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Sexual Slavery without Borders: Trafficking for Commercial Sexual Exploitation in India

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Trafficking in women and children is a gross violation of human rights. However, this does notprevent an estimated 800 000 women and children to be trafficked each year across internationalborders. Eighty per cent of trafficked persons end in forced sex work. India has been identified asone of the Asian countries where trafficking for commercial sexual exploitation has reachedalarming levels. While there is a considerable amount of internal trafficking from one state toanother or within states, India has also emerged as a international supplier of trafficked women andchildren to the Gulf States and South East Asia, as well as a destination country for women and girlstrafficked for commercial sexual exploitation from Nepal and Bangladesh. Trafficking forcommercial sexual exploitation is a highly profitable and low risk business that preys on particularlyvulnerable populations. This paper presents an overview of the trafficking of women and girls forsexual exploitation (CSE) in India; identifies the health impacts of CSE; and suggest strategies torespond to trafficking and related issues.

Document type: 
Article

Trends in Reported AIDS Defining Illnesses (ADIs) among Participants in a Universal Antiretroviral Therapy Program: an Observational Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2011
Abstract: 

Background:

We examined trends in AIDS-defining illnesses (ADIs) among individuals receiving highly activeantiretroviral therapy (HAART) in British Columbia (BC), Canada to determine whether declines in ADIs could becontributing to previously observed improvements in life-expectancy among HAART patients in BC since 1996.

Methods:

HAART-naïve individuals aged ≥ 18 years who initiated treatment in BC each of the following timeperiods1996 - 1998; 1999 - 2001; 2002 - 2004; 2005 - 2007 were included. The proportion of participants withreported ADIs were examined for each time period and trends were analyzed using the Cochran-Armitage TrendTest. Cox proportional hazards models were used to examine factors associated with ADIs.

Results:

A total of 3721 individuals (81% male) initiated HAART during the study period. A total of 251 reports ofADIs were received from 214 unique patients. These occurred in a median of 4 months (IQR = 1-19 months) fromHAART initiation. The proportion of individuals with a reported ADI did not change significantly from 4.6% in theearliest time period to 5.8% in the latest period (p = 0.181 for test of trend). There were no significant declines inany specific ADI over the study period. Multivariable Cox models found that individuals initiating HAART during2002-04 were at an increased risk of ADIs (AHR = 1.55; 95% CI 1.04-2.32) in comparison to 1996 - 98, but therewere no significant differences in other time periods.

Conclusions:

Trends in reported ADIs among individuals receiving HAART since 1996 in BC do not appear toparallel improvements in life-expectancy over the same period.

Document type: 
Article

Years of Life Lost to Prison: Racial and Gender Gradients in the United States of America

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background: The United States has the highest rate of imprisonment of any country in the world. African Americans and Hispanics comprise a disproportionately large share of the prisonpopulation. We applied a "prison life expectancy" to specify differences in exposure toimprisonment by gender and race at the population level.Methods: The impact of imprisonment on life expectancy in the United States was measured foreach year from 2000 to 2004, and then averaged. Using the Sullivan method, prison and prison-freelife expectancies were estimated by dividing the years lived in each age range of the life table intothese two states using prevalence of imprisonment by gender and race.Results: African American males can expect to spend on average 3.09 years in prison or jail overtheir lifetime and Hispanic and Caucasian males can spend on average 1.06 and 0.50 years,respectively. African American females, on the other hand, can expect to spend on average 0.23years in these institutions and Hispanic and Caucasian females can expect to spend on average 0.09and 0.05 years, respectively. Overall, African American males, the highest risk group, can expect tospend on average 61.80 times longer in prison or jail as compared to Caucasian women, the lowestrisk group.Conclusion: There are clear gender and racial gradients in life expectancy spent in prison in theUnited States. Future research needs to examine how current imprisonment practice in the UnitedStates may influence population health and health disparities.

Document type: 
Article

Investigating Maternal Risk Factors as Potential Targets of Intervention to Reduce Socioeconomic Inequality in Small for Gestational Age: a Population-Based Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2012
Abstract: 

Background:

The major aim of this study was to investigate whether maternal risk factors associated withsocioeconomic status and small for gestational age (SGA) might be viable targets of interventions to reducedifferential risk of SGA by socioeconomic status (socioeconomic SGA inequality) in the metropolitan area ofVancouver, Canada.

Methods:

This study included 59,039 live, singleton births in the Vancouver Census Metropolitan Area (Vancouver)from January 1, 2006 to September 17, 2009. To identify an indicator of socioeconomic SGA inequality, we usedhierarchical logistic regression to model SGA by area-level variables from the Canadian census. We then modelledSGA by area-level average income plus established maternal risk factors for SGA and calculated populationattributable SGA risk percentages (PAR%) for each variable. Associations of maternal risk factors for SGA withaverage income were investigated to identify those that might contribute to SGA inequality. Finally, we estimatedcrude reductions in the percentage and absolute differences in SGA risks between highest and lowest averageincome quintiles that would result if interventions on maternal risk factors successfully equalized them acrossincome levels or eliminated them altogether.

Results:

Average income produced the most linear and statistically significant indicator of socioeconomic SGAinequality with 8.9% prevalence of SGA in the lowest income quintile compared to 5.6% in the highest. Theadjusted PAR% of SGA for variables were: bottom four quintiles of height (51%), first birth (32%), bottom fourquintiles of average income (14%), oligohydramnios (7%), underweight or hypertension, (6% each), smoking (3%)and placental disorder (1%). Shorter height, underweight and smoking during pregnancy had higher prevalence inlower income groups. Crude models assuming equalization of risk factors across income levels or eliminationaltogether indicated little potential change in relative socioeconomic SGA inequality and reduction in absolute SGAinequality for shorter height only.

Conclusions:

Our findings regarding maternal height may indicate trans-generational aetiology for socioeconomicSGA inequalities and/or that adult height influences social mobility. Conditions affecting foetal and childhoodgrowth might be viable targets to reduce absolute socioeconomic SGA inequality in future generations, but moreresearch is needed to determine whether such an approach is appropriate.

Document type: 
Article

Ethics of Conducting Research in Conflict Settings

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009
Abstract: 

Humanitarian agencies are increasingly engaged in research in conflict and post-conflict settings.This is justified by the need to improve the quality of assistance provided in these settings and tocollect evidence of the highest standard to inform advocacy and policy change. The instability ofconflict-affected areas, and the heightened vulnerability of populations caught in conflict, calls forcareful consideration of the research methods employed, the levels of evidence sought, and ethicalrequirements. Special attention needs to be placed on the feasibility and necessity of doing researchin conflict-settings, and the harm-benefit ratio for potential research participants.

Document type: 
Article

12-Month Follow-up of an Exploratory 'Brief Intervention' for High-Frequency Cannabis Users among Canadian University Students

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2012
Abstract: 

Background:

One in three young people use cannabis in Canada. Cannabis use can be associated with a variety ofhealth problems which occur primarily among intensive/frequent users. Availability and effectiveness ofconventional treatment for cannabis use is limited. While Brief Interventions (BIs) have been shown to result inshort-term reductions of cannabis use risks or problems, few studies have assessed their longer-term effects. Thepresent study examined 12-month follow-up outcomes for BIs in a cohort of young Canadian high-frequencycannabis users where select short-term effects (3 months) had previously been assessed and demonstrated.

Findings:

N= 134 frequent cannabis users were recruited from among university students in Toronto, randomized toeither an oral or a written cannabis BI, or corresponding health controls, and assessed in-person at baseline, 3-months,and 12-months. N= 72 (54 %) of the original sample were retained for follow-up analyses at 12-months wherereductions in ‘deep inhalation/breathholding’ (Q = 13.1; p<.05) and ‘driving after cannabis use’ (Q = 9.3; p<.05) wereobserved in the experimental groups. Reductions for these indicators had been shown at 3-months in the experimentalgroups; these reductions were maintained over the year. Other indicators assessed remained overall stable in bothexperimental and control groups.

Conclusions:

The results confirm findings from select other studies indicating the potential for longer-term andsustained risk reduction effects of BIs for cannabis use. While further research is needed on the long-term effects of BIs,these may be a valuable – and efficient – intervention tool in a public health approach to high-risk cannabis use.

 

Document type: 
Article

A Qualitative Exploration of Prescription Opioid Injection among Street-Based Drug Users in Toronto: Behaviours, Preferences and Drug Availability

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background:

There is evidence of a high prevalence of prescription opioid (PO) and crack useamong street drug users in Toronto. The purpose of this qualitative study was to describe drug usebehaviours and preferences as well as the social and environmental context surrounding the use ofthese drugs among young and old street-based drug injection drug users (IDUs).

Methods:

In-depth interviews were conducted with 25 PO injectors. Topics covered includeddrug use history, types of drugs used, how drugs were purchased and transitions to PO use.Interviews were taped and transcribed. Content analysis was conducted to identify themes.

Results:

Five prominent themes emerged from the interviews: 1) Combination of crack andprescription opioids, 2) First injection experience and transition to prescription opioids, 3) Drugpreferences and availability, 4) Housing and income and 5) Obtaining drugs. There was consensusthat OxyContin and crack were the most commonly available drugs on the streets of Toronto.Drug use preferences and behaviours were influenced by the availability of drugs, the desired effect,ease of administration and expectations around the purity of the drugs. Distinct experiences wereobserved among younger users as compared to older users. In particular, the initiation of injectiondrug use and experimentation with POs among younger users was influenced by their experienceson the street, their peers and general curiosity.

Conclusion:

Given the current profile of street-based drug market in Toronto and the emergenceof crack and POs as two predominant illicit drug groups, understanding drug use patterns andsocio-economic factors among younger and older users in this population has importantimplications for preventive and therapeutic interventions.

Document type: 
Article

Reporting of Noninferiority and Equivalence Randomized Trials for Major Prostaglandins: A Systematic Survey of the Ophthalmology Literature

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background:

Standards for reporting clinical trials have improved the transparency of patientimportantresearch. The Consolidated Standards of Reporting Trials (CONSORT) published anextension to address noninferiority and equivalence trials. We aimed to determine the reportingquality of prostaglandin noninferiority and equivalence trials in the treatment of glaucoma.

Methods:

We searched, independently and in duplicate, 6 electronic databases for eligible trialsevaluating prostaglandins. We abstracted data on reporting of methodological criteria, includingreporting of per-protocol [PP] and intention-to-treat [ITT] analysis, sample size estimation withmargins, type of statistical analysis conducted, efficacy summaries, and use of hyperemia measures.

Results:

Trials involving the four major prostaglandin groups (latanoprost, travoprost,bimatoprost, unoprostone) were analyzed. We included 36 noninferiority and 11 equivalence trials.Seventeen out of the included 47 trials (36%, 95% Confidence Intervals [CI]: 24–51) werecrossover designs. Only 3 studies (6%, 95% CI: 2–17) reported a presented results of both ITT andPP populations. Twelve studies (26%, 95% CI: 15–39) presented only ITT results but mentionedthat PP population had similar results. Thirteen trials (28%, 95% CI: 17–42) presented only PPresults with no mention of ITT population results while 17 studies (36%, 95% CI: 24–51) presentedonly ITT results with no mention of PP population results. Thirty-four (72%, 95% CI: 58–83) ofstudies adequately described their margin of noninferiority/equivalence. Sequence generation wasreported in 22/47 trials (47%, 95% CI: 33–61). Allocation concealment was reported in only 10/47(21%, 95% CI: 12–35) of the trials. Thirty-five studies (74%, 95% CI: 60–85) employed masking ofat least two groups, 4/47 (9%, 95% CI: 3–20) masked only patients and 8/47 (17%, 95% CI: 9–30)were open label studies. Eight (17%, 95% CI: 9–30) of the 47 trials employed a combined test ofnoninferiority and superiority. We also found 6 differing methods of evaluating hyperemia.

Conclusion:

The quality of reporting noninferiority/equivalency trials in the field of glaucoma ismarkedly heterogeneous. The adoption of the extended CONSORT statement by journals willpotentially improve the transparency of this field.

 

Document type: 
Article

Conflict in the Indian Kashmir Valley II: Exposure to Violence

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background:

India and Pakistan have disputed ownership of the Kashmir Valley region for manyyears, resulting in high levels of exposure to violence among the civilian population of Kashmir(India). A survey was done as part of routine programme evaluation to assess confrontation withviolence and its consequences on mental health, health service usage, and socio-economicfunctioning.

Methods:

We undertook a two-stage cluster household survey in two districts of Kashmir (India)using questionnaires adapted from other conflict areas. Analysis was stratified for gender.

Results:

Over one-third of respondents (n = 510) were found to have symptoms of psychologicaldistress (33.3%, CI: 28.3–38.4); women scoring significantly higher (OR 2.5; CI: 1.7–3.6). A third ofrespondents had contemplated suicide (33.3%, CI: 28.3–38.4). Feelings of insecurity wereassociated with higher levels of psychological distress for both genders (males: OR 2.4, CI: 1.3–4.4;females: OR 1.9, CI: 1.1–3.3). Among males, violation of modesty, (OR 3.3, CI: 1.6–6.8), forceddisplacement, (OR 3.5, CI: 1.7–7.1), and physical disability resulting from violence (OR 2.7, CI: 1.2–5.9) were associated with greater levels of psychological distress; for women, risk factors forpsychological distress included dependency on others for daily living (OR 2.4, CI: 1.3–4.8), thewitnessing of killing (OR 1.9, CI: 1.1–3.4), and torture (OR 2.1, CI: 1.2–3.7). Self-rated poor health(male: OR 4.4, CI: 2.4–8.1; female: OR 3.4, CI: 2.0–5.8) and being unable to work (male: OR 6.7,CI: 3.5–13.0; female: OR 2.6, CI: 1.5–4.4) were associated with mental distress.

Conclusion:

The ongoing conflict exacts a huge toll on the communities' mental well-being. Wefound high levels of psychological distress that impacts on daily life and places a burden on thehealth system. Ongoing feelings of personal vulnerability (not feeling safe) was associated with highlevels of psychological distress. Community mental health programmes should be considered as away reduce the pressure on the health system and improve socio-economic functioning of thosesuffering from mental health problems.

Document type: 
Article

Conflict in the Indian Kashmir Valley I: Exposure to Violence

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008
Abstract: 

Background:

India and Pakistan have disputed ownership of the Kashmir Valley region for manyyears, resulting in several conflicts since the end of partition in 1947. Very little is known about theprevalence of violence and insecurity in this population.

Methods:

We undertook a two-stage cluster household survey in two districts (30 villages) of theIndian part of Kashmir to assess experiences with violence and mental health status among theconflict-affected Kashmiri population. The article presents our findings for confrontations withviolence. Data were collected for recent events (last 3 months) and those occurring since the startof the conflict. Informed consent was obtained for all interviews.

Results:

510 interviews were completed. Respondents reported frequent direct confrontationswith violence since the start of conflict, including exposure to crossfire (85.7%), round up raids(82.7%), the witnessing of torture (66.9%), rape (13.3%), and self-experience of forced labour(33.7%), arrests/kidnapping (16.9%), torture (12.9%), and sexual violence (11.6%). Males reportedmore confrontations with violence than females, and had an increased likelihood of having directlyexperienced physical/mental maltreatment (OR 3.9, CI: 2.7–5.7), violation of their modesty (OR3.6, CI: 1.9–6.8) and injury (OR 3.5, CI: 1.4–8.7). Males also had high odds of self-being arrested/kidnapped (OR 8.0, CI: 4.1–15.5).

Conclusion:

The civilian population in Kashmir is exposed to high levels of violence, asdemonstrated by the high frequency of deliberate events as detention, hostage, and torture. Thereported violence may result in substantial health, including mental health problems. Malesreported significantly more confrontations with almost all violent events; this can be explained byhigher participation in outdoor activities.

Document type: 
Article