Sexual harassment among employees and students at a large Swedish university: who are exposed, to what, by whom and where - a cross-sectional prevalence study.

BACKGROUND: Sexual harassment (SH) in the workplace is prevalent and associated with poor health. Universities are large workplaces with complex formal and informal power relations, which may influence the prevalence of SH. Although employees and students share the university context, few studies on SH have included both groups. The overall aim of the study was to investigate SH among employees and students at a large Swedish public university regarding types of harassment, prevalence in different groups, characteristics of the perpetrators, and the circumstances in which it occurs. METHODS: A cross-sectional analysis was performed, based on a web-based survey with 120 items that was sent out to all staff, including PhD students (N = 8,238) and students (N = 30,244) in November 2019. The response rate was 33% for staff and 32% for students. Exposure to SH was defined as having experienced at least one of ten defined SH behaviors during their work or studies. RESULTS: Among women, 24.5% of staff and 26.8% of students reported having been exposed to SH. The corresponding figures were 7.0% and 11.3% for male staff and students and 33.3% and 29.4% for non-binary individuals among staff and students. Unwelcome comments, suggestive looks or gestures, and 'inadvertent' brushing or touching were the three most common forms of reported harassment, both among staff and students. Attempted or completed rape had been experienced by 2.1% of female and 0.6% of male students. Male and female perpetrators were reported by about 80% and 15%, respectively, of exposed participants. Among staff most reported events occurred during the everyday operation of the university, while among students the majority of the events took place during social events linked to student life. When exposed to a perpetrator from the same group (staff or students), women reported more often being in a subordinate power position in relation to the perpetrator. CONCLUSIONS: The results indicate that sexual harassment is common in the university context, and interventions and case management routines of events should consider power relations between victim and perpetrator, as well as the various contexts within which sexual harassment takes place.

Children in family foster care have greater health risks and less involvement in Child Health Services.

AIM: This study investigated the impact of being in family foster care on selected health determinants and participation in Child Health Services (CHS). METHODS: Two groups of 100 children, born between 1992 and 2008, were studied using data from Swedish Child Health Services for the preschool period up to the age of six. The first group had been in family foster care, and the controls, matched for age, sex and geographic location, had not. Descriptive statistics were used to describe differences in health determinants and participation in Child Health Services between the two groups. RESULTS: The foster care group had higher health risks, with lower rates of breastfeeding and higher levels of parental smoking. They were less likely to have received immunisations and attended key nurse or physician visits and speech and vision screening. Missing data for the phenylketonuria test were more common in children in family foster care. CONCLUSION: Children in family foster care were exposed to more health risks than the control children and had lower participation in the universal child health programme during the preschool period. These results call for secure access to high-quality preventive health care for this particularly vulnerable group of children.

Joint effect of maternal depression and intimate partner violence on increased risk of child death in rural Ethiopia.

OBJECTIVES: To assess independent and interaction effect of experience of intimate partner violence and depression on risk of child death. DESIGN: Community-based cohort design. SETTING: The study was conducted within the demographic surveillance site of Butajira Rural Health Program in south central Ethiopia. PARTICIPANTS: Women (n=561) who gave birth to a live child. MAIN OUTCOME MEASURES: Exposure status comprising physical, sexual and emotional violence by intimate partner was based on the WHO multi-country questionnaire on violence against women. Depression status was measured using the Composite International Diagnostic Interview. Risk of child death and its association with maternal exposure to violence and/or being depressed was analysed by incidence, rate ratios and interaction. RESULTS: The child death in the cohort was 42.1 (95% CI, 32.7 to 53.5) children per 1000 person years, and maternal depression is associated with child death. The risk of child death increases when maternal depression is combined with physical and emotional violence (RR=4.0; 95% CI, 1.6 to 10.1) and (RR=3.7; 95% CI, 1.3 to 10.4), showing a synergistic interaction. CONCLUSION: An awareness of the devastating consequences on child survival in low income setting of violence against women and depression is needed among public health workers as well as clinicians, for both community and clinical interventions.

Encouraging farmers to retrofit tractors: a qualitative analysis of risk perceptions among a group of high-risk farmers in New York.

Tractor rollovers continue to be one of the most frequent causes of agricultural fatalities. Despite knowledge of rollovers and the efficacy of rollover protective structures (ROPS), few New York farmers have considered installing ROPS on their unprotected tractors. Qualitative interviews conducted with an "at-risk" segment of the New York farming community indicate that there are a number of barriers to safety in general and to retrofitting, in particular. The following themes and categories emerged in relation to safety and risk taking: constant exposures to risk with positive outcomes normalizes risk; the modeling of risk by significant others positions risk as part of a farming identity; and the pressure to reduce costs, save time, and accept risk frames risk-taking as the cost-effective option (especially in regard to retrofitting, which farmers believe is both expensive and time-consuming). Recommendations for researchers planning retrofitting interventions would be to focus safety messages on the risk to significant others or on the financial impact of rollovers, and to provide financial incentives and assistance to farmers considering retrofitting.

Home deliveries: implications for adherence to nevirapine in a PMTCT programme in rural Malawi.

Although nevirapine (NVP) is provided by prevention of mother-to-child-transmission (PMTCT) of HIV programmes to be taken at onset of labor independent of place of delivery, few studies have assessed adherence to NVP outside the hospital setting. This study aimed to follow women in a PMTCT programme up to delivery and to assess the adherence to the prophylaxis in rural Malawi. A total of 75 HIV-positive women were registered in the PMTCT at Malamulo SDA hospital between January and June 2005. Forty women (53%) delivered in the hospital and 35 (47%) did not. Of the 35 women who delivered at home, it was possible to trace 27 (77.2%). All women who delivered in the hospital took their NVP tablets and all their babies had NVP syrup except one baby who died soon after delivery. Of the 27 traced women who had not delivered in the hospital, 16 (59.3%) had access to NVP and had taken their tablets during labor. However, none of their babies was taken back to the health facility for NVP syrup. Traditional birth attendants might be crucial in efforts aiming to increase adherence to NVP among women and their babies.

Women's health in a rural setting in societal transition in Ethiopia.

There are reports indicating a worsening of women's health in transitional rural societies in sub-Saharan Africa in relation to autonomy, workload, illiteracy, nutrition and disease prevalence. Although these problems are rampant, proper documentation is lacking. The objective of this study was to reflect the health situation of women in rural Ethiopia. Furthermore, the study attempts to address the socio-demographic and cultural factors that have potential influence on the health of women in the context of a low-income setting. A combination of qualitative and quantitative research methods was utilised. In-depth interviews and a cross-sectional survey of randomly selected women were the main methods employed. The Butajira Rural Health Program demographic surveillance database provided the sampling frame. Heavy workload, lack of access to health services, poverty, traditional practices, poor social status and decision-making power, and lack of access to education were among the highly prevalent socio-cultural factors that potentially affect the health of women in Butajira. Though the majority of the women use traditional healers younger women show more tendency to use health services. No improvement of women's status was perceived by the younger generation compared to the older generation. Female genital mutilation is universal with a strong motivation to its maintenance. Nail polish has replaced the rite of nail-extraction before marriage in the younger generation. As the factors influencing the health of women are multiple and complex a holistic approach should be adopted with emphasis on improving access to health care and education, enhancing social status, and mechanisms to alleviate poverty.

Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania.

In the Kagera region of Tanzania, a population-based study was initiated in 1987 followed by the establishment of antenatal-clinic-based sentinel surveillance system in the town of Bukoba in 1990. Repeat studies in both populations in Bukoba in 1993 and 1996 made it possible to study the dynamics of HIV infection prevalence and incidence in the area. This study aims at comparing the findings from this sentinel surveillance system with those of cross-sectional studies in the general population to assess its validity in estimating HIV prevalence and their trends in the general population. A multistage cluster sampling technique was used in the population-based studies whereas the antenatal-clinic-based population was obtained by consecutively recruiting antenatal care attenders coming for the first time during a given pregnancy. Antibodies against HIV infection were tested using two independent enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Unlinked anonymous testing strategy was adopted for the sentinel population. Age-adjusted prevalence among antenatal care attenders decreased from 22.4% (95% confidence interval [CI], 20.6-25.2) in 1990 to 16.1% (95% CI, 15.9-18.8) in 1993 and further to 13.7% (95% CI, 11.8-14.3) in 1996. These results closely resemble those of the general population of adult women in the clinic's catchment area (the town of Bukoba) where the age-adjusted prevalence of 29.1% (95% CI, 24.4-34.6) in 1987 showed a decrease in the studies in 1993 18.7% (95% CI, 15.1-23.0) and in 1996 14.9% (95% CI, 12.0-17.1). The study indicates that general population trend estimates can be generated using sentinel surveillance data based on pregnant women visiting an antenatal clinic for the first time during a given pregnancy. The benefits of using this group outweigh its limitations that are brought about by possible selection bias. Continued surveillance of the epidemic based on antenatal care patients as a sentinel population is therefore recommended.

How many lives is equity worth? A proposal for equity adjusted years of life saved.

STUDY OBJECTIVE: To present a formula for equity adjusted years of life saved (EYLS). DESIGN: A mailed questionnaire. The survey participants were given a scenario describing a trade off between a health maximization programme and a programme that is less efficient, but eliminates social inequalities. SETTING: Swedish politicians responsible for health care in the county councils. PARTICIPANTS: A sample of 449 Swedish politicians responsible for health care in the county councils. MAIN RESULTS: The principle of health maximization was rejected. Under certain conditions, the Swedish politicians are prepared to sacrifice 15 of 100 preventable deaths to achieve equity. Based on the results a formula for EYLS is presented. CONCLUSIONS: An equity adjusted formula for years of life saved has been proposed, but must be developed and revised according to each country's specific conditions and value premises. In the future, such formulas could serve the purpose of incorporating explicit considerations of equity into cost effectiveness analyses.

An epidemiological approach towards measuring the trade-off between equity and efficiency in health policy.

The concept of social welfare functions has been discussed in health economic literature, as it provides a way of examining the extent to which society is prepared to accept a trade-off between efficiency and equity. In this paper requirements for meaningful empirical estimates of the willingness to accept lower per capita health status in order to achieve greater equity are examined. Results from a pilot study aimed at testing the proposed measurement procedure are reported. They show that at least two thirds of the politicians who participated are prepared to accept a lower growth in per capita health in exchange for increased equity. Accordingly, we found a weak empirical support for the common health economic assumption that only total health benefit should guide the use of resources.

Co-operation, participation and conflicts faced in public health--lessons learned from a long-term prevention programme in Sweden.

A comprehensive community-based programme for prevention of cardiovascular diseases (CVD) and diabetes was established in 1985 in a small municipality in northern Sweden. A cross-sectional survey to the general public was performed and semi-structured open-ended interviews were taken of actors at different levels. Notes from official records were also included in the study. The aim was to describe and discuss some factors that promote or constrain community participation in health programmes. The results generally confirmed that the right of definition concerning the health programme mainly remained with the health professionals. Community participation was mainly defined by the actors based on the medical and health planning approach and, thereby, as a means to transform health policy plans into reality by transmitting health knowledge and increasing consciousness among the citizens of the need for changing lifestyles. However, participation as a means of identifying problems and demonstrating power relationships and as elements in promoting local democracy was hardly represented among the actors at all. Overall, the CVD health programme was characterized by consensus between the actors. Despite this, debates and arguments about interpretations, social interests, personal conflicts and ideological constraints were observed. However, a majority of the public wanted the CVD preventive programme to continue.