Abstract Purpose South African adolescents have high HIV risk, yet few prevention interventions are effective. Parents play a pivotal role in youths’ healthy sexual development and may be at risk ...themselves. We tested whether Let’s Talk!, a worksite-based parenting program, improves parent-child communication about HIV and sexual health and parent condom use self-efficacy and behavior. Methods We culturally adapted Let’s Talk! in two languages, drawing on formative research and community stakeholder input. We then conducted a small randomized test at a large public worksite in Cape Town, South Africa. The intervention consisted of 5 weekly 2-hour group sessions for parents of youth aged 11–15. Sixty-six parents (64% female) and their 64 adolescents (41% female) completed surveys before and 1–2 weeks post-intervention; surveys assessed comfort with talking about sex, communication about 16 HIV- and sex-related topics, and parents’ condom use self-efficacy and behavior. Thirty-four black African (Xhosa language) and 32 coloured (mixed-race; Afrikaans language) parent-child dyads participated. Parents were randomized to intervention (n = 34) and control (n = 32) groups; randomization was stratified by language. Results Multivariate regressions indicated that the intervention significantly increased parents’ comfort with talking to their adolescent about sex, b(SE) = .98(.39), p = .02, and the number of sex- and HIV-related topics discussed with their adolescent, b(SE) = 3.26(1.12), p = .005. Compared with control parents, intervention parents were more likely to discuss new sex- and HIV-related topics not discussed before the intervention, b(SE) = 2.85(.80), p <.001. The intervention significantly increased parents’ self-efficacy for condom use, b(SE) = .60(.21), p = .007. Conclusions Let’s Talk! holds promise for improving parent-child communication, a critical first step in preventing HIV among youth.
There is increasing interest in expanding Medicare health insurance coverage in the United States, but it is not clear whether the current program is the right foundation on which to build. ...Traditional Medicare covers a uniform set of benefits for all income groups and provides more generous access to providers and new treatments than public programs in other developed countries. We develop an economic framework to assess the efficiency and equity trade-offs involved with reforming this generous uniform structure. We argue that three major shifts make a uniform design less efficient today than when Medicare began in 1965. First, rising income inequality makes it more difficult to design a single plan that serves the needs of both higher- and lower-income people. Second, the dramatic expansion of expensive medical technology means that a generous program increasingly crowds out other public programs valued by the poor and middle class. Finally, as medical spending rises, the tax financing of the system creates mounting economic costs and increasingly untenable policy constraints. These forces motivate reforms that shift toward a more basic public benefit that individuals can “top up” with private spending. If combined with an increase in other progressive transfers, such a reform could improve efficiency and reduce public spending while benefiting low-income populations.
ObjectiveTo investigate the potential impacts of several tobacco control interventions on adult daily smoking prevalence in the Australian state of Queensland, using a system dynamics model ...codeveloped with local and national stakeholders.MethodsEight intervention scenarios were simulated and compared with a reference scenario (business as usual), in which all tobacco control measures currently in place are maintained unchanged until the end of the simulation period (31 December 2037).FindingsUnder the business as usual scenario, adult daily smoking prevalence is projected to decline from 11.8% in 2017 to 5.58% in 2037. A sustained 50% increase in antismoking advertising exposure from 2018 reduces projected prevalence in 2037 by 0.80 percentage points. Similar reductions are projected with the introduction of tobacco wholesaler and retailer licensing schemes that either permit or prohibit tobacco sales by alcohol-licensed venues (0.65 and 1.73 percentage points, respectively). Increasing the minimum age of legal supply of tobacco products substantially reduces adolescent initiation, but has minimal impact on smoking prevalence in the adult population over the simulation period. Sustained reductions in antismoking advertising exposure of 50% and 100% from 2018 increase projected adult daily smoking prevalence in 2037 by 0.88 and 1.98 percentage points, respectively.ConclusionsThese results suggest that any prudent approach to endgame planning should seek to build on rather than replace existing tobacco control measures that have proved effective to date. Additional interventions that can promote cessation are expected to be more successful in reducing smoking prevalence than interventions focussing exclusively on preventing initiation.
Evidence-based family-based interventions targeting parent mental health and partner conflict during community-wide crises such as the COVID-19 pandemic are scarce. Family Foundations (FF), a 10- ...week couple/parent-based intervention targeting parent mental health, conflict and co-parenting was delivered via videoconferencing during the COVID-19 pandemic. This study aimed to: (1) explore parents' and clinicians' experiences and perceived benefits of FF, and (2) assess pre-post intervention changes in parent mental health, interparental conflict and co-parenting behaviour. A mixed methods evaluation was conducted with 62 families with young children experiencing parent mental health difficulties and/or parental conflict. Qualitative interviews with parents and FF clinicians were conducted, and intervention outcomes were assessed using mother-report surveys. Maternal stress and anxiety symptoms decreased and co-parenting support and parenting warmth increased following FF. Parents expressed high satisfaction with FF despite the perceived limited cultural and family structure diversity in the videos. Although some activities were modified and clinicians were more directive in their style of delivery, FF was implemented with fidelity. Importantly, telehealth delivery made FF accessible to meet the needs of families during the pandemic when in-person services were not available. These findings will inform further development and evaluation of telehealth FF during communitywide crises such as the COVID-19 pandemic.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
Data on the efficacy of including definitive local therapy to the primary site for head and neck squamous cell carcinoma (HNSCC) patients with synchronous distant metastasis are lacking. ...In multiple different solid tumor types, there has been benefit when using systemic therapy followed by local consolidative therapy (stereotactic ablative radiotherapy or surgery) directed at metastases. We proposed to retrospectively evaluate patients at our institution that received definitive treatment to the primary.
Methods
Single institution retrospective study evaluating 40 patients with metastatic HNSCC treated with definitive surgery (55%) or chemoradiation (45%) to the primary site from 2000 to 2020. The major endpoints were overall survival (OS) and progression‐free survival (PFS) for the total population and multiple sub‐groups. Some variables were evaluated with multiple covariates Cox model.
Results
The median PFS was 8.6 months (95% CI, 6.4–11.6), and OS was 14.2 months (95% CI, 10.9–27.5). In 28% of patients that received induction therapy, there was a twofold increase in median overall survival to 27.5 months. In the 33% of patients that received anti‐PD‐1 mAb as part of their treatment course, the median OS was significantly increased to 41.7 months (95% CI, 8.7‐NR) versus 12.1 months (95% CI, 8.4–14.4) with a 5‐year OS of 39%. Multivariate analysis for OS showed significance for age at diagnosis, use of IO, and number of metastatic sites.
Conclusion
We observed impressive survival outcomes in metastatic HNSCC patients treated with definitive local therapy to the primary site in addition to induction and/or immunotherapy. Further study is warranted.
Level of Evidence: 3.
Data on the efficacy of including definitive local therapy to the primary site for HNSCC patients with synchronous distant metastasis are lacking. We show with a single institution retrospective study that survival outcomes in metastatic HNSCC patients treated with definitive local therapy to the primary are improved.
Abstract
Epigenetic variation has the potential to influence environmentally dependent development and contribute to phenotypic responses to local environments. Environmental epigenetic studies of ...sexual organisms confirm the capacity to respond through epigenetic variation. An epigenetic response could be even more important in a population when genetic variation is lacking. A previous study of an asexual snail, Potamopyrgus antipodarum, demonstrated that different populations derived from a single clonal lineage differed in both shell phenotype and methylation signature when comparing lake versus river populations. Here, we examine methylation variation among lakes that differ in environmental disturbance and pollution histories. Snails were collected from a more pristine rural Lake 1 (Lake Lytle), and two urban lakes, Lake 2 (Capitol Lake) and Lake 3 (Lake Washington) on the Northwest Pacific coast. DNA methylation was assessed for each sample population using methylated DNA immunoprecipitation, MeDIP, followed by next-generation sequencing. The differential DNA methylation regions (DMRs) identified among the different lake comparisons suggested a higher number of DMRs and variation between rural Lake 1 and one urban Lake 2, and between the two urban Lakes 2 and 3, but limited variation between the rural Lake 1 and urban Lake 3. DMR genomic characteristics and gene associations were investigated. The presence of site-specific differences between each of these lake populations suggest an epigenetic response to varied environmental factors. The results do not support an effect of geographic distance in these populations. The role of dispersal distance among lakes, population history, environmental pollution and stably inherited methylation versus environmentally triggered methylation in producing the observed epigenetic variation are discussed. Observations support the proposal that epigenetic alterations may associate with phenotypic variation and environmental factors and history of the different lakes.
The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active ...pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.
•Lifelong quality medical care with access to multidisciplinary services, is of prime importance. Care includes regular tests for surveillance of health status.•Transition from paediatric to adult care is an active process that should commence during early adolescence and continue until successful engagement with adult congenital cardiology care.•Children and adults with a Fontan circulation often have reduced peak exercise capacity (on average, 60–65% of predicted values). Increasingly, evidence suggests exercise training may improve exercise capacity and cardiovascular function.•People with a Fontan circulation have higher rates of anxiety and behavioural disorders, and there needs to be a low threshold for the provision of mental health care.•Pregnancy has increased maternal and fetal risks, and pre-conception multidisciplinary assessment and counselling is essential.•Atrial arrhythmias are common, often late after Fontan surgical repair and due to intra-atrial re-entry or “flutter” mediated by atrial stretch and scarring. Some anti-arrhythmic agents, most classically the type IC drugs, may allow haemodynamically unstable, life-threatening 1:1 AV conduction.•Anticoagulation with warfarin is routine care in patients with atrial arrhythmias.•In patients with recurrent atrial arrhythmias, catheter ablation or surgical conversion may be considered.•The Fontan circulation is an ideal substrate for thrombus formation and may result in intracardiac or intravascular thrombosis, ischaemic stroke, or other embolic phenomena. Antiplatelet and anticoagulant agents are commonly prescribed for thromboprophylaxis in patients with a Fontan circulation. Evidence suggests that treatment with one of these agents is advantageous, but there is no consensus on which is optimal. Despite treatment, symptomatic thromboembolic events are associated with significant mortality.•Heart failure is the leading cause of morbidity and mortality. Diuretics provide symptomatic relief, however standard heart failure medical therapy is not of proven benefit.•Though not well understood, there is increasing concern regarding progressive liver disease with a long-term risk of hepatocellular carcinoma.•Despite early higher mortality post heart transplant, these individuals have better long-term survival outcomes compared with many other heart transplant recipients.
Nanoporous carbons with graphitic domains were synthesized from a polymer containing sulfur and nitrogen. The materials were characterized using adsorption of nitrogen, potentiometric titration ...TA/MS, XPS, TEM and XRD. Then they were tested as supercapacitors in three-electrode cell and under visible light irradiation after extensive wetting either in water or a sulfuric acid electrolyte. The capacitance up to 450 F/g was measured in spite of a relatively low surface (<850 m super(2)/g). The surface chemistry, and especially sulfur and nitrogen containing functional groups, were found of paramount importance for the capacitive behavior and for the effective pore space utilization by the electrolyte ions. Photocurrent measured in light also affects the capacitance. Its generation is linked to the excitation of sulfonic/sulfoxide chromophores-like moieties decorating the surface of the polymerderived carbons.
Modern mining jurisdictions commonly require a mine-site to be restored to its original land-use when mining is completed. However, the conversion of disused mine sites for agricultural purposes ...(rather than restoration to an original condition) is an innovative strategy as food security in many regions becomes critical. Selected mine-sites on Christmas Island were converted to an agricultural land use as the mining company withdrew from mineral extraction in the aim to achieve employment, economic, and socio-economic benefits for the isolated island population (pop. ∼2000). The Australian Government co-funded this research with a mining company (Phosphate Resources Limited) to assess the science required to introduce commercial agriculture to the island. This paper describes land-use change methods and results, including pre-commercial trials of selected broadacre crops, rotational cropping using legumes, high value crops, and a microbial prospecting program to determine capability of indigenous bacteria. This research demonstrates a range of successful methods have enabled a new post-mining land-use to productive farmland from an apatite (phosphate) minesite. We have outlined where productive use of post-mining lands is both desirable and has proven to be particularly challenging, but which can lead to a productive and commercially viable opportunity in both advanced and emerging economies.
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