Risk Reduction Strategies Research Articles

Atherosclerosis and HIV: Exploring Cardiovascular Risks and Management.

The advent of antiretroviral therapy has markedly improved the life expectancy of individuals with HIV, leading to a shift in clinical focus from managing opportunistic infections to addressing chronic conditions, such as atherosclerotic cardiovascular disease (ASCVD). Emerging evidence highlights an elevated risk of ASCVD among people living with HIV, characterized by a higher incidence of acute myocardial infarction, ischemic stroke, and heart failure compared with the general population. This review examines the epidemiology, pathophysiology, and management of ASCVD in the context of HIV. It explores the interplay between HIV infection, antiretroviral therapy, and traditional cardiovascular risk factors, underscoring the need for comprehensive cardiovascular risk reduction strategies tailored to people living with HIV. Through synthesizing data from clinical trials, observational studies, and basic research, the review aims to enhance understanding of HIV-associated ASCVD and inform healthcare practices to improve the longevity and quality of life for this patient population.

Climate change impact on Mediterranean viticultural regions and site-specific climate risk-reduction strategies

The global increase in extreme weather and climate events may dramatically impact agriculture, food safety, and socioeconomic dynamics. The Mediterranean basin is already exposed to extreme climatic events, severely challenging viticulture, a pivotal Mediterranean agro–industry. This study aims to understand better how climate is expected to evolve in six viticulturally important Mediterranean regions in Portugal, Italy, Turkey and Morocco, using a 4–member ensemble of climatic model projections under Representative Concentration Pathways (RCP) 4.5 and 8.5 for 2041–2070, and using the 1981–2010 period as a baseline. By comparing the main specific challenges these locations will face, we comparatively define the best strategies to reduce the impacts of climate change at the national and regional levels. Projections show increases in overall temperatures, up to + 3.6°C than the historical baseline, whilst precipitation projections indicate decreases that could reach 36% of the overall annual precipitation. Biological effective degree days, consecutive dry days, growing season length, tropical nights, or very heavy precipitation days, also show challenging prospects for viticulture in these countries. A screening of the adaptative strategies already undertaken in the studied countries suggests that growers are taking reactive rather than preventive strategies. Moreover, the discussion of the most suitable strategies in this study is region–specific, i.e., prioritised by the specific needs of each location. The conclusions drawn herein may support local growers, improving their decision–making based on the most adequate adaptive strategies to their conditions, thus optimising their sustainable production under changing climates.

Strengthening Healthcare Supply Chains: A Comprehensive Strategy for Resilience in the Face of Natural Disasters

Effective and uninterrupted management of the healthcare supply chain and healthcare system preparedness for natural disasters (e.g., pandemics, earthquakes, forest fires, etc.) is essential to ensure that victims receive critical healthcare services and products with minimal disruption, even in the event of damage to transport and logistics infrastructure as a result of significant disasters. The article examines this issue using the example of Vital Health Systems, a prominent hospital system with multiple facilities across a wide region. The qualitative data for the study was collected through interviews and focus groups with key stakeholders in Vital Health Systems, including supply chain managers, procurement specialists, frontline staff, etc. The quantitative data for the study were based on reports, internal documentation and archival documents, industry reports, market research, government databases. Analysis of the supply chain resilience of Vital Health Systems to natural disasters was carried out using the PESTLE framework, based on which a comprehensive risk reduction strategy was proposed. This strategy, while rooted in theory, is highly practical and feasible, with measures to optimise stocks, creation of alternative transport routes and logistics networks, and use of technological solutions. Organisational and managerial proposals for minimising supply chain disruptions for Vital Health Systems in the event of natural disasters are based on the theory of transformational leadership, Denison’s organisational culture, Levitt’s diamond model, and McKinsey’s theory of strategic horizons. The role of healthcare professionals, supply chain managers, procurement specialists, and researchers in healthcare management and disaster preparedness is crucial in implementing these strategies.

Analysis of an Academic Medical Center’s Corrective Action Plan in Response to Fatal Medication Error Using the Institute for Safe Medication Practices’ Hierarchy of Effectiveness

Neuromuscular blocking agents (NMBAs) are high-alert medications that require special handling, necessitating a robust process that prevents medication error, identifies near misses, and ultimately protects patients from harm. One patient at a large academic medical center (AMC) was given vecuronium, a neuromuscular blocking agent, instead of midazolam, and died as a result. Thus, AMC was tasked by the Centers for Medicare & Medicaid Services (CMS) to make a list of actions to prevent a subsequent incident. When assessing AMC’s corrective action plan in comparison to the Institute for Safe Medication Practices’ hierarchy of effectiveness of risk-reduction strategies, it was revealed that 76% of strategies were of low leverage, 16% were of medium leverage, and 8% were of high leverage. In this context, AMC’s corrective action plan should have integrated more system-based interventions, which include medium- or high-leverage strategies, rather than relying heavily on initiatives dependent on human action. Despite the lack of these systemic tools, CMS granted approval for the plan. Overlooking these systemic tools may amplify patient harm and negatively impact workforce satisfaction and efficiency. Moreover, the absence of a “just culture” also plays a role in patient harm. Therefore, recognizing that medication errors in healthcare are predominantly attributed to human error highlights the importance of fostering a just culture that advocates for system accountability to enhance patient safety.

Assessing smog risk perception in Lahore metropolitan: A survey-based analysis

Smog is a mixture of harmful air pollutants that impact people's health. Risk perception pertains to how individuals or groups perceive and prepare for potential hazards like smog. This research quantifies smog risk perception in Lahore, focusing on three distinct areas: the city center, private housing schemes, and the peri-urban regions. The study employed a proportionate sampling method with a sample size of 600 households. Data was collected through face-to-face household interviews using a questionnaire survey. The risk perception index was constructed using the weighted average index method, incorporating various indicators. Descriptive statistics and chi-square analyses were conducted to understand the differences in smog risk perception. The analysis revealed that smog risk perception was generally high in all communities. However, there were statistical differences among the selected areas. The high risk perception could influence individual behaviors by encouraging proactive measures for smog preparedness. The findings have implications for designing effective smog risk reduction strategies and risk communication.

Patterns of daily oral HIV PrEP adherence among people who inject drugs in Ukraine: an analysis of biomarkers.

Daily oral HIV pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) is recommended for people who inject drugs (PWID) but coverage is low. The real-life effectiveness of PrEP among PWID is unknown as previous studies were conducted in controlled settings and mainly relied on self-report. Analysis of PrEP metabolites-tenofovir diphosphate (TFVdp) and emtricitabine triphosphate (FTCtp)-offers an objective measure of adherence. To analyse longitudinal patterns of PrEP adherence among PWID in Ukraine, we used data from a community-based implementation trial conducted in Kyiv between July 2020 and March 2021 to test the efficacy of SMS reminders to improve adherence. Among 199 enrolled participants, 156 (78.4%) were retained through 6 months. Based on TFVdp/FTCtp levels assessed at 3 and 6 months, we identified groups with various adherence patterns (adherent at ≥2 doses/week, improved, worsened, non-adherent). Correlates of adherence were analysed using multinomial logistic regression. Most participants (53.8%, n = 84/156) had no detectable metabolites at both assessments; 7.1% (n = 11/156) were consistently taking ≥2 doses/week; 1.3% (n = 2/156) were consistently taking ≥4 doses/week; 13.5% (n = 21/156) exhibited improved and 21.8% (n = 34/156) had worsened adherence at 6 compared to 3 months. "White coat compliance" (increased dosing prior to assessment) was common. Consistent adherence was associated with SMS reminders, younger age, employment, lower income, longer injection drug use duration, recent high-risk injecting (receptive syringe sharing, using pre-filled syringe, back- or front-loading, container sharing), absence of overdose in the past 6 months, perceived HIV risk through sexual intercourse and higher PrEP self-efficacy. Alcohol consumption was associated with inconsistent PrEP use. Groups with improved and worsened adherence did not differ. Daily oral PrEP may not achieve the desired effectiveness among PWID as a standalone intervention, calling for testing of alternative PrEP formulations and innovative integrated risk reduction strategies, especially in the context of HIV epidemics associated with injection drug use in eastern Europe and central Asia and the public health crisis in Ukraine caused by the war with Russia. SMS reminders may be effective among PWID who prioritize PrEP. Our findings offer practical guidance in identifying PWID who are likely to benefit from PrEP and those who need additional support.

The effect of ambient temperatures on hospital admissions for kidney diseases in Central Australia

This study aimed to quantify risk of hospitalisations for kidney diseases related to ambient temperature in Central Australia, Northern Territory (NT).Daily hospitalisation data were extracted for Alice Springs Hospital, Central Australia, 2010–2021. The association between daily mean temperature and daily hospital admissions for total kidney and specific kidney conditions was assessed using a quasi-Poisson Generalized Linear Model combined with a distributed lag non-linear model.A total of 52,057 hospitalisations associated with kidney diseases were recorded. In general, risk of specific kidney related hospitalisations was immediate due to hot temperatures and prolonged due to cold temperatures. Relative to the minimum-risk temperature (5.1 °C), at 31 °C, cumulative relative risk (RR) of hospitalisations for total kidney disease (TKD) was 1.297 [95% CI 1.164,1.446] over lag0-1 days, for chronic kidney disease (CKD) cumulative RR was 1.269 [95% CI 1.115,1.444] and for kidney failure (KF) cumulative RR was 1.252 [95% CI 1.107,1.416] at lag 0, and for urinary tract infection (UTI) cumulative RR was 1.522 [95% CI 1.072,2.162] over lag0-7 days. At 16 °C and over lag0-7 days, cumulative RR of hospitalisations for TKD was 1.320 [95% CI 1.135,1.535], for CKD was 1.232 [95% CI 1.025,1.482], for RF was 1.233 [95% CI 1.035,1.470] and for UTI was 1.597 [95% CI 1.143, 2.231]. Both cold and hot temperatures were also associated with increased risks of kidney related total hospitalisations among First Nations Australians and women. Overall, temperature attributable to 13.7% (i.e. 7138 cases) of kidney related hospitalisations with higher attributable hospitalisations from cold temperature.Given the significant burden of kidney disease and projected increases in extreme temperatures associated with climate change in NT including Central Australia there is a need to implement public health and environmental health risk reduction strategies and awareness programs to mitigate potential adverse health effects of extreme temperatures.

Human development and disaster mortality: evidence from India

Natural disasters present substantial dangers to both human life and physical infrastructure. Although the human development index (HDI) is recognized for its pivotal role in mitigating mortality resulting from natural disasters, the exact extent of its impact on fatalities remains unclear. In this study, we investigate the relationship between HDI and fatalities resulting from floods and cyclones using panel data for 19 states of India spanning from 1983 to 2011. Employing Fixed Effects Poisson and Negative Binomial estimates, we establish a causal-effect relationship between HDI and disaster-related fatalities. Additionally, we utilize the Instrumental Variable Poisson (IV) model to address the endogeneity between HDI and fatalities. Our empirical findings indicate that states with higher HDI levels experience lower fatalities due to natural disasters. Furthermore, our results underscore the importance of critical policy discussions regarding the role of inequality-adjusted HDI, government responsiveness, and human capital development in disaster risk reduction strategies.

Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies

ABSTRACT This study investigated the extent of injury incidence and burden in a professional women football team of the Scottish Women’s Premier League during two seasons. All injuries causing time-loss or required medical attention were recorded prospectively. A total of 671 injuries, 570 requiring medical attention and 101 causing time-loss were recorded in 41 players. Injuries occurring with National Team resulted in 12% of the club’s international players’ lay-off. Overall injury incidence was 11.1/1000-hours and burden was 368.9 days/1000-hours. Injury incidence (23.9/1000-hours vs 8.2/1000-hours) and burden (1049.8 days/1000-hours vs 215.1 days/1000-hours) were higher for match compared to training. Foremost mechanism of match injury burden was indirect-contact, which was different than the non-contact predominantly observed for training injury burden. Injury incidence, burden and patterns differed between training, match and playing positions. Tailoring injury-risk reduction strategies considering context, circumstances and playing position deserve consideration to enhance player’s injury resilience in professional women footballers.

Injuries in Athletics (Track and Field): A Narrative Review Presenting the Current Problem of Injuries

Objective: In Athletics (Track and Field), athletes can be affected by injuries, especially in their quest for top performance. Therefore, we aim to provide an overview of the current knowledge about the problem of injuries in Athletics. Main findings: It is necessary to maintain a clear definition of “injury” when stakeholders in Athletics discuss clinical, administrative, and/ or research perspectives. There are several possible methodological approaches to collect injury data in Athletics depending on the context, population, and injury definition. In general, about two thirds of Athletics athletes sustain at least one injury during an Athletics season, and there are about 100 injuries per 1000 registered athletes during an international championship. The injury rates and characteristics vary by sex and discipline. The injuries can affect athletes physically, psychologically, and socially, with short- and long-term consequences for musculoskeletal function, athletics performance and athletics career. Although it is logical to try to reduce the injury risk, little scientific evidence is currently available to help Athletics-related stakeholders. Conclusions: Injury can currently be considered as an omnipresent problem in Athletics, which affects their practice, with consequences on performance and health. Injury risk is today an undeniable part of the life of Athletics athletes, which implies that there is a pressing need to continue the development of injury risk reduction strategies, to scientifically evaluate their efficacy, and to implement them in sports practice.

Determination of Mountain Equivalent Rainstorm (MER) in Qinba Maintain Area Based on TRMM

The study of extreme precipitation is a significant aspect for investigating rainstorms, flash floods, and unpredictable disasters. Qinba mountain, Shaanxi province, China, is sensitive to extreme climate and rainstorm events. It is crucial to investigate the feature of precipitation extremes in this region with satellite data. According to this, the paper using the 1Day extreme precipitation datasets of TRMM and rain-gauge to calculate the mountain rainstorm, then the statistical metrics (CC, MBE, RMSE) was used in validation as the performance measure. The 1Day, 3Day, 5Day, and 7Day extreme precipitation was identified by the 95<sup>th</sup> percentile method. Thus to determine the Mountain Equivalent Rainstorm (MER). As the results, (1) Based on the comparison, the TRMM satellite product can capture the extreme precipitation mostly at the station below 433m (R<sup>2 </sup>>0.5) for 5Day datasets, while 7Day datasets reveal contrast patterns. (2) By applying the MER concept, the TRMM-based and gauge-based ratio revealed a similar pattern of mountain rainstorms at higher elevations and slightly different in the middle region. The mountain rainstorm amount was double the extreme rainfall at a higher elevation. Therefore, the defined extreme precipitation characteristics can assist the disaster risk reduction and mitigation strategy in the Qinba mountain of Shaanxi Province, China, and also provide a reference for improving the satellite algorithm in extreme precipitation measurement.

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.

Employing Machine Learning for Seismic Intensity Estimation Using a Single Station for Earthquake Early Warning

An earthquake early-warning system (EEWS) is an indispensable tool for mitigating loss of life caused by earthquakes. The ability to rapidly assess the severity of an earthquake is crucial for effectively managing earthquake disasters and implementing successful risk-reduction strategies. In this regard, the utilization of an Internet of Things (IoT) network enables the real-time transmission of on-site intensity measurements. This paper introduces a novel approach based on machine-learning (ML) techniques to accurately and promptly determine earthquake intensity by analyzing the seismic activity 2 s after the onset of the p-wave. The proposed model, referred to as 2S1C1S, leverages data from a single station and a single component to evaluate earthquake intensity. The dataset employed in this study, named “INSTANCE,” comprises data from the Italian National Seismic Network (INSN) via hundreds of stations. The model has been trained on a substantial dataset of 50,000 instances, which corresponds to 150,000 seismic windows of 2 s each, encompassing 3C. By effectively capturing key features from the waveform traces, the proposed model provides a reliable estimation of earthquake intensity, achieving an impressive accuracy rate of 99.05% in forecasting based on any single component from the 3C. The 2S1C1S model can be seamlessly integrated into a centralized IoT system, enabling the swift transmission of alerts to the relevant authorities for prompt response and action. Additionally, a comprehensive comparison is conducted between the results obtained from the 2S1C1S method and those derived from the conventional manual solution method, which is considered the benchmark. The experimental results demonstrate that the proposed 2S1C1S model, employing extreme gradient boosting (XGB), surpasses several ML benchmarks in accurately determining earthquake intensity, thus highlighting the effectiveness of this methodology for earthquake early-warning systems (EEWSs).

Familial cancer with BRCA2 and other germline variants: A case report

High-resolution genomic studies can help understanding the predisposition to cancer by identifying constitutional genetic variants of differential penetrance and pathogenicity in a family. We present a case report of whole exome analysis in a case (62/Female) with a history of pancreatic, intestinal, and prostate cancers in the paternal side and her unaffected son from Gujarat, India. Proband showed germline alterations in BRCA2 and NOS3 genes and in NTHL1 gene in her son. BRCA2 c.8954-3C > G has conflicting interpretations being characterized as likely pathogenic and variant of unknown significance (VUS) in 2018 and 2021, while our findings in 2022 classifies it as likely pathogenic. Novel germline genetic variants NOS3 c.1246_1255del (p. Ile417Thrfster9) and NTHL1 c.374dup (p. Val127GlyfsTer43) have been classified as VUS. In-silico analysis of the BRCA2 c.8954-3C > G indicates the location of the genetic variant at the splice site. Proband and her son show co-segregation of 9 constitutional genetic variants; 8 are likely benign and one is benign according to ClinVar. Identification of germline variants and studies on functional evidence will facilitate curated genetic counselling for the family and focussed risk-reduction strategies.

Iatrogenic hemorrhage and extensive venous thromboembolism during iTTP treatment with caplacizumab-A case report.

Caplacizumab reduces the need for therapeutic plasma exchange (TPE) during treatment for thrombotic thrombocytopenic purpura (TTP), associates with fewer required TPE, and shortens hospital stay. It is therefore recommended as part of standard care. However, the treatment effects on hemostasis may complicate initial management. We present a case of a woman with immune-mediated TTP who developed an intrathoracic hemorrhage on caplacizumab treatment after replacement of her central venous catheter. Reduced von Willebrand factor (vWF):glycoprotein Ib mutant (GPIbM) activity was reversed using vWF concentrate and the bleeding stopped. Unfortunately, vWF substitution in combination with caplacizumab discontinuation likely contributed to subsequent extensive venous thromboembolism. Risk-reducing strategies against both bleeding and thrombosis are crucial during caplacizumab treatment, and emergency vWF substitution increases the already high risk of thrombosis associated with TPE.

Risk Perceptions and Vulnerability Assessment: Induced from Tropical Cyclone in the Southern Part of Coastal Bangladesh

The coastal area that borders Bangladesh is extremely vulnerable to natural disasters like tropical cyclones, which cause the majority of the damage and fatalities related to flooding. This study attempts to evaluate the susceptibility of coastal flooding induced by tropical cyclones in the South-Western coastal region of Bangladesh. It also identifies the relationship between the influencing factors and respondents' perceptions of risk in terms of socio-economic characteristics. Data was gathered by using a standardized interview schedule from coastal households of three districts named as South Khali (Bagerhat), Padma Pukur (Satkhira), and Rangopaldi (Patuakhali). The survey was taken through interview to assemble information on risk perception, also explores the impact of flood risk on agriculture, environment and livelihood sectors to describe the most specific vulnerable one of different regions that provides a robust insight of affected residents. Moreover, twenty-one predominant factors in terms of three components reveal a strong relationship with severity to flood risk. Results also indicate that, vulnerability indexes differ significantly (p value < 0.05) in the study areas (vulnerability index = 0.54 in South Khali, 0.77 in Padma Pukur, and 0.74 in Rangopaldi). In addition, disaster vulnerability index differs with different socio-economic and geographical factors which enhance the negative effect of flood for the coastal community. The study also reveals that, the selected area had no adequate dam and embankment, cyclone shelter as well as material support from the government and non-government organization which makes their life risky to flood. The research recommends that, generating different livelihood options, self-organization by different disaster preparedness training program to enhance their resilience, indigenous and disaster risk reduction strategies, build more coastal flood shelters and restore people’s livelihoods by supplying agricultural seeds, livestock, poultry etc. significantly minimize the vulnerability of the affected community.

Potentially Modifiable Dementia Risk Factors in Canada: An Analysis of Canadian Longitudinal Study on Aging with a Multi-Country Comparison

BackgroundIt has been suggested that up to 40% of dementia cases worldwide are associated with modifiable risk factors; however, these estimates are not known in Canada. Furthermore, sleep disturbances, an emerging factor, has not been incorporated into the life-course model of dementia prevention.ObjectiveTo estimate the population impact of 12 modifiable risk factors in Canadian adults including sleep disturbances, by sex and age groups, and to compare with other countries.DesignCross-sectional analysis of Canadian Longitudinal Study on Aging baseline data.SettingCommunity.Participants30,097 adults aged 45 years and older.MeasuremmentsPrevalence and Population AttributableFractions (PAFs) associated with less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and sleep disturbancesResultsThe risk factors with the largest PAF were later life physical inactivity (10.2%; 95% CI, 6.8% to 13%), midlife hearing loss (6.5%; 3.7% to 9.3%), midlife obesity (6.4%; 4.1% to 7.7%), and midlife hypertension (6.2%; 2.7% to 9.3%). The PAF of later life sleep disturbances was 3.0% (95% CI, 1.8% to 3.8%). The 12 risk factors accounted for 51.9% (32.2% to 68.0%) of dementia among men and 52.4% (32.5% to 68.7%) among women. Overall, the combined PAF of all risk factors was 49.2% (31.1% to 64.9%), and it increased with age.ConclusionNearly up to 50% of dementia cases in Canada are attributable to 12 modifiable risk factors across the lifespan. Canadian risk reduction strategies should prioritize targeting physical inactivity, hearing loss, obesity, and hypertension.

Profile and risk factors in farmer injuries: a review based on Haddon matrix and 5 E's risk reduction strategy.

Farmers are considered a high-risk group for intentional and unintentional injuries. This review identified significant risk factors for agricultural injuries in farmers and explored injury prevention countermeasures based on the literature. Therefore, CiteSpace software was used to analyze the relevant literature in this field. Additionally, we identified both key risk factors and countermeasures using the Haddon matrix and the 5 E's risk reduction strategies conceptual framework, respectively. The risk factors were identified from four categories (host, agent, physical environment, and social environment) corresponding to three phases (pre-event, event, and post-event). Interventions of 5 E's risk reduction strategies including education, engineering, enforcement, economic, and emergency response have been proven effective in preventing injuries or reducing their severity. Our findings provide a comprehensive foundation and research direction for the study and prevention of injuries among farmers.

Why did I participate in an HIV vaccine study? Experiences of participation in the first phase II HIV vaccine trial in Mozambique: An ancillary study using a mixed-method approach

IntroductionThis study recognized the lack of information regarding recruitment and retention factors associated with implementing HIV vaccine trials from the perspective of de facto participants. It aimed to describe the motives and experiences of 31 young adults who participated in a phase II HIV vaccine clinical trial conducted in Maputo, Mozambique. MethodsThis was an ancillary study with a mixed-method approach that employed a convergent design, combining both quantitative and qualitative methodologies. Data collection involved questionnaire surveys, in-depth interviews, and focus group discussions. Participants were assessed before and after learning whether they received the experimental vaccine or placebo. Thematic analysis was used for qualitative data, while descriptive analysis and statistical tests such as Fischer’s test and McNemar’s exact test were applied to quantitative data. The study also utilized the Health Belief Model to understand the decision-making process of participating in an HIV vaccine study. ResultsMost of our participants were young females, single, with limited financial resources. Participants joined the trial with the belief that they had a unique opportunity to help the fight against HIV and contribute to the research for the discovery of an HIV vaccine. Positive experiences related to trial participation include gaining knowledge about HIV and personal health and receiving risk reduction counseling. Participants reported blood collection as a negative experience and that they suffered social harm because of trial participation. Participants felt abandoned after the trial ended. ConclusionPreventive HIV vaccine trials should integrate a social-behavioral component to assess reasons for participation and refusal in real-time. Providing ongoing personal attention is crucial for young individuals who have committed 1–2 years to trial participation, extending beyond the trial period. Implementing tailored strategies for HIV risk assessment and reduction during and after the trial is essential. Addressing these factors can enhance preventive HIV vaccine trial implementation.

Determinants of neural tube defect among newborns admitted to neonatal intensive care units of teaching hospitals in Gedeo Zone and Sidama Region, Southern Ethiopia: a case–control study

BackgroundNeural tube defects are a significant cause of morbidity and mortality that can occur in the early pregnancy periods. Though the burden is high, it gains only limited attention. In...