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Conventional HIV testing services have been less comprehensive in reaching men than in reaching women globally, but HIV self-testing (HIVST) appears to be an acceptable alternative. Measurement of linkage to post-test services following HIVST remains the biggest challenge, yet is the biggest driver of cost-effectiveness. We investigated the impact of HIVST alone or with additional interventions on the uptake of testing and linkage to care or prevention among male partners of antenatal care clinic attendees in a novel adaptive trial. An adaptive multi-arm, 2-stage cluster randomised trial was conducted between 8 August 2016 and 30 June 2017, with antenatal care clinic (ANC) days (i.e., clusters of women attending on a single day) as the unit of randomisation. Recruitment was from Ndirande, Bangwe, and Zingwangwa primary health clinics in urban Blantyre, Malawi. Women attending an ANC for the first time for their current pregnancy (regardless of trimester), 18 years and older, with a primary male partner not known to be on ART were enrolled in the trial after giving consent. Randomisation was to either the standard of care (SOC; with a clinic invitation letter to the male partner) or 1 of 5 intervention arms: the first arm provided women with 2 HIVST kits for their partners; the second and third arms provided 2 HIVST kits along with a conditional fixed financial incentive of $3 or $10; the fourth arm provided 2 HIVST kits and a 10% chance of receiving $30 in a lottery; and the fifth arm provided 2 HIVST kits and a phone call reminder for the women's partners. The primary outcome was the proportion of male partners who were reported to have tested for HIV and linked into care or prevention within 28 days, with referral for antiretroviral therapy (ART) or circumcision accordingly. Women were interviewed at 28 days about partner testing and adverse events. Cluster-level summaries compared each intervention versus SOC using eligible women as the denominator (intention-to-treat). Risk ratios were adjusted for male partner testing history and recruitment clinic. A total of 2,349/3,137 (74.9%) women participated (71 ANC days), with a mean age of 24.8 years (SD: 5.4). The majority (2,201/2,233; 98.6%) of women were married, 254/2,107 (12.3%) were unable to read and write, and 1,505/2,247 (67.0%) were not employed. The mean age for male partners was 29.6 years (SD: 7.5), only 88/2,200 (4.0%) were unemployed, and 966/2,210 (43.7%) had never tested for HIV before. Women in the SOC arm reported that 17.4% (71/408) of their partners tested for HIV, whereas a much higher proportion of partners were reported to have tested for HIV in all intervention arms (87.0%-95.4%, p < 0.001 in all 5 intervention arms). As compared with those who tested in the SOC arm (geometric mean 13.0%), higher proportions of partners met the primary endpoint in the HIVST + $3 (geometric mean 40.9%, adjusted risk ratio [aRR] 3.01 [95% CI 1.63-5.57], p < 0.001), HIVST + $10 (51.7%, aRR 3.72 [95% CI 1.85-7.48], p < 0.001), and phone reminder (22.3%, aRR 1.58 [95% CI 1.07-2.33], p = 0.021) arms. In contrast, there was no significant increase in partners meeting the primary endpoint in the HIVST alone (geometric mean 17.5%, aRR 1.45 [95% CI 0.99-2.13], p = 0.130) or lottery (18.6%, aRR 1.43 [95% CI 0.96-2.13], p = 0.211) arms. The lottery arm was dropped at interim analysis. Overall, 46 male partners were confirmed to be HIV positive, 42 (91.3%) of whom initiated ART within 28 days; 222 tested HIV negative and were not already circumcised, of whom 135 (60.8%) were circumcised as part of the trial. No serious adverse events were reported. Costs per male partner who attended the clinic with a confirmed HIV test result were $23.73 and $28.08 for the HIVST + $3 and HIVST + $10 arms, respectively. Notable limitations of the trial included the relatively small number of clusters randomised to each arm, proxy reporting of the male partner testing outcome, and being unable to evaluate retention in care. In this study, the odds of men's linkage to care or prevention increased substantially using conditional fixed financial incentives plus partner-delivered HIVST; combinations were potentially affordable. ISRCTN 18421340.

Purpose of the Review As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful. Recent Findings Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients. Summary Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.

\"The brilliant new book from the multiple Sunday Times bestselling author that will explains the principles behind maintaining a healthy mind and body. The mind and body are often talked about as separate entities, but it's only when they work in harmony with one another that one can truly push oneself to the highest heights. In his new book, Ant Middleton lays out and explains the principles that he lives by to best keep his mindset and body as strong as they can possibly be\"--Publisher's description.

Background Anxiety and depression caused by gestational diabetes can lead to adverse outcomes for both the mother and the baby. Mental health self-care counseling focusing on awareness, recognition, and coping strategies can play a protective role. This study aimed to determine the effect of a mental health-based self-care counseling model on anxiety and depression in women with Gestational Diabetes Mellitus (GDM). Methods This randomized clinical trial was conducted from June 2023 to May 2024 on 84 pregnant women with gestational diabetes at Amir al-Momenin Hospital in Semnan. After block randomization, the women were divided into a self-care mental health counseling group (42 participants) and a control group (42 participants). The intervention group received six individual weekly sessions (30–45 min each) of computer-linked self-care mental health counseling. Data were collected before, immediately after, one month after the intervention, and six weeks after delivery using the questionnaires including demographic and reproductive, Hospital Anxiety and Depression Scale (HADS), health behavior during Pregnancy, mental health self-care, and gestational diabetes self-efficacy. Results The study results showed that the mean (standard deviation) anxiety scores in the intervention and control groups were 6.85 (2.11) and 7.31 (2.26) before the intervention, 4.02 (1.78) and 7.49 (1.73) at the end of the intervention, 3.88 (1.56) and 7.13 (1.36) one month after the intervention, and 2.07 (1.14) and 4.14 (1.16) six weeks after delivery ( p  < 0.001, η² = 0.56), respectively. For depression scores, the two groups had means of 6.03 (2.15) and 6.10 (1.71) before the intervention, 4.07 (1.20) and 5.82 (1.88) at the end of the intervention, 3.62 (1.12) and 5.82 (1.35) one month after the intervention, and 5.15 (1.25) and 8.62 (1.62) six weeks after delivery ( p  < 0.001, η² = 0.60). Compared to the control group, intervention group showed a significant reduction in mean anxiety and depression scores at all three follow-ups after the intervention. Additionally, the mean scores for health-promoting behaviors, mental health self-care, and self-efficacy increased significantly more in the intervention group. Based on linear regression analysis, mental health self-care was the strongest predictor of reduced anxiety and depression (β = -0.393, p  < 0.001). Conclusion Mental health-based self-care counseling is effective in reducing anxiety and depression, as well as promoting health behaviors, self-efficacy, and mental health self-care in women with gestational diabetes. Therefore, it is recommended as a valuable strategy for managing the complications of gestational diabetes. Trial registration IRCT20230130057274N1. Date of registration: 2024-08-06.

Background As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education’s effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. Methods To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. Results Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (β = 4.15, p  < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (β = − 0.25, p  < 0.05), taking aspirin (β = 0.76, p  < 0.05), and having a history of hospitalization (β = 0.91, p  < 0.05). Conclusions We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management. Trial registration number : PACTR201908812642231

A physician who defeated cancer provides information and simple guidelines on regenerating cells to recover from and prevent life-threatening or chronic illness, rebuilding the body's strength by eliminating toxic fat, and revitalizing one's life with new hope and energy.

An essential read for anyone experiencing low level anxiety or stress, this book pulls together the various individual strands of business logic, scientific research, self-care, spirituality and common sense to provide a one-stop guide to thriving at work. The widespread 'more for less' attitude is creating a dramatic rise in work-related stress and a higher ratio of staff sickness. Not only does this create a fiscal impact upon the organisation and the broader economy but it has the potential to create significant long-term mental health issues for employees. You cannot always alter the demands of your professional or personal lives but, by understanding more about how your brain functions and by actively pursuing well-being techniques, you can enhance the skills that help you manage and succeed at the challenges thrown at you and reduce the risks associated with burnout. With a focus on improving mindfulness, motivation and productivity, this book offers sound, practical advice and strategies for self-care whatever your working environment and whatever stage you are at in your career.