1,721,248 research outputs found
The global environment
No full textThe Oxford Textbook of Public Health is the ultimate resource on the subject of public health and epidemiology. With contributors drawn from across the world, offering perspectives from vastly different health systems, with ranging public health needs and priorities, this book offers a globally comprehensive picture of modern health
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Public Health in East and Southeast Asia: Challenges and Opportunities in the Twenty-First Century
Full text link“This volume is unique in its comprehensive investigation of the changing face of public health in East and Southeast Asia. The region’s countries have experienced major challenges resulting from colonialism, conflicts, economic and technological development, varying levels of government stability, widening disparities between social classes, uneven distribution of wealth, emerging epidemics, chronic diseases, occupational hazards, and changing health services. All of these issues are ably addressed by the authors, firsthand experts in their respective countries and fields. With its useful summaries and wealth of international sources, it will be an excellent resource for scholars and practitioners seeking an introduction to the region’s complex context and development.” Chitr Sitthi-amorn, former president, International Epidemiological AssociationPublic Health in East and Southeast Asia presents an overview of the state of public health across this vast region and considers the challenges and prospects for its future advancement. It pays particular attention to how rapid economic progress has brought accelerated change, both demographic and epidemiological, to an area already marked by great heterogeneity in health status and public health systems. In comparative and thematically oriented chapters, leading scholars consider such issues as changes in values and lifestyles, infectious diseases, nutrition, tobacco, chronic diseases, accidents and injury, environmental health, occupational health, the effect of globalization, and health services.Roger Detels is Distinguished Professor of Epidemiology and Infectious Diseases and Chair of Epidemiology at the University of California, Los Angeles. He is the former president of the International Epidemiological Association. Sheena G. Sullivan is an epidemiologist at the WHO Collaborating Centre for Reference and Research on Influenza and was previously with the Chinese Center for Disease Control and Prevention. Chorh Chuan Tan is President of the National University of Singapore and was previously the Director of Medical Services in Singapore’s Ministry of Health, in which capacity he was responsible for the medical response to the SARS epidemic in 2003.Contributors: Rajesh Bhatia, Chien-Jen Chen, Wen-Ta Chiu, Roger Detels, Binh Y. Goldstein, Anthony J. Hedley, Ling-I Hsu, Elizabeth A. Jahncke, Sunbaunat Ka, David Koh, Ee Heok Kua, Tai Hing Lam, William Lavely, Ting Heung Leung, Sarah M. McGhee, Jai P. Narain, Lu Pai, Donald Maxwell Parkin, Saumik Paul, Samlee Plianbangchang, Ramkishen S. Rajan, Adeline Seow, Judy Sng, Sheena G. Sullivan, Chorh Chuan Tan, U Than Sein, Kraisid Tontisirin, Shin-Han Tsai, Thomas Tsang, Kumnuan Ungchusak, Lilian W. C. Wan, Pattanee Winichagoon, Zuo-Feng Zhan
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Effect of nutritional counseling on low-density lipoprotein (LDL) cholesterol among Thai HIV-infected adults receiving antiretroviral therapy
Full text linkBackground: Although intensive antiretroviral therapies dramatically reduce mortality rates in HIV-infected patients, significant metabolic complications associated with antiretroviral therapy including dyslipidemia have been increasingly reported. Objectives of this study are to determine 1) an effect of individual nutritional counseling on dyslipidemia, particularly LDL-C, among Thai HIV-infected adults with dyslipidemia who were not currently taking lipid-lowering medication 2) predictors of reducing LDL-C in Thai HIV-infected adults receiving a stable of antiretroviral regimen for at least 3 months. Methods: We conducted a randomized, 24-week study in HIV-infected patients who were on antiretroviral therapy with dyslipidemia and were eligible to initiate therapeutic lifestyle changes according to National Cholesterol Education Program (2002). Participants were randomly assigned into two groups. The intervention group received individual counseling with a nutritionist whereas the control group received general diet advice from a physician. A 24-hr recall technique was used to assess dietary intake for both groups at baseline and at week 24. Lipid profile was measured at baseline, at 12 weeks and 24 weeks of follow up. Predictors (measured at baseline) associated with the reduction of LDL-C in HIV-infected patients were assessed for any reduction in LDL-C and for a reduction of at least 10 mg/dL. Results: Seventy-two patients were randomly assigned. Of these, 62 (86%) completed lipid profile testing and 59 (82%) completed dietary interview. We found a significant difference in mean reduction from baseline of total cholesterol (8% vs 0%) and LDL-C (13% vs 4%) between the intervention group and the control group at week 24. A significant reduction in weight and in carbohydrate intake in the intervention group was observed. Participants who had good level of knowledge of dyslipidemia were more likely to achieve reduction in LDL-C of at least 10 mg/dL at 24 weeks of follow up. Conclusions: The effectiveness of individual nutritional counseling in improving dyslipidemia, particularly total cholesterol and LDL-C, among Thai HIV-infected adults with dyslipidemia receiving antiretroviral therapy has been demonstrated. To provide a better care for HIV-infected patients receiving antiretroviral therapy with hyperlipidemia, routine HIV/AIDS care with individualized nutritional counseling integration and adequate knowledge of dyslipidemia provision are recommended
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Barriers to Expanding HIV Testing Among Male Students Who Have Sex with Men in Chengdu, China
Full text linkBackgroundIn China, HIV transmission among students who are men having sex with men (MSM) is growing at an alarming rate. This study aimed to explore barriers to expanding HIV testing among student MSM in Chengdu City, China.MethodsA mixed method was used in the study. We first conducted four anonymous focus group discussions with a total of 21 implementers of the HIV campaign in the city. Secondly, the anonymous face-to-face in-depth interviews were performed with 24 student MSM. At last, a cross-sectional survey was conducted among 536 student MSM.ResultsIn the focus group discussions, barriers to promoting HIV testing among student MSM were summarized into four levels: 1) the target-level obstacles included fear of personal information being disclosed, lack of access to HIV testing promotions, and lack of HIV knowledge and risk perceptions; 2) the provider-level challenges were HIV stigma and discrimination, lack of professional training, and extra workload with low payment; 3) the institutional-level inhibitors comprised of manpower shortage with excessive turnover, lack of funding and flexible use of it, and lack of leadership support; and 4) the policy-level barriers contained lack of involvement of MSM communities, lack of emphasis on HIV testing, and ambiguity of implementation details. In the in-depth interviews, the barriers to HIV testing identified by the participants were lack of detailed HIV knowledge and risk perceptions, concerns of confidentiality and privacy, lack of availability of HIV testing information, inconvenient location and open time of HIV testing sites, perceived and internalized homosexuality stigma, and HIV stigma and discrimination. In the cross-sectional study, 68.0% and 59.8% of the student MSM reported having received an HIV test ever and in the past 12 months, respectively. The level of HIV knowledge (adjusted odds ratio=0.84; p-value=0.019) and no affiliation to MSM-oriented organizations (adjusted odds ratio=2.88; p-value<0.001) were significantly associated with not receiving an HIV test in the past 12 months.ConclusionThe cooperation between governments, health facilities, schools, and MSM communities should be considerably strengthened to reinforce HIV health education in schools and to implement innovative strategies of promoting HIV testing among student MSM in China
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Feasibility of RDS, Effectiveness of Risk-Reduction-Counseling and Testing, and Factors Associated with Loss-to-Follow-Up in an Intervention Study for Men Who Have Sex with Men in Nanjing
Full text linkBackground: Respondent-driven-sampling (RDS) has been recognized as a method for sampling from most hard-to-reach populations. Meanwhile, loss to follow up of the participants in follow up studies usually reduces the validity of the association measured in observational studies, and this problem cannot be overcame through data analysis.Methods: In a cross sectional study in Nanjing city of Jiangsu province of China, 430 MSM were recruited including 9 seeds in 14 weeks of study period using RDS. Information regarding socio-demographic characteristics and sexual risk behavior were collected and testing was done for HIV and syphilis. Duration, completion, participant characteristics and the equilibrium of key factors were used for assessing feasibility of RDS. All the HIV negative participants were followed up at 6, 12 and 18 months to evaluate behavioral changes after counseling to reduce risk behaviors. Logistic regression was performed to identify the factors correlated with loss to follow up.Results: In the study sample, adjusted HIV and syphilis prevalence were 6.6% and 14.6% respectively, whereas HIV incidence was 5.2 per 100 person-years. The incidence was 3.8 during six to 12 months, and 1.1 during 12 to 18 months. Although there was a tendency for recruitment within the same self-identified group, considerable cross-group recruitment was also seen. During the study period, the reported unprotected anal intercourse (UAI) significantly decreased from 60.9% to 42.9%. The proportion of participants who had one or no partner significantly increased from 40.9% to 48.0%. The study also found that some risk behaviors decreased between baseline and 12 months, followed by a slight increase between 12 and 18 months. In addition, loss to follow up for the MSM study in Nanjing was associated with younger age, small social network, lower education, and non-official residence in Jiangsu.Conclusion: RDS was found to be a potential efficient and feasible sampling method for recruiting a diverse sample of MSM in a reasonable time. Reductions in UAI can be achieved through counseling and testing, but may wane over time. The factors correlated with loss-to-follow-up found in of our study may be helpful to increase the retention rate of future cohort studies
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Viral Load Tests among People Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Wenshan Prefecture, Yunnan Province of China
Full text linkBackgroundChina has made great achievements in antiretroviral therapy (ART) among people living with HIV (PLWH), however, there is still a gap with the 90-90-90 targets, especially in rural areas. This study investigated three topics about the centralized viral load (VL) testing in Wenshan, China, including the coverage and timeliness of VL tests, the turnaround time (TAT) of VL tests, and factors associated with sustained viral suppression (SVS). MethodsTo address the three topics, three clinic-based studies were conducted respectively. First, a retrospective cohort study was conducted among 815 PLWH who initiated ART from 2015 to 2016. Second, a sequential explanatory mixed-method study was conducted: (1) 2 892 VL tests performed in 2018 were reviewed; (2) in-depth interviews were conducted among 11 healthcare providers. Third, a questionnaire survey was conducted among 264 PLWH.Results First, in Wenshan, the cumulative VL testing rates (%) at 12, 18, and 24 months after ART initiation were 58.5%, 78.1%, and 93.0%, respectively. Patients who had healthier baseline status [adjusted hazard ratio (aHR)=1.40, 95% confidence interval (95%CI)=1.18-1.65] were more likely to undergo VL tests timely. On the contrary, patients who lived far away from ART sites (aHR=0.70, 95%CI=0.59-0.83) had delayed VL tests. Second, the median VL testing TAT was 54 days (IQR: 36, 92). Factors associated with prolonged TAT mainly included the annual urban-to-rural labor migration, the shortage of healthcare professionals and lab technicians, limited VL testing instruments, and the immature reagent procurement system and testing results reporting system. Third, 61.0% (n=161) of the PLWH who participated in the survey had achieved SVS. A total of 58.3% (n=154) participants reported they had ever proactively asked about VL testing results and they were more likely to achieve SVS [adjusted odds ratio (aOR)=3.08, 95%CI=1.52-6.26]. Other factors associated with SVS included baseline CD4 count, VL-related knowledge, support from non-governmental organizations (NGO), age, and time interval from HIV diagnosis to ART initiation.ConclusionsTo achieve the 90-90-90 targets, the VL testing in rural China should be improved by combining the efforts of PLWH, local healthcare providers, NGO staff, and healthcare policymakers at all levels of government
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Perceived Barriers to Post-release Participation in Methadone Maintenance Treatment: Perspectives of Compulsory Drug Detoxification Center Detainees in Yunnan, China
Full text linkBackground: The Chinese Methadone Maintenance Treatment (MMT) Program was established in 2004 and has expanded rapidly to 28 provinces, autonomous regions, and municipalities with a total of 738 MMT clinics providing treatment for a cumulative total of more than 344,000 patients at the end of 2011. However, the total number of patients being treated daily accounted for less than 20% of all registered opiate users not counting the unregistered drug-using population. Coverage of the community-based MMT program is still low and the dropout rate among MMT patients remains high. The primary objective of this study is to identify barriers associated with detainees' unwillingness to participate in community-based MMT when released from compulsory drug detoxification centers in China. Methods: This study was carried out in two compulsory drug detoxification centers in Mangshi City, Dehong Prefecture, Yunnan Province. Between July and November, 2012, in-depth interviews were conducted with 20 incarcerated drug users in one center. A total of 250 incarcerated drug users was also recruited to participate in a face-to-face cross-sectional survey using a convenient sampling method in the other center.Results: The majority of our study participants expressed their unwillingness to initiate MMT enrollment post-release, which is of great concern. Most participants' reasons for unwillingness to take part were: no perceived needs to participate in MMT; misconceptions and lack of MMT-related knowledge; limited accessibility and financial difficulties. Moreover, side-effects, inconvenience, dosage and concurrent opiate and stimulant uses were indicated as reasons for dropping out. We also documented that ethnic disparities existed in this culturally and geographically diverse population. Lastly, a surprisingly high proportion of our study participants reported using stimulants, specifically ephedrine, as their primary drug of choice.Conclusions: There is an urgent need to revamp the current practices inside the compulsory drug detoxification and rehabilitation centers as well as the community-based MMT programs in China. A comprehensive Pre-release Relapse Prevention Program needs to be established to prepare those soon-to-be released detainees for life after incarceration. The community-based MMT program needs to be expanded to include psychological counseling and behavioral modification in order to retain patients and prevent high dropouts. In addition, testing for non-opiate drugs as part of the urine-monitoring program at MMT clinics needs to be implemented. Ethnic disparities need to be considered when designing future educational campaigns and prevention programs. And educational materials regarding the danger of stimulants addiction should be developed and disseminated among drug users and the general public as soon as possible. Further training on drug addiction as a chronic disease and methadone related knowledge should be provided for compulsory drug detoxification and rehabilitation center staff. Cooperation between public security and health sectors also needs to be strengthened
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