Subjective Well-being and Family Functioning among Adolescents Left Behind by Migrating Parents in Jiangxi Province, China / 生物医学与环境科学（英文）

We sought to identify the differences between adolescents left behind in their home villages/towns (LBA) and non-left behind adolescents (NLB) on subjective well-being and family functioning due to parental migration in south China. We used a stratified cluster sampling method to recruit middle school students in a city experiencing population-emigration in Jiangxi Province in 2010. Participants included adolescents from families with: (1) one migrant parent, (2) both parents who migrated, or (3) non-left behind adolescents (i.e., no migrant parent). To determine predictors of subjective well-being, we used structural equation models. Adolescents left behind by both parents (LBB) were less likely to express life satisfaction (P = 0.038) in terms of their environments (P = 0.011) compared with NLB. A parent or parents who migrated predicts lower subjective well-being of adolescents (P = 0.051) and also lower academic performance. Being apart from their parents may affect family functioning negatively from an adolescent's viewpoint. Given the hundreds of millions of persons in China, many who are parents, migrating for work, there may be mental health challenges in some of the adolescents left behind.

Pulmonary tuberculosis in Mumbai, India: factors responsible for patient and treatment delays

To determine the factors responsible for patient delay and treatment delay in newly diagnosed sputum smear-positive pulmonary tuberculosis [TB] patients. Study subjects [N = 150] were randomly selected from municipal health centers in Mumbai, India. Duration of symptoms, treatment, and reason for delay were assessed using interviews and medical records. We defined patient delay as presentation to a health care provider [HCP] >20 days of the onset of TB-related symptoms and treatment delay as therapy initiated more than 14 days after the first consultation [for TB-related symptoms] with an HCP. Of the 150 subjects, 29% had patient delays and 81% had treatment delays. In multivariable analysis, patient delay was significantly associated with the self-perception that initial symptoms were due to TB [odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.1-12.6] and perceived inability to pay for care [OR = 2.9, 95% CI = 1.2-7.1]. Treatment delay was significantly associated with consulting a non-allopathic provider [OR = 12.3, 95% CI = 1.4-105] and consulting >3 providers [OR = 5.0, 95% CI = 1.4-17.4]. Patient interval was half the treatment interval [median days: 15 vs. 31]. Women were slightly more likely to experience patient and treatment delays than men. For two-thirds of the patients, another TB patient was a source of TB-related knowledge, while health education material [16%] and television [10%] played a smaller role. Treatment delay, primarily due to diagnosis delay, was a greater problem than patient delay. Expanding public public and public-private partnerships and regular training sessions for HCPs might decrease treatment delay. Media coverage and cured TB patients as peer advocates may help to reinforce TB-related health education messages

Evidence-based strategies for preventing HIV transmission and the Thailand perspective

A wide range of HIV prevention strategies have been evaluated or are in late-stage clinical trials. These include male circumcision, microbicides, diagnosis and treatment of sexually transmitted diseases, barriers, pre-exposure and post-exposure sexual prophylaxis with antiretroviral drugs, and behavioral interventions. While condoms are widely available and highly effective if used consistently and correctly, they have not been the answer to the problem, with UNAIDS reporting that 2.7 million new HIV infections occur each year. Current behavioural prevention interventions have been associated with a decline in HIV prevalence in some settings but have yet to demonstrate a generalizable impact. Biomedical interventions, such as male circumcision, substitution therapy for injection drug users, management of sexually transmitted diseases, antiretroviral therapy, female barrier methods and topical microbicides offer promise, with many under investigation in clinical trials. However, no single biomedical or behavioral intervention is likely to be effective and the focus of research is switching to the investigation of combinations of strategies.This review examines proven biomedical methods of reducing HIV transmission, such as male circumcision, efforts which have failed (e.g. first generation microbicides) and strategies for the future, including pre-exposure prophylaxis and next generation microbicides. Behavioural interventions are the keys to any successful efforts to reduce HIV transmission. While such interventions may provide (short-term) changes in individual behavior, new strategies seek to effect behavioural change at a population level.