RESUMO
BACKGROUND: Malaria in pregnancy is responsible for 8-14% of low birth weight and 20% of stillbirths in sub-Saharan Africa. To prevent these adverse consequences, the World Health Organization recommends intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine be administered at each ANC visit starting as early as possible in the second trimester. Global IPTp coverage in targeted countries remains unacceptably low. Community delivery of IPTp was explored as a means to improve coverage. METHODS: A cluster randomized, controlled trial was conducted in 12 health facilities in a 1:1 ratio to either an intervention group (IPTp delivered by CHWs) or a control group (standard practice, with IPTp delivered at HFs) in three districts of Burkina Faso to assess the effect of IPTp administration by community health workers (CHWs) on the coverage of IPTp and antenatal care (ANC). The districts and facilities were purposively selected taking into account malaria epidemiology, IPTp coverage, and the presence of active CHWs. Pre- and post-intervention surveys were carried out in March 2017 and July-August 2018, respectively. A difference in differences (DiD) analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level. RESULTS: Altogether 374 and 360 women were included in the baseline and endline surveys, respectively. At baseline, women received a median of 2.1 doses; by endline, women received a median of 1.8 doses in the control group and 2.8 doses in the intervention group (p-value < 0.0001). There was a non-statistically significant increase in the proportion of women attending four ANC visits in the intervention compared to control group (DiD = 12.6%, p-value = 0.16). By the endline, administration of IPTp was higher in the intervention than control, with a DiD of 17.6% for IPTp3 (95% confidence interval (CI) - 16.3, 51.5; p-value 0.31) and 20.0% for IPTp4 (95% CI - 7.2, 47.3; p-value = 0.15). CONCLUSIONS: Community delivery of IPTp could potentially lead to a greater number of IPTp doses delivered, with no apparent decrease in ANC coverage.
Assuntos
Antimaláricos/administração & dosagem , Centros Comunitários de Saúde/estatística & dados numéricos , Saúde Pública/métodos , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , Adolescente , Adulto , Burkina Faso , Análise por Conglomerados , Combinação de Medicamentos , Sistemas de Liberação de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Gravidez , Gestantes , Adulto JovemRESUMO
This article reviews existing state laws related to autonomous vehicle (AV) safety, equity, and automobile insurance. Thirty states were identified with relevant legislation. Of these, most states had one or two relevant laws in place. Many of these laws were related to safety and insurance requirements. Data are needed to evaluate the effectiveness of these laws in order to guide further policy development.
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Veículos Autônomos , Seguro Saúde , Humanos , Formulação de PolíticasRESUMO
The US opioid epidemic is a serious public health problem. Rates of opioid misuse and dependence are highest for young adults ages 18-25. Prevention strategies that reduce prescription opioid misuse while decreasing stigma around dependence and treatment are critical components of addressing the epidemic. The Truth About Opioids, a mass media public education campaign, was designed to prevent opioid misuse and dependence among young adults. This study examined the intervention's effectiveness to shift opioid-related knowledge, attitudes, and beliefs within targeted designated market areas (DMAs) over time. A sample of young adults (N = 1434) in DMAs with varying levels of media exposure was surveyed at baseline (June-September 2019) and post-intervention (July-August 2020). Logistic regression assessed associations between campaign awareness and campaign-targeted knowledge and attitudes, controlling for baseline variables. Those with any awareness had significantly higher odds of campaign-targeted opioid-related knowledge (versus no awareness) (low awareness OR = 1.52 (95% CI: 1.04, 2.24); high awareness OR = 2.47 (95% CI: 1.58, 3.87)). Those with campaign awareness were also more likely to report lower levels of opioid-related stigma and higher intentions to share information and talk to a friend about the epidemic. Mass media public education campaigns can help influence young adults' opioid-related knowledge and attitudes.
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Transtornos Relacionados ao Uso de Opioides , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Humanos , Intenção , Meios de Comunicação de Massa , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: Describe workplace vaping, prevalence of observed use, attitudes, and perceptions among US adults. METHODS: Employees of companies with more than 150 employees, drawn from an opt-in national online panel (Nâ=â1607), ages 18 to 65, completed an online survey in November 2019. RESULTS: Majority (61.6%) observed coworkers vaping at work and 19.1% reported vaping at work themselves. Participants perceived workplace vaping as moderately harmful (Mâ=â1.9 out of 3), 63.2% were bothered by workplace vaping and 52.1% thought it decreased workplace productivity among non-users. Multiple regression models found workplace vaping prevalence varied by industry and participant characteristics, and attitudes about it varied by tobacco use status. CONCLUSIONS: Workplace vaping and vaping exposure is common in US workplaces. Employees, particularly non-users, hold generally negative perceptions of workplace vaping. Comprehensive policies to prevent workplace vaping are needed to protect workers.
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Vaping , Adolescente , Adulto , Idoso , Atitude Frente a Saúde , Humanos , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Local de Trabalho , Adulto JovemRESUMO
While youth and young adult e-cigarette use has risen in the U.S., few studies have explored e-cigarette cessation behavior. This study estimates quit attempts and intentions among young people (aged 15-36) since the rise of high-nicotine products, and examines factors associated with e-cigarette quit attempts and intentions. Current e-cigarette users (past 30-day use, not already quit) were drawn from a national probability-based cohort sample. Data were collected from September to December 2019 (n = 1158). Weighted proportions of past-year quit attempts, intentions to quit in next 30 days, and general intentions to quit (at some point) were calculated. Models estimated cessation outcomes with respect to harm perceptions, friend use, dependence, use frequency, combustible use and demographic factors. Among current e-cigarette users, 54.2% reported general intentions to quit, 15.3% reported intention to quit within 30 days, and 33.3% reported a past-year quit attempt. Past-year quit attempts were associated with higher levels of harm perceptions (adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.49-2.92), dependence (aOR = 1.92, 95% CI: 1.44-2.56) and daily use (28 + days) compared to infrequent use (1-5 days) (aOR = 0.23, 95% CI: 0.12-0.43). General intentions to quit were positively associated with harm perceptions (aOR = 1.77, 95% CI: 1.23-2.56) and dependence (aOR = 1.89, 95% CI: 1.41-2.52), and negatively associated with daily use compared to infrequent use (aOR = 0.35, 95% CI: 0.19-0.65). Findings indicate that over half of young e-cigarette users want to quit, highlighting a critical need for policies and resources to promote and sustain e-cigarette cessation among young people.