HIV testing within general practices in Europe : A mixed-methods systematic review

Funding Information: This work was supported by IWT (Belgium) and the ANRS (France) through the framework of HIVERA JTC 2014. Publisher Copyright: © 2018 The Author(s).Background: Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. Methods: The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. Results: The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. Conclusions: GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.publishersversionPeer reviewe

Blood pressure-lowering effects of nifedipine/candesartan combinations in high-risk individuals: Subgroup analysis of the DISTINCT randomised trial

The DISTINCT study (reDefining Intervention with Studies Testing Innovative Nifedipine GITS - Candesartan Therapy) investigated the efficacy and safety of nifedipine GITS/candesartan cilexetil combinations vs respective monotherapies and placebo in patients with hypertension. This descriptive sub-analysis examined blood pressure (BP)-lowering effects in high-risk participants, including those with renal impairment (estimated glomerular filtration rate<90 ml min-1, n=422), type 2 diabetes mellitus (n=202), hypercholesterolaemia (n=206) and cardiovascular (CV) risk factors (n=971), as well as the impact of gender, age and body mass index (BMI). Participants with grade I/II hypertension were randomised to treatment with nifedipine GITS (N) 20, 30, 60 mg and/or candesartan cilexetil (C) 4, 8, 16, 32 mg or placebo for 8 weeks. Mean systolic BP and diastolic BP reductions after treatment in high-risk participants were greater, overall, with N/C combinations vs respective monotherapies or placebo, with indicators of a dose-response effect. Highest rates of BP control (ESH/ESC 2013 guideline criteria) were also achieved with highest doses of N/C combinations in each high-risk subgroup. The benefits of combination therapy vs monotherapy were additionally observed in patient subgroups categorised by gender, age or BMI. All high-risk participants reported fewer vasodilatory adverse events in the pooled N/C combination therapy than the N monotherapy group. In conclusion, consistent with the DISTINCT main study outcomes, high-risk participants showed greater reductions in BP and higher control rates with N/C combinations compared with respective monotherapies and lesser vasodilatory side-effects compared with N monotherapy

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The Holocene Geoarchaeological Resources of Key European River Valleys: Assessing their Potential, Understanding their Value and Managing their Future

Throughout the Quaternary, episodes of glaciation and associated low sea level have resulted in the connection of the terrestrial landmasses of Britain and mainland Europe. The river systems that established themselves across these newly emergent land surfaces of the coastal plain would have created important migration corridors for both animals and humans, a point corroborated by the affinity of Palaeolithic remains across Britain and Europe. Technological developments within the last decade have allowed these now submerged valley floors and adjacent terrestrial landscapes associated with the last cold stage and early and middle parts of the current (Holocene) interglacial to be explored and their archaeological legacies unravelled, providing geoarchaeologists with an opportunity to contribute to major cultural debates. However, in order to maximize knowledge, it is essential that geoarchaeologists working within river valleys across both Britain and the European continent are addressing similar research questions by collecting data using comparable methodologies. This paper reviews the approach taken in different regions and provides a baseline assessment to allow the development of a coherent European-wide framework for alluvial geoarchaeology and geoprospection, particularly with respect to the Holocene record

Perspective of relatives on restrictions applied to their family members with moderate intellectual disability

The application of restrictions plays a great part in daily support of people with moderate intellectual disability (ID). In this study we examine the evaluation of relatives of restrictions applied to their family members with moderate ID. Relatives are key and permanent figures in the lives of people with moderate intellectual disability. Moreover, relatives in their role as representatives are authorized to make decisions in case people with moderate ID are not able to oversee the consequences of their actions. To explore relatives’ evaluation of restrictions, we conducted semi-structured interviews with 10 relatives. Qualitative analysis was carried out using a thematic approach. We found that respondents consider restrictions necessary when they promote physical well-being, safety and indistinctive, ‘normal’, appearance of their family members with ID. In applying these restrictions a ‘rules are rules’ and a ‘tailor-made rules’ approach can be discerned. The ‘tailor-made approach’ provides space for dialogue with people with moderate ID. In this dialogue the criteria of proportionality, effectiveness, and subsidiarity are helpful. In using these criteria, the application of a restriction has to be in proportion, has to lead to the desired effect, and, finally, should be as unintrusive as possible for the person concerned. As such, it is recommended that, in dialogue, support staff, people with moderate ID themselves, and their relatives seek ways to examine what kinds of restrictions are justified for people with moderate ID

Mt. Fuji Holocene eruption history reconstructed from proximal lake sediments and high-density radiocarbon dating

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60 k.y. record of extension across the western boundary of the Basin and Range province: Estimate of slip rates from offset shoreline terraces and a catastrophic slide beneath Lake Tahoe

Deformation across three major fault strands within the Lake Tahoe basin has been mapped by using a novel combination of high-resolution seismic chirp, airborne laser-and acoustic-multibeam–derived bathymetry, and deep- and shallow-water sediment cores. Submerged erosional terraces of late Pleistocene age (19.2 ± 1.8 ka) record vertical deformation across fault strands that ranges between 10 and 15 m; offset of 10 m is observed across the southern part of the West Tahoe fault. Avalanche deposits from the catastrophic McKinney Bay slide (ca. 60 ka) are offset across the Stateline fault by at least 21–25 m. The submerged shoreline terraces and debris avalanche provide marker beds with which to constrain the extensional history of the region for the past 60 k.y. This history is then used to assess the future seismic hazard of the region. Data on deformation across these two important marker beds, combined with chronological control from 14C and optically stimulated luminescence measurements, yield an estimate of extension across the Lake Tahoe basin that is 0.4–0.5 mm/yr. On the basis of these measurements, there exists the potential for a large, seiche wave–generating M7 earthquake every ∼3 k.y. Late Pleistocene and Holocene vertical deformation rates within the Tahoe basin are characteristic of Basin and Range faulting and place the Tahoe basin within the western limits of the extensional Basin and Range province