METHODS: Adult PLHIV in care at five Asia-Pacific HIV clinics were enrolled at routine clinic visits between July 2019 and June 2020. Depression, substance use, sexual practice and socio-demographic data were collected using PHQ-9, ASSIST, and a study-specific questionnaire. Clinical data were accessed from medical records. Risk factors for medium- to high-risk sexual practices, defined based on total scores from the sexual practice questionnaire assessing number of sexual partners and condom use, were analyzed using logistic regression. Moderate to severe depression was defined as a PHQ-9 score >9, and moderate- to high-risk substance use as an ASSIST score ≥11 for alcohol or ≥4 for other substances.
RESULTS: Among 723 participants, median age was 38 years, 89% were male, 99% were on ART and 37% had medium- to high-risk sexual practices. Medium- to high-risk sexual practices were more common among those ≤30 years old, unemployed, and HIV status disclosed, and were more likely in participants with moderate to severe depression (aOR 2.09, 95%CI 1.17-3.74) compared to none to minimal depression, and moderate- to high-risk substance use (aOR 1.73, 95%CI 1.23-2.44) compared to those without.
CONCLUSIONS: Further integration of comprehensive sexual risk reduction strategies, mental health services and substance use harm reduction within HIV clinical settings in the region is needed.
METHODS: In-depth interviews, observations, informal conversational interviews, mystery client and critical incident technique were used. We estimated the size of FEW population using the census enumeration technique. The findings were used to inform intervention development and implementation.
RESULTS: We estimated 376 Vietnamese and 330 Thai FEWs in 2 geographical sites where they operated in Singapore. Their reasons for non-condom use included misconceptions on the transmission and consequences of STI/HIV, low risk perception of contracting HIV/STI from paid/casual partner, lack of skills to negotiate or to persuade partner to use condom, unavailability of condoms in entertainment establishments and fear of the police using condom as circumstantial evidence. They faced difficulties in accessing health services due to fear of identity exposure, stigmatisation, cost and language differences. To develop the intervention, we involved FEWs and peer educators, and ensured that the intervention was non-stigmatising and met their needs. To foster their participation, we used culturally-responsive recruitment strategies, and ensured that the trial was anonymous and acceptable to the FEWs. These strategies were effective as we achieved a participation rate of 90.3%, a follow-up rate of 70.5% for the comparison and 66.8% for the intervention group. The interventions group reported a significant increase in consistent condom use with a reduction in STI incidence compared to no significant change in the comparison group.
CONCLUSIONS: The qualitative inquiry approaches to gain access, to foster participation and to develop a culturally appropriate intervention, along with the census enumeration technique application to estimate the FEW population sizes has led to successful intervention implementation as well as safer sexual behaviour and STI incidence reduction.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT02780986 . Registered 23 May 2016 (retrospectively registered).
METHODOLOGY/PRINCIPAL FINDINGS: This study was conducted using the motion analysis technique with the reflex responses measured in terms of knee angles. Forty healthy subjects were selected and categorized into three different age groups. Patellar reflexes were elicited from both the left and right patellar tendons of each subject at three different tapping angles and using the Jendrassik maneuver. The findings suggested that age has a significant effect on the magnitude of the reflex response. An angle of 45° may be the ideal tapping angle at which the reflex can be elicited to detect age-related differences in reflex response. The reflex responses were also not influenced by gender and were observed to be fairly symmetrical.
CONCLUSIONS/SIGNIFICANCE: Neurologically normal individuals will experience an age-dependent decline in patellar reflex response.
METHODS: In the Malaysian Health and Adolescents Longitudinal Research Team (MyHEART) study, 1071 healthy secondary school students, aged 13 years old, participated in the step test. Parameters for body composition measures were body mass index z-score, body fat percentage, waist circumference, and waist height ratio. The step test was conducted by using a modified Harvard step test. Heart rate recovery of 1 minute (HRR1min) and heart rate recovery of 2 minutes (HRR2min) were calculated by the difference between the peak pulse rate during exercise and the resting pulse rate at 1 and 2 minutes, respectively. Analysis was done separately based on gender. Pearson correlation analysis was used to determine the association between the HRR parameters with body composition measures, while multiple regression analysis was used to determine which body composition measures was the strongest predictor for HRR.
RESULTS: For both gender groups, all body composition measures were inversely correlated with HRR1min. In girls, all body composition measures were inversely correlated with HRR2min, while in boys all body composition measures, except BMI z-score, were associated with HRR2min. In multiple regression, only waist circumference was inversely associated with HRR2min (p=0.024) in boys, while in girls it was body fat percentage for HRR2min (p=0.008).
CONCLUSION: There was an inverse association between body composition measurements and HRR among apparently healthy adolescents. Therefore, it is important to identify cardio-metabolic risk factors in adolescent as an early prevention of consequent adulthood morbidity. This reiterates the importance of healthy living which should start from young.