Sexual health and wellbeing training with women in Pacific Island Countries and Territories: a scoping review

Background: Women who are spouses of students at a faith-based university in Papua New Guinea (PNG) are afforded proximal power. These women are perceived as leaders and regularly approached by members in their communities to provide advice on sexual and reproductive health matters. Women leaders therefore need access to sexual health information and training to provide appropriate advice. Objective: The aim of this paper is to review the characteristics of community-based sexual health training in Pacific Island Countries and Territories (PICTs), as reported in published literature. This is evidence to inform the development of sexual health training programs for women in PNG. Methods: A systematic search of databases, repositories and websites identified peer-reviewed studies. Grey literature was also sourced from government and non-government organisations and PNG health professionals. Six published papers, one report, one health worker practice manual and one health worker training package were identified for inclusion. Selected papers were assessed against the Canadian Hierarchy of Evidence to determine quality of evidence for practice. Themes were identified using a thematic analysis approach. Results: Three themes became apparent from the literature synthesis: i) program development; ii) mode of delivery, and iii) evaluation. Social and cultural context influenced all elements of sexual health training in PICTs. Few studies reported evidence of comprehensive evaluation. Conclusions: Successful sexual health training programs in PICT communities are designed and delivered accounting for local contexts. Programs that engage participants with diverse abilities inspire change to achieve desired outcomes. Key findings from this study can be used to assist women leaders to contextualise and operationalise sexual health training to promote the wellbeing of members in their communities

Exploring infection prevention and control knowledge and beliefs in the Solomon Islands using Photovoice

Healthcare associated infections are the most common complication of a person’s hospital stay. Contemporary infection prevention and control programs are universally endorsed to prevent healthcare associated infections. However, western biomedical science on which contemporary infection prevention and control is based, is not the only way that staff and patients within healthcare settings understand disease causation and/or disease transmission. This results paper reports on one aspect of a study which ascertains perceptions of disease transmission and how these influence infection prevention and control practice at Atoifi Adventist Hospital Solomon Islands. Photovoice was used as the primary data collection method with staff and patients. The germ theory and hospital hygiene processes were only one of many explanations of disease transmission at the hospital. Many social, cultural and spiritual influences played an important role in how people understood disease to be transmitted. Although infection prevention and control models based on western science continue to form the premise of reducing healthcare associated infections in Solomon Islands and locations across the globe, local social, cultural and spiritual beliefs need to be considered when planning and implementing infection prevention and control programs to ensure success

Solutions to infection prevention and control challenges in developing countries, do they exist? An integrative review

Implementing sustainable infection prevention and control (IP&C) programs in developing countries is challenging. Many developing countries experience high burdens of disease and political instability. In addition, they are affected by geographical and climatic challenges, and have unique social, cultural and spiritual beliefs, all of which contribute to a higher prevalence of infections. The aim of this integrative review is to identify existing solutions to the challenges faced by developing countries when implementing IP&C programs. An extensive literature review was conducted to explore improvements in infection control in rural hospitals in developing countries. Three electronic databases were searched for relevant articles written between 1980 and 2018, published in peer reviewed English language journals, and relating to hospitals, not community settings. The findings indicate that developing countries continue to face many challenges in implementing IP&C programs. Limited success has been described with some IP&C program components but it is clear that little original research on the topic exists. Notably scarce are studies on the influences that culture, religious and spiritual beliefs have on IP&C program implementation. This review highlights opportunities for further research into healthcare workers perceptions of disease causation and infection transmission, and the role this plays in the effective implementation of an IP&C program. By exploring these opportunities appropriate and culturally sensitive solutions may be identified, which can assist with the design and implementation of culturally relevant IP&C programs in these settings

Selective lesions of the cholinergic neurons within the posterior pedunculopontine do not alter operant learning or nicotine sensitization

Cholinergic neurons within the pedunculopontine tegmental nucleus have been implicated in a range of functions, including behavioral state control, attention, and modulation of midbrain and basal ganglia systems. Previous experiments with excitotoxic lesions have found persistent learning impairment and altered response to nicotine following lesion of the posterior component of the PPTg (pPPTg). These effects have been attributed to disrupted input to midbrain dopamine systems, particularly the ventral tegmental area. The pPPTg contains a dense collection of cholinergic neurons and also large numbers of glutamatergic and GABAergic neurons. Because these interdigitated populations of neurons are all susceptible to excitotoxins, the effects of such lesions cannot be attributed to one neuronal population. We wished to assess whether the learning impairments and altered responses to nicotine in excitotoxic PPTg-lesioned rats were due to loss of cholinergic neurons within the pPPTg. Selective depletion of cholinergic pPPTg neurons is achievable with the fusion toxin Dtx-UII, which targets UII receptors expressed only by cholinergic neurons in this region. Rats bearing bilateral lesions of cholinergic pPPTg neurons (>90 % ChAT+ neuronal loss) displayed no deficits in the learning or performance of fixed and variable ratio schedules of reinforcement for pellet reward. Separate rats with the same lesions had a normal locomotor response to nicotine and furthermore sensitized to repeated administration of nicotine at the same rate as sham controls. Previously seen changes in these behaviors following excitotoxic pPPTg lesions cannot be attributed solely to loss of cholinergic neurons. These findings indicate that non-cholinergic neurons within the pPPTg are responsible for the learning deficits and altered responses to nicotine seen after excitotoxic lesions. The functions of cholinergic neurons may be related to behavioral state control and attention rather than learning

High resolution structural characterisation of laser-induced defect clusters inside diamond

Laser writing with ultrashort pulses provides a potential route for the manufacture of three-dimensional wires, waveguides and defects within diamond. We present a transmission electron microscopy (TEM) study of the intrinsic structure of the laser modifications and reveal a complex distribution of defects. Electron energy loss spectroscopy (EELS) indicates that the majority of the irradiated region remains as $sp^3$ bonded diamond. Electrically-conductive paths are attributed to the formation of multiple nano-scale, $sp^2$-bonded graphitic wires and a network of strain-relieving micro-cracks

Do penile cutting practices other than full circumcision protect against HIV?

Introduction: Male circumcision provides a high level of protection against sexually acquired HIV infection and is a key element of prevention in countries with extensive heterosexual transmission. In some countries, penile cutting practices other than full circumcision are a part of the cultural landscape, raising the question of their ability to modify the risk of HIV. One such country is Papua New Guinea. Methods: We reviewed information on prevalence of HIV, sexually transmitted infection (STI), and penile cutting practices, and their possible relationships. Results: Based on antenatal testing, the prevalence of HIV infection among pregnant women in Papua New Guinea is around 0.9%. Surveys of STI in pregnant women have found prevalences of chlamydia, gonorrhoea and trichomonas in the range 15-25%, and infectious syphilis at 2-3%. In three studies of penile cutting around half the men have some form of procedure; 10% had full foreskin removal with a further 30-40% having dorsal slits, with lateral retraction of the foreskin and exposure of the glans. There is evidence of an inverse geographic correlation between HIV prevalence and partial cutting practice. Conclusions: Levels of curable STIs in Papua New Guinea are very high by international levels, while HIV infection is at moderate levels compared to the countries in which male circumcision is now being promoted. The role of partial penile cutting procedures deserves further examination to see whether it provides protection, and if so what this tells us of the biology of HIV transmission

Integrating testing for chronic strongyloidiasis within the Indigenous adult preventive health assessment system in endemic communities in the Northern Territory, Australia: An intervention study

Background The life-threatening clinical manifestations of strongyloidiasis are preventable with early detection and effective treatment. The aim of this study was to assess if there was an increase to the number and proportion of persons tested for chronic strongyloidiasis, as a result of integrating Strongyloides stercoralis serology into the existing preventive health assessment system in four Aboriginal health services in endemic communities. Methodology A prospective, longitudinal, before-and-after intervention study was conducted in four Aboriginal health services in remote endemically infected communities in the Northern Territory, Australia, from July 2012 to December 2016. The electronic patient information and recall systems enabled the integration of Strongyloides stercoralis serology into the adult preventive health assessment. Strongyloides reports for each health service were extracted half-yearly to examine the number and proportion of persons tested for chronic strongyloidiasis during the study and to measure the effect of the intervention. Principal findings The number and proportion of persons tested increased significantly during the study. From a total resident population of 3650 Indigenous adults over 15 years of age, 1686 persons (47.4%) were tested. The percentage of adults who had at least one serology test increased in all four health services to between 41% (446/1086) and 81.9% (172/210). Of the 1686 persons tested, 680 positive cases of chronic strongyloidiasis (40.3%) were identified. Conclusions/Significance This population health systems intervention increased the number and proportion of persons tested for chronic strongyloidiasis in four health services in endemically infected communities. This intervention is relevant to other health services with high-risk populations

Point-of-care tests for syphilis and yaws in a low-income setting: a qualitative study of healthcare worker and patient experiences

The human treponematoses comprise venereal syphilis and the three non-venereal or endemic treponematoses yaws, bejel, and pinta. Serological assays remain the most common diagnostic method for all treponemal infections. Point-of-care tests (POCTs) for syphilis and yaws allow testing without further development of infrastructure in populations where routine laboratory facilities are not available. Alongside the test’s performance characteristics assessed through diagnostic evaluation, it is important to consider broader issues when rolling out a POCT. Experience with malaria POCT roll-out in sub-Saharan Africa has demonstrated that both healthcare worker and patient beliefs may play a major role in shaping the real-world use of POCTs. We conducted a qualitative study evaluating healthcare worker and patient perceptions of using a syphilis/yaws POCT in clinics in the East Malaita region of Malaita province in the Solomon Islands. Prior to the study serology was only routinely available at the local district hospital