Planning an intervention to prevent infections with the human immunodeficiency virus (HIV) should be guided by local epidemiological and socioeconomic conditions. The socioeconomic setting and ...existing public service capacity determine whether an intervention can have a significant outcome in terms of a reduction in a defined risk. The epidemiological context determines whether such risk reduction translates into a measurable impact on HIV incidence. Measurement of variables describing the epidemiological context can be used to determine the local suitability of interventions, thereby guiding planners and policy-makers in their choice of intervention. Such measurements also permit the retrospective analysis of the impact of interventions where HIV incidence was not recorded. The epidemiological context is defined for four different categories of intervention, shown to be effective in lower-income countries by randomized controlled trials. Appropriate indicators for the epidemiological context and methodological guidelines for their measurement are proposed. Their use in the transfer of a successful intervention from one context to another and in scaling up the effort to control HIV infection is explored. These indicators should provide a useful resource for those involved in planning HIV prevention interventions.
AIDS-related stigma is a major contributor to the health and psychosocial well-being of children affected by AIDS. Whilst it is often suggested that AIDS-affected children may be stigmatised by other ...children, to date no research focuses specifically on child-on-child stigma. Using social representations theory, we explore how Zimbabwean children represent AIDS-affected peers, examining (i) whether or not they stigmatise, (ii) the forms stigma takes, and (iii) the existence of non-stigmatising representations that might serve as resources for stigma-reduction interventions. Our interest in identifying both stigmatising and non-stigmatising representations is informed by a theory of change which accords a central role to community-level debate and dialogue in challenging and reframing stigmatising representations. In late 2008, 50 children (aged 10–12) were asked to “draw a picture of a child whose family has been affected by AIDS in any way”, and to write short stories about their drawings. Thematic analysis of stories and drawings revealed frequent references to stigmatisation of AIDS-affected children – with other children refusing to play with them, generally keeping their distance and bullying them. However children also frequently showed a degree of empathy and respect for AIDS-affected children’s caring roles and for their love and concern for their AIDS-infected parents. We argue that a key strategy for stigma-reduction interventions is to open up social spaces in which group members (in this case children) can identify the diverse and contradictory ways they view a stigmatised out-group, providing opportunities for them to exercise agency in collectively challenging and renegotiating negative representations. Contrary to the common view that drawings enable children to achieve greater emotional expression than written stories, our children’s drawings tended to be comparatively stereotypical and normative. It was in written stories that children most eloquently expressed meanings and emotions, and an awareness of the complexity of the scenarios they portrayed.
► Detailed examination of serious aviation incidents in USA linked to outsourcing of maintenance. ► Points to the need for more cross referencing between industries in terms of understanding safety. ...► Identifies risk factors associated with outsourcing/subcontracting across a range of industries. ► Argues US experience raises issues of global relevance to aviation safety.
Since the 1990s the safety implications of outsourcing aircraft maintenance in the US airline industry have become the subject of regulatory scrutiny and public debate. The discussion has emanated from a number of well-publicised crashes that have been attributed primarily to faulty outsourced maintenance, including the loss of a ValuJet airliner in Florida in 1996 and the crash of an Air Midwest commuter aircraft in 2003. While the overall safety performance of air travel has improved, concerns have been raised that increased outsourcing and offshoring of aircraft maintenance may contribute to a dangerous nexus between cost-cutting and weaker regulatory oversight with negative implications for future aviation safety. Drawing primarily on official investigations, we examine a number of serious aviation incidents and accidents in the USA where maintenance was outsourced to see what lessons can be drawn. Our study found that the existing modes of inquiry into the dangers of aircraft maintenance fail to draw upon recognised failure mechanisms associated with outsourcing/subcontracting trends in other industries, such as economic pressures, contingent employment, training deficits and poor regulatory oversight that can undermine safety outcomes. While we do not seek to establish a statistical association between rates of outsourcing/offshoring and rates of accidents and incidents, this article highlights a range of potential risk factors present in the US airline industry that provide salutary warnings for the global industry.
Increased male participation in antenatal care and uptake of couple voluntary counselling and testing (VCT) for HIV could reduce horizontal and vertical HIV transmission in sub-Saharan Africa.
...Randomized controlled trial to compare pregnant women's acceptance of written invitations for VCT and pregnancy information sessions (PISs) - the control group - for their male sexual partners (MSPs) and uptake of VCT among these pregnancy partners in Khayelitsha, South Africa.
All women in the study accepted the invitation letters and agreed to invite their pregnancy partners to attend for VCT or PIS as requested. Thirty-five percent (175 of 500) pregnant women given VCT invitations for their partners brought their MSPs for antenatal clinic visit compared with 26% (129 of 500) given PIS invitations relative risk (RR) 1.36, 95% confidence interval (CI) 1.12-1.64, P = 0.002. Thirty-two percent (161 of 500) MSPs in the VCT arm underwent HIV testing compared with 11% (57/500) in the PIS arm (RR 2.82, 95% CI 2.14-3.72, P < 0.001). The proportions of women and men reporting unprotected sex during the pregnancy were lower in the MSP VCT arm than in the MSP PIS arm - 25 versus 81% (RR 0.30, 95% CI 0.22-0.42, P < 0.001) and 26 versus 76% (RR 0.34, 95% CI 0.25-0.47, P < 0.001), respectively. No differences were seen in intimate partner violence.
Providing pregnant women with a written invitation for their partners increased male participation in antenatal care and uptake of couple VCT in a township in Cape Town, South Africa where community sensitization was conducted and antiretroviral therapy was available.
Background
Induction of labour (IOL) is common practice and different methods carry different effectiveness and safety profiles.
Objectives
To compare the effectiveness, and maternal and perinatal ...safety outcomes of IOL with vaginal misoprostol versus vaginal dinoprostone using individual participant data from randomised clinical trials.
Search strategy
The following databases were searched from inception to March 2023: CINAHL Plus, ClinicalTrials.gov, Cochrane Pregnancy and Childbirth Group Trial Register, Ovid Embase, Ovid Emcare, Ovid MEDLINE, Scopus and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).
Selection criteria
Randomised controlled trials (RCTs), with viable singleton gestation, no language restrictions, and all published and unpublished data.
Data collection and analysis
An individual participant data meta‐analysis was carried out.
Main results
Ten of 52 eligible trials provided individual participant data, of which two were excluded after checking data integrity. The remaining eight trials compared low‐dose vaginal misoprostol versus dinoprostone, including 4180 women undergoing IOL, which represents 32.8% of all participants in the published RCTs. Of these, 2077 were assigned to low‐dose vaginal misoprostol and 2103 were assigned to vaginal dinoprostone. Compared with vaginal dinoprostone, low‐dose vaginal misoprostol had a comparable rate of vaginal birth. Composite adverse perinatal outcomes did not differ between the groups. Compared with vaginal dinoprostone, composite adverse maternal outcomes were significantly lower with low‐dose vaginal misoprostol (aOR 0.80, 95% CI 0.65–0.98, P = 0.03, I2 = 0%).
Conclusions
Low‐dose vaginal misoprostol and vaginal dinoprostone for IOL are comparable in terms of effectiveness and perinatal safety. However, low‐dose vaginal misoprostol is likely to lead to a lower rate of composite adverse maternal outcomes than vaginal dinoprostone.
This article includes Author Insights, a video available at: https://vimeo.com/915799731.
Background Aortic aneurysm anatomy is crucial when considering patients for endovascular repair. The aim of this study was to determine the proportion of patients with aortic aneurysm suitable for ...endovascular repair with three different graft‐stent systems.
Methods Spiral computed tomographic angiography was used to assess the anatomy of 154 abdominal aortic aneurysms. Measurements were made of aneurysm neck length and diameter, renal artery to aortic bifurcation length, common iliac artery diameter and length, and external iliac artery diameter. Aneurysms were assessed for anatomical suitability for currently available aortoaortic, aortobi‐iliac and aortouni‐iliac devices.
Results Six patients (4 per cent) had a distal aortic neck suitable for implantation of a straight aortic graft. Fifteen patients (10 per cent) had arterial anatomy suitable for implantation of a bifurcated graft and 85 (55 per cent) patients were suitable for endovascular repair with an aortouni‐iliac graft. The primary reasons for unsuitability were: proximal neck length less than I.5 cm (44 patients), proximal neck diameter greater than 3.0 cm (12), and angulation of the proximal neck (three). A further ten patients were considered unsuitable for an aortouni‐iliac graft because of bilateral common iliac artery aneurysms (four), tortuous iliac arteries (four) and narrow external iliac al‐teries (two).
Conclusion The aortouni‐iliac device has the widest applicability of the currently available endovascular systems but open repair remains the only option for a large proportion of patients.
Objectives/aims: Hypertension is the leading modifiable cause of death and disability worldwide. Globally, there is some evidence that people living with HIV (PLHIV) might be at higher risk of ...hypertension. However, it has also been suggested that in African countries PLHIV may experience a lower prevalence of hypertension. Detailed information about how the burden of hypertension differs by HIV status remains scarce across the region, constraining understanding of whether HIV is a risk factor for hypertension. To begin to bridge the data gap, this study examined whether HIV status and antiretroviral therapy (ART)-exposure were associated with hypertension in Manicaland, Zimbabwe, and whether access to hypertension treatment differed by HIV status. Methods: Cross-sectional data from the most recent survey round of the Manicaland Study, a general population open cohort HIV sero-survey, were analysed. During the round, a household census was performed, then all women aged 15–24 years and all men aged 15–29 years, as well as a random sample of two-thirds of older adults, were eligible to complete a survey and undergo HIV testing. Hypertension was defined as reporting a previous diagnosis by a doctor or nurse. All data was gathered between July 2018 and December 2019. In the analysis, survey responses were weighted using data from the household census, then Chi-squared tests and logistic regression were used to explore whether HIV status and ART-exposure were associated with hypertension. Differences in reported uptake of, and payment for, hypertension treatment by HIV status were examined using Chi-squared tests. Results: The analysis included 9780 participants. Weighted HIV prevalence was 11.1% (95% confidence interval: 10.4%, 11.7%). In univariate analyses there was no evidence of a difference in weighted hypertension prevalence between PLHIV and HIV-negative people (14.1%, 11.9%, 16.3% versus 13.3%, 12.6%, 14.0%; P=0.503) or between ART-exposed and ART-naive PLHIV (14.8%, 12.0%, 17.7% versus 12.8%, 9.1%, 16.4%; P=0.388). Adjusting for socio-demographic variables did not alter this (odds ratios: HIV status: 0.87, 0.69, 1.09; P=0.234, Figure 1; ART-exposure: 0.83, 0.53, 1.30; P=0.411). The proportion of hypertensive people receiving treatment, and paying out-of-pocket, did not differ by HIV status; 43.4% (40.6%, 46.3%) of people treated paid out-of-pocket. Conclusion(s)/discussion: No association was found between HIV and hypertension or between ART and hypertension in Manicaland, suggesting that other risk factors, such as physical inactivity, may be more important in this population. In contrast with results from other African nations, there was no evidence that PLHIV had an advantage in obtaining hypertension treatment; identification of reasons for this could be valuable in supporting development of accessible services. Finally, care costs were often borne by affected people, indicating a need to improve financing mechanisms. Zimbabwe is re-orienting its health system towards control of non-communicable diseases; these results should be fully accounted for during the process.
The shoaling behaviour of the visual, epigean morph of the characin Astyanax fasciatus was found to be quantitatively different from the blind, hypogean morph.
The aim of the study was to use population-based data from 689 adults to describe the socio-demographic, behavioural and biomedical correlates of HIV infection and aid identification of effective HIV ...control strategies for rural Zimbabwe. Dried blood spot and urine samples were collected for HIV and sexually transmitted disease (STD) testing and participants were interviewed on socio-demographic characteristics, sexual behaviour and experience of STD symptoms. HIV seroprevalence was 23.3% and was higher in females, divorcees, widows, working men, estate residents, and respondents reporting histories of STD symptoms. Female HIV seroprevalence rises sharply at ages 16-25. A third of sexually-active adults had experienced STD-associated symptoms but there were delays in seeking treatment. Herpes simplex virus type 2 (HSV-2) and Trichomonas vaginalis are more common causes than syphilis, gonorrhoea, and chlamydia, and are strongly associated with HIV infection. Local programmes promoting safer sexual behaviour and fast and effective STD treatment among young women, divorcees and working men could reduce the extensive HIV transmission in rural communities.
One of the principal narratives woven around the 1912 sinking of the Titanic is that the tragedy united people around the world in a shared sense of horror and grief. This study examines the ...administration of the relief fund collected for victims and questions the established image of social unity and collective suffering. The records of the Southampton Titanic Relief Fund reveal welfare processes imbued with class and gender prejudices that consigned many of the relatives of victims to poverty-stricken lives, despite the massive fund collected in their names.
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