Neonatal Intra-Ventricular-Hemorrhage Prevention in Premature at < 30 Weeks Gestational Age

Introduction: Intraventricular Hemorrhage (IVH) is a devastating condition mostly in preterm infants at &lt; 30 weeks GA with large morbidities and mortality usually in the first 72 hours after birth. Prevention seems to be the only way to completely deal with this problem. The IVH prevention in this age group has been studied and includes some strategies such as prenatal corticosteroids, cesarean delivery, careful extraction among others, but still, it has an unacceptably high incidence in this population.Objective: To measure the application of a quality improvement project develop from the "Drive to Zero IVH Prevention Project" presented in a Epiclatino lecture in our unit.Material and method: We design a before and after observational study and measured the incidence of IVH before and after October 2017 when a minimum manipulation protocol was implemented at the Cl&iacute;nica del Country (CDC) unit. We also compare these findings to those of other units in the EpicLatino network. All patients born &lt;30 weeks GA with less than 2 days of age, who survived at least 3 days, and had a neuroimaging taken were included. We compared demographics, diagnosis, and frequency of IVH cases, before Nov 2017 and after from CDC and the from 2018-2019 EpicLatino registry using a bivariate analysis. Results: We collected data from 46 cases before, 40 after implementation, and 203 cases from the EpicLatino registry. Demographic characteristics were very similar in the post-intervention with few statistically significant differences in antenatal steroid use (97.5% post, 96% before and 79.3% Epilatino, p=0.016), prolonged rupture of membranes (15% post, 4% before and 15% EpicLatino, p &lt;0.001), vaginal deliveries (7.5% post, 10.9% before and 24.1% Epilatino, p=0.01), suspended chorioamnionitis (12.5% post, 6% before and 20.2% Epiclatino). We found a significant reduction in IVH after the protocol was implemented with only 5 (7.5%) cases post-intervention compared to 19 (29.4%) case before, and when compared to the 81 (39.1%) cases in the registry, p&lt; 0.001. Most of the cases that occurred in the post-intervention occurred before admission to the unit due to obstetric trauma.Discussion: If a well-controlled delivery minimizing obstetric trauma is achieved, a minimal manipulation protocol appears to significantly decrease the incidence of HIV. Controlled, multicenter studies are still required to confirm these findings.

The South African Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP): SARU Girls’ Youth Week Injury Surveillance Report 2019

As part of the South African Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP), the annual SARU Youth Week tournaments’ injury data are recorded and investigated by SA Rugby. The BokSmart National Rugby Safety Programme has been collecting and analysing these data annually since 2011 for the SARU Boy’s Youth Week tournaments. In 2015, the SARU Girls’ Youth Week data collection began; this report being the first to analyse the Girls’ Youth Week data. The analysis shows injury patterns over time between tournaments, and collectively, for the girls’ u16 and u18 SARU Youth Weeks. Additionally, the analysis compares the profiles of injured players at each individual tournament. When investigating these patterns, areas of concern are identified, changes in the game, tournament structure or medical support services are considered or contested against the evidence, and injury specific interventions can be created and implemented, where the evidence indicates such a need. Each medical facility at the SARU Youth Week tournaments has a designated researcher onsite, who together with the tournament medical doctors, records the tournament injury data daily. Three injury cases were removed from the analysis. These data were recorded but did not appear to be accurate on follow-up and were therefore removed. Unfortunately, inaccuracy can occur during data collection and measures have been implemented to ensure that this is limited. This 2019 SARU Girls’ Youth Week report focuses on the Girls’ tournaments, comprising of the Girls u16 Week (Gu16W) and Girls u18 Week (Gu18W) held in 2019. The tournaments consisted of 32 teams and 48 matches. Comparisons are made between SARU Girls’ Youth Week tournaments and over time between 2015 and 2019. It must be noted that no Gu16W tournament was held in 2017. In 2019, the Gu16W recorded a higher Time-Loss injury incidence at 22 (11 - 33) [mean (95% confidence intervals)] injuries per 1000 player hours. Gu18W recorded slightly lower Time-Loss injury incidence at 19 (10 – 28) injuries per 1000 player hours. The collective tournament average was measured at 21 (13 to 28) injuries per 1000 player hours. When combining the injury incidence data collected over the five years, Gu18W had a lower Time-Loss injury incidence. In 2019, the Tackler and Open Play, followed by the Ball Carrier, were the most frequent injury-causing events in that order. Tackling front-on (regulation), Tackling LOW side-on, and Tackling LOW front-on, were the most frequent injury causing mechanisms involved in the Tackler phases of play. While Collision in Open Play was the most frequent injury causing mechanism in Open Play. The most common injury type was Central Nervous System injuries, where Gu18W recorded a higher incidence. Head and Neck were the most common injury locations in 2019, accounting for 69% of the injuries, with most of these injuries occurring in the Gu18W. Scrumhalves and flyhalves were the player positions with the highest normalised injury incidence per player per position across all tournaments. As expected, the injury incidence of ‘New’ injuries was higher than subsequent ‘Recurrent’ injuries. The majority of ‘New’ injuries were injuries to the joint, while most ‘Recurrent’ injuries were ligament and joint injuries. Fourteen concussions occurred across the two tournaments in 2019, which has dropped since the spike recorded in 2018. The Gu18W had the higher concussion incidence of the two tournaments. Furthermore, the act of Tackling contributed to 50% of the events causing concussions. The tackle contest is clearly an event that requires additional injury prevention focus for coaches on preparing their younger female players better for rugby, and requires more time spent on teaching them safer techniques and body positions in the tackle contest.

Cascade screening for beta-thalassaemia in Pakistan: relatives’ experiences of a decision support intervention in routine practice

Low uptake of cascade screening for βeta-thalassaemia major (β-TM) in the ‘Punjab Thalassaemia Prevention Project’ (PTPP) in Pakistan led to the development of a ‘decision support intervention for relatives’ (DeSIRe). This paper presents the experiences of relatives of children with β-TM of the DeSIRe following its use by PTPP field officers (FOs) in routine clinical practice. Fifty-four semi-structured qualitative interviews were conducted (April to June 2021) with relatives in seven cities in the Punjab province (Lahore, Sheikhupura, Nankana Sahab, Kasur, Gujranwala, Multan and Faisalabad). Thematic analysis shows that participants were satisfied with the content of the DeSIRe and its delivery by the FOs in a family meeting. They understood that the main purpose of the DeSIRe was to improve their knowledge of β-TM and its inheritance, and to enable them to make decisions about thalassaemia carrier testing, particularly before marriage. Participants also raised concerns about the stigma of testing positive; however, they believed the DeSIRe was an appropriate intervention, which supported relatives to make informed decisions. Our findings show that the DeSIRe is appropriate for use by healthcare professionals in routine practice in a low-middle income country, and has the potential to facilitate shared decision making about cascade screening for thalassaemia. Further research is needed to prove the efficacy of the DeSIRe.

ENVOLVIMENTO DAS IGREJAS NA PREVENÇÃO ÀS DROGAS

O uso e abuso de drogas tem se tornado uma séria ameaça à humanidade devido ao grau persistente e atrativo que exerce sobre a sociedade e sobre os jovens. Esta ameaça atinge a estabilidade social, cultural, econômica e política de toda a sociedade. Esta pesquisa propõe buscar subsídios para que a comunidade de fé invista na espiritualidade como prevenção e enfrentamento às drogas e suas consequências. Tem o potencial de incentivar e instrumentalizar pastores e líderes para atuarem no aconselhamento cristão sobre prevenção continuada. Acredita-se que toda comunidade se beneficiará com o projeto de prevenção e saberão lidar melhor com essa temática para cuidar das crianças e jovens. A pesquisa traz ainda o conceito sobre drogas seguindo um raciocínio lógico sobre as diferentes abordagens, moral, política e química. Aponta as consequências para a saúde e o relacionamento familiar do usuário e implicações legais, sociais e econômicas. Conclui-se que não somente os efeitos sintomáticos das drogas que são prejudiciais, mas, também, o comércio ilegal que movimenta fortunas com os lucros e arrasta multidão, não tem surtido efeito a tentativa de parar o seu avanço. Utilizou-se a pesquisa bibliográfica como metodologia. Como resultado esperado estão o estímulo do uso dos dons espirituais e os serviços práticos dos membros da igreja no processo de prevenção com a parceria do governo, da sociedade civil e da igreja, com investimento na prevenção, visando diminuir as tragédias familiares, o número de infectados pelas drogas, e uma família feliz sem drogas. PALAVRAS-CHAVE: Prevenção ás Drogas. Comunidade de fé. Família sem Drogas. Igreja. Drogadição. ABSTRACT Drug use and abuse has become a serious threat to humanity due to the persistent and attractive degree it exerts on society and young people. This threat affects the social, cultural, economic and political stability of the entire society. This research proposes to seek subsidies for the faith community to invest in spirituality as prevention and confrontation with drugs and their consequences. It has the potential to encourage and equip pastors and leaders to act in Christian counseling on continuing prevention. It is believed that the entire community will benefit from the prevention project and will know how to better deal with this issue to care for children and young people. The research also brings the concept of drugs following a logical reasoning about the different approaches, moral, political and chemical. It points out the consequences for the health and the family relationship of the user and legal, social and economic implications. It is concluded that not only the symptomatic effects of drugs that are harmful, but also the illegal trade that moves fortunes with profits and draws the crowd, has not had an effect trying to stop its advance. Bibliographic research was used as a methodology. As an expected result are the encouragement of the use of spiritual gifts and the practical services of church members in the prevention process in partnership with the government, civil society and the church, with investment in prevention, aiming to reduce family tragedies, the number of infected by drugs, and a happy family without drugs. KEYWORDS: Drug Prevention. Faith community. Family without drugs. Church. Drug addiction.

To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach

Background Increasing HIV treatment coverage is crucial to reducing population-level HIV incidence. Methods The Botswana Combination Prevention Project (BCPP) was a community randomized trial examining the impact of multiple prevention interventions on population-level HIV incidence and was conducted from October 2013 through June 2017. Home and mobile campaigns offered HIV testing to all individuals ≥ age 16. All identified HIV-positive persons who were not on antiretroviral therapy (ART) were referred to treatment and tracked to determine linkage to care, ART status, retention in treatment, and viral suppression Results Of an estimated total of 14,270 people living with HIV (PLHIV) residing in the 15 intervention communities, BCPP identified 13,328 HIV-positive persons (93%). At study start, 10,703 (80%) of estimated PLHIV knew their status; 2,625 (20%) learned their status during BCPP, a 25% increase with the greatest increases occurring among men (37%) and youth (77%). At study start, 9,258 (65%) of estimated PLHIV were on ART. An additional 3,001 persons started ART through the study. By study end, 12,259 had initiated and were retained on ART, increasing coverage to 93%. A greater increase in ART coverage was achieved among men (40%) compared to women (29%). Of the 11,954 persons who had viral load (VL) test results, 11,687 (98%) were virally suppressed (HIV-1 RNA ≤400 copies/mL). Overall, 82% had documented VL suppression by study end. Conclusions Knowledge of HIV-positive status and ART coverage increased towards 95–95 targets with universal testing, linkage interventions, and ART. The increases in HIV testing and ART use among men and youth were essential to reaching these targets. Clinical trial number NCT01965470.