Churches, mosques, and condoms : understanding successful HIV and AIDS interventions by faith-based organisations

There are an estimated 33 million people living with the Human Immunodeficiency Virus (HIV) worldwide. While national education campaigns have been successful in providing a broad platform of awareness of HIV and AIDS, within some countries faith-based organisations (FBOs) have assumed an important role in educating and supporting local communities to reduce HIV transmission. This article conceptualises the successful characteristics of a Christian organisation in West Papua and a Muslim organisation in Thailand. The ability of both these FBOs to engage successfully with their communities on issues of sexual practice provides important lessons for other FBOs seeking to reduce HIV transmission

Escolha alimentar e fatores determinantes em idosos europeus

[resumo][abstract

Rotating biological contactors : mechanisms, modelling and design

Imperial Users onl

Food access and dietary variety among older people

Decentralisation of many food retailers to edge-of-town and out-of-town locations has resulted in some older people experiencing difficulty in accessing food shops and those experiencing the greatest difficulties in food shopping are considered to be at the greatest nutritional risk. The present study examines how and to what extent usage of, and physical access to food shops might influence dietary variety. Shopping behaviour and dietary variety are investigated using focus groups, a consumer questionnaire and a food frequency questionnaire (FFQ). A dietary variety score system, developed from the FFQ, is employed in this study. Neither usage of (particular) food shops nor basic accessibility variables are found to have a direct effect on dietary variety. Yet, coping strategies employed by older consumers to obtain food are revealed to be important. This suggests that more complex access factors remain an important issue for study in relation to the shopping experience of a proportion of the older population

Patients Emotions during Meal Experience: Understanding through Critical Incident Technique

Background and Objectives: It was established that eating experience may affect patients emotionally. Acknowledging the role and understanding the basis of patients’ emotions in their food consumption may assist in identifying their nutritional status as well as their satisfaction with foodservice. To date, there are limited studies focusing on patients’ food-related emotional experiences. Hence the present study sought to explore the issue using a qualitative approach. Methods: The study was conducted in three Malaysian public hospitals, two of which from rural and one from urban areas. Information about aspects of the hospital food experience was gathered using semi-structured interview method. A total of 29 patients who felt well enough to provide information about the hospital food were identified with the help of the head nurses. Patients were recruited based on the concept of data saturation. The interview was implemented based on Critical Incident Technique (CIT), which enables systematic extraction of information from the wealth of data in the stories told by the interviewees about things which have happened to them. Data were analysed using content analysis method. Findings: Patients were found toexperience emotions including frustration, interest, enjoyment, hostility, shame, boredom, sadness, anger, surprise and satisfaction in relation to food provision. The frequency of incidents eliciting negative emotions (56.7%) was higher than that of positive incidents (43.3%). Frustration, interest, and enjoyment were the most frequently reported emotions. Conclusions: Our study highlights emotion as an important aspect of patients’ food consumption, and lays a ground for incorporation of food-related emotion into hospital services and patient management research. Our study also indicated the CIT to be effective and credible in elucidating hidden patients’ emotions, which encourages its application in future relevant studies

Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction

BACKGROUND: Beta-blockers and inhibitors of the renin-angiotensin-aldosterone system improve survival and reduce morbidity in people with heart failure with reduced left ventricular ejection fraction (LVEF); a review of the evidence is required to determine whether these treatments are beneficial for people with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES: To assess the effects of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and mineralocorticoid receptor antagonists in people with HFpEF. SEARCH METHODS: We updated searches of CENTRAL, MEDLINE, Embase, and one clinical trial register on 14 May 2020 to identify eligible studies, with no language or date restrictions. We checked references from trial reports and review articles for additional studies.  SELECTION CRITERIA: We included randomised controlled trials with a parallel group design, enrolling adults with HFpEF, defined by LVEF greater than 40%. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 41 randomised controlled trials (231 reports), totalling 23,492 participants across all comparisons. The risk of bias was frequently unclear and only five studies had a low risk of bias in all domains. Beta-blockers (BBs) We included 10 studies (3087 participants) investigating BBs. Five studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 30 years to 81 years. A possible reduction in cardiovascular mortality was observed (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.99; number needed to treat for an additional benefit (NNTB) 25; 1046 participants; three studies), however, the certainty of evidence was low. There may be little to no effect on all-cause mortality (RR 0.82, 95% CI 0.67 to 1.00; 1105 participants; four studies; low-certainty evidence). The effects on heart failure hospitalisation, hyperkalaemia, and quality of life remain uncertain. Mineralocorticoid receptor antagonists (MRAs) We included 13 studies (4459 participants) investigating MRA. Eight studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 54.5 to 80 years. Pooled analysis indicated that MRA treatment probably reduces heart failure hospitalisation (RR 0.82, 95% CI 0.69 to 0.98; NNTB = 41; 3714 participants; three studies; moderate-certainty evidence). However, MRA treatment probably has little or no effect on all-cause mortality (RR 0.91, 95% CI 0.78 to 1.06; 4207 participants; five studies; moderate-certainty evidence) and cardiovascular mortality (RR 0.90, 95% CI 0.74 to 1.11; 4070 participants; three studies; moderate-certainty evidence). MRA treatment may have little or no effect on quality of life measures (mean difference (MD) 0.84, 95% CI -2.30 to 3.98; 511 participants; three studies; low-certainty evidence). MRA treatment was associated with a higher risk of hyperkalaemia (RR 2.11, 95% CI 1.77 to 2.51; number needed to treat for an additional harmful outcome (NNTH) = 11; 4291 participants; six studies; high-certainty evidence). Angiotensin-converting enzyme inhibitors (ACEIs) We included eight studies (2061 participants) investigating ACEIs. Three studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 70 to 82 years. Pooled analyses with moderate-certainty evidence suggest that ACEI treatment likely has little or no effect on cardiovascular mortality (RR 0.93, 95% CI 0.61 to 1.42; 945 participants; two studies), all-cause mortality (RR 1.04, 95% CI 0.75 to 1.45; 1187 participants; five studies) and heart failure hospitalisation (RR 0.86, 95% CI 0.64 to 1.15; 1019 participants; three studies), and may result in little or no effect on the quality of life (MD -0.09, 95% CI -3.66 to 3.48; 154 participants; two studies; low-certainty evidence). The effects on hyperkalaemia remain uncertain. Angiotensin receptor blockers (ARBs) Eight studies (8755 participants) investigating ARBs were included. Five studies used a placebo comparator and in three the comparator was usual care. The mean age of participants ranged from 61 to 75 years. Pooled analyses with high certainty of evidence suggest that ARB treatment has little or no effect on cardiovascular mortality (RR 1.02, 95% 0.90 to 1.14; 7254 participants; three studies), all-cause mortality (RR 1.01, 95% CI 0.92 to 1.11; 7964 participants; four studies), heart failure hospitalisation (RR 0.92, 95% CI 0.83 to 1.02; 7254 participants; three studies), and quality of life (MD 0.41, 95% CI -0.86 to 1.67; 3117 participants; three studies). ARB was associated with a higher risk of hyperkalaemia (RR 1.88, 95% CI 1.07 to 3.33; 7148 participants; two studies; high-certainty evidence). Angiotensin receptor neprilysin inhibitors (ARNIs) Three studies (7702 participants) investigating ARNIs were included. Two studies used ARBs as the comparator and one used standardised medical therapy, based on participants' established treatments at enrolment. The mean age of participants ranged from 71 to 73 years. Results suggest that ARNIs may have little or no effect on cardiovascular mortality (RR 0.96, 95% CI 0.79 to 1.15; 4796 participants; one study; moderate-certainty evidence), all-cause mortality (RR 0.97, 95% CI 0.84 to 1.11; 7663 participants; three studies; high-certainty evidence), or quality of life (high-certainty evidence). However, ARNI treatment may result in a slight reduction in heart failure hospitalisation, compared to usual care (RR 0.89, 95% CI 0.80 to 1.00; 7362 participants; two studies; moderate-certainty evidence). ARNI treatment was associated with a reduced risk of hyperkalaemia compared with valsartan (RR 0.88, 95% CI 0.77 to 1.01; 5054 participants; two studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS: There is evidence that MRA and ARNI treatment in HFpEF probably reduces heart failure hospitalisation but probably has little or no effect on cardiovascular mortality and quality of life. BB treatment may reduce the risk of cardiovascular mortality, however, further trials are needed. The current evidence for BBs, ACEIs, and ARBs is limited and does not support their use in HFpEF in the absence of an alternative indication. Although MRAs and ARNIs are probably effective at reducing the risk of heart failure hospitalisation, the treatment effect sizes are modest. There is a need for improved approaches to patient stratification to identify the subgroup of patients who are most likely to benefit from MRAs and ARNIs, as well as for an improved understanding of disease biology, and for new therapeutic approaches

Discovering and validating disease subtypes for heart failure using unsupervised machine learning methods

Notable heterogeneity exists in the clinical presentation of heart failure (HF) patients. Current subtype classifications are based on ejection fraction may not fully capture the aetiological and prognostic heterogeneity of HF. The use of unsupervised machine learning (ML) approaches, such as cluster analysis, on large-scale observational data from electronic health records (EHR), can enable the discovery of novel subtypes and guide the characterization of their clinical manifestation. Clustering methods can group HF patients based on similarities between their clinical features without making a priori assumptions about the distribution of the data. We sought to discover, characterize and replicate HF subtypes by applying a clustering method on a heterogeneous HF population derived from phenotypically rich EHR. Characterization of HF subtypes using EHR derived variable may enable more precise large-scale genomic analysis to inform better prevention, diagnostic and treatment strategies