6 research outputs found
“Slash and Clear”, a Community-Based Vector Control Method to Reduce Onchocerciasis Transmission by <i>Simulium sirbanum</i> in Maridi, South Sudan: A Prospective Study
No full textBackground: High ongoing Onchocerca volvulus transmission was recently documented in Maridi County, South Sudan. To complement community-directed treatment with ivermectin (CDTI) as the main onchocerciasis control strategy, we initiated a community-based vector control method “slash and clear” at the Maridi dam, a Simulium damnosum s.l. breeding site, to reduce O. volvulus transmission. Methods: Simulium damnosum s.l. biting rates were collected before and during the twenty months following the “slash and clear” intervention using the human landing catches. Black flies were dissected to measure parity rates before and twelve months after the intervention. Larvae and pupae of S. damnosum s.l. were collected from the dam for morphological and chromosomal characterization to identify the cytospecies involved. Results: Biting rates of S. damnosum s.l. close to the Maridi dam spillway decreased by >90% post-“slash and clear” for more than six months. Twelve months after the “slash and clear” intervention, the reduction in biting rates was still at p = 0.0007). Parity rates reduced from 13% pre-“slash and clear” (November 2019) to 5.6% post-“slash and clear” (November 2020). Larvae collected from the dam were identified as Simulium sirbanum. Conclusion: The “slash and clear” method was found to be an effective and cheap community-based method to reduce black fly biting rates caused by S. sirbanum. When repeated at least annually together with a high CDTI coverage, this intervention has the potential to considerably accelerate onchocerciasis elimination
Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND) : a randomised controlled trial
No full textBackground:
Acting on command hallucinations in psychosis can have serious consequences for the individual and for other people and is a major cause of clinical and public concern. No evidence-based treatments are available to reduce this risk behaviour. We therefore tested our new cognitive therapy to challenge the perceived power of voices to inflict harm on the voice hearer if commands are not followed, thereby reducing the hearer's motivation to comply.
Methods:
In COMMAND, a single-blind, randomised controlled trial, eligible participants from three centres in the UK who had command hallucinations for at least 6 months leading to major episodes of harm to themselves or other people were assigned in a 1: 1 ratio to cognitive therapy for command hallucinations + treatment as usual versus just treatment as usual for 9 months. Only the raters were masked to treatment assignment. The primary outcome was harmful compliance. Analysis was by intention to treat. The trial is registered, number ISRCTN62304114.
Findings:
98 (50%) of 197 participants were assigned to cognitive therapy for command hallucinations + treatment as usual and 99 (50%) to treatment as usual. At 18 months, 39 (46%) of 85 participants in the treatment as usual group fully complied with the voices compared with 22 (28%) of 79 in the cognitive therapy for command hallucinations + treatment as usual group (odds ratio 0·45, 95% CI 0·23–0·88, p=0·021). At 9 months the treatment effect was not significant (0·74, 0·40–1·39, p=0·353). However, the treatment by follow-up interaction was not significant and the treatment effect common to both follow-up points was 0·57 (0·33–0·98, p=0·042).
Interpretation:
This is the first trial to show a clinically meaningful reduction in risk behaviour associated with commanding voices. We will next determine if change in power was the mediator of change. Further more complex trials are needed to identify the most influential components of the treatment in reducing power and compliance.
Reprinted with permission from Elsevier (The Lancet Psychiatry, 2016, Volume 1, Number 1, pages 23-33
Onchocerciasis-associated epilepsy : an explorative case-control study with viral metagenomic analyses on\ua0Onchocerca volvulus
No full textAbstract: Background: A high prevalence of onchocerciasis-associated epilepsy (OAE) has been observed in onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission. However, the pathogenesis of OAE remains to be elucidated. We hypothesise that the O. volvulus virome could be involved in inducing epilepsy. With this study, we aim to describe the O. volvulus virome and identify potential neurotropic viruses linked to OAE. Methods: In Maridi County, an onchocerciasis endemic area in South Sudan with a high prevalence of OAE, we will conduct an exploratory case-control study enrolling 40 persons aged 12 years and above with palpable onchocerciasis nodules. Cases will be participants with OAE (n=20), who will be age- and village-matched with controls without epilepsy (n=20). For each study participant, two skin snips at the iliac crest will be obtained to collect O. volvulus microfilariae, and one nodulectomy will be performed to obtain adult worms. A viral metagenomic study will be conducted on microfilariae and adult worms, and the O. volvulus virome of persons with and without OAE will be compared. The number, size, and localisation of onchocerciasis nodules in persons with and without OAE will be described. Moreover, the pre- and post-nodulectomy frequency of seizures in persons with OAE will be compared
Onchocerciasis-associated epilepsy: an explorative case-control study with viral metagenomic analyses on Onchocerca volvulus [version 2; peer review: 2 approved]
No full textBackground A high prevalence of onchocerciasis-associated epilepsy (OAE) has been observed in onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission. However, the pathogenesis of OAE remains to be elucidated. We hypothesise that the O. volvulus virome could be involved in inducing epilepsy. With this study, we aim to describe the O. volvulus virome and identify potential neurotropic viruses linked to OAE. Methods In Maridi County, an onchocerciasis endemic area in South Sudan with a high prevalence of OAE, we will conduct an exploratory case-control study enrolling 40 persons aged 12 years and above with palpable onchocerciasis nodules. Cases will be participants with OAE (n=20), who will be age- and village-matched with controls without epilepsy (n=20). For each study participant, two skin snips at the iliac crest will be obtained to collect O. volvulus microfilariae, and one nodulectomy will be performed to obtain adult worms. A viral metagenomic study will be conducted on microfilariae and adult worms, and the O. volvulus virome of persons with and without OAE will be compared. The number, size, and localisation of onchocerciasis nodules in persons with and without OAE will be described. Moreover, the pre- and post-nodulectomy frequency of seizures in persons with OAE will be compared. Ethics and dissemination The protocol has been approved by the Ethics Committee of the University of Antwerp and the Ministry of Health of South Sudan. Findings will be disseminated nationally and internationally via meetings and peer-reviewed publications. Registration ClinicalTrials.gov registration NCT05868551 (https://clinicaltrials.gov/study/NCT05868551). Protocol version 1.1, dated 09/05/2023
Meeting the psychosocial needs of refugees and asylum-seekers in South Africa: prespective of NGO service providers
No full textSince 1994, South Africa has become one of the major destinations for asylum-seekers and refugees from unsettled countries throughout the African continent. While the international literature has recognised that refugees and asylum-seekers across many different countries have complex psychosocial needs, there is a dearth of literature regarding the psychosocial needs of refugees and asylum-seekers in South Africa. A number of non-governmental organisations (NGOs) provide services to refugees and asylum-seekers in South Africa. However, literature documenting the psychosocial needs that refugees and asylum-seekers present with and the range of services provided by these NGOs is severely limited. In the context of this gap, this study aimed to explore the psychosocial needs that refugees and asylum-seekers in Cape Town present with when they approach an organisation for help, as well as the service provision responses to these needs. In order to do this, a qualitative study focusing on service providers' perceptions about the psychosocial needs of refugees and asylum-seekers in Cape Town, and of service responses to these needs, was conducted. A qualitative approach was used in order to elicit in-depth data from multiple perspectives. Semi-structured interviews were conducted with 14 service providers recruited from four NGOs in Cape Town. Thematic analysis was used to analyse the data generated from the semi-structured interviews. The results of this study emphasise the need to address social and material conditions resulting from conflict and displacement. These needs were perceived as most pressing and immediate. Furthermore, the service provision responses to these needs align with the ecological model, adding to literature that suggests that a multi-modal response is more appropriate for refugees and asylum-seekers than a bio-medically focused response. The findings of this study may contribute to the development of a systematic framework for understanding and responding to the needs of refugees and asylum-seekers in South Africa, and potentially other low and middle-income countries
Estilo de vida dos portadores do vírus HIV atendidos no município de Florianópolis
No full textEste estudo objetivou avaliar o estilo de vida de indivíduos portadores do vírus HIV ou soropositivos. A amostra final foi constituída de 111 soropositivos (erro amostral de 8%). Foram 68 homens e 43 mulheres, com média de idade de 37,04 anos (DP = 7,47), e que voluntariamente aceitaram fazer parte do estudo. Os dados foram coletados através de um roteiro de entrevista, no período de outubro a dezembro de 2002, contendo as seguintes informações: a)sociodemográficas; c) clínicas de saúde e antropométricas; d) estilo de vida (Perfil do Estilo de Vida Individual) e e) nível de atividade física habitual (IPAQ-8). Na análise dos dados foi utilizado o pacote estatístico SPSSvers ão 10.0 e adotou-se um nível de significância de 5%. Destacaram-se as características sociodemográficas: 71,1% possuíam fonte de renda, sendo que 47,8% eram economicamente ativos; prevaleceram as profissões que caracterizavam um tipo de trabalho ativo, 55,9% pertenciam a famílias pequenas (com até 3 pessoas), mais da metade não era chefe da família (54,1%), estado civil solteiro/a, viúvo/a, separado/a ou divorciada/a (53,2%) com mais de oito anos de estudo formal (56,8%), e com renda familiar inferior ou até R$ 300,00 (50,4%). O tempo médio de soropositividade informado pelos pacientes foi de 5,6 anos (DP = 4,4). Dentre as categorias de exposição ao vírus HIV, destacaram-se: a heterossexual (48,7%) e a UDI (26,1%). A contagem do número de linfócitos T CD4+ apresentou uma média de 345,3 cél/mm3. O valor médio para carga viral foi de 38876,49 cópias/ml. Em torno de 80% dos pacientes faziam tratamento com anti-retrovirais e 64% usavam medicamentos profiláticos. Aproximadamente 56,8% dos entrevistados já estiveram hospitalizados devido a uma ou mais infecções oportunistas. Apesar disto, a autopercepção de saúde foi predominantemente boa, muito boa ou excelente (70,3%). Com relação ao índice de massa corporal, 66,7% apresentaram valores dentro da faixa recomendável. Quanto ao estilo de vida, maior proporção de indivíduos (61,3%), tiveram o perfil considerado satisfatório, sendo maior proporção de mulheres (69,8%), do que de homens (55,9%). O comportamento preventivo foi o aspecto mais destacado pelos soropositivos, provavelmente devido à gravidade da doença. Quanto ao nível de atividade física habitual, maior parte dos indivíduos, foi classificada como ativa ou muito ativa (79,3%). Houve associações estatisticamente significativas (p p<0,05) entre a contagem do número de linfócitos T CD4+ igual ou superior a 296 células/mm3 , possuir nível de atividade física habitual classificado como ativoou muito ativo, estar casado/a ou vivendo com parceiro/a e possuir de 21 a 37 anos de idade. Não foram verificadas associações estatisticamente significativas entre a contagem do número de linfócitos T CD4+ e as variáveis sociodemográficas (sexo, raça, nível de escolaridade e renda familiar)
