Are interventions to increase the uptake of screening for cardiovascular disease risk factors effective? A systematic review and meta-analysis

Abstract Background Cardiovascular disease (CVD) is the leading cause of death globally. However, many individuals are unaware of their CVD risk factors. The objective of this systematic review is to determine the effectiveness of existing intervention strategies to increase uptake of CVD risk factors screening. Methods A systematic search was conducted through Pubmed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials. Additional articles were located through cross-checking of the references list and bibliography citations of the included studies and previous review papers. We included intervention studies with controlled or baseline comparison groups that were conducted in primary care practices or the community, targeted at adult populations (randomized controlled trials, non-randomized trials with controlled groups and pre- and post-intervention studies). The interventions were targeted either at individuals, communities, health care professionals or the health-care system. The main outcome of interest was the relative risk (RR) of screening uptake rates due to the intervention. Results We included 21 studies in the meta-analysis. The risk of bias for randomization was low to medium in the randomized controlled trials, except for one, and high in the non-randomized trials. Two analyses were performed; optimistic (using the highest effect sizes) and pessimistic (using the lowest effect sizes). Overall, interventions were shown to increase the uptake of screening for CVD risk factors (RR 1.443; 95% CI 1.264 to 1.648 for pessimistic analysis and RR 1.680; 95% CI 1.420 to 1.988 for optimistic analysis). Effective interventions that increased screening participation included: use of physician reminders (RR ranged between 1.392; 95% CI 1.192 to 1.625, and 1.471; 95% CI 1.304 to 1.660), use of dedicated personnel (RR ranged between 1.510; 95% CI 1.014 to 2.247, and 2.536; 95% CI 1.297 to 4.960) and provision of financial incentives for screening (RR 1.462; 95% CI 1.068 to 2.000). Meta-regression analysis showed that the effect of CVD risk factors screening uptake was not associated with study design, types of population nor types of interventions. Conclusions Interventions using physician reminders, using dedicated personnel to deliver screening, and provision of financial incentives were found to be effective in increasing CVD risk factors screening uptake

The art of HIV elimination: past and present science

Introduction: Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges. Discussion: In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another. More recently, it has become clear that combination prevention strategies targeted to high transmission geographies and people at most risk of infections are required to achieve epidemic control. Biomedical strategies such as male medical circumcision and antiretroviral therapy for treatment in HIV-positive individuals and as preexposure prophylaxis in HIV-negative individuals provide immense promise for the future of HIV control. In resourcerich settings, the threat of HIV treatment optimism resulting in increased sexual risk taking has been observed and there are concerns that as ART roll-out matures in resource-poor settings and the benefits of ART become clearly visible, behavioural disinhibition may also become a challenge in those settings. Unfortunately, an efficacious vaccine, a strategy which could potentially halt the HIV epidemic, remains elusive. Conclusion: Combination HIV prevention offers a logical approach to HIV control, although what and how the available options should be combined is contextual. Therefore, knowledge of the local or national drivers of HIV infection is paramount. Problems with the HIV care continuum remain of concern, hindering progress towards the UNAIDS target of 90-90-90 by 2020. Research is needed on combination interventions that address all the steps of the cascade as the steps are not independent of each other. Until these issues are addressed, HIV elimination may remain an unattainable goal

Fault-Tolerant Partial Replication in Large-Scale Database Systems

We investigate a decentralised approach to committing transactions in a replicated database, under partial replication. Previous protocols either re-execute transactions entirely and/or compute a total order of transactions. In contrast, ours applies update values, and orders only conflicting transactions. It results that transactions execute faster, and distributed databases commit in small committees. Both effects contribute to preserve scalability as the number of databases and transactions increase. Our algorithm ensures serializability, and is live and safe in spite of faults

Marathon training improves perceived stress, self-efficacy, and aerobic fitness in adolescents

textLack of physical activity among adolescents in the United States is leading to a concerning pattern of mental and physical health outcomes. Physical activity interventions, especially those that take place during school hours, have attempted to combat this trend but results have been inconsistent. The current study is a program evaluation of an existing physical activity intervention designed to train adolescents to complete a half or full marathon within five months. No previous studies have examined this mode of physical activity in the adolescent population, but anecdotal responses to this program justify a quantitative analysis. Results showed that participants who completed the program significantly increased their aerobic fitness. Participants also significantly reduced their perceived stress, and significantly increased their enjoyment and self-efficacy for exercise. The results are discussed in the broader context of adolescent physical and psychological health, and recommendations are made for future research.Kinesiology and Health Educatio

An exploratory cluster randomised trial of a university halls of residence based social norms marketing campaign to reduce alcohol consumption among 1st year students

<p>Aims: This exploratory trial examines the feasibility of implementing a social norms marketing campaign to reduce student drinking in universities in Wales, and evaluating it using cluster randomised trial methodology.</p> <p>Methods: Fifty residence halls in 4 universities in Wales were randomly assigned to intervention or control arms. Web and paper surveys were distributed to students within these halls (n = 3800), assessing exposure/contamination, recall of and evaluative responses to intervention messages, perceived drinking norms and personal drinking behaviour. Measures included the Drinking Norms Rating Form, the Daily Drinking Questionnaire and AUDIT-C.</p> <p>Results: A response rate of 15% (n = 554) was achieved, varying substantially between sites. Intervention posters were seen by 80% and 43% of students in intervention and control halls respectively, with most remaining materials seen by a minority in both groups. Intervention messages were rated as credible and relevant by little more than half of students, though fewer felt they would influence their behaviour, with lighter drinkers more likely to perceive messages as credible. No differences in perceived norms were observed between intervention and control groups. Students reporting having seen intervention materials reported lower descriptive and injunctive norms than those who did not.</p> <p>Conclusions: Attention is needed to enhancing exposure, credibility and perceived relevance of intervention messages, particularly among heavier drinkers, before definitive evaluation can be recommended. A definitive evaluation would need to consider how it would achieve sufficient response rates, whilst hall-level cluster randomisation appears subject to a significant degree of contamination.</p&gt

Identification and Molecular Dynamic Simulation of Flavonoids from Mediterranean species of Oregano against the Zika NS2B-NS3 Protease

The Zika virus, is an emerging infectious disease causing severe complications such as microcephaly in infants and Guillain Barre syndrome in adults. There is no licensed vaccination or approved medicine to treat ZIKV infection. Therefore, extensive research is being carried out to find compounds that can be used effectively as therapeutic molecules to treat ZIKV infection. Oregano, a commonly found herb in the Mediterranean region, has been used predominantly for culinary purposes. The fact that the members of the Origanum species are a storehouse of various bioactive compounds gives us a solid reason to study compounds extracted from it for therapeutic purposes. In this study, were retrieved 20 Flavonoids found in various Origanum species belonging to the Mediterranean region from the PubChem database and pharmacological analysis using SwissADME and Molecular docking using AutoDock Vina 4.0. were carried out against the NS2B NS3 protease since it serves as an effective drug target owing to its role in viral replication and immune evasion within the host. The best hit compounds were subjected to MD simulation at 100 ns using Desmond Schrodinger to analyze the molecule's stability. We observed Cirsiliol as the best hit compound against the NS2B NS3 complex with a binding affinity of -8.5 kcal per mol. It also showed good stability during MD simulation. We recommend the use of Cirsiliol for in vitro and in vivo studies for further investigation concerning the ZIKA virus.Comment: 24 Pages, 12 Figure

Fast Distributed Transactions for Partitioned Database Systems.

ABSTRACT Many distributed storage systems achieve high data access throughput via partitioning and replication, each system with its own advantages and tradeoffs. In order to achieve high scalability, however, today's systems generally reduce transactional support, disallowing single transactions from spanning multiple partitions. Calvin is a practical transaction scheduling and data replication layer that uses a deterministic ordering guarantee to significantly reduce the normally prohibitive contention costs associated with distributed transactions. Unlike previous deterministic database system prototypes, Calvin supports disk-based storage, scales near-linearly on a cluster of commodity machines, and has no single point of failure. By replicating transaction inputs rather than effects, Calvin is also able to support multiple consistency levels-including Paxosbased strong consistency across geographically distant replicas-at no cost to transactional throughput