Slovenia's national HIV PrEP programme: Evaluation of real-world implementation.

BACKGROUND: The aim of our study was to evaluate real-world implementation of Slovenia's national HIV PrEP programme, which is fully covered by our national health insurance. METHODS: In retrospective cohort study we analysed the data from all men who have sex with men (MSM) who were enrolled in PrEP programme of our clinic between 1 January 2022 and 31 December 2022. RESULTS: A total of 190 MSM with an average age of 36.7 years were included in our analysis. 151 (79.5%) decided for event-driven PrEP and 39 (20.5%) opted for daily PrEP. Self-reported adherence was 95%. Among eligibility criteria, unprotected sex was the most common one, followed by one or more STIs in the past, use of chemsex and use of HIV post-exposure prophylaxis in the past. No new cases of HIV infection and no significant deterioration of kidney or liver function were observed during the follow-up. Sixty-seven episodes of STIs were diagnosed and treated. Gonorrhea (32), chlamydia (14), and Mpox (10) were the most common ones. CONCLUSIONS: PrEP was successfully implemented into everyday clinical practice, proving to be both safe and effective. High number of diagnosed STIs suggests that the PrEP programme, combined with STI screening and vaccination, provides a strong public health impact among MSM in Slovenia.

Systemic Antimicrobial Treatment of Chronic Osteomyelitis in Adults: A Narrative Review.

Chronic osteomyelitis in adults is a complex condition that requires prolonged and intensive antimicrobial therapy, but evidence on optimal selection and duration of antibiotics is limited. A review of PubMed and Ovid Embase databases was conducted to identify systematic reviews, meta-analyses, retrospective and randomised controlled trials (RCTs) on antibiotic treatment outcomes in adults with chronic osteomyelitis. Three main areas of interest were investigated: short-term versus long-term antibiotic therapy, oral versus parenteral antibiotic therapy, and combination antibiotic therapy with rifampicin versus without rifampicin. A total of 36 articles were identified and findings were synthesised using a narrative review approach. The available literature suffers from limitations, including a lack of high-quality studies, inconsistent definitions, and varying inclusion/exclusion criteria among studies. Most studies are open-labelled and lack blinding. Limited high-quality evidence exists that oral therapy is non-inferior to parenteral therapy and that shorter antibiotic duration might be appropriate in low-risk patients. Studies on the impact of rifampicin are inconclusive. Further well-designed studies are needed to provide more robust evidence in these areas.

On a stochastic order induced by an extension of Panjer's family of discrete distributions.

We factorize probability mass functions of discrete distributions belonging to Panjer's family and to its certain extensions to define a stochastic order on the space of distributions supported on N 0 . Main properties of this order are presented. Comparison of some well-known distributions with respect to this order allows to generate new families of distributions that satisfy various recurrrence relations. The recursion formula for the probabilities of corresponding compound distributions for one such family is derived. Applications to various domains of reliability theory are provided.

Life expectancy improvement for multiple cure distributions.

In many circumstances, the increase in life expectancy when certain causes of death are eliminated is sought. These calculations are typically based on the assumption that the causes in question are simply omitted, which is equivalent to the causes being taken out of consideration, from the outset, with certainty. In this paper, we propose models whereby probability distributions for the cures of specific causes of death over time can be incorporated so as to more accurately predict the increase in life expectancy that would ensue. The theoretical results are applied to a real data set involving Diabetes and HIV-related deaths from Denver, Colorado, United States of America, between the years 1990 and 2015 inclusive.

Epidemiology of Foot Injuries Using National Collegiate Athletic Association Data From the 2009-2010 Through 2014-2015 Seasons.

CONTEXT: Researchers analyzing data from the National Collegiate Athletic Association Injury Surveillance Program have not considered the differences in foot injuries across specific sports and between males and females. OBJECTIVE: To describe the epidemiologic differences in rates of overall foot injuries and common injuries among sports and between sexes. DESIGN: Descriptive epidemiology study. SETTING: Online injury-surveillance data from 15 unique sports involving males and females that demonstrated 1967 injuries over 4 821 985 athlete-exposures. PATIENTS OR OTHER PARTICIPANTS: Male and female athletes competing in National Collegiate Athletic Association sports from the 2009-2010 through 2014-2015 seasons. MAIN OUTCOME MEASURE(S): Foot injury rates (per 10 000 athlete-exposures) and the proportion of foot injuries were calculated for each sport. The effect of sex was calculated using Poisson-derived confidence intervals for 8 paired sports. A risk analysis was performed using a 3 × 3 quantitative injury risk-assessment matrix based on both injury rate and mean days of time loss. RESULTS: Foot injury rates differed between sports, with the highest rates in female gymnastics, male and female cross-country, and male and female soccer athletes. Cross-country and track and field had the highest proportions of foot injuries for both female and male sports. The 5 most common injuries were foot/toe contusions, midfoot injuries, plantar fascia injuries, turf toe, and metatarsal fractures. Only track and field athletes demonstrated a significant sex difference in injury rates, with female athletes having the higher rate. The quantitative injury risk-assessment matrix identified the 4 highest-risk injuries, considering both rate and severity, as metatarsal fractures, plantar fascia and midfoot injuries, and foot/toe contusions. CONCLUSIONS: Important differences were present among sports in terms of injury rates, the most common foot injuries, and the risk (combination of frequency and severity) of injury. These differences warrant further study to determine the mechanisms of injury and target intervention efforts.

Incidence and Severity of Foot and Ankle Injuries in Men's Collegiate American Football.

BACKGROUND: American football is an extremely physical game with a much higher risk of injury than other sports. While many studies have reported the rate of injury for particular body regions or for individual injuries, very little information exists that compares the incidence or severity of particular injuries within a body region. Such information is critical for prioritizing preventative interventions. PURPOSE: To retrospectively analyze epidemiological data to identify the most common and most severe foot and ankle injuries in collegiate men's football. STUDY DESIGN: Descriptive epidemiology study. METHODS: Injury data were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for all foot and ankle injuries during the 2004-2005 to 2008-2009 seasons. Injuries were analyzed in terms of incidence and using multiple measures of severity (time loss, surgeries, medical disqualifications). This frequency and severity information is summarized in tabular form as well as in a 4 × 4 quantitative injury risk assessment matrix (QIRAM). RESULTS: The rate of foot and ankle injuries was 15 per 10,000 athletic exposures (AEs). Five injuries were found to be responsible for more than 80% of all foot and ankle injuries: lateral ankle ligament sprains, syndesmotic (high ankle) sprains, medial ankle ligament sprains, midfoot injuries, and first metatarsophalangeal joint injuries. Ankle dislocations were found to be the most severe in terms of median time loss (100 days), percentage of surgeries (83%), and percentage of medical disqualifications (94%), followed by metatarsal fractures (38 days, 36%, and 49%, respectively) and malleolus fractures (33 days, 41%, and 59%, respectively). Statistical analysis suggests that the 3 measures of severity are highly correlated (r > 0.94), thereby justifying the use of time loss as a suitable proxy for injury severity in the construction of the QIRAM. CONCLUSION: Based on the QIRAM analysis, the 5 highest risk injuries were identified based on both incidence and severity (ankle dislocations, syndesmotic sprains, lateral ankle ligament sprains, metatarsal fractures, and malleolus fractures). A better understanding of the relative incidence and severity of these injuries will allow coaches, trainers, and researchers to more effectively focus their preventative interventions.

Views on unsafe nursing students in clinical learning.

Clinical education is a cornerstone of undergraduate nursing education programs. Although protecting patient safety in clinical learning experiences is a standard of practice, no standard definition of the "unsafe" student exists. The purpose of this study was to describe the viewpoints of undergraduate student nurses and their clinical educators about unsafe clinical student practices. Using Q methodology, 57 students and 14 clinical educators sorted 39 unsafe student practice statements. These statements were generated from an integrated review of nursing and related literature and two undergraduate student focus groups. The use of centroid factor analysis with varimax rotation produced three dimensions of unsafe student practices. An unsafe student was characterized by his/her Compromised Professional Accountability, Incomplete Praxis, and Clinical Disengagement. A shared attribute among these three features was violated professional integrity. While students' affective, cognitive, and praxis competencies were priority elements in the conceptualization of unsafe student practice, this study also identified the salient role of educators as active participants in preparation of safe practitioners.