Social Determinants of Health and Substance Use among Women Living with HIV in Canada: Inequalities and Impacts

The objective of this doctoral research was two-fold: 1) to estimate inequalities in social determinants of health (SDoH), health-related quality of life, and substance use among women living with HIV (WLWH) compared to the general population of women; and 2) to assess the impact of the SDoH clusters on illicit drug use and heavy alcohol drinking among WLWH. For the first objective, estimates were obtained from 1,422 WLWH aged 16+ in the 2013-2015 Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS, time-point 1), and then compared with their counterparts estimated in 46,831 general population women in the 2013-2014 Canadian Community Health Survey (CCHS), standardized to the age/ethnoracial group distribution of WLWH. For the second objective, we used longitudinal data from the 2013-2017 CHIWOS at time-point 1 (N=1,422) and time-point 2 (N=1,252). Findings showed that compared to general population women, a higher proportion of WLWH reported adversities regarding the social determinants and poor/fair self-rated health status, and greater cigarette smoking and illicit drug use, but similar to lower likelihood of binge drinking. Latent class analysis was used to determine the clustering of SDoH. We identified four distinct classes: no/least SDoH adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted regression models showed a substantial difference in illicit drug use, and heavy alcohol drinking between no/least SDoH class and other SDoH classes. These findings underscore the need for novel approaches to address socio-structural adversities and substance use among WLWH. We also discuss additional implications and future research directions

Inadequate control of diabetes and metabolic indices among diabetic patients: A population based study from the Kerman Coronary Artery Disease Risk Study (KERCADRS)

Background: The goal of diabetes control should be feasible in order to minimize the risk of its adverse events and to reduce its burden and cost on patients. The current study aimed to assess the status of glycemic control in male and female patients with Type 2 Diabetes Mellitus (T2DM) in Kerman, Iran. Methods: In the present study, 500 T2DM (300 women and 200 men) from the Kerman Coronary Artery Disease Risk Study (KERCADRS), a population-based study from 2009 to 2011, were selected. Patients were >18 years old, had Fasting Blood Sugar (FBS) higher than 126 mg/dl, and had been through treatment for their diagnosed disease. All participants underwent Glycosylated Hemoglobin (HbA1c) analysis. HbA1c less than 7% was considered as good glucose control. Other metabolic indices based on American Diabetes Association (ADA) target recommendations were considered. Results: The mean level of HbA1c in total subjects was 8.56 ± 4.72% that only 31.66% of men and 26.00% of women had controlled level of HbA1c. Total cholesterol less than 200 mg/dl was reported in 64.50% of men and 44.00% of women, High Density Lipoprotein (HDL) more than 40 mg/dl was revealed in 20.50% of men and 34.67% of women, and Low Density Lipoprotein (LDL) less than 100 mg/dl was reported in 41.50% of men and 25.33% of women. In multivariate logistic regression model, longer duration of disease and higher Waist Circumference (WC) were positively associated with uncontrolled diabetes status. Conclusion: The findings of the present study revealed that diabetes control in T2DM was inadequate. Changing the policy of treatment in individual patient and establishing better diabetes clinic to decrease the frequency of uncontrolled T2DM are crucial. Paying attention to other affecting metabolic components such as WC in the process of T2DM management is important

The effect of opium addiction on serum adiponectin and leptin levels in male subjects

Serum adiponectin and leptin levels have been shown to be related to obesity, insulin resistance and cardiovascular diseases (CVD). Opium addiction has a positive association with endocrine system disorders. The relationship between adipokines and opium addiction is unclear. In the present study, we aimed to determine serum adiponectin and leptin levels in opium addicted subjects. Methods: 176 men, 88 opium addicts and 88 non-addicts were randomly selected from subjects who participated in Kerman Coronary Artery Disease Risk factors Study (KERCADRS); a population-based study. Serum adiponectin and leptin levels were measured using ELISA and compared between two groups. We adjusted the effect of some confounding factors such as the patients’ demographic, clinical and medical history in multivariate analysis model. Results: The serum level of adiponectin in opium addicts was significantly lower than control group (6.5±3.6 vs. 9.8±8.1 μg/ml, P<0.001). There was no significant difference in serum leptin level between two groups (11.8±10.3 ng/ml in control group vs. 11.5±10.8 ng/ml in opium addicts, p = 0.80). In the multivariate analysis, after adjusting for age, cigarette smoking, body mass index, type 2 diabetes, hypertension, cholesterol, triglyceride and high and low density lipoproteins, the negative association between opium addiction and decreased adiponectin level was still present (β = -0.144, P value = 0.005). Conclusions: The results showed that opium addiction reduces serum adiponectin level. Since adiponectin has been shown to have anti-diabetic and anti-atherogenic effects, its reduction may account for increase in the risk of metabolic disorders such as insulin resistance and CVD amongst opium addicted patients

Impact of Trauma‑Informed Training and Mindfulness‑Based Social–Emotional Learning Program on Teacher Attitudes and Burnout: A Mixed‑Methods Study

A trauma-informed approach can give teachers the strategies they need to help children affected by trauma reach their full potential in the classroom. Mindfulness-based social–emotional learning (SEL) programs equip teachers with essential tools to create a trauma-informed classroom, which in turn helps alleviate stress associated with supporting trauma-impacted children. Because existing research on SEL programs has predominantly focused on student well-being, there is a paucity of research examining teacher outcomes and the integration of a trauma-informed framework. The purpose of the study was to investigate the benefits of trauma-informed training and MindUP delivery on educator attitudes and burnout. Intervention educators received trauma-informed and MindUP training and implemented MindUP in their classrooms. Comparison educators did not participate in training and taught their usual curriculum. We compared trauma-informed attitudes and burnout levels among 112 educators (n = 71 intervention, n = 41 comparison) using the Attitudes Related to Trauma-Informed Care (ARTIC) scale and the Maslach Burnout Inventory. Pre- and post-intervention quantitative data were augmented by qualitative focus group data. Results showed that educators in the intervention group reported significant decreases in emotional exhaustion, and significant improvements in the reactions subscale and overall scores on the ARTIC scale. Greatest improvements in self-efficacy and personal accomplishment were observed among educators who implemented MindUP for two consecutive years. These findings were supported by focus group data. Our results show that infusing trauma-informed training with an existing mindfulness-based SEL intervention may encourage teachers to embrace trauma-sensitive attitudes and reduce burnout

Impact of Trauma-Informed Training and Mindfulness-Based Social–Emotional Learning Program on Teacher Attitudes and Burnout: A Mixed-Methods Study

A trauma-informed approach can give teachers the strategies they need to help children affected by trauma reach their full potential in the classroom. Mindfulness-based social–emotional learning (SEL) programs equip teachers with essential tools to create a trauma-informed classroom, which in turn helps alleviate stress associated with supporting trauma-impacted children. Because existing research on SEL programs has predominantly focused on student well-being, there is a paucity of research examining teacher outcomes and the integration of a trauma-informed framework. The purpose of the study was to investigate the benefits of trauma-informed training and MindUP delivery on educator attitudes and burnout. Intervention educators received trauma-informed and MindUP training and implemented MindUP in their classrooms. Comparison educators did not participate in training and taught their usual curriculum. We compared trauma-informed attitudes and burnout levels among 112 educators (n = 71 intervention, n = 41 comparison) using the Attitudes Related to Trauma-Informed Care (ARTIC) scale and the Maslach Burnout Inventory. Pre- and post-intervention quantitative data were augmented by qualitative focus group data. Results showed that educators in the intervention group reported significant decreases in emotional exhaustion, and significant improvements in the reactions subscale and overall scores on the ARTIC scale. Greatest improvements in self-efficacy and personal accomplishment were observed among educators who implemented MindUP for two consecutive years. These findings were supported by focus group data. Our results show that infusing trauma-informed training with an existing mindfulness-based SEL intervention may encourage teachers to embrace trauma-sensitive attitudes and reduce burnout

Impact of MindUP Among Young Children: Improvements in Behavioral Problems, Adaptive Skills, and Executive Functioning

Objectives We evaluated the impacts of a mindfulness-based social and emotional learning (SEL) program on behavioral problems, adaptive skills, and executive functioning among kindergarten students. Methods A total of 23 classrooms were assigned to the intervention group, in which the teachers implemented MindUP, and 19 classrooms were assigned to the comparison group, in which the teachers delivered their classes as usual. Teachers assessed the behavior of students (N = 584; intervention n = 261; comparison n = 323) both pre- and post-intervention with two measures: the Behavior Assessment System for Children, Third Edition, Teacher Rating Scales (BASC-3 TRS) and the Behavior Rating Inventory of Executive Function-Preschool and Child Version (BRIEF-P; BRIEF-2). Results Students who received the intervention demonstrated an improvement in adaptive skills and reduction in behavioral symptoms, internalizing composite, and externalizing composite outcomes. Additionally, there was a significant decrease in executive functioning deficits among students who participated in MindUP. There were no gender differences regarding changes in any of the five study outcomes. Conclusions The study suggests that mindfulness-based SEL intervention can improve psychosocial and behavioral outcomes in young children

Characteristics of a Capable University Lecturer from the Viewpoints of Health Services Management Students in Iranian Medical Universities

Background & Objective: Understanding the characteristics and criteria that students use to select their teachers, is an indicator for evaluating teachers in order to improve the quality and effectiveness of education. Hence, the aim of this study is to investigate the characteristics of a capable university lecturer from the viewpoints of health services management students in Iranian medical universities. Methods: In this descriptive, analytical, cross-sectional study, 582 bachelor's degree students of health services management participated. Data were collected using a self-developed questionnaire, the content validity and reliability of which were confirmed. The questionnaire included six main domains, namely, teaching method, personal characteristics, evaluation skills, scholarly activities, interpersonal skills, and educational regulations. Data were analyzed using Student’s independent t-test and ANOVA in SPSS software. Results: Our findings suggest that teaching methods (4.34), interpersonal skills (4.17), and personal characteristics (4.11) were the most important domains from the students' perspectives. On the other hand, characteristic such as calling the roll (3.62), taking mid-term quizzes (3.66), and teacher's strictness (3.71) were the least important domains. There was a significant relationship between sex and the educational regulations domain (P = 0.01). However; there was no significant relationship between mean score of domains based on students' term of education (P > 0.05). In total, the correlation between all domains revealed 2 distinct categories in the form of personal characteristics and professional commitments. Conclusion: According to our results, favorable characteristics of academics, especially their individual characteristics and personality, are one of the determining factors in achieving educational goals and increasing the quality of education. Keywords Capable teacher Health services management Iranian medical universitie

A Review of the Academic Engagement of Medical Students in Kerman University of Medical Sciences, Iran, 2011-2012

Background & Objective: The concept of active engagement or academic engagement is a certain understanding of the relationship between students and the university. The university is an environment that provides learning opportunities that will lead to student learning. The nature and level of learning depends on the students way of using their environmental resources. Positive engagement and an interactive, supportive academic environment are essential elements in success in the learning process. On the other hand, isolation, alienation, and passiveness of students results in their academic failure. The aim of the present study was to investigate academic engagement of medical students of Kerman University of Medical Sciences, Iran, in 2011-2012. In this study, 2 domains of academic engagement were investigated (active and participatory learning, and level of academic challenge). Methods: In this descriptive-analytical, cross-sectional study, all medical students of Kerman University of Medical Sciences were recruited using stratified random sampling method. The data collection tool was the National Survey of Student Engagement (NSSE). Results: In this study, 211 medical students from different academic years with the average age of 22.6 ± 3.1 were enrolled. The mean active engagement score of the students was 98.64 ± 32.33. Active and cooperative learning was at a significant level based on all demographic variables, except employment. The active and cooperative learning of male students differed significantly from that of female students, married students from single students, different academic years, and native from local students. Moreover,, students who were members of one of the academic centers had significantly higher active and participatory learning scores. Mean active and participatory learning, and level of academic challenge were 17.4 ± 5.6 and 21.7 ± 7.1, respectively. Both domains were reported as unsatisfactory among students. Conclusion: The results showed the unsatisfactory academic engagment status of the students of the Kerman University of Medical Sciences. Thus, it is hoped that with future planning to use more modern teaching methods which have a higher level of academic challenges, and active and collaborative learning, and by the appropriate support of the university, university staff, and faculty members, we are able to take steps toward the improvement of academic engagement, and thereby, student success. Key Words: Academic engagement, Supportive environment, Active and cooperative learning, Scientific challenges, Medical students, Ira

Impact of MindUP Among Young Children: Improvements in Behavioral Problems, Adaptive Skills, and Executive Functioning

Objectives: We evaluated the impacts of a mindfulness-based social and emotional learning (SEL) program on behavioral problems, adaptive skills, and executive functioning among kindergarten students. Methods: A total of 23 classrooms were assigned to the intervention group, in which the teachers implemented MindUP, and 19 classrooms were assigned to the comparison group, in which the teachers delivered their classes as usual. Teachers assessed the behavior of students (N = 584; intervention n = 261; comparison n = 323) both pre- and post-intervention with two measures: the Behavior Assessment System for Children, Third Edition, Teacher Rating Scales (BASC-3 TRS) and the Behavior Rating Inventory of Executive Function-Preschool and Child Version (BRIEF-P; BRIEF-2). Results: Students who received the intervention demonstrated an improvement in adaptive skills and reduction in behavioral symptoms, internalizing composite, and externalizing composite outcomes. Additionally, there was a significant decrease in executive functioning deficits among students who participated in MindUP. There were no gender differences regarding changes in any of the five study outcomes. Conclusions: The study suggests that mindfulness-based SEL intervention can improve psychosocial and behavioral outcomes in young children

COVID-19 Pandemic: What Can the West Learn From the East?

Differences in public health approaches to control the coronavirus disease 2019 (COVID-19) pandemic could largely explain substantial variations in epidemiological indicators (such as incidence and mortality) between the West and the East. COVID-19 revealed vulnerabilities of most western countries’ healthcare systems in their response to the ongoing public health crisis. Hence, western countries can possibly learn from practices from several East Asian countries regarding infrastructures, epidemiological surveillance and control strategies to mitigate the public health impact of the pandemic. In this paper, we discuss that the lack of rapid and timely community-centered approaches, and most importantly weak public health infrastructures, might have resulted in a high number of infected cases and fatalities in many western countries