Journal of Health and Social Sciences 2020, 5(4) Click Free Full Open Access

15 November 2020

Table of Contents

JHSS 2020,5(4):437-440

Editorial in Public Health and COVID-19

Back to the “new normal”: Researching and publishing in the time of the COVID-19 pandemic

Author: Nicola Luigi BRAGAZZI1

M.D., Ph.D, Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada.



COVID-19; pandemic; scholarly research.

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JHSS 2020,5(4):441-448

Viewpoint in Public Health

Eliminating racial and ethnic disparities in behavioral health care in the U.S.

Authors: Hoa B. APPEL1, Phuoc D. NGUYEN2

PhD, MPH, Behavioral Health Director, University of Washington School of Nursing and Health Studies, Bothell, WA, USA.
2 BS, Medical Student, Des Moines University College of Medicine, Des Moines, IA, USA.


Notwithstanding much research and discussion about health care disparities over the years, racial and ethnic disparities persist. This is particularly evident in the Latino community where decades of research has been conducted. We propose a close examination of the three key issues in the struggle to eliminate obstacles to care: universal approach, insurance coverage, and diversifying the behavioral health care workforce. This viewpoint discusses individual and systemic barriers in the U.S., tailoring the examination to the specific needs of the specific population. Insurance coverage, especially Medicaid expansion, should be available in every state in order to allow access to all. Lastly, health care workers and providers should be prepared to treat behavioral health needs in their primary care practice. This paper highlights the need to further investigate these topics in order to help eliminate the disparities that still exist in our growing populations of racial and ethnic minorities from the standpoint of health care practitioners in their practices.


Keywords: Behavioral health; mental health; Latinos; health disparity; primary care; insurance.

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JHSS 2020,5(4):449-456

Viewpoint in Global Public Health

An international award-winning photograph illustrates how graphics convey climate change communication messages

Author: Deborah HILTON1,2

Previously at the Baker Medical Research Institute, St Kilda Road Central, Melbourne, VIC 3004, Australia.
2 Deborah Hilton Statistics Online, Australia (


Climate change effects are becoming extreme, persistent and permanent, with negative ramifications on agriculture, more extreme weather catastrophes, detrimental effects on human physical and mental health, destruction of small islands and while economic impacts are difficult to estimate overall the situation is apocalyptic. Policy action should address urgent issues, and consistency requires climate change understanding including knowledge of the human and environmental connections. Research showed that mass communication could be an important means to address environmental global warming. This paper shows that photographs can convey climate change communication messages. Public health committees and policymakers should utilise graphics on policy documents, websites and flyers to have dramatic influence over public opinion, to stimulate understanding and collective action. 


Keywords: Climate change; environment; photography; mass communication.

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JHSS 2020,5(4):457-470

Coping Review in Social Behaviour and Public Health

Physical activity among school-aged children and intervention programs using self-determination theory (SDT): A scoping review

Authors: Tameka STEWART1, Manoj SHARMA2

MS.ED, S.ED, Doctoral Scholar, School of Public Health, Jackson State University, Jackson, MS, USA.
2 MBBS, Ph.D., Professor,  School of Public Health, University of Nevada, Las Vegas, NV, USA.



Introduction: Moderate to vigorous physical activity (MVPA) among children is imperative for proper development. However, the problem of physical inactivity is a concern among many countries worldwide. Self-Determination Theory (SDT) has been widely used to develop interventions aimed at promoting autonomy for physical activity (PA) among children and adolescents. The aim of this scoping review was to evaluate the efficacy of intervention studies based on SDT in promoting MVPA among school-aged children.
Methods: PRISMA-ScR guidelines were used in conducting this scoping review. An electronic literature search in MEDLINE (PubMed), Google Scholar, ERIC, and Academic Search Premier was performed to identify intervention studies based on SDT aimed at promoting PA among school-aged children. Studies had to meet the following inclusion criteria: (i) participants were children or adolescents (between 5 and 18 years of age); (ii) a focus on promoting PA interventions; (iii) quantitative or mixed-method based, and (iv) intervention had to be based on SDT.
Results: A total of 10 interventions met the eligibility criteria. Nine of the 10 studies were experimental studies and 1 observational, cross sectional study. A total of 2,577 children and adolescents participated in the 10 studies.  Six studies utilized the randomized controlled trial design (RCT); only three studies demonstrated a significant, consistent, increase of MVPA among the intervention groups; one of which was a RCT study. There was little to no increase in MVPA among girls within the research. Additionally, two studies revealed that children were more physically active as long as parents or teachers were involved.
Discussion: The results of this scoping review showed insufficient evidence for the efficacy of intervention studies based on SDT in promoting MVPA among children and adolescents. Therefore, newer fourth-generation theories such as the multi-theory-model (MTM) for health behavior change is suggested and can be tested by future interventions. 

Keywords: Sedentary behavior, physical activity, moderate to vigorous physical activity, motivation, intrinsic motivation, autonomy.

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JHSS 2020,5(4):471-484

Theoretical Research in Anthropology and the History of Medicine

COVID-19 and the Black Death: Nutrition, frailty, inequity, and mortality

Authors: Katherine D. VAN SCHAIK1, Sharon N. DeWITTE2

M.D., Ph.D., M.A., American Board of Radiology Holman Research Pathway Resident in Diagnostic Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
2 Ph.D., Professor of Anthropology, Department of Anthropology, University of South Carolina, Columbia, South Carolina, United States.


Introduction: COVID-19 has challenged governments, healthcare systems, and individuals, drawing attention to the limits of modern technology and the extent of social inequity. Such challenges have directed attention to historical epidemics as repositories of data that could contribute to effective public health strategies and prognostic modeling. In light of the well-established correlation between frailty and mortality from COVID-19, this paper investigates the relationship between frailty, inequity, and mortality in the setting of the Black Death of 1346 – 1353, in order to identify trends over time in populations at the greatest risk of mortality during pandemics.
Methods: A comparative review examining relationships between frailty and mortality during the fourteenth century Black Death and the current COVID-19 pandemic was conducted. Data related to the Black Death are derived from osteological analyses of remains from mass plague graves in the United Kingdom, and data related to COVID-19 are derived from the United States, Italy, and China.
Results: Nutrition – often a consequence of socioeconomic status – plays a crucial role in pandemic mortality. During the Black Death, people with pathological indicators that can reflect undernourishment due to inadequate caloric intake were more likely to die of plague. In the COVID-19 pandemic, higher obesity rates among populations of lower socioeconomic status in the United States reveal similar relationships among nutrition, frailty, inequity, and pandemic mortality.
Conclusion: Nutrition – often a consequence of socioeconomic status – has a crucial role in risks of mortality. Our analysis underscores the importance of addressing nutrition and frailty in present and future discussions of the prevention and mitigation of pandemics.

Keywords: COVID-19; frailty; medieval plague; nutrition; selective mortality.

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JHSS 2020,5(4):485-500

Original Article in Public Health

The CREATION Model: A whole-person wellness model to facilitate patient-provider partnerships for health promotion

Authors: Gabriella A. ANDERSON1, Amanda T. SAWYER2, Stephanie L. HARRIS3, Patricia S. ROBINSON4

1 MHA, Center for Whole-Person Research, AdventHealth, Orlando, Florida, United States.
2 PhD, Center for Whole-Person Research, AdventHealth, Orlando, Florida, United States.
3 MLS, AHIP, Center for Whole-Person Research, AdventHealth, Orlando, Florida, United States.
4 PhD, ARNP, Center for Whole-Person Research, AdventHealth, Orlando, Florida, United States.



Introduction: Guiding individuals to healthier behaviors is key to improving wellness, and primary care providers are uniquely positioned to help individuals recognize and implement needed health behavior changes. This paper describes a whole-person wellness model, the CREATION model, which focuses on the relationship between individual choice and physical, psychological, social, and spiritual health.
Methods: Several theoretical models, including two wellness models, the Wheel of Wellness and Indivisible Self, and three behavior change models, Social-Ecological Model, Reasoned Action Approach, and Transtheoretical Model provide the foundation for the CREATION model. The constructs and propositions of the CREATION model are grounded in these frameworks.
Results: The CREATION model considers the contexts in which health choices occur, including modifiable determinants of health. Elements of choice, rest, environment, activity, trust, interpersonal relationships, outlook, and nutrition are the constructs that comprise this model.
Conclusion: The CREATION model posits that interventions that focus on an individual’s mind, spirit, environment, and relationships will influence choices in a continuous cycle that reinforces positive, healthy behaviors. The CREATION model can facilitate robust patient-provider partnerships that may help shift the healthcare delivery paradigm from an illness model to a wellness model. 

Keywords: Health Behavior, Health Promotion, Models, Psychological, Physician-Patient Relations.

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JHSS 2020,5(4):501-512

Original Article in HIV Prevention

HIV pre-exposure prophylaxis (PrEP) for women: Claiming risk and recognizing responsibility to end the AIDS epidemic in New York

Author: Lauren SUCHMAN1

Institute for Health and Aging, University of California San Francisco, San Francisco, CA USA.


Introduction: When the drug Truvada was approved for use as pre-exposure prophylaxis (PrEP) to prevent HIV in 2012, it was lauded as the first major advance in HIV prevention in decades and a major step toward reaching the goal of ending the epidemic. However, concerns around equitable access to PrEP arose quickly. This paper analyzes the ways in which one large-scale public health campaign framed its messaging around PrEP differently for women than for men, and suggests a more inclusive re-thinking of how ‘risk’ for HIV is conceived.
Methods: This analysis is based on 14 months (October 2014 – December 2015) of ethnographic research conducted in the context of New York State’s ‘Ending the Epidemic’ (ETE) campaign. Participant observation was conducted at public meetings and events related to ETE and 37 semi-structured qualitative interviews were conducted with direct participants in the campaign, as well as with members of affected communities. Analysis also included review of documents related to ETE, such as reports, newspaper articles, and blog posts.
Results: Some prominent women involved in ETE felt that the campaign was largely run by men in its early days. While campaign messaging around PrEP accepted men’s ‘risky’ sexual behavior, women’s experiences with PrEP often were framed in the context of responsibility and ‘risky’ behavior was a barrier rather than a gateway to access.
Conclusion: To avoid missing crucial opportunities for HIV prevention in the future and make PrEP messaging more inclusive, similar campaigns must think more broadly about what constitutes ‘risk’ for HIV and implement these definitions from the beginning.

Keywords: HIV; New York; PrEP; risk; women.

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JHSS 2020,5(4):513-524

Original Article in Public Health

Correlation between vitamin D levels, individual and socio-demographic characteristics and COVID-19 infection and death rates in 20 European countries: A modelling study

Authors: John C. DEARDEN1, Philip H. ROWE2

1 Ph.D., Emeritus Professor, School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, U.K.
2 Ph.D., Visiting Research Fellow, School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, U.K.



Introduction: Numerous potentially controlling demographic factors such as age, poverty, obesity, and cardiovascular and respiratory co-morbidities have been suggested, and high vitamin D levels have been found, to be associated with lower levels of COVID-19 infection. This study aimed to explore the correlation between vitamin D levels and socio-demographic characteristics with COVID-19 cases and deaths in 20 European countries.
Methods: A quantitative ecological study was designed. Multiple linear regression analysis was used to examine which of vitamin D levels and 20 demographic factors correlated well with COVID-19 cases and deaths up to 9 May 2020 in 20 European countries.  Data distributions were normalised by the Box and Cox approach and the  Minitab routine ‘Best Subsets’ was used to select the best descriptor sets for each quantitative model of cases and deaths.
Results: Cases were best modelled by vitamin D levels, stroke deaths, respiratory deaths, smoking, and human development levels. Deaths were best modelled by the number of cases, stroke deaths, proportion of African/Afro-Caribbean people, proportion of over 65-year-olds, population density, and levels of physical inactivity. Good correlations were obtained for each model, with coefficients of determination (r2) being around 0.7 or greater. The correlation of cases with vitamin D levels, stroke deaths, and respiratory deaths was r2 = 0.712, while the correlation of deaths with population density, levels of physical inactivity, and stroke deaths was r2 = 0.745.
Discussion and Conclusions: These results help to explain the variability of COVID-19 cases and deaths, and offer guidance in planning against future coronavirus pandemics. Controlling for a wide range of factors reduces the risk that the apparent protective effect of vitamin D might be confounded.


Keywords: COVID-19; correlation; socio-demographic factors; European countries; modelling study; multiple linear regression; vitamin D.

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JHSS 2020,5(4):525-532

Original Article in Neurology and Occupational Health

Validation of an Italian questionnaire to assess sleep disorders: The Sleep Disorders Score Questionnaire (SDS-Q)

Authors: Sergio GARBARINO1,2, Ottavia GUGLIELMI1, Giovanni RALLO2, Nicola MAGNAVITA2,3

1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
2 Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy.
3 Department of Woman/Child and Public Health, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.


Introduction: Many occupational factors disturb sleep. This can have significant consequences because sleep problems mediate the relationship between work stress and health disorders. The objective of this study is to validate the Sleep Disorders Score Questionnaire (SDS-Q), a questionnaire designed to measure sleep disorders and their consequences in workers.
Methods: A cross-sectional study was carried out. Validity was analysed by exploratory factor analyses, and reliability by Cronbach’s alpha.
Results: The study was conducted with 240 male police officers. Principal component analysis confirmed the existence of 3 subscales, regarding Insomnia symptoms, Excessive daytime sleepiness (EDS) and Obstructive Sleep Apnoea (OSA). The Cronbach’s alpha values of the subscales Insomnia symptoms (IS), Sleepiness symptoms (SS) and Apnoea symptoms (AS) were acceptable.
Discussion and Conclusions: The Insomnia, Sleepiness and Apnoea subscales of SDS-Q have demonstrated good psychometric properties in terms of reliability and validity. The SDS-Q is a valid and reliable tool for assessing workers’ sleep problems and disorders.

Keywords: Eexcessive Daytime Sleepiness; insomnia; principal component analysis; questionnaire; police officers; sleep apnoea.

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JHSS 2020,5(4)533-542

Original Article in  Health Psychology

Psychological counselling interventions to improve perceived quality of life and counter anxiety and depression in pulmonary-arterial-hypertension patients: A clinical trial

Authors: Emilia TARANTINO1, Pietro CRESCENZO2, Maria CAMPOBASSO1, Francesca D’ALESSANDRO3, Paola ARGIENTO4, Emanuele ROMEO4, Stefano GHIO5, Patrizio VITULO6, Francesco PARISI7, Massimiliano MULÈ8, Carlo ALBERA9, Carmine Dario VIZZA10, Michele D’ALTO4

1 Ps.D., Psychologist, Dipartimento di Cardiologia, Ospedale Monaldi – Università degli Studi “L. Vanvitelli”, Napoli
2 Ps.D., Ph.D., Psychologist, Università degli Studi di Salerno, Fisciano, Salerno, Italia
3 Ph.D., Dipartimento di Scienze Cliniche, Interventistiche, Anestesiologiche e Cardiovascolari. Policlinico Umberto I – Università di Roma “Sapienza”, Roma
4 M.D., Ph.D., Dipartimento di Cardiologia, Ospedale Monaldi- Università degli Studi “L. Vanvitelli”, Napoli
5 M.D., Divisione di Cardiologia – Fondazione IRCCS Policlinico S. Matteo, Pavia.
6 M.D., Pneumologia, Dipartimento per il Trattamento e lo Studio delle malattie cardiotoraciche e del trapianto cardiotoracico – IRCCS ISMETT, Palermo.
7 M.D., Ph.D., Medico Chirurgico di Cardiologia Pediatrica – Ospedale Pediatrico Bambino Gesù, Roma
8M.D., Ph.D., Centro di riferimento Regionale per le Malattie Rare del Polmone- A.O.U. “Policlinico Vittorio Emanuele”- Catania
9 MD, Dipartimento Cardiovascolare e Toracico. AOU Città della Salute e della scienza di Torino, Torino
10 M.D., Ph.D, Dipartimento di Scienze Cliniche, Interventistiche, Anestesiologiche e Cardiovascolari.Policlinico Umberto I – Università di Roma “Sapienza”, Roma.


Introduction: Pulmonary Arterial Hypertension (PAH) is a rare and progressive disease, frequently associated with a worsening of perceived quality of life as well as anxiety and depression symptomatology. Psychological counselling helps the patient understand the diagnosis and prevent the onset of psychopathologies. This study evaluates the effect of counselling sessions on anxiety and depression as well as the impact on self-reported quality of life in patients with PAH.
Methods: Patients with a diagnosis of PAH were recruited at the Monaldi Hospital (Naples). An EQ-5D 3L questionnaire was administered to all patients at baseline (pre-session), three months (post-session) after the last session to patients who received psychological counselling (experimental group, EG) and after the first questionnaire to patients who did not (control group, CG). The EQ-5D index and EQ-VAS score were analysed in both groups.
Results: A sample of 50 patients with a PAH diagnosis was evaluated; among them 6% had mild PAH, 66% moderate PAH, and 28% severe PAH. The majority (53%) did not receive psychological counselling. All patients showed no significant difference in EQ-5D index (P > 0.05), EQ-VAS score (P > 0.05), and the anxiety/depression dimension (P >.05) at baseline. However, between pre- and post-session evaluations, the analysis showed a significant change in the EQ-VAS score (P = 0.00) and the anxiety/depression dimension (P = 0.02) in the EG. In the CG, there was a similar change in the anxiety/depression dimension (P = 0.00) but not in the EQ-VAS score (P = 0.05) in CG. The z-test revealed significant intergroup relations, showing that the EG had a 37% increase in perceived quality of life and a 9% reduction in anxiety and depression, while a 12% reduction was observed for the CG’s perceived quality of life and a 44% increase in anxiety and depression.
Discussion and Conclusions: This study showed that patients with PAH who received psychological support improved their health-related quality of life by reducing anxiety and depression symptomatology. Our findings highlight the impact of psychological support in the treatment of patients with PAH.

Keywords: Anxiety; counselling psychology; depression; EQ-VAS; EQ-5D; pulmonary arterial hypertension; quality of life.

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JHSS 2020,5(4):543-558

Original Article in Psychology and Social Behavior

Executive functions and the role of dieting: A comparison between English and Greek females

Authors: Eirini TATSI1, Noreen CASWELL2

1 Policy Officer, Office of The Vice-Chancellor, Strategic Planning Department, University of West
London, London, UK.
2 Senior Lecturer in Psychology, School of Psychology, University of Central Lancashire, Preston, UK.


Introduction: This study investigated and compared the effect of dieting status and culture on executive functions (EFs) between English and Greek females. The moderating role of restrained eating, preoccupying cognitions, depressed affect and IQ was also investigated to provide further evidence of the nature of this effect.
Methods: A between-subjects design was employed, where 192 females were recruited from UK (n =45) and Greek (n =147) Universities; 99 were current dieters and 93 were non-dieters. The Behavior Rating Inventory of Executive Function (BRIEF-A) was used to assess Executive Functions (EFs). Participants also completed the Dutch Eating Behaviour Questionnaire-Restraint (DEBQ-R), Preoccupying cognitions, Centre for Epidemiologic Studies Depression scale (CES-D), Raven’s Advanced Progressive Matrices-Set I, and a questionnaire acquiring demographic information. MANOVA and MANCOVA analyses were carried out.
Results: There was a significant multivariate main effect for dieting status (P < 0.05) and nationality (P < 0.001). Specifically, dieters self-report greater difficulty on inhibit (P < 0.001), self- and task-monitor, organisation of materials and working memory (P < 0.01), and shift, emotional control, initiate and plan/organise (P < 0.05). A significant univariate effect was found for nationality, in terms of emotional control (P < .0.01), whereby a higher mean T-score was revealed for Greek (M = 62.12; SD = 11.01) compared to English females (M = 59.28; SD = 13.95). With DEBQ-R and preoccupying cognition scores entered as covariates, the effect of nationality, on emotional control, remained significant (P < 0.001). However, none of the main effects for dieting status remained significant (P > 0.05).
Discussion and Conclusion: Greek females self-report greater difficulty in controlling their emotions. Dieters found to have a poorer ability on the components of EFs; nationality also found to have an effect on EFs. Outcomes of this research provide fruitful implications on the association between dieting, culture and EFs.

Keywords: BRIEF-A; culture; dieting; eating behaviour; executive functions.

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JHSS 2020,5(4):559-572

Original Article in Public Health

Body size estimation and weight management practices in urban poor communities in Ghana: A cross-sectional study

Authors: Grace Agyemang FREMPONG1, John K. ANARFI1, Delali Margaret BADASU1, Samuel Nii Ardey CODJOE1

1 Ph.D,Regional Institute for Population Studies. University of Ghana, P.O. Box LG 96, Accra, Ghana.


Introduction: Body size perception is a pertinent issue globally due to its implications for weight management. This study examined the influence of body size estimation on weight management behaviours in urban poor areas of Ghana.
Methods: A cross-sectional design was used to collect data among a sample of 395 adults aged 18-70 years. A semi-structured questionnaire was designed for collection of data on socio-demographic characteristics, weight perceptions, and weight management strategies. Anthropometric measurements were also taken, using standard procedures. Logistic regression models were used to examine relationships among the variables.
Results: More than half (57%) of the total sample was overweight or obese and 56.7% of the participants accurately estimated their body size. Nearly a third (37%) of the participants intended to stay about the same weight, while 29.6% and 11.9% wanted to lose or gain weight, respectively. To achieve their weight management goals, 60.3% of the participants engaged in healthy weight management practices. Body size estimation had no statistically significant relationship with weight management practices. However, the likelihood of engaging in healthy practices increased as age increased (OR = 1.021; 95% CI: 1.000 to 1.042). Individuals who belonged to households of upper wealth category were less likely than those in lower wealth households to engage in healthy practices (OR = 0.548; CI: 0.330 to 0.911). Community of residence, a community conducive to physical activity and social support also significantly predicted weight management practices.
Conclusion: The findings of this study highlight the importance of age and some socio-environmental factors in public health strategies for weight management.

Keywords: Body size estimation; diet; Ghana; healthy practice; obesity; weight management.

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JHSS 2020,5(4):573-586

Original Article in Infectous Diseases and Public Health

HCV and HIV co-infection among people who inject drugs in Vietnam

Authors: Vu Toan THINH1, Li LI2, Dréan MATTHIEU3, Van Dinh HOA4, Nguyen Huu ANH4, Le Minh GIANG5

1 M.Sc, Center for Research and Training on Substance Use-HIV, Hanoi Medical University, Hanoi 100000, Vietnam.
2 Professor, Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA 90024, USA.
3 Médecins du Monde in Vietnam, Hanoi 100000, Vietnam.
4 M.D., M.P.H, Center for Research and Training on Substance Use-HIV, Hanoi Medical University, Hanoi 100000, Vietnam.
5 M.D., Associate Professor, Center for Research and Training on Substance Use-HIV, Hanoi Medical University, Hanoi 100000, Vietnam.


Introduction: HIV/HCV co-infection in people who inject drugs (PWID) continues to be a major challenge for health care systems and the PWID themselves. PWID have driven the HIV epidemic in Vietnam but information on HIV/HCV co-infection is limited.
Methods: A cross-sectional study was conducted with 509 PWID recruited in Hanoi from February 2016 to April 2017. Four mutually exclusive groups were defined based on the presence of detectable HCV RNA and positive HIV confirmation. Multiple logistic regression analyses were performed to explore life-time risk behaviors of HCV mono-infection and HIV/HCV co-infection.
Results: The overall prevalence of HIV and HCV infection was 51.08% and 61.69%, respectively. The prevalence of HCV mono-infection and HIV/HCV co-infection was 22.59% and 39.1%, respectively. We found that engaging in methadone maintenance treatment (MMT) was positively associated with HCV mono-infection (aOR = 2.38, 95% Confidential Interval [CI] 1.07 to 5.28) and with at least either HIV or HCV infection (aOR = 2.22, 95% CI 1.08 to 4.56). Ever being incarcerated was significantly associated with HCV mono-infection (aOR = 2.56, 95% CI 1.33 to 4.90) and HIV/HCV co-infection (aOR = 1.90, 95% CI 1.04 to 3.46). Those who had ever shared with and reused syringes/needles were more likely to have HIV/HCV co-infection (aORs = 5.17 and 2.86, P < 0001, respectively) and have either HIV or HCV infection (aORs = 3.42 and 2.37, P < 0001, respectively).
Conclusion: Correlates for HCV mono-infection and HIV/HCV co-infection highlight the need to address risk behaviors, expand MMT programs, and establish HCV sentinel surveillance. The high prevalence of HCV and/or HIV co-infection shows a need for access to HCV treatment.

Keywords: HIV/HCV co-infection; HCV mono-infection; People Who Inject Drugs; Vietnam.

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JHSS 2020,5(4):587-594

Original Article in COVID-19 and Statistics

Clustering of countries in terms of deaths and cases of COVID-19

Authors: Ozge PASIN1, Tugce PASIN2

1 PhD, Department of Biostatistics, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
2 MD, Department of Physical Medicine and Rehabilitation, Istanbul Goztepe Training and Research Hospital, Istanbul, Turkey.


Introduction: The novel coronavirus ‘Severe Acute Respiratory Syndrome Coronavirus Type 2’ (SARS-CoV-2), responsible for the disease termed as ‘Coronavirus disease 2019’ (COVID-19 pandemic) first broke out in Wuhan, Hubei province, mainland China. With its rapid spread and reports revealing the crucial consequences of this spread, countries adopted strict measures to tackle the disease. The objective of this study is to cluster the various countries describing the course of the COVID-19 outbreak.
Methods: The data used was obtained from the Worldometers’ website on October 22, 2020 in its most current form for 191 countries. The number of total cases and deaths were used. The numbers were calculated considering population sizes. The total deaths / 1million population and total cases/ 1million population were used for clustering. For clustering k-means clustering method and elbow method were used. Also the two-step clustering method was used for the clustering process.
Results: As a result, Armenia, Aruba, Bahrain, French Guiana, Israel, Kuwait, Montenegro, Oman, Qatar, San Marino were a single cluster apart from other countries for two-step clustering. Also in k-means clustering Aruba, Bahrain, French Guiana, Israel and Qatar was a single cluster apart from other countries for k-means clustering.
Conclusion: This study will be of great importance, when showing the differences among countries in terms of total deaths and cases in terms of population. Proper use of these data will help states take precautions regarding COVID-19.

Keywords: Clustering; Coronavirus; COVID-19: k-means; statistics.

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