A Survey on Knowledge, Prevention, and Occurrence of Sexually Transmitted Infections among Freshmen from Four Italian Universities

Background. The peak of sexually transmitted infections (STI) among adolescents/young adults suggests a low level of prevention. In order to assess whether the level of sexual health education (SHE), received by several channels, was effective at improving sexual behaviors, we conducted a survey among freshmen from four Italian universities. Methods. This observational cross-sectional study was conducted with an anonymous self-reported paper questionnaire, administered during teaching lectures to university freshmen of the northern (Padua, Bergamo, and Milan campuses) and southern (Palermo campus) parts of the country. Knowledge of STI (a linear numerical score), knowledge of STI prevention (dichotomous variable: yes vs. no) and previous STI occurrence (polytomous variable: “no”; “don’t know”; “yes”) were the outcomes in the statistical analysis. Results. The final number of freshmen surveyed was 4552 (97.9% response rate). The mean age of respondents was 21.4 ± 2.2 years and most of them (70.3%) were females. A total of 60% of students were in a stable romantic relationship. Only 28% respondents knew the most effective methods to prevent STI (i.e., condom and sexual abstinence), with a slightly higher prevalence of correct answers among females (31.3%) than males (25.8%). Students with history of STIs were 5.1%; they reported referring mostly to their general practitioner (GP) (38.1%) rather than discussing the problem with their partner (13.1%). At multivariable analysis, a significantly higher level of STI knowledge was observed in older students (25+ years of age), biomedical students, and those from a non-nuclear family; lower levels were found among students of the University of Palermo, and those who completed a vocational secondary school education. Those who had less knowledge about the most effective tools to prevent STIs included males, students from the University of Palermo, students registered with educational sciences, economics/political sciences, those of foreign nationality, and those whose fathers had lower educational levels. The risk of contracting STI was significantly lower only in students not in a stable relationship (relative risk ratio, RRR = 0.67; 95% confidence interval, 95%CI = 0.48; 0.94), whereas such risk was significantly higher in students with higher STI knowledge (RRR = 1.15; 95%CI = 1.08; 1.22). Discussion and Conclusions. University freshmen investigated in this study had poor knowledge of STIs and their prevention. Unexpectedly, those with higher levels of knowledge had an increased risk of STIs. There were no educational interventions—with good quality and long-term follow-ups—that increased the confidence that such SHE programs could have population level effects. A new high-quality study is therefore required to assess the effectiveness of an intervention generating behavioral changes; increasing only knowledge may not be sufficient.

Paleoepidemiological Considerations of Mobility and Population Interaction in the Spread of Infectious Diseases in the Prehistoric Past

The processes of human mobility have been well demonstrated to influence the spread of infectious disease globally in the present and the past. However, to date, paleoepidemiological research has focused more on factors of residential mobility and population density as drivers for epidemiological shifts in prehistoric infectious disease patterns. A strong body of epidemiological literature exists for the dynamics of infectious disease spread through networks of mobility and interaction. We review the epidemiological theory of infectious disease spread and propose frameworks for application of this theory to bioarchaeology. We outline problems with current definitions of prehistoric mobility and propose a framework shift with focus on population interactions as nodes for disease transmission. To conceptualize this new framework, we produced a theoretical model that considers the interplay between climate suitability, population density, residential mobility, and human interaction levels to influence infectious disease patterns in prehistoric assemblages. We then tested observable effects of this model in paleoepidemiological data from Asia (n = 343). Relative risk ratio analysis and correlations were used to test the impact of population interaction, residential mobility, population density, climate, and subsistence on the prevalence and diversity of infectious diseases. Our statistical results showed higher levels of population interaction led to significantly higher prevalence of infectious disease in sedentary populations and a significant increase in pathogen diversity in mobile populations. We recommend that population interaction be included as an important component of infectious disease analysis of prehistoric population health alongside other biosocial factors, such as sedentism and population density. Daar is goed gedemonstreer dat die prosesse van menslike mobiliteit die verspreiding van aansteeklike siektes wêreldwyd in die hede en in die verlede beïnvloed. Maar tot op hede het paleo-epidemiologiese navorsing egter meer gefokus op faktore van residensiële mobiliteit en bevolkingsdigtheid as dryfvere vir epidemiologiese verskuiwings in die prehistoriese infeksiesiektepatrone. Sterk epidemiologiese literatuur bestaan vir die dinamika van aansteeklike siektes wat versprei word deur netwerke van mobiliteit en interaksie. Ons ondersoek die epidemiologiese teorie van die verspreiding van aansteeklike siektes en stel raamwerke voor vir die toepassing van hierdie teorie op die bioargeologie. Ons skets probleme met huidige definisies van prehistoriese mobiliteit en stel ‘n raamwerk verskuiwing voor met die fokus op bevolkings-interaksies as nodusse vir oordrag van siektes. Om hierdie nuwe raamwerk te konseptualiseer, het ons ‘n teoretiese model vervaardig wat die wisselwerking tussen klimaatsgeskiktheid, bevolkingsdigtheid, residensiële mobiliteit en menslike interaksievlakke oorweeg om die infeksiesiektepatrone in prehistoriese samestellings te beïnvloed. Daarna het ons die waarneembare effekte van hierdie model getoets in paleo-epidemiologiese data uit Asië (n = 343). Relatiewe risiko-verhoudingsanalise en korrelasies is gebruik om die impak van bevolkings-interaksie, residensiële mobiliteit, bevolkingsdigtheid, klimaat en bestaan op die voorkoms en diversiteit van aansteeklike siektes te toets. Ons statistiese resultate het gedemonstreer dat hoër vlakke van bevolkings-interaksie gelei het tot aansienlik hoër voorkoms van aansteeklike siektes in sittende bevolkings en ‘n beduidende toename in patogeen diversiteit in mobiele bevolkings. Ons beveel aan dat bevolkings-interaksie ingesluit word as ‘n belangrike komponent van die aantstekingsiekte-ontleding van die prehistoriese bevolkingsgesondheid, tesame met ander biososiale faktore soos sedentisme en bevolkingsdigtheid.

17-Alpha-Hydroxyprogesterone vs. Placebo for Preventing of Recurrent Preterm Birth: A Systematic Review and Meta-Analysis of Randomized Trials

Background: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality.Objective: To estimate the effect of 17-alpha-hydroxyprogesterone caproate (17-OHPC) compared to placebo in singleton gestations for reducing the risk of recurrent PTB and neonatal morbidity and mortality.Work Design: Systematic review and meta-analysis.Search Strategy: Searching MEDLINE, Embase, Web of Science, SCOPUS, Cochrane Library, and clinical trial registries.Selection Criteria: Randomized controlled trials of singleton gestations with a history of PTB and treated with a weekly intramuscular injection of 17-OHPC or placebo.Data Collection and Analysis: A random meta-analysis model was performed for the PTB outcomes (<32, <35, and <37 weeks) and neonatal outcomes (neonatal death, grade 3 or 4 intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis). Effect estimates were measured by relative risk ratio (RR) with a 95% confidence interval (CI).Main Results: Six works were included. There were no statistically significant reductions in the PTB risk following the use of 17-OHPC at <32 weeks (RR = 0.61, 95% CI: 0.13–2.77, and I2 = 39%), <35weeks (RR = 0.60, 95% CI: 0.10–3.67, and I2 = 51%), and <37 weeks (RR = 0.68, 95% CI: 0.46–1, and I2 = 75%). Furthermore, all the neonatal outcomes were statistically similar between the two groups.Conclusion: Treatment with 17-OHPC is not associated with reducing the risk of PTB or neonatal outcomes compared to placebo.

Predictors of patients’ choice of hospitals under universal health coverage: a case study of the Nicaraguan capital

Background This study looks at the factors that can shape patients’ choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient’s health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shaping patients’ choice of hospitals. Methods This study was carried out in Managua, the capital of Nicaragua. Utilizing an exit-survey, patients were interviewed across five public hospitals in 2017 and then six in 2019 when a new highly-equipped hospital was added to the system. We used a multinomial logit model to investigate patients’ preference of a specific hospital over the rest within each wave. Results Our results show that being referred to a hospital is the strongest predictor and in some cases, it can increase the relative risk ratio of choosing a facility by a factor of 49 (p < 0.01; 95% CI: 27.39–87.17). For the remaining factors, the hierarchy of importance was less clear-cut yet all these factors remained significantly important at various levels. Conclusions Overall, our results highlight the importance of referral systems in making quality healthcare more equitable. Moreover, with distance also being a key predictor and in the absence of an organized referral system, those with low-income would either be further deprived by having to settle with locally available healthcare (regardless of its quality) or face high amounts of out-of-pocket expenditure when seeking help from the private sector.

Paleoepidemiological Considerations of Mobility and Population Interaction in the Spread of Infectious Diseases in the Prehistoric Past

The processes of human mobility have been well demonstrated to influence the spread of infectious disease globally in the present and the past. However, to date, paleoepidemiological research has focused more on factors of residential mobility and population density as drivers for epidemiological shifts in prehistoric infectious disease patterns. A strong body of epidemiological literature exists for the dynamics of infectious disease spread through networks of mobility and interaction. We review the epidemiological theory of infectious disease spread and propose frameworks for application of this theory to bioarchaeology. We outline problems with current definitions of prehistoric mobility and propose a framework shift with focus on population interactions as nodes for disease transmission. To conceptualize this new framework, we produced a theoretical model that considers the interplay between climate suitability, population density, residential mobility, and human interaction levels to influence infectious disease patterns in prehistoric assemblages. We then tested observable effects of this model in paleoepidemiological data from Asia (n = 343). Relative risk ratio analysis and correlations were used to test the impact of population interaction, residential mobility, population density, climate, and subsistence on the prevalence and diversity of infectious diseases. Our statistical results showed higher levels of population interaction led to significantly higher prevalence of infectious disease in sedentary populations and a significant increase in pathogen diversity in mobile populations. We recommend that population interaction be included as an important component of infectious disease analysis of prehistoric population health alongside other biosocial factors, such as sedentism and population density. Daar is goed gedemonstreer dat die prosesse van menslike mobiliteit die verspreiding van aansteeklike siektes wêreldwyd in die hede en in die verlede beïnvloed. Maar tot op hede het paleo-epidemiologiese navorsing egter meer gefokus op faktore van residensiële mobiliteit en bevolkingsdigtheid as dryfvere vir epidemiologiese verskuiwings in die prehistoriese infeksiesiektepatrone. Sterk epidemiologiese literatuur bestaan vir die dinamika van aansteeklike siektes wat versprei word deur netwerke van mobiliteit en interaksie. Ons ondersoek die epidemiologiese teorie van die verspreiding van aansteeklike siektes en stel raamwerke voor vir die toepassing van hierdie teorie op die bio-argeologie. Ons skets probleme met huidige definisies van prehistoriese mobiliteit en stel ‘n raamwerk verskuiwing voor met die fokus op bevolkings-interaksies as nodusse vir oordrag van siektes. Om hierdie nuwe raamwerk te konseptualiseer, het ons ‘n teoretiese model vervaardig wat die wisselwerking tussen klimaatsgeskiktheid, bevolkingsdigtheid, residensiële mobiliteit en menslike interaksievlakke oorweeg om die infeksiesiektepatrone in prehistoriese samestellings te beïnvloed. Daarna het ons die waarneembare effekte van hierdie model getoets in paleo-epidemiologiese data uit Asië (n = 343). Relatiewe risiko-verhoudingsanalise en korrelasies is gebruik om die impak van bevolkings-interaksie, residensiële mobiliteit, bevolkingsdigtheid, klimaat en bestaan op die voorkoms en diversiteit van aansteeklike siektes te toets. Ons statistiese resultate het gedemonstreer dat hoër vlakke van bevolkings-interaksie gelei het tot aansienlik hoër voorkoms van aansteeklike siektes in sittende bevolkings en ‘n beduidende toename in patogeen diversiteit in mobiele bevolkings. Ons beveel aan dat bevolkings-interaksie ingesluit word as ‘n belangrike komponent van die aantstekingsiekte-ontleding van die prehistoriese bevolkingsgesondheid, tesame met ander biososiale faktore soos sedentisme en bevolkingsdigtheid.

Adult retrospective report of child abuse and prospective indicators of childhood harm: a population birth cohort study

Background We aim to determine whether adult retrospective report of child abuse is associated with greater risk of prospectively assessed harmful environments in childhood. We assessed possible recall basis by adult depression status. Methods At 45 years, participants of the 1958 British birth cohort (N = 9308) reported a range of abuse types (by 16 years). Prospective data, ages 7–16 years, were obtained for impoverished upbringing, hazardous conditions, anti-social behaviours and 16 years poor parent-child relationships. We estimated associations between retrospective report of child abuse and prospectively measured harm using (i) odds ratios (ORs, 95% confidence intervals) and (ii) positive predictive values (PPVs). PPVs were calculated stratified by adult depression status. Results Prevalence of retrospectively reported abuse ranged from 10.7% (psychological) to 1.60% (sexual) and 14.8% reported ≥ 1 type; prospectively recorded harm ranged from 10% (hazardous conditions/poor parent-child relationships) to 20% (anti-social behaviours). Adults retrospectively reporting abuse were more likely to have had harmful childhood environments: 52.4% had ≥ 1 indicator of harm (vs. 35.6% among others); ORsex-adjusted for poor relationships with parents was 2.98 (2.50, 3.54). For retrospectively reported (vs. none) abuse, there was a trend of increasing relative risk ratio with number of harms, from 1.75 (1.50, 2.03) for 1 to 4.68 (3.39, 6.45) for 3/4 childhood harms. The PPV of ≥ 1 prospectively recorded harm did not differ between depressed (0.58 (0.52, 0.64)) and non-depressed (0.58 (0.55, 0.61)) groups. Conclusions In a population cohort, adult retrospective report of child abuse was associated with several harms, prospectively measured from childhood to adolescence, providing support for the validity of retrospective report-based research. Findings suggest retrospectively reported child abuse is not biased by depression in adulthood.

Does Perceived Stress of University Students Affected by Preferences for Movie Genres? an Exploratory Cross-Sectional Study in China

This study aims to explore whether different preferences for movie genres were related to different perceived stress of college students. An online questionnaire was designed and it was filled out by 1,549 students voluntarily. The 10-item perceived stress scale (PSS-10) and multinomial logistic regression were used to access the perceived stress and the association between the movie preference genres. Over 90% of participants had mild to serious levels of stress. Differences were found between participants with different stress perception states in terms of smoking history, active exercise, and sleep duration (p &lt; 0.05). The participants who showed a preference for suspense movies more probably had lower stress [relative risk ratio (RRR)1 = 0.34, RRR2 = 0.26, p &lt; 0.05], while students who showed preferences for crime film and disaster film more probably had higher stress (RRR = 2.03, p &lt; 0.05, RRR = 3.15, p &lt; 0.05). And the significant gender gap in different film genre preferences was observed in this study (p &lt; 0.05). The males who showed preference for horror movies were more probably to have moderate stress (OR = 3.68, p &lt; 0.05), and females who showed a preference for disaster movies were more probably to have high stress (OR = 3.27, p &lt; 0.05). The perceived stress of Chinese university students is high after 1.5 years of coronavirus disease (COVID-19) pandemic. The personal preferences for certain film genres were significantly associated with perceived stress. As different film genre preferences, such as the preference for disaster, crime, and horror, are associated with high perceived stress, it may turn out to be useful to pay more attention to an individual’s film viewing. The teachers need to be concerned with the media usage history and preferences of their students and may advise students with high-level stress to avoid potentially harmful media content.

Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the REGARDS Study

Social vulnerabilities increase the risk of developing hypertension and lower life expectancy, but the effect of an individual’s overall vulnerability burden is unknown. Our objective was to determine the association of social vulnerability count and the risk of developing hypertension or dying over 10 years and whether these associations vary by race. We used the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and included participants without baseline hypertension. The primary exposure was the count of social vulnerabilities defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. Among 5425 participants of mean age 64±10 SD years of which 24% were Black participants, 1468 (31%) had 1 vulnerability and 717 (15%) had ≥2 vulnerabilities. Compared with participants without vulnerabilities, the adjusted relative risk ratio for developing hypertension was 1.16 (95% CI, 0.99–1.36) and 1.49 (95% CI, 1.20–1.85) for individuals with 1 and ≥2 vulnerabilities, respectively. The adjusted relative risk ratio for death was 1.55 (95% CI, 1.24–1.93) and 2.30 (95% CI, 1.75–3.04) for individuals with 1 and ≥2 vulnerabilities, respectively. A greater proportion of Black participants developed hypertension and died than did White participants (hypertension, 38% versus 31%; death, 25% versus 20%). The vulnerability count association was strongest in White participants ( P value for vulnerability count×race interaction: hypertension=0.046, death=0.015). Overall, a greater number of socially determined vulnerabilities was associated with progressively higher risk of developing hypertension, and an even higher risk of dying over 10 years.

Impact of functional capacity on change in self-rated health among older adults in a nine-year longitudinal study

The aims of the present study were to estimate the frequency of change in self-rated health (SRH) among community-dwelling older adults, between two measures taken at a 9-year interval; and determine factors associated with a decline and an improvement in SRH, in relation to aspects of physical/emotional health and subjective wellbeing. Data were derived from a community-based study on frailty among Brazilian elderly. Associations were investigated using Pearson’s chi-square test and relative risk ratios were estimated using multinomial logistic regression analysis. 39.3% of participants did not change their SRH at both assessment times, 21.7% rated it as worse and 39.0% rated it as better. The relative risk ratio of an improvement in SRH for individuals with disability in basic activities of daily living (ADLs) was lower than for individuals with independence in basic ADLs (IRR=0.22; IC95%: 0.08-0.63). Understanding the complex interactions between self-rated health and the dimensions that influence the improvement of health perception may shed light on key determinants of the wellbeing among older adults.

Associations between maternal characteristics and pharmaceutical treatment of gestational diabetes: an analysis of the UK Born in Bradford (BiB) cohort study

ObjectivesTo identify the maternal characteristics associated with pharmaceutical treatment of gestational diabetes mellitus (GDM).DesignProspective birth cohort study.SettingBradford, UK.Participants762 women from the Born in Bradford (BiB) cohort who were treated for GDM in a singleton pregnancy. BiB cohort participants were recruited from 2007 to 2010. All women booked for delivery were screened for GDM between 26 and 28 weeks of gestation using a 75 g 2-hour oral glucose tolerance test (OGTT).Outcome measureGDM treatment type: lifestyle changes advice (lifestyle changes), lifestyle changes advice with supplementary insulin (insulin) and lifestyle changes advice with supplementary metformin (metformin).Results244 (32%) women were prescribed lifestyle changes advice alone while 518 (68%) were offered supplemental pharmaceutical treatment. The odds of receiving pharmaceutical treatment relative to lifestyle changes advice alone were increased for mothers who were obese (OR 4.6, 95% CI 2.8 to 7.5), those who smoked (OR 2.6, 95% CI 1.2 to 5.5) and had higher fasting glucose levels at OGTT (OR 2.1, 95% CI 1.6 to 2.7). The odds of being prescribed pharmaceutical treatment rather than lifestyle changes advice were lower for Pakistani women (OR 0.7, 95% CI 0.4 to 1.0)) than White British women. Relative to insulin treatment, metformin was more likely to be offered to obese women than normal weight women (relative risk ratio, RRR 3.2, 95% CI 1.3 to 7.8) and less likely to be prescribed to women with higher fasting glucose concentrations at OGTT (RRR 0.3, 95% CI 0.2 to 0.6).ConclusionsIn the BiB cohort, GDM pharmaceutical treatment tended to be prescribed to women who were obese, White British, who smoked and had more severe hyperglycaemia. The characteristics of metformin-treated mothers differed from those of insulin-treated mothers as they were more likely to be obese but had lower glucose concentrations at diagnosis.