Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia.

OBJECTIVE: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians. METHODS: This cross-sectional study was conducted July-August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. They responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk. RESULTS: In the year immediately preceding the study, 29.0% of participants had suffered a fall. Approximately one-third of women (31.1%) and one-fifth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. The overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratified analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting. CONCLUSION: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identified for the population overall and for specific populations in the home care and community setting that could help in designing fall-prevention strategies.

Associations between intimate partner violence, depression, and suicidal behavior among women attending antenatal and general outpatients hospital services in Thailand.

BACKGROUND: Battered women are exposed to multiple types and different severity of intimate partner abuse, however, little is known about the relationship between severity and different types of intimate partner violence (IPV) (physical, sexual, psychological, and danger) and symptoms of depression and suicidal behavior in a sample of women attending antenatal care or general outpatient hospital services in Thailand. MATERIALS AND METHODS: A cross-sectional study was conducted among adult women who were consecutively sampled and screened for IPV in antenatal care and general outpatient clinics in nine randomly selected hospitals in two provinces in the central region. The measures included the "Severity of Violence Against Women Scale," "Edinburgh Postnatal Depression Scale 10," "Danger Assessment Scale," and one item for suicidal behavior. Hierarchical regressions were used to assess the effects of the different types of IPV on depression and suicidal behavior. RESULTS: Of the final sample (N = 207) that screened positive for IPV, 49.3% scored positive for depression, and 17.6% reported suicidal threats or attempts in the past 12 months. One type of IPV (sexual) was significantly associated with depression, whereas psychological abuse and femicide risk or danger was correlated with suicidal behavior. CONCLUSION: A high proportion of women with IPV suffered from depression and suicidal behavior. The study provides evidence of an association between the severity of IPV and mental health problems (depression and suicidal behavior). In assessing IPV, the different identified dimensions contributing to poor mental health should be incorporated.

"Safe Foods" or "Fear Foods": the implications of food avoidance in college students from low- and middle-income countries.

PURPOSE: The primary objective of this study was to explore if self-reported food avoidance (fats, carbohydrates and protein) exists among college students in low- and middle-income countries (LMICs) and its relationship with body mass index (BMI), dieting, mood/anxiety symptoms, physical activities and general health knowledge. METHODS: This study is a subset (N = 6096) of a larger 26 LMICs cross-sectional survey, which consisted of 21,007 college students. We ascertained socio-demographic information, food avoidance, physical activities, dieting behaviours, depressive and PTSD symptoms, and recorded anthropometric measurements. Chi-square analyses assessed the relationship between predictor variables and food categories eliminated from participants' diet. Multiple logistic regression assessed if food avoidance predicts outcome variables such as binge drinking, high physical activity, being underweight, exhibiting significant depressive and PTSD symptoms. RESULTS: Food avoidance exists in as many as one-third of college students in low- and middle-income countries, with this being more likely in persons who are trying to lose weight whether by dieting or otherwise. Food avoidance was associated with higher BMI, depressive symptoms, and high intensity exercises, as well as the level of health knowledge influencing the types of food avoided. A significant difference was noted between lower middle-income and upper middle-income countries with respect to the foods they avoided. CONCLUSION: Despite being knowledgeable about health-related behaviours, we found that college students in our sample were not that different from those in developed countries and may be influenced by a similar advice given by non-experts about macronutrients. These results hold implications for intervention programmes and policy makers. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional survey.

Early Sexual Debut and Associated Factors among In-school Adolescents in Six Caribbean Countries.

OBJECTIVE: This report examines early sexual debut (< age 15 years) among 15-year old in-school adolescents in six Caribbean countries. SUBJECTS AND METHODS: The total sample included 9948 school children aged primarily 13-16 years from nationally representative samples from six Caribbean countries. Univariate and multivariate analyses were conducted to assess the relationship between early sexual debut and substance use, unintentional injuries and violence, mental distress, physical activity, protective factors and socio-economic status variables. RESULTS: Approximately one-fourth of the sample (26.9%) had experienced sexual debut before age 15 years, 37.2% among boys and 16.9% among girls. In multivariate logistic regression analysis, it was found that male gender, substance use (smoking and alcohol use), having been in a physical fight in the past 12 months, sedentary behaviour, truancy and lack of parental or guardian attachment were associated with early sexual debut. CONCLUSION: This study found a high prevalence of early sexual debut. The risk factors identified were consistent with the Problem Behaviour Theory, which can be incorporated into broader sexual health promotion programmes.

Mental health and HIV sexual risk behaviour among University of Limpopo students

Background. Little attention has been paid to the role of poor mental health among young people with regard to HIV risk behaviour and HIV prevention in Africa. Objective. To determine the association between mental health; substance use and HIV sexual risk behaviour among a sample of university students in South Africa. Methods. A cross-sectional survey was conducted among undergraduate students who were recruited conveniently from public campus venues at the University of Limpopo Medical University of Southern Africa (Medunsa) campus. The sample included 722 university students (57.6 men and 42.4women) with a mean age of 21.7 years (standard deviation _}8.8). Results. Of the 722 students; 39.5 reported depression; 23.4 screened positive for post-traumatic stress disorder (PTSD); 22 reported hazardous or harmful alcohol use; 33 reported .2 sexual partners in the past 12 months; 50 reported inconsistent condom use; 46 reported unknown HIV status of a sexual partner and 20 reported alcohol use in the context of sex in the past 3 months. In multivariate analysis; HIV risk behaviour was associated with; among men; hazardous or harmful alcohol use and having screened positive for PTSD; and among women; being in the 4th or more year of study and current cannabis use. Conclusion. Poor mental health; including substance use; was found to be associated with HIV risk behaviour. Co-ordinated mental health and sexual and reproductive health services that meet the needs of university students would be desirable

Alcohol use and associated factors among adolescent students in Thailand / El uso de alcohol y factores asociados entre los estudiantes adolescentes de Tailandia

OBJECTIVE: Alcohol misuse is a relevant public health issue in Thailand. The assessment of the prevalence of alcohol use among adolescents may guide policies and programmes aimed at reducing alcohol use among this age group. METHOD: Using data from the Thailand Global School-based Student Health Survey (GSHS) 2008, we assessed the prevalence of alcohol use and the associated factors among adolescents (n = 2758). RESULTS: Overall, the prevalence of current alcohol use was 14.8% (21.2% males and 9.3% females). Variables positively associated with the outcome in multivariable analysis among boys were older age, other substance use (smoking and illicit drug use), sex in the past 12 months, physical fighting, injury in the past 12 months; and among girls, poverty, smoking, physical fighting and lack of parental or guardian connectedness. CONCLUSION: Efforts to prevent and control alcohol misuse may need to address a cluster of risk behaviours including cigarette smoking.

OBJETIVO: El abuso del alcohol es un problema de salud pública importante en Tailandia. La valoración de la prevalencia del uso de alcohol entre los adolescentes puede guiar las políticas y programas encaminados a reducir el uso del alcohol entre este grupo etario. MÉTODO: Usando datos de la Encuesta Mundial de Salud Escolar (GSHS) 2008, efectuada en Tailandia, se evaluó la prevalencia del uso del alcohol y los factores asociados, entre los adolescentes (n = 2758). RESULTADOS: En general, la prevalencia del uso del alcohol corrientemente fue 14.8% (21.2% varones y 9.3% hembras). Las variables positivamente asociadas con el resultado del análisis multivariable entre los muchachos fueron: tener más edad, uso de otra sustancia (hábito de fumar y uso ilícito de droga), sexo en los últimos 12 meses, pelea física, lesión en los últimos 12 meses. Entre las muchachas estas variables fueron: la pobreza, el hábito de fumar, la pelea física, y la falta de relación con los padres o los tutores. CONCLUSIÓN: Los esfuerzos por prevenir y controlar el abuso del alcohol entre los adolescentes pueden llevar a la necesidad de abordar una serie de comportamientos de riesgo, incluyendo el hábito de fumar.

Alcohol use and associated factors among adolescent students in Thailand.

OBJECTIVE: Alcohol misuse is a relevant public health issue in Thailand. The assessment of the prevalence of alcohol use among adolescents may guide policies and programmes aimed at reducing alcohol use among this age group. METHOD: Using data from the Thailand Global School-based Student Health Survey (GSHS) 2008, we assessed the prevalence of alcohol use and the associated factors among adolescents (n = 2758). RESULTS: Overall, the prevalence of current alcohol use was 14.8% (21.2% males and 9.3% females). Variables positively associated with the outcome in multivariable analysis among boys were older age, other substance use (smoking and illicit drug use), sex in the past 12 months, physical fighting, injury in the past 12 months; and among girls, poverty, smoking, physical fighting and lack of parental or guardian connectedness. CONCLUSION: Efforts to prevent and control alcohol misuse may need to address a cluster of risk behaviours including cigarette smoking.

Awareness; and Use of and Barriers to Family Planning Services among Female University Students in Lesotho

Background. Unwanted pregnancy and sexually transmitted infections among young women can be prevented through effective use of contraception. Unmet need for contraception in developing world and rates of unintended pregnancy among young women is high. Aim. To assess the level of awareness of contraceptives and utilization of family planning services among young women and barriers that hinders effective use of such services. Methods: In a quantitative descriptive survey 360 female undergraduate students of the National University of Lesotho; Roma; Lesotho respondent to a hand delivered self-administered questionnaire. Results: Awareness of family planning is high (98.3). Condom is the most commonly known and used family planning method. Level of sexual experience and contraceptive prevalence is high. Access to services is good but there are misconceptions. Married status is associated with current use; positive perception on health benefit while formal teaching on family planning is associated with misconceptions. Conclusion: The level of awareness and utilization of family planning services is high among female students of University of Lesotho. There is the need to introduce family planning teaching that is based on accurate knowledge to school curriculum

HIV Counselling and Testing Utilisation and Attitudes of Male Inmates in a South African Prison

The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction; their experiences and expectations; and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre; South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34; 95CI:0.23 - 0.50) was inversely associated with HIV testing acceptance in prison; while age; educational level; population group; marital status; length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services; ranging from 79 (fair to very good) for 'the way he/she received you' to 62 'clarified all your concerns'. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctionalcentres especially with regard to VCT services

Effect of exposure to clinic-based health education interventions on behavioural intention to prevent mother-to-child transmission of HIV infection.

HIV and AIDS incidence among infants in South Africa is on the increase. The uptake of prevention of mother-to-child transmission (PMTCT) interventions is often said to be dependent on the beliefs and educational needs of those requiring PMTCT services. This study therefore sought to examine the effect of clinic-based health education interventions (HEI) on behavioural intention of PMTCT among 300 pregnant women from 4 primary health care clinics in Tshilidzini Hospital catchments area, South Africa. An interview schedule was used to obtain information regarding participants' demographic characteristics, level of exposure to clinic-based HEI, salient beliefs and behavioural intention on PMTCT. The major findings included that approximately 85% of the participants had heard of PMTCT. There was very little association between frequency of antenatal clinic (ANC) visits and level of exposure to PMTCT information. Condom use had the lowest set of salient belief scores. Control belief was the most common belief contributing to behavioural intention. Generally, the association between PMTCT salient beliefs and behavioural intention was weak. Clinic-based HEI had an impact on behavioural intention of HIV testing, normative belief of regular ANC visit and nevirapine use. The vital contribution of alternative PMTCT information sources such as the radio and television was observed. Enhancing initiatives that empower women, and a better coordination of the existing HEI through better implementation of health education strategy may strengthen the prevailing moderate PMTCT intention in the area investigated.

Effect of Exposure to Clinic-Based Health Education Interventions on Behavioural Intention to Prevent Mother-to-Child Transmission of HIV infection

HIV and AIDS incidence among infants in South Africa is on the increase. The uptake of prevention of motherto-child transmission (PMTCT) interventions is often said to be dependent on the beliefs and educational needs of those requiring PMTCT services. This study therefore sought to examine the effect of clinic-based health education interventions (HEI) on behavioural intention of PMTCT among 300 pregnant women from 4 primary health care clinics in Tshilidzini Hospital catchments area; South Africa. An interview schedule was used to obtain information regarding participants' demographic characteristics; level of exposure to clinic-based HEI; salient beliefs and behavioural intention on PMTCT. The major findings included that approximately 85 of the participants had heard of PMTCT. There was very little association between frequency of antenatal clinic (ANC) visits and level of exposure to PMTCT information. Condom use had the lowest set of salient belief scores. Control belief was the most common belief contributing to behavioural intention. Generally; the association between PMTCT salient beliefs and behavioural intention was weak. Clinic-based HEI had an impact on behavioural intention of HIV testing; normative belief of regular ANC visit and nevirapine use. The vital contribution of alternative PMTCT information sources such as the radio and television was observed. Enhancing initiatives that empower women; and a better coordination of the existing HEI through better implementation of health education strategy may strengthen the prevailing moderate PMTCT intention in the area investigated