Partial cross-enhancement in models for dengue epidemiology

AbstractFour distinct serotypes of dengue virus co-circulate in many parts of the world. Antibodies to one serotype prevent infection with the homologous serotype, but may enhance infections with heterologous serotypes. Enhanced secondary infections have been implicated in the majority of severe cases, termed dengue hemorrhagic fever. Conventionally, mathematical models assume that all heterologous secondary infections are subject to enhanced susceptibility or transmissibility. However, empirical data show that only a minority of secondary infections lead to severe disease, which suggests that only a minority of secondary infections are subject to enhancement. We present a new modelling framework in which the population susceptible to secondary infection is split into a group prone to enhanced infection and a group with some degree of cross-protection. We use this framework to re-evaluate the role of enhanced infections in several well known dengue models that exhibit multi-annual epidemiological oscillations. We show that enhancement is unlikely to be driving such oscillations but may be modifying the effects of other drivers

Media exposure, behavioural risk factors and HIV testing among women of reproductive age in Papua New Guinea: a cross-sectional study

Background: Reproductive health remains a major health concern in developing countries such as Papua New Guinea (PNG). The prevalence of human immunodeficiency virus (HIV) in PNG is the highest in the Southern Pacific region, with women having a higher risk of contracting the infection. Hence, there have been several policies aimed at mitigating the spread of the disease. One of these policies include the use of mass media as a health promotion tool to educate the population on the risk of the disease. Therefore, this study aimed at investigating the association of mass media to HIV testing among women. Methods: Data were obtained from the PNG Demographic and Health Survey (DHS) of 2019. A total of 15,005 reproductive-age women was included in this analysis. Results: The results showed that women with low (aOR = 1.63, 95% CI: 1.39, 1.90) and high (aOR = 1.53, 95% CI: 1.36, 1.72) media exposure were more likely to undertake HIV testing compared to those with no media exposure. Compared to no education, women with incomplete primary (aOR = 1.22, 95% CI: 1.06, 1.40), complete primary (aOR = 1.56, 95% CI: 1.30, 1.87), incomplete secondary (aOR = 2.18, 95% CI: 1.85, 2.58), complete secondary (aOR= 2.33, 95% CI: 1.77, 3.09) and higher (aOR = 3.38, 95% CI: 2.57, 4.46) education were more likely to undertake HIV testing. Compared to women with the poorest wealth index, women with richer indexes were more likely to undertake HIV testing. Women living in rural areas were less likely to undertake HIV testing (aOR = 0.72, 95% CI: 0.63, 0.82). However, marital status, knowledge of transmission and religion were not associated with HIV testing. Conclusion: In conclusion, this study provides strong evidence that mass media exposure increases the likelihood of HIV testing in women of reproductive age in PNG. Mass media campaigns would serve as a cost-effective health promotion tool against the spread of disease

Putting food in the driver’s seat: aligning food-systems policy to advance sustainability, health, and security

Food is a basic need, but seldom a basic policy area. Food systems are widely governed by disconnected policies distributed across a range of sectors including agriculture, education, health, environment, economy, and security. Failure to align food system strategies often results in these disparate policies operating at cross-purposes. Conventional food production and consumption practices contribute to biodiversity decline and climate change, cause diet-related health problems, are associated with worker exploitation, and create national security risks. Drawing on agroecology for cohesive national food strategies can provide benefits across all these sectors: supporting public health, environmental sustainability, economic stability, social cohesion, and national security and sovereignty

Cultural safety in telehealth consultations with Indigenous people: A scoping review of global literature

Introduction: Telehealth has become increasingly routine within healthcare and has potential to reduce barriers to care, including for Indigenous populations. However, it is crucial for practitioners to first ensure that their telehealth practice is culturally safe. This review aims to describe the attributes of culturally safe telehealth consultations for Indigenous people as well as strategies that could promote cultural safety. Methods: A scoping review was conducted on key features of cultural safety in telehealth for Indigenous people using the Johanna Briggs Institute (JBI) guidelines and PRISMA-ScR checklist. Five electronic databases were searched, and additional literature was identified through handsearching. Results: A total of 649 articles were screened resulting in 17 articles included in the review. The central themes related to the provision of culturally safe telehealth refer to attributes of the practitioner: cultural and community knowledge, communication skills and the building and maintenance of patient–provider relationships. These practitioner attributes are modified and shaped by external environmental factors: technology, the availability of support staff and the telehealth setting. Discussion: This review identified practitioner-led features which enhance cultural safety but also recognised the structural factors that can contribute, both positively and negatively, to the cultural safety of a telehealth interaction. For some individuals, telehealth is not a comfortable or acceptable form of care. However, if strategies are undertaken to make telehealth more culturally safe, it has the potential to increase opportunities for access to care and thus contribute towards reducing health inequalities faced by Indigenous peoples

Assessing cultural safety in general practice consultations for Indigenous patients: protocol for a mixed methods sequential embedded design study

Abstract Background Assessment of cultural safety in general practice consultations for Indigenous patients is a complex notion. Design and development of any assessment tool needs to be cognizant that cultural safety is determined by Indigenous peoples and incorporates defined components of cultural safety and current educational theory. Consideration of how social, historical, and political determinants of health and well-being impact upon the cultural safety of a consultation is also important. Given this complexity, we assume that no single method of assessment will be adequate to determine if general practice (GP) registrars are demonstrating or delivering culturally safe care. As such, we propose that development and assessment of cultural safety can be conceptualised using a model that considers these variables. From this, we aim to develop a tool to assess whether GP registrars are conducting a culturally safe consultation, where cultural safety is determined by Aboriginal and Torres Strait Islander peoples. Methods This protocol will be situated in a pragmatic philosophical position to explore cultural safety primarily from the Australian Aboriginal and Torres Strait Islander patients’ perspective with triangulation and validation of findings with the GP and GP registrar perspective, the Aboriginal and Torres Strait Islander community, and the medical education community. The study will integrate both quantitative and qualitative data through three sequential phases. Data collection will be through survey, semi-structured interviews, an adapted nominal group technique, and a Delphi questionnaire. We aim to recruit approximately 40 patient and 20 GP participants for interviews, conduct one to five nominal groups (seven to 35 participants) and recruit fifteen participants for the Delphi process. Data will be analysed through a content analysis approach to identify components of an assessment of cultural safety for GP registrars. Discussion This study will be one of the first to explore how cultural safety, as determined by Indigenous peoples, can be assessed in general practice consultations. This protocol is shared to stimulate awareness and discussion around this significant issue and prompt other studies in this area

Exploring what GP registrars consider distinctive to consultations with Aboriginal and Torres Strait Islander patients: a mixed-methods study

Background and objective Understanding what general practice (GP) registrars consider as distinctive in their consultations with Aboriginal and Torres Strait Islander patients may help bridge the gap between patient-determined cultural safety and current medical and behavioural practice. This project seeks to explore what GP registrars perceive as distinctive to their consultations with Aboriginal and Torres Strait Islander patients.Methods This mixed-methods study involved a survey considering demographic details of GP registrars, questionnaire regarding attitude and cultural capability, and semistructured interviews.Results 26 registrars completed the survey. 16 registrars completed both the survey and the interview. Despite recognising a need to close the gap on health outcomes for Aboriginal and Torres Strait Islander peoples and wanting to do things differently, most registrars adopted a generic approach to all consultations.Discussion This study suggests that overall, GP registrars want to improve the health of Aboriginal and Torres Strait Islander patients, but do not want their consultations with Aboriginal and Torres Strait Islander patients to be distinctive. Registrars appeared to approach all consultations in a similar manner using predominantly patient-centred care principles. Given the importance of a culturally safe consultation, it is important for us to consider how to increasingly transform these learners and teach cultural safety in this context

08. The Oculus Rift VR Enhances Mindfulness Practice Adjunctive Treatment

In modern society, technology is often thought of as a distraction, but the purpose of this study was to observe if technology could be utilized to aid in mindfulness practice. We examined the effect of virtual reality (VR) on mindfulness to assess levels of nonjudgement, awareness, and attention. We used an Oculus Rift (Facebook Technologies, LLC) ©, the Perfect (NDreams) © virtual reality environment, and the Hill’s Mindfulness Practice (HMP) © auditory training instructions, created by the authors. Participants were randomly selected into three conditions over a six-session trial: a VR group with mindfulness training, an auditory mindfulness group, and a VR control group. A significant main effect on nonjudgement showed an increase in scores, F (1, 32) = 5.75, p = .02, ηp2 = .15. The mindfulness control group had the same amount of time awareness in the first session and significantly lower awareness for sessions two through six, F (10,160) = 2.69, p = .02, ηp2 = .12. There was a main effect of calmness between training groups, F (2, 32) = 6.211, p = .005, ηp2 = .28. The VR control (M = 6.83, SD = .32) showed significantly lower reports of calmness than the mindfulness control (M = 7.79, SD = .31) and mindfulness VR groups (M = 8.40, SD = .31) which did not differ. Together, these findings could be used to help college students learn to be present in the moment and maintain awareness in their everyday life. Key Words: Mindfulness, virtual reality, technology, awareness, attention, nonjudgemen