Evaluation of factors associated with bulk milk somatic cell count and total plate count in Indonesian smallholder dairy farms.

Increasing milk quality in smallholder dairy farms will result in a greater quantity of milk being delivered to milk collection centers, an increased milk price for farmers and consequently an improved farmers' livelihood. However, little research on milk quality has been performed on smallholder farms in Southeast Asia. The objective of this study was to identify risk factors associated with somatic cell count (SCC) and total plate count (TPC) in Indonesian smallholder dairy farms. One dairy cooperative in West Java, Indonesia was selected based on its willingness to participate. All 119 member farmers in the cooperative, clustered in six groups, were interviewed and a bulk milk sample from all farms was collected in April 2022. Risk factors associated with dairy farms' SCC and TPC were investigated using multivariable population-averaged generalized estimating equations (GEE) models. The mean geometric SCC and TPC from these farms were 529,665 cells/mL of milk and 474,492 cfu/mL of milk, respectively. Five risk factors including manure removal frequency, receiving mastitis treatment training, washing the udder using soap, number of workers, and ownership of the pasture area were associated with SCC. Two risk factors, manure removal frequency and dairy income contribution, were associated with TPC. These findings can therefore be used as a starting point to improve udder health and milk quality in Indonesia and other countries where smallholder farmers play a significant role in milk production.

Measuring quality of vision including negative dysphotopsia.

PURPOSE: To adapt the Quality of Vision Questionnaire (QoV) for measuring negative dysphotopsia and to validate the original and modified versions in the Dutch population. METHODS: The QoV was translated into Dutch according to standardized methodology. Negative dysphotopsia items were constructed based on focus group interviews, literature review and clinical data. The questionnaire was completed by 404 subjects, including contact lens wearers, patients with cataract and after cataract surgery (95.5% with a monofocal, 4.5% with a multifocal intraocular lens). Rasch analysis was applied for evaluation of reliability and validity of the original QoV and modified version, Negative Dysphotopsia QoV (ND-QoV). RESULTS: The frequency, severity and bothersome scales of the QoV and ND-QoV demonstrated good measurement precision, good fit statistics for all but one item, but significant mistargeting of more than one logit. Item estimations were stable across the study groups and scales were unidimensional with more than 50% of variance explained by the measurements. There was a positive correlation between questionnaire scores and best corrected visual acuity (r = 0.3, p < 0.01). The quality of vision measured by all three scales was significantly poorer (p < 0.01) in patients with negative dysphotopsia compared to asymptomatic pseudophakic patients. CONCLUSION: The Dutch version of the QoV questionnaire has shown good psychometric properties comparable to the native version as well as good reliability and validity. The addition of negative dysphotopsia items is a valuable modification for the reliable assessment of quality of vision in pseudophakic patients.

Smallholder milk-quality awareness in Indonesian dairy farms.

In most low- and middle-income countries, milk is produced by smallholders, thereby contributing to the livelihood of their households. With the increasing importance of milk production in these countries, it is essential that milk quality is of a high level to ensure a safe product for consumers. It is, however, unclear whether smallholder dairy farmers are aware of the quality of their milk. The aim of this cross-sectional study was to gain insight on Indonesian smallholder dairy farmer awareness of milk quality parameters and to identify factors associated with the total plate count (TPC) and somatic cell count (SCC). A stratified sampling method was used to select smallholder farms in 4 districts in West Java, Indonesia, that were interviewed between August and September 2017. Factors putatively associated with awareness of TPC were investigated with multinomial regression models, whereas a Firth-type logistic regression was applied to identify factors associated with SCC awareness. Of the total 600 farmers surveyed, 264 (44%), 109 (18%), 170 (28%), 111 (19%), and 23 (4%) farmers were aware of TPC, total solid, fat content, milk density, and SCC, respectively, but did not know its value. Those that were conceptually aware of these quality parameters were generally unaware of their value. Furthermore, this study revealed that the following variables were significantly associated with dairy farmers' awareness of TPC: cooperative to which the farmer belonged, distance to neighboring dairy farmer, technology adoption index, TPC as the most important quality factor for the buyer, milk production information from cooperatives, and cow health information from veterinarians. Similarly, cooperative, dairy business experience, and milk quality test adoption were significantly associated with dairy farmers' awareness of SCC. Cooperative was the only variable that was significant in both final statistical models. This indicates that cooperatives play an important role in increasing farmer awareness of milk quality parameters in these smallholder dairies. This may be valid for other regions in the world also where milk production is dominated by smallholder dairy farmers.

The ISAC Paradigm to Tame Oral Cancer in Saudi Arabia: A Quasi-experimental Study.

Late detection of oral cancer (OC) cases in Saudi Arabia is concerning. It reduces survival rate and complicates treatment. The ISAC intervention was developed to bridge the gaps observed in dentists' practice of OC examination and patient education. The ISAC stands for I, informing patients of OC screenings; S, screening for OC; A, advising high-risk patients to quit risk factors; and C, connecting patients to advanced services. This study tested the potential effect of the ISAC in influencing dentists' cognitive and behavioral skills, to enhance early detection and prevention of OC. A quasi-experimental study was conducted among dental interns (DIs) at dental setting to test the effect on comprehensive oral cancer examination score (COCE), awareness, self-efficacy, descriptive-norms, and self-reported behavior. Data were collected through triangulation of methods pre and post the intervention at two-months. Multiple linear mixed effects regression models were utilized for data analysis. Between October 2020 and April 2021, 47 DIs participated in the study. The final model showed the significant effects of time (ISAC) on COCE (95% CI = 25.12-29.42, P < .001). DIs had a significant improvement in awareness, self-efficacy, descriptive norms, and self-reported behavior. The findings showed promising effects of the intervention toward the early detection and prevention of OC. Dentists, dental organizations, and policymakers in areas with a high risk of OC could benefit from the current intervention which contributes to capacity building and improved community health. A pragmatic study with a robust design is needed to test the effectiveness of the intervention on a wider scale.

Perspective on the Prevention of Suicide among School Learners by School Management.

BACKGROUND: Adolescents in South Africa have higher suicide rates than older people. A suicide or unexpected death of a fellow student can result in increased copycat behavior. Previous studies have placed emphasis on the significance of school involvement in the prevention of suicide. The study sought to explore the perspective on the prevention of suicide among school learners by school management. A qualitative phenomenological design was applied. The study used purposive sampling to select six high schools. In-depth interviews were conducted with six focus group discussions comprising fifty school management. A semi-structured interview guide guided the interviews. Data were analyzed using a general inductive approach. Findings revealed that school management should be supported through workshops to increase their skills in handling stressful situations at school. Support for learners through audio-visuals, professional counseling, and awareness campaigns also emerged. Parents-school partnership was said to be effective in preventing suicide among learners as both parties will be free to discuss the problems faced by the learner. In conclusion, empowering school management in the prevention of suicide is critical for Limpopo learners. Awareness campaigns conducted by suicide survivors where they can share their testimonies is necessary. School-based professional counseling services should be established to benefit all learners, particularly those experiencing financial challenges. Pamphlets in local languages should be developed for students to convey information about suicide.

Using Intervention Mapping to Develop ISAC, a Comprehensive Intervention for Early Detection and Prevention of Oral Cancer in Saudi Arabia.

Oral cancer forms a major public health issue. In Saudi Arabia, Jazan region has the highest rate of oral cancer; > 35% of total cases. Furthermore, dentists' engagement in oral cancer screening and patient education in Jazan region is limited. This paper aimed to describe the process used to develop a comprehensive oral cancer (OC) practice intervention to be implemented in dental clinics. The intervention was informed by the six steps of intervention mapping (IM). Steps 1-3 included mixed methods approach of reviewing relevant existing literature, focus group discussions, observations, one-on-one interviews, and questionnaires utilizing the community participatory approach. Step 4 used information form steps 1-3 to develop the intervention components and its associated tools to facilitate its delivery. Steps 5 and 6 specified the prospective plans for implementation and evaluation. ISAC is the developed intervention that comprises the following: Informing dental patients about performing routine OC screenings, Screenings for OC, Advising patients, and Connecting patients to the required services. ISAC practical applications were clustered into two components: (a) didactical session covering aspects related to OC practices and introducing ISAC and (b) practical session that included a step-by-step modeling of the intervention. Using IM facilitated the systematic planning of the ISAC intervention that covers the main issues revealed by the need's assessments. Working towards developing the ISAC required extensive work in assessing dental public health issues in a specific context with limited data - and this constituted a great challenge. The development of the ISAC was a lesson that casts light on the advantages of engaging multidisciplinary expertise to tackle serious public health issue like OC.

Hormone use for reproductive diseases and heat induction in relation to herd-level reproductive performance in Dutch dairy farms.

This ecological study aimed to associate hormone use for reproductive diseases and heat induction with reproductive performance at herd level. Hormone use, herd characteristics, and test-day recording data were obtained from 754 representative Dutch dairy farms belonging to five large veterinary practices from 2017 to 2019 (1679 observations in total). Hormone use was classified into prostaglandin, gonadotropin-releasing hormone (GnRH), and progesterone, and was expressed at herd level as the annual number of hormone doses per 100 adult dairy cows. Hormone use was categorized into four levels (no usage, low, medium, and high use), following the 33rd and 66th percentiles of herds that applied them. Three herd-level reproductive performance indicators (calving interval, calving-to-1st insemination interval, number of inseminations per cow) were analyzed using multivariable General Estimating Equations models. The median annual total hormone use was 36.1 (mean=43.1; min=0.0; max=248.2) doses per 100 adult dairy cows in all herds while the median was 39.2 (mean=46.8; min=0.4; max=248.2) doses per 100 adult dairy cows among the user-herds. The median annual group-specific hormone use was 21.3 (mean=26.1; min 0.0; max=180.0), 11.0 (mean=15.3; min=0.0; max=127.0) and 0.0 (mean=1.8; min=0.0; max=40.3) doses per 100 adult dairy cows for prostaglandin, GnRH, and progesterone, respectively. The final statistical models identified that herds with a high hormone use had a calving interval and a calving-to-1st insemination interval that was 9.3 ± 2.6 and 16.4 ± 2.1 days shorter than that of non-user herds (424.0 ± 2.7 and 114.0 ± 2.1 days), respectively. Furthermore, high-user herds needed on average 0.3 ± 0.04 inseminations more to get their cows pregnant compared to non-user herds (1.83 ± 0.04 no. of inseminations per cow). Medium-user herds had a 6.5 ± 2.6 days shorter calving interval and a 12.0 ± 2.1 days shorter calving-to-1st insemination interval with 0.2 ± 0.04 additional inseminations per cow compared to non-user herds. Low-user herds had a 6.2 ± 2.7 days shorter calving interval and a 7.9 ± 2.2 days shorter calving-to-1st insemination interval compared to non-user herds. The model produced the same trend for prostaglandin and GnRH use, with the higher use being associated with a shorter calving interval, a shorter calving-to-1st insemination interval, and a higher insemination per cow number. For progesterone use the opposite effect was observed. In conclusion, using a large representative herd-level dataset, hormone use was associated with a better reproductive performance in terms of calving interval and calving-to-1st insemination interval but gave extra average number of inseminations per cow. It should be monitored how reproduction performance changes when striving for a more prudent hormone use.

Epidemiology of foot-and-mouth disease outbreaks in Thailand from 2011 to 2018.

Foot-and-mouth disease (FMD) is one of the most important animal diseases hindering livestock production in Thailand. In this study, a temporal and spatial analysis at the subdistrict level was performed on FMD outbreak reports in Thailand from 2011 to 2018. Risk factors associated with FMD outbreaks were furthermore investigated using generalized estimating equations. The results showed that the incidence of FMD outbreaks was the highest in 2016 and was affected by season, with a peak in FMD outbreaks occurring in the rainy-winter season, during October to December. FMD outbreaks were mostly distributed in small clusters within a few subdistricts. Some high-risk areas with repeated outbreaks were detected in the central regions. Risk factors, including the increase of subdistrict's size of the dairy population, beef population or pig population, the low percentage of forest area, subdistricts in the provinces adjacent to Malaysia, the presence of a livestock market and the occurrence of an FMD outbreak in a neighbouring subdistrict in the previous month significantly increased the odds of having an FMD outbreak. The increase in proximity to the nearest subdistrict with an FMD outbreak in the previous month decreased the odds of having FMD outbreaks. This study helped to identify high-risk areas and periods of FMD outbreaks in Thailand. Together with the identified risk factors, its results can be used to optimize the FMD control programme in Thailand and in other countries having a similar livestock industry and FMD situation.

Rural-Urban Migration, Childbearing Decision-Making, Fertility and Contraceptive Perspectives of Street Adolescents and Youth in Kampala, Uganda.

Introduction: This paper aims to describe and assess social demographic factors associated with childbearing decision-making, fertility and contraceptive intentions among street adolescents and youth in Kampala, Uganda while considering rural-urban migration as an explanatory factor. Materials and Methods: A cross-sectional survey of 513 adolescents and youth aged 12-24 years self-identifying as street adolescents and youth were interviewed with a structured questionnaire in 2019. Street adolescents and youth who migrated from other rural districts to Kampala were compared with those from the city. Logistic regression was performed to assess associations between the independent factors and personal childbearing decision-making, fertility and contraceptive intentions. Results: Overall, 80.31% of the street adolescents and youth had a rural-urban migration experience. Fifty six percent (56.32%) of the street adolescents and youth made personal childbearing decisions, 94.15% expressed intentions to have children in the future and 42.88% expressed intentions to use contraceptives in the future. Intentions to use contraceptives were significantly higher among males (58.75%) than females (20.00%), and higher among migrants (65.91%) compared to non-migrants (34.09%). Contraceptive intentions were positively associated with self-perceived permanent residential status (aOR = 10.26, 2.70-39.08), intra-urban mobility (aOR = 4.99, 95%CI 1.50-6.59) and intentions to migrate to other towns within the country (aOR = 5.33, 95%CI 1.59-17.80). Being married (aOR = 0.13, 95%CI 0.02-0.85), a large shelter population size (aOR = 0.13, 95%CI 0.03-0.63) and having repeat migrations between the city and home district (aOR = 0.23, 95%CI 0.05-0.94), including migration-associated challenges reduced the odds of street youth's personal childbearing decision-making, while belonging to a social support group increased the odds of childbearing decision-making. We found no significant association between social demographic characteristics and fertility intentions. Discussion: Factors that influenced personal childbearing decision-making and contraceptive intentions among street adolescents and youth in Kampala operate mainly at the interpersonal and community levels, with marital status, shelter population size, rural-urban migration and its associated challenges associated with childbearing decision-making. Interventions to promote childbearing decision-making and contraceptive use among street adolescents and youth should take into consideration their migration and intra-urban mobility patterns.

Disentangling the relationships between lameness, milking frequency and milk production in Dutch dairy herds using an automatic milking system.

Lameness in dairy cattle commonly results in milk production losses. Previous studies have quantified this effect in cows milked with conventional milking systems. The effect of lameness on milk production in herds with automatic milking systems (AMS) might differ because lame cows may visit the AMS less frequently, resulting in an additional milk production loss. This observational study aimed to quantify the direct and indirect effect, through milking frequency, of lameness on milk production in AMS herds by means of a multilevel mediation analysis. Lameness scores, the number of visits to the AMS, and daily milk production records of 1608 dairy cows from 87 Dutch AMS herds were available for analysis. Of those cows, 27 % were mildly lame and 11 % were severely lame. Using a multilevel Poisson regression model, both mildly lame and severely lame cows were identified to visit the AMS less frequently. A separate multilevel linear regression model identified that the direct effect of severe lameness on milk production was 1.4 kg per day. The subsequent multilevel mediation analysis showed that the relationship between severe lameness and milk production was mediated through a reduced milking frequency; 63 % of the total milk production losses (3.9 kg per day) were due to a reduced milking frequency (2.5 kg per day). The mediating effect of a reduced milking frequency was most prominent in cows with parity ≥ 4 and in cows that were ≥ 30 days in lactation. This study suggests that milk production losses due to severe lameness of dairy cows might be higher in AMS herds compared with cows in herds with a conventional milking system, a likely result of a reduced milking frequency of those cows. Prevention of severe lameness may be more cost-effective in AMS herds than in herds with a conventional milking system.

Migration, personal physical safety and economic survival: drivers of risky sexual behaviour among rural-urban migrant street youth in Kampala, Uganda.

BACKGROUND: Despite the vulnerabilities associated with the youth migration process, knowledge on the drivers of risky sexual behaviour among migrant street youth is limited. This study sought to explore the pathways driving risky sexual behaviour among rural-urban migrant street youth in Kampala, Uganda. METHODS: We conducted 11 focus-group discussions composed of 8-10 participants each, and 15 in-depth interviews with urban street adolescents and youth aged 12-24 years. We purposively recruited street youth who had migrated from other districts to Kampala, Uganda, and who identified themselves as street youth. Data were analysed thematically using an inductive approach facilitated by Dedoose software. RESULTS: The migration journey acted as a catalyst for risky sexual behaviour among the adolescents and youth moving from rural districts to Kampala. Three primary pathways were found to drive risky sexual behaviour of street youth: 1) rural-urban migration itself, through sexual exploitation of and violence toward street youth especially young girls during movement, 2) economic survival through engaging in casual jobs and sex work upon arrival in the city, and 3) personal physical safety through friendships and networks, which consequently lead to having multiple sexual partners and unprotected sex. Engagement in risky sexual behaviour, especially sex work, was found to be an adaptation to the challenging and complex street life within the city. CONCLUSIONS: This study highlights the migration process, personal physical safety and economic survival as major pathways driving risky sexual behaviour among rural-urban street youth in Kampala. Interventions to improve sexual health, physical safety and protection of street youth during the migration process and within the city spaces should be prioritised.

Process Evaluation of a Comprehensive Intervention for the Early Detection and Prevention of Oral Cancer: A Mixed Methods Study.

Process evaluations help to understand and refine health interventions. The "ISAC" intervention targeted the enhancement of early detection and prevention of oral cancer (OC) through tobacco-cessation counseling, patient communications, and ISAC role-modeling. Over six months, throughout ISAC implementation in the Jazan region of Saudi Arabia, Linnan and Steckler's process evaluation framework's specified indicators were assessed, by mixed methods, on context, reach, dose delivered, dose received, fidelity, recruitment, and participant's satisfaction. Findings showed that 47 of 80 (58.75%) eligible dentists were reached and received all components. Thirty-six (76.6%) participants reported reading all intervention materials, visited the ISAC website, scored high on the perceived quality of provided information (M = 4.62 ± 0.63), and provided support (M = 4.67 ± 0.57). The fidelity was scored high across all intervention components. Role-modeling of the ISAC had the highest satisfaction score (M = 9.77 ± 0.58 out of 10). High perceived-effects were reported in relation to feeling confident in performing OC examination and training patients on OC self-examination (3.95 ± 0.22). The intervention attained high implementation levels for dose delivered, dose received, and fidelity. The intervention delivery was associated with high satisfaction and perceived effects. Using multiple data sources enhanced the understanding of the implementation process and strengthened the validity of the study's findings.

Community-Based Control of Malaria Vectors Using Bacillus thuringiensis var. Israelensis (Bti) in Rwanda.

Larval source management (LSM) programs for control of malaria vectors are often vertically organized, while there is much potential for involving local communities in program implementation. To address this, we evaluated the entomological impact of community-based application of Bacillus thuringiensis var. israelensis (Bti) in a rice irrigation scheme in Ruhuha, Rwanda. A non-randomized trial with control compared a Bti implementation program that was supervised by the project team (ES) with a program that was led and carried out by local rice farming communities (CB). One other area served as a control to assess mosquito populations without Bti application. Entomological surveys were carried out every two weeks and assessed the presence and abundance of the larval, pupal, and adult stages of Anopheles mosquitoes. In ES, the per round reduction in Anopheles larval habitats was estimated at 49%. This reduction was less in CB (28%) and control (22%) although the per round reduction in CB was still significantly higher than in control. Pupal production was almost completely prevented from round 5 (out of 10) onwards in both CB (average habitat occupancy 0.43%) and ES intervention arms (average habitat occupancy 0.27%), whereas pupal occupancy rates were on average 12.8% from round 5 onwards in the control. Emergence of adult mosquitoes from rice fields was thus prevented although this was not directly noticeable in adult An. gambiae populations in houses nearby the rice fields. Together with our earlier work on the willingness to financially contribute to the LSM program and the high perceived safety and acceptance of the Bti product, the current study demonstrates that, in an environment with limited resources, communities could become more engaged in LSM program implementation and contribute directly to malaria vector control in their environment.

Towards a better understanding of the psychosocial determinants associated with adults' use of smokeless tobacco in the Jazan Region of Saudi Arabia: a qualitative study.

BACKGROUND: Most diagnosed oral cancer cases in Saudi Arabia are in the Jazan region. A common type of smokeless tobacco "Shammah" is prevalent in this region. This study aimed to gain an in-depth understanding of the possible psychosocial determinants of Shammah consumption among adult Shammah users in Jazan region. METHODS: A qualitative study was conducted by means of one-on-one interviews among thirty adult Shammah users. Participants were recruited by means of a purposive sampling technique. Data were collected using a semi-structured interview guide utilizing face-to-face and phone-call interviews. Thematic analysis with hybrid approach was used to analyze the dataset. RESULTS: Twenty-four sub-codes within four overarching themes were generated. Participants revealed uncertainty related to Shammah composition, how to quit knowledge and Shammah prevention/cessation programs. Shammah use identified as a normal phenomenon in society. Its use was frequently reported in participants' close network but most users faced family and peers' disapproval. Some users expressed joy, happiness and focused when using Shammah. Others were disgusted or neutral. Many users believed Shammah causes cancer and tears oral tissues. Others believed it relieves toothache or has no effect. Majority of users were confident to quit and recalled some quitting aids. Toothache, craving, drinking tea and chewing Khat (leaves of Catha edulis plant that causes moderate euphoria) perceived to be triggers to use Shammah. Availability of Shammah, withdrawal symptoms, stress, lack of support, seeing others using Shammah, losing part of routine and toothache were barriers to quit. CONCLUSIONS: Shammah use was associated with uncertainty about Shammah composition and quitting knowledge, social acceptability, influence from family/friends, a range of positive and negative attitudinal beliefs toward its use and high quitting efficacy beliefs. Future interventions targeting Shammah should address the acknowledged triggers and barriers in the present study including the dual use of Shammah and Khat.

Dentists' perceptions and usability testing toward the implementation of the ISAC, a comprehensive oral cancer intervention in dental practices: a qualitative study in Jazan region, Saudi Arabia.

OBJECTIVE: We aimed to explore dentists' perceptions toward the implementation of a comprehensive intervention (ISAC) for the early detection and prevention of oral cancer in a dental clinic. METHODS: The ISAC intervention was presented to ten purposefully sampled dentists in Jazan Dental School (JDS). Participating dental interns were asked to practice the ISAC intervention whilst thinking aloud. A semi-structured interview technique was used to allow free expression of participants' perceptions related to the ISAC intervention and to control the flow of topics. Fleuren's framework theory informed the analysis. The interviews were transcribed verbatim and analyzed using the deductive-inductive framework analysis. RESULTS: Practicing the ISAC intervention was perceived to enhance the early detection and prevention of oral cancer. Serving community needs and engaging community groups were perceived to be related to a high relevance and compatibility of the ISAC intervention. Being a comprehensive intervention with well-defined objectives and being built on relevant data from the participants' community and having dentists as a target group were the perceived relative advantages of the ISAC intervention compared to other programs. A supportive environment, gender-concordance, use of regional trainers, standard examination form and collaboration with other sectors were perceived to be the facilitators. Competition with clinical time, use of different examination forms and low organizational leader interests were perceived as impeding factors against effective implementation in a real-world context. Reward, easy to practice, feeling confidence and satisfaction, advertisement as well as use of a role model approach were perceived to be motivating factors. CONCLUSIONS: Integrating data from representers of different participant groups during intervention conceptualization and development are critical for the intervention compatibility and acceptability. The study findings showed the opportunities of intertwining the intrinsic motivators of satisfaction and altruism existing in the target group and the extrinsic motivator of official diagnostic skill, certification that may boost and sustain the behavior change. Intervention features that influence perceived relevance, compatibility, relative advantage and motivation may be of great importance for intervention practice.

Vaccine Hesitancy among Parents and Its Association with the Uptake of Measles Vaccine in Urban Settings in Khartoum State, Sudan.

Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parent Attitudes about Childhood Vaccines (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake, controlling for sociodemographic variables, and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was created, and the area under the curve (AUC) for the PACV was computed. Data were collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicts the uptake of measles vaccine after controlling for other potential social confounders, such as the mother's age and the number of children (aOR 1.055; 95% CI 1.028-1.028). Additionally, the ROC for the PACV yielded an area under the curve (AUC 0.686 (95% CI 0.620-0.751; p < 0.001)). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake.

Dentists Behavioral Factors Influencing Early Detection of Oral Cancer: Direct Clinical Observational Study.

This study aimed to investigate the possible factors affecting dentists' behavior relating to performing oral cancer examinations as part of routine clinical examination. A total of 95 direct clinical observation sessions-utilizing an instrument consisting of 19 evidence-based observational criteria for oral cancer examinations-were observed by four calibrated dentists. Thirty-two final-year students, 32 interns, and 31 faculty members of Jazan Dental School were examined between April 9 and May 4, 2017. A descriptive analysis was conducted to investigate the frequencies/percentages of the performed observing criteria by all examiners. ANOVA and Tukey tests were carried out to investigate the difference between the examiner groups. A total number of 32 patients participated in the study, whereby each patient was examined by three different examiners from each group, as well as by the attending observer/s. Fewer than 50% of the examiners performed the clinical steps necessary for an oral cancer examination-for example, taking into account past medical history, as well as extra and intra-oral examinations. More than 90% of the examiners examined hard tissue, whereas fewer than 30% of them educated their patients about possible risk factors. A significant difference between examiner groups was found in favor of faculty members. A gap between knowledge and actual practice of oral cancer examinations was evident: majority of participants failed to perform the necessary steps for an oral cancer examination. Previous experience and confidence in performing oral cancer examination are possible explanations for the dentist's behavior toward oral cancer examination.

Willingness to Contribute to Bio-Larviciding in the Fight against Malaria: A Contingent Valuation Study among Rice Farmers in Rwanda.

There is broad consensus that successful and sustained larval source management (LSM) interventions, including bio-larviciding campaigns, require embeddedness in local community institutions. Ideally, these community structures should also be capable of mobilizing local resources to (co-)finance interventions. To date, farmer cooperatives, especially cooperatives of rice growers whose economic activity facilitates mosquito breeding, have remained under the radar in designing community-based bio-larviciding campaigns. This study explores the potential of rice farmer cooperatives in Bugesera district, Rwanda, to take up the aforementioned roles. To this purpose, we surveyed 320 randomly selected rice farmers who belonged to one of four rice cooperatives in the area and elicited their willingness-to-pay (WTP) for application of Bti, a popular bio-larvicide, in their rice paddies. Results from a (non-incentivized) bidding game procedure, which tested two alternative contribution schemes showed that financial contributions would be significantly different from zero and sufficient to carry a co-financing share of 15-25 per cent. A strong heterogeneity in mean WTP is revealed across cooperatives, in addition to variation among individual farmers, which needs to be anticipated when engaging farmer cooperatives in LSM.

Identifying Behavior Change Techniques Used in Tobacco Cessation Interventions by Oral Health Professionals and Their Relation to Intervention Effects-A Review of the Scientific Literature.

This review aimed to identify the behavioral change techniques (BCTs) used in behavioral interventions for tobacco cessation at dental practices in relation to their effect on tobacco use. Six scientific databases were searched for behavior change interventions for tobacco cessation and were coded using the BCT taxonomy of behavioral support for smoking cessation (BCTTsm). Fifteen interventions were identified, and data related to intervention characteristics were abstracted. Sixteen BCTs were identified, mainly related to increased motivation and teaching regulatory skills. Goal setting was the most commonly used BCT. Ten out of fifteen interventions effectively impacted tobacco cessation outcomes (OR = 2 to 5.25). Effective interventions more frequently included goal setting, written materials, readiness to quit and ability assessment, tobacco-use assessment, self-efficacy boost, listing reasons for quitting, action planning and environment restructuring. Other BCTs were not clearly associated with an increased effect. Among the behavioral interventions, certain techniques were associated with successful tobacco quitting. Tobacco cessation interventions in a dental setting appear to benefit from using BCTs that increase motivation and teach regulatory skills. The identified BCTs in this review could provide a source to better inform researchers and dentists about the active ingredients in behavior change interventions for tobacco cessation in a dental setting.

Using the Exploratory Sequential Mixed Methods Design to Investigate Dental Patients' Perceptions and Needs Concerning Oral Cancer Information, Examination, Prevention and Behavior.

OBJECTIVES: The objective of this study was to investigate dental patients' behavior, thoughts, opinions and needs for oral cancer information, and dentists' behavior regarding prevention and examination of oral cancer. MATERIALS AND METHODS: This study utilized an exploratory sequential mixed methods design. Semi-structured interviews with open-ended questions were conducted for forty dental patients of both sexes. Based on the qualitative analysis, a structured questionnaire was developed and distributed among the participants. Data were analyzed for 315 participants to quantify their thoughts, needs, behavior and behavior expected from dentists regarding oral cancer. Frequency, percentages and cumulative percentages were calculated. RESULTS: This study reveals that patients' oral cancer knowledge levels were adequate, but most reported that their dentist had never examined them for oral cancer. Additionally, the participants had never performed self-examinations for oral cancer, nor were they aware of the possibility of doing so. Participants showed a preference for being examined and educated by their dentist about oral cancer and believed it would help early detection. CONCLUSIONS: The study participants are aware of oral cancer and its risk factors. The practice of oral cancer examinations and patient education of its risk factors by dental practitioners is limited. Patients feel a need for more attention to be paid to oral cancer examinations, preventive measures and targeted information on oral cancer risk factors.