イランに住むアフガニスタン女性における適切な出産前ケアに対する障壁と関連要因に関する研究：ミクストメソッド研究

京都大学新制・課程博士博士(社会健康医学)甲第23119号社医博第115号新制||社医||11(附属図書館)京都大学大学院医学研究科社会健康医学系専攻(主査)教授 近藤 尚己, 教授 万代 昌紀, 教授 川上 浩司学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDFA

The association of child marriage with morbidities and mortality among children under 5 years in Afghanistan: findings from a national survey

Background There is still a gap in knowledge of the impact that child marriage could have on the mortality and morbidity of children in Afghanistan. This study used the data from the latest Afghanistan demographic health survey conducted in 2015 (ADHS) to address this gap and advance the current knowledge. Methods A secondary analysis of the 2015 ADHS, including the births in the past 5 years to ever-married women aged 15–24 years old, was carried out. Logistic regression analyses were employed to examine the association of child marriage (< 18y) with morbidities (diarrhea, acute respiratory infection, and fever in the last 2 weeks), mortality (neonatal, infant, child), and size at birth among the children under 5 born to women aged 15–24 years, before and after adjusting for the effect of sociodemographic and structural inequalities. Results Approximately two-thirds of births in the past 5 years belong to 15–24 years old mothers who married at ages < 18. The majority of them were born to mothers residing in rural areas (75.67%) with no education (51.68%) from poor households (39.39%). As compared to the births to women married at ages ≥ 18, there was a significantly higher likelihood of neonatal mortality among births to women married at ages < 18 (crude OR = 2.30, 95% CI: 1.52–3.49 & adjusted OR = 1.94, 95% CI: 1.25–3.01) and higher infant mortality among the births to the women married at ages ≤ 14y (crude OR = 1.94, 95% CI: 1.06–3.53). However, it disappeared for neonatal mortality after adjustment for adequacy of antenatal care (ANC) and infant mortality after adjustment for sociodemographic inequalities. Conclusion Although the births to women married as a child (< 18) were more likely to die at an early age, this association disappeared after adjustment for the adequacy of ANC. Given the unavoidable practice of child marriage in Afghanistan, this finding emphasizes the importance of providing adequate ANC for young brides to prevent child mortality. In addition, strong global advocacy is required to empower and support young Afghan women in negotiating their reproductive and maternity rights with their partners by reducing social and gender-based inequalities.publishedVersio

Suicidal behaviours and their correlates in school-going Lebanese adolescents: findings from a national survey

Background Adolescent suicide is regarded as a serious phenomenon that affects the well-being of the youth. This study aims to investigate the prevalence of suicidal behaviours and their association with physical/psychological harm and substance use in a nationally representative sample of adolescents in Grades 7–12 in Lebanon. Methods Data from the latest Global School-Based Student Health Survey conducted in 2017 were used in this study. The prevalence and correlates of suicidal ideation and suicide attempts among those who had considered committing suicide, at least once, were explored. Results An estimated 13.45% of Lebanese adolescents, particularly females in Grades 7–12 had considered suicide at least once in the past 12 months. More importantly, almost half of them had attempted it at least once in the past 12 months. Those who frequently felt lonely or worried (previous year), were involved in physical fights or assaults (previous year), had been verbally or physically bullied (previous month), had missed more school days, experienced food insecurity, and had a history of substance abuse (marijuana, amphetamine, alcohol, and tobacco products) were more likely to exhibit suicidal behaviours. Parental support and older age at drug initiation appeared to be protective factors. Discussion The findings characterise the correlates of suicidal behaviours among school-going Lebanese adolescents and determine the attributes of the risk group susceptible to engaging in suicide attempts. Future interventions and policies should consider these attributes when monitoring target groups, particularly those with the alarming behaviours identified in this study. In addition, awareness campaigns that engage all stakeholders, particularly parents, should be prioritised by the authorities.publishedVersio

Internal migration and utilization of reproductive and maternity care among women in Pakistan: evidence from a recent National Survey

Background: During the last decades, migratory behavior has had a key role in population growth and redistribution in Pakistan. Migration has far-reaching socioeconomic implications for individuals and society at large that could influence the health integrity of Pakistani women. This study aimed to describe the migration patterns and drivers as well as their association with adequate access to reproductive and maternal care among married Pakistani women aged 15–49. Methods: The data from the 2017–18 Pakistan Demographic Health Survey (PDHS) was used to extract the information on the explanatory (sociodemographic and migration backgrounds) and outcome variables (unmet needs for family planning, adequate antenatal care, and delivery at health facilities). Bivariate and multivariate logistic regression analyses were employed to examine the relationship between these explanatory and outcome variables before and after adjustment for sociodemographic inequalities. Results: In unadjusted models, the odds of having adequate ANC and delivery at health facilities were approximately 2 to 4 times higher in those living (urban non-migrant), moving to (urban to urban, rural to urban), or leaving the urban areas (rural to urban) as compared to rural non-migrants; likewise, the odds of the unmet needs for family planning was about 20–50% lower in the same migration streams compared to rural non-migrant. However, after adjustment for sociodemographic inequalities, most of these associations attenuated and only the association of urban to urban migration with unmet needs for family planning and the association of urban non-migrant with delivery at health facilities remained significant. Conclusion: Although the findings suggest that Internal migration flows, particularly those to urban areas (urban to urban and rural to urban), could be associated with better access to reproductive and maternity care among married Pakistani women aged 15–49 years; adjustment for sociodemographic inequalities, particularly education and wealth, nullified this association to a great extent. This has important implications for current policies and interventions in Pakistan and calls for policy reform and women’s rights advocacy to enhance the literacy level of young Pakistani girls through well-tailored interventions, maintaining them at school.publishedVersio

Mental Health among People Living with HIV (PLWH) in Iran: A Policy Brief Teaser: The necessity of a Tool for Mental Health in PLWH in Iran

Depression and anxiety are the most common mental health disorders in people living with HIV (PLWH). Adherence to antiretroviral therapy (ART) is an important concern that could be significantly affected by psychological problems among PLWH. Therefore, the authors recommend using an anxiety and depression screening tool, among Iranian PLWH in HIV health care system and determine potential barriers to depression screening and effective care

Content Analysis of Teleconsultation Enquiries in Positive Health Club, Imam Khomeini Hospital, Tehran, Iran

Objective: With the availability of specialists and the overflowing information in public and social networks, individuals have easy access to information about HIV and AIDS. However, medical counselling and healthcare settings still have an essential role. The aim of the present study was to analyze phone enquiries directed to the Positive Club of Imam Khomeini Hospital in Tehran; this analysis was based on demographic features of participants.Design/Methodology/Approach: In this cross-sectional study, 5255 questions were extracted and coded from the Positive Club's counselling questionnaires; the coding procedure was based on Huber and Gilapsy's decimal classification. Data were processed by descriptive statistics and SPSS software.Findings: A majority of callers were men (59.43%), most callers were aged between 26 and 30 years, and HIV transmission and high-risk sexual behaviours were among frequently asked questions (47%).Originality/Value: Taking into account that most callers were concern about transmission via sexual contact (anal, vaginal, and oral) rather than injection and its related equipment, it seems reasonable to assume that HIV transmission flow may shift from shared injection equipment to high-risk sexual behaviors

Exercise Motivation among Fitness Center Members: A Combined Qualitative and Q-Sorting Approach

This study aimed to explore the components of Exercise Maintenance Motivation (EMM) and identify its consensus and distinguishing aspects among members of fitness centers (FCs) in Vietnam. The study incorporated both qualitative and Q-sorting methodologies across two stages. The first stage involved conducting ten in-depth and four focus-group interviews with 39 members of six different FCs in Vietnam, resulting in the generation of 40 EMM statements. In the second stage, these statements were subjected to Q-sorting by 39 participants. The KADE application for the Q method was used for data analysis, and Principal Component Analysis was employed to determine the optimal number of factors. The analysis yielded four factors, encompassing 34 statements and accounting for 86% of the variance in EMM components among participants. These components, labeled “F1. Exercise achievements”, “F2. Exercise environments”, “F3. Exercise enjoyment”, and “F4. Workout-aholic”, achieved consensus among 17 (37%), 14 (30%), 5 (12%), and 3 (7%) participants, respectively. The leading motivational expressions were “get to be healthier”, “a better-looking appearance”, and “get a fit body appearance”. These were followed by FC-based supportive exercise conditions, positive feelings, and exercise addiction. There were five consensus statements that spanned all four factors. The numbers of distinguishing statements varied across factors, with F1, F3, and F4 each contributing 11 (28.2%) and F2 contributing 15 (38.5%). This study contributed to the four central drivers of EMM. To facilitate the development of a comprehensive EMM scale, future research should incorporate larger samples, allowing for a dissection of motivational paradigms.   Doi: 10.28991/HEF-2023-04-03-07 Full Text: PD

Disease Burden Attributed to Drug use in the Nordic Countries: a Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2019

The Nordic countries share similarities in many social and welfare domains, but drug policies have varied over time and between countries. We wanted to compare differences in mortality and disease burden attributed to drug use over time. Using results from the Global Burden of Disease (GBD) study, we extracted age-standardized estimates of deaths, DALYs, YLLs and YLDs per 100 000 population for Denmark, Finland, Iceland, Norway, and Sweden during the years 1990 to 2019. Among males, DALY rates in 2019 were highest in Finland and lowest in Iceland. Among females, DALY rates in 2019 were highest in Iceland and lowest in Sweden. Sweden have had the highest increase in burden since 1990, from 252 DALYs to 694 among males, and from 111 to 193 among females. Norway had a peak with highest level of all countries in 2001–2004 and thereafter a strong decline. Denmark have had the most constant burden over time, 566–600 DALYs among males from 1990 to 2010 and 210–240 DALYs among females. Strict drug policies in Nordic countries have not prevented an increase in some countries, so policies need to be reviewed.publishedVersio

The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990–2019:Results From the Global Burden of Disease Study 2019

Objectives: As little is known about the burden of type 1 (T1DM) and type 2 diabetes (T2DM) in adolescents in Western Europe (WE), we aimed to explore their epidemiology among 10–24 year-olds. Methods: Estimates were retrieved from the Global Burden of Diseases Study (GBD) 2019. We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for prevalence, incidence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. Results: In 2019, prevalence and disability estimates were higher for T1DM than T2DM among 10–24 years old adolescents in WE. However, T2DM showed a greater increase in prevalence and disability than T1DM in the 30 years observation period in all WE countries. Prevalence increased with age, while only minor differences were observed between sexes. Conclusion: Our findings highlight the substantial burden posed by DM in WE among adolescents. Health system responses are needed for transition services, data collection systems, education, and obesity prevention.</p

The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990–2019:Results From the Global Burden of Disease Study 2019

Objectives: As little is known about the burden of type 1 (T1DM) and type 2 diabetes (T2DM) in adolescents in Western Europe (WE), we aimed to explore their epidemiology among 10–24 year-olds. Methods: Estimates were retrieved from the Global Burden of Diseases Study (GBD) 2019. We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for prevalence, incidence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. Results: In 2019, prevalence and disability estimates were higher for T1DM than T2DM among 10–24 years old adolescents in WE. However, T2DM showed a greater increase in prevalence and disability than T1DM in the 30 years observation period in all WE countries. Prevalence increased with age, while only minor differences were observed between sexes. Conclusion: Our findings highlight the substantial burden posed by DM in WE among adolescents. Health system responses are needed for transition services, data collection systems, education, and obesity prevention.</p