Subtype‐specific differences in transmission cluster dynamics of HIV‐1 B and CRF01_AE in New South Wales,Australia

IntroductionThe human immunodeficiency virus 1 (HIV‐1) pandemic is characterized by numerous distinct sub‐epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses.MethodsWe used HIV‐1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV‐1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01_AE (CRF01_AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01_AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW‐specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi‐Square statistics.ResultsWe identified 104 subtype B and 11 CRF01_AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01_AE respectively. We observed a > 2‐fold increase in the number of NSW‐specific CRF01_AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01_AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01_AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above‐average growth rate (>1.5 sequences / 6‐months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01_AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01_AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals.ConclusionsThe large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01_AE.     

Completion of Primary Care Referrals Among New York State Refugees

An important component of the New York State Refugee Health Program’s (NYSRHP) mission is to ensure refugees with identified medial conditions are referred to primary and specialty care. A programmatic evaluation was conducted to assess the completion rate for primary care referral appointments made during the initial domestic health assessment among refugees in NYS (exclusive of New York City). Upon arrival in NYS, refugees may receive a domestic health assessment by one of NYSRHP contracted providers. As part of the assessment, referrals for primary and specialty care may be assigned. From July 2010 to June 2011, 69 % of NYS-bound refugees that received a primary care referral by a NYSRHP contracted provider completed their appointment.     

Spontaneous peri-talar dislocation after steroid intra-articular injections: A case report

We report a case of spontaneous peri-talar dislocation after intra-articular steroid injections. We have reviewed the literature on spontaneous peri- and sub-talar dislocations and the effects of intra-articular steroid injections.     

Documented Complications of Staple Hemorrhoidopexy: A Systematic Review

A systematic review addressing reported complications of stapled hemorrhoidopexy was conducted. Articles were identified via searching OVID and MEDLINE between July 2011 and October 2013. Limitations were placed on the search criteria with articles published from 1998 to 2013 being included in this review. No language restrictions were placed on the search, however foreign language articles were not translated. Two reviewers independently screened the abstracts for relevance and their suitability for inclusion. Data extraction was conducted by both reviewers and entered and analyzed in Microsoft Excel. The search identified 784 articles and 78 of these were suitable for inclusion in the review. A total of 14,232 patients underwent a stapled hemorrhoidopexy in this review. Overall complication rates of stapled hemorrhoidopexy ranged from 3.3%–81% with 5 mortalities documented. Early and late complications were defined individually with overall data suggesting that early complications ranged from 2.3%–58.9% and late complications ranged from 2.5%–80%. Complications unique to the procedure were identified and rates recorded. Both early and late complications unique to stapled hemorrhoidopexy were identified and assessed.Key words: Stapled anopexy, Stapled hemorrhoidectomy, Stapled hemorrhoidopexy, ComplicationsThe stapled hemorrhoidopexy was introduced in 1993 and has been used as an alternative method to the Ferguson and Milligan-Morgan technique for the surgical management of hemorrhoidal disease. The technique has received enthusiasm as it was claimed that it could be completed with speed, minimal postoperative pain and good postoperative outcomes, in comparison with the previously used methods. Despite this, however, long-term sequelae of the stapled hemorrhoidopexy have not been widely documented and recent evidence has led to suspicion surrounding the complication rates of the procedure and how these actually compare with other techniques of hemorrhoidectomy. This review addressed and provided a review in regard to the complication rates of the stapled hemorrhoidopexy and has allowed for collation of data surrounding the major complications reported, within the literature, associated with this technique. It has allowed for a long-term collation of the complications associated with the procedures that have not been readily available and reported on, in the previously conducted randomized control trials (RCTs).     

The Role of Self-Monitoring and Response Inhibition in Improving Sleep Behaviours

Background

Young adults tend to have poor sleep, which may be a result of poor self-regulation.

Purpose

This study investigated whether manipulating two aspects of self-regulation: self-monitoring and response inhibition could improve sleep behaviours.

Method

University students (N?=?190) were randomly allocated to complete (1) a self-monitoring sleep diary and response inhibition training, (2) a sleep diary only, or (3) a control questionnaire daily for a period of 7 days.

Results

Outcome measures were three sleep hygiene behaviours previously found to be particularly important in this population: avoiding going to bed hungry and thirsty, avoiding anxiety and stress-provoking activity before bed, and making the bedroom and sleep environment restful. Those who completed diary-based self-monitoring successfully avoided anxiety and stress-provoking activity before bed more frequently than control participants, corresponding to a medium effect size, and further development may provide a simple intervention to improve aspects of sleep and other health behaviours.

Conclusion

There was no incremental effect of response inhibition training. Modified response inhibition training tasks may be worth investigating in future research.     

High-acuity GIS mapping of private practice dental services in New Zealand: does service match need?

Objectives: New Zealand is a country with a relatively small population (4 million people) distributed unevenly over a relatively large land area. Adult oral health services in New Zealand are almost all delivered through a market‐driven, private practice model and are funded directly by patient payments. Little attention has been given to the distribution of these services. This study reports the findings of a high‐acuity examination of the distribution of private dental practices in New Zealand, using modern geographic information system (GIS) tools. Methods: A total of 1,045 private dental practices in New Zealand were geocoded. These dental practices overlaid 1,909 area units. Results: The highest practice : adult population ratios found in this study reflected the areas with the highest population densities of Maori and Pacific Islander people. Conclusions: Oral health has a substantial impact on health‐related quality of life and the utilisation of dental care services can contribute to its improvement. As such, it is expected that access to care should be focused on the population groups with the highest degree of need. However, in a market‐driven, mostly private practice model, such as that in New Zealand, available care is concentrated largely in areas of high socioeconomic status and in populations with lower levels of oral disease.     

Longer-term effects of school-based counselling in UK primary schools

Children’s mental health is deteriorating while access to child and adolescent mental health services is decreasing. Recent UK policy has focused on schools as a setting for the provision of mental health services, and counselling is the most common type of school-based mental health provision. This study examined the longer-term effectiveness of one-to-one school-based counselling delivered to children in UK primary schools. Data were drawn from a sample of children who received school-based counselling in the UK in the 2015/16 academic year, delivered by a national charitable organisation. Mental health was assessed at baseline, immediately post-intervention, and approximately 1 year post-intervention, using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Paired t tests compared post-intervention and follow-up SDQ total difficulties scores with baseline values. Propensity score matching was then used to identify a comparator group of children from a national population survey, and linear mixed effects models compared trajectories of SDQ scores in the two groups. In the intervention group, teacher and parent SDQ total difficulties scores were lower at post-intervention and longer-term follow-up compared to baseline (teacher: baseline 14.42 (SD 7.18); post-intervention 11.09 (6.93), t(739) = 13.78, p < 0.001; follow-up 11.27 (7.27), t(739) = 11.92, p < 0.001; parent: baseline 15.64 (6.49); post-intervention 11.90 (6.78), t(361 = 11.29, p < 0.001); follow-up 11.32 (7.19), t(361) = 11.29, p < 0.001). The reduction in SDQ scores was greater in the intervention compared to the comparator group (likelihood ratio test comparing models with time only versus time plus group-by-time interaction: χ² (3) = 24.09, p < 0.001), and model-predicted SDQ scores were lower in the intervention than comparator group for 2 years post-baseline. A one-to-one counselling intervention delivered to children in UK primary schools predicted improvements in mental health that were maintained over a 2 year follow-up period.