Time elapsed from onset of symptoms to diagnosis of gonorrhoea in Swedish patients, 1999-2009

Background: Gonococcal infection remains an important public health problem worldwide. The incidence of reported gonorrhoea cases in Sweden raised by 32%, from 5.9 to 7.8 cases per 100,000 in 2001 to 2008.The aim of this study is to estimate the lag time or time elapsed between onset of symptoms and diagnosis of gonorrhoea, and to identify the factors associated with diagnostic delay in a sample of reported gonorrhoea cases in Sweden. Methods: A retrospective cohort study was conducted using all reported gonorrhoea cases at the Swedish Institute for Communicable Disease Control (SMI) from the time period 1999-2009. Total number of cases included in final analysis was 2161. Descriptive statistics, ANOVA, independent t-test and multiple linear regression analysis were applied for data analysis. Results: The mean lag time between onset of symptoms and diagnosis of gonorrhoea was 12.3 ± 18.8 days. There was a significant association of lag time with sex, region, type of clinics and type of specimen and year of diagnosis. In multivariate analysis with adjusted model, type of specimen was found to have independent effect on lag time and there was a significant interaction observed between region and sex indicating difference between sexes was due to difference in regions. Conclusion: The result of our study revealed a significant delay in establishing a diagnosis in Gonorrhoea patient sample in Sweden. The variables influencing this delay in diagnosis should be addressed to shorten the lag time leading to an early diagnosis and a proper treatment in our patients. However, more research needs to be carried out in this area to better understand the factors at work.NonePublishe

Low maternal education and socioeconomic status were associated with household food insecurity in children under five with diarrhoea in Bangladesh.

Household food insecurity (HFI) is insufficient access to nutritionally safe and adequate foods to meet the dietary needs for an active and healthy life. We examined the prevalence and determinants of HFI in Bangladeshi children under five with diarrhoea

Does the addiction in online pornography affect the behavioral pattern of undergrad private university students in Bangladesh?

Anecdotal reports from Bangladesh indicated that some young adults were becoming addicted to online pornography similar to how others become addicted to gambling, drugs, and alcohol. Such behaviors can have social, academic, and behavioral implications in this population. This study investigated the association between consumption of online pornography and sociobehavioral patterns among students from a private university in Bangladesh.In total, 299 undergraduate students (70.6% male) at the First Capital University of Bangladesh were interviewed using a structured questionnaire. The questions included sociodemographic characteristics, online-based pornography consumption habits and sociobehavioral characteristics. Chi-square test and binary logistic regression analysis were performed to examine correlations between online pornography addiction and sociobehavioral factors such as socializing habits, nature of interactions, university attendance and study focus, sleeping habits, and consumption of main meals.The use of pornography was significantly higher among students who gathered late nights with their friends (58.4%, P < 0.001). Furthermore, those who frequently argue/fight with their friends (51.0%, P = 0.001) frequently fooled around with their friends (48.4%, P < 0.001) and those who did not go to bed on time (57.7%, P < 0.001) reported greater consumption of pornography. Students who fooled around with their friends and those did not go to bed on time were more than twice as likely to watch pornography than students who did not fool around, and those went to bed on time.The study provides the first overview of online pornography consumption. A significant proportion of male students consumed erotic materials online than females. Students who did not go to bed emerged to consume online pornography. Such behaviors can have negative impacts on studies education outcomes as well as wider social and moral impacts for students and the society as a whole. In this digital era, technology has invaded every aspect of our lives, with increasing access to the internet. Therefore, it is imperative to provide specifically designed pornography addiction education programs to educate students about the adverse effects of pornography. Furthermore, targeted treatment programs for sexual addiction, sexual abuse, and pornography abuse are needed to support the individuals who are addicted to pornography

Differences in risk factors associated with single and multiple concurrent forms of undernutrition (stunting, wasting or underweight) among children under 5 in Bangladesh: a nationally representative cross-sectional study

Objectives- The study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh. Design- A nationally representative cross-sectional study. Setting- Bangladesh. Respondents- Children age under 5 years of age. Outcome measure- This study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition. Statistical analysis- Adjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis. Results- Around 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24–35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24–35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father’s occupation, children’s age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition. Conclusion- One-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father’s occupation, children’s age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children

Does household food insecurity influence nutritional practice of children age 6 to 23 months in Bangladesh?

To examine the prevalence of household food insecurity (HHFI) among children aged between 6-23 months in Bangladesh. This paper also aims to identify the individual, household and community levels determinants of HHFI and the association between nutritional behavior and HHFI. Bangladesh Demographic Health Survey (BDHS), 2011 was used for this research. A total of 2,344 children were selected for analysis. Statistical analysis and tests were guided by the nature of the variables. Finally, logistic regression analysis was used to find out the association between independent variables and outcome. The overall prevalence of HHFI was 36.3% (95% CI: 33.6-39.0) among the participants (children). The prevalence of HHFI was significantly higher among children who did not receive nutritional items. In contrast, HHFI was more prevalent among children who were breastfed (37.0%) as compared to non-breastfed. Binary logistic regression analysis showed that children of illiterate mothers (adjusted OR: 2.20, 95% CI: 1.17-4.10), illiterate fathers (adjusted OR: 2.27, 95% CI: 1.41-3.66) and socio-economically poor families (adjusted OR: 11.35, 95% CI: 7.20-17.91) were more at risk of experiencing HHFI, whereas, rural children (adjusted OR: 0.72, 95% CI: 0.57-0.93) were more protective. In the adjusted logistic regression model, children who did not receive juice (adjusted OR: 1.54, 95% CI: 1.09-2.16) had experienced HHFI. The prevalence of HHFI among children is still high in Bangladesh. Therefore, to achieve the Millennium Development Goals, the Government of Bangladesh should priorities HHFI as a major public health issue. Strong collaborations among various stakeholders are also crucial to improve the situation

Urban-rural differences in the associated factors of severe under-5 child undernutrition based on the composite index of severe anthropometric failure (CISAF) in Bangladesh

Introduction Severe undernutrition among under-5 children is usually assessed using single or conventional indicators (i.e., severe stunting, severe wasting, and/or severe underweight). But these conventional indicators partly overlap, thus not providing a comprehensive estimate of the proportion of malnourished children in the population. Incorporating all these conventional nutritional indicators, the Composite Index of Severe Anthropometric Failure (CSIAF) provides six different undernutrition measurements and estimates the overall burden of severe undernutrition with a more comprehensive view. This study applied the CISAF indicators to investigate the prevalence of severe under-5 child undernutrition in Bangladesh and its associated socioeconomic factors in the rural-urban context. Methods This study extracted the children dataset from the 2017–18 Bangladesh Demographic Health Survey (BDHS), and the data of 7661 children aged under-5 were used for further analyses. CISAF was used to define severe undernutrition by aggregating conventional nutritional indicators. Bivariate analysis was applied to examine the proportional differences of variables between non-severe undernutrition and severe undernutrition group. The potential associated socioeconomic factors for severe undernutrition were identified using the adjusted model of logistic regression analysis. Results The overall prevalence of severe undernutrition measured by CISAF among the children under-5 was 11.0% in Bangladesh (rural 11.5% vs urban 9.6%). The significant associated socioeconomic factors of severe undernutrition in rural areas were children born with small birth weight (AOR: 2.84), children from poorest households (AOR: 2.44), and children aged < 36 months, and children of uneducated mothers (AOR: 2.15). Similarly, in urban areas, factors like- children with small birth weight (AOR: 3.99), children of uneducated parents (AOR: 2.34), poorest households (APR: 2.40), underweight mothers (AOR: 1.58), mothers without postnatal care (AOR: 2.13), and children’s birth order ≥4 (AOR: 1.75), showed positive and significant association with severe under-5 undernutrition. Conclusion Severe undernutrition among the under-5 children dominates in Bangladesh, especially in rural areas and the poorest urban families. More research should be conducted using such composite indices (like- CISAF) to depict the comprehensive scenario of severe undernutrition among the under-5 children and to address multi-sectoral intervening programs for eradicating severe child undernutrition

Activity avoidance, perceived walking difficulties, and use of mobility devices in people with Parkinson's disease

Background: Parkinson's disease (PD) is a chronic progressive neurodegenerative disease that results in functional loss and disability. People with PD have an increased risk of falling, and most of their falls occur while walking. As yet, there is limited knowledge concerning activity avoidance due to perceived risk of falling in people with PD. In order to quantitatively assess perceived walking difficulties, a psychometrically-sound instrument is necessary. Although the generic Walk-12 scale (the Walk-12G) seems promising, only one prior study has investigated its psychometric properties in people with PD. Moreover, little is known about factors that independently contribute to perceived walking difficulties in people with PD. No study has yet investigated the use and perceived needs of mobility devices (MDs) over a period of time in people with PD. Aim: The overarching aim of this PhD thesis was to gain increased knowledge regarding activity avoidance due to perceived risk of falling, perceived walking difficulties, and the use and perceived needs of MDs in people with PD. Methods: The thesis was based on a longitudinal cohort survey of participants with PD with a baseline data collection (n = 255), using self-administered and structured questions/questionnaires, observations and clinical assessments, and an equivalent 3-year follow-up (n = 165). Statistical analyses included bivariate analyses (Study I), psychometric evaluation (Study II), multivariate analyses (Study III), and descriptive- and follow-up analyses (Study IV). Main results: Study I: Activity avoidance due to perceived risk of falling was reported by 30% of the non-fallers whereas the corresponding rate was 57% in recurrent fallers (i.e. ≥ 2 falls). Twenty-four percent of participants with an early/mild PD stage reported activity avoidance due to the perceived risk of falling which rose to 74% among those in the most severe stages. Moreover, it was reported by 51% of participants with near falls (but no falls). Seventy percent of participants with fear of falling reported that they avoided activities due to the perceived risk of falling. Study II: In the PD sample, the Walk-12G had acceptable missing item responses and floor/ceiling effects, and corrected item-total correlations > 0.60. Based on ordinal alpha and Cronbach’s alpha, values for internal consistency were > 0.95. External construct validity was satisfactory. Study III: The strongest contributing factor to perceived walking difficulties (assessed with the Walk-12G) was freezing of gait, followed by general self-efficacy, fatigue, PD duration, lower extremity function, orthostatic hypotension, bradykinesia and postural instability. Study IV: Over the 3-year period, MD use increased significantly from 22% to 40% for indoor use, and from 48% to 66% for outdoor use. The perceived need of MDs increased from 5% to 21% in people with PD. Conclusion: Activity avoidance due to perceived risk of falling can be reported even when the person has mild PD. The findings imply that this aspect should not only be considered when the person has a history of falls, since a history of near falls appears also to be of importance. This thesis strengthens the recommendation for using the Walk-12G when assessing perceived walking difficulties in people with PD. It appears that freezing of gait and general self-efficacy should be the primary targets when addressing perceived walking difficulties in people with PD. The knowledge gained on the use and perceived needs of MDs over the 3-year period has implications for improving the provision and follow-ups of MDs, as well as for policy making, planning, and health services. However, the findings need to be replicated in other PD-samples as well as in different national contexts

Association between betel nut consumption and folate deficiency among pregnant women in Matlab, Bangladesh

Background:  Betel nut (BN) or Areca nut (AN) chewing habits on its own or with other ingredients including chewing tobacco are highly prevalent in many South East Asian countries as well as among the migrants from these countries residing around the world. The major alcaloid arecoline in betel nut has been found to carcinogenic and to be associated with a range of health risks, including negative effects on pregnancy outcomes.  It is also reportedly associated with nutritional deficiencies including lower folate status among men and women. Pregnancy imposes stress on folate stores because of increased requirements for growth of maternal tissues, the fetus and the placenta.  Folate deficiency during pregnancy is a major public health concern as it is associated with many adverse health outcomes including neural tube defects, low birth weight, preterm birth, delayed maturation of the nervous system, growth retardation and megaloblastic anemia. Aim: To evaluate the association between betel nut use and folate status among pregnant women in Matlab, Bangladesh. Design: A secondary analysis of data from the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) trial.  A sub sample of pregnant women aged 14-50 years and living in the study area Matlab with available serum folate measurements (N= 730) was included in this study. Outcome variable was folate level and folate deficiency and the independent variable was betel nut consumption.  Logistic regression analysis and analyses of covariance (ANCOVA) were done. Results were adjusted for potential confounders. Results: Two-thirds (63%) of the women consumed betel nut and 17% had folate deficiency. Women who consumed betel nut combined with  chewing  tobacco were 2.57 times more likely to have folate deficiency (OR = 2.57; 95% CI = 1.23-5.36; p =0.012;) and  betel nut consumption 2-3 times/day was significantly associated with folate deficiency among users (OR = 2.51; 95% CI = 1.07–5.92; p =0.035). Mean serum folate levels were significantly lower among betel nut users as compared to non-users. Conclusion: Betel nut consumption combined with chewing tobacco is associated with lower serum folate level or folate deficiency among pregnant women in Matlab in Bangladesh. Strategies are needed for prevention and control of betel nut consumption in order to prevent adverse health outcomes. There is a need of more knowledge regarding betel nut use and other combined substances to distinguish their individual effects on folate deficiency.