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ObjectivesTo describe and quantify the dengue-related knowledge, attitudes and practices of residents in an urban shantytown in Lima, Peru.Design/settingA cross-sectional survey of adults between 18 and 80 years living in approximately 120 blocks in Oasis, an urban shantytown situated in the low-to-middle income district of Villa El Salvador in Southern Lima. The survey was adapted from an existing survey previously used in Iquitos, Peru, and included questions relating to knowledge of dengue symptoms, transmission, prevention and current mosquito control practices.ParticipantsA total of 240 surveys were completed with 80% of respondents being female and approximately 50% of all respondents describing themselves as housewives.ResultsAlthough 97.9% of respondents had heard of dengue, only 6.2% of people knew someone who had experienced the disease. Approximately half (54.2%) of the respondents knew dengue was transmitted by mosquitoes and 51.7% were able to identify fever and one other correct symptom of dengue. Female sex was significantly associated with greater symptom knowledge (OR 2.22, 95% CI 1.08 to 4.72) and prevention knowledge (OR 2.12, 95% CI 1.06 to 4.21). Past or current higher education attendance was significantly associated with symptom knowledge (OR 2.56, 95% CI 1.25 to 5.44) and transmission knowledge (OR 3.46, 95% CI 1.69 to 7.57). Knowledge of dengue was not significantly associated with carrying out practices to control mosquitoes (OR 1.76, 95% CI 0.87 to 3.54).ConclusionsThis population demonstrated baseline dengue knowledge. However, this was incomplete and substantially less when compared with endemic areas. Given the sporadic nature of dengue transmission in Lima, it is not surprising that knowledge of the disease was not associated with carrying out practices to reduce mosquitoes. However, as dengue transmission in Lima is likely to increase, understanding how best to improve public knowledge of the disease and how to translate this into appropriate community action will be a key public health consideration.

Objective Scalable nonpharmacologic treatment options are needed for chronic pain conditions. Migraine is an ideal condition to test smartphone-based mind-body interventions (MBIs) because it is a very prevalent, costly, disabling condition. Progressive muscle relaxation (PMR) is a standardized, evidence-based MBI previously adapted for smartphone applications for other conditions. We sought to examine the usability of the RELAXaHEAD application (app), which has a headache diary and PMR capability. Methods Using the "Think Aloud" approach, we iteratively beta-tested RELAXaHEAD in people with migraine. Individual interviews were conducted, audio-recorded, and transcribed. Using Grounded Theory, we conducted thematic analysis. Participants also were asked Likert scale questions about satisfaction with the app and the PMR. Results Twelve subjects participated in the study. The mean duration of the interviews (SD, range) was 36 (11, 19-53) minutes. From the interviews, four main themes emerged. People were most interested in app utility/practicality, user interface, app functionality, and the potential utility of the PMR. Participants reported that the daily diary was easy to use (75%), was relevant for tracking headaches (75%), maintained their interest and attention (75%), and was easy to understand (83%). Ninety-two percent of the participants would be happy to use the app again. Participants reported that PMR maintained their interest and attention (75%) and improved their stress and low mood (75%). Conclusions The RELAXaHEAD app may be acceptable and useful to migraine participants. Future studies will examine the use of the RELAXaHEAD app to deliver PMR to people with migraine in a low-cost, scalable manner.

Background Progressive muscle relaxation (PMR) has level A evidence in preventing migraine and tension-type headaches. However, there is limited research on behavioral therapy for post-traumatic headache (PTH) let alone delivered via a smartphone application. Aims/objective To gain preliminary evidence as to whether smartphone based PMR is feasible for subjects with PTH. Method(s) We performed a single-arm study of prospective patients calling our Concussion Center between June 2017 and May 2018. Subjects met ICHD-3 criteria for persistent headache secondary to mTBI, were age 18–85 and 3–12 months post injury, with no prior behavioral treatments for headache in the past year. We assessed prior and current headache and neuropsychologic histories. Using the RELAXaHEAD smartphone application, subjects were instructed to record headache symptoms daily and practice 20 minutes of PMR daily. There was a 1-month follow-up assessment. Results In our ongoing study, 21 subjects are currently enrolled, 13 female (62%) with mean age 41.4 (SD 13.1, range 20–65). Nine (43%) subjects had pre-existing headaches. Subjects' injuries were on average 6 months prior to enrollment (SD 2.6, range 4–12). Three (14%) were sports-related. In the month prior to enrollment, subjects reported 19.3 headache days (SD 8.76, median 20, range 5–30). 17 (81%) subjects reported memory problems and 18 (86%) reported impaired concentration. Of 17 subjects enrolled for at least 1 month, 9 (53%) imputed data for 20 or more days within the first month (mean 17 days, SD 12.2, median 20, range 0–31). 4 (24%) practiced PMR 2 + times/wk (mean 8.4 days, SD 8.6, median 6, range 0–31). Conclusion PTH subjects' obstacles regarding adherence to mHealth technology should be further assessed before PMR efficacy can be assessed. Notably, many subjects concurrently reported difficulties with memory and concentration, which may be contributing to poor adherence. Future work will attempt to assess for differences among users vs non-users.