk factors of diet, exercise, cognitive activity and social interaction in older adults.MeasurementsThe ‘LIfestyle for BRAin health’ (LIBRA) index was used to assess participants’ modifiable dementia risk based on 12 factors, with higher scores indicating greater risk. Dementia literacy was measured using a modified questionnaire derived from Dutch and British surveys, encompassing knowledge, risk reduction, and awareness aspects. Paired t-tests were used to compare dementia risk scores and dementia literacy before and after the program. Multivariate regressions were performed to identify sociodemographic and psychological factors associated with change in the LIBRA index.ResultsProgram attrition was high (58.3%). Participants who completed the program had decreased dementia risk scores (Cohen’s d=0.59, p<0.001), increased dementia literacy and awareness (Cohen’s d=0.64, p<0.001) and increased motivation to change lifestyle behaviors (Cohen’s d=0.25–0.52, p<0.016). Participants with higher motivational beliefs had greater dementia risk reduction.ConclusionsImproving older adults’ motivation and knowledge may help modify lifestyle behaviors to reduce dementia risk. However, program attrition remains a challenge, suggesting the need for strategies to enhance participant engagement and retention in such interventions.

Risk factors associated with the Motoric Cognitive Risk syndrome: A meta-analysis of data from a cross-national study.

Identifying risk factors associated with the Motoric Cognitive Risk (MCR) syndrome (a pre-dementia syndrome) can assist in developing risk reduction strategies and interventions to delay progression to dementia. Tailored interventions require comparisons of high- and middle-income countries to determine if the same or different risk factors should be targeted. We examined risk factors associated with MCR in seven Health and Retirement Studies with harmonized measures. Data from adults aged ≥65 years (n = 20,036, mean age 71.2(SD 6.2)-80.1(SD 4.1)) from the U.S. Health and Retirement Study, English Longitudinal Study of Aging, Survey of Health, Aging and Retirement in Europe, China Health and Retirement Longitudinal Study, Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India, Mexican Health and Aging Study, and Brazilian Longitudinal Study of Aging was included. MCR was defined as the presence of cognitive complaints and slow gait (no mobility disability and dementia). Associations of demographic [education], medical [hypertension, diabetes, heart disease, obesity, stroke, Parkinson's, falls], psychological [depressive symptoms, psychiatric problems], sensorimotor [grip strength, hearing], and behavioral factors [smoking, sedentariness, sleep], with prevalent MCR were examined using age- and sex-adjusted logistic regression models. A meta-analysis was performed to compare risk factors for MCR in high- versus middle-income countries. Except for depressive symptoms and weak grip strength, different risk factor clusters were associated with individual studies. Poor sleep, hearing, weak grip, and multiple falls emerged as novel associations with MCR. When grouped by income, some risk factors (i.e., education) were associated with MCR in high- and middle-income countries. Others (i.e., obesity) were specific to high-income countries. This cross-sectional, cross-national study identified new, shared, and specific risk factors associated with MCR in high- and middle-income countries, providing insights to develop public health approaches and interventions to forestall the onset of dementia in those with MCR.

Effects of Weight Loss on Key Obesity-Related Biomarkers Linked to the Risk of Endometrial Cancer: A Systematic Review and Meta-Analysis.

Endometrial cancer (EC) includes various histologic types, with estrogen-dependent endometrioid carcinoma being the most common. Obesity significantly increases the risk of developing this type, especially in postmenopausal women, due to elevated estrogen production by adipocytes. This review examines the impact of weight loss from different interventions on reducing obesity-related risk factors for endometrioid EC. A systematic review and meta-analysis were conducted on three weight loss interventions: bariatric surgery, pharmacotherapy, and lifestyle changes. The effects of these interventions on inflammatory biomarkers (CRP, TNF-α, IL-6) and hormones (leptin, estrogen) were analyzed. Data from controlled studies were pooled to assess the significance of weight loss in reducing these biomarkers. Despite heterogeneity, bariatric surgery resulted in an overall 25.8% weight reduction, outperforming lifestyle and pharmacotherapy interventions. Weight loss reduced CRP levels by 33.5% and IL-6 levels by 41.9%. TNF-α levels decreased by 13% with percent weight loss over 7%. Leptin levels also decreased significantly, although the exact weight loss percentage was not statistically significant. Weight loss effectively reduces proinflammatory markers and hormones associated with increased risk of endometrioid EC. The strengths of this review include a comprehensive examination of different weight-loss interventions and a large pool of participants. However, limitations include high heterogeneity among studies and only 43% of the participants being postmenopausal. Limited data on sex hormones and racial disparities underscore the need for further research.

Alcohol Interventions on Online Grocery Shopping Platforms

Introduction &amp; BackgroundThere is opportunity to engage light to moderate drinkers in alcohol reduction interventions as a preventative measure. In the space of online grocery shopping there is an added challenge in intervention development in the form of deceptive patterns, which influence consumer behaviour in unhealthy ways including automating behaviour and encouraging overconsumption. Objectives &amp; ApproachThe objectives of this study are to: 1) identify deceptive patterns in the online grocery shopping context, 2) develop interventions which support healthier decision making in this context, 3) apply those interventions to appropriate product categories. The method utilised in the first objective is heuristic analysis which was conducted across eleven major online grocery shopping platforms. The interventions were then developed using the Rapid Iterative Testing and Evaluation (RITE) method, which involved interviewing participants and iterating upon the inventions after every interview. Each interview was analysed using content analysis. When incorporating the interventions into the online grocery shopping environment, interviews were conducted to gain insight into drinking and purchasing habits of consumers. These final interviews were then analysed with inductive thematic analysis. Relevance to Digital FootprintsDigital Footprints underpin the entire intervention development space. The background of the project is built upon human shopping and interaction behaviour online when encountering deceptive patterns. These deceptive patterns have been established using mobile gaming micro-transaction data, online grocery shopping log-in and rewards data, among other data sources. Digital Footprints data can further support the findings from the thematic analysis by further showing cultural and social trends around drinking (e.g., increased purchasing of seasonal beers and ciders in the summer and during sporting tournaments). The purpose of the drinking identified through those social and cultural trends gauge the appropriateness of proposed alcohol interventions. Beyond this, digital footprints data around engagement with health and wellness promoting applications (e.g., active users and app downloads) provides greater insight into the types of health messaging that garner attention and can be used to further inform how to approach those currently outside the health-engaged group. Digital footprints serve to attach larger societal trends to the smaller-scaled interviews and thematic analysis conducted as part of the study. ResultsInitial findings have shown opportunities for nudging light to moderate drinkers who primarily consume beer, wine, or cider. Spirits have been identified as difficult to substitute due to a lack of substitution options in the low alcohol spirit category that are widely available on the consumer market via online grocery retailers. Conclusions &amp; ImplicationsWithout significant change, costs to the National Health Service (NHS) in alcohol related harm are set to rise by over 1 billion GBP. Alcohol consumption is a public health risk and there are opportunities to utilise digital footprint informed interventions to engage the public in preventative interventions.

HIV Stigma, Health, and Violence: A Longitudinal Study among Adolescent Boys with HIV in Soweto, South Africa.

There are over 1.4million adolescents living with HIV in sub-Saharan Africa, the majority of whom acquired the virus through perinatal transmission (PHIV). HIV stigma is particularly high among adolescents living with HIV and is associated with several outcomes that worsen health and increase the risk of onward HIV transmission. We tested associations between internalized HIV stigma and four of these outcomes over a one-year period among a sample of adolescent boys living with PHIV in Soweto, South Africa. Participants (N = 241) answered questions about internalized HIV stigma at baseline. They completed weekly mobile surveys over the following year to answer questions about their experiences with depression, binge drinking, medication adherence, and violence victimization. Using generalized linear mixed models, we found that baseline internalized HIV stigma was associated with increased odds of depression (OR 1.74), alcohol misuse (OR 2.09), and violence victimization (OR 1.44) and decreased odds of medication adherence (OR 0.60) over the course of a year. These outcomes negatively impact the health and wellbeing of adolescents living with PHIV and increase their risk of transmitting HIV to their partners in the future. Our findings provide novel, longitudinal evidence for the deleterious effects of HIV stigma. To improve health outcomes for adolescents with PHIV, it will be crucial to develop effective HIV stigma reduction interventions that address specific developmental, gendered, and cultural experiences.

A feasibility study of the CRISP intervention; a cardiovascular risk reduction intervention in patients with an abdominal aortic aneurysm

Background Abdominal aortic aneurysm (AAA) screening/surveillance is implemented widely. Those in AAA-surveillance are at high-risk of cardiovascular-events. We developed an intervention, called CRISP, using intervention-mapping with patients and stakeholders, to reduce cardiovascular-risk in AAA-surveillance. This study tested the CRISP intervention in routine clinical-care. Methods The CRISP intervention, consisting of a nurse-led cardiovascular risk assessment and subsequent lifestyle change support using a self-care workbook and low-intensity nurse input was delivered across Leicestershire and Rutland AAA screening/surveillance programmes. Those who consented to take part were followed-up with cardiovascular-assessments. Fidelity of intervention-delivery was assessed quantitatively and qualitatively. Results 40 men (mean age 75 + 7 years) took part over four months and were followed-up for a minimum six months. A sub-group of 25 patients and nine Health Care Professionals (HCPs) were interviewed. The median number of risk-factors that patients chose to focus on was two (range 0 to 4), with physical activity (n=17) being the most popular. Participants who had a ‘red light’ risk factor for stress, low mood, smoking or alcohol intake were offered a referral to appropriate services. Two were offered referral to mental-health services and took it up, three declined referrals to smoking or alcohol support services. The fidelity of intervention-delivery was generally low. The highest mean score (on a 0-5 scale) for the nurse assessment was 1.5 for engaging the participant, lowest 0.5 for exploring the importance for selected lifestyle behaviours. In qualitative interviews, the intervention was liked and viewed as beneficial by patients and HCPs. Based on qualitative interviews and observations, the low fidelity of intervention-delivery was due to intervention-training not being detailed. Conclusions The CRISP intervention can be delivered in AAA-surveillance, but the fidelity of delivery is low. The intervention and its training course need to be refined and tested before wider implementation. Registration ISRCTN (ISRCTN93993995; 18/11/2020).

Addressing anti-Gypsyism with context-dependent psychological tools: Research review, meta-analysis and secondary analysis of prejudice against the Roma

ABSTRACT Anti-Gypsyism is a deeply entrenched form of ethnic bias in Europe, characterised by realistic conflict perceptions, social norms approving bias, unacknowledged historical victimisation, and denial of cultural autonomy. Mainstream prejudice reduction interventions may have limited applicability to anti-Gypsyism, because prejudice is normative, hence people are not motivated to change their views; interventions focusing on increased liking, but not competence perception consolidate status differences; stereotypes are resistant to change because of the overlap with low SES stereotypes and assimilation of counter-stereotypical members. With the help of a meta-analysis with 169 effect sizes from 18 countries in 14 languages we showed that contact frequency was indeed only associated with affective (liking), but not cognitive and behavioural prejudice. However, we found the expected negative association between positive contact and prejudice. Eurobarometer data also showed the salience of counter-normative experiences, as friendships had a stronger impact in countries with higher overall means of anti-Gypsyism.

Lung Cancer and Air Quality in a Large Urban County in the United States.

Lung cancer is the leading cancer-related killer in the United States. The incidence varies geographically and may be affected by environmental pollutants. Our goal was to determine associations within time series for specific air pollutants and lung cancer cases over a 33-year period in Wayne County, Michigan, controlling for population change. Lung cancer data for Wayne County were queried from the Michigan Cancer Registry from 1985 to 2018. Air pollutant data were obtained from the United States Environmental Protection Agency from 1980 to 2018. Autoregressive distributed lag (ARDL) models were estimated to investigate time lags in years between specific air pollution levels and lung cancer development. A total of 58,866 cases of lung cancer were identified. The mean age was 67.8 years. Females accounted for 53 percent of all cases in 2018 compared to 44 percent in 1985. Three major clusters of lung cancer incidence were detected with the most intense clusters in downtown Detroit and the heavily industrialized downriver area. Sulfur dioxide (SO2) had the strongest statistically significant relationship with lung cancer, showing both short- and long-term effects (lag range, 1-15 years). Particulate matter (PM2.5) (lag range, 1-3 years) and nitrogen dioxide (NO2) (lag range, 2-4 years) had more immediate effects on lung cancer development compared to carbon monoxide (CO) (lag range, 5-6 years), hazardous air pollutants (HAPs) (lag range, 9 years) and lead (Pb) (lag range, 10-12 years), which had more long-term effects on lung cancer development. Areas with poor air quality may benefit from targeted interventions for lung cancer screening and reductions in environmental pollution.

Reasons for patients keeping or missing their appointments in family medicine in the United States: importance of no-show history in the previous year

Background Missed appointments at primary care clinics are detrimental to patients' health and clinics' efficiency. We investigate reasons for no-shows, motivation to keep appointments and self-perception of health among patients with different no-show histories. Methods Using archival data of patient visits (2018-2020) at Medical College of Georgia (MCG) Family Medicine Clinic (FMC) at Augusta University, we categorized patients based on the number of no-shows in the previous calendar year (Group 1 = zero; Group 2 = one or two; Group 3 = three or more). We gathered descriptive statistics on patient age, race, gender and insurance type and performed a regression analysis to estimate these factors' impact on the likelihood of shifting between groups. We administered FMC patients an anonymous survey on reasons for no-shows, motivations to keep appointments and self-perception of health. Results Patients in Group 1 versus Groups 2 and 3 differed in self-perception of health and the presence of a household dependent. Reasons for no-shows indicate difficulties with timing of appointment and change in health status and suggest an association between no-shows and health status. The main motivation to keep the appointment in all three groups was health concerns. Conclusions This study highlights the importance of distinguishing patients based on no-show history when designing no-show reduction interventions.

Perceptions of a Cardiovascular Risk Reduction Intervention for Sexual Minority Adults

Sexual minority (SM) adults have a higher prevalence of risk factors for cardiovascular disease (CVD), largely attributed to increased exposure to minority stressors. There are no evidence-based CVD risk reduction interventions tailored to the needs of SM adults. We conducted a qualitative descriptive study to explore SM adults’ perceptions and preferences for a culturally tailored, minority stress-informed intervention for CVD risk reduction. SM adults without CVD were interviewed and presented with a proposed 10-week intervention that combined elements of existing interventions for minority stress and CVD risk reduction. Participants were asked about preferences regarding intervention delivery methods, setting, and duration. Interviews were deductively coded into cognitive, behavioral, and socio-environmental themes informed by the social cognitive theory (SCT). Themes were also inductively coded based on participant responses. The sample included 22 SM adults with a mean age of 52 (±7.16) years; approximately 55% were female-identified and 59% were non-Latinx White. Cognitive themes included recognition of stress associated with minoritized identities and self-efficacy for behavior change. Behavioral themes included stress management skills and maintaining a healthy lifestyle (e.g., exercise). Socio-environmental themes included barriers (e.g., time commitment) and facilitators (e.g., financial incentives) for participating in the proposed intervention. All participants were interested in an intervention that would improve their cardiovascular health. A majority indicated they preferred a 12-week, virtual, synchronous, group intervention. All participants endorsed the proposed intervention with particular emphasis on stress reduction components. This study provides important knowledge that should be considered in designing tailored interventions for CVD risk reduction among SM adults.

Weight bias reduction intervention among nurse practitioner students using simulation-based experiences.

Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.

Predictive stability study of poverty trend in Uganda using selected indicators

This study investigates poverty dynamics in Uganda, employing an extensive stability analysis of different socioeconomic indicators to understand long-term trends and likely drivers of poverty. An eighteen years yearly secondary data from 1992 to 2020 on poverty rates for the selected indicators under review sourced from World Bank site was utilized for all the data analysis. Outcomes from extensive data analysis shows considerable reductions in poverty rates over time, especially in outlying areas of eastern and northern Uganda despite increasing income inequality as suggested by the increasing Gini coefficient. All the metrics have a significant impact on Uganda's poverty rates, with the exception of the poverty headcount ratio, which stands at USD 6.85 per day (2017 PPP) as a percentage of the population. Particularly, the forecasted values also show a fluctuating trend movement, both downward and upward, suggesting possible variability in future poverty rates in Uganda. The necessity to carefully evaluate as well as monitor poverty dynamics to guide policy interventions aimed at reducing poverty is underlined by this information. Additionally, the stability analysis framework suggested in this research provides insights into the viability as well as resilience of Uganda's socioeconomic system in tackling poverty, enabling evidence based policies and interventions in poverty reduction. The study suggests more examination of various other dimensions of poverty and non-monetary indicators of well-being to better our understanding and support better poverty alleviation methods in Uganda along with other similar settings.

Walk With Me: reducing harm and confronting the toxic drug poisoning crisis in small British Columbia cities through community engaged research

In an era of escalating and intersectional crises, the toxic drug poisoning crisis stands out as a devastating and persistent phenomenon. Where we write from in British Columbia (BC), Canada, over 13,000 deaths have occurred in the eight years since the toxic drug poisoning crisis was declared a provincial health emergency. While many of these deaths have occurred in large urban centres, smaller rural communities in British Columbia are also grappling with the profound impacts of the toxic drug poisoning crisis and are struggling to provide adequate support for their vulnerable populations. In response to these challenges, the Walk With Me research project has emerged in the Comox Valley of Vancouver Island, BC, employing community-engaged methodologies grounded in pluralist knowledge production. Walk With Me seeks to understand the unique manifestations of the toxic drug poisoning crisis in small communities, identifying local harm reduction interventions that can foster community resilience, and aiming to catalyze sustainable change by amplifying the voices of those directly affected by the crisis to advocate for policy changes. This paper outlines the conceptual and methodological underpinnings of the Walk With Me project as a harm reduction initiative, which holds community partnerships and diverse ways of knowing at its heart. It presents the community-engaged research framework used by the project to address overlapping health and social crises, offering practical examples of its application in various research projects across sites and organizations. The paper concludes with a reflection on the impacts of Walk With Me to date, highlighting the lessons learned, challenges encountered, and opportunities for future research and action. Overall, this article captures the urgent need for community-engaged approaches to address the toxic drug poisoning crisis and other multidimensional crises facing society, particularly in smaller and rural communities, underscoring the potential for meaningful change through collaborative, grassroots efforts.

Is badger culling associated with risk compensation behaviour among cattle farmers?

Risk compensation theory suggests that behaviours are modified in response to interventions that remove risks by substituting them with other risky behaviours to maintain a 'risk equilibrium'. Alternatively, risk reduction interventions may result in spill-over behaviours that seek to minimise risks further. This paper assessed evidence for these behavioural risk responses among farmers in response to badger culling that seeks to remove the risk of bovine tuberculosis in cattle. Data from the UK's randomised badger culling trial were re-analysed, comparing farmers' cattle movement practices in proactive and reactive culling areasand control areas. Analysis compared cattle movementsduring and after the trial using zero-inflated negative binomial regression. The analysis found no strong evidence of risk compensation behaviours among farmers who experienced proactive culling. However, strong evidence for a reduction in cattle movements in reactive culling areas was found. The results indicate high levels of inertia within farming systems in relation to cattle purchasing. Data do not account for the risk of cattle purchases and reflect previous policy regimens. Evidence from recent badger culling interventions should be analysed. Proactive badger culling was not associated with risk compensation behaviours, while reactive badger culling was associated with decreased risk taking among farmers.

Establishing Geriatric Opiate Use Patterns in Trauma.

Introduction: There is evidence that providers often overprescribe opiates in the postoperative period. Despite an ever-growing geriatric population, there is little research detailing current opiate usage in older patients after trauma. This population presents a unique set of challenges for pain management and prescription drug dependence due to sensitivity, a narrow therapeutic window, and high rates of pre-existing polypharmacy.Objective: Assess the use of narcotics in geriatric trauma patients with various injury patterns to establish a reference point for future intervention for reduction in narcotic dependence.Methods: We created a database of trauma patients' age ≥65 years admitted to a single level 1 trauma center in the Southeastern United States during the 2019 calendar year. Information gathered included patient factors, injury patterns, operative intervention, pain medications prescribed during hospitalization and at discharge, total and average daily morphine milligram equivalents (MME) inpatient and outpatient, and requests/prescriptions for narcotics at follow-up.Results: In 2019, there were 475 patients aged ≥65 admitted to our level 1 trauma center for acute traumatic injuries. 219 of those patients required operative intervention. Average total inpatient MME for this cohort was 169.0 with average daily MME of 22.89. The average total prescribed MME upon discharge was 79.27. There were 29 patients documented to request narcotic prescription refill at time of clinic follow-up, 27 of whom were prescribed a narcotic medication at follow-up.Conclusion: This dataset establishes a reference point for opiate use in geriatric trauma patients to facilitate further research for mitigation of risk in this population.

Personalized risk reduction of hiv plans with artificial intelligence: a narrative review

This narrative review explores the current landscape and future potential of utilizing Artificial Intelligence (AI) in the development and implementation of personalized risk reduction plans for individuals at risk of HIV infection. Traditional HIV prevention strategies often adopt a generic approach, overlooking the diverse and dynamic factors contributing to an individual's risk profile. In contrast, this review synthesizes existing literature to highlight recent advancements in AI applications, focusing on their role in tailoring HIV risk reduction interventions to the unique characteristics and circumstances of each individual. The review encompasses studies employing machine learning algorithms, predictive modeling, and data analytics to analyze and interpret large datasets related to HIV epidemiology, behavioral patterns, and socio-economic determinants. By providing an overview of these AI-driven methodologies, the review aims to showcase the potential for personalized risk assessment and intervention planning. Furthermore, it examines the integration of AI into mobile health applications, wearable devices, and telehealth platforms, facilitating real-time monitoring, feedback, and support for individuals seeking personalized risk reduction strategies.