Global health journal (Amsterdam, Netherlands)最新文献

Background

Sexually transmitted infections (STIs) are responsible for a high burden of morbidity and mortality in many developing countries especially among adolescents. Adolescents are predisposed to STIs because they are more likely to engage in unhealthy lifestyles. However, these adolescents have limited knowledge of the use and barriers to sexual and reproductive health information and care services. This study explored the knowledge of STIs among Senior High School Adolescents in the Wa Municipality of Ghana.

Method

The study designed as a descriptive cross-sectional research. A multistage sampling technique was used to recruit these adolescents for the study. Totally 355 adolescents were selected from senior high schools in the Wa Municipality. Descriptive statistics and Chi-square test were used to analyze the data, at a significance level of P < 0.05.

Results

The majority of respondents had good knowledge of STIs, with the most common examples of STIs identified as HIV/AIDS (80.8%, 287/355) and gonorrhea (73.8%, 262/355). The main known signs and symptoms identified were discharges from the penis/vagina (72.4%, 257/355), painful urination (71.5%, 254/355), and itching, and sores around the genital area (72.7%, 258/355). The main sources of information/education of STIs for these adolescents were the school, hospital, internet and mother. Whom respondent lived with was found to be significantly associated with knowledge of STI (P < 0.001).

Conclusion

Many of the respondents had good knowledge of STI, and the school was the most common source of information on STI. It is, therefore, important for the Ghana Education Service and the Ghana Health Service to strengthen the School Health Education Programme in second cycle institutions in the Wa Municipality. Parents, especially mothers, should be actively involved in the sexual health education of adolescents.

Menopausal hormone therapy (MHT) is used to treat menopausal complaints including the genitourinary syndrome of menopause, to prevent osteoporosis, and to treat bleeding problems. Since these can be the indications also in young women, especially with POI (premature ovarian insufficiency) or with surgical menopause (bilateral oophorectomy), also the old term “Hormone Replacement Therapy (HRT)” is still used. The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations. Additional preventive benefits are reduction of cardiovascular disease (including prevention of diabetes mellitus and metabolic syndrome), reduction of colon cancer, and perhaps also Alzheimer's disease, if started within a “window of opportunity”, i.e. in perimenopause or within 6–10 years after menopause.

Primary indication for progestogen addition is to avoid the development of estrogen-dependent endometrial cancer, i.e. addition not recommended in hysterectomized women. Two main schedules, sequential- or continuous-combined estrogen/progestogen regimens, are used for treatment of bleeding problems. For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.

The WHI-study demonstrated the main risks using MHT within a “worst-case scenario”, i.e. start of MHT in old women with high risk for breast cancer and cardiovascular diseases, whereby only “conjugated equine estrogens” and “medroxprogesterone acetate” have been tested. One main result was that the progestogen component is decisive for the risk of breast cancer, which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone. In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound receptors in breast cancer tissue or blood can increase this risk. To reduce the risk of venous thromboembolism and stroke, transdermal estradiol (gels, patches,) should be used, in free combination with progesterone or dydrogesterone as “golden standard” in patients with increased risk. To increase the compliance in our patients without special risks we mostly use the available fix-combinations of estradiol/dydrogesterone getting strong efficacy, good menstrual regulation or amenorrhea, respectively, but also other combinations may be indicated to take advantage of for example androgenic or antiandrogenic progestogens.

Polycystic ovary syndrome (PCOS) is the most common endocrine and metabolic disease in women of reproductive age. PCOS is characterized by ovulatory disruption, which can lead to infertility. Patients with PCOS are also more likely to have poor pregnancy outcomes. For obese women, lifestyle interventions are recommended first, which have general health benefits. For women who have difficulty changing their lifestyle, drugs for the treatment of obesity or bariatric surgery could be considered. Clomiphene citrate is the first-line medication after weight loss that has been utilized in the past. Letrozole is supplanting clomiphene as the best option for ovulation induction for now, particularly in patients with PCOS. Metformin can improve ovulation and pregnancy rates; however, it has minimal effects in terms of raising live birth rates. Second-line therapies include gonadotropins and laparoscopic ovary drilling. In vitro fertilization can be utilized as a third-line treatment for patients with PCOS who have failed ovulation induction therapy or have other infertility factors. In summary, to achieve fertility, patients with PCOS require standardized individualized therapy.

Objectives

Coronavirus disease 2019 (COVID-19) pandemic has been associated with a great level of psychological distresses in people around the world. This study aims to assess the prevalence of depression, anxiety and stress among COVID-19 patients and identify the associated factors, in Herat Province of Afghanistan.

Methods

This cross-sectional study was conducted on 459 hospitalized patients between May and September 2021. Data was collected with a structured questionnaire on depression, anxiety and stress scale, which was the validated Dari-version. Chi-square test was adopted to analyze the associations of the prevalence of the mental disorders and the factors.

Results

The mean age of participants was 38.05; 51.9% (238/459) were male and 84.1% (386/459) were married. Median scores for depression, anxiety and stress were 5.0, 8.0, and 10.0, respectively. Gender, general health condition, nutritional status, COVID-19 clinical manifestation and concurrent comorbidities (except diabetes and hypertension) were significantly associated with mental disorders; while association between marital status and these psychological disorders was not significant. Moreover, a significant difference was observed in the level of anxiety between healthcare workers and other respondents.

Conclusion

This is the first study to report the high prevalence of depression, anxiety and stress among COVID-19 patients in Herat, which indicates the negative effect of mental health for COVID-19 patients globally and highlights the need for urgent and appropriate interventions to improve mental health of people during the pandemic.

Aims

To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019 (COVID-19) and the challenges associated with their use.

Methods

To determine the status of digital health utilization during COVID-19 in South Africa, the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study. We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021.

Results

Total of 24 articles were included into this study. This study revealed that South Africa adopted digital technologies such as SMS-based solutions, mobile health applications, telemedicine and telehealth, WhatsApp-based systems, artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic. These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases, disease surveillance and monitoring, medication and treatment compliance, creating awareness and communication. The study also revealed that teleconsultation and e-prescription, telelaboratory and telepharmacy, teleeducation and teletraining, teledermatology, teleradiology, telecardiology, teleophthalmology, teleneurology, telerehabilitation, teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa. However, these smart digital health technologies face several impediments such as infrastructural and technological barriers, organization and financial barriers, policy and regulatory barriers as well as cultural barriers.

Conclusion

Although COVID-19 has invigorated the use of digital health technologies, there are still some shortcomings. The outbreak of pandemics like COVID-19 in the future is not inevitable. Therefore, we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.

Objective

Evidence on potential cardiovascular benefits of personal-level intervention among the elderly exposed to high levels of particulate matter (PM) remains limited. We aimed to assess improvements in surrogate markers of cardiovascular injury in vulnerable populations at risks by using indoor air filtration units.

Methods

We conducted a randomized crossover trial for 2 separate 2-week air filtration interventions in 20 households of patients with stable chronic obstructive pulmonary disease and their partners in the winter of 2013, with concurrent measurements of indoor PM. The changes in biomarkers indicative of cardiac injury, atherosclerosis progression and systemic inflammation following intervention were evaluated using linear mixed-effect models.

Results

In the analysis, average levels of indoor PM with aerodynamic diameters < 2.5 µm (PM_2.5) decreased significantly by 59.2% (from 59.6 to 24.3 µg/m³, P < 0.001) during the active air filtration. The reduction was accompanied by improvements in levels of high-sensitivity cardiac troponin I by −84.6% (95% confidence interval [CI]: −90.7 to −78.6), growth differentiation factor-15 by −48.1% (95% CI: −31.2 to −25.6), osteoprotegerin by −65.4% (95% CI: −56.5 to −18.7), interleukin-4 by −46.6% (95% CI: −62.3 to −31.0) and myeloperoxidase by −60.3% (95% CI: −83.7 to −3.0), respectively.

Conclusion

Indoor air filtration intervention may provide potential cardiovascular benefits in vulnerable populations at risks.

Objective

The exact biological mechanism whereby exposure to ambient ozone (O₃) may contribute to clinical onset of cardiovascular events remains unclear. In this study, we aim to examine the impacts of O₃ exposure on cardiac arrhythmias and potential pathways involved through autonomic dysfunction and myocardial injury.

Methods

Seventy-three non-smoking healthy adults were followed with 4 repeated measurements of 24-hour ambulatory arrhythmias, heart rate variability, ST-segment deviation, and blood pressure (BP) in Beijing, China, 2014‒2016. Generalized additive mixed models coupled with distributed lag nonlinear models were constructed to evaluate the associations and potential interlinks between O₃ exposure and outcome measurements.

Results

During the study period, 24-hour average concentrations of ambient O₃ were 47.4 µg/m³ (ranging from 1.0 to 165.9 µg/m³). Increased risks of premature ventricular contraction and ventricular tachycardia were associated with interquartile range increases in O₃ exposure during the last 5 days before each participant's clinic visit, with relative risks of 2.14 (95% confidence interval [CI]: 1.95 to 2.32) and 5.47 (95% CI: 3.51 to 7.43), respectively. Mediation analyses further showed that sympathetic activation, parasympathetic inhibition, and elevated BP levels, as well as heightened risks of ST-segment depression could mediate up to 47.74% of the risks of arrhythmias attributable to O₃ exposure.

Conclusion

Our results suggest that short-term exposure to ambient O₃ could prompt the genesis of arrhythmias partially through worsening autonomic function and myocardial burden.

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacity-building measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.