Dialogues in health最新文献

The current study is concerned with how HIV is spatialized, or emplaced in everyday life, and therefore how prevention, Queer identity, and the virus itself are given meaning. Employing a transdisciplinary methodology based in Critical Discourse Studies and critical human geography, this study provides a geosemiotic analysis of an HIV prevention social marketing effort called the Little Prick campaign. Findings showed that space was constructed through multiple competing dynamics across professionals and citizens, as well as amidst contested notions of risk and branding in the epidemic. The analysis illuminates the discursive relationship amongst Queer, HIV, and prevention. Equally, this study counters the biased notion that “prevention fatigue” in high-risk populations hampers professional labor by, instead, exposing a semiotic fatigue in the HIV epidemic and prevention efforts.

Background

Previous literature suggests that men reporting more gender-equitable attitudes are more likely to use condoms, but there is a paucity of data evaluating whether these attitudes are associated with contraceptive communication and use. The objective of this study is to test the hypothesis that men reporting more gender-equitable attitudes will be more likely to (a) engage in contraceptive communication with their wives and (b) that they and/or their wives will be more likely to use all forms of family planning, compared to men with less equitable attitudes.

Methods

Using cross-sectional dyadic survey data from young married couples from rural Maharashtra, India (N = 989), we assessed the associations between men's gender role attitudes and a) spousal contraceptive communication and b) contraceptive use by type (none, traditional, condoms, pills, or IUD). The contraceptive use outcome is based on wives' report. We assessed these associations via bivariate t-test (communication outcome) or ANOVA test (contraceptive type outcome), as well as unadjusted and adjusted logistic (communication outcome) and multinomial logistic (contraceptive type outcome) regression models. Adjusted models included sociodemographic factors selected a priori based on established associations with gender-equitable attitudes and/or our assessed outcomes.

Findings

Men with more gender-equitable attitudes were more likely to discuss family planning with their wives (AOR = 1·05, 95%CI 1·03-1·07, p < 0·001) and to use condoms (ARRR = 1·03, 95%CI 1·00-1·06, p = 0·07). There was no association between gender-equitable attitudes and use of other types of contraception.

Interpretation

While gender-equitable attitudes among men may facilitate condom use and family planning communication in marriage, they do not appear to be linked with greater likelihood of use of more effective types of contraceptive use. This suggests that males supportive of gender equity may take greater responsibility for family planning vis a vis a less effective contraceptive, condoms, in the absence of more effective short-acting contraceptives for men.

Funding

The National Institutes of Health [Grant number 5R01HD084453-01A1] and the Bill & Melinda Gates Foundation, Seattle, WA [grant number INV-002967].

Purpose

To examine the impact of the national poultry housing order the UK government introduced on 7 November 2022 on the spreading of the avian influenza virus among poultry premises.

Methods

A longitudinal design with 15 weeks of infected poultry specialist incidence rates per 100 poultry specialists during the 2022/23 winter for 8 English regions. A multilevel regression model was used to analyse repeated measurements. Time was level-1 unit and regions level-2 unit resulting in 120 observations. Random intercept models included interactions between housing order and weekly infected wild birds, poultry density, or weekly average temperatures divided into terciles. In models where these variables were not included as an interaction term they were introduced as confounders.

Results

After the introduction of the housing order, it took 3 weeks for a considerable reduction in poultry specialist incidence rates. Reduction in incidence rates was strongest in regions with highest poultry density, from 1.27 (95%CI 0.99 to 1.56) to 0.30 (95%CI 0.09 to 0.52). Considerable reductions were also seen in regions with most detected infected wild birds.

Conclusion

The housing order was successful in reducing infected poultry specialist incidence rates three weeks after its introduction. Strongest impact in regions with highest poultry density.

Background

A study was conducted to evaluate the role of mobile health clinics (MHCs) in providing healthcare services in rural areas, focusing on the population of KwaMachi in KwaZulu Natal, South Africa. The objective of the study was to explore the level of health promotion and health-seeking behaviour in KwaMachi, understand the services provided by the MHCs, and assess the experiences of individuals accessing healthcare through these clinics.

Methods

The study used qualitative research methods, including face-to-face interviews and focused group discussions. A sample of 20 patients, with equal representation of males and females across different age groups, was selected using purposive and convenience sampling methods. Two themes were developed: positive experiences and negative experiences. The collected data was analyzed using manual thematic analysis.

Findings

The findings of the study revealed that MHCs serve as the main entry point to the national healthcare system in rural areas, but they offer limited services, which contributes to the ongoing struggle of rural communities to access primary healthcare. While respondents generally had positive experiences with MHCs, some negative aspects need to be addressed. These included concerns about privacy during consultations, the unavailability of essential medications, limited services offered, lack of doctors, and inadequate management of clinical records leading to diagnostic inaccuracies.

Conclusion

The study highlights the challenges faced by rural communities in accessing healthcare services and the role of MHCs in addressing these challenges Based on these findings, the study concludes that there is a need for sustainable MHC programs that address the specific needs and preferences of the local population.

Recommendations

These insights are of value to policymakers seeking to enhance the impact of MHCs in improving healthcare access and outcomes in rural areas. By looking at areas of improvement in the services provided by MHCs, including addressing privacy concerns, ensuring the availability of essential medications, and improving the management of clinical records. The study provides valuable insights for policymakers to enhance the effectiveness of MHC programs in rural areas.

Background

COVID-19 disrupted the TB prevention programme in the UK, especially for TB infection (TBI) care. We explore whether experience of the COVID-19 pandemic impacted on patients' perceptions of TBI and its treatment.

Methods

Semi-structured interviews were conducted as part of the Research to Improve Detection and Treatment of TBI (RID-TB) programme, exploring perceptual and practical barriers to TBI treatment. Nineteen people diagnosed with TBI were interviewed between August 2020 and April 2021. Recordings were transcribed and analysed using a constant comparative approach, allowing for a dynamic and iterative exploration of themes. Themes are organised using the Perceptions and Practicalities Approach.

Findings

Some participants perceived TBI as a risk factor for increased susceptibility to COVID-19, while some thought that treatment for TBI might protect against COVID-19 or mitigate its effects. Adaptations to TB services (e.g., remote follow-up) and integrated practices during the COVID-19 restrictions (e.g., medication being posted) addressed some practical barriers to TBI treatment. However, we identified beliefs about TBI and COVID-19 that are likely to act as barriers to engagement with TBI treatment, including: interpreting service delays as an indication of TBI not being serious enough for treatment and concerns about contracting COVID-19 in TB clinics.

Interpretation

COVID-19 and TBI service delays influence people's perceptions and practical barriers to TBI treatment adherence. Failure to address these beliefs may lead to people's concerns about their treatment not being fully addressed. Utilised service adaptations like remote consultations to address practical barriers may be relevant beyond COVID-19.

Funding

NIHR RID-TB Program (RP-PG-0217-20009).

This cross-sectional, descriptive study conducted on in June 2022 reviewed 100 TikTok videos using the hashtag #africansinukriane that depicted discrimination against Black people attempting to flee Ukraine at the onset of the war in February 2022. Two of the 16 themes were significant and present in over 50% of videos: raising awareness (67%) and racial discrimination (64%). Videos with elements of physical contact (N = 16, 76.2%), violence (N = 12, 75%), and dehumanization (N = 11, 68.8%) had higher shares than overall media shares. Less than 10% of the videos included dark humor (8%), sharing helpful resources (7%), and appreciation of countries that offered support (5%). Results indicate that videos that include raising awareness (p = .02), racial discrimination (p = .001), on-scene clips or war scenes (p = .007), physical contact (p = .006), and denied entry (p = .022). Their estimated differences in locations indicate that all of these themes were related to higher median shares of the videos. This study supports that TikTok is a place where marginalized groups can raise awareness about injustice and create counternarratives. This study exemplifies international anti-blackness with implications for health marketing and communication, human rights efforts, refugee health, and targeted mental health and policy support for those displaced by war.

Background

Multiple international assessments have highlighted gaps in blood banking globally. However, there is a dearth of subnational assessments. We applied a thematic framework with multiple composite indices to assess blood bank performance across Indian states and districts.

Methods

In this retrospective cross-sectional analysis, data for 2493 blood banks in 35 states/union territories (UTs) and 616 districts was extracted from the National Blood Transfusion Council for 2016. The framework involved seven themes (accreditation, ownership, safety, volume, infrastructure, regulation, and workforce) with several indicators nested under them. Composite thematic indices and an overall index (0-100, with 100 being the best performance) were constructed using the adjusted Mazziotta-Pareto index method that can provide composite indices that are partially non-compensatory and easily interpretable.

Results

The state-level median [interquartile range] value of the overall index was 59.61 [46.35, 71.67]. Chandigarh had the highest values for safety, regulation, workforce, and ownership indices, Maharashtra for volume and infrastructure indices, and Manipur for accreditation index. Districts in southern and western states performed well on the overall index with inter- and intra-state variations for themes. District-level correlations depicted positive associations among indices with the strongest correlation between ownership and accreditation indices (n=616, R=0.92, p<0.001).

Conclusion

Blood banking in India is fragmented, with variations in themes across geographies. The northern and northeastern states require more attention for volume, accreditation, infrastructure, and ownership. While the southern and western-central regions need to prioritize safety. The framework with thematic indices, when applied to routine data, can be useful for monitoring and evaluation to decide local policies and resource allocations.

Purpose

Healthcare avoidance and delay (HAD) in the transgender population has been well documented, and research has explored a range of associated factors that help to identify those most at risk of HAD. This review addresses a gap in the research by synthesizing research exploring associations between HAD and demographic factors.

Methods

A systematic search of literature published at any time up to December 2021 was conducted, using five databases (EBSCO, EMBASE, PubMed, Scopus, and Web of Science) and manually searching reference lists of included studies. After exclusion of duplicates, 608 unique records were subjected to double screening. Papers reporting statistical analyses of HAD in association with any sociodemographic variables were included in this review. Papers consisted of nineteen cross-sectional studies. Narrative synthesis was used to address findings.

Results

Nineteen studies met inclusion criteria, exploring HAD in association with a wide range of demographic factors, including sex and gender, social transition factors, age, race and ethnicity, socioeconomic factors, veteran status, education, sexuality, relationship status, citizenship, place of residence, and state demographics. Findings identified intra-community demographic risk factors, with consistent evidence for increased HAD among transmasculine, and younger, participants. Lower income and higher educational attainment were also associated with increased HAD, while remaining areas had weak or little evidence for association with HAD.

Conclusion

This review expands knowledge in this area by highlighting demographic factors associated with increased HAD in research literature, and exploring how these may be further investigated to address substantial gaps in the body of research.

Long-term use of asbestos-contaminated talcum power has been reported to be the main causative agent for carcinogenesis in many research studies. In recent developments Johnson & Johnson has lost multimillion-dollar lawsuits for being associated with the development of mesothelioma and ovarian cancer by its talc-based baby powder. In May 2020, the company announced, the end of the sale of its baby powder in the USA and Canada and in August 2022, announced the global discontinuation by 2023. However, in India vast proportions of people are using talc-based baby powder and the products are readily available in the market. The purpose of this communication is to create awareness and draw attention of authorities for effective regulation, including prohibition of sale and retraction of the contaminated talc-based products from the Indian market at the earliest.