Handmade Wellbeing Handbook : Facilitating art and craft workshops for older people in care settings

This handbook was developed during international Handmade Wellbeing project, coordinated by the University of Helsinki, Sirpa Kokko. The project was Funded by European Union Erasmus+ Programme. The European Commission accepts no responsibility for the contents of the publication.Making crafts can enhance the wellbeing of older people. Research shows that engaging in arts and crafts improves the mood, gives the feeling of ability and provides opportunities for socialising. Making crafts also activates and sustains abilities that are necessary in activities of daily living, such as cognitive skills, memory and hand function. Therefore, creative arts and crafts activities should be included in wellbeing services for older people, both for those who live at home and for those who live in care homes. But what aspects should be considered in the planning and facilitation of craft activities for older people? The purpose of the Handmade Wellbeing Handbook is to provide the arts and crafts facilitator with information and ideas about developing pedagogical thinking and practical arrangements of the craft workshops. The handbook explores the special features of working with older people, for example, choosing suitable materials, techniques and working methods as well as communication, the importance of feedback and cooperation with care settings. In addition, the handbook presents practical examples of craft workshops that have been conducted in care settings. The publication is intended to be a resource for educational purposes especially in the fields of arts, culture, social and health care, as well as for professionals working with older people. The Handmade Wellbeing Handbook has been created during the Handmade Wellbeing project. The aim of this Erasmus+ project was to enhance and expand the professional competences of arts and crafts practitioners to facilitate craft activities in elderly care contexts. During the project (1.9.2015 – 31.8.2017), students and professionals from partner countries Finland, UK, Austria and Estonia conducted arts and crafts workshops in care settings in their respective countries. Experiences and practices of facilitating crafts for older people were shared in international training sessions, and now they have been compiled into a practical and inspirational Handmade Wellbeing Handbook

Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: baseline analysis of a demonstration study in Amsterdam.

The Amsterdam PrEP project is a prospective, open-label demonstration study at a large sexually transmitted infection (STI) clinic. We examined the uptake of PrEP; the baseline characteristics of men who have sex with men (MSM) and transgender persons initiating PrEP; their choices of daily versus event-driven PrEP and the determinants of these choices

Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: baseline analysis of a demonstration study in Amsterdam.

The Amsterdam PrEP project is a prospective, open-label demonstration study at a large sexually transmitted infection (STI) clinic. We examined the uptake of PrEP; the baseline characteristics of men who have sex with men (MSM) and transgender persons initiating PrEP; their choices of daily versus event-driven PrEP and the determinants of these choices

Sexually transmitted infections: challenges ahead.

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health

Scenarios of future mpox outbreaks among men who have sex with men:a modelling study based on cross-sectional seroprevalence data from the Netherlands, 2022

Background: Following the 2022–2023 mpox outbreak, crucial knowledge gaps exist regarding orthopoxvirus-specific immunity in risk groups and its impact on future outbreaks. Aim: We combined cross-sectional seroprevalence studies in two cities in the Netherlands with mathematical modelling to evaluate scenarios of future mpox outbreaks among men who have sex with men (MSM). Methods: Serum samples were obtained from 1,065 MSM attending Centres for Sexual Health (CSH) in Rotterdam or Amsterdam following the peak of the Dutch mpox outbreak and the introduction of vaccination. For MSM visiting the Rotterdam CSH, sera were linked to epidemiological and vaccination data. An in-house developed ELISA was used to detect vaccinia virus (VACV)-specific IgG. These observations were combined with published data on serial interval and vaccine effectiveness to inform a stochastic transmission model that estimates the risk of future mpox outbreaks.Results: The seroprevalence of VACV-specific antibodies was 45.4% and 47.1% in Rotterdam and Amsterdam, respectively. Transmission modelling showed that the impact of risk group vaccination on the original outbreak was likely small. However, assuming different scenarios, the number of mpox cases in a future outbreak would be markedly reduced because of vaccination. Simultaneously, the current level of immunity alone may not prevent future outbreaks. Maintaining a short time-to-diagnosis is a key component of any strategy to prevent new outbreaks. Conclusion: Our findings indicate a reduced likelihood of large future mpox outbreaks among MSM in the Netherlands under current conditions, but emphasise the importance of maintaining population immunity, diagnostic capacities and disease awareness.</p

Kidney function in tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis users: a systematic review and meta-analysis of published literature and a multi-country meta-analysis of individual participant data

BACKGROUND: Previous WHO guidance on tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis (PrEP) suggests measuring creatinine levels at PrEP initiation and regularly afterwards, which might represent barriers to PrEP implementation and uptake. We aimed to systematically review published literature on kidney toxicity among tenofovir disoproxil fumarate-based oral PrEP users and conducted an individual participant data meta-analysis (IPDMA) on kidney function among PrEP users in a global implementation project dataset. METHODS: In this systematic review and meta-analysis we searched PubMed up to June 30, 2021, for randomised controlled trials (RCTs) or cohort studies that reported on graded kidney-related adverse events among oral PrEP users (tenofovir disoproxil fumarate-based PrEP alone or in combination with emtricitabine or lamivudine). We extracted summary data and conducted meta-analyses with random-effects models to estimate relative risks of grade 1 and higher and grade 2 and higher kidney-related adverse events, measured by elevated serum creatinine or decline in estimated creatinine clearance or estimated glomerular filtration rate. The IPDMA included (largely unpublished) individual participant data from 17 PrEP implementation projects and two RCTs. Estimated baseline creatinine clearance and creatinine clearance change after initiation were described by age, gender, and comorbidities. We used random-effects regressions to estimate the risk in decline of creatinine clearance to less than 60 mL/min. FINDINGS: We identified 62 unique records and included 17 articles reporting on 11 RCTs with 13 523 participants in meta-analyses. PrEP use was associated with increased risk of grade 1 and higher kidney adverse events (pooled odds ratio [OR] 1·49, 95% CI 1·22-1·81; I2=25%) and grade 2 and higher events (OR 1·75, 0·68-4·49; I2=0%), although the grade 2 and higher association was not statistically significant and events were rare (13 out of 6764 in the intervention group vs six out of 6782 in the control group). The IPDMA included 18 676 individuals from 15 countries (1453 [7·8%] from RCTs) and 79 (0·42%) had a baseline estimated creatinine clearance of less than 60 mL/min (increasing proportions with increasing age). Longitudinal analyses included 14 368 PrEP users and 349 (2·43%) individuals had a decline to less than 60 mL/min creatinine clearance, with higher risks associated with increasing age and baseline creatinine clearance of 60·00-89·99 mL/min (adjusted hazard ratio [aHR] 8·49, 95% CI 6·44-11·20) and less than 60 mL/min (aHR 20·83, 12·83-33·82). INTERPRETATION: RCTs suggest that risks of kidney-related adverse events among tenofovir disoproxil fumarate-based oral PrEP users are increased but generally mild and small. Our global PrEP user analysis found varying risks by age and baseline creatinine clearance. Kidney function screening and monitoring might focus on older individuals, those with baseline creatinine clearance of less than 90 mL/min, and those with kidney-related comorbidities. Less frequent or optional screening among younger individuals without kidney-related comorbidities may reduce barriers to PrEP implementation and use. FUNDING: Unitaid, Bill & Melinda Gates Foundation, WHO

PrEP in the Netherlands: The introduction of HIV pre-exposure prophylaxis

Pre-exposure prophylaxis ( PrEP ) involves the use of antiretroviral agents, namely those commonly used in the treatment of HIV, to prevent HIV infection. HIV-negative persons engaging in behaviours that place them at high risk for HIV infection can substantially decrease this risk through the use of PrEP. In the Netherlands, both men who have sex with men and transgender persons with additional risk factors for HIV infection, such as having anal sex without the use of a condom with casual partners, are key groups that could benefit from PrEP . Previous research has shown that PrEP prevents HIV effectively, if taken as prescribed, and is safe to use. In this thesis, we discuss various aspects of implementing PrEP among men who have sex with men and transgender persons in the Netherlands. In particular, we aimed to shed light on whether the use of PrEP is associated with changes in sexual behaviour and the incidence of sexually transmitted infections, including hepatitis C virus. We use data from the Amsterdam PrEP demonstration project (AMPrEP), which started in 2015 with the intent of assessing PrEP uptake, and acceptability and usability of PrEP in HIV-negative men who have sex with men and transgender persons. One innovative part of AMPrEP’s design is that participants were offered a choice of regimen: daily use of PrEP (one tablet once daily) or event-driven use (consisting of two tablets before having sex, followed by one tablet 24 hours and one tablet 48 hours later). Additional specific aims of this thesis are to evaluate the attitudes of healthcare professionals towards PrEP implementation and to study the adoption of health technology in order to monitor adherence