Table of Contents
Editorial in Global Public Health
Stop violence and crimes against children
Author: Francesco Chirico1
1 M.D., Health Service Department, State Police, Ministry of Interior, Italy
Keywords: Child; child abuse; child maltreatment; health policy; human development; public health; violence.
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Systematic review in Public Health
Prevalence and management of child sexual abuse cases presented at Nigerian hospitals: A systematic review
Author: Elizabeth Oluwatoyin Akin-Odanye1
1 Ph.D., Clinical Psychology Unit, Department of Family Medicine, University College Hospital, Ibadan, Nigeria
Introduction: Aim of this study was to review all suspected sexual abuse (SA) cases presenting at Nigerian hospitals, in order to examine both the prevalence of child sexual abuses (CSA) cases and the availability of hospital protocols and medical and forensic services for their evaluation, management and follow-up.
Methods: A systematic review of literature including only studies published in English from 2006 to 2016 and cited in the Medline, Scopus and Web of Science databases was carried out.
Results: A total of 16 hospital-based studies were included. Out of the total of 166,985 suspected SA cases presented at hospitals, only 1,553 (0.93%) of them were confirmed. Most of them (n = 1,164, 74.95%) occurred in children (< 18 years) and majority of the CSA victims were female (n = 1,155, 99.23%). HIV screening (n = 13, 81.25%) and vaginal swab (n = 8, 50%) were the most common investigations carried out by clinicians, whereas the most common medical treatments offered by the health facilities were emergency contraceptives (n = 8, 50%) and HIV post exposure prophylaxis (n = 7, 43.75%), with only a quarter of the cases (n = 4, 25%) offering any form of psychological counseling to victims and/or their parents. Written protocol for CSA evaluation and management was absent in nearly all of the health facilities.
Conclusions: In Nigeria, healthcare and forensic management of CSA are poor, probably due to late presentation of victims at the hospital and to negligence on the part of health and security personnel. CSA is also possibly under-reported, with serious implications for the child and society. Prevention, proper medical treatment, management and follow-up for victims and their families, as well as making the perpetrators answerable for their crimes are highly recommended measures to tackle this issue.
Keywords: Child abuse, sexual; health services; Nigeria; psychological trauma; public health; sexual assault; violence.
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Mini-Review Article in Health Education
Efficacy of education strategies concerning organ shortage: state-of-the-art and proposals
Author: Felix Cantarovich1
1 M.D., Prof, Catholic University Argentine, Faculty of Medical Sciences, Buenos Aires, Argentina
Introduction: Aim of this study was to review the underlying reasons for organ shortage and the efficacy of current education programs, in order to propose messages to modify socio-psychological feelings to donation.
Discussion: Emotional barriers such as fear of death and mutilation are the major reasons for inadequate organ donation; nevertheless, education programs do not consider these barriers. Concerning non-cognitive factors as donation’s inhibitions, phrases ‘after death, our body is a unique source of health’ and ‘throughout life, we are potential recipients of a transplant’ should be suggestions for a slogan change. Youth education, starting early, should be well thought out to avoid irrational prejudice to donation. Educational curriculums should be globally established. Education and health stakeholders as well as religious authorities should support this strategy. In search to a long-term solution to the present crisis for society, this teaching strategy should be pedagogically adapted to the socioeconomic characteristics of each region.
Conclusion: Educational options to improve knowledge and attitudes toward organ donation should be carefully planned to prevent ‘organ shortage’ becoming a permanent and unjustifiable critical health crisis.
Keywords: Cognitive and non-cognitive factors; health education; mortality on waiting lists; organ donation; social behaviour; youth education.
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Original Article in Occupational Medicine
Pulmonary function among stone quarry workers in India: The effect of duration of exposure, smoking status and job profile on pulmonary function tests
Authors: Junaid Aziz Sheikh1, Zahid Ali Khan2, Tazeen Khan3, Sumaira Chowdhary4
1 M.D., Department of Physiology, M.M. Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India
2 M.D., Department of Community Medicine, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
3 M.D., Department of Physiology, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
4 M.D., Department of Physiology, Government Medical College Srinagar, Jammu & Kashmir, India
Introduction: Despite advances in technology, in India workers of stone processing industry continue to be at high risk for lung function deterioration. This study was designed to analyse the effect of duration of exposure, job profile and smoking on lung function of stone quarry workers from Jammu city, Jammu and Kashmir State, India.
Methods: A cross-sectional study was carried out among 100 male stone crusher workers, selected through multi-stage random sampling technique. Effect of risk factors on the pulmonary function tests of the workers was analysed by ‘Students independent t-test’, one-way ANOVA and simple linear regression. The significance threshold was set up at P < 0.05.
Results: We observed a significant reduction in lung function in subjects having duration of exposure above 10 years (Group III) with respect of stone crushers with duration of exposure up to 5 years (Group I) and 6 to 10 years of exposure (Group II). Lung function tests revealed a statistically significant (P < 0.05) reduction in lung function test parameters among manual workers compared to non-manual group of workers and among smokers compared to non-smokers. However, simple linear regression analysis revealed that only increase in duration of silica dust exposure was significantly associated with a reduction in pulmonary function tests, specifically in FVC (P = 0.019), FEV3 needs to be as subscript (P = 0.016), FEF25 (P = 0.016), FEF0.2-1.2 (P = 0.048), PEFR (P = 0.019) and MVV (P = 0.001) values.
Conclusion: Duration of silica dust exposure is the most important determinant of pulmonary function deterioration. Therefore, limiting cumulative silica dust exposure can effectively reduce damage to airways in silica-exposed workers.
Keywords: Duration of exposure; job profile; occupational medicine; respiratory function tests; quarry workers; silicosis; smoking.
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Original Article in Sexual Health Education
“What’s that on your phone?” The aftermath of parents finding sexual and reproductive health messages on their children’s phone in coastal Kenya
Authors: Jefferson Mwaisaka1, Lianne Gonsalves2, Lale Say3, Peter Gichangi4
1 M.A., International Centre for Reproductive Health, Kenya
2 M.S.P.H., World Health Organization, Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
3 M.D., World Health Organization, Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
4 M.M.E.D. (O/G),P.h.D, Prof, International Centre for Reproductive Health, Kenya
Introduction: Digital health interventions allow young people to access information quickly and discreetly, but privacy remains a concern. This article explores what happens when a young user’s privately-access Sexual and Reproductive Health (SRH) messages from a digital health campaign in Kenya are discovered by his/her parents.
Methods: This qualitative study took place in Mtwapa, Kenya. Participants were young people aged 15-24 and parents/caregivers of young people aged 15-24. Focus Group Discussions (FGD) with youth (n = 12 FGD, M = 48, F = 49) and caregiver (n = 4 FGD, M =14, F = 19), by using vignettes, explored perceived parental responses about their children accessing SRH information on mobile phones. 97 young people and 33 parent/caregivers participated.
Results and Discussion: Sociodemographic characteristics of participants revealed that phone ownership was higher among young men than young women, and particularly low among young women aged 15-17. Youth participants indicated that parents finding SRH messages on their children’s phone would have a range of reactions, from positive to negative: supportive parents would appreciate the messages as a sign their child was being proactive about their health; negative reactions would stem from fear of the message recipient being sexually active. Parent participants accepted children accessing SRH information outside the home as an inevitability, and indicated that parents would cautiously accept or be fully supportive of their child accessing messages on their phone.
Conclusions: In the event that a digital health intervention’s young user’s privacy is compromised, these findings demonstrate that the fears of extreme adverse reactions on the part of parents are likely overstated. Specific considerations for future digital health interventions are proposed.
Keywords: Adolescent; cell phones; digital health; health education; health promotion; parents; privacy; reproductive health.
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Original Article in Medical Anthropology
Acute Respiratory Infection (ARI) in children in Ethnic Minority Communities of Chittagong Hill Tracts, Bangladesh: A qualitative study
Author: Maidul Alam Chaklader1
1 Lecturer, BSc, MPH (IUB), MSc (Durham, UK), Independent University, Bangladesh (IUB), Department of Social Sciences and Humanities, School of Liberal Arts and Social Sciences, Dhaka, Bangladesh
Introduction: The Chittagong Hill Tracts (CHT) region of Bangladesh, home to 11 distinct ethnic minority communities, has been disadvantaged and isolated for many years due to 25 years of insurgency and political turmoil. This area has higher child mortality rates than the national average. This study attempts to explore a holistic understanding on the ways that Acute Respiratory Infections (ARIs) are understood and managed in the CHT.
Methods: An ethnographic approach based on participant observation coupled with semi-structured interviews, key informant interviews and focus groups has been used. The notion of Explanatory Models (EMs) encompassing concepts such as local aetiology and terminologies, treatment-seeking behaviour, illness experience, symptom recognition and reporting held by local communities has been employed as a conceptual framework.
Results and discussion: The study findings indicate that EMs for childhood ARI varied within and across ethnic groups. Study participants tended to integrate both physical and supernatural causes into their EMs. Despite the widespread tendency to consider folk beliefs in binary opposition to biomedical causes, findings from this study show that both consider proximate and underlying factors related to childhood ARI and many of these underlying factors that render children more susceptible to ARI are actually common to both models. Treatment-seeking behaviour is a complex process represented by shifting interpretations of the illness and treatment options and constrained by poverty and other structural factors that set the context in which study participants operate on a daily basis.
Conclusion: Researchers and policy-makers need to employ a more expansive concept of EMs that accommodates the mundane struggles and involuntary aspects of health care and treatment-seeking behaviour of individuals from marginal communities all over the world and should subsequently move away from the simplistic idea that exotic beliefs and practices of local communities are ‘cultural barriers’ to effective health care.
Keywords: Acute respiratory infection; Bangladesh; child health; explanatory models; health inequality; medical anthropology.
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Original Article in Sociology of Health
Social role performance and self-identity among breast cancer patients in Lagos, Nigeria
Authors: Samuel Ojima Adejoh1 , Deborah Tolulope Esan2, Adeola Adejayan3
1 Ph.D, Department of Sociology, Social Work Unit, University of Lagos, Akoka, Lagos, Nigeria
2 M.Sc, Department of Nursing, Afe Babalola University, Ado-Ekiti, Nigeria
3 BSc, Department of Sociology, Social Work Unit, University of Lagos, Akoka, Lagos, Nigeria
Introduction: Aim of this study was to explore the impact of breast cancer diagnosis and treatment on perceived self-identity and family, social and occupational roles perfomance of women in Nigeria.
Methods: A qualitative method was adopted by face-to-face, semi-structured interviews administered to a sample of 15 women. The population study comprised of women who were diagnosed with breast cancer, had undergone surgery, and were currently or recently receiving chemotherapy and/or radiotherapy at private hospitals in Ikeja, capital of Lagos State, Nigeria, from December 2015 to March 2016.
Results and Discussion: A total of 15 women with breast cancer, between 30 and 60 years of age (M = 42.3), participated in this study. All the respondents were married, had children and were working before the cancer diagnosis. Our findings showed that breast cancer diagnosis and treatment may alter role performance of women in their families, workplaces and community in which they live, and may affect negatively their self-identity, due to negative self-image and self-perception, and due to fear to be socially stigmatised by neighbours. However, women with such diagnosis may find support within their religious circles, as spirituality might be an important coping mechanism for this patient popolution.
Conclusion: In Nigeria, policy makers should support women diagnosed with breast cancer through economic investments to set up socio-occupational support networks at national and local levels.
Keywords: Breast cancer; family role performance; Nigeria; occupational role performance; quality of life; social role performance; social functioning; spirituality.
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Case Report in Psychiatry
Quetiapine-related weight loss: Report of a rare adverse effect
Authors: Nicodemus Okwudili K Obayi1, David HN Nweke1, Edidiong Idio2, Darlington Okey2, Cletus Ozibo2
1 MBBS, FMC Psych, Department of Psychiatry, Ebonyi State University, Abakaliki, Nigeria
2 MBBS, Department of Psychiatry, Federal Teaching Hospital, Abakaliki, Nigeria
Quetiapine is a second-generation antipsychotic that has been reported to be associated with moderate weight gain. Nevertheless, weight loss that is an infrequent adverse effect of quetiapine has been reported in a few cases of patients who were ab initio started on quetiapine or who gained weight during previous antipsychotic treatment but who lost weight when shifted to quetiapine. We report the case of a 28-year old quarry worker being treated for bipolar affective disorder. Due to unbearable muscle rigidity, she was switched from haloperidol to olanzapine. She gained about 26 kg over 12 months. Her repeated complaints about the weight gain and threats to stop all medications if nothing was done led to her being switched over to quetiapine. Within two months of this switch-over, she gained 1 kg before she gradually started losing weight and by the sixth month, she dropped from 85 kg to 67 kg despite eating well. Unsatisfied with the weight loss, she was switched to aripiprazole. Over few months, she gained up to 3 kg. She had remained mentally stable and functional, and also maintained roughly 70 kg over a year. Though weight gain could occur in virtually every antipsychotic, weight loss has been recorded in very few cases. The mechanism by which quetiapine causes weight loss is not certain. Some proposed mechanisms include paradoxical suppression of appetite, induction of deterioration in insulin resistance, induction of hypoglycaemia, as well as mere switching from a high-risk to a low-risk antipsychotic. Our patient had different experiences with three atypical antipsychotics: she gained excessive weight with olanzapine, lost significant weight with quetiapine, and maintained a normal weight with aripiprazole. Weight changes should be monitored on patients taking antipsychotics. Most of the time clinicians are concerned about weight gain but not weight loss. We recommend that clinicians should pay attention to weight loss as well.
Keywords: Antipsychotics; quetiapine; switch-over; weight loss.
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Book Review in Global Health Policy
Germless Borders: A Review of “The Health of Newcomers: Immigration, Health Policy, and the Case for Global Solidarity”
Author: Beatríz Eugenía Mafla Satizábal1
1 M.A., DrPH, Department of Public Health, University of Tennessee Knoxville, United States
Keywords: Book review; immigration; health policy; solidarity.
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