Diverse realities: Understanding sexually transmitted infections and HIV in India

Sexually transmitted infections (STIs), including HIV, currently have high salience on the health care agendas of many countries, including India. Strategies for their control are ideally based on a number of well-recognised principles. These include: assessments of the burden of disease; the availability of interventions at policy and programme levels, to influence behaviour change and technical ‘solutions’; and the calculated cost-effectiveness of these interventions. In the case of India, data to inform these principles are often lacking in the case of STI control. In this paper we have reviewed the evidence base for STI control in the Indian context. The paper is split into a number of sections: a review of the socio-demographic and structural level factors which may indicate vulnerability to epidemics of the sexually transmitted infections; a compilation of the available evidence on the prevalence and epidemiology of these infections; individual level risk factors for infection; responses to risk and infection—both at the individual level and within the pluralistic health service; and a detailed review of the STI/HIV control programme in the country. We conclude with a summary of the evidence base and make suggestions for areas where further work is needed to strengthen this base

Instream vegetation survey of Marsh Creek

Agriculture can have a vast impact on stream ecosystems through increasing erosion and nutrient inputs. Vegetation influences an array of ecosystem characteristics in streams, including concentrations of dissolved oxygen and nutrients. Physical characteristics can be influenced as well, including flow velocity, turbidity, light penetration, and turbulence. Using the Braun-Blanquet cover scale we measured instream vegetation cover at six sites along Marsh Creek, a stream in southeastern Idaho that has seen strong anthropomorphic influences through the development of agriculture, both croplands and pastures. We found that in stream vegetation cover was high overall, but varied across sites. Mean vegetation cover across all sites was 25-50%. The highest cover observed was 75-100% and the lowest was 5-25%. From this data we can see variations from site to site as you move downstream but no discernible patterns are evident. Surveys will be continued through the summer to assess temporal trends across sites, and vegetation cover will be compared with dissolved oxygen and turbidity data to assess relationships between vegetation and water quality. This study will yield important information about stream ecosystem responses to agriculture and the role of instream vegetation

Protecting and promoting the rights of the ‘reserve army of labour’: a policy analysis of structural determinants of migrant worker health in Pakistan and Qatar

Labour migrants who travel overseas for employment can face deep health inequities driven in large part by upstream social and structural determinants of health. We sought to study the ‘labour migrant health ecosystem’ between one sending country (Pakistan) and one host country (Qatar), with a focus on how the ecosystem realizes the rights of labour migrants when addressing the social and structural determinants (e.g. housing, employment law, etc.) of health. Study objectives were to (1) undertake an in-depth review of policies addressing the structural and social determinants of the health of labour migrants in both Pakistan and Qatar, analysing the extent to which these policies align with global guidance, are equity-focused and have clear accountability mechanisms in place, and (2) explore national stakeholder perspectives on priority setting for labour migrant health. We used a mixed methods approach, combining policy content analysis and interviews with stakeholders in both countries. We found a wide range of guidance from the multilateral system on addressing structural determinants of the health of labour migrants. However, policy responses in Pakistan and Qatar contained a limited number of these recommended interventions and had low implementation potential and minimal reference to gender, equity and rights. Key national stakeholders had few political incentives to act and lacked inter-country coordination mechanisms required for an effective and cohesive response to labour migrant health issues. Effectively addressing such determinants to achieve health equity for labour migrants will depend on a shift in governments’ attitudes towards migrants—from a reserve army of transient, replaceable economic resources to rights-holding members of society deserving of equality, dignity and respect

Making waves in education

Making Waves in Education is a book of a collaborative nature, being a collection of chapters written by undergraduates studying B.A. Hons in Education at the Universities of Plymouth and York. Thirteen chapters, each from a different student, cover topics from learning theories to sex education, home education and autism. The chapters are well-organised and written, and they cover key topics in an accessible and thoughtful way. The chapters are generally well - referenced and present critical and balanced arguments. Many use hard statistics in an effective way to back up their points and all include bibliographies as indeed one expects from a serious publication. The collection therefore addresses itself to a wide readership of anyone interested in education, and students and teachers/trainers in HE in particula

Searching for the Right to Health in the Sustainable Development Agenda Comment on “Rights Language in the Sustainable Development Agenda: Has Right to Health Discourse and Norms Shaped Health Goals?”

The United Nations (UN) Sustainable Development Agenda offers an opportunity to realise the right to health for all. The Agenda’s “interlinked and integrated” Sustainable Development Goals (SDGs) provide the prospect of focusing attention and mobilising resources not just for the provision of health services through universal health coverage (UHC), but also for addressing the underlying social, structural, and political determinants of illness and health inequity. However, achieving the goals’ promises will require new mechanisms for inter-sectoral coordination and action, enhanced instruments for rational priority-setting that involve affected population groups, and new approaches to ensuring accountability. Rights-based approaches can inform developments in each of these areas. In this commentary, we build upon a paper by Forman et al and propose that the significance of the SDGs lies in their ability to move beyond a biomedical approach to health and healthcare, and to seize the opportunity for the realization of the right to health in its fullest, widest, most fundamental sense: the right to a healthpromoting and health protecting environment for each and every one of us. We argue that realizing the right to health inherent in the SDG Agenda is possible but demands that we seize on a range of commitments, not least those outlined in other goals, and pursue complementary openings in the Agenda – from inclusive policy-making, to novel partnerships, to monitoring and review. It is critical that we do not risk losing the right to health in the rhetoric of the SDGs and ensure that we make good on the promise of leaving no one behind

Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours

Implementing risk-stratified breast cancer screening is being considered internationally. It has been suggested that primary care will need to take a role in delivering this service, including risk assessment and provision of primary prevention advice. This systematic review aimed to assess the acceptability of these tasks to primary care providers. Five databases were searched up to July–August 2020, yielding 29 eligible studies, of which 27 were narratively synthesised. The review was pre-registered (PROSPERO: CRD42020197676). Primary care providers report frequently collecting breast cancer family history information, but rarely using quantitative tools integrating additional risk factors. Primary care providers reported high levels of discomfort and low confidence with respect to risk-reducing medications although very few reported doubts about the evidence base underpinning their use. Insufficient education/training and perceived discomfort conducting both tasks were notable barriers. Primary care providers are more likely to accept an increased role in breast cancer risk assessment than advising on risk-reducing medications. To realise the benefits of risk-based screening and prevention at a population level, primary care will need to proactively assess breast cancer risk and advise on risk-reducing medications. To facilitate this, adaptations to infrastructure such as integrated tools are necessary in addition to provision of education