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• 1. [Article] Health-Related Needs Assessment of Older Residents in Subsidized Housing

  When a nonprofit organization with nursing-home and assisted-living experience purchased a 30-year-old highrise apartment building in downtown Portland, Oregon, the new owners were faced with how to manage ...

  Citation × Citation Citation Abstract Copy Title: Health-Related Needs Assessment of Older Residents in Subsidized Housing Author: Cotrell, Victoria, Carder, Paula C. Year: 2010 When a nonprofit organization with nursing-home and assisted-living experience purchased a 30-year-old highrise apartment building in downtown Portland, Oregon, the new owners were faced with how to manage a building that provided housing to more than 200 older residents whom they knew very little about. As long-term care providers, they knew that older people were at risk for developing chronic illnesses, disabilities, and other factors that could result in moves to nursing homes, hospitalizations, and early death. They also knew that older adults in subsidized housing, such as this Section 8 building, have higher levels of disability than their age cohorts in unsubsidized housing and apartment rentals (Redfoot and Kochera, 2004). What they did not know was whether and in what ways these residents' independence and quality of life might be jeopardized by unmet health and social service needs. In collaboration with the Portland State University School of Social Work, a multidimensional needs assessment was developed and conducted to identify the most important unmet needs of the residents as a group so that targeted services could be planned. Findings based on interviews with 130 residents revealed a heterogeneous population of older adults whose health status varied considerably, especially among the four different ethnic and language groups living in the building. This article describes how the results of such an assessment can be used to plan for enriching services to those most in need. Title: Health-Related Needs Assessment of Older Residents in Subsidized Housing Author: Cotrell, Victoria, Carder, Paula C. Year: 2010 When a nonprofit organization with nursing-home and assisted-living experience purchased a 30-year-old highrise apartment building in downtown Portland, Oregon, the new owners were faced with how to manage a building that provided housing to more than 200 older residents whom they knew very little about. As long-term care providers, they knew that older people were at risk for developing chronic illnesses, disabilities, and other factors that could result in moves to nursing homes, hospitalizations, and early death. They also knew that older adults in subsidized housing, such as this Section 8 building, have higher levels of disability than their age cohorts in unsubsidized housing and apartment rentals (Redfoot and Kochera, 2004). What they did not know was whether and in what ways these residents' independence and quality of life might be jeopardized by unmet health and social service needs. In collaboration with the Portland State University School of Social Work, a multidimensional needs assessment was developed and conducted to identify the most important unmet needs of the residents as a group so that targeted services could be planned. Findings based on interviews with 130 residents revealed a heterogeneous population of older adults whose health status varied considerably, especially among the four different ethnic and language groups living in the building. This article describes how the results of such an assessment can be used to plan for enriching services to those most in need. Close

• 2. [Article] AHRQ Series on Complex Intervention Systematic Reviews-Paper 7: PRISMA-CI Elaboration and Explanation

  Background Complex interventions are widely used in health care, public health, education, criminology, social work, business, and welfare. They have increasingly become the subject of systematic reviews ...

  Citation × Citation Citation Abstract Copy Title: AHRQ Series on Complex Intervention Systematic Reviews-Paper 7: PRISMA-CI Elaboration and Explanation Author: Guise, Jeanne-Marie, Butler, Mary E., Chang, Christine, Viswanathan, Meera, Pigott, Terri, Tugwell, Peter Year: 2017 Background Complex interventions are widely used in health care, public health, education, criminology, social work, business, and welfare. They have increasingly become the subject of systematic reviews and are challenging to effectively report. The Complex Interventions Methods Workgroup developed an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Complex Interventions (PRISMA-CI). Rationale Following the EQUATOR Network guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions, this Explanation and Elaboration (EE) document accompanies the PRISMA-CI checklist to promote consistency in reporting of systematic reviews of complex interventions. Discussions The EE document explains the meaning and rationale for each unique PRISMA-CI checklist item and provides examples to assist systematic review authors in operationalizing PRISMA-CI guidance. The Complex Interventions Workgroup developed PRISMA-CI as an important start toward increased consistency in reporting of systematic reviews of complex interventions. Because the field is rapidly expanding, the Complex Interventions Methods Workgroup plans to re-evaluate periodically for the need to add increasing specificity and examples as the field matures. Title: AHRQ Series on Complex Intervention Systematic Reviews-Paper 7: PRISMA-CI Elaboration and Explanation Author: Guise, Jeanne-Marie, Butler, Mary E., Chang, Christine, Viswanathan, Meera, Pigott, Terri, Tugwell, Peter Year: 2017 Background Complex interventions are widely used in health care, public health, education, criminology, social work, business, and welfare. They have increasingly become the subject of systematic reviews and are challenging to effectively report. The Complex Interventions Methods Workgroup developed an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Complex Interventions (PRISMA-CI). Rationale Following the EQUATOR Network guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions, this Explanation and Elaboration (EE) document accompanies the PRISMA-CI checklist to promote consistency in reporting of systematic reviews of complex interventions. Discussions The EE document explains the meaning and rationale for each unique PRISMA-CI checklist item and provides examples to assist systematic review authors in operationalizing PRISMA-CI guidance. The Complex Interventions Workgroup developed PRISMA-CI as an important start toward increased consistency in reporting of systematic reviews of complex interventions. Because the field is rapidly expanding, the Complex Interventions Methods Workgroup plans to re-evaluate periodically for the need to add increasing specificity and examples as the field matures. Close

• 3. [Article] Objective Monitoring of Insecticide-Treated Bednet Use to Improve Malaria Prevention: SmartNet Development and Validation

  Malaria is a serious health concern for three billion people worldwide, killing nearly 600,000 people a year. Insecticide-treated bednets (ITNs) are an effective and valuable tool for preventing malaria ...

  Citation × Citation Citation Abstract Copy Title: Objective Monitoring of Insecticide-Treated Bednet Use to Improve Malaria Prevention: SmartNet Development and Validation Author: Krezanoski, Paul J., Santorino, Data, Campbell, Jeffrey, Bangsberg, David Year: 2017 Malaria is a serious health concern for three billion people worldwide, killing nearly 600,000 people a year. Insecticide-treated bednets (ITNs) are an effective and valuable tool for preventing malaria and hundreds of millions of ITNs have been distributed throughout sub-Saharan Africa. Nevertheless, our current methods for measuring ITN use are inadequate to inform malaria prevention programs. The most common method, self-reported ITN use, is limited by 1) social desirability, 2) recall and 3) sampling bias. An acceptable objective and longitudinal method of assessing adherence to ITN use would improve our ability to better understand the determinants of ITN use and design more effective malaria prevention interventions. We describe the development and initial proof-of-concept validity testing of an ITN adherence monitoring tool called SmartNet. SmartNet uses conductive thread interwoven into an ITN and a microcontroller to detect the state of the ITN. We tested SmartNet among five volunteers using the device over their beds in Boston, USA for two weeks with the goal of evaluating device reliability, accuracy and acceptability to inform future device improvements. The device recorded data for 63.1% (35172/55711) of installed two-minute time intervals, with 97.3% (19990/20539) of the recording errors relating to battery failures. Overall, the device was 71.7% (25204/35172) accurate in determining the state of the ITN (whether it was folded up or unfurled) and performed significantly better at detecting an unfurled ITN than a folded ITN, 77.3% versus 68.4% (p Title: Objective Monitoring of Insecticide-Treated Bednet Use to Improve Malaria Prevention: SmartNet Development and Validation Author: Krezanoski, Paul J., Santorino, Data, Campbell, Jeffrey, Bangsberg, David Year: 2017 Malaria is a serious health concern for three billion people worldwide, killing nearly 600,000 people a year. Insecticide-treated bednets (ITNs) are an effective and valuable tool for preventing malaria and hundreds of millions of ITNs have been distributed throughout sub-Saharan Africa. Nevertheless, our current methods for measuring ITN use are inadequate to inform malaria prevention programs. The most common method, self-reported ITN use, is limited by 1) social desirability, 2) recall and 3) sampling bias. An acceptable objective and longitudinal method of assessing adherence to ITN use would improve our ability to better understand the determinants of ITN use and design more effective malaria prevention interventions. We describe the development and initial proof-of-concept validity testing of an ITN adherence monitoring tool called SmartNet. SmartNet uses conductive thread interwoven into an ITN and a microcontroller to detect the state of the ITN. We tested SmartNet among five volunteers using the device over their beds in Boston, USA for two weeks with the goal of evaluating device reliability, accuracy and acceptability to inform future device improvements. The device recorded data for 63.1% (35172/55711) of installed two-minute time intervals, with 97.3% (19990/20539) of the recording errors relating to battery failures. Overall, the device was 71.7% (25204/35172) accurate in determining the state of the ITN (whether it was folded up or unfurled) and performed significantly better at detecting an unfurled ITN than a folded ITN, 77.3% versus 68.4% (p Close

• 4. [Article] Antimicrobial-Resistant Infections Among Postpartum Women at a Ugandan Referral Hospital

  Introduction Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking. Methods We performed a prospective cohort ...

  Citation × Citation Citation Abstract Copy Title: Antimicrobial-Resistant Infections Among Postpartum Women at a Ugandan Referral Hospital Author: Bebell, Lisa M., Ngonzi, Joseph, Bazira, Joel, Fajardo, Yarine, Boatin, Adeline A., Siedner, Mark J., Bassett, Ingrid V., Nyehangane, Dan, Nanjebe, Deborah, van Geertruyden, Jean-Pierre, Mwanga-Amumpaire, Juliet, Bangsberg, David R., Riley, Laura E., Boum, Yap, II Year: 2017 Introduction Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking. Methods We performed a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care, measured vital signs after delivery, performed structured physical exam, symptom questionnaire, and microbiologic evaluation of febrile and hypothermic women. Malaria rapid diagnostic testing, blood and urine cultures were performed aseptically and processed at Epicentre Mbarara Research Centre. Antimicrobial susceptibility and breakpoints were determined using disk diffusion per EUCAST standards. Hospital diagnoses, treatments and outcomes were abstracted from patient charts. Results Mean age was 25 years, 12% were HIV-infected, and 50% had cesarean deliveries. Approximately 5% (205/4176) with ≥1 temperature measurement recorded developed postpartum fever or hypothermia; blood and urine samples were collected from 174 (85%), and 17 others were evaluated clinically. Eighty-four (48%) had at least one confirmed source of infection: 39% (76/193) clinical postpartum endometritis, 14% (25/174) urinary tract infection (UTI), 3% (5/174) bloodstream infection. Another 3% (5/174) had malaria. Overall, 30/174 (17%) had positive blood or urine cultures, and Acinetobacter species were the most common bacteria isolated. Of 25 Gram-negatives isolated, 20 (80%) were multidrug-resistant and cefepime non-susceptible. Conclusions For women in rural Uganda with postpartum fever, we found a high rate of antibiotic resistance among cultured urinary and bloodstream infections, including cephalosporin-resistant Acinetobacter species. Increasing availability of microbiology testing to inform appropriate antibiotic use, development of antimicrobial stewardship programs, and strengthening infection control practices should be high priorities. Title: Antimicrobial-Resistant Infections Among Postpartum Women at a Ugandan Referral Hospital Author: Bebell, Lisa M., Ngonzi, Joseph, Bazira, Joel, Fajardo, Yarine, Boatin, Adeline A., Siedner, Mark J., Bassett, Ingrid V., Nyehangane, Dan, Nanjebe, Deborah, van Geertruyden, Jean-Pierre, Mwanga-Amumpaire, Juliet, Bangsberg, David R., Riley, Laura E., Boum, Yap, II Year: 2017 Introduction Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking. Methods We performed a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care, measured vital signs after delivery, performed structured physical exam, symptom questionnaire, and microbiologic evaluation of febrile and hypothermic women. Malaria rapid diagnostic testing, blood and urine cultures were performed aseptically and processed at Epicentre Mbarara Research Centre. Antimicrobial susceptibility and breakpoints were determined using disk diffusion per EUCAST standards. Hospital diagnoses, treatments and outcomes were abstracted from patient charts. Results Mean age was 25 years, 12% were HIV-infected, and 50% had cesarean deliveries. Approximately 5% (205/4176) with ≥1 temperature measurement recorded developed postpartum fever or hypothermia; blood and urine samples were collected from 174 (85%), and 17 others were evaluated clinically. Eighty-four (48%) had at least one confirmed source of infection: 39% (76/193) clinical postpartum endometritis, 14% (25/174) urinary tract infection (UTI), 3% (5/174) bloodstream infection. Another 3% (5/174) had malaria. Overall, 30/174 (17%) had positive blood or urine cultures, and Acinetobacter species were the most common bacteria isolated. Of 25 Gram-negatives isolated, 20 (80%) were multidrug-resistant and cefepime non-susceptible. Conclusions For women in rural Uganda with postpartum fever, we found a high rate of antibiotic resistance among cultured urinary and bloodstream infections, including cephalosporin-resistant Acinetobacter species. Increasing availability of microbiology testing to inform appropriate antibiotic use, development of antimicrobial stewardship programs, and strengthening infection control practices should be high priorities. Close

• 5. [Article] Association of Traditional Chinese Medicine Therapy and the Risk of Dementia in Patients with Hypertension: A Nationwide Population-based Cohort Study

  Background: Patients with hypertension (HTN) reportedly have a higher risk of developing dementia. However, it remains unclear if use of Traditional Chinese Medicine (TCM), the most common form of complementary ...

  Citation × Citation Citation Abstract Copy Title: Association of Traditional Chinese Medicine Therapy and the Risk of Dementia in Patients with Hypertension: A Nationwide Population-based Cohort Study Author: Chen, Kuen-Hau, Yeh, Ming-Hsien, Livneh, Hanoch, Chen, Bor-Chyuan, Lin, I-Hsin, Lu, Ming-Chi, Tsai, Tzung-Yi, Yeh, Chia-Chou Year: 2017 Background: Patients with hypertension (HTN) reportedly have a higher risk of developing dementia. However, it remains unclear if use of Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of dementia for these patients. So the aim of the study was to investigate the effects of TCM on dementia risk among patients with hypertension. Methods: This longitudinal cohort study used the Taiwanese National Health Insurance Research Database (NHIRD) to identify 143,382 newly diagnosed hypertension patients aged 20–90 years who received treatment between 1998 and 2007. Among them, 52,365 (36.52%) had received TCM after the onset of hypertension (TCM users), and the remaining 91,017 patients (63.48%) were designated as a control group (non-TCM users). All enrollees were followed until the end of 2012 to record the incidence of dementia. A Cox proportional hazards regression model was used to compute the hazard ratio (HR) of dementia in patients who received TCM. Results: During the 15-year follow-up, 3933 TCM users and 10,316 non-TCM users developed dementia, representing an incidence rate of 8.41 and 11.55%, respectively, per 1000 person-years. TCM users had a significantly reduced risk of dementia compared to non-TCM users (adjusted HR = 0.76; 95% confidence interval [CI] = 0.74–0.81). The predominant effect was observed among those treated with TCM longer than 180 days (adjusted HR = 0.65; 95% CI = 0.62–0.69). Among the commonly used TCM products, Tian-Ma-Gou-Teng-Yin, Dan-Shen (Radix Salviae Miltiorrhizae), Chuan-Niu-Xi (Radix Cyathulae), Ge-Gen (Radix Puerariae), Jia-Wei-Xiao-Yao-San, and Jue-Ming-Zi (Semen Cassiae) were significantly associated with a lower risk of dementia. Conclusions: Results from this population-based study support the effects of TCM on reducing dementia risk, which may provide a reference for dementia prevention strategies. Title: Association of Traditional Chinese Medicine Therapy and the Risk of Dementia in Patients with Hypertension: A Nationwide Population-based Cohort Study Author: Chen, Kuen-Hau, Yeh, Ming-Hsien, Livneh, Hanoch, Chen, Bor-Chyuan, Lin, I-Hsin, Lu, Ming-Chi, Tsai, Tzung-Yi, Yeh, Chia-Chou Year: 2017 Background: Patients with hypertension (HTN) reportedly have a higher risk of developing dementia. However, it remains unclear if use of Traditional Chinese Medicine (TCM), the most common form of complementary and alternative medicine, can help lower the risk of dementia for these patients. So the aim of the study was to investigate the effects of TCM on dementia risk among patients with hypertension. Methods: This longitudinal cohort study used the Taiwanese National Health Insurance Research Database (NHIRD) to identify 143,382 newly diagnosed hypertension patients aged 20–90 years who received treatment between 1998 and 2007. Among them, 52,365 (36.52%) had received TCM after the onset of hypertension (TCM users), and the remaining 91,017 patients (63.48%) were designated as a control group (non-TCM users). All enrollees were followed until the end of 2012 to record the incidence of dementia. A Cox proportional hazards regression model was used to compute the hazard ratio (HR) of dementia in patients who received TCM. Results: During the 15-year follow-up, 3933 TCM users and 10,316 non-TCM users developed dementia, representing an incidence rate of 8.41 and 11.55%, respectively, per 1000 person-years. TCM users had a significantly reduced risk of dementia compared to non-TCM users (adjusted HR = 0.76; 95% confidence interval [CI] = 0.74–0.81). The predominant effect was observed among those treated with TCM longer than 180 days (adjusted HR = 0.65; 95% CI = 0.62–0.69). Among the commonly used TCM products, Tian-Ma-Gou-Teng-Yin, Dan-Shen (Radix Salviae Miltiorrhizae), Chuan-Niu-Xi (Radix Cyathulae), Ge-Gen (Radix Puerariae), Jia-Wei-Xiao-Yao-San, and Jue-Ming-Zi (Semen Cassiae) were significantly associated with a lower risk of dementia. Conclusions: Results from this population-based study support the effects of TCM on reducing dementia risk, which may provide a reference for dementia prevention strategies. Close

• 6. [Article] Predictors of Parent–child Communication Among a Nationally Representative Sample in Nigeria

  This study explores what constructs are associated with parent–adolescent communication about AIDS/sexually transmitted infections (STIs) and sexual relationships in Nigeria. The analyses use data from ...

  Citation × Citation Citation Abstract Copy Title: Predictors of Parent–child Communication Among a Nationally Representative Sample in Nigeria Author: Sun, Christina J., Berg, Kristina, Babalola, Stella Year: 2012 This study explores what constructs are associated with parent–adolescent communication about AIDS/sexually transmitted infections (STIs) and sexual relationships in Nigeria. The analyses use data from the 2007 National HIV/AIDS and Reproductive Health Survey on 2593 men and women who had at least one child over the age of 12 years. The respondents were classified as low, medium, or high communicators. Low communicators were parents who did not talk to their child about either AIDS/STIs or sexual relationships. Medium communicators were parents who discussed only one topic with at least one child. High communicators were parents who discussed both topics with at least one child. Logistic regression was used to compare high communicators with low/medium communicators. There are commonalities and differences among men and women in the factors associated with parent–adolescent communication. Age, religion, and knowing where to obtain information about HIV/AIDS were associated with the extent of communication, regardless of the parent's gender. Perceived social support was an important correlate for fathers, while knowledge of female STI symptoms showed a significant association only for mothers. Programmatic and communication implications of the findings include addressing men and women differently, developing strategies to specifically reach younger parents and Muslims, and increasing general awareness of HIV/AIDS information resources. Further research is needed to understand the context, content, and timing of parent–adolescent conversations about AIDS/STIs and sexual relationships and how these factors affect the sexual behaviors of adolescents. Title: Predictors of Parent–child Communication Among a Nationally Representative Sample in Nigeria Author: Sun, Christina J., Berg, Kristina, Babalola, Stella Year: 2012 This study explores what constructs are associated with parent–adolescent communication about AIDS/sexually transmitted infections (STIs) and sexual relationships in Nigeria. The analyses use data from the 2007 National HIV/AIDS and Reproductive Health Survey on 2593 men and women who had at least one child over the age of 12 years. The respondents were classified as low, medium, or high communicators. Low communicators were parents who did not talk to their child about either AIDS/STIs or sexual relationships. Medium communicators were parents who discussed only one topic with at least one child. High communicators were parents who discussed both topics with at least one child. Logistic regression was used to compare high communicators with low/medium communicators. There are commonalities and differences among men and women in the factors associated with parent–adolescent communication. Age, religion, and knowing where to obtain information about HIV/AIDS were associated with the extent of communication, regardless of the parent's gender. Perceived social support was an important correlate for fathers, while knowledge of female STI symptoms showed a significant association only for mothers. Programmatic and communication implications of the findings include addressing men and women differently, developing strategies to specifically reach younger parents and Muslims, and increasing general awareness of HIV/AIDS information resources. Further research is needed to understand the context, content, and timing of parent–adolescent conversations about AIDS/STIs and sexual relationships and how these factors affect the sexual behaviors of adolescents. Close

• 7. [Article] The Role of Simulation in Mixed-Methods Research: a Framework & Application to Patient Safety

  Background: Research in patient safety is an important area of health services research and is a national priority. It is challenging to investigate rare occurrences, explore potential causes, and account ...

  Citation × Citation Citation Abstract Copy Title: The Role of Simulation in Mixed-Methods Research: a Framework & Application to Patient Safety Author: Guise, Jeanne-Marie, Hansen, Matthew, Lambert, William E., O'Brien, Kerth Year: 2017 Background: Research in patient safety is an important area of health services research and is a national priority. It is challenging to investigate rare occurrences, explore potential causes, and account for the complex, dynamic context of healthcare - yet all are required in patient safety research. Simulation technologies have become widely accepted as education and clinical tools, but have yet to become a standard tool for research. Methods: We developed a framework for research that integrates accepted patient safety models with mixed- methods research approaches and describe the performance of the framework in a working example of a large National Institutes of Health (NIH)-funded R01 investigation. Results: This worked example of a framework in action, identifies the strengths and limitations of qualitative and quantitative research approaches commonly used in health services research. Each approach builds essential layers of knowledge. We describe how the use of simulation ties these layers of knowledge together and adds new and unique dimensions of knowledge. Conclusions: A mixed-methods research approach that includes simulation provides a broad multi-dimensional approach to health services and patient safety research. Keywords: Health services research, Patient safety, Research design, Patient simulation, Mixed methods, Qualitative research, Pediatrics, Emergency care, National Institutes of Health Title: The Role of Simulation in Mixed-Methods Research: a Framework & Application to Patient Safety Author: Guise, Jeanne-Marie, Hansen, Matthew, Lambert, William E., O'Brien, Kerth Year: 2017 Background: Research in patient safety is an important area of health services research and is a national priority. It is challenging to investigate rare occurrences, explore potential causes, and account for the complex, dynamic context of healthcare - yet all are required in patient safety research. Simulation technologies have become widely accepted as education and clinical tools, but have yet to become a standard tool for research. Methods: We developed a framework for research that integrates accepted patient safety models with mixed- methods research approaches and describe the performance of the framework in a working example of a large National Institutes of Health (NIH)-funded R01 investigation. Results: This worked example of a framework in action, identifies the strengths and limitations of qualitative and quantitative research approaches commonly used in health services research. Each approach builds essential layers of knowledge. We describe how the use of simulation ties these layers of knowledge together and adds new and unique dimensions of knowledge. Conclusions: A mixed-methods research approach that includes simulation provides a broad multi-dimensional approach to health services and patient safety research. Keywords: Health services research, Patient safety, Research design, Patient simulation, Mixed methods, Qualitative research, Pediatrics, Emergency care, National Institutes of Health Close

• 8. [Article] Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda

  Diarrhea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural ...

  Citation × Citation Citation Abstract Copy Title: Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda Author: Rosa, Ghislaine, Majorin, Fiona, Boisson, Sophie, Barstow, Christina, Johnson, Michael, Kirby, Miles, Ngabo, Fidele, Thomas, Evan A., Clasen, Thomas Year: 2014 Diarrhea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semicontinuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean fecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p,0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Title: Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda Author: Rosa, Ghislaine, Majorin, Fiona, Boisson, Sophie, Barstow, Christina, Johnson, Michael, Kirby, Miles, Ngabo, Fidele, Thomas, Evan A., Clasen, Thomas Year: 2014 Diarrhea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semicontinuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean fecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p,0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions. Close

• 9. [Article] AHRQ Series on Complex Intervention Systematic Reviews-Paper 6: PRISMA-CI Extension Statement and Checklist

  Background: Complex interventions are widely used in health systems, public health, education, and communities and are increasingly the subject of systematic reviews. Oversimplification and inconsistencies ...

  Citation × Citation Citation Abstract Copy Title: AHRQ Series on Complex Intervention Systematic Reviews-Paper 6: PRISMA-CI Extension Statement and Checklist Author: Guise, Jeanne-Marie, Butler, Mary E., Chang, Christine, Viswanathan, Meera, Pigott, Terri, Tugwell, Peter Year: 2017 Background: Complex interventions are widely used in health systems, public health, education, and communities and are increasingly the subject of systematic reviews. Oversimplification and inconsistencies in reporting about complex interventions can limit the usability of review findings. Rationale: Although guidance exists to ensure that reports of individual studies and systematic reviews adhere to accepted scientific standards, their design-specific focus leaves important reporting gaps relative to complex interventions in health care. This paper provides a stand-alone extension to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting tool for complex interventionsdPRISMA-CIdto help authors, publishers, and readers understand and apply to systematic reviews of complex interventions. Discussion: PRISMA-CI development followed the Enhancing the QUAlity and Transparency Of health Research Network guidance for extensions and focused on adding or modifying only essential items that are truly unique to complex interventions and are not covered by broader interpretation of current PRISMA guidance. PRISMA-CI provides an important structure and guidance for systematic reviews and meta-analyses for the highly prevalent and dynamic field of complex interventions. Title: AHRQ Series on Complex Intervention Systematic Reviews-Paper 6: PRISMA-CI Extension Statement and Checklist Author: Guise, Jeanne-Marie, Butler, Mary E., Chang, Christine, Viswanathan, Meera, Pigott, Terri, Tugwell, Peter Year: 2017 Background: Complex interventions are widely used in health systems, public health, education, and communities and are increasingly the subject of systematic reviews. Oversimplification and inconsistencies in reporting about complex interventions can limit the usability of review findings. Rationale: Although guidance exists to ensure that reports of individual studies and systematic reviews adhere to accepted scientific standards, their design-specific focus leaves important reporting gaps relative to complex interventions in health care. This paper provides a stand-alone extension to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting tool for complex interventionsdPRISMA-CIdto help authors, publishers, and readers understand and apply to systematic reviews of complex interventions. Discussion: PRISMA-CI development followed the Enhancing the QUAlity and Transparency Of health Research Network guidance for extensions and focused on adding or modifying only essential items that are truly unique to complex interventions and are not covered by broader interpretation of current PRISMA guidance. PRISMA-CI provides an important structure and guidance for systematic reviews and meta-analyses for the highly prevalent and dynamic field of complex interventions. Close

• 10. [Article] The Role of Relationship Dynamics and Gender Inequalities As Barriers to HIV-Serostatus Disclosure: Qualitative Study among Women and Men Living with HIV in Durban, South Africa

  Background: This qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South ...

  Citation × Citation Citation Abstract Copy Title: The Role of Relationship Dynamics and Gender Inequalities As Barriers to HIV-Serostatus Disclosure: Qualitative Study among Women and Men Living with HIV in Durban, South Africa Author: Bhatia, Divya S., Harrison, Abigail D., Kubeka, Muriel, Milford, Cecilia, Kaida, Angela, Bajunirwe, Francis, Wilson, Ira B., Psaros, Christina, Safren, Steven A,, Bangsberg, David R., Smit, Jennifer A., Matthews, Lynn T. Year: 2017 Background: This qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South Africa. HIV serodiscordance among men and women within stable partnerships contributes to high HIV incidence in southern Africa, yet disclosure rates remain low. Given the emphasis on prevention for HIV-serodiscordant couples, this research supports the urgent need to explore how best to support couples to recognize that they are part of this priority population and to access appropriate prevention and treatment. Methods: Thirty-five in-depth individual interviews were conducted with 15 HIV-positive men and 20 HIV-positive women (not couples) receiving care at public-sector clinics near Durban. A structured coding scheme was developed to investigate men's and women's attitudes toward HIV-serostatus disclosure and behaviors of sharing (or not sharing) HIV serostatus with a partner. Narratives were analyzed for barriers and facilitators of disclosure through the lens of sociocultural gender inequality, focusing on reasons for non-disclosure. Results: Among 35 participants: median age was 33 years (men) and 30 years (women); average years since HIV diagnosis was 1 (men) and 1.5 (women). Four themes related to gender inequality and HIV-serostatus disclosure emerged: (1) Men and women fear disclosing to partners due to concerns about stigma and relationship dissolution, (2) suspicions and mistrust between partners underlies decisions for non-disclosure, (3) unequal, gendered power in relationships causes differential likelihood and safety of disclosure among men and women, and (4) incomplete or implicit disclosure are strategies to navigate disclosure challenges. Findings illustrate HIV-serostatus disclosure as a complex process evolving over time, rather than a one-time event. Conclusion: Partner communication about HIV serostatus is infrequent and complicated, with gender inequalities contributing to fear, mistrust, and partial or implicit disclosure. Relationship dynamics and gender roles shape the environment within which men and women can engage successfully in the HIV-serostatus disclosure process. Integrated interventions to reduce barriers to trustful and effective communication are needed for HIV-affected men and women in partnerships in which seeking couples-based HIV counseling and testing (CHCT) is challenging or unlikely. These data offer insights to support HIV-serostatus disclosure strategies within relationships over time. Title: The Role of Relationship Dynamics and Gender Inequalities As Barriers to HIV-Serostatus Disclosure: Qualitative Study among Women and Men Living with HIV in Durban, South Africa Author: Bhatia, Divya S., Harrison, Abigail D., Kubeka, Muriel, Milford, Cecilia, Kaida, Angela, Bajunirwe, Francis, Wilson, Ira B., Psaros, Christina, Safren, Steven A,, Bangsberg, David R., Smit, Jennifer A., Matthews, Lynn T. Year: 2017 Background: This qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South Africa. HIV serodiscordance among men and women within stable partnerships contributes to high HIV incidence in southern Africa, yet disclosure rates remain low. Given the emphasis on prevention for HIV-serodiscordant couples, this research supports the urgent need to explore how best to support couples to recognize that they are part of this priority population and to access appropriate prevention and treatment. Methods: Thirty-five in-depth individual interviews were conducted with 15 HIV-positive men and 20 HIV-positive women (not couples) receiving care at public-sector clinics near Durban. A structured coding scheme was developed to investigate men's and women's attitudes toward HIV-serostatus disclosure and behaviors of sharing (or not sharing) HIV serostatus with a partner. Narratives were analyzed for barriers and facilitators of disclosure through the lens of sociocultural gender inequality, focusing on reasons for non-disclosure. Results: Among 35 participants: median age was 33 years (men) and 30 years (women); average years since HIV diagnosis was 1 (men) and 1.5 (women). Four themes related to gender inequality and HIV-serostatus disclosure emerged: (1) Men and women fear disclosing to partners due to concerns about stigma and relationship dissolution, (2) suspicions and mistrust between partners underlies decisions for non-disclosure, (3) unequal, gendered power in relationships causes differential likelihood and safety of disclosure among men and women, and (4) incomplete or implicit disclosure are strategies to navigate disclosure challenges. Findings illustrate HIV-serostatus disclosure as a complex process evolving over time, rather than a one-time event. Conclusion: Partner communication about HIV serostatus is infrequent and complicated, with gender inequalities contributing to fear, mistrust, and partial or implicit disclosure. Relationship dynamics and gender roles shape the environment within which men and women can engage successfully in the HIV-serostatus disclosure process. Integrated interventions to reduce barriers to trustful and effective communication are needed for HIV-affected men and women in partnerships in which seeking couples-based HIV counseling and testing (CHCT) is challenging or unlikely. These data offer insights to support HIV-serostatus disclosure strategies within relationships over time. Close