A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study

Background In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed. Objective We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence. Methods A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks. Results The Conectad@s project has been approved by our local institutional review board (#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022. Conclusions The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission. International Registered Report Identifier (IRRID) DERR1-10.2196/34885

Peningkatan Pengetahuan Masyarakat Jemaah Mesjid Ulil Amri Tentang Pencegahan Dan Penanganan Diare Di Tingkat Rumah Tangga

Diarrhea can be prevented in various ways, including treating patients, providing health education about hygiene, and personal and environmental hygiene including water sources, trash cans, and disposal of feces. One of the efforts to prevent diarrheal disease is to provide counseling on diarrheal diseases. The selection of community service locations in Manggala Village, Manggala District, Makassar City, especially the Ulil Amri mosque congregation because the community, especially mothers do not have sufficient knowledge about proper hand washing, people who are not used to it. washing hands in every activity, and the community still lacks knowledge about diarrheal disease, its handling and prevention. Counseling in the context of community service is important because it can communicate information and materials about the dangers and possibilities of preventing diarrheal disease and protecting oneself, the community, and the environment from the spread of disease. Increasing public knowledge through counseling and demonstrations has shown very good results. The community was very enthusiastic about the material provided, the community was active in the question and answer session by seeing the many questions, opinions and experiences they issued that could be used to prevent and overcome diarrheal diseases and maintain environmental health.

A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study (Preprint)

BACKGROUND In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed. OBJECTIVE We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence. METHODS A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks. RESULTS The Conectad@s project has been approved by our local institutional review board (#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022. CONCLUSIONS The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/34885

A súlyos korai gyermekkori fogszuvasodás előfordulása és összefüggései pécsi bölcsődések között

Összefoglaló. Bevezetés és célkitűzés: A 3 év alatti korcsoportban a súlyos kisgyermekkori fogszuvasodás (S-ECC) gyakoriságának vizsgálata és a kisgyermekes szülők szájegészséggel kapcsolatos ismereteinek felmérése. Módszer: Háromszázhatvankét, 36 hónapos vagy annál fiatalabb gyermek (átlagéletkor: 28,49 ± 5,25 hónap) fogászati szűrővizsgálatát végeztük el, és szüleik számára önkéntesen kitölthető kérdőívet állítottunk össze. A 306 kitöltött kérdőív eredményét a gyermekek fogászati statusával egyénenként összevetve statisztikai analízist végeztünk. Eredmények: A gyermekek fogászati szűrésekor 15,46% volt a cariesprevalencia: df-t-index = 0,685 ± 2,20; az általunk javasolt, az előtört fogak számával módosított df-t-index = 0,758 ± 2,42, SiC-index = 2,06 ± 3,33. A vizsgált populációban nem találtunk tömött vagy fogszuvasodás miatt eltávolított fogat. A korábban szájhigiénés tájékoztatásban részesült/nem részesült szülők gyermekeinél nem volt szignifikáns különbség a szuvas fogak számának (p = 0,196), a fogyasztott folyadék cukortartalmának (81,5%/71,5%) és a bevitel módjának (p = 0,453) tekintetében. A gyermeküket 6 hónapos korukig kizárólagosan anyatejjel tápláló édesanyák nagyobb eséllyel választották a vízzel történő itatást (75%/52%) pohárból (68,1%/28,8%) a későbbiekben. Az édesanya legmagasabb iskolai végzettsége kulcsszerepet játszik mind az anyatejes táplálás melletti elhivatottságban (felsőfok: 53,4%, középfok: 34,2%, alapfok: 37,5%), mind a cariesfrekvencia csökkentésében (p = 0,015). Következtetés: A szülői szájhigiénés prevenciós tájékoztatás jelenleg nem hatékony. Eredményeink alapján a fogászati szűrést 1 éves kor előtt meg kell kezdeni, amely a hatékony, rendszeres fogászati prevenciós tanácsadás lehetőségét is megteremtené. Szükségesnek látjuk a védőnők és a gyermekháziorvosok folyamatos továbbképzésében a kisgyermekkori fogszuvasodás alapismereteinek integrációját. Orv Hetil. 2021; 162(22): 861–869. Summary. Introduction and objective: To investigate the frequency of severe early childhood caries (S-ECC) under 3 years of age and to assess the oral health related knowledge of parents/guardians with preschool children. Method: 362 children younger than 36 months (mean age: 28.49 ± 5.25 months) were screened and a voluntary questionnaire for their parents was compiled. Statistical analysis was carried out comparing the results of the 306 completed questionnaires with the dental status of the screened children. Results: Caries prevalence in the examined population was 15.46%, df-t index = 0.685 ± 2.20, our suggested modified df-t index based on the number of erupted teeth = 0.758 ± 2.42, SiC-index = 2.06 ± 3.33. No filled or extracted tooth due to caries was found in the study group. There was no significant difference in the number of carious teeth (p = 0.196), consumption of sugar-containing drinks (81.5%/71.5%) and administration of drinks (p = 0.453) in the case of children whose parents had previously received/not received oral hygiene information. Mothers who exclusively breastfed until the age of 6 months were more likely to choose to offer water (75%/52%) from cup (68.1%/28.8%) later. The mother’s highest level of education plays a key role in both the commitment to breastfeeding (tertiary: 53.4%, secondary: 34.2%, primary: 37.5%) and in reducing the incidence of caries (p = 0.015). Conclusion: Parental oral hygiene preventive instruction is currently ineffective. Based on our results, dental screening should be started before the age of 1 year, that would also provide an opportunity of effective, regular dental prevention counseling. There is a need for the integration of the basics of early childhood caries in the continuous professional training of district nurses and pediatricians. Orv Hetil. 2021; 162(22): 861–869.

Methods in Authenticating Participants in Fully-online Youth Mobile Application Trials: Lessons from the iREACH Project (Preprint)

BACKGROUND Mobile health (mHealth) applications are important interventions to increase the scale and reach of prevention services, including HIV testing and prevention counseling, pre-exposure prophylaxis (PrEP), condom distribution, and education, all of which are required to decrease incidence rates. The use of these apps online as well as fully online intervention trials can be challenged by the need to remove fraudulent or duplicative entries and authenticate unique trial participants prior to randomization to protect the integrity of the sample and trial results. It is critical to make sure data collected through this modality are valid and reliable. OBJECTIVE This manuscript discusses the electronic and manual authentication strategies for the iREACH randomized control trial (RCT) that were used to monitor and prevent fraudulent enrollment. METHODS iREACH is a RCT focused on same-sex-attracted, cis-gender males aged 13-18 years in the US with a focus on enrolling racial/ethnic minorities and those in rural communities. Evaluation of the data was done by identifying possible duplications in enrollment, identifying potentially fraudulent or ineligible participants through inconsistencies in registration and survey data, and by reviewing baseline completion times to avoid enrolling bots and those who did not complete the baseline survey. Electronic systems flagged questionable enrollment. Additional manual reviews included verification of age, IP addresses, email addresses, social media accounts, and completion times for surveys. RESULTS The strategies used identified and averted 624 cases of potential fraudulent, duplicative or ineligible enrollment using electronic and manual strategies including the integration of social media profiles. Seventy-nine percent of the potentially fraudulent or ineligible cases were identified through electronic strategies, thereby reducing the burden of manual authentication for the majority of cases. A case study is included with scenario, resolution, and authentication strategy response. CONCLUSIONS As online trials are more common, methods to handle suspicious enrollment that compromise data quality are increasingly important for inclusion in protocols. INTERNATIONAL REGISTERED REPORT RR2-10.2196/10174

On Naevi and Melanomas: Two Sides of the Same Coin?

Benign naevi are closely linked to melanoma, as risk factors, simulators, or sites of melanoma formation. There is a heavy genetic overlap between the two lesions, a shared environmental influence of ultraviolet radiation, and many similar cellular features, yet naevi remain locally situated while melanomas spread from their primary site and may progress systemically to distal organs. Untangling the overlapping contributors and predictors of naevi and melanoma is an ongoing area of research and should eventually lead to more personalized prevention and treatment strategies, through the development of melanoma risk stratification tools and early detection of evolving melanomas. This will be achieved through a range of complementary strategies: risk-adjusted primary prevention counseling; the use of lesion imaging technologies such as sequential 3D total body photography and consumer-performed lesion imaging; artificial intelligence deep phenotyping and clinical assistance; a better understanding of genetic drivers of malignancy, risk variants, clinical genetics, and polygenic effects; and the interplay between genetics, phenotype and the environment.

The role of organization of care in GPs’ prevention practice

Background: General practitioners (GPs) do not systematically include preventive recommendations in their practice, and some characteristics of health care organization are associated with more systematic prevention. But the characteristics of health care organization may act in a nonuniform manner depending on the type of preventive care. Thus, one characteristic can be positively associated with one type of preventive care and negatively associated with another. Our aim was to investigate the association between health care organization in general practice and different areas of preventive care (immunization and addiction prevention), in search of nonuniform associations. Methods: We used a representative survey of 1,813 French GPs conducted in 2009. Four preventive care practices were studied: immunization through flu and HPV vaccination, and prevention of addictive behaviors concerning tobacco and alcohol use. Characteristics of GPs’ health care organization and the social context of their practice were collected (spatial accessibility to GPs and socioeconomic level of the area of practice). We constructed mixed models to study associations and interactions between the organization variables and preventive care. Results: Four out of five characteristics of GPs’ organization have uneven impacts on different types of preventive care (p-interaction < 10-4). For example, number of daily consultations is associated with better immunization prevention but with poorer prevention counseling in addictive behaviors. In contrast, working with digital medical files is uniformly associated with both types of preventive care (OR = 1.29 [1.15–1.45]; P < 10-4). Conclusion: An approach centered on specific types of preventive care should help deepen our understanding of prevention and possibly help to identify a new typology for preventive care.

Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: A Pragmatic Evaluation (Preprint)

BACKGROUND Tobacco use, physical inactivity and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice and support by a primary care provider leads to behaviour change attempts among patients. However, although physicians consider preventative health important the focus on symptoms presentation, acute care and medication review often overshadows primary prevention counseling. OBJECTIVE This study evaluates feasibility, adoption and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. METHODS This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. RFIT was implemented in two primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. RESULTS Clinicians reported a smooth and fast transfer of RFIT responses to an EMR encounter note. Two hundred seven patients used the RFIT with a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Among the patients that used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 minutes of PA a week, and 8.2% lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. CONCLUSIONS Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, RFIT can inform brief interventions within primary care.