Determinants of health-related lifestyles among university students

AIMS: To investigate students’ health-related lifestyles and to identify barriers and social determinants of healthier lifestyles. METHODS: An online survey, two focus groups, and three in-depth interviews across 2014/15. A stratified by School size and random sample [n=468] of university students answered a 67-item questionnaire comprising six scales: RAPA, REAP-S, CAGE, FTND, SWEMWBS and ad hoc scale for drug use/misuse. Stratified by gender X2 tests were run to test associations/estimate risks and three multivariate Logistic Regression models were adjusted. A thematic approach guided the analysis of qualitative data. RESULTS: 60% of the respondents were insufficiently physically active, 47% had an unbalanced diet and 30% had low mental wellbeing. Alcohol drinkers vs. abstinent were almost equally distributed. 42% of alcohol drinkers reported getting drunk at least once a month. Smokers accounted for 16% of the respondents. Identified risk factors for suboptimal physical activity were: Being a woman, not using the university gym and smoking. For unbalanced diet: low mental wellbeing and drugs use. Poor mental wellbeing was predicted by unbalanced diet, not feeling like shopping and cooking frequently, and a lack of help-seeking behaviour in case of distress. Qualitative analysis revealed seven thematic categories: transition to new life, university environment and systems, finances, academic pressure, health promotion in campus and recommendations. CONCLUSIONS: This study provides robust evidence that the health-related lifestyles of the student population are worrying and suggests that the trend in chronic diseases associated with unhealthy lifestyles sustained over years might be unlikely to change in future generations. University students’ health-related lifestyle is a concern. Nine out of the identified ten predictors of problematic physical activity, nutrition and mental wellbeing, were environmental/societal or institutional barriers. Universities must expand corporate responsibilities to include the promotion of health as part of their core values

Evolution of Chagas’ disease in Brazil. Epidemiological perspective and challenges for the future: a critical review

Aims: This paper aimed to provide a critical review of the evolution of Chagas’ disease in Brazil, its magnitude, historical development and management, and challenges for the future. Methods: A literature search was performed using PubMed, SciELO and Google Scholar and throughout collected articles’ references. Narrative analysis was structured around five main themes identified: vector transmission, control program, and transfusion, oral and congenital transmission. Results: In Brazil, the Chagas’ disease Control Program was fully implemented in the 1980s, when it reached practically all the endemic areas, and in 1991, the Southern Cone Initiative was created, aiming to eliminate the disease transmission through eliminating the Triatoma infestans and controlling blood banks. As a result, the prevalence of chagasic donors in blood banks reduced from 4.4% in the 80s to 0.2% in 2005. In 2006, PAHO certified the interruption of transmission of Chagas’ disease through this vector in Brazil. However, there are still challenges, such as the domiciliation of new vector species, the need for medical care of the infected individuals, the prevention of alternative mechanisms of transmission, the loss of political concern regarding the disease and, the weakening of the control program. Conclusion: Despite the progress towards control, there are still many challenges ahead to maintain and expand such control and minimise the risk of re-emergence

Improving health literacy about Tuberculosis among drug users. A pilot randomized controlled trial

Introduction: Despite effective treatment, tuberculosis remains among the top-10 causes of death causing ~1.3 million deaths in 2017. Furthermore, tuberculosis infection rates have increased amongst excluded populations such as people misusing substances. Objectives and design: We conducted a two London sites pilot randomized controlled trial to test interventions, recruitment, attrition rates and assessment procedures of a parallel, three-arms controlled trial to assess the effectiveness of tuberculosis health literacy interventions among drug dependent (heroin, crack cocaine or heroin and crack cocaine) population in treatment. Results: Forty-two subjects were recruited to the pilot trial (response rate = 26%) and randomized to three interventions (1st: Information booklet; 2nd: Interactive seminar; 3rd: Interactive seminar + contingency management targeting tuberculosis-health-related action). Baseline and post-intervention tuberculosis knowledge scores were obtained and re-assessed at 2-months follow up. The overall attrition rate was 43%. The knowledge scale had good internal reliability (Cronbach’s α = 0.7). Statistically significant increases in knowledge scores (baseline to post-intervention = 5.9 points, baseline to follow-up = 4.3) were recorded for the whole sample (CI = 99%; p < 0.001 for both analysis), but no statistically significant differences between-groups were observed (p = 0.7). Half of participants in the contingency management group achieved their health-action targets. Conclusion: Health literacy interventions to increase knowledge about tuberculosis among drug users are feasible and achieve promising increases in knowledge and health-related actions but measures to prevent a high attrition rate in a large-scale trial must be introduced. The absence of difference between trial-group outcomes suggests low-intensity interventions may achieve knowledge gain too. Further investigation of contingency management to promote tuberculosis-related health behaviours is needed

Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: case study from the WHO Drug Injection Study Phase II

BACKGROUND: Successful cross-national research requires methods that are both standardized across sites and adaptable to local conditions. We report on the development and implementation of the methodology underlying the survey component of the WHO Drug Injection Study Phase II – a multi-site study of risk behavior and HIV seroprevalence among Injecting Drug Users (IDUs). METHODS: Standardized operational guidelines were developed by the Survey Coordinating Center in collaboration with the WHO Project Officer and participating site Investigators. Throughout the duration of the study, survey implementation at the local level was monitored by the Coordinating Center. Surveys were conducted in 12 different cities. Prior rapid assessment conducted in 10 cities provided insight into local context and guided survey implementation. Where possible, subjects were recruited both from drug abuse treatment centers and via street outreach. While emphasis was on IDUs, non-injectors were also recruited in cities with substantial non-injecting use of injectable drugs. A structured interview and HIV counseling/testing were administered. RESULTS: Over 5,000 subjects were recruited. Subjects were recruited from both drug treatment and street outreach in 10 cities. Non-injectors were recruited in nine cities. Prior rapid assessment identified suitable recruitment areas, reduced drug users' distrust of survey staff, and revealed site-specific risk behaviors. Centralized survey coordination facilitated local questionnaire modification within a core structure, standardized data collection protocols, uniform database structure, and cross-site analyses. Major site-specific problems included: questionnaire translation difficulties; locating affordable HIV-testing facilities; recruitment from drug treatment due to limited/selective treatment infrastructure; access to specific sub-groups of drug users in the community, particularly females or higher income groups; security problems for users and interviewers, hostility from local drug dealers; and interference by local service providers. CONCLUSION: Rapid assessment proved invaluable in paving the way for the survey. Central coordination of data collection is crucial. While fully standardized methods may be a research ideal, local circumstances may require substantial adaptation of the methods to achieve meaningful local representation. Allowance for understanding of local context may increase rather than decrease the generalizability of the data

Size estimation of injecting drug users (IDU) using multiplier method in five Districts of India

The HIV epidemic in Manipur, the highest HIV prevalence state of India, is primarily driven by injecting drug use. Reliable estimate of population size of injecting drug users (IDU) is critical for aiding HIV prevention program in the state to combat drug driven HIV epidemic. The study described multiplier method, an indirect technique of estimation of IDU size in five districts of Manipur, India making use of existing records of rapid intervention and care (RIAC) programs. Number of IDUs who accessed RIAC services during the past 12 months was taken as the benchmark data for the size estimation. The benchmark data were then multiplied by the inverse of the proportion of the IDUs who reported having accessed RIAC services during the same period to derive the sizes of IDU population in each study districts. The estimated sizes of IDU population in five districts were: 7353 (95% CI: 6759-8123) in Imphal West, 5806 (95% CI: 5635-6054) in Imphal East, 3816 (95% CI: 3571-4139) in Thoubal, 2615 (95% CI: 2528-2731) in Churachandpur and 2137 (95% CI: 1979-2343) in Bishenpur district. Multiplier method seems to be a feasible indirect technique which can be applied to estimate of IDU population using existing data from intervention programs in settings like Manipur where reliable size estimation of IDU population is lacking

Continuing the conversation about public health ethics: education for public health professionals in Europe

An important related question is why we should teach public health ethics. Fundamentally, we must teach public health ethics because ethical practice creates and maintains public trust and public health cannot function without public trust. To serve the public—whether through controlling an outbreak of an infectious disease, preparing for or responding to public health emergencies, or reducing the impact of non-communicable diseases—communities and individuals must trust our decisions and actions. This trust grows in large part from past successes, transparent and participatory decision making, and ethical management of the inevitable moral tensions that arise in our work.S

Transitions from Injection-Drug-Use-Concentrated to Self-Sustaining Heterosexual HIV Epidemics: Patterns in the International Data

Background: Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics. Methods: Fourteen countries that had experienced high seroprevalence (,20%) HIV epidemics among PWID and had reliable data for injection drug use (IDU) and heterosexual cases of HIV or AIDS were identified. Graphs of newly reported HIV or AIDS cases among PWID and heterosexuals were constructed to identify temporal relationships between the two types of epidemics. The year in which newly reported cases among heterosexuals surpassed newly reported cases among PWID, aspects of the epidemic curves, and epidemic case histories were analyzed to assess whether it was ‘‘plausible’ ’ or ‘‘highly unlikely’ ’ that the HIV epidemic among PWID might have initiated the heterosexual epidemic in each country. Results: Transitions have occurred in 11 of the 14 countries. Two types of temporal relationships between IDU and heterosexual HIV epidemics were identified, rapid high incidence transitions vs. delayed, low incidence transitions. In six countries it appears ‘‘plausible’ ’ that the IDU epidemic initiated a heterosexual epidemic, and in five countries it appears ‘‘highly unlikely’ ’ that the IDU epidemic initiated a heterosexual epidemic. A rapid decline in incidence among PWID after the peak year of new cases and national income were the best predictors of the ‘‘highly unlikely’ ’ initiation of a heterosexua