Determinants of malnutrition risk among the older adult community: a secondary analysis of the Health, Wellbeing, and Aging Study (SABE) in Mexico

OBJECTIVE: To determine the psychosocial and health determinants associated with malnutrition risk (MR) among older adults living in the community of Mexico City, Mexico. METHODS: This was a cross-sectional study. Secondary analysis was performed on the data of adults who were 60 or more years of age, living in the metropolitan area of Mexico city, and had participated in the multi-city study on Health, Wellbeing, and Aging in 1999 and 2000. Information on 820 participants was analyzed (mean age 69.7 +/- 7.6 years; 62.9% female). In addition to the MR (dependent variable) that was established through a basic nutrition evaluation, the following variables were analyzed: sociodemographics, body mass index, comorbidity, symptoms of depression, oral health, mental function, functional capability, among others. Independent associations from among the variables and the MR were calculated by univariate and multivariate logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (95%CI) were determined. RESULTS: MR was present in 261 (31.8%) participants. The univariate logistic regression analysis adjusted for possible confounding variables showed that the following variables demonstrated significant and independent associations with MR among the study sample population: not having a pension (adjusted OR = 1.45; 95%CI: 1.01 - 2.38); feeling that one did not have enough money to live on (adjusted OR = 2.52; 95%CI: 1.69 - 3.74); having osteoarthritis (adjusted OR = 2.34; 95%CI: 1.42 - 3.85); having a low body mass index (adjusted OR = 0.89; 95%CI: 0.85 - 0.93); having symptoms of depression (adjusted OR = 5.41; 95%CI: 1.90 - 15.34); eating only once daily (adjusted OR = 12.95; 95%CI: 5.19 - 32.28) or twice daily (adjusted OR = 3.27; 95%CI: 2.18 - 4.9); and having physical difficulty with getting to bed (adjusted OR = 3.25; CI 95%: 1.58 - 6.68), going out alone (adjusted OR = 2.70; CI 95%: 1.54 - 4.73), and using the telephone (adjusted OR = 1.95; CI 95%: 1.10 - 3.43). CONCLUSIONS: There are multiple and various determinants of malnutrition risk. To determine MR, the older adult's financial and social situation must be carefully evaluated along with the more traditional health and anthropometric information.     

Violence against young Australian women and association with reproductive events: a cross-sectional analysis of a national population sample

OBJECTIVE: This study aimed to investigate associations between violence and younger women's reproductive events using Survey 1 (1996) data of the Younger cohort of the Australian Longitudinal Study of Women's Health (ALSWH). METHODS: Multinomial regression, using composite variables for both violence and reproductive events, adjusting for socioeconomic variables and weighted for rural and remote areas. RESULTS: 23.8% of 14,784 women aged 18 to 23 years reported violence; 12.6% reported non-partner violence in the previous year; and 11.2% reported ever having had a violent relationship with a partner. Of the latter group, 43% (4.8% overall) also reported violence in the past year. Compared with women reporting no violence, women reporting partner but not recent violence (OR 2.55, 95% CI 2.10-3.09) or partner and recent violence (OR 3.96, 95% CI 3.18-4.93) were significantly more likely to have had one or more pregnancies. Conversely, having had a pregnancy (2561) was associated with an 80% increase in prevalence of any violence and a 230% increase in partner violence. Among women who had a pregnancy, having had a miscarriage or termination was associated with violence. Partner and recent violence is strongly associated with having had a miscarriage, whether alone (OR = 2.85, 95% CI 1.74-4.66), with a termination (OR = 4.60, 2.26-9.35), or with birth, miscarriage and a termination (OR = 4.12, 1.89-9.00). CONCLUSIONS AND IMPLICATIONS: Violence among young women of childbearing age is a factor for which doctors should be vigilant, well-trained and supported to identify and manage effectively.     

Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges

Opioid-involved overdose deaths are on the rise, both nationwide and in the state of Washington. In a survey of 443 participants at syringe exchanges in Seattle, Washington, 16% had overdosed in the last year. Several factors were significantly associated in bivariate analysis: lack of permanent housing; incarceration of five or more days in the past year; gender of sex partners; sharing of syringes and other injection paraphernalia; use of speedballs (cocaine and heroin together), goofballs (methamphetamine and heroin together), buprenorphine; injection use of crack cocaine and sedatives; and use of opioids with sedatives. Adjusting for other variables in multivariate logistic regression analyses, only recent incarceration and sharing of injection materials were still significantly associated with overdose. Correctional facilities, syringe exchange programs, and other agencies serving opioid injectors should include overdose prevention components in release planning and services.     

Sexual and drug risk behaviors among women who have sex with women

OBJECTIVES: We examined risk behaviors of female drug users, comparing those who reported recently having had sex with women (recent WSW), those who reported previously having had sex with women (former WSW), and those who reported never having had sex with women (never WSW). METHODS: We used data from the Risk Evaluation and Assessment of Community Health III Study. Adjusted odds for predictors of WSW status were determined via multinomial logistic regression analyses. RESULTS: Of the participants, 75% were never WSW, 12% were former WSW, and 13% were recent WSW. In comparison with never WSW status, significant predictors of recent WSW status were living away from one's parents as a child (adjusted odds ratio [OR]=3.05; 95% confidence interval [CI]=1.07, 8.67) and recently having been paid for sex by men (adjusted OR=4.02; 95% CI=1.67, 9.68). Also, recently having been paid for sex by men was a significant predictor of former WSW status as opposed to never WSW status (adjusted OR=3.97; 95% CI=1.65, 9.59). CONCLUSIONS: The recency with which they had sex with women is one of the facets influencing the risk profile of WSW. The diverse characteristics of the WSW population need to be incorporated into future studies and risk interventions targeting this group.     

云南省部分地区注射吸毒者海洛因过量情况及影响因素分析

目的 了解云南省部分地区注射吸毒者(IDU)海洛因过量情况及其影响因素。方法 采用横断面调查的方法,于2015年7-8月对云南省红河州和德宏州的4个美沙酮维持治疗(MMT)门诊和2个州强制戒毒所的IDU进行问卷调查,内容包括社会人口学特征、毒品使用情况、过去1年海洛因过量情况以及最近1次海洛因过量情况等。对过去1年发生过海洛因过量的相关因素进行logistic回归分析。结果 共340名IDU符合入选标准,男性占85.3%(290/340),年龄为(37.7±8.7)岁,汉族占65.6%(223/340),HIV阳性检出率为49.4%(167/338),过去6个月使用过新型毒品占22.6%(77/340)。自吸毒以来,曾有过海洛因过量的比例为41.8%(142/340),海洛因过量次数M=3次。在过去1年中海洛因过量发生率为15.6%(53/340),M=1次。发生海洛因过量的年龄为(36.7±8.4)岁,吸毒年限为(16.5±7.6)年,男性占83.0%(44/53)。发生海洛因过量的主要原因为增加海洛因用量(26.4%,14/53)和多药滥用(28.3%,15/53)。非条件logistic回归模型分析显示:过去1年参加过MMT(OR=0.534,95%CI:0.290~0.980)可降低海洛因过量的风险,而过去6个月共用针具(OR=2.735,95%CI:1.383~5.407)和刚出戒毒所不满1年(OR=2.881,95%CI:1.226~6.767)会增加海洛因过量的风险。结论 云南省IDU过去1年海洛因过量发生率较高。需要持续促进该地IDU参加MMT并加强预防和应对吸毒过量宣传教育,特别是对戒毒所吸毒人员出所前的宣传教育,同时应建立针对吸毒人员的戒毒所与MMT门诊转介机制。     

Revolving doors: imprisonment among the homeless and marginally housed population

OBJECTIVES: We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless. METHODS: We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment. RESULTS: Almost one fourth of participants (23.1%) had a history of imprisonment. Models that examined lifetime substance use showed cocaine use (odds ratio [OR]=1.67; 95% confidence interval [CI]=1.04, 2.70), heroin use (OR=1.51; 95% CI=1.07, 2.12), mental illness (OR=1.41; 95% CI=1.01, 1.96), HIV infection (OR=1.69; 95% CI=1.07, 2.64), and having had more than 100 sexual partners were associated with a history of imprisonment. Models that examined recent substance use showed past-year heroin use (OR = 1.65; 95% CI = 1.14, 2.38) and methamphetamine use (OR=1.49; 95% CI=1.00, 2.21) were associated with lifetime imprisonment. Currently selling drugs also was associated with lifetime imprisonment. CONCLUSIONS: Despite high levels of health risks among all homeless and marginally housed people, the levels among homeless former prisoners were even higher. Efforts to eradicate homelessness also must include the unmet needs of inmates who are released from prison.     

Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets.

OBJECTIVE: To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients. DESIGN: Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years. SETTING: 76 not-for-profit US dialysis clinics. STUDY PARTICIPANTS: 678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey. MAIN OUTCOME MEASURES: Achievement of accepted 6 month clinical performance targets of albumin (> or =3.5 g/dl), calcium-phosphate (Ca-P) product (<60 mg(2)/dl(2)), dialysis dose (Kt/V > or = 1.2), vascular access type (fistula), and hemoglobin (> or =11 g/dl). RESULTS: By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR) = 0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR = 0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR = 0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR = 0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR = 1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR = 1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR = 0.43, 95% CI, 0.20-0.94). CONCLUSIONS: More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.     

Violent behaviour among adolescents in Iceland: a national survey

BACKGROUND: Violence among adolescents may have serious developmental, physical, and mental health consequences for the affected individuals. In this study, we assessed the prevalence of violent behaviour and its correlates among 15-16 year old schoolchildren in Iceland. METHODS: In 1997, a cross-sectional survey was conducted among a random half of all Icelandic schoolchildren aged 15-16 years. The overall response rate was 91% (N = 3872). In the present study, socio-demographic background, social support, negative life events, psychological distress, and substance use were considered in relation to violent behaviour using logistic regression techniques. RESULTS: The majority of the respondents reported having committed violence within the last year. Boys were more likely to use violence than girls (odds ratio [OR] = 5.6; 95% CI: 4.7, 6.6). Respondents who had experienced >/=4 negative life events in the past year were more likely to use violence than respondents with no negative life events (OR = 3.0; 95% CI: 2.2, 4.2). Smokers were more likely than non-smokers to use violence (OR = 1.7; 95% CI: 1.2, 2.2), and adolescents who had used alcohol >20x in their lifetime were more than twice as likely to commit violence compared with those who had never used alcohol (OR = 2.5; 95% CI: 1.8, 3.4). CONCLUSION: Rates of violent behaviour among Icelandic schoolchildren were high. Gender, parental support, life stress, anger/aggression, and substance use were all significantly related to the perpetration of violent acts.     

德宏傣族景颇族自治州不同年龄跨境婚姻人群艾滋病相关公共卫生服务现况

  目的  了解德宏自治州跨境婚姻人群艾滋病相关公共卫生服务现况及其年龄差异。  方法  采用横断面调查研究,2017年5月-2019年6月,招募德宏州所有跨境婚姻人员开展调查。  结果  共调查并纳入分析32 182人,年龄15~85岁。曾接受过艾滋病检测服务、近1年接受过艾滋病相关干预服务、近1年得到关怀帮助和参加新农合比例分别为57.8%、92.7%、6.5%和94.5%;其中后三项存在年龄差异（P < 0.001）。多因素Logistic回归分析显示,曾接受过艾滋病检测服务的影响因素包括年龄（51~85岁:OR=0.71,95% CI:0.63~0.81）、女性（OR=1.14,95% CI:1.03~1.25）、地区（陇川:OR=6.30,95% CI:5.72~6.93;梁河:OR=1.27,95% CI:1.11~1.44;盈江:OR=0.88,95% CI:0.82~0.94）、傣族（OR=1.60,95% CI:1.50~1.72）、婚姻登记（办理边民通婚登记:OR=0.60,95% CI:0.56~0.65;未办任何手续:OR=0.66,95% CI:0.62~0.70）、结婚年数（4~5年:OR=1.21,95% CI:1.12~1.31;6~60年:OR=1.30,95% CI:1.22~1.39）、近1年未得到关怀帮助（OR=0.64,95% CI:0.58~0.71）、未参加新农合（OR=0.58,95% CI:0.52~0.65）。  结论  德宏州跨境婚姻人群艾滋病相关公共卫生服务总体实施较好。但是,接受艾滋病检测服务比例相对较低,需在个别人群和县市加强检测。     

Heroin use during methadone maintenance treatment: the importance of methadone dose and cocaine use.

OBJECTIVES. The purpose of this study was to examine factors associated with heroin use during methadone maintenance treatment. METHODS. Logistic regression statistical models were used to examine data obtained in a cross-sectional sample of 652 methadone patients. RESULTS. Heroin use during the 3 months prior to interview was shown to be greatest among (1) patients maintained on methadone dosages of less than 70 mg/day (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3, 3.4) and (2) patients who used cocaine during treatment (adjusted OR = 5.9, 95% CI = 3.8, 9.1). These results were independent of treatment duration, treatment compliance, alcohol use, and socioeconomic factors. Cocaine users were more likely than nonusers of cocaine to use heroin at all methadone dosage levels. CONCLUSIONS. This study confirms and extends past research showing high-dose methadone maintenance to be important to heroin abstinence. Further investigation of the independent association between heroin use and cocaine use is needed.     

Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV

BACKGROUND: This paper aims to describe factors associated with HIV sero-status in young, rural South African women and the relationship between intimate partner violence (IPV) and HIV. METHODS: A total of 1295 sexually active female volunteers, aged 15-26, from 70 villages were recruited to participate in a cluster randomized controlled trial of an HIV behavioural intervention. The main measures were HIV sero-status, and IPV and sexual practices measured using a questionnaire administered during baseline interviews. RESULTS: About 12.4% of women had HIV and 26.6% had experienced more than one episode of physical or sexual IPV. After adjusting for age, HIV infection was associated with having three or more past year partners [odds ratio (OR) 2.39; 95% confidence interval (95% CI) 1.48-3.85], sex in past 3 months (OR 3.33; 95% CI 1.87-5.94), a partner three or more years older (OR 1.69; 95% CI 1.16-2.48), and a more educated partner (OR 1.91; 95% CI 1.30-2.78). IPV was associated with HIV in two-way analyses (OR 1.56; 95% CI 1.08-2.23), but the effect was non-significant after adjusting for HIV risk behaviours. The experience of IPV was strongly associated with past year partner numbers, time of last sex, and partner's education; it was also marginally associated with partner age difference. Adverse experiences in childhood, including sexual abuse, increased the likelihood of having more past year partners (OR 1.43; 95% CI 1.21-1.69). CONCLUSIONS: IPV was strongly associated with most of the identified HIV risk factors. Our findings provide further evidence of links between IPV and HIV among women and the importance of joint prevention.     

Factors associated with HIV testing among male motorbike taxi drivers in urban Vietnam

Using the Attitude-Skills-Knowledge (ASK) model, this study examined the prevalence of, and factors associated with, human immunodeficiency virus (HIV) testing among male motorbike taxi drivers (MMTDs). In a cross-sectional design, using quantitative approaches, 291 MMTDs were recruited from 135 sites across 13 districts in Hanoi, Vietnam, for a face-to-face interview. Applying the ASK model modified as a central theory, logistic regression was used to identify determinants of HIV testing. Although many MMTDs engaged in multiple risk behaviours for HIV, only 20.6% had been tested for HIV during the past 12 months. The tested model included one factor of the ASK model, HIV prevention knowledge (adjusted odds ratio [AOR] = 4.76; 95% confidence interval [CI] = 2.12–10.7) and five additional factors: being married (AOR = 3.13; 95% CI = 1.25–4.78), preferring sex with men or with both men and women (AOR = 8.72; 95% CI = 1.48–51.5), having lower number of lifetime sex partners (AOR = 0.66; 95% CI = 0.49–0.88), higher number of past year sex partners (AOR = 2.97: 95% CI = 1.21–7.31) and discussing condom use when having sex with partners (AOR = 0.08; 95% CI = 0.01–7.31). This modified ASK model provided better fit than the ASK model, as it explained more variance in HIV testing (47 vs. 29.8%). Recognising factors associated with HIV testing among MMTDs enables us to create suitable public health intervention strategies.     

Occupational risk factors associated with voice disorders among teachers

PURPOSE: This study was designed to determine the occupational risk factors associated with voice disorders among schoolteachers, a high-risk population for developing voice problems. METHODS: Telephone interviews were completed by 1243 teachers from Utah and Iowa. Response rates were 98% and 95%, respectively. Bivariate analyses were computed and assessed using chi-square test and Cochran-Mantel-Haenszel test, and logistic regression analyses were performed and resulting odds ratios assessed using 95% confidence intervals. RESULTS: Teachers of vocal music, drama, other performing arts and chemistry were at significantly greater risk of having a voice disorder (OR=2.2, 95% CI: 1.2-4.0; OR=2.1, 95% CI: 0.9-4.8; OR=1.6, 95% CI: 1.0-2.4; OR=2.0, 95% CI: 1.1-3.4), while teachers of special and vocational education had a significantly lower risk (OR=0.5, 95% CI: 0.3-0.7; OR=0.6, 95% CI: 0.4-0.9). When adjusted for the intensity of vocalization, only teachers of chemistry were significantly at risk (OR=2.0, 95% CI: 1.1-3.5) while teachers of special education continued to have less of a risk (OR=0.5, 95% CI: 0.4-0.8). Chronic voice disorders were more prevalent among teachers of vocal music (OR=4.1, 95% CI: 2.2-7.9) and less prevalent among teachers of vocational education (OR=0.29, 95% CI: 0.09-0.95). CONCLUSIONS: These findings suggest that teachers of specific courses are at greater risk of developing a voice disorder.     

Predisposing and Enabling Factors Associated with Mammography Use Among Hispanic and Non-Hispanic White Women Living in a Rural Area

ABSTRACT:  Context: Women who do not receive regular mammograms are more likely than others to have breast cancer diagnosed at an advanced stage. Purpose: To examine predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic White women. Methods: Baseline data were used from a larger study on cancer prevention in rural Washington state. In a sample of 20 communities, 537 women formed the sample for this study. The main outcomes were ever having had a mammogram and having had a mammogram within the past 2 years. Findings: Reporting ever having had a mammogram was inversely associated with lack of health insurance (OR = 0.37, 95% CI: 0.16-0.84), ages under 50 years (OR = 0.23, 95% CI: 0.12-0.45), high cost of exams (OR = 0.48, 95% CI: 0.27-0.87), and lack of mammography knowledge (OR = 0.16, 95% CI: 0.07-0.37), while increasing education levels were positively associated (OR = 1.72, 95% CI: 1.09-2.70). Reporting mammography use within the past 2 years was inversely associated with ages under 50 years (OR = 0.49, 95% CI: 0.27-0.88) and over 70 years (OR = 0.47, 95% CI: 0.24-0.94), lack of health insurance (OR = 0.23, 95% CI: 0.10-0.50), and high cost of exams (OR = 0.55, 95% CI: 0.35-0.87). Conclusions: Continued resources and programs for cancer screening are needed to improve mammography participation among women without health insurance or low levels of education.     

Risk behaviors for sexually transmitted diseases among truck drivers in Brazil

OBJECTIVE: To evaluate the frequency of sexually transmitted diseases (STD) and associated risk factors based on self-reporting by long-haul truck drivers in Brazil. METHOD: From October 2005-October 2006, 641 long-haul truck drivers that travel federal highway BR-153, traversing the country from south to north, were interviewed. A structured interview was used to collect sociodemographic data. The truck drivers also completed a self-administered questionnaire on risk behaviors and STD history. The data were adjusted and analyzed using logistic regression. RESULTS: Of 641 drivers interviewed, 620 (96.7%) provided answers on STD history. Of these, 35.6% (95% confidence interval (CI) = 31.9-39.6) reported past or current STD. Being 30 years of age or older was statistically associated with having a history of STD. In addition, truck drivers who reported using amphetamines (odds ratio (OR) = 1.7; 95%CI = 1.1-2.6), having been incarcerated (OR = 2.2; 95%CI = 1.2-4.2), and sexual relations with sex professionals (OR = 1.9; 95%CI = 1.3-2.8) had increased odds for having a history of STD. CONCLUSION: These results confirm that Brazilian truck drivers are highly vulnerable to STD and show the importance of prevention programs targeting this specific group, one that is constantly on the move and may efficiently disseminate STD.     

Anger expression, negative life events and violent behaviour among male college students in Ethiopia

AIMS: To assess the prevalence of violent behaviour and to identify risk factors associated with violent behaviour among male college students in Ethiopia. METHODS: A cross-sectional study among 1294 male college students in Awassa, Ethiopia was conducted in June 2006. A self-administered questionnaire was used to collect information concerning violent acts, anger expression, and sociodemographic and lifestyle characteristics. Multivariable logistic regression procedures were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: More than half of the students (54.3%) reported committing at least one act of physical violence during the current academic year. Academic year of studies, use of khat, a natural stimulant with amphetamine-like effects, anger proneness and stressful life events were statistically significant covariates associated with committing acts of violence. Seniors, as compared with freshmen, were less likely to admit violent behaviour (OR=0.46; 95% CI 0.30-0.71). Those who reported using khat were more likely to report committing violent acts (OR=1.46, 95% CI 1.02-2.08) than were non-users. Students with moderate levels of anger expression (scores of 11- 14) were 3.40 times more likely to report committing acts of violence (OR=3.40; 95% CI 2.42-4.79) than were those with low levels of anger expression (scores v11). For students with high levels of anger expression (> or = 15 scores), the corresponding OR was 7.62 (95% CI 5.15-11.29). Participants who had experienced > or = 4 negative life events during the current academic year were more likely (OR=2.41; 95% CI 1.58-3.69) to report violent behaviour than were those with fewer stressful life events. CONCLUSIONS: Screening for violent behaviour and violence prevention programmes, particularly those in educational settings, should include strategies that address students' stressful life events, anger management, and substance use.     

Perceived job stress and mental health in precision machine workers of Japan: a 2 year cohort study

OBJECTIVES: To determine whether perceived job stress affects mental health in occupational settings. METHODS: A 2 year cohort study was conducted. Initially, a survey including the general health questionnaire (GHQ) and a questionnaire about perceived job stress was carried out. Of 462 workers who initially showed a GHQ score of < or = 7,310 were successfully followed up for 2 years. The 2 year risks of developing mental ill health (a GHQ score > or = 8) were assessed relative to perceived job stress. To control for potential confounding factors, multiple logistic regression analyses were conducted. RESULTS: The overall 2 year risk for developing mental ill health was high at 57.7%. Workers who reported aspects of perceived job stress showed a greater 2 year risk than those without stress. Multiple logistic regression analyses showed that some components of perceived job stress were associated with a higher 2 year risk, among which "not allowed to make mistakes" showed the largest adjusted odds ratio (OR) (95% confidence interval (95% CI) of 2.37 (1.32 to 4.29). "Poor relationship with superior" had a significant effect on mental health only in women, with an adjusted OR (95% CI) of 3.79 (1.65 to 8.73). CONCLUSIONS: Certain specific items of perceived job stress seem to be associated with mental ill health in workers. These could broadly be described as job strain, or job demand items. The type of job stress that predicts mental health may be dependent on the characteristics of the workplace investigated.     

Population beliefs about the efficacy of injections in Pakistan's Sindh province

OBJECTIVE: Reused syringes have been identified as a major risk factor for hepatitis B and C in Pakistan, a country facing a growing epidemic of these infections. We conducted this study to identify factors associated with receiving at least one injection during the past 3 months in an urban and a rural area in the Sindh province of Pakistan. METHODS: A population-based cross-sectional study of individuals aged 3 months was conducted in 34 clusters in an urban and a rural setting. Information was obtained on the number of contacts with healthcare providers and the number of injections received during the past 3 months. Beliefs about the efficacy of injections were also tested. Multivariable logistic regression analysis was performed to identify factors associated with receiving at least one injection during the past 3 months. RESULTS: Of 1150 subjects who participated in the study, 848 (74%) reported having received at least one injection during the past 3 months. Seventy-one percent (815/1150) believed that injections act faster than oral drugs and relieve symptoms quickly. There was a lack of risk perception among the participants: 19% (222/1150) believed that injections involve less risk than do oral drugs. Multivariable logistic regression analysis revealed that individuals who had visited unqualified practitioners (adjusted OR=6.1; 95% CI: 2.6-14.1) or general practitioners (adjusted OR=3.4; 95% CI: 1.9-6.0) were more likely to have received an injection. Belief that 'injections act faster and relieve symptoms quickly' had a multiplicative interaction with the area of dwelling: people in rural areas who held this belief were more likely to receive injections than people who did not hold this belief and were living in urban areas. CONCLUSIONS: In Pakistan, people's lack of awareness of risks associated with injections and their strong belief in the fast action of injections are driving injection overuse. These factors are supplemented by general practitioners' and unqualified providers' inclinations to prescribe more injections. Efforts must be made to include the unqualified practitioners in any interventions aimed to reduce injection overuse in Pakistan.     

Seroepidemiology of Trichomonas vaginalis in rural women in Zimbabwe and patterns of association with HIV infection

Serological assays using dried blood spots from 5221 women in rural areas of eastern Zimbabwe were used to assess the epidemiology of Trichomonas vaginalis infection, and its association with HIV. Antibodies to T. vaginalis and to HIV were detected by enzyme immunoassays. Behavioural and demographic data were collected by confidential questionnaires. In total, 516 (9.9%) women were seropositive for T. vaginalis and seroprevalence increased with age among younger women. Divorced, widowed and single women were more likely to be seropositive. After controlling for age, seropositivity was significantly associated with being sexually active, having multiple sex partners, having a partner who had multiple sex partners, and having a new sex partner in the past year. Seropositivity was associated with a recent history of genital discharge. Overall, 208 (40.3%) T. vaginalis-positive samples were also positive for HIV, compared with 1106 (23.5%) T. vaginalis-negative samples (age and sex adjusted OR 2.11, 95% CI 1.74-2.55, P < 0.001). There was increased risk for being HIV-positive amongst T. vaginalis-seropositive women regardless of residence, employment or education. In a logistic regression controlling for common risk factors, the association remained significant. T. vaginalis-seropositive young women with a history of genital discharge were much more likely to be HIV-positive than women who were T. vaginalis-seronegative and had no history of discharge (OR 6.08, 95 % CI 2.95-12.53). Although a causal relationship cannot be assumed, detection and treatment of trichomoniasis may be important in strategies to reduce HIV transmission through sexually transmitted infection control.