#Gaps in #Sexual #Assault Health #Care Among #Homeless Young Adults (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Gaps in Sexual Assault Health Care Among Homeless Young Adults

Diane M. Santa Maria, DrPH, RN1, Khara Breeden, DNP, RN2, Stacy A. Drake, PhD, MPH, RN1, Sarah C. Narendorf, PhD3, Anamika Barman-Adhikari, PhD4, Robin Petering, PhD5, Hsun-Ta Hsu, PhD6, Jama Shelton, PhD7, Kristin Ferguson-Colvin, PhD8, Kimberly Bender, PhD4

Open Access / DOI: https://doi.org/10.1016/j.amepre.2019.09.023

Published online: December 16, 2019

 

Abstract

Introduction

Young adults experiencing homelessness are at increased risk for sexual assault. Receiving a post–sexual assault examination has important implications for HIV and unintended pregnancy prevention; yet, utilization is not well understood. In a population at elevated risk for HIV, unintended pregnancy, and sexual violence, identifying barriers and facilitators to post–sexual assault examination is imperative.

Methods

As part of a large, multisite study to assess youth experiencing homelessness across 7 cities in the U.S, a cross-sectional survey was conducted between June 2016 and July 2017. Data were analyzed in 2019 to determine the prevalence and correlates of sexual violence and examine the correlates of post–sexual assault examination utilization.

Results

Respondents (n=1,405), aged 18–26 years, were mainly youth of color (38% black, 17% Latinx) and identified as cisgender male (59%) and lesbian, gay, bisexual, or queer (29%). HIV risks were high: 23% of participants had engaged in trade sex, 32% had experienced sexual assault as a minor, and 39% had experienced sexual exploitation. Young adults reported high rates of sexual assault (22%) and forced sex (24%). Yet, only 29% of participants who were forced to have sex received a post–sexual assault examination. Latinx young adults were more likely than other races/ethnicities to receive post-assault care. Participants frequently said they did not get a post–sexual assault exam because they did not want to involve the legal system and did not think it was important.

Conclusions

Interventions are needed to increase use of preventive care after experiencing sexual assault among young adults experiencing homelessness.

© 2019 American Journal of Preventive Medicine. Published by Elsevier Inc.

Keywords: USA; Society; Poverty; Violence.

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#Risk #factors, #awareness of disease and use of #medications in a deprived population: differences between #indigent natives and undocumented #migrants in #Italy (J Pub Health, abstract)

[Source: Journal of Public Health, full page: (LINK). Abstract, edited.]

Risk factors, awareness of disease and use of medications in a deprived population: differences between indigent natives and undocumented migrants in Italy

Gianfrancesco Fiorini, Cesare Cerri, Flavia Magri, Luca Chiovato, Laura Croce, Antonello E Rigamonti, Alessandro Sartorio, Silvano G Cella

Journal of Public Health, fdz123, https://doi.org/10.1093/pubmed/fdz123

Published: 08 November 2019

 

Abstract

Background

Undocumented migrants experience many health problems; a comparison with a suitable control group of natives living in the same socio-economic conditions is still lacking.

Methods

Demographic data and data on risk factors, chronic conditions and dietary habits were obtained for 6933 adults (2950 Italians and 3983 undocumented migrants) receiving medical assistance from 40 non-governmental organizations all over the country.

Results

Attributed to the fact that these were unselected groups, differences were found in their demographic features, the main ones being their marital status (singles: 50.5% among Italians and 42.8% among migrants; P < 0.001). Smokers were more frequent among Italians (45.3% versus 42.7% P = 0.03); the same happened with hypertension (40.5% versus 34.5% P < 0.001). Migrants were more often overweight (44.1% versus 40.5% P < 0.001) and reporting a chronic condition (20.2% versus 14.4% P < 0.001). Among those on medications (n = 1354), Italians were fewer (n = 425) and on different medications. Differences emerged also in dietary habits.

Conclusions

Differences in health conditions exist between native-borns and undocumented migrants, not because of a bias related to socio-economic conditions. Further studies are needed to design sustainable health policies and tailored prevention plans.

chronic diseases, dispensation of medications, poverty, undocumented migrants

Topic: hypertension – diet – adult – chronic disease – demography – habits – health policy – italy – marital status – medical assistance – single person – socioeconomic factors – poverty – overweight – prevention – nongovernmental organizations – smokers

Issue Section: Original Article

© The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Public Health; Society; Poverty; Migrants; Italy.

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The #publichealth #crisis of #underimmunisation: a global plan of action (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

The public health crisis of underimmunisation: a global plan of action

Prof Lawrence O Gostin, JD, Prof James G Hodge Jr, JD, Prof Barry R Bloom, MD, Ayman El-Mohandes, MD, Prof Jonathan Fielding, MD, Prof Peter Hotez, MD, Dean Ann Kurth, PhD, Prof Heidi J Larson, PhD, Prof Walter A Orenstein, Kenneth Rabin, PhD, Prof Scott C Ratzan, MD, Prof Daniel Salmon, PhD

Published: November 06, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30558-4

 

Summary

Vaccination is one of public health’s greatest achievements, responsible for saving billions of lives. Yet, 20% of children worldwide are not fully protected, leading to 1·5 million child deaths annually from vaccine-preventable diseases. Millions more people have severe disabling illnesses, cancers, and disabilities stemming from underimmunisation. Reasons for falling vaccination rates globally include low public trust in vaccines, constraints on affordability or access, and insufficient governmental vaccine investments. Consequently, an emerging crisis in vaccine hesitancy ranges from hyperlocal to national and worldwide. Outbreaks often originate in small, insular communities with low immunisation rates. Local outbreaks can spread rapidly, however, transcending borders. Following an assessment of underlying determinants of low vaccination rates, we offer an action based on scientific evidence, ethics, and human rights that spans multiple governments, organisations, disciplines, and sectors.

Keywords: Vaccines; Society; Politics; Public Health.

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Sustainable #development #levers are key in #global #response to #antimicrobial #resistance (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Sustainable development levers are key in global response to antimicrobial resistance

Angelina Taylor, Jasper Littmann, Anna Holzscheiter, Maike Voss, Lothar Wieler, Tim Eckmanns

Published: October 30, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32555-3

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Antimicrobial resistance (AMR) is a borderless challenge, with drug-resistant infections estimated to cause at least 700 000 deaths per year globally. 1  To address this, member states of WHO agreed to the Global Action Plan for AMR in 2015, followed by adoption of the UN political declaration on AMR in 2016. A global governance structure is in place—namely, the Tripartite, made up of WHO, the Food and Agriculture Organization of the UN (FAO), and the World Organisation of Animal Health (OIE)—all of which are strengthening their AMR mandates. 2  The UN Interagency Coordination Group on AMR (IACG), tasked by the UN Secretary-General, has been engaging with member states and other stakeholders and has made recommendations for globally combatting AMR. 3

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Keywords: Society; Poverty; Global Health; Antibiotics; Drugs Resistance.

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Long-term #survival and cause-specific #mortality of #patients newly diagnosed with #tuberculosis in São Paulo state, #Brazil, 2010–15: a population-based, longitudinal study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010–15: a population-based, longitudinal study

Otavio T Ranzani, PhD, Prof Laura C Rodrigues, PhD, Sidney Bombarda, PhD, Cátia M Minto, MSc, Prof Eliseu A Waldman, PhD, Prof Carlos R R Carvalho, PhD

Open Access / Published: October 29, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30518-3

 

Summary

Background

Long-term survival and cause-specific mortality of patients who start tuberculosis treatment is rarely described. We aimed to assess the long-term survival of these patients and evaluate the association between vulnerable conditions (social, health behaviours, and comorbidities) and cause-specific mortality in a country with a high burden of tuberculosis.

Methods

In this population-based, longitudinal study in São Paulo state, Brazil, we described the 5-year survival of patients who were newly diagnosed with tuberculosis in 2010. We included patients with newly-diagnosed tuberculosis, aged 15 years or older, and notified to the São Paulo State Tuberculosis Program in 2010. We excluded patients whose diagnosis had changed during follow-up (ie, they did not have tuberculosis) and patients who had multidrug-resistant (MDR) tuberculosis. We selected our population with tuberculosis from the dedicated electronic system TBweb. Our primary objective was to estimate the excess mortality over 5 years and within the group who survived the first year, compared with the general São Paulo state population. We also estimated the association between social vulnerability (imprisonment and homelessness), health behaviours (alcohol and drug use), and comorbidities (diabetes and mental disorders) with all-cause and cause-specific mortality. We used the competing risk analysis framework, estimating cause-specific hazard ratios (HRs) adjusted for potential confounding factors.

Findings

In 2010, there were 19 252 notifications of tuberculosis cases. We excluded 550 cases as patients were younger than 15 years, 556 cases that were not tuberculosis, 2597 retreatments, and 48 cases of MDR tuberculosis, resulting in a final cohort of 15 501 patients with tuberculosis. Over a period of 5 years from tuberculosis diagnosis, 2660 (17%) of 15 501 patients died. Compared with the source population, matched by age, sex, and calendar year, the standardised mortality ratio was 6·47 (95% CI 6·22–6·73) over 5 years and 3·93 (3·71–4·17) among those who survived the first year. 1197 (45%) of 2660 deaths were due to infection. Homelessness and alcohol and drug use were associated with death from infection (adjusted cause-specific HR 1·60, 95% CI 1·39–1·85), cardiovascular (1·43, 1·06–1·95), and external or ill-defined causes of death (1·80, 1·37–2·36). Diabetes was associated with deaths from cardiovascular causes (1·70, 1·23–2·35).

Interpretation

Patients newly diagnosed with tuberculosis were at a higher risk of death than were the source population, even after tuberculosis treatment. Post-tuberculosis sequelae and vulnerability are associated with excess mortality and must be addressed to mitigate the tuberculosis burden worldwide.

Funding

Wellcome Trust.

Keywords: Tuberculosis; Antibiotics; Drugs Resistance; Society; Poverty; Brazil.

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#Mapping 123 million #neonatal, #infant and #child #deaths between 2000 and 2017 (Nature, abstract)

[Source: Nature, full page: (LINK). Abstract, edited.]

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Roy Burstein, Nathaniel J. Henry,  […] Simon I. Hay

Nature, volume 574, pages353–358 (2019)

 

Abstract

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Keywords: Society; Poverty; Pediatrics; Global Health.

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A perfect #storm in the #Caribbean requires a concerted #response (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

A perfect storm in the Caribbean requires a concerted response

Sandeep Maharaj, Terence Seemungal, Martin McKee

Published: September 17, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)31822-7

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The countries of the Caribbean are facing a perfect storm of events that pose a severe threat to the health of their people. 2018 was the third consecutive year of above average meteorological activity, with several countries, including Anguilla and the British Virgin Islands, devastated by major hurricanes. The effects of climate change mean the situation can only get worse.

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We declare no competing interests.

Keywords: Public Health; Hurricanes; Caribbean; Society; Poverty.

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