Tobacco endgames: what they are and are not, issues for tobacco control strategic planning and a possible US scenario. Tobacco 'endgame' discourse has emerged in recognition of the nature of the global public health emergency created by tobacco use and tobacco promotion. This discourse is a promising development, but translating it into action requires developing some consensus, at least by countries or regions. It also requires negotiating some of the recurring tensions within the tobacco control movement, contributing to risks for the movement as visionaries clash with pragmatists. This paper outlines one combination of approaches that might hold promise for the US situation.
Perceived risk for sexually transmitted infections aligns with sexual risk behavior with the exception of condom nonuse: data from a nonclinical sample of sexually active young adult women. The objective of this study is to investigate the extent to which 3 measures of perceived risk accurately reflect 5 sexual risk behaviors in a sample of healthy, sexually active young adult women. A sample of 1192 female U.S. Marine Corps on their first duty assignment 10 to 11 months (on average) after graduation from recruit training answered a self-administered paper-and-pencil questionnaire as part of a larger study evaluating an intervention to prevent STIs and unintended pregnancy that was administered during recruit training.
Effect of the levonorgestrel intrauterine device on genital HIV-1 RNA shedding among HIV-1-infected women not taking antiretroviral therapy in Nairobi, Kenya. The effect of the levonorgestrel-releasing intrauterine device (LNG-IUD) on genital HIV-1 RNA shedding and inflammation among 25 HIV-infected women was evaluated. Blood, endocervical, and cervicovaginal lavage samples were collected from HIV-infected women not taking antiretrovirals before LNG-IUD insertion and 1 month, 3 month, and 6 months. HIV-1 RNA was quantitated by real-time reverse transcriptase-PCR. Inflammatory markers were measured by enzyme immunoassay. Genital HIV-1 RNA shedding and inflammatory markers did not differ between LNG-IUD placement and month 6, with the exception of interleukin 1β that increased. The LNG-IUD did not increase genital HIV-1 RNA shedding after 6 months of use
Household ventilation and tuberculosis transmission in Kampala, Uganda. To test the feasibility of measuring household ventilation and evaluate whether ventilation is associated with tuberculosis in household contacts in Kampala, Uganda. Adults with pulmonary TB and their household contacts received home visits to ascertain social and structural household characteristics. Ventilation was measured in air changes per hour in each room by raising CO₂ levels using dry ice, removing the dry ice, and measuring changes in the natural log of CO₂ over time. Ventilation was compared in homes with and without co-prevalent TB.
Mobile digital fluorescence microscopy for diagnosis of tuberculosis. Access to sputum smear microscopy in high-tuberculosis (TB)-burden regions is limited by a scarcity of microscopes and experienced technicians. We evaluated the accuracy of CellScope, a novel digital fluorescence microscope that may expand access to microscopy. The study utilized smear microscopy slides prepared from sputum specimens submitted by consecutive adults with ≥ 2 weeks of cough who were admitted to Mulago Hospital (Kampala, Uganda). Future studies should evaluate the device when operated by health workers in low-resource settings, the feasibility of image transmission and analysis by experienced microscopists, and the accuracy of automated image analysis algorithms.
Impact of Social Network Characteristics on Shelter Use Among Street Youth in San Francisco. We examined the cross-sectional and longitudinal association between social network characteristics and street youths' shelter use, a determinant of health outcomes for homeless youth. We analyzed interview data from 138 street youth recruited through venue-based sampling in San Francisco, to assess the cross-sectional relationship between shelter use in youths' social networks and youths' reported shelter use. We also assessed the relationship between baseline network shelter use and shelter use at 6-month follow-up.
Model-Based Estimates of the Effects of Efavirenz on Bedaquiline Pharmacokinetics and Suggested Dose Adjustments for Patients Coinfected with HIV and Tuberculosis Safe, effective concomitant treatment regimens for tuberculosis (TB) and HIV infection are urgently needed. Bedaquiline (BDQ) is a promising new anti-TB drug, and efavirenz (EFV) is a commonly used antiretroviral. Due to EFV's induction of cytochrome P450 3A4, the metabolic enzyme responsible for BDQ biotransformation, the drugs are expected to interact. Based on data from a phase I, single-dose pharmacokinetic study, a nonlinear mixed-effects model characterizing BDQ pharmacokinetics and interaction with multiple-dose EFV was developed. The results suggest that simple adjustments of the standard regimen during EFV coadministration can prevent reduced exposure to BDQ without increasing exposures to M2. However, exposure to M3 would increase. Evaluation in clinical trials of adjusted regimens is necessary to ensure appropriate dosing for HIV-infected TB patients on an EFV-based regimen.
Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support.
Smoking Intensity Among Male Factory Workers in Kunming, China. This study investigated the intensity of cigarette consumption and its correlates in China among urban male factory workers, a cohort especially vulnerable to tobacco exposure. Data were collected from men working in factories of Kunming city, Yunnan, China, who are current daily smokers . A multinomial logistic regression was conducted to examine the factors in association with smoking intensity in light, moderate, and heavy levels.
Reactive case detection for malaria elimination: real-life experience from an ongoing program in Swaziland. Reactive case detection, whereby individuals living in close proximity to passively detected malaria cases are screened and treated, is one approach being used by a number of countries including Swaziland. To establish the epidemiologically and operationally optimal screening radius around passively detected index cases,we analysed data collected between December 2009 and June 2012 from reactive case detection (RACD) activities in Swaziland. Using satellite imagery, we also evaluated the household coverage achieved during reactive case detection.
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