Tenofovir gel for HIV prevention for women: Perspectives of Key Opinion Leaders from India

ObjectivesCountry decision-making regarding adoption of new health technologies is a lengthy process that is informed by scientific, public health, and policy analyses. Key Opinion Leaders (KOLs), who include a range of influential individuals (e.g., Ministry of Health officials, leaders of medical and pharmacy associations, civil society representatives, donors), play a critical role in country decision-making around adoption and availability of new HIV-prevention tools. Their perspectives can shape public opinion and influence policy, programming, and procurement decisions.MethodsIn-depth face-to-face interviews with a dozen purposefully selected national KOLs in India were conducted to gain their perspectives around ARV-based prevention for women, focusing on microbicides in general and tenofovir vaginal gel specifically. Theme-based content emerged and was analyzed using ATLAS.ti software.ResultsWhile generally supportive, KOLs expressed caveats regarding the role tenofovir gel might play in the overall HIV-prevention program. Key outstanding issues that would need to be addressed include product effectiveness, potential for resistance, product cost, feasibility of HIV testing and re-testing, and effective targeting of key populations for public health impact.ConclusionsAs new HIV-prevention technologies advance through clinical trials, there is a concomitant necessity to engage in policy analysis exercises. Formative research with stakeholders early in the process is an important yet often overlooked step. The potential role that the tenofovir gel could play in India will depend in large part on epidemiological, public health, and economic factors. Understanding target populations' perspectives on the product will also be critical for its successful introduction.     

Relationship between unhealthy sleep status and dry eye symptoms in a Japanese population: The JPHC-NEXT study

PurposeTo investigate whether and how unhealthy sleep habits (i.e., the frequency of difficulty falling or staying asleep, and the frequency of waking up tired) and the duration of sleep are related to the prevalence of dry eye disease (DED) in a general population.MethodsThis study included a total of 106,282 subjects aged 40–74 years who participated in a baseline survey of the Japan Public Health Center-based Prospective Study for the Next Generation. DED was defined as the presence of clinically diagnosed DED or severe symptoms. Multivariable-adjusted logistic regression models were used to assess the relationships of various components of sleep status with DED.ResultsHigher frequencies of having difficulty falling or staying asleep, and waking up tired were significantly related to increased DED in both sexes (P_trend<0.001). Compared with those with 8 h/day of sleep, shorter sleepers had an increased prevalence of DED in both sexes, although DED was increased among men who slept ≥10 h/day. By comparing participants with the greatest vs. the least difficulty of falling asleep, the multivariable-adjusted odds ratios (95% confidence interval [CI]) were 2.23 (95% CI, 1.99–2.49) for men and 1.91 (95% CI, 1.76–2.07) for women. When analyzed separately, the magnitude of each relationship was stronger with severe DED symptoms than with clinically diagnosed DED.ConclusionsSleep deprivation and poor sleep quality were significantly related to DED in a Japanese population.     

Prevalence of metabolic syndrome and associated factors in adults living in Fernando de Noronha,Brazil

Metabolic Syndrome (MetS) is multivariate disease, clustered with socioeconomic and behavioral risk factors. Investigations about epidemiology estimative could be a prevention strategy.Aimto investigate the prevalence of metabolic syndrome and its associated factors in adult population in Fernando de Noronha Archipelago (PE-Brazil).MethodsA cross-sectional study was performed on a representative sample (N = 375) of adult residents of the region, aged 24–59 years, were harmonized according to the International Diabetes Federation (IDF) criteria.ResultsThe prevalence of metabolic syndrome was 45 (12%) and, the age was associated with MetS, which increases the chances to MetS development around 3% respectively (OR: 1.03; CI 95%: 1.002–1.070 P 0.0384). Waist circumference was elevated in female population 266 (70.74%), however, levels of fasting blood glucose (304 [80.85%]), blood pressure (375 [100%]), TG (302 [80.32]), and low HDLc (297 [78.99]) presented normal biochemical values. There is no significative difference for male and female gender and, the social and behavior factors did not present significative association.ConclusionThe Fernando de Noronha presents lower prevalence of MetS thus, shows associations for elderly people. The waist circumference was elevated on female population. The results of this study provide further evidence and underscore the need for public health strategies that include education about MetS, promotion of cardiometabolic health, and prevention of undesirable outcomes such as diabetes and cardiovascular disease.     

A proposal for an alcohol purchase license

ABSTRACT

Background: Recent advances in technology have allowed for innovative targeting of high-risk alcohol users.

Objectives: We propose the implementation of an alcohol purchase license linked to a state agency managed database, or so-called Banned Drinker Register (BDR).

Methods: Individuals who are unable to drink safely will be identified by a well-founded criterion and their ability to purchase alcohol proscribed. A state agency will be responsible for maintaining the BDR and compiling mandated reports from hospitals, courts, police and child protective agencies of alcohol-related dangerous behavior, adjudicating reports with the input of those involved in these events, and determining which individuals will not be allowed to purchase alcohol. Outlets of alcohol sales will then be required to assess customers for eligibility of alcohol purchase using an electronic card reader (as used for age verification). Individuals wanting to protect themselves from drinking may also self-request to be placed on the BDR.

Results: Overall, the convenience/access for persons who injure themselves with alcohol and others with intoxicated behavior would be reduced. Opportunities for cost savings would come from a decrease in yearly incarcerations, a reduction in preventable traffic accidents and property damage requiring state municipal intervention, a decreased cost to offending individuals by preventing increased insurance rates, loss of jobs to incarceration and loss of potential future wages, and the possibility of preventing long term medical complications of chronic alcohol use and its toll on the health care system.

Conclusions: Health benefits will include increased public safety and awareness about drinking consequences and reduced alcohol-related morbidity and mortality.     

Higher levels of greenness and biodiversity associate with greater subjective wellbeing in adults living in Melbourne,Australia

Natural environments may be important for subjective wellbeing, yet evidence is sparse and measures of nature are unspecific. We used linear regression models to investigate the relationship between greenness, biodiversity and blue space and subjective wellbeing in 4,912 adults living in metropolitan Melbourne, Australia. Greenness (overall, private and public) and biodiversity associated with subjective wellbeing. In particular, we highlight the importance of the private greenness-subjective wellbeing association. Our work has implications for urban policy and planning in the context of increased urban densification.     

A unique case of bradycardia recognized by wearable technology as first presentation of complete heart block

Wearable technology has advanced significantly, and the proposed health benefits have been widely touted. Most of the discussion has been surrounding the identification and diagnosis of asymptomatic atrial fibrillation. However, the heart monitoring functions of the wearable technology can also identify other abnormalities as well. We present the first case of wearable technology identified bradycardia diagnosed as the primary presentation of complete heart block. Wearable technology has advanced significantly, but still poses questions regarding its use in screening for rare conditions. One remaining challenge is balancing the desire to screen for rare asymptomatic conditions without overburdening emergency departments with patients responding to alarms on their devices.     

Public Awareness and Mask Usage during the COVID-19 Epidemic: A Survey by China CDC New Media

An online survey conducted March 18–19, 2020 on the official China CDC WeChat account platform was used to evaluate the effect of public education about masks usage during the new coronavirus disease 2019 (COVID-19) epidemic. Chinese nationals older than 18 were eligible for the survey. The survey collected 5,761 questionnaires from the 31 provinces, municipalities, and autonomous regions of mainland China. 99.7% and 97.2% of the respondents answered correctly that respiratory droplets and direct contact were the main transmission routes. 73.3% of the respondents considered COVID-19 to be ‘serious’ or ‘very serious’. When going to the hospital, 96.9% (2,885/2,976 had gone to a hospital) used a mask during the COVID-19 epidemic, while 41.1% (2,367/5,761) did not use a mask before the epidemic. Among the respondents that used public transportation and went shopping, 99.6% and 99.4%, respectively, wore masks. Among respondents who returned to work, 75.5% wore a mask at the workplace, while 86.3% of those who have not returned to work will choose to use masks when they return to the workplace. The Chinese public is highly likely to use a mask during COVID-19 epidemic, and the mask usage changed greatly since the COVID-19 outbreak. Therefore, public education has played an important role during the COVID-19 epidemic.     

Epidemiological,demographic and clinical data on chronic viral hepatitis C in Tuscany

Background: Recent introduction of direct antiviral agents (DAAs) has completely changed the scenario regarding hepatitis C virus (HCV) treatment. Certain countries’ economic health programs prioritize DAAs according to specific clinical features of HCV-infected patients. The aim of this study was to define epidemiological, demographic and clinical characteristics of HCV-infected patients in the Tuscany region of central Italy.

Methods: We enrolled HCV patients with chronic viral hepatitis who were referred to the outpatient services of 16 hospitals in Tuscany from 1 January 2015 to 31 December 2015. Case report forms contained patient information including main demographic data, blood chemistry data, viral hepatitis markers, instrumental evaluations (liver biopsy or transient elastometry, liver ultrasound), eligibility for DAAs, and liver transplantation or therapy already in progress.

Results: Of all patients considered, 2919 HCV patients were enrolled (mean age: 57.44?±?15.15; 54% males, 46% females). All routes of transmission were well represented (intravenous drug use in 20.7%; nosocomial/dental care in 20.6%; and coagulation factors/blood transfusions in 13.3%). Diabetes was the highest represented comorbidity (20.8%), followed by metabolic syndrome (15.5%) and ischemic heart disease (6.2%). The most prevalent HCV genotypes were 1b (47.4%) and 2 (16.5%). In the whole cohort of patients, 32.8% were cirrhotic (40 patients were listed for liver transplantation). Signs of portal hypertension were present mostly in the group older than 45 years (92.3%). Extrahepatic HCV-related diseases were present in 13.3% of cases (cryoglobulinemic syndrome in 58.3% and B-cell non-Hodgkin’s lymphoma in 10.5%).

Conclusions: Our study provides evidence of a high prevalence of epidemiological changes in HCV infection with a major prevalence of advanced liver disease, such as portal hypertension, in this elderly cohort of patients.     

不同民族城市公职人员精神疾病知晓率及态度

目的:调查了解新疆克拉玛依区不同民族城市公职人员对精神卫生与心理保健知识的知晓情况及对精神疾病的态度差异。方法:整群抽取新疆克拉玛依区城市公职人员2046人,采用精神卫生与心理保健知识问卷(MK)、精神疾病有关态度问卷(MA)进行调查。应用SPSS 17.0软件对数据进行方差分析、独立样本t检验以及描述性统计。结果:城市公职人员对精神疾病的认识不够全面,对精神疾病仍存在一定的偏见和误解;不同民族的城市公职人员在精神卫生与心理保健知识上的得分差异具有显著统计学意义(F=23.65,P0.001);不同民族的公职人员在精神卫生态度上的得分差异显著,具有统计学意义(F=2.766,P0.01)。结论:城市公职人员对精神疾病缺乏正确认识;城市公职人员的精神卫生知晓率、对精神疾病有关态度具有民族差异。