Causes of death among undocumented migrants in Sweden, 1997–2010

Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country's Cause of Death Register (CDR). Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants. Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample's mean age at death±a half standard deviation. Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83–4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73–2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04–0.14). Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage

Scaling a waterfall: a meta-ethnography of adolescent progression through the stages of HIV care in sub-Saharan Africa.

INTRODUCTION: Observational studies have shown considerable attrition among adolescents living with HIV across the "cascade" of HIV care in sub-Saharan Africa, leading to higher mortality rates compared to HIV-infected adults or children. We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub-Saharan Africa. METHODS: We systematically searched five databases for studies published between 2005 and 2016 that met pre-defined inclusion criteria. We used a meta-ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio-ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade. RESULTS AND DISCUSSION: We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third-order constructs emerged to explain adolescents' engagement in HIV care. Stigma was the most salient factor impeding adolescents' interactions with HIV care over the past decade. Self-efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent-friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual-level factors, including past illness experiences, identifying mechanisms to manage pill-taking in social situations, financial (in)stability and the presence/absence of future aspirations also shaped adolescents HIV care engagement. CONCLUSIONS: Adolescents' initial and ongoing use of HIV care was frequently undermined by individual-level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual-level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as "test and treat" policies are scaled up

Alternatives to carbon dioxide stunning during pig slaughter : obstacles and opportunities related to implementation

I Sverige och andra länder inom EU är koldioxid den dominerande metoden för bedövning av grisar vid kommersiell slakt. När ett djur bedövas i samband med slakt ska metoden som används leda till medvetslöshet utan att djuret känner smärta, vilket inkluderas i lagstiftning i såväl Sverige som EU. I EFSAs (2020) utvärdering av grisarnas välfärd vid slakt lyfts problematik med smärta och rädsla relaterat till koldioxidbedövning. Till följd av koldioxidbedövningens negativa inverkan på grisars djurvälfärd eftersöks alternativa bedövningsmetoder. Den här studiens huvudfokus var att undersöka hinder och möjligheter relaterat till implementering av alternativa bedövningsmetoder till koldioxidbedövning vid kommersiell slakt av gris. Studien är en litteraturstudie där information samlades under perioden mars till maj 2023 och begränsades till litteratur som publicerats 2009–2022. Resultaten visar att det idag inte finns alternativa bedövningsmetoder som är redo att implementeras i kommersiell slakt. Det beror delvis på att alternativa bedövningsmetoderna fortfarande är i forskningsstadium, inte är ekonomiskt realistisk, eller att befintliga system för bedövning inte är utformade så att alternativa metoder kan appliceras. Delar av den pågående forskningen gällande alternativa bedövningsmetoder har god potential för implementering i framtiden och genom framtida forskning finns möjligheter till utfasning av koldioxidbedövning. Det finns en politisk vilja inom EU och i civilsamhället att fasa ut koldioxidbedövning vilket kan vara en stark drivkraft att snabba på utfasningen av bedövningsformen.In Sweden and other EU countries, carbon dioxide is the dominant stunning method used for pigs in commercial slaughter. When an animal is stunned at slaughter, the method used must lead to unconsciousness without the animal feeling pain. EFSAs (2020) evaluation of the welfare of pigs at slaughter emphasises that carbon dioxide stunning is associated with pain and fear for the pig. Due to the negative impact of carbon dioxide stunning on the animal welfare of pigs, alternative stunning methods are being investigated. The main focus of the study was to investigate obstacles and opportunities related to implementation of alternative stunning methods to replace carbon dioxide stunning for pigs in commercial slaughter. The study is a literature study in which data was collected systematically from March to May 2023 and was restricted to literature published between 2009–2022. The results indicate that there are currently no alternative stunning methods to carbon dioxide that are ready to be implemented in commercial slaughter. This is partly because the alternative stunning methods are either still in a research stage, are not economically realistic, or that the design of current systems do not allow them to be applied. On the other hand, there has been some research on alternative stunning methods and through future research there are possibilities that carbon dioxide stunning can be phased out. There is a political will within the EU and civil society to phase out carbon dioxide stunning, which can be a strong driving force to speed up the process

Sexual Behaviour and Sexually Transmitted Infections Among Urban Ugandan Youth – Perceptions, Attitudes and Management

The aims of this thesis were to expand the knowledge about sexual and reproductive health among urban Ugandan youths, living in a slum, and to evaluate the national flow-chart for management of the abnormal vaginal discharge (AVD) syndrome in adolescent girls. Data collection included individual interviews, focus-group discussions and clinical investigations with tests for chlamydia trachomatis (CT), neisseria gonorrhoea (NG), trichomonas vaginalis (TV), syphilis, and HIV infection. Poverty, peer pressure and gender power imbalance were obstacles to safe sexual practices: to abstain from sex, be faithful or to use condoms. Prevalence among the 199 female and 107 male adolescents for CT, NG, TV, syphilis and HIV was 4.5%, 9.0%, 8.0%, 4.0% and 15.2% for females and 4.7%, 5.7%, 0%, 2.8% and 5.8% for males. The national AVD flow-chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. A flow-chart using risk factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3% respectively. Socially disadvantaged females had a high risk to be HIV infected and HIV infection was associated to other STIs. Females were more likely than males to have any of the infections studied. Voluntary counselling and testing (VCT) for HIV was considered as helpful in preventing the spread of HIV. Obstacles for testing were: lack of time and money, fear of stigmatisation and fear that the knowledge of HIV positive status could shorten someone's life. An alternative flow-chart for management of AVD among adolescent girls should be evaluated. Girl's opportunities for education and income generating work should be a priority. VCT services for young people should be made accessible in terms of cost, time and quality of counselling

Sexual Behaviour and Sexually Transmitted Infections Among Urban Ugandan Youth – Perceptions, Attitudes and Management

The aims of this thesis were to expand the knowledge about sexual and reproductive health among urban Ugandan youths, living in a slum, and to evaluate the national flow-chart for management of the abnormal vaginal discharge (AVD) syndrome in adolescent girls. Data collection included individual interviews, focus-group discussions and clinical investigations with tests for chlamydia trachomatis (CT), neisseria gonorrhoea (NG), trichomonas vaginalis (TV), syphilis, and HIV infection. Poverty, peer pressure and gender power imbalance were obstacles to safe sexual practices: to abstain from sex, be faithful or to use condoms. Prevalence among the 199 female and 107 male adolescents for CT, NG, TV, syphilis and HIV was 4.5%, 9.0%, 8.0%, 4.0% and 15.2% for females and 4.7%, 5.7%, 0%, 2.8% and 5.8% for males. The national AVD flow-chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. A flow-chart using risk factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3% respectively. Socially disadvantaged females had a high risk to be HIV infected and HIV infection was associated to other STIs. Females were more likely than males to have any of the infections studied. Voluntary counselling and testing (VCT) for HIV was considered as helpful in preventing the spread of HIV. Obstacles for testing were: lack of time and money, fear of stigmatisation and fear that the knowledge of HIV positive status could shorten someone's life. An alternative flow-chart for management of AVD among adolescent girls should be evaluated. Girl's opportunities for education and income generating work should be a priority. VCT services for young people should be made accessible in terms of cost, time and quality of counselling

Sexual Behaviour and Sexually Transmitted Infections Among Urban Ugandan Youth – Perceptions, Attitudes and Management

The aims of this thesis were to expand the knowledge about sexual and reproductive health among urban Ugandan youths, living in a slum, and to evaluate the national flow-chart for management of the abnormal vaginal discharge (AVD) syndrome in adolescent girls. Data collection included individual interviews, focus-group discussions and clinical investigations with tests for chlamydia trachomatis (CT), neisseria gonorrhoea (NG), trichomonas vaginalis (TV), syphilis, and HIV infection. Poverty, peer pressure and gender power imbalance were obstacles to safe sexual practices: to abstain from sex, be faithful or to use condoms. Prevalence among the 199 female and 107 male adolescents for CT, NG, TV, syphilis and HIV was 4.5%, 9.0%, 8.0%, 4.0% and 15.2% for females and 4.7%, 5.7%, 0%, 2.8% and 5.8% for males. The national AVD flow-chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. A flow-chart using risk factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3% respectively. Socially disadvantaged females had a high risk to be HIV infected and HIV infection was associated to other STIs. Females were more likely than males to have any of the infections studied. Voluntary counselling and testing (VCT) for HIV was considered as helpful in preventing the spread of HIV. Obstacles for testing were: lack of time and money, fear of stigmatisation and fear that the knowledge of HIV positive status could shorten someone's life. An alternative flow-chart for management of AVD among adolescent girls should be evaluated. Girl's opportunities for education and income generating work should be a priority. VCT services for young people should be made accessible in terms of cost, time and quality of counselling

“Safe sex advice is good - but so difficult to follow”. Views and experiences of the youth in a health centre in Kampala: From Kiswa Youth Clinic, Kampala, Uganda

Background: Young people in Uganda are advised by the Ministry of Health and other ities to abstain from sex in order to avoid the human immunodeficiency virus (HIV), other sexually transmitted diseases (STD) and early pregnancies. If they cannot abstain they should use condoms and they should stay faithful to their partner. Objective: To find out how young people perceive this advice and if they find it possible and realistic to follow. Method: In May and June 2000 twenty informants were selected by purposeful sampling and were interviewed in English. Given items were discussed. The interviews were recorded on tape, transcribed, extracted and sorted into categories in a qualitative research method. Results: Most of the interviewed youth claimed that the advice is good and helpful but there are many obstacles. The results showed that information given in schools about condom use and safer sex behaviour is not always adequate. However, despite lack of clear health education messages, the risk of being HIV positive is of major concern to many youth. In addition, the expected lack of support if the test is positive is a common reason for abstaining from HIV testing. Conclusions: More discussions in society are needed to create consensus on safe sex messages presented to young people. HIV infection is a major concern but many young people abstain from testing, as they expect to receive inadequate support. African Health Sciences 2002; 2(3): 107-11

Self-reported sexual behaviour among adolescent girls in Uganda: reliability of data debated

Objective: To compare self-reported information about sexual behaviour in a research interview to information retrieved during a clinical consultation. Method: 595 sexually experienced women below 20 years, were interviewed by a social worker about genital symptoms and sexual behaviour. A midwife interviewed, examined, and took vaginal samples for gonorrhoea and chlamydia. Four questions were embedded in both the social workers interviews and among midwife's questions. The women were asked if they perceived their latest /current partner to be faithful, if he had complained about any genital symptoms, if a condom was used at latest sexual intercourse and if the woman knew her HIV status. Results: The prevalence of gonorrhoea and/or chlamydia was 7.1% but for women who reported that their partner had complained about genital symptoms it was significantly higher. Agreement between answers given in the research interview and to the midwife was good for HIV status but only fair or moderate for perceived faithfulness, partner's symptoms and recent condom use. Conclusion: Information about risk factors revealed in individual interviews and by the midwives taking a history was incongruent. Any approach for management of STIs, which is built on self-reported risk factors, needs careful assessment of reliability