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Background: Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons' healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons' healthcare access in Uganda, using a nationally representative sample. Methods: We conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. We used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations. We fit generalized linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda. Results: More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households (RR = 0.91, 95% CI: 0.83-0.99); with some walking difficulty (RR = 0.90, 95% CI: 0.83-0.97); or with a lot of walking difficulty (RR = 0.84, 95% CI: 0.75-0.95). Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages (RR = 1.08, 95% CI: 1.00-1.15) and missed work due to illness for 1-7 days (RR =1.19, 95% CI: 1.10-1.30); and 8-14 days (RR = 1.19, 95% CI: 1.07-1.31). In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes (RR= 1.09, 95% CI: 1.01-1.16); were more likely to access healthcare during the last 30 days. Conclusion: In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility imitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons. [ABSTRACT FROM AUTHOR]

Childhood sexual and physical abuse have been linked to adolescent and adult risky sexual behaviors, including early sexual debut, an increased number of sexual partners, unprotected sex, alcohol and drug use during sex and sexual violence. This paper explores these relationships among both men and women who report histories of childhood abuse from representative samples of communities in three countries in southern and eastern Africa (South Africa, Zimbabwe and Tanzania). Data were collected as part of a 3-year randomized community trial to rapidly increase knowledge of HIV status and to promote community responses through mobilisation, mobile testing, provision of same-day HIV test results and post-test support for HIV. The results indicate that reported childhood sexual and physical abuse is high in all three settings, also among men, and shows strong relationships with a range of sexual risk behaviors, including age at first sex (OR −0.6 (CI: −0.9, −0.4, p < 0.003)-among men, OR −0.7 (CI: −0.9, −0.5, p < 0.001)-among women), alcohol (OR 1.43 (CI: 1.22, 1.68, p < 0.001)-men, OR 1.83 (CI: 1.50, 2.24, p < 0.001)-women) and drug use (OR 1.65 (CI: 1.38, 1.97, p < 0.001)-men, OR 3.14 (CI: 1.95, 5.05, p < 0.001)-women) and two forms of partner violence-recent forced sex (OR 2.22 (CI: 1.66, 2.95, p < 0.001)-men, OR 2.76 (CI: 2.09, 3.64, p < 0.001)-women) and ever being hurt by a partner (OR 3.88 (CI: 2.84, 5.29, p < 0.001)-men, OR 3.06 (CI: 2.48, 3.76, p < 0.001)-women). Individuals abused in childhood comprise between 6 and 29 % of young adult men and women living in these African settings and constitute a population at high risk of HIV infection. [ABSTRACT FROM AUTHOR]

This paper examines whether a multi-country workplace peer education HIV prevention program is effective in influencing knowledge, attitudes and behavior in a highly educated and technically skilled workforce. Self-administered surveys were used to measure change among N=993 male and female workers exposed to a comprehensive and culturally-appropriate program. Most knowledge indicators and all attitude indicators showed significant improvement between baseline and post-intervention. The odds ratio was 2.48 for reporting confidence in using condoms correctly after exposure to the program compared with the baseline survey. The results on changes in practice were mixed; while respondents were more likely to report being tested for HIV post-intervention, they were also more likely to self-report risky behavior. The findings suggest that peer education prevention programs in the workplace may create a climate of open discussion about sexual issues that increases self-reporting of risk behavior. Reinforcement of the messages contained in the program is therefore extremely important for influencing future behavior change. [ABSTRACT FROM AUTHOR]

Background: Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Direct attribution of impact to large-scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes. Methods: This study uses the synthetic control analysis method to estimate the impact of one donor's funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016. Results: In the study period (2000–16), countries with above average USAID funding had an under-five mortality rate lower than the synthetic control by an average of 29 deaths per 1000 live births (year-to-year range of − 2 to − 38). This finding was consistent with several sensitivity analyses. Conclusions: The synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To identify whether a Compassionate Mind Model‐based curriculum reduces students' perceived fears of compassion and improves their professional well‐being. Background: Enabling compassion is mandatory within nurse education but evidencing it is challenging. Research suggests that application of the Compassionate Mind Model might reduce students' fears of compassion and also decrease compassion fatigue. This study reports outcomes of a post‐registration curriculum based on that model for training Specialist Community Public Health Nurses (Health Visiting). Design: A quantitative, prospective evaluation of a 12‐month training course for Health Visiting students. Reporting was guided by the STROBE checklist for observational studies. Methods: Fears of compassion scales were applied at course start (time 1), mid‐point (time 2; +6 months) and end (time 3; +12 months) to evaluate fears of compassion of 26 post‐registration student Health Visitors (81% of course cohort) who provided data at all three points. The Professional Quality of Life tool was administered simultaneously to evaluate compassion satisfaction and burnout/secondary traumatic stress (compassion fatigue). Results: Between time 1 and time 3, mean fears of compassion scores decreased by 16.6‐48.5% (repeated measures analysis of variance); mid‐point scores were intermediary. At time 3, compassion satisfaction had increased slightly (+4.1%), negatively correlated with fears of compassion for self (r = −0.602; p =.001; n = 26) and fears of receiving compassion from others (r = −0.568; p =.002; n = 26). Burnout score decreased by 18.7%, correlated positively with fear of compassion for self (r = 0.493; p =.011; n = 26) and fear of receiving compassion from others (r = 0.615; p =.001; n = 26). Secondary traumatic stress score decreased by 16.5% but was not correlated with any fear of compassion. Conclusion: Findings suggest that application of the Compassionate Mind Model might reduce practitioners' fears of compassion linked to a decrease in risk of compassion fatigue. Relevance to clinical practice: The Compassionate Mind Model could provide an effective vehicle to promote compassion and nurse well‐being. [ABSTRACT FROM AUTHOR]

New and emerging infectious diseases such as the Ebola virus and the recent coronavirus create ideal conditions for cross-border disease outbreaks. The need to undertake comparative studies across contexts in affected regions becomes important for health communication and policy decision making. The purpose of this study is to compare the differences in knowledge, risk perception, affect, and self-efficacy about Ebola between respondents in an affected and an unaffected but proximate country in West Africa. This study used a survey with multi-stage sampling of community members in two peri-urban districts in Ghana and Liberia. Transmission knowledge lowered comparative vulnerability and perceived risk, while knowledge about signs and symptoms and knowledge about prevention increased self-efficacy. But knowledge was not a predictor of self-efficacy. Affective imagery analysis presents distinct affective profiles of respondents in the two countries. Different kinds of knowledge relate to risk perception and self-efficacy differently and this should be considered when developing health communication campaigns. Health and risk communication should no longer be just a context specific affair but must have a regional or sub-regional component that considers unaffected but at-risk countries. Finally, risk and health communicators need to consider the affective states of community members because affective states may indicate the basic feeling (individual and societal) profile of the audience, which will be beneficial for determining the level and type of messaging likely to be effective. [ABSTRACT FROM AUTHOR]

Antiretroviral therapy (ART)-naïve patients are vulnerable to becoming lost-to-care (LTC) because they are not monitored as often as patients on treatment. We examined data from 19,461 HIV positive adults at 10 HIV clinics in Democratic Republic of Congo (DRC), Cameroon, and Burundi participating in the Phase 1 International epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) study. Patients were LTC if they were ART-naïve and did not return within 7 months of the end of data collection. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with LTC. Of 5353 ART-naïve patients, 4420 (83%) were LTC and 933 (17%) were in-care. The odds of being LTC were greatest among patients from DRC (OR = 2.16, CI: 1.64–2.84,p< .0001), males (OR = 1.39, CI: 1.15–1.69,p= .0009), and ages 18–49 (OR = 1.45, CI: 1.16–1.82,p= .001). The odds of being LTC were least among patients with a WHO Clinical Stage of 1 or 2 (OR = 0.65, CI: 0.55–0.77,p< .0001) and in a perceived concordant relationship (OR = 0.61, CI: 0.43–0.87,p< .0001). LTC patients were more likely to have characteristics associated with higher risk for HIV transmission and progression. Many entered care at advanced stages and were less likely to know their partner’s serostatus. Greater efforts to retain ART-naïve patients may increase earlier initiation of ART. [ABSTRACT FROM AUTHOR]

Aims To determine prevalence and incidence estimates for clinically recognized cases of Type 1 diabetes from the Life For a Child Program ( LFAC) with onset < 26 years in six representative districts, and the capital, of Rwanda. Methods Cases were identified from the LFAC registry and visits to district hospitals. Denominators were calculated from district-level population surveys. Period prevalence data were collected from 1 August 2011 to 31 July 2012 and annual incidence rates were calculated, retrospectively, for 2004-2011. Ninety-five per cent confidence intervals (95% CI) were calculated using a Poisson distribution. Results The prevalence of known Type 1 diabetes in seven districts in Rwanda for ages < 26 years was 16.4 [95% CI 14.6-18.4]/100 000 and for < 15 years was 4.8 [3.5-6.4]/100 000. Prevalence was higher in females (18.5 [15.8-21.4]/100 000) than males (14.1 [11.8-16.7]/100 000; P = 0.01) and rates increased with age. The annual incidence rate for those < 26 years was stable between 2007 and 2011 with a mean incidence over that time of 2.7 [2.0-3.7]/100 000 ( < 15 years = 1.2 [0.5-2.0]/100 000). Incidence rates were higher in females than males and peaked in males at ages 17 and 22 years and in females at age 18 years. Conclusions Our report of known Type 1 diabetes cases shows lower incidence and prevalence rates in Rwanda than previously reported in the USA and most African countries. Incidence of recognized cases has increased over time, but has recently stabilized. However, the likelihood of missed cases due to death before diagnosis and misdiagnosis is high and therefore more definitive studies are needed. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate the prevalence of current alcohol use and its association with cigarette and drug use among 13-15-year-olds in Africa and the Americas. Method: Cross-sectional data of the WHO Global School-based Student Health Survey from nine countries in the WHO African Region and seven countries/territories in the WHO Region of the Americas were analysed. Single and joint prevalence rates, and prevalence odds ratios were computed. Results: In the majority of countries, alcohol was the most often consumed psychoactive substance, with the prevalence of current alcohol use outweighing the prevalence of current cigarette and lifetime drug use. Gender differences for alcohol were not marked. The use of alcohol was strongly associated with cigarette or drug use, indicating clustering. Conclusions: For the bulk of countries in the Americas and for single countries in Africa, current alcohol use is as high as prevalence rates occurring in other parts of the world. It is imperative to monitor psychoactive substance use among adolescents in these countries to be able to prevent future health and social harm with the information gained. [ABSTRACT FROM AUTHOR]

Immigrant populations in the United States (US) have lower cancer screening rates compared to none immigrant populations. The purpose of this study was to assess the rates of cancer screening and examine factors associated with cancer screening behavior among African immigrant women in Minnesota. A cross sectional survey of a community based sample was conducted among African immigrants in the Twin Cities. Cancer screening outcome measures were mammography and Papanicolau smear test. The revised theoretical model of health care access and utilization and the behavioral model for vulnerable populations were utilized to assess factors associated with cancer screening. Only 61 and 52 % of the age eligible women in the sample had ever been screened for breast and cervical cancer respectively. Among these women, duration of residence in the US and ethnicity were significant determinants associated with non-screening. Programs to enhance screening rates among this population must begin to address barriers identified by the community. [ABSTRACT FROM AUTHOR]

Use of HIV prevention methods may vary for women by types of sexual partners. In a microbicide safety and effectiveness trial (HPTN 035) differences in adherence to a microbicide study gel were compared between women with new versus ongoing partnerships over time. 1,757 women in the three HPTN 035 trial's arms completed the Follow-up Partner Status (FPS) questionnaire at their last study visit. Women married at baseline were asked if they had the same husband, new husband or new partner. Unmarried women were asked if they had changed partners or married. Self-reported gel adherence during the last sex act was compared at each quarterly visit between women with ongoing versus new partners. High gel adherence was compared with low gel adherence (85-100 vs. <85 % of last vaginal sex acts reported with gel use, respectively) in multivariable models to assess associations with partner change. Overall 7 % of women ( n = 123) reported a new partner and 41 % (51) of those reported a new husband. Median gel adherence was reported to be 100 % in women with ongoing partners and 75 % for women with new partners ( p < 0.001). In women reporting no gel use in their last sex act, only 12.5 % of the women with a new partner and none of those with an ongoing partner reported using condoms ( p < 0.001). Fewer women with new partners reported using both the gel and condom during the last sex act as compared to women with ongoing partners (median 50 vs. 71.4 %, p < 0.001). After adjusting for age, site, education level, and sexual frequency, women with ongoing partners were more likely to report high gel adherence than those with new partners (AOR 2.5, 95 % CI 1.6, 3.9). This pattern persisted when gel use over time was compared between women with new versus ongoing partners. In the HPTN 035 trial, women with new partners had higher HIV incidence and reported less gel use and higher condom use. Specific counseling and support are needed to help women use potential HIV prevention methods, including microbicides, when they are changing partners. [ABSTRACT FROM AUTHOR]

We examined the associations of maternal intimate partner violence (IPV) victimization with early initiation and exclusive breastfeeding in eight African countries. For mothers 15-49 years with an infant aged less than 6 months from national Demographic and Health Surveys since 2007 for Ghana (n = 173), Kenya (n = 449), Liberia (n = 313), Malawi (n = 397), Nigeria (n = 2007), Tanzania (n = 549), Zambia (n = 454), and Zimbabwe (n = 480), logistic regression was used to estimate the unadjusted and adjusted associations of lifetime maternal emotional, physical, and sexual IPV victimization with early initiation (less than 1 hour of birth) and exclusive breastfeeding in the prior 24 hours. Maternal lifetime IPV victimization often was adversely associated with optimal breastfeeding practices. Physical IPV in Zimbabwe (aOR 0.40, p = 0.002), sexual IPV in Zambia (aOR 0.42, p = 0.017), and emotional IPV in Kenya (aOR 0.54, p = 0.050) and Tanzania (aOR 0.57, p = 0.088) were associated with lower adjusted odds of early initiation. Sexual IPV in Liberia (aOR 0.09, p = 0.026), Ghana (aOR 0.17, p = 0.033), and Kenya (aOR 0.34, p = 0.085) were associated with lower adjusted odds of exclusive breastfeeding. Atypically, physical IPV in Tanzania (aOR 2.11, p = 0.042) and sexual IPV in Zambia (aOR 2.49, p = 0.025) were associated with higher adjusted odds of early initiation and exclusive breastfeeding, respectively. Across several settings, maternal IPV victimization may adversely influence breastfeeding practices. Longitudinal research of these relationships is warranted. Screening for IPV victimization and breastfeeding counseling in prenatal and postpartum care may mitigate the potential intergenerational effects of IPV. [ABSTRACT FROM AUTHOR]

Research has identified sexual concurrency as a potential underlying driver of high HIV infection levels in sub-Saharan Africa, though few studies have explicitly examined the contribution of marital concurrency. Utilizing a multi-level model of Demographic and Health Surveys with HIV-biomarkers for sixteen African countries, this study assessed the relationship between an individual's HIV serostatus and rates of formal and informal marital concurrency (% polygamous unions, % extramarital partner past year) among married men and women. Mutually exclusive regional-level variables were constructed and modeled to test the contextual risk posed by living in a region with higher levels of formal and informal marital concurrency controlling for individual sexual partnerships and other covariates. Compared with regions where monogamous unions were more prevalent, the odds of having HIV were higher among individuals living in regions with more informal marital concurrency, but lower in regions with more polygamy, even accounting for individual-level sexual behavior. These results can help inform prevention policy and practice in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Objectives. We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. Methods. We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. Results. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. Conclusions. Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the mental health disparities between second-generation Jewish groups and immigrants. It mentions that data were taken from the Israel World Mental Health Survey including the General Health Questionnaire and the Composite International Diagnostic Interview. It shows that there are mental health disparities between the advantaged European/American group and the disadvantaged North African/Asian group of Israeli Jews.

Comprehension is fundamental for informed consent-an individual's right to choose a medical procedure, such as male circumcision (MC). Because optimal benefits depend on post-surgical behaviors, comprehension is particularly critical for MC programs. We evaluated clients' comprehension of MC's risks and benefits, wound care instructions, and risk reduction post-MC using a true/false test ( n = 1181) and 92 semi-structured interviews (SSIs) in Zambia and Swaziland. Most participants (89 % Zambia, 93 % Swaziland) passed the true/false test, although adolescents scored lower (significantly so in Swaziland) than adults and one-third (including nearly half of adolescents in Zambia) said MC has no risks. SSIs indicated confusion between 'risk' of adverse surgical outcomes and reduced 'risk' of HIV; most respondents acknowledged the 6 week abstinence period post-MC, yet few said resuming sex early increases HIV risk. Providers should distinguish between surgical 'risks' and reduced HIV 'risk,' and emphasize that HIV risk increases with sex before complete healing. [ABSTRACT FROM AUTHOR]

Clinic-based pill counts of unused study medication are frequently used to measure adherence in HIV-1 prevention trials. Monthly pill count adherence data from the Partners in Prevention HSV/HIV Transmission Study, a double-blind, placebo controlled trial of twice-daily acyclovir suppression of herpes simplex virus type 2 (HSV-2) in HIV-1 infected persons was used to compare changes between 3,381 placebo and active arm participants in two objective biologic measures of acyclovir's drug activity: reduction in plasma HIV-1 RNA and HSV-2 genital ulcer disease (GUD). Higher acyclovir pill count adherence was associated with greater reductions in plasma HIV-1 RNA and GUD, indicating pill count data is strongly correlated with biological effects of adherence. However, when calculated adherence exceeded 102 % (i.e., fewer pills returned than expected) and when pill counts were missing because bottles were not returned, plasma HIV-1 RNA and GUD effects were diminished, likely indicating periods of non-adherence. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify the social factors that explain the differences in knowledge with regards to HIV/AIDS among immigrants in the Basque Country (Spain). We conducted a cross-sectional study based on information obtained in the Basque Health Survey for 754 immigrants from: 86 China, 368 Latin America, 237 the Maghreb and 74 Senegal. Odds ratios (95% CI) were calculated from logistic regression models to measure the degree of association between inadequate knowledge regarding transmission, prevention and places where HIV testing is offered, and the independent variables. We found that this inadequate knowledge is associated with place of birth, sex, a lower level of education, immigration status, difficulties in understanding Spanish, and not receiving advice about AIDS in primary care. These findings indicate that initiatives must be developed to promote equity in the provision of healthcare through clinical guidelines, including details of the specific needs of different groups of immigrants and considering gender issues. [ABSTRACT FROM AUTHOR]

High adherence and maintenance of blinding are critical for placebo-controlled efficacy trials of HIV-1 biomedical prevention strategies. We assessed adherence to study drug and factors affecting adherence, including perceived randomization group, in a post-trial questionnaire of participants who completed HPTN 039, a randomized, placebo-controlled trial of HSV-2 suppression with twice-daily acyclovir to reduce HIV-1 acquisition. Of the 3172 trial participants, 2003 (63%) completed the post-trial questionnaire. Of these 2003, 72% reported missing a dose of study drug less than twice a week. Study drug adherence was not compromised by perceived randomization or genital ulcer symptoms during the study. Alcohol use was cited as an adherence barrier in some populations. Assessment of study drug adherence during and at the end of trials can evaluate perceptions of randomization and adherence by randomization arm, help to better understand barriers to and motivations for adherence, and develop interventions to increase adherence for future trials. [ABSTRACT FROM AUTHOR]

This study aimed to describe the proportion of HIV testing among an African immigrant population in Portugal and identify the socio-demographic factors that may be associated. A questionnaire was applied to 522 African immigrants (53% men) who attend the National Immigrant Support Centre, in Lisbon. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were calculated through logistic regression to analyse the relationships between HIV testing and other variables. Around 52% of participants reported having been HIV tested, mostly women. After adjusting for potential confounders, age and educational level were significantly associated with HIV testing for both women and men. Searching for HIV information at NHS was also significantly associated with HIV testing, but only among men. This study points out interesting challenges for HIV prevention programs among African immigrants and may help in the development of tailored projects focused on the promotion of HIV testing among these populations. [ABSTRACT FROM AUTHOR]

Collecting self-reported data on adherence to highly active antiretroviral therapy (HAART) can be complicated by patients' reluctance to report poor adherence. The timeliness with which patients attend visits might be a useful alternative to estimate medication adherence. Among Kenyan and Zambian women receiving twice daily HAART, we examined the relationship between self-reported pill taking and timeliness attending scheduled visits. We analyzed data from 566 Kenyan and Zambian women enrolled in a prospective 48-week HAART-response study. At each scheduled clinic visit, women reported doses missed over the preceding week. Self-reported adherence was calculated by summing the total number of doses reported taken and dividing by the total number of doses asked about at the visit attended. A participant's adherence to scheduled study visits was defined as 'on time' if she arrived early or within three days, 'moderately late' if she was four-seven days late, and 'extremely late/missed' if she was more than eight days late or missed the visit altogether. Self-reported adherence was <95% for 29 (10%) of 288 women who were late for at least one study visit vs. 3 (1%) of 278 who were never late for a study visit (odds ratios [OR] 10.3; 95% confidence intervals [95% CI] 2.9, 42.8). Fifty-one (18%) of 285 women who were ever late for a study visit experienced virologic failure vs. 32 (12%) of 278 women who were never late for a study visit (OR 1.7; 95% CI 1.01, 2.8). A multivariate logistic regression model controlling for self-reported adherence found that being extremely late for a visit was associated with virologic failure (OR 2.0; 95% CI 1.2, 3.4). Timeliness to scheduled visits was associated with self-reported adherence to HAART and with risk for virologic failure. Timeliness to scheduled clinic visits can be used as an objective proxy for self-reported adherence and ultimately for risk of virologic failure. [ABSTRACT FROM AUTHOR]