Oral Rapid HIV Testing in the Dental Setting: Experiences from Three Dental Hygiene Clinics

Background: Oral rapid HIV testing (ORHT) is implemented in the dental setting to make individuals aware of their possibly undiagnosed HIV infection. The testing process and characteristics of clients willing to receive ORHT has yet, however, to be systematically collected. Case description: Three dental hygiene clinics located in academic institutions implemented ORHT from March 2016 to April 2017. Results: 231 persons received ORHT; all had non-reactive results. Most had seen a primary care provider in the past year (n = 130), had had a previous ORHT (n = 111), and described themselves as extremely likely or likely to accept a chairside screening in the future (n = 169). The main reason cited for accepting ORHT was that it was free (n = 138). Conclusion: In order to ensure everyone living with HIV is aware of their infection, HIV testing should be expanded into non-traditional settings. The dental setting may help achieve this important public health milestone

Providers’ perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative

Background. In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. Objective. To describe providers’ perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation.Methods. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Results. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Conclusion. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

Patients’ Willingness to Participate in Rapid HIV Testing: A Pilot Study in Three New York City Dental Hygiene Clinics

Purpose: One in eight people living with an HIV infection in the United States is unaware of their status. Rapid HIV testing (RHT) is an easily used and accepted screening tool that has been introduced in a limited number of clinical settings. The purpose of this study was to investigate patient acceptability, certainty of their decision, and willingness to pay for screening if RHT was offered in university-based dental hygiene clinics. Methods: A cross-sectional survey was administered to 426 patients at three dental hygiene clinics in New York City over a period of four months. The survey questionnaire was based on the decisional conflict scale measuring personal perceptions; with zero indicating extremely high conflict to four indicating no conflict. Patients were assessed for their acceptance of RHT, provider preference for administration of the test and their willingness to pay for RHT. Results: Over half (72.2%) indicated acceptance of HIV testing in a dental hygiene clinic setting; with 85.3% choosing oral RHT, 4.9% fingerstick RHT, and 8.8% venipuncture. Respondents were amenable to testing when offered by dental hygienists (71.7%) and dentists (72.4%). Over 30% indicated their willingness to receive HIV testing in the dental setting when offered at no additional cost. The mean decisional conflict score was 3.42/4.0 indicating no decisional conflict. Conclusions: Patients are willing to undergo oral RHT when offered as a service and provided by dental hygienists in the dental setting. Patients appear to be aware of the benefits and risks associated with RHT. Further research is needed to evaluate the public health benefits and logistical challenges facing the delivery of RHT within in the dental setting

Effects of Timing of Grazing on Arthropod Communities in Semi-Natural Grasslands

Arthropod communities were investigated in two Swedish semi-natural grasslands, each subject to two types of grazing regime: conventional grazing from May to September (continuous grazing) and traditional late management from mid-July (late grazing). Pitfall traps were used to investigate abundance of carabids, spiders, and ants over the grazing season. Ant abundance was also measured by mapping nest density during three successive years. Small spiders, carabids and ants (Myrmica spp.) were more abundant in continuous grazing than in late grazing while larger spiders, carabids, and ants (Formica spp.) were more abundant in late grazing. The overall abundance of carabids was higher in continuous grazing in the early summer but higher in late grazing in the late summer. The switch of preference from continuous to late grazing coincided with the time for larvae hibernating species replacing adult hibernating. We discuss possible explanations for the observed responses in terms of effects of grazing season on a number of habitat variables for example temperature, food resources, structure of vegetation, litter layer, competition, and disturbance

Exploring synergies and trade-offs among the sustainable development goals: collective action and adaptive capacity in marginal mountainous areas of India

Global environmental change (GEC) threatens to undermine the sustainable development goals (SDGs). Smallholders in marginal mountainous areas (MMA) are particularly vulnerable due to precarious livelihoods in challenging environments. Acting collectively can enable and constrain the ability of smallholders to adapt to GEC. The objectives of this paper are: (i) identify collective actions in four MMA of the central Indian Himalaya Region, each with differing institutional contexts; (ii) assess the adaptive capacity of each village by measuring livelihood capital assets, diversity, and sustainable land management practices. Engaging with adaptive capacity and collective action literatures, we identify three broad approaches to adaptive capacity relating to the SDGs: natural hazard mitigation (SDG 13), social vulnerability (SDG 1, 2 and 5), and social–ecological resilience (SDG 15). We then develop a conceptual framework to understand the institutional context and identify SDG synergies and trade-offs. Adopting a mixed method approach, we analyse the relationships between collective action and the adaptive capacity of each village, the sites where apparent trade-offs and synergies among SDGs occur. Results illustrate each village has unique socio-environmental characteristics, implying distinct development challenges, vulnerabilities and adaptive capacities exist. Subsequently, specific SDG synergies and trade-offs occur even within MMA, and it is therefore crucial that institutions facilitate locally appropriate collective actions in order to achieve the SDGs. We suggest that co-production in the identification, prioritisation and potential solutions to the distinct challenges facing MMA can increase understandings of the specific dynamics and feedbacks necessary to achieve the SDGs in the context of GEC

Desastres naturais: convivência com o risco

Estudos sobre riscos de desastres naturais têm-se aprimorado de uma abordagem fisicalista para uma perspectiva socioambiental. No entanto, planejamento e gestão ainda seguem o paradigma antropocêntrico da superioridade humana e do poder ilimitado da ciência e tecnologia. Evidencia-se uma incapacidade cognitiva, cultural e de ação por parte de especialistas, científicos e tomadores de decisão (claimmakers) para identificar e atuar sobre as causas sociais da produção de risco. Frente a uma ciência cartesiana e positivista na resolução de problemas, baseada na segurança e controle sobre o mundo natural, propõe-se uma ciência pós-normal que considera os riscos e incertezas do conhecimento científico e das problemáticas ambientais. Essa nova proposta também incide sobre a participação e o diálogo entre stakeholders como referência para ampliar a qualidade do saber científico e o entendimento da complexidade das questões ambientais. Este artigo discute a necessidade de se promover um salto epistemológico sobre a forma de pensar e produzir conhecimentos, bem como implementar a gestão dos riscos de desastres, tendo como objeto de estudo processos de comunicação e educação para prevenção de desastres.Studies on the risks of natural disasters have improved from a physicalist approach to a social and environmental perspective. However, planning and management still follow the anthropocentric paradigm of human superiority and the unlimited power of science and technology, evincing a cognitive, cultural and action inability on the part of experts, scientists and decision makers (or, rather, claim makers) to identify and act upon the social causes of risk production. In view of the Cartesian and Positivist science used to solve problems, based on security and on control over the natural world, a post-normal science has been proposed that considers the risks and uncertainties of scientific knowledge and environmental issues. This new approach encompasses participation and dialogue among stakeholders as a means to increase the quality of scientific knowledge and acknowledge the complexity of environmental issues. This article discusses the need for an epistemological leap on how we think and produce knowledge, as well as for implementing the management of disaster risk. Its objects of study are communication processes and education for disaster prevention

Zespoly bezkregowcow glebowych na lakach o przeksztalconych glebach hydrogenicznych

In 1987-1989 studies were conducted on soil invertebrates occurring on meadows in the Biebrza river valley (Kuwasy), spreading on muck developed of peats of various origin and under different degree of transformation. There was recorded a pronounced differentiation of invertebrate density in successive years of studies and dependence of density on the amount and distribution of precipitation in a season. With regard to density of invertebrates two groups of habitats were distinguished, namely, a) located on soil developed of sedge-moss and moss-tall sedge peats and b) sedge- moss-alder and alder peats. As compared to the former group of habitats, fauna on meadows located of soil formed of alder peats was marked for a lower mean abundance and a lesser differentiation of large taxa (order) composition, a closer similarity of dynamics of seasonal changes, stranger dependence on precipitation. In the series of habitats of a progressing degree of soil transformation there was observed a tendency of changes in the system of trophic groups, i.e., a decrease in contribution of large groups of predators (Aranea, Staphylinidae, Formicidae) and an increase in contribution of phytophages (Elateridae). The two-group division of the examined habitats was also noted while analyzing physical properties of soil and its microbial activity. In the gradient of the examined habitats there were recorded correlations between the changes in physical properties of soil (x), microbiological activity (y) and density of soil invertebrate fauna (z), expressed by Kendall partial rank correlation coefficient.W latach 1987-89 badane były bezkręgowce glebowe występujące na łąkach w dolinie Biebrzy (Kuwasy) położonych na murawach z torfów o różnej genezie i różnym stopniu przeobrażenia. Stwierdzono duże zróżnicowanie zagęszczenia bezkręgowców w kolejnych latach i jego zależność od ilości i rozkładu opadów w sezonie. Zagęszczenie bezkręgowców wykazuje podział na dwie grupy siedlisk: a) położone na glebach z torfów mechowiskowych i mechowiskowo- turzucowiskowych oraz b) mechowiskowo-olesowych i olesowych. Fauna łąk na glebach z torfów olesowych w porównaniu z poprzednimi charakteryzuje się niższą średnią liczebnością i mniejszym zróżnicowaniem obsady dużych taksonów (rzędów), większym podobieństwem dynamiki zmian sezonowych, wyższą zależnością od opadów. W ciągu środowisk o wzrastającym stopniu przemian glebowych daje się zauważyć tendencja zmian układu grup troficznych; zmniejszenie udziału dużych grup drapieżców (Aranea, Staphylinidae, Formicidae) i wzrost udziału roślinożerców (Elateridae). Podział na dwie w.w. grupy środowisk wykazują także właściwości fizyczno-wodne i aktywność mikrobiologiczną. W gradiencie badanych środowisk występują związki między zmianami właściwości fizyczno- wodnych gleb, (x), aktywnością mikrobiologiczną (y) i zagęszczeniem fauny bezkręgowców glebowych (z) wyrażone współczynnikiem korelacji rang Kendalla

A qualitative study on the adaptation of community programmes for the promotion of early detection and health-seeking of perinatal depression in Nepal

BackgroundDespite the high burden of perinatal depression in Nepal, the detection rate is low. Community-based strategies such as sensitization programmes and the Community Informant Detection Tool (CIDT) have been found to be effective in raising awareness and thus promoting the identification of mental health problems. This study aims to adapt these community strategies for perinatal depression in the Nepalese context.MethodsWe followed a four-step process to adapt the existing community sensitization program manual and CIDT. Step 1 included in-depth interviews with women identified with perinatal depression (n=36), and focus group discussions were conducted with health workers trained in community mental health (n=13), female community health volunteers (FCHVs), cadre of Nepal government for the prevention and promotion of community maternal and child health (n=16), and psychosocial counsellors (n=5). We explored idioms and understanding of depression, perceived causes, and possible intervention. Step 2 included draft preparation based on the qualitative study. Step 3 included a one-day workshop with the psychosocial counsellors (n=2) and health workers (n=12) to assess the understandability and comprehensiveness of the draft and to refine the content. A review of the CIDT and community sensitization program manual by a psychiatrist was performed in Step 4.ResultsThe first step led to the content development for the CIDT and community sensitization manual. Multiple stakeholders and experts reviewed and refined the content from the second to fourth steps. Idioms of depression and commonly cited risk factors were incorporated in the CIDT. Additionally, myths of perinatal depression and the importance of the role of family were added to the community sensitization manual.ConclusionBoth the CIDT and community sensitization manual are grounded in the local context and are simple, clear, and easy to understand