Successful introgression of wMel Wolbachia into Aedes aegypti populations in Fiji, Vanuatu and Kiribati.

Pacific Island countries have experienced periodic dengue, chikungunya and Zika outbreaks for decades. The prevention and control of these mosquito-borne diseases rely heavily on control of Aedes aegypti mosquitoes, which in most settings are the primary vector. Introgression of the intracellular bacterium Wolbachia pipientis (wMel strain) into Ae. aegypti populations reduces their vector competence and consequently lowers dengue incidence in the human population. Here we describe successful area-wide deployments of wMel-infected Ae. aegypti in Suva, Lautoka, Nadi (Fiji), Port Vila (Vanuatu) and South Tarawa (Kiribati). With community support, weekly releases of wMel-infected Ae. aegypti mosquitoes for between 2 to 5 months resulted in wMel introgression in nearly all locations. Long term monitoring confirmed a high, self-sustaining prevalence of wMel infecting mosquitoes in almost all deployment areas. Measurement of public health outcomes were disrupted by the Covid19 pandemic but are expected to emerge in the coming years.

Levels and Predictors of Knowledge, Attitude, and Practice Regarding the Health Hazards Associated With Barber's Profession in Fiji.

Introduction: This study aimed to determine the level and predictors of Knowledge, Attitude and Practice (KAP) among barbers regarding health hazards associated with their profession in Fiji. Methods: A quantitative study was used to assess the levels and predictors of KAP using a structured questionnaire among 117 barbers who were chosen between June and November 2020 in Suva, Fiji. All those barbershops that operated at least for 6 months, were licensed, and 18 years and above were included. A self-administrative closed-ended structured questionnaire was used to collect data. The level of KAP was assessed using the modified Bloom's cut-off points. A correlation test was used to determine predictors of KAP. Results: The majority of participants had a medium level of knowledge (62.4%), medium level of attitude (63.2%), and low level of practice (64.1%) towards health hazards associated with barbering the profession. However, 28.2% had low knowledge and attitude scores. The major source of knowledge was through the internet. The results of the correlation test showed that religion, education level, and weekly income were significantly correlated with knowledge (<.05) whereas age and weekly income was significantly correlated with the level of attitude of participants towards health hazards associated with their profession (<.05). Conclusion: Barbers had medium knowledge and attitude towards health hazards associated with the barbering profession while their practice was poor. These findings call for prompt and target group interventions such as strengthening enforcement, awareness, training on equipment decontamination and Good Hygiene Practices to be conducted.

What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation?

OBJECTIVE: Ketamine has become the drug most favoured by emergency physicians for sedation of children in the ED. Some emergency physicians do not use ketamine for paediatric procedural sedation (PPS) because of concern about emergence delirium on recovery. The present study set out to determine the true incidence and nature of this phenomenon. METHODS: Prospective data relating to any emergence agitation, crying, hallucinations, dreams, altered perceptions, delirium and necessary interventions were recorded in consecutive cases of ketamine PPS from March 2002 to June 2007, and analysed. Standard inclusion and exclusion criteria for the use of ketamine were followed. RESULTS: A total of 745 prospective data collection records were available for analysis over the 5 year period. Of all, 93 (12.5%) children cried on awakening when recovering from PPS, 291 (39%) experienced pleasant altered perceptions and 16 (2.1%) experienced what was called 'emergence delirium'. None required any active treatment and all except one settled within 20 min. There was no evidence of an increased rate of nightmares on telephone follow up in the weeks post procedure. CONCLUSION: The belief that ketamine, in the doses used for ED PPS, causes frequent emergence delirium is flawed. A pleasant emergence phenomenon is common, but is not distressing for the child, and has no long-term (up to 30 days) negative sequelae. Rarely, there is anxiety or distress on awakening from ketamine sedation, which settles spontaneously. This should not deter emergency physicians from using ketamine for PPS.

Optimization of propofol dose shortens procedural sedation time, prevents resedation and removes the requirement for post-procedure physiologic monitoring.

OBJECTIVE: To examine the effect of propofol dosing (total dose and number of doses) on patient sedation time and likelihood of resedation. METHODS: This was a prospective, observational patient series in an urban district hospital ED with 42 000 attendances per annum. Patients undergoing an emergent procedure requiring procedural sedation were included. Titrated intravenous propofol was administered according to departmental procedure. Standardized consent and data collection forms were used. Time taken for the patient to become conversational after first administration was recorded and any resedation documented. RESULTS: Four hundred patients, undergoing 404 procedures, were enrolled for the period commencing August 2004 until March 2006. The mean initial propofol bolus was 0.8 mg/kg (SD 0.6), and mean total propofol dose was 1.8 mg/kg (SD 1.0), comprising a mean of 2.3 (SD 2.1) doses of 15.8 mg (SD 11.4). Mean sedation time was 11.8 min (SD 6.9), and increased sedation times were associated with higher total propofol dose and number of boluses (P < 0.0001). Resedation occurred in two patients (0.5%, 95% CI 0-1.6%). CONCLUSION: Shorter sedation times are seen with lower doses of propofol. Patients do not need prolonged post-procedure monitoring because the occurrence of spontaneous resedation associated with propofol use is a rare event. This has implications for patient flow and staff resource allocation in a busy ED.