Health consequences of sex trafficking: A systematic review

Background: Sex trafficking is one of the most common forms of human trafficking globally. It is associated with health, emotional, social, moral and legal problems. The victims of sex trafficking when returned home are often ignored. This study aimed to explore the health consequences of sex trafficking among women and children. Methods: Medline EMBASE, PsycINFO and CINAHL were systematically searched, from date of inception to July 2016 using a combination of Medical Subject Headings (MeSH) and text words on health risks and consequences of sex trafficking. Electronic searches were supplemented by searching the reference lists of included papers and citation tracking. Both Qualitative and quantitative primary studies published in English and exploring health-related problems among sex trafficked women and children were included in this review. Health outcomes considered were: physical, psychological or social risks and consequences of sex trafficking among women and children. No restrictions were applied to geographical regions as sex trafficking involves victims being trafficked between different countries, and within countries. Data were extracted and study quality independently appraised by two reviewers and narrative synthesis was conducted for this review. Results: A total of fifteen articles were included covering health risks and well-being related to sex trafficking. Sexual and physical violence among victims such as rape and repetitive stress and physical injuries were common. The prevalence of STI (sexually transmitted infections) and HIV (human immunodeficiency virus) was also reported as high. Being trafficked at a young age, having been in brothels for a longer period and sexual violence and forced prostitution were linked with a higher risk for HIV infection. Physical health problems reported included headaches, fatigue, dizziness, back pain, memory problem, stomach pain, pelvic pain, gynaecological infections, weight loss, lesions or warts, unwanted pregnancies and abortions. The studies on mental health reported that depression, anxiety and post-traumatic stress disorder (PTSD) were commonly reported health consequences among sex trafficking victims. Conclusion: there is a compelling need for interventions raising awareness about sex trafficking among young girls and women most at risk of being trafficked. Most studies in this review have focussed on the physical health problems of the trafficked victims although there is also remarkable mental burden amongst those victims. Key policy makers, government officials, public health officials, health care providers, legal authorities and non-governmental organisations (NGOs) should be made aware about the health risks and consequences of trafficking. Trafficking consequences should be recognised as a health issue and all the sectors involved including regulating bodies should collaborate to fight against sex trafficking. Due to the heterogeneity of the articles, no meta-analysis could be conducted

Acting as external examiners in UK: going beyond quality assurance

Traditionally the role of the external examiners in UK universities or more formally Higher Education Institutions (HEIs) is that of quality assurance (QA). Typically, an experienced academic who is not affiliated with the HEI (i.e., someone from another university) is invited to act as an external examiner for a particular course or a module. The external examiner’s primary role is to provide impartial and independent advice to ensure academic standards are upheld for a degree program; and that the degree is comparable with similar programs across the country and that the achievements of students are also comparable with students on courses at other universities. This primary role makes external examiners highly valued people in UK universities, and as a result, their views are nearly always taken seriously. Over and above this recognized primary role of QA, external examiners can also be engaged by the host university in other ways. These additional roles or tasks of the external examiner can help enhance teaching and learning in higher education. This chapter will reflect on the range of roles, including the ones that go beyond QA

PhD supervision in Public Health

Roles of PhD supervisors are diverse, ranging from providing in-depth discipline-specific Public Health knowledge and technical (e.g., methodological) support to the students, encouraging them towards pub-lications or conference presentations, offering pastoral support for student wellbeing, and finally prepar-ing them to defend their thesis by conducting a mock viva. Effective supervision plays a vital role in a PhD journey reflecting on the quality of the PhD work, positive PhD experience, and supervisor-student relationship. While some student-supervisors team may encounter conflicting and challenging relation-ships, many relationships between PhD supervisor(s) and students progress into mentorship through joint publications and grant applications, career advice and support establishing wider collaborative networks. Drawing from the wider experiences of the authors, this article highlights the responsibilities, opportunities, and sometimes the challenging nature of being a PhD supervisor. This reflection will inform good practices for PhD supervisors in countries including Nepal, where the numbers of PhD students in the field of Public Health is steadily increasin

Physical activity attitudes, intentions and behaviour among 18-25 year olds: a mixed method study

Peer reviewedPublisher PD

Dielectric spectroscopy on mixture of rice husk, rice husk ash and rice bran from 4 Hz to 1 MHz

In this study, mixtures of rice husk/rice husk ashes (RHA) with RB on different ratios were prepared. Dielectric permittivity (ε'), loss factor (ε") and AC conductivity (σ') were measured in the frequency range of 4 Hz to 1 MHz in ambient temperature. Results for mixture of RHA and RB indicate that a dipolar relaxation occurring between 103 - 105 Hz and the peak is depressed and shifted to lower frequency as the RB content increases in the mixture. Moreover, AC conductivity decreases as the RB content increase. This may attributed to production of natural oil content from RB. In contrast, a dielectric characteristic for RH is generally not affected by the RB contents. This study explore dielectric characteristic of mixture between RH/RHA and RB in low frequency range because lack of literature is reported on low frequency response. Additionally, the potential application of RH/RHA and RB could be explored in effort to diminish waste disposal and enhance environmental protection

Caesarean Section rates in South Asian cities: Can midwifery help stem the rise?

Introduction: Caesarean section (CS) is a life-saving surgical intervention for delivering a baby when complications arisein childbirth. World Health Organization recommends a rate of CS from 10% to 15%. However, CS rates increased steadily in recent decades and have almost doubled from 12.1% in 2000 to 21.1% in 2015. Therefore, this has become a global public health problem. The main purpose of the scoping review article is to give an overview and analysis of the rising CS use in four South Asian countries: Bangladesh, India, Nepal and Pakistan. Methods: A scoping review was carried-out using several bibliographic electronic databases (MEDLINE, EMBASE, SCOPUS, CINAHL and Web of Science), organizational websites and open access journal databases. Literature was searched from December 2011 to December 2018 for articles reporting hospital-based CS rates.Inclusion criteria were primary studies conducted ininstitutional setting in Bangladesh, India, Nepal and Pakistan and published in the English language. Results: We have included 43 studies. Together these studies show that the rate of CS is increasing in all four countries: Nepal, Bangladesh, Pakistan and India. However, this isuneven with very low rates in rural and very high rates in urban settings, theco-existence of ‘Too Little Too Late & Too Much Too Soon’. Hospital based studies have shown that the CS rate is higher in urban and private hospitals. Age, education andsocio-economic status of women, urban residence and distance from health facility are associated with CSs. CS is higher among highlyeducated affluent urban women in private hospitals in South Asian Countries. Conclusion: Rising CS rates in South Asian cities, particularly in specific groups of women, present a challenge to hospital staff and managers and policy-makers. The challenge is to avoid ‘Too Much Too Soon’ in otherwise healthy urban women and avoid ‘Too Little Too Late’ in women living in remote and rural area and in poor urban women

Prevention and management of excessive gestational weight gain: a survey of overweight and obese pregnant women

Background - Excessive gestational weight gain is associated with adverse infant, childhood and maternal outcomes and research to develop interventions to address this issue is ongoing. The views of women on gestational weight gain and the resources they would consider helpful in addressing this are however largely unknown. This survey aimed to determine the views of newly pregnant women, living in areas of social disadvantage, on 1) their current body weight and potential gestational weight gain and 2) the resources or interventions they would consider helpful in preventing excessive gestational weight gain. Methods - A convenience sample of overweight and obese pregnant women living in Fife, UK, were invited to complete a short anonymised questionnaire at their 12 week booking visit. Results - 428 women, BMI>25 kg/m2, completed the questionnaire. Fifty-four per cent of respondents were obese (231) and 62% were living in areas of mild to moderate deprivation. Over three-quarters of participants felt dissatisfied with their current weight (81%). The majority of women (60%) expressed some concern about potential weight gain. Thirty-nine percent were unconcerned about weight gain during their pregnancy, including 34 women (19%) who reported having retained weight gained in earlier pregnancies. Amongst those concerned about weight gain advice on physical activity (41%) and access to sports/leisure facilities were favoured resources (36%). Fewer women (12%) felt that group sessions on healthy eating or attending a clinic for individualised advice (14%) would be helpful. "Getting time off work" was the most frequently cited barrier (48%) to uptake of resources other than leaflets. Conclusions- These data suggest a lack of awareness amongst overweight and obese women regarding excessive gestational weight gain. Monitoring of gestational weight gain, and approaches for its management, should be formally integrated into routine antenatal care. Barriers to the uptake of resources to address weight gain are numerous and must be considered in the design of future interventions and services

A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa

Background The HIV/AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV/AIDS and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Methods Searches were conducted in Medline, Embase, Cinahl and PsychINFO according to agreed a priori criteria for studies published between 1986 and 2006. Further searches were conducted in UNAIDS and WHO (World Health Organization) websites, and 'Google'. Relevant journals were hand-searched and references cited in identified articles were followed up. Data extraction and quality assessment was carried out on studies selected for full text appraisal, and results were analysed and presented in narrative format. Results Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. Conclusion There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions

Non-pharmacological interventions to reduce the risk of diabetes in people with impaired glucose regulation : a systematic review and economic evaluation

Background The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the UK and worldwide. Before the onset of T2DM, there are two conditions characterised by blood glucose levels that are above normal but below the threshold for diabetes. If screening for T2DM in introduced, many people with impaired glucose tolerance (IGT) will be found and it is necessary to consider how they should be treated. The number would depend on what screening test was used and what cut-offs were chosen. Objective To review the clinical effectiveness and cost-effectiveness of non-pharmacological interventions, including diet and physical activity, for the prevention of T2DM in people with intermediate hyperglycaemia. Data sources Electronic databases, MEDLINE (1996–2011), EMBASE (1980–2011) and all sections of The Cochrane Library, were searched for systematic reviews, randomised controlled trials (RCTs) and other relevant literature on the effectiveness of diet and/or physical activity in preventing, or delaying, progression to T2DM.The databases were also searched for studies on the cost-effectiveness of interventions. Review methods The review of clinical effectiveness was based mainly on RCTs, which were critically appraised. Subjects were people with intermediate hyperglycaemia, mainly with IGT. Interventions could be diet alone, physical activity alone, or the combination. For cost-effectiveness analysis, we updated the Sheffield economic model of T2DM. Modelling based on RCTs may not reflect what happens in routine care so we created a ‘real-life’ modelling scenario wherein people would try lifestyle change but switch to metformin after 1 year if they failed. Results Nine RCTs compared lifestyle interventions (predominantly dietary and physical activity advice, with regular reinforcement and frequent follow-up) with standard care. The primary outcome was progression to diabetes. In most trials, progression was reduced, by over half in some trials. The best effects were seen in participants who adhered best to the lifestyle changes; a scenario of a trial of lifestyle change but a switch to metformin after 1 year in those who did not adhere sufficiently appeared to be the most cost-effective option. Limitations Participants in the RCTs were volunteers and their results may have been better than in general populations. Even among the volunteers, many did not adhere. Some studies were not long enough to show whether the interventions reduced cardiovascular mortality as well as diabetes. The main problem is that we know what people should do to reduce progression, but not how to persuade most to do it. Conclusion In people with IGT, dietary change to ensure weight loss, coupled with physical activity, is clinically effective and cost-effective in reducing progression to diabetes