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NICE of you to notice – Are users of image and performance-enhancing drugs finally getting the help they need?
Druglink Volume 29, Issue 4, August/September 2014.
The differential impact of a classroom-based, alcohol harm reduction intervention, on adolescents with different alcohol use experiences: A multi-level growth modelling analysis
Dr Michael McKay, Professor Harry Sumnall, Nyanda McBride, Séamus Harvey
Journal of Adolescence, Volume 37, Issue 7, Pages 1057–1067, October 2014.
Abstract: While evidence has accumulated suggesting that prevention initiatives may have a limited impact on alcohol use behaviour, reviews suggest that interventions with most potential for behavioural change are interactive and developmental in design. The School Health and Alcohol Harm Reduction Project (SHAHRP) is an example of such an intervention. Researchers are increasingly attempting to understand the differential effects of programmes in population subgroups. The present study is a secondary analysis of data from a non-randomised trial of SHAHRP, a classroom-based alcohol education intervention, involving school children (aged 13–16 years old) in the United Kingdom. Results showed that there were significant positive changes in knowledge about and attitudes towards alcohol in baseline abstainers, supervised drinkers and unsupervised drinkers. Significant positive behavioural effects in terms of amounts consumed, frequency of drinking and self-reported alcohol related harms, were observed almost exclusively among baseline unsupervised drinkers. These behavioural effects support those previously observed in Australia and suggest that the intervention is a viable health promotion tool in the UK.
INHDR Newsletter June 2014, June 2014.
Nirmal Aryal, Debbi Marais, Professor Padam Simkhada
DOI: 10.14302/issn.2324-7339.jcrhap, 12-157, 2014.
Abstract Background: Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) are found to be strongly associated with cardiovascular diseases. Data are sparse on the prevalence and distribution of cardiovascular risk factors among people being treated for HIV in South Asia region. Methods: A cross-sectional study of 103 HIV patients (51 women and 52 men) attending routine follow-up consultations at the largest ART centre in Nepal was conducted. Data on several cardiovascular risk factors were collected through interview questionnaires, biophysical measurements and consulting medical records. Results: The most common cardiovascular risk factors observed were central obesity [34.6%, 95% Confidence Interval (CI): 25.3% to 43.9%], chronic kidney disease [20.7% (95% CI: 11.6% to 29.7%)] and tachycardia [20.6% (95% CI: 12.7% to 28.5%)]. Females were significantly more likely to have central obesity (male 9.8% vs. female 60%, p=0.016) and chronic kidney disease (male 15.4% vs. female 26.3%, p=0.003) as compared to the males. Participants were fairly active but a large proportion, especially men, had smoked [65% (95% CI: 57%-72.3%)], used tobacco products [66% (95% CI: 56.4%-74.4%)] or drugs (53.8% of the men) and consumed alcohol [60.2% (95% CI: 50.5%-69.1%)]. Conclusion: A high prevalence of several cardiovascular risk factors was observed among patients being treated for HIV in Nepal. Further larger studies are warranted to better understand the relevance and public health impact of cardiovascular risk factors in this region.
Ghrelin: Ghrelin as a Regulatory Peptide in Growth Hormone Secretion
Nazli Khatib, Shilpa Gaidhane, Abhay Gaidhane, Mahanaaz Khatib, Professor Padam Simkhada, Dilip Gode, Quazi Zahiruddin
Journal of Clinical and Diagnostic Research 8 (8), MC13-MC17, 2014.
Abstract. Background: Ghrelin is a type of growth hormone (GH) secretagogue that stimulates the release of GH. It is a first hormone linking gastrointestinal-pituitary axis. Objective: This review highlights the interaction of ghrelin with GHRH and somatostatin to regulate the secretion of GH and intends to explore the possible physiological role of the ghrelin-pituitary-GH axis linkage system. Observation: Ghrelin is highly conserved among species and is classified into octanoylated (C8:0), decanoylated (C10:0), decenoylated (C10:1) and nonacylated,ghrelin. Acylated ghrelin is the major active form of human ghrelin. The primary production site of ghrelin is the stomach, and it interacts with stomach ghrelin as well as hypothalamic GHRH and somatostatin in the regulation of pituitary GH secretion. Ghrelin stimulate GH release through the GHS receptor to increase intracellular Ca2+ ([Ca2+] levels via IP3 signal transduction pathway. Ghrelin is a specific endogenous ligand for the GHS receptor and provides a definitive proof of the occurance of a GHS–GHS receptor signalling system in the regulation of GH secretion. Conclusion: Studies suggests that ghrelin is a powerful pharmacological agent that exerts a potent, time-dependent stimulation of pulsatile secretion of GH.
Nazli Khatib, Shilpa Gaidhane, Abhay Gaidhane, Professor Padam Simkhada, Dilip Gode, Quazi Zahiruddin
Journal of Clinical and Diagnostic Research, 8(8). doi:10.7860/JCDR/2014/9863.4767, 2014.
Abstract Ghrelin is a type of growth hormone (GH) secretagogue that stimulates the release of GH. It is a first hormone linking gastrointestinal-pituitary axis.
Why do costs act as a barrier in maternity care for some, but not all women? A qualitative study in rural Nepal
Dr Bibha Simkhada, Maureen Porter, Edwin van Teijlingen, Professor Padam Simkhada
International Journal of Social Economics 41 (8), 705-713, 2014.
Purpose – The purpose of this paper is to analyse cost as a barrier to the uptake of antenatal care (ANC) in rural Nepal amidst a variety of barriers and facilitators. Design/methodology/approach – A qualitative study with face-to-face interviews were conducted with 50 ANC users and non-users participants. The setting is rural Nepal, some 20 kilometres outside the capital Kathmandu. Interviews were audiotaped, transcribed and translated into English and results were presented thematically. Findings – Cost was sometimes a barrier to seeking ANC for poor rural women. It included transport costs, opportunity costs of not being able to work in the household and service-related costs (such as blood or urine tests). The effect of cost as a barrier varied between women of different socio-economic status. Cost was a barrier to accessing ANC partly due to the women's lack of control over household resources. Social implications – It is important to consider cost in the wider socio-economic context of rural people's lives as financial costs alone do not explain the level of uptake of ANC. Originality/value – This study provides an original insight of women's experiences on financial issues relating to the use of ANC services in Nepal. Another important aspect of this study was approached with the multiple respondents (i.e. women, their husbands and their mothers-in-law) regarding the use of ANC and financial impact in the use of services. The findings of this study have important implications in health policy formation by providing clear picture of women's financial situation in access to ANC.
Knowledge and Risk Perceptions about HIV/AIDS among Nepalese Migrants in Gulf Countries: a Cross-sectional Study
Suresh Joshi, Gordon Prescott, Professor Padam Simkhada, Narayan Sharma, Yagya Bhurtyal
Health Science Journal 8 (3), 350-360, 2014.
Abstract: Background: Migration is considered as one of the major risk factor for HIV/AIDS transmission. Inadequate knowledge and misconceptions about HIV/AIDS transmission are still the major challenges in developing countries. Aim: This study aimed to explore the knowledge and risk perceptions about HIV/AIDS among a sample of Nepalese migrants working in three Gulf countries. Method and Material: A cross-sectional study was performed among a sample of 408 adult Nepalese migrants who had a work experience of at least six months in one of the three Gulf countries, (Qatar, Saudi Arabia and United Arab Emirates). An interview-based questionnaire was used to obtain the information from these migrant workers. Results: The respondents in this study were from different parts of Nepal and the majority were adult males, most frequently of age 26-35. More than half of the respondents were involved in construction related works. The majority of the respondents were aware that HIV virus is transmitted through sexual intercourse without using condoms and having sex with many people. The most prevalent misconceptions about HIV/AIDS transmission was that a person can get HIV/AIDS from a mosquito bite. More than a quarter of the respondents perceived that they were not at risk of being infected with HIV/AIDS due to their sexual activities. Conclusions: There is still a lack of adequate awareness and risk perceptions about HIV/AIDS among some of the Nepalese migrants. We can suggest to government of Nepal and employers to provide proper preventive health information regarding HIV/AIDS to migrant workers in both home and destination countries.
Rebekah Brennan, Professor Marie Claire Van Hout
JOURNAL OF PSYCHOACTIVE DRUGS, 46(3), 243-251. doi:10.1080/02791072.2014.921746, 2014.
Abstract: Gamma hydroxybutyrate (GHB) is a central nervous system depressant with euphoric and relaxant effects. Documentation of GHB prevalence and the underreporting of abuse remains problematic, given the availability of GHB and its precursors γ-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) and the ease of synthesis from kits available on the Internet. The continued abuse of and dependence on GHB, and associated fatalities, present an on-going public health problem. As the drug GHB remains an underresearched topic, a scoping review was chosen as a technique to map the available literature into a descriptive summarized account. PRISMA was used to assist in data retrieval, with subsequent data charting into three key themes (pharmacology and toxicology, outcomes, and user groups). Administered orally, GHB is dose-dependent and popular for certain uses (therapeutic, body enhancement, sexual assault) and amongst user sub groups (recreational party drug users, homosexual men). Despite the low prevalence of use in comparison to other club drugs, rising abuse of the drug is associated with dependence, withdrawal, acute toxicity, and fatal overdose. Clinical diagnosis and treatment is complicated by the co-ingestion of alcohol and other drugs. Limitations of the scoping review and potential for further research and harm reduction initiatives are discussed.
Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study
Harm Reduction Journal 11:19, 2014.
Abstract (provisional): Background The UK continues to experience a rise in the number of anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes. Methods The present study uses interviews conducted with harm reduction service providers as well as illicit users of anabolic steroids from different areas of England and Wales to explore harm reduction for this group of drug users, focussing on needle distribution policies and harm reduction interventions developed specifically for this population of drug users. Results The article addresses the complexity of harm reduction service delivery, highlighting different models of needle distribution, such as peer-led distribution networks, as well as interventions available in steroid clinics, including liver function testing of anabolic steroid users. Aside from providing insights into the function of interventions available to steroid users, along with principles adopted by service providers, the study found significant tensions and dilemmas in policy implementation due to differing perspectives between service providers and service users relating to practices, risks and effective interventions. Conclusion The overarching finding of the study was the tremendous variability across harm reduction delivery sites in terms of available measures and mode of operation. Further research into the effectiveness of different policies directed towards people who use anabolic steroids is critical to the development of harm reduction.