Travel, sexual behaviour, and the risk of contracting sexually transmitted diseases

This study investigates sexual behaviour and the risk of contracting sexually transmitted diseases among travellers departing from Hong Kong, with an aim supporting the design of local intervention in continuing health promotion. Travellers were interviewed by five trained multilingual interviewers in the departure lounge at Kai Tak International Airport, Hong Kong, between May and June 1996, by using a structured, pretested questionnaire. Forty-four percent (168/383) of the respondents who travelled at least once within the previous year had had sex with strangers during their travel and 37% (139/376) of the respondents reportedly do not use condoms during sexual intercourse. Middle-aged and married travellers were more likely to be in the high-risk group. These findings reflect the urgent need to target travellers in any strategy that is designed to prevent the spread of sexually transmitted diseases in Hong Kong and Asia Pacific region.published_or_final_versio

Predictors of smoking cessation among Chinese parents of young children followed up for 6 months

Health Services Research Fund & Health Care and Promotion Fund: Research Dissemination Reports (Series 2)published_or_final_versio

Smoking reduction intervention for smokers not willing to quit smoking: a randomised controlled trial

Key Messages 1. This smoking reduction study examined the effectiveness of smoking reduction counselling together with free nicotine replacement therapy (NRT) for smoking cessation and tested the effectiveness of brief counselling on adherence to NRT among Chinese smokers who were not willing to quit but intended to reduce cigarette consumption. 2. The smoking reduction intervention was effective in helping the unmotivated smokers in quitting (intervention: 17.0% vs control: 10.2%, P=0.012) and in reducing their daily cigarette consumption by 50% or more (intervention: 50.9% vs control: 25.7%, P<0.001) at 6-month follow-up. 3. Our results provided evidence for the effectiveness of smoking reduction intervention, which is important for planning smoking cessation services. 4. Free NRT was widely accepted by participants (8-week NRT adherence rate: 54.5%). Free NRT together with smoking reduction counselling was a feasible and cost-effective approach to help unmotivated smokers to reduce and quit smoking, especially in developing countries like China where NRT is expensive and not used extensively. 5. The motivation to quit smoking was not undermined by smoking reduction intervention. To the contrary, offering assistance to reduce smoking could attract smokers who were not willing or ready to quit.published_or_final_versio

Cause and analysis of cost of living allowance fluctuation in Yokosuka, Japan

In June 1995, an unexpected decrease in COLA index on the Kanto Plain of Japan, to include the Yokosuka area, caused concern amongst service members stationed in this area. The purchasing power of the dollar was in decline when compared to the yen and all other economic indicators at the time of the COLA decrease suggested that the COLA index should have increased or at least remained constant. What explains the apparent inconsistency between the declining value of the dollar relative to the yen and the concurrent decrease in COLA provided to service members? This thesis conducted a critical analysis of the procedures and methods used by the Per Diem, Travel and Transportation Allowance Commiflee (PDTATAC) to calculate the cost of living allowance (COLA) index and determine the cause and effect of the June 1995 decrease in COLA index. This thesis addressed the policies of the COLA system, utilizing both historical data and a stylized model, to determine if they are equitable from an economic standpoint. The analysis revealed that the Living Pattern Survey (LPS) was a viable tool to obtain information on where service members made purchases, if exchange rates were stable. If exchange rates were increasing, the LPS prevented overpayment of service members. If exchange rates were declining, the LPS reduced the 'purchasing power' of service membershttp://archive.org/details/causeanalysisofc00woodLieutenant, United States NavyApproved for public release; distribution is unlimited

Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, −0.68 (−0.91, −0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedem

Infrared Thermal Imaging as a Novel Non-Invasive Point-Of-Care Tool to Assess Filarial Lymphoedema

Lymphatic filariasis causes disfiguring and disabling lymphoedema, which is commonly and frequently exacerbated by acute dermatolymphangioadenitis (ADLA). Affected people require long‐term care and monitoring but health workers lack objective assessment tools. We examine the use of an infrared thermal imaging camera as a novel non‐invasive point‐of‐care tool for filarial lower‐limb lymphoedema in 153 affected adults from a highly endemic area of Bangladesh. Tem‐perature differences by lymphoedema stage (mild, moderate, severe) and ADLA history were vis‐ualised and quantified using descriptive statistics and regression models. Temperatures were found to increase by severity and captured subclinical differences between no lymphoedema and mild lymphoedema, and differences between moderate and severe stages. Toes and ankle temperatures detected significant differences between all stages other than between mild and moderate stages. Significantly higher temperatures, best captured by heel and calf measures, were found in partici‐pants with a history of ADLA, compared to participants who never had ADLA, regardless of the lymphoedema stage. This novel tool has great potential to be used by health workers to detect sub‐clinical cases, predict progression of disease and ADLA status, and monitor pathological tissue changes and stage severity following enhanced care packages or other interventions in people af‐fected by lymphoedema

Cigarette smokers' intention to quit smoking in Dire Dawa town Ethiopia: an assessment using the Transtheoretical Model

<p>Abstract</p> <p>Background</p> <p>Cessation of smoking reduces morbidity and mortality related to tobacco smoking. It is essential to explore the intention of individuals to quit smoking to design effective interventions. The objective of this study was to assess cigarette smokers' intention to quit smoking in Dire Dawa town using the Transtheoretical model.</p> <p>Methods</p> <p>From February 15 to 19, 2009, we conducted a community based cross-sectional study among 384 current cigarette smokers in Dire Dawa town east Ethiopia. Data was collected by trained personnel using a pretested structured questionnaire. The data was analyzed using SPSS version 16.0.</p> <p>Results</p> <p>Two hundred and nineteen (57%) smokers in the study area had the intention to quit cigarette smoking within the next six months and all the process of change had an increasing trend across the stages. Based on the Fragestrom test of nicotine dependence of cigarette, 35 (9.1%), 69 (18%) and 48(12.5%) were very high, high and medium dependent on nicotine respectively. For the majority 247(64.3%) of the respondents, the mean score of cons of smoking outweighs the pros score (negative decisional balance). Only 66(17.2%) had high self efficacy not to smoke in places and situations that can aggravate smoking.</p> <p>Conclusions</p> <p>Majority of the smokers had the intention to quit smoking. All the process of change had an increasing trend across the stages. Those who had no intention to quit smoking had high level of dependence on nicotine and low self efficacy. The pros of smoking were decreasing while the cons were increasing across the stages. Stage based interventions should be done to move the smokers from their current stage to an advanced stages of quitting cigarette smoking.</p

Safety and effi cacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial

Background Severe infections remain one of the main causes of neonatal deaths worldwide. Possible severe infection is diagnosed in young infants (aged 0–59 days) according to the presence of one or more clinical signs. The recommended treatment is hospital admission with 7–10 days of injectable antibiotic therapy. In low-income and middle-income countries, barriers to hospital care lead to delayed, inadequate, or no treatment for many young infants. We aimed to identify eff ective alternative antibiotic regimens to expand treatment options for situations where hospital admission is not possible. Methods We did this randomised, open-label, equivalence trial in four urban hospitals and one rural fi eld site in Bangladesh to determine whether two alternative antibiotic regimens with reduced numbers of injectable antibiotics combined with oral antibiotics had similar effi cacy and safety to the standard regimen, which was also used as outpatient treatment. We randomly assigned infants who showed at least one clinical sign of severe, but not critical, infection (except fast breathing alone), whose parents refused hospital admission, to one of the three treatment regimens. We stratifi ed randomisation by study site and age (<7 days or 7–59 days) using computer-generated randomisation sequences. The standard treatment was intramuscular procaine benzylpenicillin and gentamicin once per day for 7 days (group A). The alternative regimens were intramuscular gentamicin once per day and oral amoxicillin twice per day for 7 days (group B) or intramuscular procaine benzylpenicillin and gentamicin once per day for 2 days, then oral amoxicillin twice per day for 5 days (group C). The primary outcome was treatment failure within 7 days after enrolment. Assessors of treatment failure were masked to treatment allocation. Primary analysis was per protocol. We used a prespecifi ed similarity margin of 5% to assess equivalence between regimens. This study is registered with ClinicalTrials.gov, number NCT00844337. Findings Between July 1, 2009, and June 30, 2013, we recruited 2490 young infants into the trial. We assigned 830 infants to group A, 831 infants to group B, and 829 infants to group C. 2367 (95%) infants fulfi lled per-protocol criteria. 78 (10%) of 795 per-protocol infants had treatment failure in group A compared with 65 (8%) of 782 infants in group B (risk diff erence –1·5%, 95% CI –4·3 to 1·3) and 64 (8%) of 790 infants in group C (–1·7%, –4·5 to 1·1). In group A, 14 (2%) infants died before day 15, compared with 12 (2%) infants in group B and 12 (2%) infants in group C. Non-fatal relapse rates were similar in all three groups (12 [2%] infants in group A vs 13 [2%] infants in group B and 10 [1%] infants in group C). Interpretation Our results suggest that the two alternative antibiotic regimens for outpatient treatment of clinical signs of severe infection in young infants whose parents refused hospital admission are as effi cacious as the standard regimen. This fi nding could increase treatment options in resource-poor settings when referral care is not available or acceptable