bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors influencing length of hospital stay during the intensive phase of multidrug resistant tuberculosis treatment at Amhara Regional State hospitals, Ethiopia: retrospective follow up study
Authors: Tamirat Koku Sisay , Andargie Gashaw , Babel Yaregal Animut
Published: March 2020

Background: Tuberculosis (TB) generally considered as an ambulatory disease. However, hospitalization remains an important component for isolation and medical stabilization of patients. Hence, this study aimed to identify factors influencing the length of hospital stay during the intensive phase of multidrug resistant tuberculosis treatment at Amhara Regional State hospitals, Ethiopia: retrospective follow up study.Methods: An institution based retrospective follow up study was conducted at three hospitals, namely the University of Gondar comprehensive specialized, Borumeda and Debremarkos referral from September 2010 to December 2016 (n=465). Data were extracted from hospital admission/discharge logbooks and individual patient medical charts. Logistic regression was used to identify factors associated with longer hospital stays during the intensive phase of multidrug resistant tuberculosis treatment.Result: Most patients (92.5%) had a pulmonary form of multidrug resistant tuberculosis and a quarter of them HIV co-infections. The median length of hospital stay was 61 (interquartile range 34 to 101) days. The pulmonary form of tuberculosis (Adjusted odds ratio [AOR], 3.20, 95% confidence interval [CI]; 1.28 to 7.96), treated at the University of Gondar (AOR= 2.11, 95%CI; 1.02 to 4.41) and Borumeda Hospital (AOR= 3.59, 95%CI; 1.67 to 7.72), functional status of ambulatory (AOR=2.25, 95% CI; 1.19 to 4.27) and bedridden (AOR= 3.39, 95%CI; 1.57 to 7.35), and reported adverse drug reactions (AOR=2.54, 95%CI; 1.60 to 4.02) were significant predictors of extended hospital stays.Conclusion: The study revealed that longer hospital stay and significant differences were observed among hospitals. Decreased functional status at admission, pulmonary form of tuberculosis and reported adverse drug reactions were determinants of longer hospital stays. This underscores the importance of early case detection and prompt treatment of adverse effects.
Spatial Distribution and Associated Factors of Neonatal Mortality in Ethiopia: using Ethiopian Demographic and Health Survey 2016
Authors: Deres Gedamnesh Bitew , Teshome Destaw Fetene , Lakew Ayenew Molla
Published: March 2020

Background: Neonatal mortality is continuing on top of the agenda of public health and international development agencies. In Ethiopia, it is still high accounts 60% infant mortality and 43% of under-five mortality. However, the distribution of the problem across the regions of Ethiopia is not well addressed. Therefore, this analysis aimed to assess spatial distribution of neonatal mortality and identify associated factors in Ethiopia using the 2016 Ethiopian Demographic Health Survey (EDHS). Exploring spatial distribution and identifying associated factors is important to select priority areas and design effective intervention program to reduce neonatal mortality. Methods: The analysis included 7,193 live births, selected by stratified two-stage cluster sampling techniques. Spatial analysis was done to explore spatial distribution of neonatal death using Geographic information system and Sat scan. Multilevel logistic regression was fitted to identify individual and community level factors associate with neonatal mortality. Results: The hot-spot areas for neonatal mortality were Amhara, West Tigray, northeast, southwest and central part of Oromia. Mother’s with age >35 years (AOR=2.25, 95CI%: 1.47, 3.45), family size of 3-5 (AOR=0.14, 95CI%: 0.06, 0.36) and 6 and above (AOR=0.08, 95%CI: 0.02, 0.20), male neonates (AOR=3.45, 95%CI: 2.27, 5.22), smaller birth size (AOR=1.61, 95%CI: 1.02, 2.54), birth interval less than 2 years (AOR=3.58, 95%CI: 1.66, 7.70) and 2 years and more (AOR=2.54, 95%CI: 1.26-5.11), early initiation of breast feeding (AOR=0.20, 95%CI: 0.09-0.42), had no ANC visit (AOR=1.68, 95%CI: 1.08, 2.60), did not receive PNC services (AOR=3.58, 95%CI: 1.13 -11.33) and C/S delivery (AOR=19.55, 95%CI: 8.07, 47.34) were statistically significant variables for neonatal mortality. Conclusions: High risk areas for neonatal mortality were identified in northern, central and southwest part of the Ethiopia. Individual level variables were important factors associated with neonatal mortality. Focusing on maternal health care services, increase birth interval and initiation of breast feeding early will be needed to reduce neonatal mortality.
Prevalence of Primary Headache Disorders among Information Technology Staff in China: The Negative Effects of Computer Use and Other Correlative Factors
Authors: Li Chunlin , Zhang Lei , Zhou Jin , Fan Zhiliang , Wang Yan , Wang Xiaolin , Wang Weidong , Yu Shengyuan
Published: March 2020

Background To date, there have been very few studies that have explored the relationship between headaches and computer use. The chief aim of this study is to investigate the prevalence of primary headache disorders among informational technology staff and identify the potential factors contributing to it. Methods This is a cross-sectional study based on annual health checks of employees from the information technology industry. We identified 2216 information technology staff members from Beijing by stratified random sampling who met the inclusion criteria. All participants were initially required to have a physical examination, after which they complete a general situation questionnaire that included a headache screening question. Those who had suffered from headache within the previous year also completed the questionnaire developed by Lifting the Burden. The International Classification of Headache Disorders 3(ICHD-3) criteria was used for the diagnosis of headache. Results A total of 2012 valid questionnaires (males, 1544; females, 468) were obtained from 2216 participants for a response rate of 90.8%. A total of 619 participants were diagnosed with primary headache, the one-year prevalence of which was 30.8%. Regarding the classification of the primary headache, 152 participants suffered from migraine, with a one-year prevalence of 7.6%; 440 and 27 suffered from tension-type headache and unclassified headaches, with one-year prevalences of 21.9% and 1.3%, respectively. Multivariate regression analysis showed that female gender was a risk factor for migraine and tension-type headache (OR 3.21 and 1.88, respectively). Age was also related to migraine and tension-type headache. The 41-50 age group had 2.02 times the probability of migraine, and the 31-40 age group had 1.89 times the probability of tension-type headaches compared to the 18-30 age group. Obesity and excessive computer use (more than 12 hours per day) were also factors contributing to tension-type headache (OR: 2.61 and 1.63, respectively). Conclusions The one-year prevalence of primary headache in this population was 30.8%. The prevalence of tension-type headache in this population was higher than that in the general Chinese population. The occurrence of primary headache is correlated with many factors, among which excessive computer use significantly contributed to the risk of tension-type headache.
Planning and optimising a digital intervention to reduce older adults' cognitive decline
Authors: Essery Rosie , Pollet Sebastien , Smith Kirsten A , Mowbray Fiona , Slodkowska-Barabasz Joanna , Denison-Day James , Hayter Victoria , Bradbury Katherine , Grey Elisabeth , Western Max J , Milton Alexander , Hunter Cheryl , Ferrey Anne E , Müller Andre Matthias , Stuart Beth , Mutrie Nanette , Griffin Simon , Kendrick Tony , Gudgin Bernard , Phillips Rosemary , Stokes Tom , Niven John , Little Paul , Yardley Lucy
Published: March 2020

BackgroundBy 2050 worldwide dementia prevalence is expected to triple, rising to 152 million. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the development of ‘Active Brains’: a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults, and key findings arising from this process.MethodsA theory-, evidence- and person-based approach to intervention development was undertaken. Scoping reviews and behavioural analysis contributed to intervention planning. Optimisation involved qualitative interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes.ResultsThe development process synthesised findings from planning and optimisation activities. Scoping reviews and qualitative interviews suggested that the same intervention content should be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of highly acceptable intervention content and functionality for target users.ConclusionsA digitally-delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention, the insights obtained through our development process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.
The Bat Meat Chain and Perceptions of the risk of contracting Ebola in the Mount Cameroon Region
Authors: Akem Efuet Simon , Pemunta Ngambouk Vitalis
Published: March 2020

Background Local people’s interaction with bats render them vulnerable to Ebola Virus Disease (EVD). This paper examines perceptions of risk involved in the hunting, handling, processing and consumption of bat meat in the Mount Cameroon region of Southwest Cameroon. It focuses on the myriad cultural beliefs, gendered patterns of activity and institutional arrangements in which the bat meat production chain is embedded. Methods We conducted 30 ethnographic interviews with a sample of purposively selected men and women involved in the bat meat trade. The interviews were tape recorded, transcribed verbatim and inductive analysis was performed on the data. Findings The findings suggests that more urban men than villagers and hunters consume bat meat. Different practices and behaviours expose the mostly uneducated, young, single men and women to the risk of Ebola infection depending on their differential level of intervention in the human-bat interaction and value chain linking hunters, sellers and customers. The killing of bats with the mouth during hunting expose hunters (young men) while the preparation of bat carcasses for consumption also put women, (mostly young and unmarried) at risk. Conclusions This study demonstrates that the complexity and nuances of gender, poverty and Ebola outcomes predispose some marginal groups to the risk of infection with zoonotic diseases. There is the need to improve public health intervention and health education among the rural masses in the Mount Cameroon region.
Reaching hard-to-reach men through home-based couple HIV testing among pregnant women and their male partners in Western Kenya: A qualitative study
Authors: Krakowiak Daisy , Makabong’o Pamela , Goyette Marielle , Kinuthia John , Osoti Alfred Onyango , Asila Victor , Gone Molly Ann , Mark Jennifer , Farquhar Carey
Published: March 2020

Background Globally only 79% of HIV positive adults know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach population for HIV testing. Home-based HIV couple testing during the antenatal period is a safe and effective method that has been used to test male partners of pregnant women. The goal of this qualitative study was to identify elements that made couple testing successful and describe important characteristics of this home-based intervention from couples’ perspectives. Methods Couples who received scheduled home-based couple testing during pregnancy in Kisumu, Kenya, were purposively sampled based on HIV status from January to May 2015. An interviewer administered all of the in-depth interviews and two coders were directly involved in the data analysis and reconciled codes several times in the process. Results Twenty-one couples were enrolled: 9 concordant HIV-negative couples, 8 HIV discordant couples, 3 HIV concordant HIV-positive couples, and 1 whose concordance status was unknown. Median age at the time of home-based couple testing was 24 and 28 years for women and men, respectively. Median relationship duration was 3 years and couples had a median of two pregnancies. The major themes that emerged were that home-based couple testing 1) removed the female burden of requesting couple testing, 2) overcame logistical barriers associated with clinic-based testing, 3) encouraged participants to overcome their fear of testing and disclosure, 4) was preferred due to privacy in the home, and 5) provided quality time with the health advisors. Importantly, some women appreciated individual testing at the clinic before couple testing and some couples preferred skilled, anonymous health advisors delivering the intervention rather than known community health workers. Conclusions The results of this qualitative study suggest that home-based couple testing during pregnancy overcame many of the barriers that limit men’s access to and uptake of clinic-based testing. It encouraged participants to overcome their fear of testing and disclosure through a setting that afforded privacy and quality time with skilled health advisors. These qualitative results may help design effective partner and couple HIV testing programs in the antenatal setting and alongside or within other assisted partner notification services.
Analysis of the Association between environmental-meteorological factors and Acute Suppurative Otitis Media: Further Epidemiological Evidence from Lanzhou, Northwestern China
Authors: Wang Xinlan , Xu Baicheng , Tian Haiyue , Wang Jinyan , Xiang Dawei , Zhong Cuiping
Published: March 2020

Objective To investigate the possible associations, lag effects and pathogenic characteristics of urban air quality on acute suppurative otitis media (ASOM）in Lanzhou, a city in Northwestern China. Methods SPSS software was used to analyze Spearman correlation between ambient environment-meteorological factors and the daily number of patient ASOM visits. The GAM of time series was used to analyze the exposure -response curve, and R software was used to calculate RR.Using above results to discuss the relationship of air pollutions , meteorological factors and morbidity of ASOM. Results The number of patients with ASOM in 2014, 2015 and 2016 were 916, 875 and 1023 respectively. There was no significant difference in three years (P=0.85). The annual visits peaked in December, the lowest in August, followed by February, Summer was less than the other three seasons. The morbidity of ASOM had a largest peak within 14 years old (53.84%), and the number of male patients 1514 (53.6%) is 1.16 times that of female patients 1309 (46.4%). Spearman correlation analysis showed that the correlation between air pollutions and environmental variables. As for single-day lag effects , there were positive correlations between PM 2.5 , PM 10 , CO, NO 2 , SO 2 and the daily number of ASOM visits, but the correlation between O 3 and ASOM did not pass the significance test . As for multi-day lag effects, PM 2.5 , PM 10 , CO, NO 2 had lagging effects on the daily number of ASOM visits, but the correlation between SO 2 and O 3 did not pass the significant test. There was a positive correlation between ATM and the daily number of patient ASOM visits, and negative correlation between T and the daily number of patient ASOM visits ,while the correlation between W, RH and ASOM was weak. Conclusions The incidence of ASOM has obvious age and seasonal characteristics. There may be some correlation between environmental-meteorological factors and the incidence of ASOM. Therefore, it is of great significance to strengthen environmental control and public health strategy in order to reduce and prevent the occurrence of ASOM diseases.
Implementing a layperson post-crash first aid training programme in Tanzania: a qualitative study of stakeholder perspectives
Authors: Ndile Menti Lastone , Saveman Britt-Inger , Outwater Anne H , Mkoka Dickson A , Backteman-Erlanson Susann
Published: March 2020

Background: In low and middle-income countries (LMICs), laypersons play a significant role in providing initial care to injured victims of traffic accidents. Post-crash first aid (PFA) training programmes for laypersons have become an important response to addressing knowledge and skills gaps in pre-hospital care. However, little is known about factors influencing effective implementation of such programmes from stakeholders’ point of view. Therefore, this study aimed to explore views of stakeholders on potential factors that may facilitate or hinder successful implementation of a PFA training programme for lay persons. Methods: Twelve semi-structured qualitative interviews with leaders at a traffic police department and leaders of an association of city bus drivers, taxi drivers and motorcycle taxis in Tanzania were conducted. Interviews were audio-recorded and transcribed verbatim. A thematic analysis approach was used to identify themes and sub-themes. Results: Three themes pertaining to implementation of a PFA training programme were identified: Motivation for engaging in training, Constrains for engaging in training and Training processes. They consisted of a total of six sub-themes: “perceived benefits of first aid training” and “availability of incentives” were considered as facilitators to PFA training. “Availability of time to attend training” and “accessibility of training” were reported as a potential barriers to successful training. Finally, they felt that “methods of training delivery” and “availability of first aid training materials and equipment” could either facilitate or impede delivery of PFA training. Conclusion: This study highlights potential facilitators and barriers to implementing a PFA training programme for lay persons from the perspectives of leaders from police department and associations of city bus drivers, taxi drivers, and motorcycle taxis. This may be useful information for other stakeholders, and may enable government-level leaders and persons higher up in the health service hierarchy to take action to meet WHO recommendations for emergency pre-hospital care.
Cross-cultural validation of the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction scale in the Dutch general population
Authors: Joxhorst Tessa , Vrijsen Joyce , Niebuur Jacobien , Smidt Nynke
Published: March 2020

BACKGROUND: This study aims to translate and validate the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale in the Dutch general population. METHODS: A random sample of Dutch residents aged between 30 and 80 years old were invited to complete an online questionnaire including the translated MCLHB-DRR scale. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to assess construct validity. Cronbach’s alpha was calculated to assess internal consistency. RESULTS: 618 participants completed the questionnaire. EFA and Cronbach’s alpha showed that four items were candidate for deletion. CFA confirmed that deleting these items led to an excellent fit (RMSEA = 0.043, CFI = 0.960, TLI = 0.951, χ²/df = 2.130). Cronbach’s alpha ranged from 0.69 to 0.93, indicating good internal consistency. CONCLUSION: The Dutch MCLHB-DRR scale demonstrated to have good validity to assess the health beliefs and attitudes towards dementia risk reduction.
Process evaluation of a national elderly nutrition care program in Iran: Perspectives of clients and providers
Authors: Kheirouri Sorayya , Alizadeh Mohammad , Foroumandi Elaheh , Khodayari-zarnaq Rahim
Published: March 2020

Background The rapid growth of Iran elderly population highlights the importance of more attention to nutritional needs of this age group. Process evaluation study on the nutritional part of the national Elderly-Integrated Care Program was conducted to examine degree of exposure and satisfaction of the targets with the program components, and assess the reach, delivery, fidelity, and external contexts of the program.Methods To evaluate perspectives of clients on elderly integrated nutrition care program (EINCP) implementation process, a self-administrated questionnaire was constructed, validated, and applied to 256 individuals with the age of above 60 years attending the program at 57 health care centers of Tabriz metropolitan area of East Azerbaijan province in Iran using convenience sampling method. Another valid questionnaire was also applied to investigate viewpoint of the perceptions of 76 staffs of these health care centers as the program providers around the EINCP.Results The reach rate of the clients was reported 20.0%. Delivery of the educational components to entire program providers was accomplished (100.0%); however, the delivery of some parts of the program to the clients had some main weaknesses. The fidelity of the program tools was considered inadequate from perspectives of both clients and providers. 77.5% of the clients had exposure to the program. Clients’ satisfaction rate was varied from 4.2 to 34.7% with various available services, but 42.8% of the clients had high satisfaction with overall parts of the EINCP. The program also suffered from some external contexts such as the lack of financial support of program providers.Conclusion The format of the EINCP and strategies related to recruitment of the clients should be improved in order to minimize the barriers highlighted in this study. The providers should focus on raising the compliance of clients to receive a higher reach rate. It is suggested that program planners add periodic monitoring and evaluation of the program.
Cardiovascular Disease Trends in Nepal - An Analysis of Global Burden of Disease Data 2017
Authors: Bhattarai Sanju , Aryal Anu , Pyakurel Manita , Bajracharya Swornim , Baral Phanindra , Citrin David , Cox Helen , Dhimal Meghnath , Fitzpatrick Annette , Jha Anjani Kumar , Jha Niharika , Karmacharya Biraj Man , Koju Rajendra , Maharjan Rashmi , Oli Natalia , Pyakurel Prajjwal , Sapkota Bhim Prasad , Shrestha Rajeev , Shrestha Soniya , Spiegelman Donna , Vaidya Abhinav , Shrestha Archana
Published: March 2020

Background Cardiovascular diseases (CVDs) are the leading cause of death and disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. The findings from this study provide a base for public health priorities and for creating evidence-informed policies.Methods We used the Institute of Health Metrics and Evaluation (IHME)’s Global Burden of Diseases (GBD) database on cardiovascular disease mortality rates, prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017. Tables, graphs and histograms are used to compare patterns and trends across all metrics. Data are presented as percentages or as rates per 100,000 population.Results In 2017, CVDs contributed to 26·9% of total deaths and 12·8% of total DALYs in Nepal. Ischemic heart disease and stroke were the predominant CVDs, contributing 16·4% and 7·5% to total deaths and 7·5% and 3·5% to total DALYs, respectively. Cardiovascular disease incidence and mortality rates have increased from 1990 to 2017, with the burden greater among males and among older age groups. The leading risk factors for CVDs were determined to be high systolic blood pressure, high low density lipoprotein (LDL) cholesterol, smoking, air pollution, a diet low in whole grains, and a diet low in fruit.Conclusion CVDs are a major public health problem in Nepal contributing to the high DALYs with unacceptable numbers of premature deaths. There is an urgent need to address the increasing burden of CVDs and their associated risk factors, particularly high blood pressure, body mass index (BMI) and unhealthy diet.
Association between malaria-related health service readiness and malaria mortality in under 5-year-old children in Burkina Faso
Authors: Millogo Ourohiré , Doamba Jean Edouard Odilon , Sié Ali , Utzinger Juerg , Vounatsou Penelope
Published: March 2020

Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso.Methods: Data on malaria-related visits and associated deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA), applied to the selected indicators, was used to construct a composite facility readiness score based on multiple factorial axes. Geostatistical models were employed to characterise the geographical distribution of facility malaria readiness. The analysis was carried out separately for 112 medical centres (“health facility order 1”; HF1) and 546 dispensaries (HF2).Results: The composite readiness score explained 30% and 53% of the original indicators for HF1 and HF2, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of HF2, compared to the low readiness group. HF1 readiness was not related to malaria mortality.Conclusion: Performant health services in resource-constrained settings are associated with lower malaria mortality rates. To accelerate progress towards malaria elimination in low-resource settings, appropriate funding should be made available to strengthen health systems.
Social, economic and family factors associated with binge drinking in Spanish adolescents
Authors: Vargas-Martínez Ana Magdalena , Trapero-Bertran Marta , Mora Toni , Lima-Serrano Marta
Published: March 2020

Background: The main aim of this study was to determine the socioeconomic and family factors associated with binge drinking in Spanish adolescents who participated in a web-based computer intervention for the prevention of binge drinking known as Alerta Alcohol. Methods: Longitudinal analyses were carried out in a sample of Andalusian adolescents aged 15 to 19 enrolled in public schools, which was part of a two-arm cluster randomized controlled trial. Panel count data and the following econometric procedures were used: negative binomial, a two-part model and a finite mixture model. A total of 1,247 subjects in the pre-intervention period, with an average age of 16.8 years, plus 612 adolescents in the follow-up period, were included in the analysis. Results: In relation to findings, being older (≥ 17 years old), having more pocket money and higher family alcohol consumption were associated with greater binge drinking. By contrast, subjects who completed the questionnaire on Wednesday, Thursday or Friday, further from the previous weekend, indicated a lower number of occasions of binge drinking. Conclusions: Our results suggest the need to include families, especially parents and siblings, in interventions aimed at preventing alcohol use among adolescents, given the association shown between both weekly pocket money or availability of money to adolescents, family alcohol consumption and binge drinking. Given the findings with regard to age, future research aimed at intervening in early adolescence to prevent binge drinking would be justified.
Building Towards Common Psychosocial Measures in U.S. Cohort Studies: A Qualitative Assessment of Principal Investigators’ Views regarding the Role of Spirituality in Human Health
Authors: Shields Alexandra E. , Balboni Tracy
Published: March 2020

Background. The goal of this study was to understand prospective cohort Principal Investigators’ (PIs’) attitudes regarding the importance of religion and spirituality (R/S) on disease etiology in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research.Methods. One-hour, semi-structured qualitative interviews were conducted with 20 PIs representing 24 National Institutes of Health (NIH)-funded prospective cohort studies in the US, collectively capturing health data on 1 in 100 Americans. Sample size was calculated to achieve thematic saturation.Results. The majority of PIs we interviewed saw R/S as a potentially important area to investigate to better understand disease etiology, but some were unsure about the mechanisms through which R/S can impact health and how to translate this knowledge into public health interventions. PIs identified 5 key areas that are lacking in current R/S research that need to be addressed in future research to convince them of collecting more R/S measures in their cohorts: (1) high-quality, prospective studies; (2) examining a plausible biological mechanism; (3) commonly collected, well-validated R/S measures; (4) addressing bias against R/S research; and (5) NIH funding for R/S research.Conclusions. Results of this study provide a roadmap for future R/S research investigating the impact of R/S on disease etiology in the context of U.S. prospective cohort studies. Such research could provide potentially important information concerning how to address existing health disparities in the U.S.
Transitions in Adolescent Boys and Young Men’s High-Risk Sexual Behaviour in India
Authors: Sharma Santosh Kumar , Vishwakarma Deepanjali
Published: March 2020

Background: The study aims to understand the transitions in adolescent boys and young men’s high-risk sexual behaviour in India using two rounds of Indian demographic health survey, NFHS-3 (2005-06) and NFHS-4 (2015-16). Methods: A total of 25,538 in NFHS-3 (2005-06) and 35,112 in NFHS-4 (2015-16) men were considered for the analysis. Men have been divided into two age groups as 15-19 years (adolescent) and 20-24 (young men) for comparison purposes. Descriptive and multivariate statistics have been used.Results: A significant decline was observed in the proportion of adolescent boys (from 11% to 8%) and young men (from 44% to 38%) among those who ever had sexual intercourse during the last decade. Adolescent boys and young men living in rural areas have also developed live-in-relationship as men belonging to urban areas over the last ten years. Adolescent boys having 10th and above years of education, residing in urban areas and belonging to the affluent class of households were more likely to engage in high-risk sexual activity than the young men in India. Conclusions: Findings conclude that early sexual debut and multi-partner sexual behaviour among adolescent boys put them at higher-risky sexual behaviour as compared to young men. Adolescent’s’ sexual behaviours have both short-term and long-term consequences, and interventions that focus on multiple domains of risk may be the most effective in helping to promote broad reproductive health among young adults.
Modifiable risk factors for non-communicable diseases among medical and non-medical University students in Dar es Salaam, Tanzania: A cross sectional study
Authors: Abdulbasat Suddeys , Kazaura Method
Published: March 2020

Background: Currently, non-communicable diseases (NCDs) are among the global health problems accounting for more than 70% of deaths. Yet, healthcare, workers, university and college students who are key educators to the public are at high risk of NCDs. The objective of this study was to assess modifiable risk factors for NCDs among medical and non-medical university students in Dar es Salaam, Tanzania.Methods: A cross-sectional study included respondents from six universities; split equally between medical and non-medical programmes. From universities with medical programmes, we randomly selected students in clinical track. We administered a modified WHO STEP-1 questionnaire to collect data on modifiable risk factors of NCDs.Results: A total of 574 students participated in the study. Of these, 315 (54.9%) undergraduates were in medical programmes. Few, 7 (3.1%), of the non-medical undergraduates and 14 (4.7%) of the non-medical undergraduates had none of the NCDs risk factors. The proportion of harmful alcohol consumption among medical and non-medical university students was 15 (4.8%) and 6 (2.3%) respectively. Students reporting sedentary lifestyle was significantly (p < 0.01) higher among non-medical undergraduates, 97 (37.5%), as compared to 82 (31.2%) students in non-medical universities. Undergraduates in non-medical programmes have 10% significantly increased prevalence ratio of high modifiable risk as compared to medical university students, (aPR=1.1, 95%CI: 1.0–1.2) independent of age and sex.Conclusion: Tobacco and armful alcohol consumption among students in medical and non-medical universities is low. Reported physical inactivity and unhealthy diet are high. We suggest broader communication strategies targeting university students in medical and non-medical programmes on dangers of NCDs and awareness of their modifiable risk factors.
Examining the association between HIV prevalence and socioeconomic factors among young people in Zambia: Do neighbourhood contextual effects play a role?
Authors: Nakazwe Chola , Fylkesnes Knut Martin , Michelo Charles , Sandøy Ingvild F.
Published: March 2020

Background: Evidently, socioeconomic factors are strongly associated with HIV infection, however, the pattern of association varies. Understanding how these factors influence HIV infection can help public health authorities design targeted comprehensive prevention strategies. Methods: We used multi-level logistic regression models to examine the association of individual and neighbourhood level variables on HIV prevalence based on data from the 2013-14 Zambia Demographic and Health Survey, a population-based cross-sectional survey. The analysis was restricted to young people (15–24 years) with HIV serostatus results (n= 11,751). HIV serostatus was the outcome variable and socioeconomic status was measured by wealth, education and employment.Results: Overall, at individual level, an additional year of education was associated with 5% and 2% reduced odds of infection among young women and men, respectively. Conversely, relative wealth and employment were associated with increased odds of infection among women, while among men the socioeconomic factors were associated with reduced odds of HIV infection. Living in neighbourhoods with medium proportion employed residents and neighbourhoods with higher average level of education were associated with a tendency of higher odds of HIV infection. Thirty percent and 9% of the variation in HIV infection among young men and women, was attributed to neighbourhoods. Inclusion of individual variables to the intercept-only model accounted for 34.9% and 58.1% of the variance for men and women, and reduced the unexplained variance by an average of 17%. However, adding neighbourhood variables to the intercept-only model explained a relatively small part of the variance (0.04 for men and 0.06 for women), and adding the cluster variables to the individual variables only lead to a slight increase in R-squared (explained variance) (36.2% and 58.4%).Conclusion: Our study shows that individual-level socioeconomic factors are clearly associated with young people’s vulnerability to HIV infection in Zambia and that community level factors are less important than previous studies in selected areas of Zambia have indicated. However, the high neighbourhood variation among men, which was mostly unexplained, indicates that there are dynamics within communities, possibly affecting the way people interrelate, that can put them at increased risk.
Migrants’ and refugees’ health status and healthcare in Europe: A scoping literature review
Authors: Lebano Adele , Hamed Sarah , Bradby Hannah , Gil-Salmerón Alejandro , Durá-Ferrandis Estella , Garcés-Ferrer Jorge , Azzedine Fabienne , Riza Elena , Karnaki Pania , Zota Dina , Linos Athena
Published: March 2020

Background There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. Methods This review scoped seventy seven papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants’ access to healthcare. The review aims at identifying what is known about access to healthcare and healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onward. Results The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described. Conclusions The European situation concerning migrants’ and refugees’ health status and access to healthcare is heterogenous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants’ health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants’ own views on their health and barriers to access to healthcare is key.
A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa
Authors: Lebina Limakatso , Oni Tolu , Alaba Olufunke A. , Kawonga Mary
Published: March 2020

Background Chronic care models like the Integrated Chronic Disease Management (ICDM) model are innovative strategies to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to identify moderating factors of implementation fidelity of the ICDM model. Methods This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors on the implementation fidelity of the ICDM model. A total of 30 healthcare workers from four clinics with different levels of implementation fidelity of the ICDM model were interviewed. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically. Results The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3)years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that was said to compromise fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. Conclusion There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors of the implementation fidelity of the ICDM model. Augmenting some of the elements, like supply chain management and leadership support, could further improve the degree of fidelity during the implementation of the ICDM model.
Establishing a pain management program in cardiology: what we can learn from social marketing and normalization process theory Implementation of pain management in cardiology
Authors: Bode Kerstin , Doerschner Miriam , Bauer Yvonne , Hindricks Gerhard , Ali Haider
Published: March 2020

Background We analyzed how a pain management program (PMP) in a cardiology department of a high-volume center was implemented into daily practice. The results provide some very valuable insights into the dynamics of complex professional behavioral changes, including the barriers to and facilitators of such changes. Methodology The behavioral dynamics during the implementation of the PMP were analyzed using normalization process theory (NPT) because NPT reflects both individual and collective contributions. NPT elements were then studied in their relation to social marketing tools, especially the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy. Where the EPOC tools did not wholly reflect the scope of the PMP, further marketing concepts were introduced. Results The frameworks used provided a useful structure to analyze the behavior change intervention, yielding insights into significant aspects of the change process (such as barriers and facilitators) at the level of the individual, within groups, and across the organization. By also integrating EPOC with NPT, we show how improvements in PMP tangibility can aid communication between PMP leaders and project participants. We also show how value can be co-created between the two groups. Conclusion Hospitals represent complex environments where effective behavior modification requires changes at many different levels. Nevertheless, we demonstrated, using NPT and the incorporation and adaptation of social marketing/EPOC tools, that an intervention designed to change behavior could succeed even in such extreme conditions.
The Impact of Legalization of Access to Recreational Cannabis on Canadian Medical Users with Cancer.
Authors: Hawley Philippa Helen , Gobbo Monica , Afghari Narsis
Published: March 2020

Background Canada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that would be of use to other countries considering similar legislation. Method Two identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia, 5 months apart (2 months before and 3 months following legalization), with the same eligibility criteria. The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed. Results The overall response rate was 27% with 821 and 852 individuals returning the first and second surveys respectively. Both cohorts were similar regarding participants’ characteristics, including age (median= 66yrs), gender (53% of participants were female), and education (one-third of participants had an education level of high school or less). Comparison of the two cohorts showed that legalization increased the prevalence of current cannabis use by 21% (23·1% to 29·1%, p-value 0·01). However, after legalization, Current Users reported more issues in getting cannabis (18% compared to 8%, p-value: <0·01). The most common barrier cited was lack of available preferred products, from closure of illegal dispensaries. Conclusions Results showed that legalization of access to cannabis for recreational purposes will have an unintended negative impact on those who use cannabis products for medical purposes. These should be anticipated and mitigated in the design and implementation of new legislation. Keywords Cannabis, Cancer, Survey, Symptom Management
Effects of Pruning at Planting on Pecan Trunk Development and Total Shoot Growth
Authors: Ouedraogo Frederic B. , Brorsen B. Wade , Biermacher Jon T. , Rohla Charles T.
Published: March 2020

Pecan (Carya illinoinensis) trees were pruned using varying intensities at planting to determine the effect of pruning on trunk development and shoot growth. Data on trunk diameter, number and length of shoots, as well as the total shoot growth were recorded annually from a completely randomized design experiment that assigned 0%, 50%, and 75% pruning of above-ground height to single-trunk transplants. The results suggest that pruning intensity has little effect on trunk diameter. The pruned trees had fewer shoots initially and more growth per shoot, leading to a difference of 7 cm/shoot higher for the 50% pruning group than the control group and to a difference of 11 cm/shoot higher for the 75% pruning group compared with the control group. The total length of all shoots was not significantly different across treatments. Because previous research has sometimes shown that pruning increases tree survival and this research shows that trees can recover from pruning, there is no need to change the current recommendation of pruning seedlings at planting.