Dietary intake and growth of HIV exposed and unexposed 6-12 months old infants in South Africa.

Factors affecting the growth of HIV-exposed-uninfected (HEU) children are multi-factorial, with limited information available on the dietary intake from 6 months. This study compared the dietary intake, micronutrient composition of breastmilk, and growth of HEU and HIV-unexposed-uninfected (HUU) infants aged 6 and 12 months in an urban setting. A repeated cross-sectional study used structured questionnaires to collect socio-demographic, dietary intake, food group data, and anthropometric measurements in the Siyakhula study. The HEU (48%) and HUU (52%) infants were included (total n = 181). At 6 months, HEU infants had lower weight-for-age z-scores (WAZ) (-0.6 ± 1.1 vs. 0.1 ± 1.2; p < 0.001), length-for-age z-scores (-0.8 ± 1.4 vs. -0.1 ± 1.2; p < 0.001), and mid-upper-arm circumference-for-age z-scores (MUACAZ) (0.5 ± 1.1 vs. 1.0 ± 0.9; p < 0.001) than HUU infants. At 12 months, HEU infants had lower WAZ, MUACAZ, and weight-for-length z-scores compared to HUU infants (p < 0.05). Stunting was found at 6 (15%) and 12 (12%) months in HEU infants. The micronutrient composition of breastmilk fed to both groups was similar. Breastfeeding rates were lower in HEU than in HUU infants at 6 (49% vs. 64%; p = 0.005) and 12 (24% vs. 46%; p = 0.002) months. Less than 3% of HEU and HUU infants achieved minimal dietary diversity scores at 12 months. Dietary intake of fat was similar in all breastfed infants, but iron and vitamin B12 were higher in non-breastfed HEU infants at 12 months. HEU infants had lower breastfeeding rates than HUU infants. A lack of dietary diversity was found in all infants. Nutrition education and counselling in the complementary feeding phase are essential for optimal growth.

The Association between Post-Traumatic Stress Disorder and Problematic Alcohol and Cannabis Use in a Multi-Ethnic Cohort in The Netherlands: The HELIUS Study.

(1) Background: Ethnic minorities exhibit a higher prevalence of post-traumatic stress disorder (PTSD), while results for problematic substance use among ethnic groups remain mixed. PTSD and problematic substance use often co-occur; however, the impact of ethnicity on this association has not yet been investigated. (2) Methods: Self-report data on problematic alcohol/cannabis use (AUDIT/CUDIT) and presence of severe PTSD symptoms (PSS-SR) of N = 22,841 participants of Dutch (n = 4610), South-Asian Surinamese (n = 3306), African Surinamese (n = 4349), Ghanaian (n = 2389), Turkish (n = 3947), and Moroccan (n = 4240) origin were available from the HELIUS study. (3) Results: We found a positive association between the presence of severe PTSD symptoms and problematic alcohol and cannabis use. Ethnicity did not moderate the association between the presence of severe PTSD symptoms and problematic alcohol/cannabis use. (4) Conclusions: We demonstrated the relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use in a multi-ethnic sample. The relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use was similar between ethnic groups. We recommend screening for PTSD symptoms in those exhibiting problematic substance use and vice versa, regardless of ethnic background.

"I Haven't Had Moose Meat in a Long Time": Exploring Urban Indigenous Perspectives on Traditional Foods in Saskatchewan.

This qualitative study investigates the perspectives of urban Indigenous individuals in Saskatchewan, Canada, regarding their consumption of traditional foods. Through in-depth, semi-structured interviews with 14 participants across Saskatoon, Regina, and Prince Albert, the research aimed to uncover the benefits, risks, and barriers associated with acquiring and consuming traditional foods. Participants emphasized the nutritional advantages of traditional foods, such as higher nutrient density and absence of industrial additives, which they linked to improved health outcomes and alignment with Indigenous biology. The study also highlighted the vital role of traditional foods in maintaining cultural identity and fostering community connections through practices of food sharing and intergenerational knowledge transfer. However, significant challenges were identified, including economic and physical barriers to access, environmental degradation, and regulatory issues that restrict the availability of traditional foods in urban settings. The findings suggest a complex landscape where cultural practices are both preserved and challenged within the urban environment. This study contributes to the broader understanding of how Indigenous populations navigate the preservation of their culinary heritage in the face of modern economic and environmental pressures, providing insights for policy and community-based interventions aimed at supporting Indigenous food sovereignty.

[Development of violence-associated penetrating trauma in the Düsseldorf metropolitan region over a 5-year period (GewPen study)]. / Entwicklung gewaltassoziierter penetrierender Traumata in der Metropolregion Düsseldorf über einen fünfjährigen Zeitraum (GewPen-Studie).

INTRODUCTION: Penetrating injuries are a rare but recurring emergency situation in the out-of-hospital and in-hospital emergency settings. The purpose of this study was to determine the incidence and characteristics of injuries associated with penetrating violence across a German metropolitan region over a 5-year period. MATERIAL AND METHODS: In the retrospective study, a database query of the control center of the Düsseldorf rescue service area was used to identify and descriptively analyze all rescue service operations with penetrating violence-associated injuries in the years 2015, 2017, and 2019. For those patients who were transferred to the major trauma center, a further analysis of the in-hospital course was performed. RESULTS: In the 3 years 2015, 2017 and 2019 a total of 266 patients (age: 33 ± 14 years, male: 79%) could be recorded (2015 vs. 2017 vs. 2019: n = 81 vs. n = 93 vs. n = 92, respectively). The most common age group involved had an age range of 15-34 years. A particularly higher frequency of emergency calls was found for the areas of Old Town, City Center, and one other district (Oberbilk). A high frequency of rescue missions was found in the nights from Saturday to Sunday between 20.00 p.m. and 04.00 a.m. Rescue missions with emergency physicians on board increased over the years (2015 vs. 2019: 27 vs. 42%, p = 0.04). The primary weapons used were knives (56%), broken glass bottles (18%) and broken glasses (6%). Out of all patients 71 (27%, injury severity score 11 ± 14) were admitted to the major trauma center. Among these patients, the proportion of immediate surgical care (2015 vs. 2019: 20% vs. 35%, p < 0.05) and positive alcohol detection increased over the years (2015 vs. 2019: 10% vs. 43%, p < 0.05). The 30-day mortality in the 3 years studied was 1.1% (n = 3). CONCLUSION: Penetrating injuries associated with violence are relevant but rare rescue missions. Future care strategies should focus on deployment of rescue resources close to the scene of the incident ("old town guard", central station), and prevention strategies should focus on weapon prohibition zones. A control of alcohol consumption should be discussed.

Community-friendly tool to assess patient satisfaction in tuberculosis programme in the covid pandemic period; Bhubaneswar; India.

National Tuberculosis Elimination Programme (NTEP) is a priority programme for India, given that India is one of the 20 countries with high burden of TB. Odisha (a state in Eastern India) in 2017 reported 159/lakh/year cases as against a national average incidence of 138.33/lakh/year. Thus, the state, under an encouraging political milieu went to vigorously implement the newer initiatives outlined in the National Strategic Plan 2020-25, the result of which in 2021 Odisha was ranked second in the country for its efforts on TB elimination. The current article attempts to take community feedback on the programmatic endeavours, by using a tool for client satisfaction. 350 consecutive subjects, adults aged 18 years and above consented among the 465 who were diagnosed and started on treatment between 5/4/21 to 5/4/22. The selected subjects were interviewed after confirmation of diagnosis at one DOTS centre in an urban city, using a pre-designed and pretested tool after taking requisite ethical permission from the institute as well as after consent from the participating subjects. The tool had 10 items on structure; 10 items on the process and 3 on outcome each rated on a Likert scale of 1-5 (very satisfied to very dissatisfied) and lastly a score on 10 scale for overall satisfaction. For all the 24 items; alpha Cronbach coefficient was 0.928 (bootstrap 95% CI); for subscales infrastructure, process and outcome isolatedly was 0.931, 0.912 and 0.959 respectively. This shows that the questionnaire had very good reliability. Infrastructure mean score for all 10 questions was above 4.5; for processes, it was <4.05 for a few questions and mainly these referred to Out of pocket expenditures and waiting time; outcome again for all three questions mean score was near or above 4.4. The overall score was between 5 and 10; maximally at 8. This simple tool gave clear-cut hints at the best picture scenario, as the study was done at a single DOTS service centre in the capital city of the state, which ran effectively even during the pandemic. However, it brings out the weak points in the processes like the cost incurred to come to the centre and communication with ancillary staff. No difference in satisfaction levels was reported among pulmonary and extrapulmonary cases (ratio 8.4:1.5) in this study in the covid period; with overall satisfaction being 4.45 ± 0.44 and 4.41 ± 0.25 respectively. The promptness in the programmatic services at the DOTS centre under study is encouraging but warrants conformity with DOTS centres in rural and far-to-reach areas. Best evaluation of achievements of programme can be determined by word of mouth of the beneficiaries. Hence, this tool if replicated at all service centres can help programme managers plug any disconnects in service delivery and assure good satisfaction from all quarters.

Motivations Associated with Food Choices among Adults from Urban Setting.

Motivation for food choices is one of the most important determinant of eating behavior, because it comes from within the person. The aim of this study was to observe food choice motivations and estimate differences in demographic and health characteristics towards food choice motives in the adult population (n = 675; 54% women, ≥18 years) from urban setting. Food choice motivations were assessed using an online questionnaire validated by the EATMOT project. Using K-Means cluster analysis, participants were divided into two clusters of six motivational categories for food choices. Regarding the most and least important motivations, participants in cluster 1 chose food based on emotional motivations, and in cluster 2, they chose based on environmental and political motivations. In addition, younger and obese individuals had more pronounced emotional motivations. In conclusion, this study emphasizes the need to address emotional motivations for healthier food choices among overweight and young people. In addition, the prevalence of health motivations and growing awareness of sustainability indicate a willingness to take actions that benefit personal health and the environment. Apart from providing education, it is society's responsibility to create an environment that promotes the implementation of acquired knowledge and changes in dietary habits.

Correlates of poor self-rated health among school-going adolescent girls in urban Varanasi, India.

BACKGROUND: The concept of self-rated health (SRH) has widely been studied among the adults and older population in developed as well as developing countries, including India. Also, studies are available in abundance examining the various concepts of SRH among adolescents. However, in India, studies on the SRH of adolescents remain scarce, especially those aiming to understand the correlates of SRH among school-going adolescent girls in an urban setting. Therefore, this study aims to determine the correlates of poor SRH among school-going adolescent girls in the urban setting of Varanasi, India. METHODS: This study is based on the primary data collected in the Varanasi district of Uttar Pradesh, India, from October 2019 to February 2020. Nearly 350 adolescent girls and their mothers were personally interviewed. Self-rated health was the primary outcome variable of this study. The exact wording of the question asked from the adolescent girls was, "In general, how would you say your health is?". RESULTS: Almost one-fifth (19.4%) of the adolescent girls reported poor SRH. Adolescent girls from Other Backward Class (OBC) [OR: 0.39; 95% CI: .18-.85] and Others caste [OR: 0.58; 95% CI: .23-0.87] were less likely to report poor SRH than their Scheduled Caste/Scheduled Tribe (SC/ST) counterparts. Girls residing in households where number of daughters were more than sons were more likely to report poor SRH [OR: 7.8; 95% CI: 1.5-39.5] than girls who belonged to the daughters only households. CONCLUSION: Composition of children was one of the important factors as outlined in this study. The role of mothers in improving the overall SRH of the girls is critical as they are involved in caring process of their daughters.

Perspectives on Migrant Children's Mental Health Needs and Existing Services: A Qualitative Study Among Psychological Service Providers of Chinese Social Organizations.

Background: China is comprehensively promoting the construction of social psychological service system. Social organizations provide psychosocial care services to migrant children in China and hold important information and perspectives different from educators and parents on children's mental health. This study aims to analyze mental health service delivery to migrant adolescents for their psychological well-being, to explore how society responds effectively to their psychological needs and to support in better program implementation of mental health services for migrant children. Methods: Following qualitative approach semi-structured interviews were conducted with community mental health service providers experienced in working with migrant children. The 15 individual interviews were conducted in Hubei province and Guangdong province, including professionals working with different social organization and social psychological service program in communities. The data were analysed through coding, comparing fragments, constant comparison and recognizing patterns. Results: The analysis yielded 3 categories (Stimulate the internal strength, Reconstruct the support systems, Understanding and participate in social activities) and 6 sub-categories (Improve the understanding of "me" and explore excellent qualities, Clearly envision "my" future and clear career planning, Improve the parent-child relationship and understand the family environment, Improve subjective support and actively develop support system, Acquire reasonable cognition and behavior and interact with surrounding ecology, Take greater responsibility and cultivate a sense of ownership). The results found that individual traits, family, communities and multiple factors affect the mental health of migrant children and identified the urgent needs, and ways to improve mental health service in efficiently and economically. Social psychological service providers contribute in strengthening the psychological well-being of the migrant children. Conclusion: Social psychological service sectors need to be strengthened to enhance the psychological well-being of the migrant children. The inherent gaps between the service required and service provided needs to be addressed through further studies on mental health needs of the migrant children.

Smoking and COPD Knowledge in the General Spanish Population: A CONOCEPOC Study.

BACKGROUND: The objective of this analysis is to evaluate tobacco use and the level of chronic obstructive pulmonary disease (COPD) knowledge among the general adult population in Spain and to compare these results to those obtained in the 2011 survey. METHODS: A cross-sectional, observational, epidemiological study was conducted by telephone interviews and stratified by sex, age, and setting. The study design was identical to that of the study conducted in 2011. RESULTS: Of a total of 89,601 phone contacts, there were 6534 respondents. The average age was 61.5 years. With respect to smoking, 30.9% reported being former smokers and 14.7% were current smokers, 63.6% of whom reported having attempted to quit. Among the current smokers, 19.7% claimed to use electronic cigarettes, although 88% believe these pose a health risk. No significant differences were found in smoking prevalence or frequency of attempts to quit according to residential setting (rural/urban). The highest prevalence of current smoking in men was recorded in the 55-64 years age range (31.6%), while in women it was from 45 to 54 years (34.6%). Smoking has decreased with respect to 2011, from 21.1% to 16.1% in men and from 17.9% to 13.2% in women, with a clear variability according to region. Of the population surveyed, 32.5% had spontaneous knowledge about COPD, with significant geographic variability. The most frequent sources of information about the disease were social media and the Internet (39.6%), followed by the media (35.2%). CONCLUSIONS: The prevalence of tobacco use in adults has considerably decreased and there is greater knowledge about COPD in Spain, although there is significant variability according to region, which could explain the geographic variability in the prevalence of COPD. Strategies are needed to increase COPD education and awareness and to reinforce smoking prevention measures among women.

A Rare Case of Weil's Syndrome With Extreme Hyperbilirubinemia in an Urban Setting.

We present a unique case of Weil's disease, a severe form of leptospirosis caused by Leptospira interrogans, a rare agent seen in both temperate and tropical climates but is more commonly seen in tropical climates and transmitted to humans commonly by rodent urine contamination. It is an under-reported infection, with 1.03 million cases documented annually, and is not commonly found in the United States. A 32-year-old African American male presented with abdominal pain and pressure in his chest associated with nausea, vomiting, and diarrhea. On exam, scleral icterus, sublingual jaundice, and hepatosplenomegaly were noted. Imaging studies revealed the patient had incidental situs inversus and dextrocardia. Labs revealed leukocytosis, thrombocytopenia, transaminitis, and significant direct hyperbilirubinemia of over 30 mg/dL. An extensive workup revealed the patient had leptospirosis due to rat contamination in his apartment. The patient was treated with doxycycline, and his clinical status improved. The heterogeneous and unique clinical presentation of leptospirosis gives rise to a broad differential diagnosis. We aim to encourage physicians who encounter similar presentations in similar urban settings in the United States to include leptospirosis in their differential.

Early Childhood Teachers of Color in New York City: heightened stress, lower quality of life, declining health, and compromised sleep amidst COVID-19.

Stress and well-being are known to influence the quality of teacher-student interactions, teachers' delivery of emotional and instructional support, and the social competence and executive function skills of young learners-dynamics that impact the education and development of young children. Even prior to COVID-19, 46% of teachers reported notably high levels of daily stress. Given the additional stressors associated with the pandemic, this multi-methods study explores the well-being of Latinx, Black, and multiracial early childhood teachers in New York City, where communities of Color have been particularly hard hit by COVID-19. Via an amalgamation of descriptive and interpretive approaches-a survey, time-use diaries, and qualitative interviews-this study documents early childhood teachers' experiences making sense of and negotiating the impacts of intersecting stressors on their stress, health, quality of life, and sleep amidst COVID-19. Survey findings show reduced well-being across measures among the early childhood teachers in the sample, while qualitative findings illustrate the many layers of challenges that teachers of Color faced during the pandemic. Time-use diaries show extremely high demands and long work hours associated with concerning lack of self-care and attention to mental health. Interviews elucidate how stress is layered across environmental, occupational, and racial factors. This study points to the need to attend to the well-being of Black, Latinx, and multiracial early childhood teachers in urban settings during and after COVID-19 recovery.

Outcomes of a Pharmacist-Led Hepatitis C Virus Treatment Program in an Urban Safety-Net Health System, Chicago, 2017-2019.

OBJECTIVE: A recommendation in March 2020 to expand hepatitis C virus (HCV) screening to all adults in the United States will likely increase the need for HCV treatment programs and guidance on how to provide this service for diverse populations. We evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago, Illinois. METHODS: We collected data on all patient treatment applications submitted from January 1, 2017, through June 30, 2019, and assessed outcomes of and patient retention in the treatment cascade. RESULTS: During the study period, 203 HCV treatment applications were submitted for 187 patients (>1 application could be submitted per patient): 49% (n = 91) were aged 55-64, 62% (n = 116) were male, 67% (n = 125) were Black, and 15% (n = 28) were Hispanic. Of the 203 HCV treatment applications, 87% (n = 176) of patients were approved for treatment, 91% (n = 161) of whom completed treatment. Of the 161 patients who completed treatment, 81% (n = 131) attended their sustained virologic response (SVR) follow-up visit, 98% (n = 129) of whom reached SVR. The largest drop in the treatment cascade was the 19% decline from receipt of treatment to SVR follow-up visit. CONCLUSION: The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR. Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.

Is there an association between socioeconomic status and the degree of diurnal variation in heart rate?

BACKGROUND: Disruption in circadian rhythms is associated with cardiovascular disease and may play a role in socioeconomic differences in cardiovascular disease prevalence. However, it is unclear whether low SES is associated with a lower diurnal rhythm in autonomic activity markers. We investigated the association between SES and the amplitude of the daily fluctuation of heart rate. METHODS: We included data of 450 participants of a HELIUS sub-study in Amsterdam, the Netherlands. Participants wore an Actiheart monitor (CamNtech), a chest-worn monitor which measures heart rate every 15 s for several days. Cosinor analysis was performed on the time series of heart rate within each participant. We analyzed the association between the cosinor parameters (amplitude, midline and peak time of the diurnal HR rhythm) and SES indicators (education, occupational class and a proxy of income) in multivariate linear regression models, adjusting for age, sex and ethnicity. RESULTS: There was a clear diurnal rhythm in the average heart rates, with a peak between noon and 18:00 and a trough between 04:00 and 06:00. This rhythm was present for all categories of education, occupation and income proxy. The estimates for the cosinor parameters did not differ consistently and significantly between categories of education, occupation or income proxy. CONCLUSIONS: We did not find any consistent evidence to support our hypothesis of a diminished amplitude in the diurnal variation of heart rate in individuals with lower SES. Future studies should explore SES differences in the diurnal variation in markers of autonomic activity other than heart rate.

Re-Evaluating Stroke Systems of Care: Association of Transfer Status With Thrombectomy Outcomes at an Urban Comprehensive Stroke Center.

Introduction Given the efficacy of mechanical thrombectomies (MT) for large vessel occlusions (LVO), there is concern that the Hub and Spoke model of stroke care, which prioritizes initial assessment of the acute ischemic stroke (AIS) patient at a primary stroke center, would cause a delay in arterial reperfusion, thus leading to worse outcomes. In this study that occurred at our comprehensive stroke center in New York, we compared the clinical outcomes of patients that were either directly admitted for thrombectomy versus those who were transferred from another institution. Methods Retrospective review of the electronic medical record (EMR) was performed on all adult patients treated with endovascular therapy for ischemic stroke between January 2016 and February 2020. A bivariate analysis was performed to compare patients in the direct admit versus transfer group. A multivariable logistic regression model was developed to determine which factors affect 90-day modified Rankin score (mRS) and to evaluate if transfer status was an independent predictor in this model. Results Three hundred and twenty-five patients were included in this study; 127 patients belonged to the direct admit group while 198 were in the transfer group. Thirteen patients (20%) in the direct admit group had a 90-day mRS score of 0-2 and so did 29 patients (25.2%) in the transfer group; thus, no statistically significant difference found in clinical outcomes between both groups (p-value = 0.427). In a multivariable logistic regression model that accounts for age, gender, smoking status, baseline mRS, presenting National Institute of Health Stroke Scale (NIHSS), procedure duration, thrombolysis in cerebral infarction (TICI) score, post-NIHSS and decompressive hemicraniectomy, transfer status was not found to be predictive of clinical outcomes (OR 0.727 95% CI 0.349-1.516; p-value = 0.396).  Conclusion Transfer status is not significantly associated with 90-day outcome. Since Hub and Spoke is not associated with worse outcomes compared to direct admit, it remains a viable model for providing effective care to stroke patients in an urban setting.

A Cross-Sectional Quantitative Study on Sexual and Reproductive Health Knowledge and Access to Services of Arab and Kurdish Syrian Refugee Young Women Living in an Urban Setting in Lebanon.

Since data on the sexual and reproductive health (SRH) of young refugee women living in urban settings in Lebanon are particularly scarce, we aim through this exploratory study to assess the SRH knowledge and access to services of Arab and Kurdish Syrian refugee young women living in Bourj Hammoud. From January to March 2020, a cross-sectional survey was conducted among 297 Syrian Arab and Kurdish participants and aged 18-30 years old. It was found that participants coming from Syrian urban areas or who completed an education above secondary level have higher overall knowledge on SRH issues. Only a total of 148 out of the 297 participants (49.8%) knew a health facility in Bourj Hammoud that provides SRH services and among them 36.4% did not know which type of services are available there. The Syrian refugee young women's access to SRH services is inadequate due to different obstacles. The overall knowledge level on different SRH topics is limited. The context of multiple crises in Lebanon should be taken into consideration when delivering future SRH services.

Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey.

BACKGROUND: Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey. DISCUSSION: In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week. CONCLUSIONS: The research team's experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes.

Sexual and reproductive health of Syrian refugee adolescent girls: a qualitative study using focus group discussions in an urban setting in Lebanon.

BACKGROUND: The war in Syria caused the forced displacement of millions of Syrians to neighboring countries. Lebanon is the host country with the largest overall number of Syrian refugees per capita. Adolescent refugee girls experience a unique level of vulnerability during human emergencies and are at increased risk of suffering from poor sexual and reproductive health (SRH) outcomes. We conducted an exploratory qualitative study to learn about the SRH perceptions and experiences of refugee adolescent girls living in Bourj Hammoud, an urban setting in Lebanon. METHODS: We employed a qualitative design with eight focus group discussions (FGDs) conducted with 40 Syrian Arab and Syrian Kurdish adolescent girls between January and March 2020. Every FGD consisted of five participants aged 13 to 17 years. A semi-structured guide was used covering multiple themes: menstruation, puberty, SRH awareness, and sexual harassment. FGDs were transcribed and analyzed using thematic analysis. FINDINGS: The participants discussed adolescent girls' health and named six elements of good health, such as healthy activities and self-protection. The majority of the FGD participants reported a lack of awareness about menstruation when they experienced it for the first time and the social stigma associated with menstruation. When defining puberty, they indicated its social link to a girl's readiness for marriage and her need to become cautious about sexual harassment. Most FGD participants had very poor knowledge of the female reproductive system. Mothers were the most approached persons to receive information on SRH issues; however, the girls indicated a wish to receive advice from specialists in a comfortable and private atmosphere. All the girls reported that either they themselves, or an acquaintance, had experienced some type of sexual harassment. The girls rarely reported those incidents due to fear of being blamed or subjected to mobility restrictions, or forced to drop out of school. CONCLUSIONS: The findings show the refugee girls need for satisfactory knowledge on SRH issues and interventions to prevent sexual and gender-based violence that take into consideration the complexity of urban settings.

After almost 10 years of war, Syria's neighboring countries are hosting millions of Syrians who were forcibly displaced. Most prominent among these countries is Lebanon. Adolescent refugee girls are exposed to precarious conditions, which make them more prone to sexual and reproductive health (SRH) problems. This qualitative study was performed in Bourj Hammoud, an urban setting in Lebanon, in order to explore Syrian refugee adolescent girls' SRH perceptions and experiences. The agenda of the International Conference on Population and Development (ICPD) in addition to the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings (IAFM) and its Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings issued by the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) formed the framework of this study. Focus group discussions were performed with 40 Syrian Arab and Syrian Kurdish adolescent girls, each group consisting of five participants aged 13 to 17 years. Different themes were discussed within the groups including menstruation, puberty, and sexual harassment. The participants talked about the social stigma related to menstruation and the social link between puberty, a girl's readiness for marriage, and her need to be careful about sexual harassment. Most of the girls had insufficient information about the female reproductive system. The girls consulted their mothers to learn about SRH issues; however, they expressed a wish to receive well-informed advice from specialists in a safe atmosphere. All the girls reported incidents of sexual harassment, which happened either to them or to other girls they know; however, they were discouraged to report them because they feared other consequences, such as being blamed or not being allowed to go to school anymore. The outcomes of the study show the girls' urgent need to have adequate information about SRH issues and appropriate interventions to prevent sexual and gender-based violence within complex urban settings.

"People Don't Just Start Shooting Heroin on Their 18th Birthday": A Qualitative Study of Community Stakeholders' Perspectives on Adolescent Opioid Use and Opportunities for Intervention in Baltimore, Maryland.

Initiation of non-medical prescription opioid use (NMPO) during early adolescence is tightly linked to heroin and other drug use disorders and related sequelae in later adolescence and young adulthood. Few studies explore stakeholders' perspectives on the burden and determinants of youth opioid use and barriers and facilitators to engaging youth in opioid use prevention and treatment services in urban settings with longstanding opioid epidemics. In-depth interviews were conducted with 22 stakeholders representing health and social service agencies in Baltimore, Maryland from May 2018- February 2019, to examine their perspectives on the burden and context of adolescent opioid use and identify barriers and facilitators to preventing and responding to adolescent opioid use. Transcripts were analyzed using the constant comparison method to identify themes. Most respondents described a recent uptick in opioid use independently, and in combination with other substances. As compared to heroin, NMPO was perceived to be more frequently used and less stigmatized among youth. Stakeholders perceived the process of transitioning from using NMPO to heroin as more common among White vs. Black youth and was perceived as occurring faster among White vs. Black youth. Some stakeholders believed racial differences in internal stigma against heroin use, and differential health service use among Black youth and White youth may have influenced these differences. Trauma and poverty were noted determinants of youth opioid use. Barriers to service provision included youth cognitive development, stigma and structural factors (e.g., disinvestment, lack of youth-centered and integrated services). Stakeholders perceive prevalent NMPO among Baltimore youth and identify multilevel barriers to delivering prevention, treatment and harm reduction services to this population. These findings encourage further investigation of determinants and consequences of opioid use among diverse racial/ethnic groups of youth in urban settings, and development of multilevel, youth-driven and youth-centered approaches to prevention and treatment.

Risk factors of dengue fever in an urban area in Vietnam: a case-control study.

BACKGROUND: Dengue is a mosquito-borne flavivirus present in many metropolitan cities of tropical countries. METHODS: During and after the dengue season (September 2018 to January 2019), we conducted a case-control study in order to determine the risk factors for dengue fever in Hanoi city, Vietnam. 98 dengue patients and 99 patients with other acute infections, such as Hepatitis B virus infection, were recruited at Department of Infectious Disease of Bach Mai national hospital in Hanoi. Patients were interviewed using a structured questionnaire covering demographic, housing, environmental factors and knowledge, attitude, and practice on dengue prevention and control. Univariate analysis and multivariable logistic regression were used to determine the risk factors of dengue status. RESULTS: The mean score of knowledge items and practice items was only 7.9 out of total 19 points and 3.9 out of total 17 points, respectively. While the mean score of attitude items was 4.8 out of total 6 points. Multivariable logistic regression indicated that older patients had lesser risk of getting dengue infection as compared to younger adults aged 16-30, and patients living in peri-urban districts were less likely to suffer of dengue fever than patients living in central urban districts (OR = 0.31; 95% CI 0.13-0.75). This study could not find any association with occupation, water storage habit, knowledge, attitude, or practice on dengue prevention. CONCLUSIONS: All patients had a relatively low level of knowledge and practice on dengue prevention and control. However, the attitude of the participants was good. We found that age group and living district were the risk factors correlated with the dengue status. Communication programs on raising dengue awareness should be repeated all year round and target particular groups of adolescents, younger adults, landlords and migrants from other provinces to improve their knowledge and encourage them to implement preventive measures against dengue fever.