RESUMEN

BACKGROUND: Hendra virus is a paramyxovirus that causes periodic serious disease and fatalities in horses and humans in Australia first identified in 1994. Pteropid bats (commonly known as flying-foxes) are the natural host of the virus, and the putative route of infection in horses is by ingestion or inhalation of material contaminated by flying-fox urine or other bodily fluids. Humans become infected after close contact with infected horses. Horse owners in Australia are encouraged to vaccinate their horses against Hendra virus to reduce the risk of Hendra virus infection, and to prevent potential transmission to humans. After the vaccine was released in 2012, uptake by horse owners was slow, with some estimated 11-17% of horses in Australia vaccinated. This study was commissioned to examine barriers to vaccine uptake and potential drivers to future adoption of vaccination by horse owners. METHODS: This study examined qualitative comments from respondents to an on-line survey, reporting reasons for not vaccinating their horses. The study also investigated scenarios in which respondents felt they might consider vaccinating their horses. RESULTS: Self-reported barriers to uptake of the Hendra virus vaccine by horse owners (N = 150) included concerns about vaccine safety, cost, and effectiveness. Reduction in vaccination costs and perception of immediacy of Hendra virus risk were reported as being likely to change future behaviour. However, the data also indicated that horse owners generally would not reconsider vaccinating their horses if advised by their veterinarian. CONCLUSION: While changes to vaccine costs and the availability data supporting vaccine safety and efficacy may encourage more horse owners to vaccinate, this study highlights the importance of protecting the relationship between veterinarians and horse owners within the risk management strategies around Hendra virus. Interactions and trust between veterinarians and animal owners has important implications for management of and communication around Hendra virus and other zoonotic disease outbreaks.

Asunto(s)

RESUMEN

Hendra virus was identified in horses and humans in 1994, in Queensland, Australia. Flying foxes are the natural host. Horses are thought to acquire infection by direct or indirect contact with infected flying fox urine. Humans are infected from close contact with infected horses. To reduce risk of infection in horses and humans, Australian horse owners are encouraged to vaccinate horses against the virus and adopt property risk mitigation practices that focus on reducing flying fox horse contact and contamination of horses' environment with flying fox bodily fluids. This study investigates uptake of four Hendra virus risk mitigation practices in a sample of non- and partially vaccinating horse owners living close to previous Hendra virus cases. Protection motivation theory was used to develop a conceptual model to investigate risk perception and coping factors associated with uptake of risk mitigation practices. An online survey was administered via Facebook pages of veterinary clinics close to previous Hendra virus cases. Factors associated with uptake of risk mitigation practices were investigated using univariate and multivariate binary logistic regression. Belief that a risk mitigation practice would be effective in reducing Hendra virus risk was significantly associated with the uptake of that practice. Issues around the practicality of implementing risk mitigation practices were found to be the greatest barrier to uptake. Factors that relate to risk immediacy, such as nearby infection, were identified as more likely to trigger uptake of risk mitigation practices. The role of veterinarians in supporting Hendra risk mitigation was identified as more influential than that of respected others or friends. Findings from this study are being used to assist stakeholders in Australia responsible for promotion of risk mitigation practice in identifying additional pathways and reliable influencing factors that could be utilized for engaging and communicating with horse owners to promote Hendra virus risk mitigation behaviour.

Asunto(s)

RESUMEN

OBJECTIVES: To determine population attributable risks (PARs) estimates for factors associated with non-use of postnatal care (PNC) in Nigeria. DESIGN, SETTING AND PARTICIPANTS: The most recent Nigeria Demographic and Health Survey (NDHS, 2013) was examined. The study consisted of 20 467 mothers aged 15-49 years. Non-use of PNC services was examined against a set of demographic, health knowledge and social structure factors, using multilevel regression analysis. PARs estimates were obtained for each factor associated with non-use of PNC in the final multivariate logistic regression model. MAIN OUTCOME: PNC services. RESULTS: Non-use of PNC services was attributed to 68% (95% CI 56% to 76%) of mothers who delivered at home, 61% (95% CI 55% to 75%) of those who delivered with the help of non-health professionals and 37% (95% CI 31% to 45%) of those who lacked knowledge of delivery complications in the study population. Multiple variable analyses revealed that non-use of PNC services among mothers was significantly associated with rural residence, household poverty, no or low levels of mothers' formal education, small perceived size of neonate, poor knowledge of delivery-related complications, and limited or no access to the mass media. CONCLUSIONS: PAR estimates for factors associated with non-use of PNC in Nigeria highlight the need for community-based interventions regarding maternal education and services that focus on mothers who delivered their babies at home. Our study also recommends financial support from the Nigerian government for mothers from low socioeconomic settings, so as to minimise the inequitable access to pregnancy and delivery healthcare services with trained healthcare personnel.

Asunto(s)

RESUMEN

BACKGROUND: After a 1996 firearm massacre in Tasmania in which 35 people died, Australian governments united to remove semi-automatic and pump-action shotguns and rifles from civilian possession, as a key component of gun law reforms. OBJECTIVE: To determine whether Australia's 1996 major gun law reforms were associated with changes in rates of mass firearm homicides, total firearm deaths, firearm homicides and firearm suicides, and whether there were any apparent method substitution effects for total homicides and suicides. DESIGN: Observational study using official statistics. Negative binomial regression analysis of changes in firearm death rates and comparison of trends in pre-post gun law reform firearm-related mass killings. SETTING: Australia, 1979-2003. MAIN OUTCOME MEASURES: Changes in trends of total firearm death rates, mass fatal shooting incidents, rates of firearm homicide, suicide and unintentional firearm deaths, and of total homicides and suicides per 100 000 population. RESULTS: In the 18 years before the gun law reforms, there were 13 mass shootings in Australia, and none in the 10.5 years afterwards. Declines in firearm-related deaths before the law reforms accelerated after the reforms for total firearm deaths (p=0.04), firearm suicides (p=0.007) and firearm homicides (p=0.15), but not for the smallest category of unintentional firearm deaths, which increased. No evidence of substitution effect for suicides or homicides was observed. The rates per 100 000 of total firearm deaths, firearm homicides and firearm suicides all at least doubled their existing rates of decline after the revised gun laws. CONCLUSIONS: Australia's 1996 gun law reforms were followed by more than a decade free of fatal mass shootings, and accelerated declines in firearm deaths, particularly suicides. Total homicide rates followed the same pattern. Removing large numbers of rapid-firing firearms from civilians may be an effective way of reducing mass shootings, firearm homicides and firearm suicides.

RESUMEN

Globally, Nigeria had the fourth highest incidence of tuberculosis (TB) cases in 2009. Datasets of the 2008 Nigeria Demographic and Health Survey (NDHS) were used for examining factors associated with respondents' knowledge of and attitude towards TB in Nigeria. With the same age-group of males and females, the sample included 47,193 respondents aged 15-49 years. Factors associated with the knowledge of and attitude towards TB were examined against a set of individual-, household- and community-level variables, using multiple binary logistic regression analyses. Respondents who reported having ever heard of TB was 74.7%. Of those who ever heard of TB, 76.9% believed that TB can be cured, and 19.6% would want a family member's TB to be kept secret. Of those who ever heard of TB, 63.1% believed that TB was spread from person to person through the air by coughing or sneezing. Multivariate analysis indicated that the probability of having poor knowledge of and negative attitude towards TB was consistently significant among the poorest household (lowest wealth quintile), geopolitical regions (North Central), respondents with no schooling, non-working respondents, youngest age-group (15-19 years), and rural areas [adjusted odds ratios (AOR)=0.76, 95% CI 0.66-0.86 for respondents who had ever heard of TB; AOR=0.89, 95% CI 0.80-0.99 for respondents who had ever heard of TB and believed that TB can be cured; AOR=0.83, 95% CI 0.73-0.94 for those who had ever heard of TB and concealed the fact that a family member had TB; and AOR=0.88, 95% CI 0.78-0.99 for those who had ever heard of TB and believed TB was spread from person to person through the air by coughing or sneezing]. Efforts to improve the knowledge of and attitude towards TB in Nigeria should focus on the youngest age-group (15-19 years), the poorest households, and respondents with no schooling. Improving the knowledge and attitude of these groups of individuals may result in an increase in the number of people who will seek early treatment.

Asunto(s)

RESUMEN

This short report summarises data on the prevalence of high psychological distress in horse industry participants during the 2007 Australian equine influenza (EI) outbreak and the statistical analysis undertaken to identify the factors associated with this high psychological distress. In addition, follow-up data collected 1 year later are reported briefly.

Asunto(s)

RESUMEN

The aim of this study was to determine the prevalence and investigate the aetiology of hypogonadism in men on methadone or buprenorphine maintenance treatment (MMT, BMT). 103 men (mean age 37.6 +/- 7.9) on MMT (n = 84) or BMT (n = 19) were evaluated using hormone assays, body mass index (BMI), serological, biochemical, demographic and substance use measures. Overall 54% of men (methadone 65%; buprenorphine 28%) had total testosterone (TT) <12.0 nm; 34% (methadone 39%; buprenorphine 11%) had TT <8.0 nm. Both methadone- and buprenorphine-treated men had lower free testosterone, luteinising hormone and estradiol than age-matched reference groups. Methadone-treated men had lower TT than buprenorphine-treated men and reference groups. Prolactin did not differ between methadone, buprenorphine groups, and reference groups. Primary testicular failure was an uncommon cause of hypogonadism. Yearly percentage fall in TT by age across the patient group was 2.3%, more than twice that expected normally. There were no associations between TT and opioid dose, cannabis, alcohol and tobacco consumption, or chronic hepatitis C viraemia. On multiple regression higher TT was associated with higher alanine aminotransferase and lower TT with higher BMI. Men on MMT have high prevalence of hypogonadotrophic hypogonadism. The extent of hormonal changes associated with buprenorphine needs to be explored further in larger studies. Men receiving long term opioid replacement treatment, especially methadone treatment, should be screened for hypogonadism. Wide interindividual differences in methadone metabolism and tolerance may in a cross-sectional study obscure a methadone dose relationship to testosterone in individuals. Future studies of hypogonadism in opioid-treated men should examine the potential benefits of dose reduction, choice of opioid medication, weight loss, and androgen replacement.

Asunto(s)

RESUMEN

The study was conducted to assess the prevalence of and factors associated with haemoglobin (Hb) concentrations among children aged 6-59 months in Timor-Leste. The 2003 Demographic and Health Survey was a multi-stage cluster survey of 4,320 households from four different geographic regions in Timor-Leste. In total, 4,514 children aged 6-59 months were included in the analysis. The prevalence of anaemia (Hb concentration <11.0g/dL) was 38.2% (638/1,668) for children aged 6-23 months and 22.6% (644/2,846) for older children (p<0.001). Girls had a higher mean Hb concentration than boys (11.9g/dL vs 11.7g/ dL, p<0.006) and children who had diarrhoea in the previous two weeks had a lower Hb concentration than children without diarrhoea (11.5g/dL vs 11.9g/dL, p<0.001). Children from the richest and middle-class households had a lower average Hb concentration than those from the poorest households (11.8g/ dL, 11.7g/dL vs 12.0g/dL, p<0.001). Children of mothers with some secondary or more education had a lower mean Hb concentration than children of mothers with completed primary, some primary and no education (11.7 g/dL vs 11.9 g/dL, 11.8 g/dL, and 11.9 g/dL, p=0.002). Children from severely-anaemic mothers had a lower mean Hb concentration than children from moderately-, mild and not anaemic mothers (10.5 g/dL vs 11.1 g/dL, 11.6 g/dL, 12.0 g/dL, p<0.001). After backward stepwise hierarchical multiple regression, wasting, male sex, recent diarrhoea, household wealth index (richest and middle-class), maternal educational status (some secondary or more and some primary), and maternal anaemic status were significantly associated with a lower Hb concentration in children and increased age of child and duration of breastfeeding (6 months) with a higher Hb concentration. Anaemia-prevention programmes among children in Timor-Leste should focus on those children aged less than two years, children with recent diarrhoea, wasted children, high socioeconomic status, and anaemic mothers.

Asunto(s)

RESUMEN

OBJECTIVE: To describe breastfeeding practices and to assess the sociodemographic factors associated with selected breastfeeding indicators. DESIGN AND SETTING: The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households from four different geographic areas in Timor-Leste. SUBJECTS: A total of 2162 children aged 0-23 months. RESULTS: A high proportion (97.6%) of infants had been ever breastfed, but only 46.1% had initiated breastfeeding within the first hour of birth. Seventy-eight percent of children <24 months were currently breastfed, 30.7% of infants <6 months were exclusively breastfed and 12.5% of infants <12 months were bottle-fed. A high proportion of infants of 6-9 months (82.0%) were receiving complementary food in addition to breast milk. Multivariate analysis revealed that exclusive breastfeeding was significantly lower in the rural west region (odds ratio (OR)=3.15) compared to the urban region, and among those from richest households (OR=1.90) compared to poorest. Mothers with primary education were significantly more likely to exclusively breastfeed than mothers with no education (OR=0.62). Increasing age of the infant was associated with significantly less current (OR=1.23) and exclusive (OR=1.35) breastfeeding. Continuation of breastfeeding at the end of the first year was significantly lower in non-working mothers (OR=1.58) compared to working mothers, and among infants born in health-care facilities (OR=2.16) than those born at home. CONCLUSIONS: Breastfeeding practices in Timor-Leste were satisfactory, except the exclusive breastfeeding at 6 months. However, more socioeconomically privileged groups demonstrated a poorer breastfeeding performance than disadvantaged groups. Further breastfeeding promotion programmes are needed across all population groups, and should include health-care providers and maternity institutions.

Asunto(s)

RESUMEN

BACKGROUND: After a 1996 firearm massacre in Tasmania in which 35 people died, Australian governments united to remove semi-automatic and pump-action shotguns and rifles from civilian possession, as a key component of gun law reforms. OBJECTIVE: To determine whether Australia's 1996 major gun law reforms were associated with changes in rates of mass firearm homicides, total firearm deaths, firearm homicides and firearm suicides, and whether there were any apparent method substitution effects for total homicides and suicides. DESIGN: Observational study using official statistics. Negative binomial regression analysis of changes in firearm death rates and comparison of trends in pre-post gun law reform firearm-related mass killings. SETTING: Australia, 1979-2003. MAIN OUTCOME MEASURES: Changes in trends of total firearm death rates, mass fatal shooting incidents, rates of firearm homicide, suicide and unintentional firearm deaths, and of total homicides and suicides per 100,000 population. RESULTS: In the 18 years before the gun law reforms, there were 13 mass shootings in Australia, and none in the 10.5 years afterwards. Declines in firearm-related deaths before the law reforms accelerated after the reforms for total firearm deaths (p = 0.04), firearm suicides (p = 0.007) and firearm homicides (p = 0.15), but not for the smallest category of unintentional firearm deaths, which increased. No evidence of substitution effect for suicides or homicides was observed. The rates per 100,000 of total firearm deaths, firearm homicides and firearm suicides all at least doubled their existing rates of decline after the revised gun laws. CONCLUSIONS: Australia's 1996 gun law reforms were followed by more than a decade free of fatal mass shootings, and accelerated declines in firearm deaths, particularly suicides. Total homicide rates followed the same pattern. Removing large numbers of rapid-firing firearms from civilians may be an effective way of reducing mass shootings, firearm homicides and firearm suicides.

Asunto(s)