Queer binge: harmful alcohol use among sexual minority young people in Australia

© 2019 The Royal Society for Public Health Objectives: The literature suggests that sexual minority young people (SMYP) use alcohol at disproportionate levels when compared with their heterosexual counterparts. Little is known about alcohol dependency symptoms and correlations between high-risk alcohol use/dependency symptoms and minority stress in this population in general and between subgroups. Study design: Cross-sectional study. Methods: Descriptive statistics, adjusted odds ratios, and analysis of covariance were used to determine high-risk alcohol use, dependency symptoms, differences between subgroups, and correlations between alcohol use, dependency symptoms, and minority stress. Results: A total of 1556 Australian SMYPs aged 18 to 35 years completed the survey. Fifty percent of the participants reported high-risk alcohol consumption with significant differences between subgroups. Typical dependency symptoms such as ‘health, social, legal or financial problems due to alcohol consumption’ (16.8%, n = 247) were identified in large parts of the sample. High-risk consumption and dependency symptoms were significantly correlated with minority stress. Conclusion: High levels of high-risk alcohol use and dependency symptoms were found, largely consistent with existing literature. However, disparities are not distributed equally in this population, suggesting that future health promotion interventions should focus on SMYP subgroups. Significant correlations between minority stress and dependency symptoms/high-risk use suggest a potential route for future interventions in these populations

Bayesian spatial analysis of factors influencing neonatal mortality and its geographic variation in Ethiopia.

BACKGROUND: Ethiopia is a Sub-Saharan country with very high neonatal mortality rates, varying across its regions. The rate of neonatal mortality reduction in Ethiopia is slow, and Ethiopia may not meet the third United Nations sustainable development target by 2030. This study aimed to investigate the spatial variations and contributing factors for neonatal mortality rates in Ethiopia. METHODS: We analysed data from the 2016 Ethiopian Demographic and Health Survey (EDHS), which used a two-stage cluster sampling technique with a census enumeration area as primary and households as secondary sampling units. A Bayesian spatial logistic regression model using the Stochastic Partial Differential Equation (SPDE) method was fitted accounting for socio-economic, health service-related and geographic factors. RESULTS: Higher neonatal mortality rates were observed in eastern, northeastern and southeastern Ethiopia, and the Somali region had higher risks of neonatal mortality. Neonates from frequently drought-affected areas had a higher mortality risk than less drought-affected areas. Application of traditional substances on the cord increased the risk of neonatal mortality (Adjusted Odds Ratio (AOR) = 2.07, 95% Credible Interval (CrI): 1.12 to 4.30) and getting health facility delivery services had a lower odds of neonatal mortality (AOR = 0.60, 95% CrI: 0.37, 0.98). CONCLUSIONS: Residing in drought-affected areas, applying traditional substances on the umbilical cord and not delivering at health facilities were associated with a higher risk of neonatal mortality. Policy-makers and resource administrators at different administrative levels could leverage the findings to prioritise and target areas identified with higher neonatal mortality rates

Technology in Public Health Higher Education

© 2018 APJPH. Streamed and recorded lectures as well as audience response technology are increasingly used in public health tertiary education, to train practitioners to address Asia-Pacific region’s rapidly changing health needs. However, little is known about the impact on student performance, satisfaction, and understanding. This study aimed to assess postgraduate students’ perceptions and their use of technology in a large epidemiology subject at an Australian university in internal and external modes. The study used both routinely collected student data (n = 453) and survey data (n = 88). Results indicate that students accept and use technology-based learning tools, and perceive audience response technology as well as streamed and recorded lectures as useful for their learning (96.6%). Students have shown a preference to review recorded lectures rather than viewing streamed lectures. Analyses further suggest that the use of recorded and streamed lectures may be linked to better student performance for external students (passing, any use odds ratio = 3.32). However, these effects are not consistent across all student subgroups and externally enrolled students may profit more than those enrolled internally

Geographical accessibility of emergency neonatal care services in Ethiopia: analysis using the 2016 Ethiopian Emergency Obstetric and Neonatal Care Survey.

INTRODUCTION: Access to emergency neonatal health services has not been explored widely in the Ethiopian context. Accessibility to health services is a function of the distribution and location of services, including distance, travel time, cost and convenience. Measuring the physical accessibility of health services contributes to understanding the performance of health systems, thereby enabling evidence-based health planning and policies. The physical accessibility of Ethiopian health services, particularly emergency neonatal care (EmNeC) services, is unknown. OBJECTIVE: To analyse the physical accessibility of EmNeC services at the national and subnational levels in Ethiopia. METHODS: We analysed the physical accessibility of EmNeC services within 30, 60 and 120 min of travel time in Ethiopia at a national and subnational level. We used the 2016 Ethiopian Emergency Obstetric and Neonatal Care survey in addition to several geospatial data sources. RESULTS: We estimated that 21.4%, 35.9% and 46.4% of live births in 2016 were within 30, 60 and 120 min of travel time of fully EmNeC services, but there was considerable variation across regions. Addis Ababa and the Hareri regional state had full access (100% coverage) to EmNeC services within 2 hours travel time, while the Afar (15.3%) and Somali (16.3%) regional states had the lowest access. CONCLUSIONS: The physical access to EmNeC services in Ethiopia is well below the universal health coverage expectations stated by the United Nations. Increasing the availability of EmNeC to health facilities where routine delivery services currently are taking place would significantly increase physical access. Our results reinforce the need to revise service allocations across administrative regions and consider improving disadvantaged areas in future health service planning

Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis.

INTRODUCTION:Undernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA. METHODS AND ANALYSIS:PubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger's and Begg's tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI. ETHICS AND DISSEMINATION:Ethical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available. PROSPERO REGISTRATION NUMBER:CRD42021277741

The proportion of loss to follow-up from antiretroviral therapy (ART) and its association with age among adolescents living with HIV in sub-Saharan Africa: A systematic review and meta-analysis.

BACKGROUND: Human immunodeficiency virus (HIV) remains a global health threat, especially in developing countries. The successful scale-up of antiretroviral therapy (ART) programs to address this threat is hindered by a high proportion of patient loss to follow-up (LTFU). LTFU is associated with poor viral suppression and increased mortality. It is particularly acute among adolescents, who face unique adherence challenges. Although LTFU is a critical obstacle on the continuum of care for adolescents, few regional-level studies report the proportion of LTFU among adolescents receiving ART. Therefore, a systematic review and meta-analysis were conducted to estimate the pooled LTFU in ART programs among adolescents living with HIV in sub-Saharan Africa (SSA). METHODS: We searched five databases (PubMed, Embase (Elsevier), PsycINFO, CINAHL, and Scopus) for articles published between 2005 and 2020 and reference lists of included articles. The PRISMA guidelines for systematic reviews were followed. A standardised checklist to extract data was used. Descriptive summaries were presented using narrative tables and figures. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I2 test. Random effect models were used to estimate the pooled prevalence of LTFU among ALHIV. We used Stata version 16 statistical software for our analysis. RESULTS: Twenty-nine eligible studies (n = 285,564) were included. An estimated 15.07% (95% CI: 11.07, 19.07) of ALHIV were LTFU. Older adolescents (15-19 years old) were 43% (AOR = 0.57, 95% CI: 0.37, 0.87) more likely to be LTFU than younger (10-14 years old) adolescents. We find an insignificant relationship between gender and LTFU (AOR = 0.95, 95% CI: 0.87, 1.03). A subgroup analysis found that regional differences in the proportion of adolescent LTFU were not statistically significant. The trend analysis indicates an increasing proportion of adolescent LTFU over time. CONCLUSIONS AND RECOMMENDATIONS: The proportion of LTFU among HIV-positive adolescents in SSA seems higher than those reported in other regions. Older adolescents in the region are at an increased risk for LTFU than younger adolescents. These findings may help policymakers develop appropriate strategies to retain ALHIV in ART services. Such strategies could include community ART distribution points, appointment spacing, adherence clubs, continuous free access to ART, and community-based adherence support

Effects of participation in and connectedness to the LGBT community on substance use involvement of sexual minority young people

© 2018 Elsevier Ltd Introduction: Research shows disproportionate levels of substance use among sexual minority young people. A range of reasons for these disparities have been suggested, including connectedness to and participation in the LGBT community. Little is known about how these constructs are related to substance use involvement in sexual minority (sub)groups or how these relationships are affected by other factors. Methods: 1266 young sexual minority Australians completed a cross-sectional online survey. Multiple regressions were conducted to assess associations between connectedness to and participation in the LGBT community on substance use involvement, before and after controlling for other factors such as substance use motives, psychological distress, wellbeing, resilience, minority stress, and age. Results/conclusion: Most participants identified as homosexual (57%, n = 726) and male (54%, n = 683). In the overall sample, participation in and connectedness the LGBT community were significantly associated with increased substance use involvement before (F(2,1263) = 35.930, p ≤ 0.001, R 2 = 0.052) and after controlling for other variables (F(8,1095) = 33.538, p ≤ 0.001, R 2 = 0.191), with meaningfully higher effect sizes for participation than for connectedness. After controlling for other variables, connectedness only remained significant for homosexuals. Effect sizes for participation were higher for females than males, and bisexuals than homosexuals. However, participation in the LGBT Community was not associated with substance use in participants identifying with a non-binary gender identity. In conclusion, substance use involvement was associated with participation in the LGBT community, but connectedness to the LGBT community only had a weak association with substance use involvement in the homosexual subgroup

Personal, social, and environmental factors associated with lifejacket wear in adults and children: A systematic literature review

Objective: Drowning claims 7% of the global burden of injury-related deaths. Lifejackets are routinely recommended as a drowning prevention strategy; however, a review of related factors regarding lifejacket wear has not previously been investigated. Methods: This systematic review examined literature published from inception to December 2016 in English and German languages. The personal, social, and environmental factors associated with lifejacket wear among adults and children were investigated, a quantitative evaluation of the results undertaken, and gaps in the literature identified. Results: Twenty studies, with sample sizes of studies ranging between 20 and 482,331, were identified. Fifty-five percent were cross-sectional studies. All studies were scored IV or V on the Australian National Health and Medical Research Council (NHMRC) grading system indicating mostly descriptive and cross-sectional levels of evidence. Factors associated with increased wear included age (mostly children), gender (mostly female), boat type (non-motorised), boat size (small boats), role modelling (children influenced by adult lifejacket wear), and activity (water-skiing, fishing). Factors not associated or inconsistent with lifejacket wear included education, household income, ethnicity, boating ability, confidence in lifejackets, waterway type, and weather and water conditions. Factors associated with reduced lifejacket wear included adults, males, discomfort, cost and accessibility, consumption of alcohol, and swimming ability. Three studies evaluated the impact of interventions. Conclusion: This review identified factors associated with both increased and decreased lifejacket wear. Future research should address the motivational factors associated with individuals’ decisions to wear or not wear lifejackets. This, combined with further research on the evaluation of interventions designed to increase lifejacket wear, will enhance the evidence base to support future drowning prevention interventions

Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis.

AIMS: To examine the patient-related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries. DESIGN: A systematic review and meta-analysis. DATA SOURCES: A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer-reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified. REVIEW METHODS: Extracted data were analysed using Review Manager 5.4. RESULTS: The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self-management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006). CONCLUSION: These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control